HSSC Staff Nurse cheat sheet

Normal adult vital signs: temperature 36.5–37.5 °C oral, pulse 60–100/min, respiration 12–20/min, blood pressure 120/80 mmHg, SpO2 95–100%.

Body temperature sites ranked by value: rectal is 0.5 °C higher than oral; axillary is 0.5 °C lower than oral; core temperature is best reflected by rectal, tympanic, or pulmonary artery readings.

Pulse deficit = apical rate minus radial rate; it is counted by two nurses simultaneously for a full 60 seconds and is significant in atrial fibrillation.

Stages of pressure ulcer (NPIAP): 1 = non-blanchable erythema of intact skin; 2 = partial-thickness loss with dermis exposed; 3 = full-thickness loss with fat visible; 4 = full-thickness loss with fascia, muscle, or bone exposed; unstageable = slough or eschar obscuring the bed.

Wound healing phases: haemostasis (0–several hours), inflammatory (days 1–4), proliferative (day 4 to ~3 weeks), maturation/remodelling (up to 1–2 years).

Intramuscular injection sites and maximum volumes: deltoid 1 mL, ventrogluteal 3 mL (site of choice for adults), dorsogluteal 4 mL but avoided due to sciatic nerve risk; the Z-track method seals irritant medication in the muscle.

Isolation precautions: standard precautions for all patients; contact for MRSA, C. difficile, scabies; droplet for influenza, pertussis, meningococcus; airborne with N95 for tuberculosis, measles, varicella.

The nursing process runs Assessment → Diagnosis → Planning → Implementation → Evaluation (ADPIE); the diagnosis statement has three parts: problem, aetiology (related to), and defining characteristics (as evidenced by).

Normal adult urine output is 0.5–1 mL/kg/hour (about 30 mL/hour); output below 30 mL/hour or below 400 mL/day suggests oliguria and must be reported.

Myocardial infarction: ST-elevation MI requires reperfusion (primary PCI within 90 minutes of first medical contact); MONA-B sequence - morphine, oxygen only if SpO2 <90%, nitroglycerin, aspirin 300 mg chewed, beta-blocker.

Left-sided heart failure produces pulmonary congestion (dyspnoea, orthopnoea, pink frothy sputum, crackles); right-sided failure produces systemic congestion (raised JVP, hepatomegaly, peripheral oedema).

Digoxin therapeutic range 0.5–2 ng/mL; early toxicity signs are anorexia, nausea, and visual halos (yellow-green); hypokalaemia potentiates toxicity, so check potassium before each dose and hold if apical pulse <60/min.

Diabetic ketoacidosis: blood glucose usually >250 mg/dL, pH <7.3, bicarbonate <18 mEq/L, ketonaemia, anion gap >12; treatment is isotonic saline first, then insulin infusion, with potassium replacement once K+ <5.5 mEq/L.

Hypoglycaemia is glucose <70 mg/dL; give 15–20 g fast carbohydrate orally if conscious, or 25 g (50 mL of 50%) dextrose IV if unconscious, then recheck in 15 minutes.

Stroke: thrombolysis with alteplase is licensed up to 4.5 hours from symptom onset; blood pressure must be <185/110 mmHg before giving it; do not give aspirin within 24 hours of thrombolysis.

Chronic obstructive pulmonary disease: controlled oxygen to target SpO2 88–92% in those at risk of hypercapnia; theophylline, anticholinergics, and inhaled corticosteroids are standard; pursed-lip breathing prolongs expiration.

Cirrhosis with ascites: paracentesis of more than 5 L requires albumin replacement (6–8 g per litre removed) to prevent circulatory dysfunction; lactulose titrated to 2–3 soft stools daily treats hepatic encephalopathy.

Acute pancreatitis diagnosis needs two of three: characteristic epigastric pain radiating to the back, serum amylase or lipase >3 times the upper limit, and imaging findings; lipase is more specific than amylase.

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

Levels of prevention: primordial (risk-factor avoidance in the whole population), primary (immunisation, health education before disease), secondary (screening, early diagnosis, treatment), tertiary (rehabilitation, disability limitation).

Incidence = new cases in a period ÷ population at risk × 1000; prevalence = all existing cases at a point ÷ total population × 1000; prevalence rises with longer disease duration and better survival.

Epidemiological measures: attack rate = cases ÷ exposed × 100; case fatality rate = deaths ÷ diagnosed cases × 100; infant mortality rate = infant deaths under 1 year ÷ live births × 1000.

Herd immunity threshold = 1 − 1/R0; for measles (R0 ≈ 12–18) this requires about 92–95% two-dose coverage to interrupt transmission.

India's cold chain: vaccines are stored at +2 to +8 °C in the ILR; OPV is kept frozen at −20 °C; the vaccine vial monitor changes from square to circle as heat exposure accumulates, and discard the vial at the discard point.

National Health Mission programmes include JSY (cash incentive for institutional delivery), JSSK (free delivery and newborn care), RBSK (child screening 0–18 years), and NPCDCS for non-communicable diseases.

Sub-centre staffing norm is one ANM (plus a second where deliveries are conducted) for 3,000–5,000 population in plains and 3,000 in hilly or tribal areas; a PHC serves 20,000–30,000 rural population.

