Haryana BSEH Senior Secondary NSQF Healthcare cheat sheet

Healthcare is delivered through a hierarchy: tertiary hospitals (referral, specialised care), secondary (district hospitals), primary (PHC, CHC) and community level (sub-centre, ASHA).

India's rural health pyramid: sub-centre serves about 3,000–5,000 population; PHC about 20,000–30,000; CHC about 80,000–1,20,000.

National Health Policy 2017 targets government health expenditure of 2.5% of GDP by 2025.

Healthcare team roles: physician diagnoses and prescribes; nurse assesses, administers care and medication; pharmacist dispenses and checks interactions; laboratory technician performs diagnostics; physiotherapist restores movement.

Allied health includes radiography, medical laboratory technology, optometry, dental hygiene, nutrition and medical records - each with defined scope of practice.

Ayush systems (Ayurveda, Yoga, Unani, Siddha, Homeopathy) are integrated through AYUSH hospitals, co-located facilities and National AYUSH Mission.

NSQF is a 10-level framework; the BSEH Senior Secondary Healthcare course sits at Level 4, aligning school vocational learning with industry competency standards.

Scope of practice rule: a worker performs only tasks for which they hold recognised training and authorisation; delegation does not transfer accountability.

Anatomical position: standing erect, face forward, arms at sides with palms forward; all positional terms are referenced to this stance.

Directional pairs: anterior/ventral vs posterior/dorsal; superior/cranial vs inferior/caudal; medial vs lateral; proximal vs distal; superficial vs deep.

Body planes: sagittal divides left and right; coronal (frontal) divides front and back; transverse divides upper and lower.

Four abdominal quadrants (RUQ, LUQ, RLQ, LLQ) are used clinically; nine regions include epigastric, umbilical, hypogastric and the hypochondriac, iliac and lumbar areas.

Organ systems: skeletal (support, protection, blood cell formation), muscular (movement, heat), cardiovascular (transport), respiratory (gas exchange), digestive (absorption), urinary (filtration, fluid balance), nervous (control), endocrine (hormones).

Vital physiological values: normal adult resting heart rate 60–100/min; respiratory rate 12–20/min; body temperature about 37 °C; blood pH 7.35–7.45.

Terminology building blocks: root (organ or tissue), prefix (location, number, time), suffix (condition, procedure); e.g., 'bradycardia' = brady (slow) + cardia (heart).

Common suffixes: -itis (inflammation), -ectomy (surgical removal), -otomy (incision), -ostomy (opening), -algia (pain), -emia (blood condition), -uria (urine condition).

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

Transmission modes: contact (direct/indirect), droplet (particles >5 micrometres, travel about 1 metre), airborne (droplet nuclei <5 micrometres, remain suspended), vector-borne and common vehicle.

Standard precautions apply to all patients regardless of diagnosis: hand hygiene, gloves, gown, mask/eye protection as risk dictates, safe sharps handling, safe waste disposal, clean linen handling.

Transmission-based precautions are added to standard precautions: contact (gloves and gown), droplet (surgical mask), airborne (N95 respirator, negative-pressure room, door closed).

Sterilisation destroys all microorganisms including spores (autoclave 121 °C at 15 psi for 15–20 minutes); disinfection reduces pathogens but may not kill spores.

Spill management: contain, cover with absorbent, apply 1% sodium hypochlorite (or as per protocol) for 30 minutes, remove with forceps, then clean the area.

Sharps rule: never recap, bend or break needles by hand; dispose immediately in a puncture-proof, colour-coded sharps container filled to no more than three-quarters.

Immunisation of healthcare workers (hepatitis B, tetanus, influenza) and post-exposure prophylaxis after needlestick injury are core occupational safeguards.

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

Hand hygiene methods: alcohol-based handrub (20–30 seconds, 6 steps) for visibly clean hands; soap and water (40–60 seconds) when hands are visibly soiled or after exposure to spore-formers such as Clostridioides difficile.

Six handrub steps cover palms, backs of hands, interdigital spaces, fingertips, thumbs and wrists; rub until dry, do not towel off.

PPE donning order: gown, mask/respirator, goggles or face shield, gloves last. Doffing order: gloves, goggles/face shield, gown, mask/respirator; hand hygiene after glove removal and after mask removal.

Gloves do not replace hand hygiene; they are removed immediately after the task and never worn between patients or used to touch shared surfaces.

N95 respirator requires a fit check each donning (negative pressure check and positive pressure check); a surgical mask does not provide airborne protection.

PPE must be removed in a designated area, avoiding self-contamination; single-use items are never reused unless the manufacturer specifies reprocessing.

