Haryana BSEH Secondary NSQF Healthcare cheat sheet

Healthcare system levels in India: sub-centre (population ~5,000 plains/3,000 hilly), Primary Health Centre (~30,000/20,000), Community Health Centre (~1,20,000/80,000), then district hospital and tertiary care.

National Health Programmes include NRHM/NHM, National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS), RNTCP/NTEP for TB, and Universal Immunization Programme.

Levels of prevention: primordial (risk-factor reduction), primary (pre-disease, e.g., immunisation), secondary (early detection, e.g., screening), tertiary (disability limitation/rehabilitation).

Primary health care principles (Alma-Ata 1978): equitable distribution, community participation, appropriate technology, intersectoral coordination, focus on prevention.

Healthcare team roles: physician diagnoses and prescribes; nurse assesses, implements nursing care, administers treatment; ANM/ASHA link community to facility; pharmacist dispenses; lab technician performs investigations.

India's health infrastructure is organised as rural (sub-centre to CHC) and urban (urban PHC, urban CHC, district hospital), with referral links upward and back-referral downward.

Indicators: Infant Mortality Rate, Maternal Mortality Ratio, Crude Birth Rate, Crude Death Rate, life expectancy; India's MMR has declined substantially under NHM.

Ayushman Bharat has two components: Health and Wellness Centres (comprehensive primary care) and PM-JAY health insurance for secondary/tertiary hospitalisation.

Anatomical position: standing erect, face forward, arms at sides with palms forward, feet together; all positional terms (anterior, medial, proximal) are referenced to this position.

Body planes: sagittal divides left/right, coronal (frontal) divides anterior/posterior, transverse divides superior/inferior.

Skeletal system: 206 bones in an adult; axial skeleton (skull, vertebral column, ribs, sternum) = 80 bones, appendicular = 126 bones.

Respiratory tract order: nose → pharynx → larynx → trachea → bronchi → bronchioles → alveoli; gas exchange occurs only in alveoli.

Heart: four chambers; right side pumps deoxygenated blood to lungs (pulmonary circulation), left side pumps oxygenated blood to the body (systemic circulation).

Digestive tract order: mouth → oesophagus → stomach → small intestine (duodenum, jejunum, ileum) → large intestine → rectum → anus; most absorption occurs in the small intestine.

Nervous system divides into central (brain, spinal cord) and peripheral (somatic and autonomic, which splits into sympathetic and parasympathetic).

Urinary system: kidneys filter blood into urine → ureters → urinary bladder → urethra; the kidney's functional unit is the nephron.

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

Standard precautions apply to all patients regardless of diagnosis: hand hygiene, gloves, gown, mask/eye protection, safe sharps handling, safe injection practice.

WHO 5 Moments for Hand Hygiene: before touching a patient, before clean/aseptic procedure, after body fluid exposure risk, after touching a patient, after touching patient surroundings.

Hand hygiene options: alcohol-based hand rub for visibly clean hands, or soap and water when hands are visibly soiled or after exposure to spore-formers such as C. difficile.

BMW colour coding (India, 2016 rules): yellow - human/animal anatomical waste, soiled waste, expired medicines; red - contaminated recyclable plastic; white - sharps in puncture-proof container; blue - glassware and metallic implants.

Sharps must never be recapped by hand; use a needle destroyer or puncture-proof container, and never mix sharps with general waste.

Sterilisation vs disinfection: sterilisation kills all microorganisms including spores (autoclave 121°C, 15 psi, 15–20 min); disinfection reduces pathogens but may not kill spores.

Personal protective equipment sequence (donning): hand hygiene → gown → mask → goggles → gloves; remove in reverse with hand hygiene after glove removal.

Positioning: supine (flat), Fowler's (head raised 45–60°), semi-Fowler's (30°), lateral (side-lying), prone, Trendelenburg (head lower than feet), Sims' (left lateral for enemas).

Pressure ulcer risk: assess with Braden scale; reposition immobile patients at least every 2 hours and keep skin clean and dry.

Vital care routines: bed bath, oral care, hair care, nail care, back care and perineal care; maintain privacy and observe skin condition during each.

Intake-output charting: record all oral, tube and IV fluids as intake; urine, vomitus, drainage and stool (as liquid) as output; normal adult urine output ~1,500 mL/day (~0.5–1 mL/kg/hr).

Bed-making: unoccupied bed for ambulatory patients; occupied bed when the patient cannot be moved; always place soiled linen away from uniform and never shake linen in the ward.

Feeding assistance: position patient upright or in high Fowler's, check for dysphagia, feed slowly, and stop if choking signs appear.

Safety measures: side rails up for confused or sedated patients, bed in lowest position, call bell within reach, non-skid footwear, and identify patients by two identifiers.

Documentation of care must be contemporaneous, factual, signed and timed; record refusal of care and report abnormal findings to the nurse in charge.