Water purification: chlorine demand is the difference between chlorine dose and residual chlorine; the Horrocks apparatus tests bleaching powder strength, and 0.5 ppm free residual chlorine after 1 hour contact is the target.

Naegele's rule: estimated date of delivery = first day of last menstrual period + 7 days − 3 months + 1 year (or + 9 months), assuming a 28-day cycle.

Normal labour stages: first stage from onset to full 10 cm dilatation; second stage from full dilatation to delivery (up to 2 hours in primigravida, 1 hour in multigravida); third stage from delivery of the baby to expulsion of the placenta (usually under 30 minutes); fourth stage is the first 1–2 hours postpartum.

Partograph action line is 4 hours to the right of the alert line; plotting cervical dilatation crossing the action line mandates intervention. In the WHO simplified partograph, dilatation of 1 cm/hour is the reference.

Postpartum haemorrhage: >500 mL after vaginal birth or >1000 mL after caesarean; causes are the 4 Ts - Tone (atony, 70–80%), Trauma, Tissue, Thrombin; first-line drug is oxytocin 10 IU IM, then carboprost or misoprostol.

Pre-eclampsia is blood pressure ≥140/90 mmHg on two occasions 4 hours apart with proteinuria ≥300 mg/24 h or organ dysfunction after 20 weeks; magnesium sulphate 4 g IV loading then 1 g/hour prevents and treats eclampsia, with respiratory rate, reflexes, and urine output monitored hourly.

Antepartum haemorrhage: placenta praevia gives painless bright bleeding with a soft uterus - no vaginal examination; abruptio placentae gives painful dark bleeding with a hard, tender uterus.

Fetal heart rate baseline 110–160/min; late decelerations indicate uteroplacental insufficiency, variable decelerations indicate cord compression, and early decelerations are benign head compression.

Contraception effectiveness: copper IUCD lasts 10 years and works mainly by spermicidal action; levonorgestrel intrauterine systems last 3–5 years; combined oral pills are taken for 21 days with a 7-day break and are contraindicated in smokers over 35.

Puerperium lasts 6 weeks; lochia rubra lasts 1–4 days, serosa 4–10 days, alba up to 6 weeks; a return to red lochia after it has faded suggests retained products or infection.

Normal newborn: weight 2.5–4 kg, length 50 cm, head circumference 33–35 cm (about 2 cm larger than chest), respiratory rate 30–60/min, heart rate 120–160/min.

Weight milestones: birth weight doubles by 4–5 months, triples by 12 months, and quadruples by 2 years; expected weight at 1 year is about 10 kg.

APGAR is scored at 1 and 5 minutes on five items (appearance, pulse, grimace, activity, respiration) each 0–2; 7–10 is normal, 4–6 needs stimulation, 0–3 needs immediate resuscitation.

Neonatal jaundice appearing within 24 hours is always pathological; physiological jaundice appears after 24 hours and peaks on day 3–5, treated with phototherapy, with eyes shielded and insensible water loss monitored.

Infant feeding: exclusive breastfeeding for the first 6 months, complementary feeding from 6 months, continued breastfeeding to 2 years; colostrum is rich in IgA and should not be discarded.

Dehydration in children: 5% loss is mild, 10% moderate, 15% severe; WHO Plan A treats no dehydration at home, Plan B uses ORS 75 mL/kg over 4 hours for some dehydration, Plan C uses IV Ringer's lactate 100 mL/kg for severe dehydration.

Paediatric drug doses are calculated by weight (mg/kg); Young's rule is age ÷ (age + 12) × adult dose, and Clark's rule is weight in lb ÷ 150 × adult dose.

Kangaroo mother care: skin-to-skin contact for at least 8 hours a day for low-birth-weight babies, with exclusive breastfeeding and early discharge; it reduces hypothermia and mortality.

Nephrotic syndrome in children shows the classic tetrad of proteinuria, hypoalbuminaemia, oedema, and hyperlipidaemia, with the first-line treatment being prednisolone 2 mg/kg/day for 6 weeks.

Therapeutic communication techniques: open-ended questioning, reflecting, restating, clarifying, silence, and offering self; non-therapeutic techniques include giving advice, false reassurance, and asking 'why' questions.

Nurse–patient relationship phases: orientation (establishing trust), working (problem-solving), and termination (summarising gains and preparing for separation).

Schizophrenia: positive symptoms are delusions, hallucinations, and disorganised speech; negative symptoms are flat affect, alogia, avolition, and anhedonia; first-line drugs are second-generation antipsychotics.

Extrapyramidal side effects: acute dystonia appears within hours (treat with anticholinergics such as promethazine or benzhexol), akathisia in days to weeks, parkinsonism in weeks, and tardive dyskinesia after months to years.

Neuroleptic malignant syndrome is a triad of rigidity, hyperthermia above 38 °C, and autonomic instability with raised creatine kinase; stop the antipsychotic, give dantrolene or bromocriptine, and cool the patient.

Depression: first-line drugs are SSRIs with a 2–4 week lag to effect; the risk of suicide may rise early in treatment as energy returns before mood lifts, so close monitoring is essential.

