Maharashtra HSC Child, Old Age & Health Care (Vocational) cheat sheet

Developmental domains: gross motor, fine motor, language, cognitive, social-emotional; delay in one domain warrants screening across all.

Gross motor milestones: head control ~3 months, sitting without support ~6-8 months, walking independently ~12-15 months.

Fine motor/self-help sequence: palmar grasp ~5 months, pincer grasp ~9-10 months, scribbling ~15 months, cup drinking ~12-15 months.

Language milestones: cooing ~2 months, babbling ~6 months, first words ~12 months, two-word phrases ~18-24 months, ~50 words by 2 years.

Piaget stages: sensorimotor (0-2 y), preoperational (2-7 y), concrete operational (7-11 y), formal operational (11+ y).

Erikson early stages: trust vs mistrust (0-1 y), autonomy vs shame (1-3 y), initiative vs guilt (3-6 y), industry vs inferiority (6-12 y).

Red flags: no social smile by 3 months, no babbling by 9 months, no single words by 16 months, no two-word phrases by 24 months, loss of skills at any age.

Play is the main learning medium in early childhood; parallel play is typical at 2-3 years, cooperative play from ~4 years.

Under-5 danger signs needing urgent referral: inability to feed/drink, persistent vomiting, convulsions, lethargy/unconsciousness, chest indrawing, stridor at rest.

Dehydration grading (WHO): no dehydration - alert, drinks normally; some dehydration - restless, sunken eyes, drinks eagerly, skin pinch slow; severe - lethargic, unable to drink, very slow skin pinch.

ORS: low-osmolarity solution, given by spoon/syringe in small frequent amounts; zinc supplementation for 10-14 days is part of standard diarrhoea management.

Pneumonia in children: fast breathing thresholds are 60/min (<2 months), 50/min (2-12 months), 40/min (1-5 years).

Fever in infants under 3 months is a medical emergency regardless of how well the baby appears.

Measles: fever with rash, cough, coryza, conjunctivitis; vitamin A is given in measles to reduce complications.

Severe acute malnutrition indicators: weight-for-height below -3 SD, MUAC under 11.5 cm (6-59 months), or bilateral pitting oedema.

Immunisation schedule anchors (India/UIP): BCG-OPV-HepB at birth; pentavalent at 6, 10, 14 weeks; measles-rubella first dose 9-12 months; DPT and OPV boosters 16-24 months.

Normal ageing changes: reduced skin elasticity, decreased lean mass, reduced renal clearance, slower reaction time, diminished hearing for high frequencies, reduced near vision (presbyopia).

Falls are the leading cause of injury in older adults; screen for gait/balance problems, home hazards, sedative use, and postural hypotension.

Osteoporosis risk rises after menopause; weight-bearing exercise, adequate calcium and vitamin D, and fall prevention reduce fracture risk.

Polypharmacy is a major risk: review medication lists regularly, as altered renal/hepatic clearance increases adverse drug reactions.

Delirium vs dementia: delirium has acute onset, fluctuating attention and consciousness; dementia is chronic and progressive with preserved consciousness until late.

Pressure ulcer prevention: reposition at least every 2 hours, keep skin clean and dry, use pressure-relieving surfaces, screen nutrition.

Geriatric syndromes to screen: incontinence, falls, immobility, cognitive impairment, sensory loss, and malnutrition - often multifactorial.

Elder abuse warning signs: unexplained bruises, fear of a caregiver, sudden financial changes, withdrawal; caregivers have a legal and ethical duty to report.

Exclusive breastfeeding for the first 6 months; complementary feeding starts at 6 months while breastfeeding continues to 2 years or beyond.

First foods should be soft, energy-dense, and iron-rich; add one new food at a time to identify allergies.

Macronutrient energy values: carbohydrate 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g.

Protein-energy malnutrition forms: marasmus (severe wasting, no oedema) vs kwashiorkor (oedema, distended abdomen, hair/skin changes).

Adolescence has high iron and calcium needs due to growth spurt and (in girls) menstrual losses; iron absorption is enhanced by vitamin C and inhibited by tea/coffee with meals.