Normal adult ranges: temperature 36.1–37.2°C (oral), pulse 60–100 beats/min, respirations 12–20/min, blood pressure 120/80 mmHg (normal <120/<80), SpO2 95–100%.

Temperature sites: oral, axillary (0.5°C lower than oral), rectal (0.5°C higher), tympanic and temporal; axillary is safest for children and unconscious patients.

Pulse assessment: rate, rhythm, volume, and character; count for a full 60 seconds when irregular; common sites are radial, carotid, brachial, femoral, popliteal, dorsalis pedis.

Respiration: count for one full minute without telling the patient; observe rate, depth, rhythm and character; normal adult ratio of pulse to respiration is about 4:1.

Blood pressure: measure with arm at heart level, cuff bladder covering ~80% of arm circumference; record systolic (Korotkoff I) and diastolic (Korotkoff V).

Hypertension staging (adult): normal <120/80; elevated 120–129/<80; stage 1 130–139 or 80–89; stage 2 ≥140 or ≥90 mmHg.

Pulse oximetry: SpO2 <90% is significant hypoxaemia and requires urgent assessment; poor perfusion, nail polish and motion can cause false readings.

Pain is the fifth vital sign; use a 0–10 numeric rating scale for adults and Wong-Baker FACES or FLACC for children.

Adult BLS sequence: check scene safety → check responsiveness → call for help/activate EMS → check breathing and pulse simultaneously ≤10 s → start chest compressions.

High-quality CPR for adults: compression rate 100–120/min, depth 5–6 cm, full recoil, minimise interruptions, compression:ventilation ratio 30:2 for one or two rescuers.

Child/infant CPR: ratio 30:2 for single rescuer, 15:2 for two rescuers; infant compression depth ~4 cm (one-third AP chest) using two fingers or two-thumb technique.

AED use: apply pads, follow voice prompts, deliver shock if advised, resume compressions immediately after the shock; do not delay compressions to apply pads.

Choking: for a conscious adult/child give 5 back blows then 5 abdominal thrusts (Heimlich); for an infant use 5 back blows then 5 chest thrusts; for an unconscious victim start CPR.

Severe bleeding: apply direct pressure with a clean dressing, elevate if possible, add dressings without removing the first; use a tourniquet only for life-threatening limb bleeding.

Burns: cool with running water for at least 20 minutes, remove jewellery, cover loosely; never apply ice, toothpaste or oil, and never burst blisters.

Recovery position for an unconscious but breathing patient: lateral side-lying with head tilted back and chin up to maintain the airway; monitor breathing until help arrives.

Macronutrients: carbohydrates 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g; vitamins and minerals provide no energy.

Balanced diet concept: cereals, pulses, vegetables, fruits, milk/curd, fats and sugars in recommended proportions, with adequate water and fibre.

Deficiency diseases: vitamin A - night blindness/xerophthalmia; vitamin D - rickets/osteomalacia; iron - anaemia; iodine - goitre; vitamin C - scurvy; thiamine (B1) - beriberi.

Diabetes diet: controlled carbohydrate portions, high fibre, low refined sugar, regular meal timing; monitor for hypoglycaemia (sweating, tremor, confusion) and treat with fast-acting glucose.

Hypertension diet: restrict salt (<5 g/day), limit processed foods, increase potassium-rich fruits and vegetables unless contraindicated.

Therapeutic diets: clear liquids (water, clear broth), full liquids, soft diet, bland diet, low-residue diet, diabetic diet, renal diet (protein, sodium, potassium and fluid restrictions).

Protein-energy malnutrition: marasmus is severe wasting without oedema; kwashiorkor shows oedema, low serum albumin and moon face; both need cautious nutritional rehabilitation.

Nutritional assessment: weight, height, BMI (weight kg / height m²), mid-upper arm circumference, and haemoglobin; BMI <18.5 is underweight, 25–29.9 overweight.

Word roots plus prefixes/suffixes build terms: brady- (slow), tachy- (fast), hyper- (high), hypo- (low), -itis (inflammation), -ectomy (removal), -otomy (incision), -ology (study of).

Common abbreviations: BP, HR, RR, SpO2, TPR, NPO (nothing by mouth), PRN (as required), OD (once daily), BD (twice daily), TDS (three times daily), SOS (if needed).

Documentation principles: accurate, objective, complete, timely, legible, signed with name and designation; record facts not opinions, and never alter a record retrospectively.

SOAP note format: Subjective (patient's complaint), Objective (observations and measurements), Assessment (interpretation), Plan (actions and follow-up).

Communication types: verbal, non-verbal (posture, eye contact, touch), written; use therapeutic communication - active listening, open questions, empathy, reflection.

Confidentiality: patient information is shared only with authorised staff on a need-to-know basis; do not discuss patients in public areas or on social media.

Barriers to communication include language, hearing loss, pain, anxiety and cultural differences; use interpreters, simple language and hearing aids as needed.

