ESIC Nursing Officer cheat sheet

Normal adult vital signs: temperature 36.5-37.5 C oral, pulse 60-100/min, respirations 12-20/min, blood pressure under 120/80 mmHg, SpO2 95-100% on room air.

Maslow hierarchy order used for priority setting: physiological, safety/security, love/belonging, esteem, self-actualization; physiological needs are met first.

Stages of the nursing process: assessment, diagnosis, planning, implementation, evaluation (ADPIE); reassessment restarts the cycle.

Wound healing phases: haemostasis (minutes-hours), inflammatory (1-4 days), proliferative (4-21 days), maturation/remodelling (21 days to 2 years).

Pressure ulcer staging: stage 1 non-blanchable erythema, stage 2 partial-thickness loss, stage 3 full-thickness loss with visible fat, stage 4 exposed bone/tendon/muscle.

Intake-output normal adult: intake about 2500 mL/day, urine output 1-2 mL/kg/hour; oliguria is under 400 mL/24 h, anuria under 100 mL/24 h.

Sites for intramuscular injection: ventrogluteal (safest, no major nerves or vessels), dorsogluteal, vastus lateralis (infants), deltoid (small volumes up to 1 mL).

Sterile field rule: sterile items touching non-sterile surfaces are contaminated; never turn the back on a sterile field; 1-inch border is considered unsterile.

Myocardial infarction triad: chest pain unrelieved by rest or nitrates, ST elevation, and rising troponin; MONA-B order is morphine, oxygen, nitrates, aspirin, beta-blocker.

Left-sided heart failure: pulmonary congestion, dyspnoea, orthopnoea, pink frothy sputum; right-sided: raised JVP, hepatomegaly, peripheral oedema, ascites.

Hypoglycaemia threshold under 70 mg/dL; give 15 g fast carbohydrate, recheck in 15 minutes (rule of 15).

Diabetic ketoacidosis: glucose over 250 mg/dL, pH under 7.3, bicarbonate under 18 mEq/L, ketones positive, Kussmaul breathing; treat with isotonic saline then insulin.

Chronic kidney disease stages by eGFR: stage 1 over 90, stage 2 60-89, stage 3 30-59, stage 4 15-29, stage 5 under 15 (dialysis or transplant).

Stroke: thrombolysis window 3-4.5 hours from symptom onset; do not give aspirin within 24 hours of alteplase.

COPD oxygen target saturation 88-92% to avoid carbon dioxide retention; asthma presents with reversible airflow obstruction and prolonged expiration.

Cirrhosis complications: portal hypertension, oesophageal varices, ascites, hepatic encephalopathy (raised ammonia), coagulopathy from reduced clotting factors.

Naegele rule: estimated date of delivery = first day of last menstrual period minus 3 months plus 7 days plus 1 year.

Normal labour stages: first stage 0-10 cm dilatation, second stage full dilatation to birth, third stage birth to placental delivery (up to 30 minutes), fourth stage first 1-2 hours postpartum.

Pregnancy-induced hypertension: BP 140/90 mmHg or higher after 20 weeks with proteinuria (preeclampsia); severe features include BP 160/110, headache, visual changes, RUQ pain.

Magnesium sulphate toxicity signs: loss of deep tendon reflexes, respiratory depression under 12/min, oliguria; antidote is calcium gluconate 10%.

Postpartum haemorrhage: blood loss over 500 mL after vaginal birth or over 1000 mL after caesarean; uterine atony is the commonest cause.

Fetal heart rate baseline 110-160 beats/min; early decelerations follow head compression, variable decelerations follow cord compression, late decelerations indicate uteroplacental insufficiency.

Contraceptive effectiveness: implant and intrauterine device over 99%, combined oral pill about 91% typical use, male condom about 87% typical use.

Puerperium lasts 6 weeks; lochia rubra days 1-4, serosa days 4-10, alba after day 10.

Infant weight doubles by 5 months and triples by 12 months; birth weight averages 2.5-3.5 kg.

Milestones: social smile 6 weeks, head control 3 months, sits unsupported 6-8 months, walks 12-15 months, two-word phrases 18-24 months.