ADLs include bathing, dressing, grooming, toileting, feeding, transferring and ambulation; IADLs include cooking, shopping, managing money and medication.

Positioning: supine, lateral, prone, Fowler (30–60°), semi-Fowler, Trendelenburg, Sims; reposition a bed-bound patient at least every 2 hours to prevent pressure ulcers.

Pressure ulcer risk assessment uses the Braden Scale (sensory perception, moisture, activity, mobility, nutrition, friction/shear); lower score = higher risk.

Bed bath sequence: face and neck first, then arms, chest, abdomen, legs, back, perineal area last; maintain privacy and warmth, change water as needed.

Safe patient handling: assess weight and ability, use mechanical hoists and slide sheets, keep the load close, bend knees, avoid twisting; never lift alone if the patient cannot assist.

Intake-output charting: record all oral, enteral and intravenous intake and urine, vomit, drain and stool output; normal adult urine output is roughly 1–2 mL/kg/hour (about 1,500 mL/day).

Fall prevention: bed in lowest position, brakes locked, side rails used per policy, call bell within reach, non-slip footwear, adequate lighting.

Oral care, nail care and eye care are nursing measures that reduce infection and maintain dignity; dentures are removed at night and cleaned separately.

Normal adult ranges: temperature 36.1–37.2 °C oral; pulse 60–100 beats/min; respiration 12–20 breaths/min; blood pressure about 120/80 mmHg; SpO2 95–100% on room air.

Pulse sites: radial, brachial, carotid, femoral, popliteal, posterior tibial, dorsalis pedis; count for 30 seconds and double, or a full 60 seconds for irregular rhythm.

Pulse qualities documented: rate, rhythm, volume/strength, and equality between sides.

Blood pressure: cuff width should be about 40% of arm circumference; patient seated, arm supported at heart level, rest 5 minutes before measurement.

Respiration is counted without the patient's awareness (e.g., while still holding the wrist); note rate, depth, rhythm and effort.

Temperature routes: oral, axillary (about 0.5 °C lower), tympanic, rectal (about 0.5 °C higher); document route used.

Early warning indicators requiring urgent report: respiratory rate above 30 or below 8/min, SpO2 below 90%, systolic BP below 90 mmHg, heart rate above 130/min, altered consciousness, urine output below 0.5 mL/kg/hour.

SBAR reporting: Situation, Background, Assessment, Recommendation - a structured handover used for escalation.

DRABC sequence: Danger, Response, Airway, Breathing, Circulation - assess before any intervention.

Adult CPR: compressions at 100–120/min, depth 5–6 cm, full recoil, ratio 30 compressions to 2 breaths; use an AED as soon as available.

Recovery position is used for an unresponsive person who is breathing normally and has no suspected spinal injury.

Choking: encourage coughing for mild obstruction; for severe obstruction in a conscious adult, give up to 5 back blows then up to 5 abdominal thrusts, alternating.

Severe bleeding: apply direct pressure with a clean dressing, elevate if possible, add dressings on top rather than removing soaked ones; use a tourniquet only for life-threatening limb bleeding.

Burns: cool with running water for about 20 minutes, remove jewellery and loose clothing, cover with a clean non-adherent dressing; never apply ice, toothpaste or oil.

Fracture and spinal injury: immobilise, do not attempt to straighten a deformed limb, and avoid moving a suspected spinal injury unless the airway is at risk.

Poisoning and snakebite: do not induce vomiting or cut/suck a bite; keep the patient still, remove constricting items, and transport to hospital with the container or a description of the agent.

A medical record is a legal document; entries must be accurate, contemporaneous, legible, signed (with name and designation) and free of abbreviations that are not approved.

Corrections: draw a single line through the error, write 'error', initial and date, then write the correct entry; never overwrite, use correction fluid or destroy pages.

Documentation must record what was observed and done, not opinions; objective findings and patient statements are labelled distinctly.

Confidentiality is protected under the Indian Medical Council (Professional Conduct) Regulations and the Digital Personal Data Protection Act, 2023; disclosure requires patient consent or a legal mandate.

Minimum record contents: patient identification, history, examination findings, diagnosis, orders, medication administration, progress notes, results, discharge summary.

Retention follows institutional and statutory schedules; medico-legal records are retained longer and are never altered once litigation is anticipated.

Electronic health records require unique user logins, audit trails, role-based access and secure transmission; shared passwords are prohibited.

Health information systems in India include the HMIS portal, ABDM/ABHA health ID and eSanjeevani teleconsultation; data entered must match source documents.