Reporting: use ISBAR/SBAR (Identify, Situation, Background, Assessment, Recommendation) for handovers and escalation of deteriorating patients.

Occupational hazards in healthcare: biological (bloodborne pathogens), sharps injuries, chemical (disinfectants, anaesthetic gases), ergonomic (lifting injuries), radiation and psychological stress.

Needlestick injury protocol: wash with soap and water, do not squeeze the wound, report immediately, and follow post-exposure prophylaxis guidelines for HIV and hepatitis B.

Ethical principles: autonomy (respect patient choice), beneficence (do good), non-maleficence (do no harm), justice (fair treatment), veracity (truthfulness), confidentiality.

Informed consent requires capacity, adequate information, voluntariness and documentation; emergency care may proceed without consent if life is at risk.

Professional conduct: punctuality, uniform and identity badge, respect for patient dignity, avoiding boundary violations, no discrimination based on caste, religion or gender.

Patient rights: right to information, privacy, confidentiality, second opinion, and to refuse treatment; duty of care includes never abandoning a patient.

Ergonomic safety: use correct lifting technique (bend knees, keep load close, avoid twisting), use mechanical aids, and ask for help with heavy patients.

Fire safety in the ward: know the RACE sequence (Rescue, Alarm, Contain, Extinguish/Evacuate) and the location of extinguishers and exits.

Clinical skills commonly assessed: hand hygiene, vital signs measurement, bed making, bed bath, oral care, positioning, temperature/pulse/respiration recording, and basic dressing.

Before any procedure: verify patient identity with two identifiers, explain the procedure, check doctor's order, gather supplies, and maintain privacy with screens or curtains.

Aseptic technique: perform hand hygiene, use sterile gloves and sterile field, keep sterile items above waist level, and never turn away from the sterile field.

Specimen collection: label containers with patient name, ID, date, time and specimen type before sending; use correct container and transport promptly.

Injection safety: check the five rights (right patient, drug, dose, route, time), use a new needle and syringe for each patient, and dispose of sharps immediately in the white puncture-proof container.

Record keeping during internship: maintain logbook of procedures performed, get countersignature from supervisor, and reflect on errors as learning opportunities.

Infection control in ward rounds: clean stethoscope between patients, follow hand hygiene before and after patient contact, and segregate waste at the point of generation.

Patient safety event reporting: report falls, medication errors and near-misses through the institutional reporting system without fear of blame, to enable system improvement.

Healthcare system levels in India: sub-centre (population ~5,000 plains/3,000 hilly), Primary Health Centre (~30,000/20,000), Community Health Centre (~1,20,000/80,000), then district hospital and tertiary care.

National Health Programmes include NRHM/NHM, National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS), RNTCP/NTEP for TB, and Universal Immunization Programme.

Levels of prevention: primordial (risk-factor reduction), primary (pre-disease, e.g., immunisation), secondary (early detection, e.g., screening), tertiary (disability limitation/rehabilitation).

Primary health care principles (Alma-Ata 1978): equitable distribution, community participation, appropriate technology, intersectoral coordination, focus on prevention.

Healthcare team roles: physician diagnoses and prescribes; nurse assesses, implements nursing care, administers treatment; ANM/ASHA link community to facility; pharmacist dispenses; lab technician performs investigations.

India's health infrastructure is organised as rural (sub-centre to CHC) and urban (urban PHC, urban CHC, district hospital), with referral links upward and back-referral downward.

Indicators: Infant Mortality Rate, Maternal Mortality Ratio, Crude Birth Rate, Crude Death Rate, life expectancy; India's MMR has declined substantially under NHM.

Ayushman Bharat has two components: Health and Wellness Centres (comprehensive primary care) and PM-JAY health insurance for secondary/tertiary hospitalisation.

Anatomical position: standing erect, face forward, arms at sides with palms forward, feet together; all positional terms (anterior, medial, proximal) are referenced to this position.

Body planes: sagittal divides left/right, coronal (frontal) divides anterior/posterior, transverse divides superior/inferior.

Skeletal system: 206 bones in an adult; axial skeleton (skull, vertebral column, ribs, sternum) = 80 bones, appendicular = 126 bones.

Respiratory tract order: nose → pharynx → larynx → trachea → bronchi → bronchioles → alveoli; gas exchange occurs only in alveoli.

Heart: four chambers; right side pumps deoxygenated blood to lungs (pulmonary circulation), left side pumps oxygenated blood to the body (systemic circulation).

Digestive tract order: mouth → oesophagus → stomach → small intestine (duodenum, jejunum, ileum) → large intestine → rectum → anus; most absorption occurs in the small intestine.

Nervous system divides into central (brain, spinal cord) and peripheral (somatic and autonomic, which splits into sympathetic and parasympathetic).