Normal paediatric respiratory rates: newborn 30-60/min, infant 30-53/min, toddler 22-37/min, school age 18-25/min.

Dehydration grading in children: mild under 5% weight loss, moderate 5-10%, severe over 10% with sunken eyes and lethargy; ORS is first-line for mild-moderate.

Kangaroo mother care: skin-to-skin contact with exclusive breastfeeding for low-birth-weight babies reduces hypothermia and mortality.

Immunisation schedule (India): BCG, OPV-0 and hepatitis B at birth; pentavalent, OPV, rotavirus and fIPV at 6, 10 and 14 weeks; measles-rubella at 9-12 months and 16-24 months.

Paediatric drug dosing is by body weight (mg/kg); check maximum adult dose before administering.

Neonatal jaundice appearing within 24 hours is always pathological; physiological jaundice appears after 24 hours and peaks at days 3-5.

Primary health centre covers about 30,000 rural population (20,000 in hilly areas); a sub-centre covers 5,000 (3,000 hilly).

Levels of prevention: primordial, primary (immunisation, health promotion), secondary (screening, early diagnosis), tertiary (rehabilitation).

Incidence counts new cases in a period; prevalence counts all existing cases at a point or period.

Crude death rate = deaths in a year divided by mid-year population, multiplied by 1000.

Infant mortality rate = infant deaths under 1 year per 1000 live births in the same year; neonatal mortality is deaths under 28 days.

Notifiable diseases in India include cholera, plague, yellow fever, dengue, malaria, polio and diphtheria; reporting is to the local health authority.

Cold chain: OPV stored at minus 20 C, most other vaccines at 2-8 C; freeze-sensitive vaccines include hepatitis B, DPT and tetanus toxoid.

Home visit bag technique: wash hands, place a clean plastic sheet, keep bag on the sheet, use clean articles first and contaminated last.

Therapeutic communication techniques: open-ended questions, reflection, restating, silence, clarification; avoid false reassurance, giving advice and why-questions.

Schizophrenia first-rank symptoms: auditory hallucinations, thought insertion or withdrawal, thought broadcasting, delusions of control, passivity phenomena.

Depression core symptoms: low mood and anhedonia for at least 2 weeks plus sleep, appetite, energy, concentration or suicidal changes.

Mania: elevated or irritable mood, grandiosity, decreased need for sleep, pressured speech, flight of ideas, risky behaviour for at least 1 week.

Neuroleptic malignant syndrome: fever, rigidity, autonomic instability, raised creatine kinase; stop the antipsychotic and give dantrolene or bromocriptine.

Serotonin syndrome: agitation, hyperreflexia, clonus, tremor, fever after serotonergic drugs; stop the drug and give supportive care.

Nursing care in acute psychosis: ensure safety, reduce stimuli, short clear sentences, do not argue with delusions, build trust.

Electroconvulsive therapy: pre-procedure NPO for 6-8 hours, consent, remove dentures; commonest side effect is transient memory impairment.

Normal blood pH 7.35-7.45; bicarbonate 22-26 mEq/L; PaCO2 35-45 mmHg; PaO2 80-100 mmHg.

Cardiac output = heart rate multiplied by stroke volume; normal about 5 L/min; stroke volume depends on preload, afterload and contractility.

Bones in the adult skeleton: 206; infant has about 270; axial skeleton 80 bones, appendicular 126.

Blood groups: O negative is the universal donor for red cells, AB positive the universal recipient; A has anti-B antibodies.

Nephron: glomerular filtration about 125 mL/min; most reabsorption occurs in the proximal convoluted tubule.

Cranial nerves count 12 pairs; the vagus (X) provides parasympathetic supply to thoracic and abdominal organs.

Insulin lowers blood glucose; glucagon, cortisol, adrenaline and growth hormone raise it.

Normal serum electrolytes: sodium 135-145, potassium 3.5-5.0, calcium 8.5-10.5 mg/dL, chloride 95-105 mEq/L.

Routes and onset: intravenous fastest, then intramuscular, subcutaneous, oral; first-pass metabolism reduces oral bioavailability.

Digoxin therapeutic range 0.5-2 ng/mL; signs of toxicity include nausea, visual halos, bradycardia; check apical pulse before giving, hold if under 60/min in adults.