Pregnancy: extra calories are modest (about 300-350 kcal/day in the second and third trimesters); folic acid and iron are priority micronutrients.

Older adults need adequate protein, calcium, vitamin D, and fibre with sufficient fluids; reduced thirst and taste changes raise dehydration and malnutrition risk.

Iodised salt, iron-fortified staples, and vitamin A supplementation are common public health nutrition strategies in India.

DRABC sequence: Danger, Response, Airway, Breathing, Circulation - assess and act in that order.

Choking in a conscious adult/child: encourage coughing, then back blows and abdominal thrusts; for infants under 1 year use back blows and chest thrusts, not abdominal thrusts.

Severe bleeding: apply direct pressure with a clean dressing and elevate the limb if possible; do not remove soaked dressings, add layers on top.

Burns: cool with running water for at least 20 minutes, remove jewellery, cover with a clean non-stick dressing; never apply ice, butter, or toothpaste.

Recovery position for an unconscious but breathing casualty: on the side to keep the airway clear and prevent aspiration.

Poisoning: do not induce vomiting; keep the container and note the time and amount, then contact a poison information centre.

Fracture/suspected spinal injury: immobilise and do not move the casualty unless there is immediate danger.

Emergency numbers in India: 112 (all-in-one emergency), 108 (ambulance).

Hand hygiene: wet, apply soap, rub all surfaces for at least 20 seconds (palms, backs, between fingers, thumbs, fingertips, wrists), rinse, dry with a clean towel or air-dry.

Hands must be washed before food preparation, before and after caring for a sick person, after toilet use, after handling waste, and after coughing/sneezing.

Standard precautions apply to all patients regardless of diagnosis: hand hygiene, gloves when touching blood/body fluids, and safe sharps disposal.

Five moments for hand hygiene: before patient contact, before an aseptic task, after body-fluid exposure risk, after patient contact, after contact with patient surroundings.

Safe drinking water and sanitation: use boiled, filtered, or chlorinated water; store in a covered container; avoid open defecation to break faecal-oral transmission.

Food hygiene: separate raw and cooked food, cook thoroughly, keep food at safe temperatures, and use clean utensils and surfaces.

Personal hygiene practices: daily bathing, oral hygiene twice daily, regular nail trimming, and clean clothing reduce skin and respiratory infections.

Waste segregation: colour-coded bins - yellow (infectious), red (contaminated recyclables), white (sharps), and general waste separately.

Active listening: maintain eye contact, nod, paraphrase, and reflect feelings; avoid interrupting or finishing the client's sentences.

Open-ended questions invite fuller responses; closed questions are for confirming specific facts.

Informed consent requires capacity, adequate information, and voluntary agreement - obtained before any care procedure.

Confidentiality: share information only on a need-to-know basis; breaches include discussing a client's condition in public areas.

Professional boundaries: do not accept gifts that create obligation, do not use a client's belongings, and avoid personal relationships that compromise care.

Client rights: dignity, privacy, choice, safety, and the right to refuse care; respect cultural and religious preferences in caregiving.

Documentation: record observations objectively with time, date, and signature; avoid subjective judgments and never alter records after the fact.

Mandatory reporting: suspected abuse, neglect, or serious incidents must be reported to the appropriate authority, following organisational policy.

Common childhood illnesses include diarrhoea, acute respiratory infection, fever, measles, and malnutrition; early recognition and referral prevent complications.

Diarrhoea management: oral rehydration solution, continued feeding, zinc supplementation, and referral for severe dehydration or blood in stool.

Acute respiratory infection: count breaths for a full minute; fast breathing plus cough indicates pneumonia and requires prompt treatment.

Fever care: tepid sponging, light clothing, adequate fluids; antipyretics as prescribed - do not give aspirin to children.

Immunisation is the most cost-effective preventive measure; maintain cold chain and record all doses in the child's card.

Malnutrition screening: plot weight and height on growth charts; falling growth curve or crossing centiles needs nutritional assessment.

Prevention of childhood illness: handwashing, safe water, sanitation, exclusive breastfeeding, and complete immunisation.

When to refer urgently: convulsions, inability to feed, persistent vomiting, chest indrawing, lethargy, or severe dehydration.