Urinary system: kidneys filter blood into urine → ureters → urinary bladder → urethra; the kidney's functional unit is the nephron.

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

Standard precautions apply to all patients regardless of diagnosis: hand hygiene, gloves, gown, mask/eye protection, safe sharps handling, safe injection practice.

WHO 5 Moments for Hand Hygiene: before touching a patient, before clean/aseptic procedure, after body fluid exposure risk, after touching a patient, after touching patient surroundings.

Hand hygiene options: alcohol-based hand rub for visibly clean hands, or soap and water when hands are visibly soiled or after exposure to spore-formers such as C. difficile.

BMW colour coding (India, 2016 rules): yellow - human/animal anatomical waste, soiled waste, expired medicines; red - contaminated recyclable plastic; white - sharps in puncture-proof container; blue - glassware and metallic implants.

Sharps must never be recapped by hand; use a needle destroyer or puncture-proof container, and never mix sharps with general waste.

Sterilisation vs disinfection: sterilisation kills all microorganisms including spores (autoclave 121°C, 15 psi, 15–20 min); disinfection reduces pathogens but may not kill spores.

Personal protective equipment sequence (donning): hand hygiene → gown → mask → goggles → gloves; remove in reverse with hand hygiene after glove removal.

Positioning: supine (flat), Fowler's (head raised 45–60°), semi-Fowler's (30°), lateral (side-lying), prone, Trendelenburg (head lower than feet), Sims' (left lateral for enemas).

Pressure ulcer risk: assess with Braden scale; reposition immobile patients at least every 2 hours and keep skin clean and dry.

Vital care routines: bed bath, oral care, hair care, nail care, back care and perineal care; maintain privacy and observe skin condition during each.

Intake-output charting: record all oral, tube and IV fluids as intake; urine, vomitus, drainage and stool (as liquid) as output; normal adult urine output ~1,500 mL/day (~0.5–1 mL/kg/hr).

Bed-making: unoccupied bed for ambulatory patients; occupied bed when the patient cannot be moved; always place soiled linen away from uniform and never shake linen in the ward.

Feeding assistance: position patient upright or in high Fowler's, check for dysphagia, feed slowly, and stop if choking signs appear.

Safety measures: side rails up for confused or sedated patients, bed in lowest position, call bell within reach, non-skid footwear, and identify patients by two identifiers.

Documentation of care must be contemporaneous, factual, signed and timed; record refusal of care and report abnormal findings to the nurse in charge.

Normal adult ranges: temperature 36.1–37.2°C (oral), pulse 60–100 beats/min, respirations 12–20/min, blood pressure 120/80 mmHg (normal <120/<80), SpO2 95–100%.

Temperature sites: oral, axillary (0.5°C lower than oral), rectal (0.5°C higher), tympanic and temporal; axillary is safest for children and unconscious patients.

Pulse assessment: rate, rhythm, volume, and character; count for a full 60 seconds when irregular; common sites are radial, carotid, brachial, femoral, popliteal, dorsalis pedis.

Respiration: count for one full minute without telling the patient; observe rate, depth, rhythm and character; normal adult ratio of pulse to respiration is about 4:1.

Blood pressure: measure with arm at heart level, cuff bladder covering ~80% of arm circumference; record systolic (Korotkoff I) and diastolic (Korotkoff V).

Hypertension staging (adult): normal <120/80; elevated 120–129/<80; stage 1 130–139 or 80–89; stage 2 ≥140 or ≥90 mmHg.

Pulse oximetry: SpO2 <90% is significant hypoxaemia and requires urgent assessment; poor perfusion, nail polish and motion can cause false readings.

Pain is the fifth vital sign; use a 0–10 numeric rating scale for adults and Wong-Baker FACES or FLACC for children.

Adult BLS sequence: check scene safety → check responsiveness → call for help/activate EMS → check breathing and pulse simultaneously ≤10 s → start chest compressions.

High-quality CPR for adults: compression rate 100–120/min, depth 5–6 cm, full recoil, minimise interruptions, compression:ventilation ratio 30:2 for one or two rescuers.

Child/infant CPR: ratio 30:2 for single rescuer, 15:2 for two rescuers; infant compression depth ~4 cm (one-third AP chest) using two fingers or two-thumb technique.

AED use: apply pads, follow voice prompts, deliver shock if advised, resume compressions immediately after the shock; do not delay compressions to apply pads.

Choking: for a conscious adult/child give 5 back blows then 5 abdominal thrusts (Heimlich); for an infant use 5 back blows then 5 chest thrusts; for an unconscious victim start CPR.

Severe bleeding: apply direct pressure with a clean dressing, elevate if possible, add dressings without removing the first; use a tourniquet only for life-threatening limb bleeding.

Burns: cool with running water for at least 20 minutes, remove jewellery, cover loosely; never apply ice, toothpaste or oil, and never burst blisters.