Communication components: sender, message, channel, receiver, feedback; barriers include noise, jargon, language, culture, hearing loss and emotional state.

Active listening uses paraphrasing, reflecting, clarifying and summarising; open questions gather information, closed questions confirm facts.

Therapeutic communication avoids false reassurance, judgemental remarks, giving personal advice and changing the subject.

Patient rights under the Charter of Patients' Rights (2019): right to information, informed consent, second opinion, privacy and confidentiality, non-discrimination, safety, and grievance redressal.

Informed consent requires capacity, adequate information (nature, risks, benefits, alternatives) and voluntariness; it is documented before procedures.

Professional boundaries: no personal or financial relationships with patients, no social media disclosure of patient information, no accepting gifts that create obligation.

Medical confidentiality exceptions: statutory notifiable diseases, court order, risk to a third party, and public health emergencies.

Team communication: use read-back for verbal orders, identify the patient with two identifiers before every intervention, and speak up using graded assertiveness when safety is at risk.

Biomedical waste is regulated by the Bio-Medical Waste Management Rules, 2016 (amended 2018, 2019); occupier is responsible for compliance and annual reporting.

Colour coding: yellow - human/animal anatomical waste, soiled waste, expired medicines, chemical and discarded linen; red - contaminated recyclable plastic and tubing; white - sharps (needles, blades, glass); blue - glassware, metallic implants, broken thermometers.

Yellow category waste is incinerated or deep-buried; red is autoclaved or shredded then recycled; white sharps are autoclaved or shredded then sent to a secure landfill or cement kiln.

Cytotoxic waste, discarded cytotoxic drugs and their contaminated items go in the yellow category in a labelled container; mercury waste is handled separately.

Bins are labelled with the biohazard symbol and category; waste is segregated at the point of generation and never mixed after segregation.

Storage limit before treatment is 48 hours; treated waste is handed to an authorised common biomedical waste treatment facility with manifest documentation.

Occupational hazards: needlestick and sharps injury, blood-borne pathogens (HBV, HCV, HIV), chemical exposure, ergonomic strain, fire and electrical risk.

Post-exposure needlestick protocol: wash with soap and water, do not squeeze or scrub, report immediately, and start hepatitis B post-exposure prophylaxis and HIV PEP assessment within hours.

Healthcare career pathways: clinical (nursing, physiotherapy, laboratory technology, radiography, pharmacy), diagnostic, administrative (medical records, hospital administration) and community (ASHA, health worker).

Entry routes include BSEH Senior Secondary Healthcare (NSQF Level 4), diploma courses (DMLT, D.Pharm, GNM), and degree programmes (B.Sc. Nursing, BPT, B.Sc. MLT) with bridge options.

Registration and licensure: nurses register with State Nursing Councils, pharmacists with State Pharmacy Councils; practising without registration is an offence.

Entrepreneurship models in healthcare: diagnostic laboratory, pharmacy retail, home nursing service, physiotherapy clinic, medical equipment supply, health insurance facilitation, teleconsultation support.

Key start-up requirements: business plan, market assessment, location and infrastructure norms, licences (e.g., drug licence for a pharmacy, Clinical Establishments Act registration), staff, and financial planning.

Sources of finance and support: bank loans under schemes such as MUDRA and Stand-Up India, State financial corporations, and incubators; maintain records for GST and income tax.

Employability skills assessed in interviews: technical competence, communication, teamwork, infection control awareness, punctuality, documentation accuracy and ethical conduct.

A portfolio and CV should document qualifications, registration, skills checklist, clinical placements, continuing education and references; verify all claims before submission.

Clinical placement assessment typically covers attendance, skill checklists, logbook entries, supervisor feedback and a final practical examination.

A logbook entry records date, ward/unit, skill performed, patient category (never full name), supervisor signature and reflection on what was learned.

Core assessable skills: hand hygiene, vital signs measurement, bed making, bed bath, patient positioning, oral care, specimen collection, PPE donning/doffing, waste segregation, CPR.

Assessment checklists score steps in sequence; a critical (fail) step - such as breaking asepsis or incorrect sharps disposal - results in automatic failure of that skill.

Portfolio contents: personal profile, certificates, skill checklist with signatures, reflective notes, case reports, attendance record and supervisor evaluation forms.

Confidentiality in the portfolio: anonymise patient identifiers, do not paste prescriptions or reports with names, and never photograph patients.

Reflective practice uses the 'what happened - so what - now what' cycle to convert clinical experience into documented learning.

Professional conduct during placement: report on time in uniform with ID, follow the chain of command, never perform a skill unsupervised until declared competent, and report incidents immediately.