Aminoglycosides (gentamicin) are nephrotoxic and ototoxic; monitor peak and trough levels and creatinine.

Heparin is monitored by aPTT (target 1.5-2.5 times control); antidote is protamine sulphate. Warfarin is monitored by INR (target 2-3); antidote is vitamin K.

Paracetamol overdose causes hepatic necrosis; antidote is N-acetylcysteine, most effective within 8 hours.

Opioid overdose triad: pinpoint pupils, respiratory depression, coma; antidote naloxone.

Corticosteroids must not be stopped abruptly; taper to avoid adrenal insufficiency.

Antitubercular drugs: isoniazid causes peripheral neuritis (give pyridoxine), rifampicin turns urine orange and is hepatotoxic, ethambutol causes optic neuritis.

Gram-positive bacteria stain purple with thick peptidoglycan; gram-negative stain pink with thin peptidoglycan and outer membrane.

Koch postulates: organism found in all cases, isolated in pure culture, causes disease when inoculated, recovered again from the host.

Sterilisation: autoclave 121 C at 15 psi for 15-20 minutes; hot air oven 160 C for 2 hours; alcohol is a disinfectant, not a sterilant.

Hepatitis B is a DNA virus spread by blood and body fluids; hepatitis A and E spread by faecal-oral route.

Inflammation cardinal signs: redness, heat, swelling, pain, loss of function; mediated by histamine, prostaglandins and bradykinin.

Benign versus malignant: benign tumours are encapsulated, well differentiated and do not metastasise; malignant tumours invade and metastasise.

Energy values: carbohydrate and protein 4 kcal/g, fat 9 kcal/g; protein requirement about 0.8-1 g/kg/day in healthy adults.

Deficiency diseases: vitamin A night blindness, vitamin D rickets, vitamin C scurvy, thiamine beriberi, niacin pellagra, iodine goitre.

ESIC was established under the Employees State Insurance Act 1948; it provides sickness, maternity, disablement and dependent benefits.

ESIC Act applies to factories and establishments with 10 or more employees (20 in some states); wage ceiling for coverage is revised by government notification.

Maternity benefit under ESIC is paid for 26 weeks for confinement, with additional leave for complications.

Indian nursing regulatory bodies: Indian Nursing Council (national), State Nursing Councils (registration), and Trained Nurses Association of India (professional body).

National health programmes include National Health Mission, Revised National Tuberculosis Control Programme (now National TB Elimination Programme) and Ayushman Bharat.

World Health Organization was founded in 1948 with headquarters in Geneva; World Health Day is 7 April.

International Nurses Day is 12 May, the birthday of Florence Nightingale; Nurses Week runs 6-12 May.

Red Cross emblem use is restricted to the International Committee of the Red Cross and authorised medical services under the Geneva Conventions.

Percentage change = (new value minus old value) divided by old value, multiplied by 100.

Simple interest = principal x rate x time / 100; compound amount = principal x (1 + rate/100)^time.

Speed = distance / time; to convert km/h to m/s multiply by 5/18.

Average = sum of values / number of values; if every value increases by k, the average increases by k.

Ratio and proportion: if a:b = c:d then a x d = b x c; use cross multiplication to solve.

Work formula: if A finishes in x days and B in y days, together they finish in xy/(x+y) days.

Blood relation and direction sense: draw a diagram first; north-south and east-west are perpendicular, left/right reverses with facing direction.

Number series: check differences, then ratios, then squares and cubes; odd-one-out questions test a common property of the majority.

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

Body temperature routes ranked by typical reading: rectal highest, then oral, then axillary lowest; tympanic is close to core temperature.

Pulse sites: radial, brachial, carotid, femoral, popliteal, posterior tibial, dorsalis pedis; apical pulse counted for a full minute.

Positioning: Fowler for respiratory distress, Trendelenburg for hypotension, lateral for unconscious patients to prevent aspiration, lithotomy for gynaecological procedures.

Oxygen delivery devices: nasal cannula 1-6 L/min (24-44%), simple mask 5-8 L/min (40-60%), non-rebreather up to 90-100%.