Recovery position for an unconscious but breathing patient: lateral side-lying with head tilted back and chin up to maintain the airway; monitor breathing until help arrives.

Macronutrients: carbohydrates 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g; vitamins and minerals provide no energy.

Balanced diet concept: cereals, pulses, vegetables, fruits, milk/curd, fats and sugars in recommended proportions, with adequate water and fibre.

Deficiency diseases: vitamin A - night blindness/xerophthalmia; vitamin D - rickets/osteomalacia; iron - anaemia; iodine - goitre; vitamin C - scurvy; thiamine (B1) - beriberi.

Diabetes diet: controlled carbohydrate portions, high fibre, low refined sugar, regular meal timing; monitor for hypoglycaemia (sweating, tremor, confusion) and treat with fast-acting glucose.

Hypertension diet: restrict salt (<5 g/day), limit processed foods, increase potassium-rich fruits and vegetables unless contraindicated.

Therapeutic diets: clear liquids (water, clear broth), full liquids, soft diet, bland diet, low-residue diet, diabetic diet, renal diet (protein, sodium, potassium and fluid restrictions).

Protein-energy malnutrition: marasmus is severe wasting without oedema; kwashiorkor shows oedema, low serum albumin and moon face; both need cautious nutritional rehabilitation.

Nutritional assessment: weight, height, BMI (weight kg / height m²), mid-upper arm circumference, and haemoglobin; BMI <18.5 is underweight, 25–29.9 overweight.

Word roots plus prefixes/suffixes build terms: brady- (slow), tachy- (fast), hyper- (high), hypo- (low), -itis (inflammation), -ectomy (removal), -otomy (incision), -ology (study of).

Common abbreviations: BP, HR, RR, SpO2, TPR, NPO (nothing by mouth), PRN (as required), OD (once daily), BD (twice daily), TDS (three times daily), SOS (if needed).

Documentation principles: accurate, objective, complete, timely, legible, signed with name and designation; record facts not opinions, and never alter a record retrospectively.

SOAP note format: Subjective (patient's complaint), Objective (observations and measurements), Assessment (interpretation), Plan (actions and follow-up).

Communication types: verbal, non-verbal (posture, eye contact, touch), written; use therapeutic communication - active listening, open questions, empathy, reflection.

Confidentiality: patient information is shared only with authorised staff on a need-to-know basis; do not discuss patients in public areas or on social media.

Barriers to communication include language, hearing loss, pain, anxiety and cultural differences; use interpreters, simple language and hearing aids as needed.

Reporting: use ISBAR/SBAR (Identify, Situation, Background, Assessment, Recommendation) for handovers and escalation of deteriorating patients.

Occupational hazards in healthcare: biological (bloodborne pathogens), sharps injuries, chemical (disinfectants, anaesthetic gases), ergonomic (lifting injuries), radiation and psychological stress.

Needlestick injury protocol: wash with soap and water, do not squeeze the wound, report immediately, and follow post-exposure prophylaxis guidelines for HIV and hepatitis B.

Ethical principles: autonomy (respect patient choice), beneficence (do good), non-maleficence (do no harm), justice (fair treatment), veracity (truthfulness), confidentiality.

Informed consent requires capacity, adequate information, voluntariness and documentation; emergency care may proceed without consent if life is at risk.

Professional conduct: punctuality, uniform and identity badge, respect for patient dignity, avoiding boundary violations, no discrimination based on caste, religion or gender.

Patient rights: right to information, privacy, confidentiality, second opinion, and to refuse treatment; duty of care includes never abandoning a patient.

Ergonomic safety: use correct lifting technique (bend knees, keep load close, avoid twisting), use mechanical aids, and ask for help with heavy patients.

Fire safety in the ward: know the RACE sequence (Rescue, Alarm, Contain, Extinguish/Evacuate) and the location of extinguishers and exits.

Clinical skills commonly assessed: hand hygiene, vital signs measurement, bed making, bed bath, oral care, positioning, temperature/pulse/respiration recording, and basic dressing.

Before any procedure: verify patient identity with two identifiers, explain the procedure, check doctor's order, gather supplies, and maintain privacy with screens or curtains.

Aseptic technique: perform hand hygiene, use sterile gloves and sterile field, keep sterile items above waist level, and never turn away from the sterile field.

Specimen collection: label containers with patient name, ID, date, time and specimen type before sending; use correct container and transport promptly.

Injection safety: check the five rights (right patient, drug, dose, route, time), use a new needle and syringe for each patient, and dispose of sharps immediately in the white puncture-proof container.

Record keeping during internship: maintain logbook of procedures performed, get countersignature from supervisor, and reflect on errors as learning opportunities.

Infection control in ward rounds: clean stethoscope between patients, follow hand hygiene before and after patient contact, and segregate waste at the point of generation.

Patient safety event reporting: report falls, medication errors and near-misses through the institutional reporting system without fear of blame, to enable system improvement.