Mania in bipolar disorder is treated with lithium or valproate; lithium has a narrow therapeutic range of 0.6–1.2 mEq/L, and toxicity causes tremor, vomiting, ataxia, and seizures; monitor levels and sodium intake.

Alcohol withdrawal: symptoms begin 6–24 hours after the last drink, peak at 24–72 hours, and include tremor, sweating, and seizures; delirium tremens is treated with benzodiazepines (chlordiazepoxide or lorazepam) and thiamine to prevent Wernicke's encephalopathy.

Mental health law in India: the Mental Healthcare Act 2017 decriminalises attempted suicide, mandates advance directives, and requires insurance parity for mental illness; the National Mental Health Programme launched in 1982.

Adult human skeleton has 206 bones; the axial skeleton has 80 and the appendicular 126; an infant has about 270 bones that fuse during growth.

Blood components: haemoglobin 13–17 g/dL in men and 12–15 g/dL in women; normal WBC count 4,000–11,000/mm³; platelets 150,000–450,000/mm³; red cells survive about 120 days.

Cardiac output = heart rate × stroke volume, normally about 5 L/min; the cardiac cycle has systole (0.3 s) and diastole (0.5 s) at 72 beats per minute.

Respiratory physiology: tidal volume 500 mL, vital capacity about 4,800 mL in men, residual volume 1,200 mL; anatomical dead space is about 150 mL.

The nephron's functional unit filters about 125 mL/min (GFR); the loop of Henle's descending limb is permeable to water and the ascending limb is impermeable but pumps sodium chloride, creating the medullary gradient.

Cranial nerves: I olfactory, II optic, III oculomotor, IV trochlear, V trigeminal, VI abducens, VII facial, VIII vestibulocochlear, IX glossopharyngeal, X vagus, XI accessory, XII hypoglossal.

Gram-positive bacteria retain crystal violet and stain purple due to a thick peptidoglycan wall; Gram-negative organisms have a thin wall and an outer membrane with lipopolysaccharide endotoxin, and stain pink with safranin.

Sterilisation: autoclave at 121 °C and 15 psi for 15–20 minutes kills spores; hot-air oven at 160 °C for 2 hours for glassware; 70% alcohol is a disinfectant, not a sterilant.

Hepatitis B is a DNA virus transmitted by blood and body fluids; HIV is an RNA retrovirus targeting CD4 T-helper cells; both are confirmed by ELISA and Western blot or nucleic acid testing.

Drug routes and onset: IV is fastest with 100% bioavailability; oral drugs face first-pass hepatic metabolism; sublingual nitroglycerin bypasses first-pass metabolism.

Therapeutic index = toxic dose ÷ therapeutic dose; drugs with a narrow index (digoxin, lithium, warfarin, phenytoin, aminoglycosides) need serum monitoring.

Half-life is the time for plasma concentration to fall by half; a drug reaches steady state after about 4–5 half-lives, and loading doses are given to reach therapeutic levels sooner.

Adrenaline is the first-line drug for anaphylaxis: 0.5 mg (0.5 mL of 1:1000) IM into the anterolateral thigh, repeated every 5 minutes; antihistamines and steroids are adjuncts only.

Antibiotic mechanisms: penicillins and cephalosporins inhibit cell-wall synthesis; aminoglycosides and tetracyclines inhibit protein synthesis at the ribosome; fluoroquinolones inhibit DNA gyrase; sulphonamides block folate synthesis.

Atropine is contraindicated in narrow-angle glaucoma and prostatic enlargement; it causes dry mouth, mydriasis, tachycardia, and urinary retention as normal anticholinergic effects.

Warfarin inhibits vitamin K-dependent clotting factors II, VII, IX, and X; monitor INR with a target of 2–3, and give vitamin K as the antidote for over-anticoagulation.

Basal metabolic rate is about 1 kcal/kg/hour; energy yield is 4 kcal/g for carbohydrate and protein and 9 kcal/g for fat; a mixed Indian diet provides about 60–70% of energy from carbohydrate.

Protein-energy malnutrition: marasmus is severe wasting without oedema; kwashiorkor shows oedema, moon face, and flaky-paint dermatosis with low serum albumin; both are managed by WHO therapeutic food (F-75 then F-100).

Domains of learning: cognitive (knowledge - Bloom's levels remember, understand, apply, analyse, evaluate, create), affective (attitudes, Krathwohl's hierarchy), and psychomotor (skills, from imitation to naturalisation).

Lesson plan structure: specific objectives, previous knowledge testing, introduction, presentation, recapitulation, evaluation, and assignment; the Herbartian five steps are preparation, presentation, comparison, generalisation, and application.

Teaching methods: lecture is economical for large groups but passive; demonstration suits psychomotor skills; case study and role play develop problem-solving; clinical teaching uses the preceptor or mentorship model.

Principles of management (Fayol): planning, organising, commanding, coordinating, and controlling; POSDCORB (Gulick) adds staffing, directing, reporting, and budgeting.

Span of control is the number of subordinates one manager can supervise effectively; a tall hierarchy has narrow spans with many levels, a flat one has wide spans with few levels.