Enema administration: position left lateral, insert tube 7-10 cm, instil solution slowly, keep patient on left side to aid retention.

Urinary catheterisation: use strict aseptic technique, inflate balloon only after confirming urine flow, normal adult balloon 10 mL.

Documentation principles: objective, accurate, timely, complete, signed; record facts not opinions, and never alter a record after the fact.

Fracture healing: haematoma, granulation tissue, callus formation, ossification, remodelling; signs of compartment syndrome are the 5 Ps.

5 Ps of compartment syndrome: pain out of proportion, pallor, paraesthesia, paralysis, pulselessness; pain is the earliest sign.

Burns: rule of nines adult - head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%; Parkland formula 4 mL x weight x % burn for 24 hours.

Appendicitis: pain starts periumbilical then shifts to right iliac fossa; McBurney point tenderness, rebound tenderness; avoid heat and enemas before diagnosis.

Thyroid storm: fever, tachycardia, agitation, hypertension; give antithyroid drugs, beta-blockers, iodine and supportive care.

Pneumothorax: sudden dyspnoea, decreased breath sounds, hyper-resonance; tension pneumothorax needs immediate needle decompression.

Blood transfusion reaction: stop transfusion immediately, keep IV line with normal saline, monitor vitals, send blood and urine samples.

Post-operative deep vein thrombosis prevention: early ambulation, compression stockings, hydration, and low-molecular-weight heparin as prescribed.

Fetal circulation shunts: ductus venosus, foramen ovale, ductus arteriosus; they close functionally after birth and anatomically over weeks.

Apgar score components: appearance, pulse, grimace, activity, respiration; scored 0-2 each at 1 and 5 minutes; 7-10 is normal.

Antenatal visits under the Indian schedule: at least 4 visits - first trimester, 14-26 weeks, 28-34 weeks, 36 weeks to term.

Hyperemesis gravidarum: persistent vomiting, dehydration, ketosis, weight loss over 5%; treat with IV fluids, antiemetics and thiamine.

Placenta praevia: painless vaginal bleeding in late pregnancy; avoid vaginal examination; caesarean delivery is usual.

Abruptio placentae: painful bleeding, board-like uterus, fetal distress; risk of disseminated intravascular coagulation.

Ectopic pregnancy triad: amenorrhoea, abdominal pain, vaginal bleeding; ruptured ectopic causes shoulder-tip pain and shock.

Menopause averages around 45-55 years; oestrogen deficiency causes hot flushes, osteoporosis and atrophic vaginitis.

APGAR and newborn assessment: check respiration, heart rate, tone, reflexes, colour; normal newborn heart rate 120-160/min.

Breastfeeding: exclusive for 6 months, complementary feeding from 6 months, continued breastfeeding to 2 years; colostrum is rich in immunoglobulin A.

Growth charts plot weight-for-age, height-for-age and head circumference; crossing two centile lines downward suggests failure to thrive.

Paediatric fluid maintenance by Holliday-Segar: 100 mL/kg for first 10 kg, 50 mL/kg for next 10 kg, 20 mL/kg thereafter per day.

Signs of respiratory distress in children: nasal flaring, grunting, intercostal retractions, tachypnoea, cyanosis.

Kawasaki disease: fever over 5 days, conjunctivitis, rash, strawberry tongue, cervical lymphadenopathy; risk of coronary aneurysm.

Nephrotic syndrome in children: heavy proteinuria, hypoalbuminaemia, oedema, hyperlipidaemia; treat with corticosteroids and monitor for infection.

ORAL REHYDRATION solution composition: sodium 75 mEq/L, glucose 75 mmol/L; give small frequent sips via cup and spoon.

Epidemiological triad: agent, host, environment; disease occurs when they interact unfavourably.

Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives).

Maternal mortality ratio = maternal deaths per 100,000 live births; India target under Sustainable Development Goal is below 70 by 2030.

DOTS for tuberculosis: directly observed treatment short course; sputum smear at 2, 5 and 6 months under the older regimen.

Vector control: Anopheles for malaria (breeds in clean water), Aedes for dengue (breeds in clean stagnant water, bites by day), Culex for filariasis.