Promote independence: encourage self-care, mobility aids when needed, and a safe home environment with grab bars and adequate lighting.

Nutrition in old age: small frequent meals, adequate protein, calcium, vitamin D, and fluids; screen for chewing and swallowing difficulty.

Skin care: inspect pressure areas daily, keep skin moisturised, and manage incontinence to prevent breakdown.

Mental health: screen for depression, anxiety, and social isolation; encourage social contact and meaningful activities.

Medication safety: use pill organisers, review prescriptions, and monitor for side effects; avoid self-medication.

Hydration: older adults have reduced thirst sensation; offer fluids regularly and monitor for confusion, dry mouth, and dark urine.

Exercise: gentle weight-bearing and balance exercises reduce fall risk and maintain function.

End-of-life care: respect advance directives, provide comfort and dignity, and support the family through the grieving process.

Balanced diet: include cereals, pulses, vegetables, fruits, milk products, and fats in appropriate proportions; use the food pyramid as a guide.

Meal planning principles: variety, moderation, balance, and consideration of age, activity, health status, and cultural preferences.

Child nutrition: energy-dense foods, iron-rich foods (green leafy vegetables, legumes), and vitamin C to enhance iron absorption.

Adolescent nutrition: address iron-deficiency anaemia, calcium for bone growth, and healthy snacking habits.

Pregnancy and lactation: increase protein, iron, folic acid, calcium, and fluids; avoid alcohol and tobacco.

Old age nutrition: soft, easily chewable foods, adequate fibre to prevent constipation, and sufficient protein to prevent sarcopenia.

Therapeutic diets: diabetic (low glycaemic index, controlled carbohydrate), renal (restricted protein, sodium, potassium), and cardiac (low fat, low salt).

Food safety in meal planning: wash hands and produce, cook thoroughly, refrigerate leftovers promptly, and avoid cross-contamination.

First aid aims to preserve life, prevent deterioration, and promote recovery - always assess scene safety before helping.

Primary survey: check responsiveness, open airway, check breathing, and circulation; call for help early.

CPR for adults: 30 chest compressions to 2 rescue breaths, compression depth 5-6 cm, rate 100-120 per minute.

CPR for children: 30:2 for one rescuer, 15:2 for two rescuers; for infants use two fingers or two thumbs for compressions.

Recovery position: for unconscious breathing casualties to maintain airway and prevent aspiration.

Burns: cool with running water for at least 20 minutes, cover with clean non-stick dressing, do not apply ice or ointments.

Choking: encourage coughing; back blows and abdominal thrusts for adults/children; back blows and chest thrusts for infants.

Emergency numbers in India: 112 for all emergencies, 108 for ambulance.

Hand hygiene is the single most effective way to prevent infection; wash with soap and water for at least 20 seconds or use alcohol-based hand rub.

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

Personal protective equipment: gloves, apron, mask, and goggles as indicated; remove in correct order to avoid contamination.

Waste segregation: yellow bag for infectious waste, red for contaminated recyclables, white for sharps, and black for general waste.

Safe water and sanitation: use boiled/filtered water, store in covered containers, and practise safe disposal of human waste.

Food hygiene: wash hands before cooking, separate raw and cooked foods, cook thoroughly, and store at safe temperatures.

Environmental cleaning: regularly clean and disinfect surfaces, especially in kitchens, toilets, and patient care areas.

Respiratory hygiene: cover mouth and nose when coughing or sneezing, dispose of tissues properly, and wash hands afterwards.

Effective communication: active listening, empathy, clear language, and appropriate non-verbal cues (eye contact, posture, tone).

Barriers to communication: language differences, hearing loss, anxiety, and environmental noise; use interpreters and written information when needed.

Informed consent: explain procedure, risks, benefits, and alternatives; obtain voluntary agreement before care.

Confidentiality: protect client information; share only with authorised persons involved in care.

Professional boundaries: maintain a caring but professional relationship; avoid dual relationships and financial exploitation.

Client rights: dignity, privacy, autonomy, safety, and the right to refuse treatment.