Nursing research steps: identify the problem, review literature, state hypothesis, choose design, select sample, collect data, analyse, and disseminate; a hypothesis is a testable statement of relationship between variables.

Study designs: randomised controlled trial is best for causation; cohort studies measure incidence and relative risk; case-control studies measure odds ratio and suit rare diseases; cross-sectional studies measure prevalence.

Levels of evidence (highest to lowest): systematic review of RCTs, RCT, cohort, case-control, cross-sectional, case report, expert opinion.

Informed consent requires disclosure, comprehension, voluntariness, and competence; the Institutional Ethics Committee approves research involving human participants, and confidentiality and anonymity must be protected.

Haryana was carved out of Punjab on 1 November 1966 on the recommendation of the Shah Commission (Parliamentary Committee on the Reorganisation of Punjab), with Chandigarh as the shared capital.

Haryana has 22 districts; the state animal is the blackbuck, the state bird the black francolin, the state tree the peepal, and the state flower the lotus.

Haryana's literacy rate was 75.55% in the 2011 census (male 84.06%, female 65.94%), and its sex ratio was 879 females per 1,000 males.

Major rivers: Yamuna forms the eastern boundary, the Ghaggar drains the north-west (often called the Sarsuti), and the Markanda and Sahibi are seasonal streams; the Western Yamuna Canal and Gurgaon Canal are major irrigation channels.

Kurukshetra, called the land of the Mahabharata, hosts the Brahma Sarovar and Jyotisar; the Gita Jayanti fair is held there in November–December.

Major industries: Maruti Suzuki at Manesar and Gurugram, Hero MotoCorp at Gurugram and Dharuhera, and Faridabad's engineering and tractor units; Haryana is a leading producer of basmati rice and mustard.

Haryana's first Chief Minister was Bhagwat Dayal Sharma; the state legislature has 90 Assembly seats and 10 Lok Sabha seats, plus 5 Rajya Sabha seats.

Haryana Day is celebrated on 1 November; the Surajkund International Crafts Mela is held at Faridabad in February; Pinjore Gardens in Panchkula is a Mughal-style garden laid out by Fidai Khan.

Haryana's soil and climate: the south-west is semi-arid with sandy soil, the north-east is fertile alluvial plain; the state has no perennial river of its own apart from the Yamuna.

Average = sum of values ÷ number of values; if a group of n items has average A and one item x is replaced by y, the new average is A + (y − x)/n.

Percentage change = (new − old) ÷ old × 100; successive changes of a% and b% give a net change of a + b + ab/100 percent.

Simple interest = P × R × T ÷ 100; compound interest = P(1 + R/100)^T − P; for two years the difference between CI and SI is P(R/100)².

Speed = distance ÷ time; to convert km/h to m/s multiply by 5/18; for equal distances at speeds a and b, average speed = 2ab/(a + b).

Work: if A finishes in x days and B in y days, together they take xy/(x + y) days; if A is twice as efficient as B, A takes half the time of B.

Ratio and proportion: if a:b = c:d then ad = bc; to divide amount N in ratio a:b:c, the shares are N × a/(a+b+c), and so on.

Permutation and combination: nPr = n!/(n−r)!; nCr = n!/[r!(n−r)!]; the number of diagonals of an n-sided polygon is n(n−3)/2.

Series and coding: in an alphabet series, A = 1, B = 2 … Z = 26, and the reverse value is 27 minus the forward value; for odd-one-out questions, check squares, cubes, and prime patterns first.

Probability of an event = favourable outcomes ÷ total outcomes; for independent events P(A and B) = P(A) × P(B), and P(A or B) = P(A) + P(B) − P(A and B).

Subject–verb agreement: a singular subject takes a singular verb; with 'either…or' and 'neither…nor' the verb agrees with the nearer subject; collective nouns take a singular verb when acting as a unit.

Common error patterns: 'one of the boys is' (singular verb), 'each of the students has' (singular), 'the number of' takes a singular verb while 'a number of' takes a plural verb.

Active to passive: move the object to subject position, use the correct form of 'be' plus the past participle, and add 'by' plus the agent; tense and number must be preserved.

Direct to indirect speech: change the reporting verb to 'said that', shift tense back one step, change pronouns to the third person, and adjust time and place words (now → then, today → that day).

Idioms: 'a blessing in disguise' means an apparent misfortune that turns out well; 'to burn the midnight oil' means to study or work late; 'once in a blue moon' means very rarely.

Computer basics: 1 byte = 8 bits, 1 KB = 1024 bytes, 1 MB = 1024 KB, 1 GB = 1024 MB; ROM is non-volatile, RAM is volatile and loses data on power-off.

Input devices include keyboard, mouse, scanner, and microphone; output devices include monitor, printer, and speaker; both are peripherals connected to the CPU via the motherboard.

MS Word shortcuts: Ctrl+C copy, Ctrl+V paste, Ctrl+X cut, Ctrl+Z undo, Ctrl+Y redo, Ctrl+S save, Ctrl+P print, Ctrl+F find; in Excel, Ctrl+arrow moves to the edge of data.

Network and internet: IP addresses identify devices, HTTP/HTTPS transfer web pages, email uses SMTP to send and POP3 or IMAP to receive, and a firewall filters incoming and outgoing traffic.