Screening versus diagnostic test: screening is applied to asymptomatic populations, diagnostic confirms disease in symptomatic individuals.

Health education planning steps: identify needs, set objectives, choose methods, implement, evaluate.

Sanitation: safe drinking water residual chlorine 0.2-0.5 mg/L at point of use; chlorination kills most bacteria but not spores.

Mental status examination domains: appearance, behaviour, speech, mood and affect, thought, perception, cognition, insight and judgement.

Suicide risk factors: previous attempt, male sex, older age, substance use, depression, hopelessness, access to means; ask directly about suicidal ideas.

Defence mechanisms: denial, projection, displacement, rationalisation, sublimation, regression; identify the mechanism used by the patient.

Anxiety disorders: generalised anxiety, panic disorder, phobias, obsessive-compulsive disorder; cognitive behavioural therapy is first-line psychological treatment.

Alcohol withdrawal timeline: tremor and anxiety at 6-12 hours, seizures at 12-48 hours, delirium tremens at 48-96 hours; treat with benzodiazepines and thiamine.

Antipsychotic side effects: extrapyramidal symptoms (dystonia, akathisia, parkinsonism, tardive dyskinesia), metabolic syndrome, hyperprolactinaemia.

Lithium therapeutic range 0.6-1.2 mEq/L; toxicity signs include tremor, vomiting, ataxia; monitor levels and renal and thyroid function.

Therapeutic milieu elements: safety, structure, reality orientation, group activities, consistent limits and patient participation in care.

Respiratory volumes: tidal volume 500 mL, vital capacity about 4800 mL, residual volume about 1200 mL; total lung capacity about 6000 mL.

Heart conduction: SA node (pacemaker, 60-100/min), AV node, bundle of His, bundle branches, Purkinje fibres; AV node delay allows ventricular filling.

Digestive tract order: mouth, oesophagus, stomach, duodenum, jejunum, ileum, caecum, colon, rectum, anus; most absorption in small intestine.

Muscle contraction: sliding filament theory; actin slides over myosin with calcium and ATP; rigor mortis occurs when ATP is depleted.

Endocrine glands: pituitary, thyroid, parathyroid, adrenal, pancreas, gonads; posterior pituitary stores ADH and oxytocin.

Blood cells: red cells live about 120 days, platelets 8-10 days, neutrophils are the first responders to bacterial infection.

Kidney functions: filtration, reabsorption, secretion, acid-base balance, erythropoietin and renin production, vitamin D activation.

Brain lobes: frontal (motor, personality), parietal (sensory), temporal (hearing, memory), occipital (vision); cerebellum controls balance and coordination.

Drug half-life: time for plasma concentration to halve; about 4-5 half-lives are needed to reach steady state.

Rightsof medication administration: right patient, drug, dose, route, time, documentation, reason and response (eight rights).

Antihypertensives: ACE inhibitors cause dry cough and hyperkalaemia; calcium channel blockers cause oedema and flushing; beta-blockers mask hypoglycaemia.

Insulin types by onset: rapid (lispro, aspart) 15 minutes, short (regular) 30 minutes, intermediate (NPH) 1-2 hours, long (glargine) 1-2 hours with no peak.

Antibiotic principles: take culture before starting, complete the full course, avoid unnecessary use to prevent resistance.

Chemotherapy safety: prepare in biological safety cabinet, use personal protective equipment, dispose of sharps and cytotoxic waste separately.

Anticoagulant reversal: warfarin with vitamin K, heparin with protamine, dabigatran with idarucizumab.

Drug interactions: tetracycline binds calcium and iron, so avoid milk and antacids; rifampicin induces liver enzymes and reduces oral contraceptive efficacy.

Bacterial growth phases: lag, log (exponential), stationary, decline; antibiotics act best during the log phase.

Common pathogens: Staphylococcus aureus (pus, food poisoning), Streptococcus pyogenes (pharyngitis, rheumatic fever), Mycobacterium tuberculosis (acid-fast bacilli).

HIV attacks CD4 T-helper cells; window period before antibodies appear; transmission by blood, sexual contact and mother to child.

Immunity: active immunity follows infection or vaccination and is long lasting; passive immunity from maternal antibodies or immunoglobulins is short lived.