Healthcare system levels in India: sub-centre (population ~5,000 plains/3,000 hilly), Primary Health Centre (~30,000/20,000), Community Health Centre (~1,20,000/80,000), then district hospital and tertiary care.

National Health Programmes include NRHM/NHM, National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS), RNTCP/NTEP for TB, and Universal Immunization Programme.

Levels of prevention: primordial (risk-factor reduction), primary (pre-disease, e.g., immunisation), secondary (early detection, e.g., screening), tertiary (disability limitation/rehabilitation).

Primary health care principles (Alma-Ata 1978): equitable distribution, community participation, appropriate technology, intersectoral coordination, focus on prevention.

Healthcare team roles: physician diagnoses and prescribes; nurse assesses, implements nursing care, administers treatment; ANM/ASHA link community to facility; pharmacist dispenses; lab technician performs investigations.

India's health infrastructure is organised as rural (sub-centre to CHC) and urban (urban PHC, urban CHC, district hospital), with referral links upward and back-referral downward.

Indicators: Infant Mortality Rate, Maternal Mortality Ratio, Crude Birth Rate, Crude Death Rate, life expectancy; India's MMR has declined substantially under NHM.

Ayushman Bharat has two components: Health and Wellness Centres (comprehensive primary care) and PM-JAY health insurance for secondary/tertiary hospitalisation.

Anatomical position: standing erect, face forward, arms at sides with palms forward, feet together; all positional terms (anterior, medial, proximal) are referenced to this position.

Body planes: sagittal divides left/right, coronal (frontal) divides anterior/posterior, transverse divides superior/inferior.

Skeletal system: 206 bones in an adult; axial skeleton (skull, vertebral column, ribs, sternum) = 80 bones, appendicular = 126 bones.

Respiratory tract order: nose → pharynx → larynx → trachea → bronchi → bronchioles → alveoli; gas exchange occurs only in alveoli.

Heart: four chambers; right side pumps deoxygenated blood to lungs (pulmonary circulation), left side pumps oxygenated blood to the body (systemic circulation).

Digestive tract order: mouth → oesophagus → stomach → small intestine (duodenum, jejunum, ileum) → large intestine → rectum → anus; most absorption occurs in the small intestine.

Nervous system divides into central (brain, spinal cord) and peripheral (somatic and autonomic, which splits into sympathetic and parasympathetic).

Urinary system: kidneys filter blood into urine → ureters → urinary bladder → urethra; the kidney's functional unit is the nephron.

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

Standard precautions apply to all patients regardless of diagnosis: hand hygiene, gloves, gown, mask/eye protection, safe sharps handling, safe injection practice.

WHO 5 Moments for Hand Hygiene: before touching a patient, before clean/aseptic procedure, after body fluid exposure risk, after touching a patient, after touching patient surroundings.

Hand hygiene options: alcohol-based hand rub for visibly clean hands, or soap and water when hands are visibly soiled or after exposure to spore-formers such as C. difficile.

BMW colour coding (India, 2016 rules): yellow - human/animal anatomical waste, soiled waste, expired medicines; red - contaminated recyclable plastic; white - sharps in puncture-proof container; blue - glassware and metallic implants.

Sharps must never be recapped by hand; use a needle destroyer or puncture-proof container, and never mix sharps with general waste.

Sterilisation vs disinfection: sterilisation kills all microorganisms including spores (autoclave 121°C, 15 psi, 15–20 min); disinfection reduces pathogens but may not kill spores.

Personal protective equipment sequence (donning): hand hygiene → gown → mask → goggles → gloves; remove in reverse with hand hygiene after glove removal.

Positioning: supine (flat), Fowler's (head raised 45–60°), semi-Fowler's (30°), lateral (side-lying), prone, Trendelenburg (head lower than feet), Sims' (left lateral for enemas).

Pressure ulcer risk: assess with Braden scale; reposition immobile patients at least every 2 hours and keep skin clean and dry.

Vital care routines: bed bath, oral care, hair care, nail care, back care and perineal care; maintain privacy and observe skin condition during each.

Intake-output charting: record all oral, tube and IV fluids as intake; urine, vomitus, drainage and stool (as liquid) as output; normal adult urine output ~1,500 mL/day (~0.5–1 mL/kg/hr).

Bed-making: unoccupied bed for ambulatory patients; occupied bed when the patient cannot be moved; always place soiled linen away from uniform and never shake linen in the ward.

Feeding assistance: position patient upright or in high Fowler's, check for dysphagia, feed slowly, and stop if choking signs appear.

Safety measures: side rails up for confused or sedated patients, bed in lowest position, call bell within reach, non-skid footwear, and identify patients by two identifiers.

Documentation of care must be contemporaneous, factual, signed and timed; record refusal of care and report abnormal findings to the nurse in charge.