Normal adult vital signs: temperature 36.5–37.5 °C oral, pulse 60–100/min, respiration 12–20/min, blood pressure 120/80 mmHg, SpO2 95–100%.

Body temperature sites ranked by value: rectal is 0.5 °C higher than oral; axillary is 0.5 °C lower than oral; core temperature is best reflected by rectal, tympanic, or pulmonary artery readings.

Pulse deficit = apical rate minus radial rate; it is counted by two nurses simultaneously for a full 60 seconds and is significant in atrial fibrillation.

Stages of pressure ulcer (NPIAP): 1 = non-blanchable erythema of intact skin; 2 = partial-thickness loss with dermis exposed; 3 = full-thickness loss with fat visible; 4 = full-thickness loss with fascia, muscle, or bone exposed; unstageable = slough or eschar obscuring the bed.

Wound healing phases: haemostasis (0–several hours), inflammatory (days 1–4), proliferative (day 4 to ~3 weeks), maturation/remodelling (up to 1–2 years).

Intramuscular injection sites and maximum volumes: deltoid 1 mL, ventrogluteal 3 mL (site of choice for adults), dorsogluteal 4 mL but avoided due to sciatic nerve risk; the Z-track method seals irritant medication in the muscle.

Isolation precautions: standard precautions for all patients; contact for MRSA, C. difficile, scabies; droplet for influenza, pertussis, meningococcus; airborne with N95 for tuberculosis, measles, varicella.

The nursing process runs Assessment → Diagnosis → Planning → Implementation → Evaluation (ADPIE); the diagnosis statement has three parts: problem, aetiology (related to), and defining characteristics (as evidenced by).

Normal adult urine output is 0.5–1 mL/kg/hour (about 30 mL/hour); output below 30 mL/hour or below 400 mL/day suggests oliguria and must be reported.

Myocardial infarction: ST-elevation MI requires reperfusion (primary PCI within 90 minutes of first medical contact); MONA-B sequence - morphine, oxygen only if SpO2 <90%, nitroglycerin, aspirin 300 mg chewed, beta-blocker.

Left-sided heart failure produces pulmonary congestion (dyspnoea, orthopnoea, pink frothy sputum, crackles); right-sided failure produces systemic congestion (raised JVP, hepatomegaly, peripheral oedema).

Digoxin therapeutic range 0.5–2 ng/mL; early toxicity signs are anorexia, nausea, and visual halos (yellow-green); hypokalaemia potentiates toxicity, so check potassium before each dose and hold if apical pulse <60/min.

Diabetic ketoacidosis: blood glucose usually >250 mg/dL, pH <7.3, bicarbonate <18 mEq/L, ketonaemia, anion gap >12; treatment is isotonic saline first, then insulin infusion, with potassium replacement once K+ <5.5 mEq/L.

Hypoglycaemia is glucose <70 mg/dL; give 15–20 g fast carbohydrate orally if conscious, or 25 g (50 mL of 50%) dextrose IV if unconscious, then recheck in 15 minutes.

Stroke: thrombolysis with alteplase is licensed up to 4.5 hours from symptom onset; blood pressure must be <185/110 mmHg before giving it; do not give aspirin within 24 hours of thrombolysis.

Chronic obstructive pulmonary disease: controlled oxygen to target SpO2 88–92% in those at risk of hypercapnia; theophylline, anticholinergics, and inhaled corticosteroids are standard; pursed-lip breathing prolongs expiration.

Cirrhosis with ascites: paracentesis of more than 5 L requires albumin replacement (6–8 g per litre removed) to prevent circulatory dysfunction; lactulose titrated to 2–3 soft stools daily treats hepatic encephalopathy.

Acute pancreatitis diagnosis needs two of three: characteristic epigastric pain radiating to the back, serum amylase or lipase >3 times the upper limit, and imaging findings; lipase is more specific than amylase.

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

Levels of prevention: primordial (risk-factor avoidance in the whole population), primary (immunisation, health education before disease), secondary (screening, early diagnosis, treatment), tertiary (rehabilitation, disability limitation).

Incidence = new cases in a period ÷ population at risk × 1000; prevalence = all existing cases at a point ÷ total population × 1000; prevalence rises with longer disease duration and better survival.

Epidemiological measures: attack rate = cases ÷ exposed × 100; case fatality rate = deaths ÷ diagnosed cases × 100; infant mortality rate = infant deaths under 1 year ÷ live births × 1000.

Herd immunity threshold = 1 − 1/R0; for measles (R0 ≈ 12–18) this requires about 92–95% two-dose coverage to interrupt transmission.

India's cold chain: vaccines are stored at +2 to +8 °C in the ILR; OPV is kept frozen at −20 °C; the vaccine vial monitor changes from square to circle as heat exposure accumulates, and discard the vial at the discard point.

National Health Mission programmes include JSY (cash incentive for institutional delivery), JSSK (free delivery and newborn care), RBSK (child screening 0–18 years), and NPCDCS for non-communicable diseases.

Sub-centre staffing norm is one ANM (plus a second where deliveries are conducted) for 3,000–5,000 population in plains and 3,000 in hilly or tribal areas; a PHC serves 20,000–30,000 rural population.