Cell injury and necrosis types: coagulative, liquefactive, caseous, fat and fibrinoid; apoptosis is programmed cell death without inflammation.

Oedema mechanisms: increased hydrostatic pressure, reduced oncotic pressure, lymphatic obstruction, sodium retention, increased capillary permeability.

Nutrition assessment: body mass index = weight in kg / height in m squared; underweight under 18.5, normal 18.5-24.9, obese 30 and above.

Balanced diet proportions: carbohydrate 50-60%, fat 20-30%, protein 10-15% of total energy.

Employees State Insurance Corporation was set up in 1952; the Act came into force in 1948 and the scheme started in Kanpur in 1952.

ESIC benefits include medical benefit, sickness benefit, maternity benefit, disablement benefit, dependants benefit, funeral expenses and rehabilitation.

Nursing cadres in India: Auxiliary Nurse Midwife, General Nursing and Midwifery, Bachelor of Science in Nursing, and specialty postgraduate nursing.

National Health Policy 2017 targets health expenditure of 2.5% of GDP and universal health coverage.

World Health Organization essential medicines list is updated every two years; India's National List of Essential Medicines guides public procurement.

Important health days: World TB Day 24 March, World Malaria Day 25 April, World AIDS Day 1 December, World Mental Health Day 10 October.

Indian Red Cross Society was founded in 1920; its activities include blood banks, disaster relief and first aid training.

Nursing ethics principles: autonomy, beneficence, non-maleficence, justice and confidentiality; informed consent is an autonomy requirement.

Profit and loss: profit percent = profit / cost price x 100; selling price = cost price x (1 + profit percent/100).

Discount: selling price = marked price x (1 - discount percent/100); successive discounts are not additive.

Time and distance with trains: relative speed adds when moving opposite directions and subtracts when moving the same direction.

Mixture and alligation: ratio of quantities = (mean price - cheaper price) : (dearer price - mean price).

Permutation and combination: nPr = n!/(n-r)!; nCr = n!/[r!(n-r)!]; use combination when order does not matter.

Probability = favourable outcomes / total outcomes; independent events multiply, mutually exclusive events add.

Coding-decoding: identify the shift in alphabet position between letters; verify with all letters before applying to the target word.

Clocks and calendars: clock hands coincide every 65 5/11 minutes; odd days determine the day of the week for a date.

Acute pancreatitis: severe epigastric pain radiating to the back, raised amylase and lipase, vomiting; keep patient NPO and give IV fluids.

Peptic ulcer: Helicobacter pylori eradication with triple or quadruple therapy; avoid NSAIDs and smoking; bleeding presents as haematemesis or melaena.

Liver function tests: raised ALT and AST in hepatitis, raised alkaline phosphatase in biliary obstruction, low albumin in chronic liver disease.

Hypothyroidism: weight gain, cold intolerance, bradycardia, constipation; treat with levothyroxine on an empty stomach.

Hyperkalaemia management: calcium gluconate for cardiac protection, insulin with glucose, salbutamol, potassium binders, dialysis if severe.

Shock types: hypovolaemic, cardiogenic, distributive (septic, anaphylactic, neurogenic) and obstructive; treatment depends on cause.

Cataract surgery: day-care procedure under local anaesthesia; avoid bending, straining and eye rubbing post-operatively.

Fracture immobilisation: check distal pulse, colour, movement and sensation before and after applying a cast or splint.

Fetal presentation and position: cephalic commonest; vertex is the most favourable cephalic presentation; breech increases cord prolapse risk.

Labour progress: latent phase 0-6 cm slower, active phase 6-10 cm at about 1 cm/hour in first labours.

Partograph records cervical dilatation, descent, fetal heart rate, contractions, maternal vitals; alert line and action line guide referral.

Induction of labour: oxytocin infusion titrated to contractions; monitor fetal heart rate and uterine hyperstimulation.

Episiotomy: mediolateral is commonest in India; keep perineum clean and dry, use sitz baths, and inspect for infection.

Pre-eclampsia management: magnesium sulphate for seizure prophylaxis, antihypertensives such as labetalol, and delivery is the definitive treatment.