Normal adult ranges: temperature 36.1–37.2°C (oral), pulse 60–100 beats/min, respirations 12–20/min, blood pressure 120/80 mmHg (normal <120/<80), SpO2 95–100%.

Temperature sites: oral, axillary (0.5°C lower than oral), rectal (0.5°C higher), tympanic and temporal; axillary is safest for children and unconscious patients.

Pulse assessment: rate, rhythm, volume, and character; count for a full 60 seconds when irregular; common sites are radial, carotid, brachial, femoral, popliteal, dorsalis pedis.

Respiration: count for one full minute without telling the patient; observe rate, depth, rhythm and character; normal adult ratio of pulse to respiration is about 4:1.

Blood pressure: measure with arm at heart level, cuff bladder covering ~80% of arm circumference; record systolic (Korotkoff I) and diastolic (Korotkoff V).

Hypertension staging (adult): normal <120/80; elevated 120–129/<80; stage 1 130–139 or 80–89; stage 2 ≥140 or ≥90 mmHg.

Pulse oximetry: SpO2 <90% is significant hypoxaemia and requires urgent assessment; poor perfusion, nail polish and motion can cause false readings.

Pain is the fifth vital sign; use a 0–10 numeric rating scale for adults and Wong-Baker FACES or FLACC for children.

Adult BLS sequence: check scene safety → check responsiveness → call for help/activate EMS → check breathing and pulse simultaneously ≤10 s → start chest compressions.

High-quality CPR for adults: compression rate 100–120/min, depth 5–6 cm, full recoil, minimise interruptions, compression:ventilation ratio 30:2 for one or two rescuers.

Child/infant CPR: ratio 30:2 for single rescuer, 15:2 for two rescuers; infant compression depth ~4 cm (one-third AP chest) using two fingers or two-thumb technique.

AED use: apply pads, follow voice prompts, deliver shock if advised, resume compressions immediately after the shock; do not delay compressions to apply pads.

Choking: for a conscious adult/child give 5 back blows then 5 abdominal thrusts (Heimlich); for an infant use 5 back blows then 5 chest thrusts; for an unconscious victim start CPR.

Severe bleeding: apply direct pressure with a clean dressing, elevate if possible, add dressings without removing the first; use a tourniquet only for life-threatening limb bleeding.

Burns: cool with running water for at least 20 minutes, remove jewellery, cover loosely; never apply ice, toothpaste or oil, and never burst blisters.

Recovery position for an unconscious but breathing patient: lateral side-lying with head tilted back and chin up to maintain the airway; monitor breathing until help arrives.

Macronutrients: carbohydrates 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g; vitamins and minerals provide no energy.

Balanced diet concept: cereals, pulses, vegetables, fruits, milk/curd, fats and sugars in recommended proportions, with adequate water and fibre.

Deficiency diseases: vitamin A - night blindness/xerophthalmia; vitamin D - rickets/osteomalacia; iron - anaemia; iodine - goitre; vitamin C - scurvy; thiamine (B1) - beriberi.

Diabetes diet: controlled carbohydrate portions, high fibre, low refined sugar, regular meal timing; monitor for hypoglycaemia (sweating, tremor, confusion) and treat with fast-acting glucose.

Hypertension diet: restrict salt (<5 g/day), limit processed foods, increase potassium-rich fruits and vegetables unless contraindicated.

Therapeutic diets: clear liquids (water, clear broth), full liquids, soft diet, bland diet, low-residue diet, diabetic diet, renal diet (protein, sodium, potassium and fluid restrictions).

Protein-energy malnutrition: marasmus is severe wasting without oedema; kwashiorkor shows oedema, low serum albumin and moon face; both need cautious nutritional rehabilitation.

Nutritional assessment: weight, height, BMI (weight kg / height m²), mid-upper arm circumference, and haemoglobin; BMI <18.5 is underweight, 25–29.9 overweight.

Word roots plus prefixes/suffixes build terms: brady- (slow), tachy- (fast), hyper- (high), hypo- (low), -itis (inflammation), -ectomy (removal), -otomy (incision), -ology (study of).

Common abbreviations: BP, HR, RR, SpO2, TPR, NPO (nothing by mouth), PRN (as required), OD (once daily), BD (twice daily), TDS (three times daily), SOS (if needed).

Documentation principles: accurate, objective, complete, timely, legible, signed with name and designation; record facts not opinions, and never alter a record retrospectively.

SOAP note format: Subjective (patient's complaint), Objective (observations and measurements), Assessment (interpretation), Plan (actions and follow-up).

Communication types: verbal, non-verbal (posture, eye contact, touch), written; use therapeutic communication - active listening, open questions, empathy, reflection.

Confidentiality: patient information is shared only with authorised staff on a need-to-know basis; do not discuss patients in public areas or on social media.

Barriers to communication include language, hearing loss, pain, anxiety and cultural differences; use interpreters, simple language and hearing aids as needed.