Documentation: accurate, timely, objective records with date, time, and signature; follow legal and organisational requirements.

Reporting: report suspected abuse, neglect, or unsafe practice to the appropriate authority without delay.

Common childhood illnesses: diarrhoea, respiratory infections, fever, measles, and malnutrition; early recognition and referral prevent complications.

Diarrhoea: oral rehydration solution, continued feeding, zinc supplementation, and referral for severe dehydration or blood in stool.

Pneumonia: fast breathing (60/min under 2 months, 50/min 2-12 months, 40/min 1-5 years) with cough requires prompt treatment.

Fever: tepid sponging, fluids, and antipyretics as prescribed; never give aspirin to children.

Immunisation: follow the national schedule; maintain cold chain and record all doses.

Malnutrition: plot growth on charts; falling centiles or MUAC under 11.5 cm indicate severe acute malnutrition.

Prevention: handwashing, safe water, sanitation, exclusive breastfeeding, and complete immunisation.

Urgent referral signs: convulsions, inability to feed, persistent vomiting, chest indrawing, lethargy, severe dehydration.

Developmental domains: gross motor, fine motor, language, cognitive, and social-emotional; assess all domains at each visit.

Gross motor milestones: head control 3 months, sitting without support 6-8 months, walking independently 12-15 months.

Fine motor: palmar grasp 5 months, pincer grasp 9-10 months, scribbling 15 months, cup drinking 12-15 months.

Language: cooing 2 months, babbling 6 months, first words 12 months, two-word phrases 18-24 months, 50 words by 2 years.

Piaget: sensorimotor (0-2 y), preoperational (2-7 y), concrete operational (7-11 y), formal operational (11+ y).

Erikson: trust vs mistrust (0-1 y), autonomy vs shame (1-3 y), initiative vs guilt (3-6 y), industry vs inferiority (6-12 y).

Red flags: no social smile by 3 months, no babbling by 9 months, no words by 16 months, no two-word phrases by 24 months, loss of skills.

Play: parallel play typical at 2-3 years, cooperative play from 4 years; play is the main learning medium.

Exclusive breastfeeding for 6 months; complementary feeding from 6 months with continued breastfeeding to 2 years or beyond.

First foods: soft, energy-dense, iron-rich; introduce one new food at a time to identify allergies.

Macronutrient energy: carbohydrate 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g.

Protein-energy malnutrition: marasmus (severe wasting, no oedema) vs kwashiorkor (oedema, distended abdomen, skin/hair changes).

Adolescence: high iron and calcium needs; vitamin C enhances iron absorption, tea/coffee inhibits it.

Pregnancy: extra ~300-350 kcal/day in second and third trimesters; folic acid and iron are priority micronutrients.

Older adults: adequate protein, calcium, vitamin D, fibre, and fluids; reduced thirst raises dehydration risk.

Public health strategies: iodised salt, iron-fortified staples, and vitamin A supplementation.

DRABC: Danger, Response, Airway, Breathing, Circulation - assess and act in that order.

Severe bleeding: direct pressure with clean dressing, elevate limb, add layers if soaked; do not remove soaked dressings.

Burns: cool with running water for at least 20 minutes, remove jewellery, cover with non-stick dressing; never apply ice, butter, or toothpaste.

Choking adult/child: encourage coughing, then back blows and abdominal thrusts; infants under 1 year: back blows and chest thrusts, no abdominal thrusts.

Poisoning: do not induce vomiting; keep container, note time and amount, contact poison information centre.

Fracture/spinal injury: immobilise and do not move unless immediate danger.

Recovery position: unconscious but breathing casualty on the side to keep airway clear.

Emergency numbers India: 112 (all-in-one), 108 (ambulance).

Hand hygiene: wet, soap, rub all surfaces at least 20 seconds, rinse, dry with clean towel or air-dry.

Wash hands before food preparation, before/after caring for sick person, after toilet use, after handling waste, after coughing/sneezing.

Standard precautions apply to all: hand hygiene, gloves for blood/body fluids, safe sharps disposal.

Five moments for hand hygiene: before patient contact, before aseptic task, after body-fluid exposure risk, after patient contact, after contact with surroundings.