Water purification: chlorine demand is the difference between chlorine dose and residual chlorine; the Horrocks apparatus tests bleaching powder strength, and 0.5 ppm free residual chlorine after 1 hour contact is the target.

Naegele's rule: estimated date of delivery = first day of last menstrual period + 7 days − 3 months + 1 year (or + 9 months), assuming a 28-day cycle.

Normal labour stages: first stage from onset to full 10 cm dilatation; second stage from full dilatation to delivery (up to 2 hours in primigravida, 1 hour in multigravida); third stage from delivery of the baby to expulsion of the placenta (usually under 30 minutes); fourth stage is the first 1–2 hours postpartum.

Partograph action line is 4 hours to the right of the alert line; plotting cervical dilatation crossing the action line mandates intervention. In the WHO simplified partograph, dilatation of 1 cm/hour is the reference.

Postpartum haemorrhage: >500 mL after vaginal birth or >1000 mL after caesarean; causes are the 4 Ts - Tone (atony, 70–80%), Trauma, Tissue, Thrombin; first-line drug is oxytocin 10 IU IM, then carboprost or misoprostol.

Pre-eclampsia is blood pressure ≥140/90 mmHg on two occasions 4 hours apart with proteinuria ≥300 mg/24 h or organ dysfunction after 20 weeks; magnesium sulphate 4 g IV loading then 1 g/hour prevents and treats eclampsia, with respiratory rate, reflexes, and urine output monitored hourly.

Antepartum haemorrhage: placenta praevia gives painless bright bleeding with a soft uterus - no vaginal examination; abruptio placentae gives painful dark bleeding with a hard, tender uterus.

Fetal heart rate baseline 110–160/min; late decelerations indicate uteroplacental insufficiency, variable decelerations indicate cord compression, and early decelerations are benign head compression.

Contraception effectiveness: copper IUCD lasts 10 years and works mainly by spermicidal action; levonorgestrel intrauterine systems last 3–5 years; combined oral pills are taken for 21 days with a 7-day break and are contraindicated in smokers over 35.

Puerperium lasts 6 weeks; lochia rubra lasts 1–4 days, serosa 4–10 days, alba up to 6 weeks; a return to red lochia after it has faded suggests retained products or infection.

Normal newborn: weight 2.5–4 kg, length 50 cm, head circumference 33–35 cm (about 2 cm larger than chest), respiratory rate 30–60/min, heart rate 120–160/min.

Weight milestones: birth weight doubles by 4–5 months, triples by 12 months, and quadruples by 2 years; expected weight at 1 year is about 10 kg.

APGAR is scored at 1 and 5 minutes on five items (appearance, pulse, grimace, activity, respiration) each 0–2; 7–10 is normal, 4–6 needs stimulation, 0–3 needs immediate resuscitation.

Neonatal jaundice appearing within 24 hours is always pathological; physiological jaundice appears after 24 hours and peaks on day 3–5, treated with phototherapy, with eyes shielded and insensible water loss monitored.

Infant feeding: exclusive breastfeeding for the first 6 months, complementary feeding from 6 months, continued breastfeeding to 2 years; colostrum is rich in IgA and should not be discarded.

Dehydration in children: 5% loss is mild, 10% moderate, 15% severe; WHO Plan A treats no dehydration at home, Plan B uses ORS 75 mL/kg over 4 hours for some dehydration, Plan C uses IV Ringer's lactate 100 mL/kg for severe dehydration.

Paediatric drug doses are calculated by weight (mg/kg); Young's rule is age ÷ (age + 12) × adult dose, and Clark's rule is weight in lb ÷ 150 × adult dose.

Kangaroo mother care: skin-to-skin contact for at least 8 hours a day for low-birth-weight babies, with exclusive breastfeeding and early discharge; it reduces hypothermia and mortality.

Nephrotic syndrome in children shows the classic tetrad of proteinuria, hypoalbuminaemia, oedema, and hyperlipidaemia, with the first-line treatment being prednisolone 2 mg/kg/day for 6 weeks.

Therapeutic communication techniques: open-ended questioning, reflecting, restating, clarifying, silence, and offering self; non-therapeutic techniques include giving advice, false reassurance, and asking 'why' questions.

Nurse–patient relationship phases: orientation (establishing trust), working (problem-solving), and termination (summarising gains and preparing for separation).

Schizophrenia: positive symptoms are delusions, hallucinations, and disorganised speech; negative symptoms are flat affect, alogia, avolition, and anhedonia; first-line drugs are second-generation antipsychotics.

Extrapyramidal side effects: acute dystonia appears within hours (treat with anticholinergics such as promethazine or benzhexol), akathisia in days to weeks, parkinsonism in weeks, and tardive dyskinesia after months to years.

Neuroleptic malignant syndrome is a triad of rigidity, hyperthermia above 38 °C, and autonomic instability with raised creatine kinase; stop the antipsychotic, give dantrolene or bromocriptine, and cool the patient.

Depression: first-line drugs are SSRIs with a 2–4 week lag to effect; the risk of suicide may rise early in treatment as energy returns before mood lifts, so close monitoring is essential.