Reporting: use ISBAR/SBAR (Identify, Situation, Background, Assessment, Recommendation) for handovers and escalation of deteriorating patients.

Occupational hazards in healthcare: biological (bloodborne pathogens), sharps injuries, chemical (disinfectants, anaesthetic gases), ergonomic (lifting injuries), radiation and psychological stress.

Needlestick injury protocol: wash with soap and water, do not squeeze the wound, report immediately, and follow post-exposure prophylaxis guidelines for HIV and hepatitis B.

Ethical principles: autonomy (respect patient choice), beneficence (do good), non-maleficence (do no harm), justice (fair treatment), veracity (truthfulness), confidentiality.

Informed consent requires capacity, adequate information, voluntariness and documentation; emergency care may proceed without consent if life is at risk.

Professional conduct: punctuality, uniform and identity badge, respect for patient dignity, avoiding boundary violations, no discrimination based on caste, religion or gender.

Patient rights: right to information, privacy, confidentiality, second opinion, and to refuse treatment; duty of care includes never abandoning a patient.

Ergonomic safety: use correct lifting technique (bend knees, keep load close, avoid twisting), use mechanical aids, and ask for help with heavy patients.

Fire safety in the ward: know the RACE sequence (Rescue, Alarm, Contain, Extinguish/Evacuate) and the location of extinguishers and exits.

Clinical skills commonly assessed: hand hygiene, vital signs measurement, bed making, bed bath, oral care, positioning, temperature/pulse/respiration recording, and basic dressing.

Before any procedure: verify patient identity with two identifiers, explain the procedure, check doctor's order, gather supplies, and maintain privacy with screens or curtains.

Aseptic technique: perform hand hygiene, use sterile gloves and sterile field, keep sterile items above waist level, and never turn away from the sterile field.

Specimen collection: label containers with patient name, ID, date, time and specimen type before sending; use correct container and transport promptly.

Injection safety: check the five rights (right patient, drug, dose, route, time), use a new needle and syringe for each patient, and dispose of sharps immediately in the white puncture-proof container.

Record keeping during internship: maintain logbook of procedures performed, get countersignature from supervisor, and reflect on errors as learning opportunities.

Infection control in ward rounds: clean stethoscope between patients, follow hand hygiene before and after patient contact, and segregate waste at the point of generation.

Patient safety event reporting: report falls, medication errors and near-misses through the institutional reporting system without fear of blame, to enable system improvement.

Healthcare system levels in India: sub-centre (population ~5,000 plains/3,000 hilly), Primary Health Centre (~30,000/20,000), Community Health Centre (~1,20,000/80,000), then district hospital and tertiary care.

National Health Programmes include NRHM/NHM, National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS), RNTCP/NTEP for TB, and Universal Immunization Programme.

Levels of prevention: primordial (risk-factor reduction), primary (pre-disease, e.g., immunisation), secondary (early detection, e.g., screening), tertiary (disability limitation/rehabilitation).

Primary health care principles (Alma-Ata 1978): equitable distribution, community participation, appropriate technology, intersectoral coordination, focus on prevention.

Healthcare team roles: physician diagnoses and prescribes; nurse assesses, implements nursing care, administers treatment; ANM/ASHA link community to facility; pharmacist dispenses; lab technician performs investigations.

India's health infrastructure is organised as rural (sub-centre to CHC) and urban (urban PHC, urban CHC, district hospital), with referral links upward and back-referral downward.

Indicators: Infant Mortality Rate, Maternal Mortality Ratio, Crude Birth Rate, Crude Death Rate, life expectancy; India's MMR has declined substantially under NHM.

Ayushman Bharat has two components: Health and Wellness Centres (comprehensive primary care) and PM-JAY health insurance for secondary/tertiary hospitalisation.

Anatomical position: standing erect, face forward, arms at sides with palms forward, feet together; all positional terms (anterior, medial, proximal) are referenced to this position.

Body planes: sagittal divides left/right, coronal (frontal) divides anterior/posterior, transverse divides superior/inferior.

Skeletal system: 206 bones in an adult; axial skeleton (skull, vertebral column, ribs, sternum) = 80 bones, appendicular = 126 bones.

Respiratory tract order: nose → pharynx → larynx → trachea → bronchi → bronchioles → alveoli; gas exchange occurs only in alveoli.

Heart: four chambers; right side pumps deoxygenated blood to lungs (pulmonary circulation), left side pumps oxygenated blood to the body (systemic circulation).

Digestive tract order: mouth → oesophagus → stomach → small intestine (duodenum, jejunum, ileum) → large intestine → rectum → anus; most absorption occurs in the small intestine.

Nervous system divides into central (brain, spinal cord) and peripheral (somatic and autonomic, which splits into sympathetic and parasympathetic).

Urinary system: kidneys filter blood into urine → ureters → urinary bladder → urethra; the kidney's functional unit is the nephron.