Safe water and sanitation: boiled/filtered/chlorinated water, covered storage, no open defecation to break faecal-oral transmission.

Food hygiene: separate raw and cooked, cook thoroughly, safe temperatures, clean utensils and surfaces.

Personal hygiene: daily bathing, oral hygiene twice daily, nail trimming, clean clothing reduce infections.

Waste segregation: yellow (infectious), red (contaminated recyclables), white (sharps), general waste separately.

Active listening: eye contact, nodding, paraphrasing, reflecting feelings; avoid interrupting.

Open-ended questions invite fuller responses; closed questions confirm specific facts.

Informed consent: capacity, adequate information, voluntary agreement - before any care procedure.

Confidentiality: share only on need-to-know basis; avoid discussing client condition in public areas.

Professional boundaries: no gifts creating obligation, no use of client belongings, no personal relationships compromising care.

Client rights: dignity, privacy, choice, safety, right to refuse care; respect cultural and religious preferences.

Documentation: objective, timed, dated, signed; never alter records after the fact.

Mandatory reporting: suspected abuse, neglect, or serious incidents reported to appropriate authority per policy.

Normal ageing: reduced skin elasticity, decreased lean mass, reduced renal clearance, slower reaction time, presbyopia, high-frequency hearing loss.

Falls: leading cause of injury; screen gait/balance, home hazards, sedative use, postural hypotension.

Osteoporosis: risk rises after menopause; weight-bearing exercise, calcium, vitamin D, fall prevention reduce fractures.

Polypharmacy: review medication lists regularly; altered renal/hepatic clearance increases adverse drug reactions.

Delirium vs dementia: delirium acute onset, fluctuating attention/consciousness; dementia chronic progressive with preserved consciousness until late.

Pressure ulcer prevention: reposition every 2 hours, keep skin clean/dry, pressure-relieving surfaces, nutrition screening.

Geriatric syndromes: incontinence, falls, immobility, cognitive impairment, sensory loss, malnutrition - often multifactorial.

Elder abuse signs: unexplained bruises, fear of caregiver, sudden financial changes, withdrawal; duty to report.

Developmental screening at each well-child visit; use age-appropriate milestones and growth charts.

Gross motor: head control 3 months, rolling 4-6 months, sitting 6-8 months, crawling 8-10 months, walking 12-15 months.

Fine motor: palmar grasp 5 months, pincer grasp 9-10 months, scribbling 15 months, tower of 2 cubes 15 months.

Language: cooing 2 months, babbling 6 months, first words 12 months, two-word phrases 18-24 months.

Social-emotional: social smile 6-8 weeks, stranger anxiety 6-9 months, parallel play 2-3 years, cooperative play 4 years.

Cognitive (Piaget): sensorimotor 0-2 y, preoperational 2-7 y, concrete operational 7-11 y, formal operational 11+ y.

Red flags: no social smile by 3 months, no babbling by 9 months, no words by 16 months, no two-word phrases by 24 months, regression.

Caregiving: respond consistently to cues, provide safe play, nutrition, immunisation, and early stimulation.

Under-5 danger signs: inability to feed/drink, persistent vomiting, convulsions, lethargy/unconsciousness, chest indrawing, stridor at rest.

Dehydration (WHO): no dehydration - alert, drinks normally; some - restless, sunken eyes, drinks eagerly, slow skin pinch; severe - lethargic, unable to drink, very slow skin pinch.

ORS: low-osmolarity, small frequent amounts by spoon/syringe; zinc for 10-14 days in diarrhoea.

Pneumonia fast breathing: 60/min (<2 months), 50/min (2-12 months), 40/min (1-5 years).

Fever in infants under 3 months is a medical emergency regardless of appearance.

Measles: fever with rash, cough, coryza, conjunctivitis; vitamin A reduces complications.

Severe acute malnutrition: weight-for-height below -3 SD, MUAC under 11.5 cm (6-59 months), or bilateral pitting oedema.

Immunisation anchors (India/UIP): BCG-OPV-HepB at birth; pentavalent 6, 10, 14 weeks; MR 9-12 months; DPT/OPV boosters 16-24 months.