Mania in bipolar disorder is treated with lithium or valproate; lithium has a narrow therapeutic range of 0.6–1.2 mEq/L, and toxicity causes tremor, vomiting, ataxia, and seizures; monitor levels and sodium intake.

Alcohol withdrawal: symptoms begin 6–24 hours after the last drink, peak at 24–72 hours, and include tremor, sweating, and seizures; delirium tremens is treated with benzodiazepines (chlordiazepoxide or lorazepam) and thiamine to prevent Wernicke's encephalopathy.

Mental health law in India: the Mental Healthcare Act 2017 decriminalises attempted suicide, mandates advance directives, and requires insurance parity for mental illness; the National Mental Health Programme launched in 1982.

Adult human skeleton has 206 bones; the axial skeleton has 80 and the appendicular 126; an infant has about 270 bones that fuse during growth.

Blood components: haemoglobin 13–17 g/dL in men and 12–15 g/dL in women; normal WBC count 4,000–11,000/mm³; platelets 150,000–450,000/mm³; red cells survive about 120 days.

Cardiac output = heart rate × stroke volume, normally about 5 L/min; the cardiac cycle has systole (0.3 s) and diastole (0.5 s) at 72 beats per minute.

Respiratory physiology: tidal volume 500 mL, vital capacity about 4,800 mL in men, residual volume 1,200 mL; anatomical dead space is about 150 mL.

The nephron's functional unit filters about 125 mL/min (GFR); the loop of Henle's descending limb is permeable to water and the ascending limb is impermeable but pumps sodium chloride, creating the medullary gradient.

Cranial nerves: I olfactory, II optic, III oculomotor, IV trochlear, V trigeminal, VI abducens, VII facial, VIII vestibulocochlear, IX glossopharyngeal, X vagus, XI accessory, XII hypoglossal.

Gram-positive bacteria retain crystal violet and stain purple due to a thick peptidoglycan wall; Gram-negative organisms have a thin wall and an outer membrane with lipopolysaccharide endotoxin, and stain pink with safranin.

Sterilisation: autoclave at 121 °C and 15 psi for 15–20 minutes kills spores; hot-air oven at 160 °C for 2 hours for glassware; 70% alcohol is a disinfectant, not a sterilant.

Hepatitis B is a DNA virus transmitted by blood and body fluids; HIV is an RNA retrovirus targeting CD4 T-helper cells; both are confirmed by ELISA and Western blot or nucleic acid testing.

Drug routes and onset: IV is fastest with 100% bioavailability; oral drugs face first-pass hepatic metabolism; sublingual nitroglycerin bypasses first-pass metabolism.

Therapeutic index = toxic dose ÷ therapeutic dose; drugs with a narrow index (digoxin, lithium, warfarin, phenytoin, aminoglycosides) need serum monitoring.

Half-life is the time for plasma concentration to fall by half; a drug reaches steady state after about 4–5 half-lives, and loading doses are given to reach therapeutic levels sooner.

Adrenaline is the first-line drug for anaphylaxis: 0.5 mg (0.5 mL of 1:1000) IM into the anterolateral thigh, repeated every 5 minutes; antihistamines and steroids are adjuncts only.

Antibiotic mechanisms: penicillins and cephalosporins inhibit cell-wall synthesis; aminoglycosides and tetracyclines inhibit protein synthesis at the ribosome; fluoroquinolones inhibit DNA gyrase; sulphonamides block folate synthesis.

Atropine is contraindicated in narrow-angle glaucoma and prostatic enlargement; it causes dry mouth, mydriasis, tachycardia, and urinary retention as normal anticholinergic effects.

Warfarin inhibits vitamin K-dependent clotting factors II, VII, IX, and X; monitor INR with a target of 2–3, and give vitamin K as the antidote for over-anticoagulation.

Basal metabolic rate is about 1 kcal/kg/hour; energy yield is 4 kcal/g for carbohydrate and protein and 9 kcal/g for fat; a mixed Indian diet provides about 60–70% of energy from carbohydrate.

Protein-energy malnutrition: marasmus is severe wasting without oedema; kwashiorkor shows oedema, moon face, and flaky-paint dermatosis with low serum albumin; both are managed by WHO therapeutic food (F-75 then F-100).

Domains of learning: cognitive (knowledge - Bloom's levels remember, understand, apply, analyse, evaluate, create), affective (attitudes, Krathwohl's hierarchy), and psychomotor (skills, from imitation to naturalisation).

Lesson plan structure: specific objectives, previous knowledge testing, introduction, presentation, recapitulation, evaluation, and assignment; the Herbartian five steps are preparation, presentation, comparison, generalisation, and application.

Teaching methods: lecture is economical for large groups but passive; demonstration suits psychomotor skills; case study and role play develop problem-solving; clinical teaching uses the preceptor or mentorship model.

Principles of management (Fayol): planning, organising, commanding, coordinating, and controlling; POSDCORB (Gulick) adds staffing, directing, reporting, and budgeting.

Span of control is the number of subordinates one manager can supervise effectively; a tall hierarchy has narrow spans with many levels, a flat one has wide spans with few levels.

Nursing research steps: identify the problem, review literature, state hypothesis, choose design, select sample, collect data, analyse, and disseminate; a hypothesis is a testable statement of relationship between variables.