Rh incompatibility: give anti-D immunoglobulin to Rh-negative mother within 72 hours of delivery of an Rh-positive baby.

Gynaecological cancers: cervical cancer screening by Pap smear from age 21-30 and human papillomavirus vaccination for girls 9-14 years.

Childhood developmental theories: Piaget stages (sensorimotor 0-2, preoperational 2-7, concrete operational 7-11, formal operational 11 and above).

Erikson stages for children: trust versus mistrust (infancy), autonomy versus shame (1-3), initiative versus guilt (3-6), industry versus inferiority (6-12).

Congenital heart disease: cyanotic types include tetralogy of Fallot and transposition; acyanotic include ventricular septal defect and patent ductus arteriosus.

Tetralogy of Fallot: ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, overriding aorta; squatting relieves cyanotic spells.

Acute respiratory infection in children: fast breathing is 50/min or more in infants under 2 months, 40/min for 2-12 months, 40/min for 1-5 years.

Severe acute malnutrition: weight-for-height below -3 SD or oedema; treat with F-75 and F-100 therapeutic foods and manage hypoglycaemia and hypothermia.

Intussusception: colicky abdominal pain, red currant jelly stools, sausage-shaped mass; treat with air or barium enema reduction.

Paediatric drug safety: use weight-based dosing, oral syringes for liquids, and never give aspirin to children with viral illness (Reye syndrome risk).

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

Referral system levels: sub-centre to primary health centre, to community health centre, to district hospital, to tertiary care.

National immunisation cold chain equipment: ice-lined refrigerators at 2-8 C, deep freezers at minus 20 C, vaccine carriers with conditioned ice packs.

Disease surveillance: epidemic is a rise above expected in a community; endemic is constant presence; pandemic is worldwide spread.

Nutrition programmes: Integrated Child Development Services provides supplementary nutrition, immunisation and pre-school education to children under 6.

Family planning methods: temporary (condoms, pills, intrauterine devices) and permanent (tubectomy, vasectomy); male sterilisation is simpler and safer.

Occupational health: personal protective equipment, ventilation, periodic medical examination and reporting of occupational diseases.

Disaster management cycle: prevention, mitigation, preparedness, response, recovery; triage colour codes red (immediate), yellow (delayed), green (minor), black (dead).

Psychiatric interview structure: introduction and rapport, chief complaint, history of present illness, past and family history, mental status examination, plan.

Psychosis versus neurosis: psychosis has impaired reality testing and insight, neurosis retains insight and reality testing.

Obsessive-compulsive disorder: obsessions are intrusive thoughts, compulsions are repetitive acts; SSRIs and exposure-response prevention are treatment.

Post-traumatic stress disorder: re-experiencing, avoidance, hyperarousal and negative cognition lasting over 1 month after trauma.

Bipolar disorder: mood stabilisers such as lithium or valproate; monitor adherence and educate about early signs of relapse.

Eating disorders: anorexia nervosa has low body weight, fear of weight gain and amenorrhoea; bulimia has binge-purge cycles with normal weight.

Restraint and seclusion: use only when less restrictive measures fail, for the shortest time, with continuous monitoring and documentation.

Community mental health: deinstitutionalisation, day-care centres, halfway homes, family education and rehabilitation support.

Skeletal muscle types: skeletal (voluntary, striated), cardiac (involuntary, striated, intercalated discs), smooth (involuntary, non-striated).

Bone cells: osteoblasts build bone, osteoclasts resorb bone, osteocytes maintain matrix; parathyroid hormone raises blood calcium.

Skin layers: epidermis (avascular), dermis (vessels, nerves, glands), subcutaneous fat; pressure injury risk rises with immobility and moisture.

Nervous system divisions: central (brain, spinal cord) and peripheral (somatic and autonomic); autonomic splits into sympathetic and parasympathetic.

Sympathetic response: increased heart rate, bronchodilation, dilated pupils, reduced digestion; parasympathetic restores resting functions.

Hormones of the anterior pituitary: growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, follicle-stimulating hormone, luteinising hormone, prolactin.