Study designs: randomised controlled trial is best for causation; cohort studies measure incidence and relative risk; case-control studies measure odds ratio and suit rare diseases; cross-sectional studies measure prevalence.

Levels of evidence (highest to lowest): systematic review of RCTs, RCT, cohort, case-control, cross-sectional, case report, expert opinion.

Informed consent requires disclosure, comprehension, voluntariness, and competence; the Institutional Ethics Committee approves research involving human participants, and confidentiality and anonymity must be protected.

Haryana was carved out of Punjab on 1 November 1966 on the recommendation of the Shah Commission (Parliamentary Committee on the Reorganisation of Punjab), with Chandigarh as the shared capital.

Haryana has 22 districts; the state animal is the blackbuck, the state bird the black francolin, the state tree the peepal, and the state flower the lotus.

Haryana's literacy rate was 75.55% in the 2011 census (male 84.06%, female 65.94%), and its sex ratio was 879 females per 1,000 males.

Major rivers: Yamuna forms the eastern boundary, the Ghaggar drains the north-west (often called the Sarsuti), and the Markanda and Sahibi are seasonal streams; the Western Yamuna Canal and Gurgaon Canal are major irrigation channels.

Kurukshetra, called the land of the Mahabharata, hosts the Brahma Sarovar and Jyotisar; the Gita Jayanti fair is held there in November–December.

Major industries: Maruti Suzuki at Manesar and Gurugram, Hero MotoCorp at Gurugram and Dharuhera, and Faridabad's engineering and tractor units; Haryana is a leading producer of basmati rice and mustard.

Haryana's first Chief Minister was Bhagwat Dayal Sharma; the state legislature has 90 Assembly seats and 10 Lok Sabha seats, plus 5 Rajya Sabha seats.

Haryana Day is celebrated on 1 November; the Surajkund International Crafts Mela is held at Faridabad in February; Pinjore Gardens in Panchkula is a Mughal-style garden laid out by Fidai Khan.

Haryana's soil and climate: the south-west is semi-arid with sandy soil, the north-east is fertile alluvial plain; the state has no perennial river of its own apart from the Yamuna.

Average = sum of values ÷ number of values; if a group of n items has average A and one item x is replaced by y, the new average is A + (y − x)/n.

Percentage change = (new − old) ÷ old × 100; successive changes of a% and b% give a net change of a + b + ab/100 percent.

Simple interest = P × R × T ÷ 100; compound interest = P(1 + R/100)^T − P; for two years the difference between CI and SI is P(R/100)².

Speed = distance ÷ time; to convert km/h to m/s multiply by 5/18; for equal distances at speeds a and b, average speed = 2ab/(a + b).

Work: if A finishes in x days and B in y days, together they take xy/(x + y) days; if A is twice as efficient as B, A takes half the time of B.

Ratio and proportion: if a:b = c:d then ad = bc; to divide amount N in ratio a:b:c, the shares are N × a/(a+b+c), and so on.

Permutation and combination: nPr = n!/(n−r)!; nCr = n!/[r!(n−r)!]; the number of diagonals of an n-sided polygon is n(n−3)/2.

Series and coding: in an alphabet series, A = 1, B = 2 … Z = 26, and the reverse value is 27 minus the forward value; for odd-one-out questions, check squares, cubes, and prime patterns first.

Probability of an event = favourable outcomes ÷ total outcomes; for independent events P(A and B) = P(A) × P(B), and P(A or B) = P(A) + P(B) − P(A and B).

Subject–verb agreement: a singular subject takes a singular verb; with 'either…or' and 'neither…nor' the verb agrees with the nearer subject; collective nouns take a singular verb when acting as a unit.

Common error patterns: 'one of the boys is' (singular verb), 'each of the students has' (singular), 'the number of' takes a singular verb while 'a number of' takes a plural verb.

Active to passive: move the object to subject position, use the correct form of 'be' plus the past participle, and add 'by' plus the agent; tense and number must be preserved.

Direct to indirect speech: change the reporting verb to 'said that', shift tense back one step, change pronouns to the third person, and adjust time and place words (now → then, today → that day).

Idioms: 'a blessing in disguise' means an apparent misfortune that turns out well; 'to burn the midnight oil' means to study or work late; 'once in a blue moon' means very rarely.

Computer basics: 1 byte = 8 bits, 1 KB = 1024 bytes, 1 MB = 1024 KB, 1 GB = 1024 MB; ROM is non-volatile, RAM is volatile and loses data on power-off.

Input devices include keyboard, mouse, scanner, and microphone; output devices include monitor, printer, and speaker; both are peripherals connected to the CPU via the motherboard.

MS Word shortcuts: Ctrl+C copy, Ctrl+V paste, Ctrl+X cut, Ctrl+Z undo, Ctrl+Y redo, Ctrl+S save, Ctrl+P print, Ctrl+F find; in Excel, Ctrl+arrow moves to the edge of data.

Network and internet: IP addresses identify devices, HTTP/HTTPS transfer web pages, email uses SMTP to send and POP3 or IMAP to receive, and a firewall filters incoming and outgoing traffic.