Acid-base compensation: respiratory compensation is fast via carbon dioxide changes; renal compensation is slow via bicarbonate and hydrogen ion excretion.

Normal urine specific gravity 1.010-1.025; urine formation depends on glomerular filtration, tubular reabsorption and secretion.

Drug administration checks: verify prescription, patient identity, allergies, expiry date and dose calculation before giving any medicine.

Diuretics: furosemide is a loop diuretic causing hypokalaemia and hypovolaemia; spironolactone is potassium-sparing and causes hyperkalaemia.

Antihypertensive emergency: lower blood pressure gradually, not abruptly, to avoid cerebral hypoperfusion.

Antiepileptics: phenytoin has a narrow therapeutic range (10-20 mcg/mL) and causes gum hyperplasia; give with food and monitor levels.

Antiemetics: ondansetron for chemotherapy-induced vomiting; metoclopramide promotes gastric emptying but can cause extrapyramidal effects.

Vaccine storage: keep in the refrigerator door, never freeze adjuvanted vaccines, discard a vaccine exposed to heat or freezing.

Nursing drug calculation: dose required = (desired dose / stock strength) x stock volume; double-check high-risk drugs with a second nurse.

Adverse drug reaction reporting: report to the national pharmacovigilance programme; document the reaction in the patient record.

Sterilisation versus disinfection: sterilisation destroys all micro-organisms including spores; disinfection reduces pathogens on inanimate objects.

Hand hygiene with alcohol-based rub is preferred for routine decontamination; soap and water is needed when hands are visibly soiled or after Clostridioides difficile exposure.

Antibiotic resistance mechanisms: enzyme production (beta-lactamase), efflux pumps, altered target sites, reduced permeability.

Inflammation versus infection: inflammation is a response to injury, infection is invasion by micro-organisms; not all inflammation is infective.

Wound healing factors: nutrition (protein, vitamin C, zinc), blood supply, infection control and absence of foreign bodies promote healing.

Diabetes pathology: insulin resistance or deficiency causes hyperglycaemia; long-term complications include retinopathy, nephropathy, neuropathy and vascular disease.

Nutrition in disease: low-salt diet for hypertension and heart failure, low-protein for advanced kidney disease, high-fibre for constipation, iron-rich foods for anaemia.

Food safety: cook food thoroughly, store at safe temperatures, boil water, and wash hands before food preparation.

Indian Nursing Council was established in 1947 as a statutory body under the Indian Nursing Council Act 1947 to regulate nursing education.

National Florence Nightingale Award is given to nurses for exceptional service; International Council of Nurses represents nursing worldwide.

Sustainable Development Goal 3 targets good health and well-being; SDG 2 targets zero hunger and improved nutrition.

Pradhan Mantri Jan Arogya Yojana (Ayushman Bharat) provides health cover of 5 lakh rupees per family per year for secondary and tertiary care.

Janani Suraksha Yojana promotes institutional delivery for pregnant women; Janani Shishu Suraksha Karyakram provides free delivery care.

National AIDS Control Organisation runs HIV prevention, testing and treatment; antiretroviral therapy is provided free of cost at designated centres.

Biomedical waste rules segregate waste into yellow, red, white and blue categories with colour-coded bins.

Nursing research ethics: informed consent, anonymity, confidentiality, voluntary participation and institutional ethics committee approval.

Simple and compound interest difference for 2 years = principal x (rate/100)^2; use this shortcut for two-year problems.

Pipes and cisterns: if one pipe fills in x hours and another empties in y hours, net rate = 1/x - 1/y per hour.

Boats and streams: downstream speed = boat speed + stream speed; upstream speed = boat speed - stream speed.

Percentage to fraction conversions: 25% = 1/4, 33 1/3% = 1/3, 16 2/3% = 1/6, 12.5% = 1/8; use them to speed up calculations.

Syllogism: draw Venn diagrams for each premise; a conclusion is valid only if true in every possible diagram.

Seating arrangement: fix the most constrained person first, then place others relative to that position.

Data interpretation: read the axis units carefully, compute totals and percentages before comparing categories.

Number system: divisibility by 3 and 9 by digit sum, by 4 by last two digits, by 8 by last three digits, by 11 by alternating digit sum.