Balanced diet: cereals, pulses, vegetables, fruits, milk products, fats in appropriate proportions; food pyramid guide.

Meal planning: variety, moderation, balance; consider age, activity, health status, cultural preferences.

Child nutrition: energy-dense, iron-rich foods (green leafy vegetables, legumes) with vitamin C to enhance iron absorption.

Adolescent nutrition: address iron-deficiency anaemia, calcium for bone growth, healthy snacking.

Pregnancy/lactation: increase protein, iron, folic acid, calcium, fluids; avoid alcohol and tobacco.

Old age: soft chewable foods, adequate fibre for constipation, sufficient protein to prevent sarcopenia.

Therapeutic diets: diabetic (low glycaemic index, controlled carbohydrate), renal (restricted protein, sodium, potassium), cardiac (low fat, low salt).

Food safety: wash hands and produce, cook thoroughly, refrigerate leftovers promptly, avoid cross-contamination.

First aid aims: preserve life, prevent deterioration, promote recovery; assess scene safety first.

Primary survey: responsiveness, airway, breathing, circulation; call for help early.

Adult CPR: 30 compressions to 2 breaths, depth 5-6 cm, rate 100-120/min.

Child CPR: 30:2 one rescuer, 15:2 two rescuers; infant compressions with two fingers or two thumbs.

Recovery position: unconscious breathing casualty on side to maintain airway.

Burns: cool running water at least 20 minutes, clean non-stick dressing, no ice or ointments.

Choking: encourage coughing; back blows and abdominal thrusts for adults/children; back blows and chest thrusts for infants.

Emergency numbers India: 112 all emergencies, 108 ambulance.

Hand hygiene is the single most effective infection prevention measure; soap and water 20 seconds or alcohol hand rub.

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

PPE: gloves, apron, mask, goggles as indicated; remove in correct order to avoid contamination.

Waste segregation: yellow infectious, red contaminated recyclables, white sharps, black general waste.

Safe water/sanitation: boiled/filtered water, covered storage, safe disposal of human waste.

Food hygiene: wash hands before cooking, separate raw and cooked, cook thoroughly, safe storage temperatures.

Environmental cleaning: regularly clean and disinfect surfaces, especially kitchens, toilets, patient care areas.

Respiratory hygiene: cover mouth/nose when coughing or sneezing, dispose tissues properly, wash hands after.

Effective communication: active listening, empathy, clear language, appropriate non-verbal cues.

Barriers: language differences, hearing loss, anxiety, noise; use interpreters and written information.

Informed consent: explain procedure, risks, benefits, alternatives; obtain voluntary agreement.

Confidentiality: protect client information; share only with authorised persons involved in care.

Professional boundaries: caring but professional relationship; avoid dual relationships and financial exploitation.

Client rights: dignity, privacy, autonomy, safety, right to refuse treatment.

Documentation: accurate, timely, objective records with date, time, signature; follow legal/organisational requirements.

Reporting: report suspected abuse, neglect, or unsafe practice to appropriate authority without delay.

Promote independence: self-care, mobility aids, safe home with grab bars and adequate lighting.

Nutrition: small frequent meals, adequate protein, calcium, vitamin D, fluids; screen chewing/swallowing difficulty.

Skin care: inspect pressure areas daily, moisturise, manage incontinence to prevent breakdown.

Mental health: screen for depression, anxiety, social isolation; encourage social contact and meaningful activities.

Medication safety: pill organisers, prescription review, monitor side effects; avoid self-medication.

Hydration: reduced thirst sensation; offer fluids regularly, monitor confusion, dry mouth, dark urine.

Exercise: gentle weight-bearing and balance exercises reduce fall risk and maintain function.

End-of-life care: respect advance directives, provide comfort and dignity, support family through grieving.

Growth charts: plot weight, height, head circumference at each visit; falling centiles warrant assessment.

Head circumference: increases ~2 cm/month first 3 months, ~1 cm/month 4-6 months, ~0.5 cm/month 6-12 months.

Teething: first tooth ~6 months; symptoms include drooling, gum rubbing, mild irritability; not a cause of high fever.

Toilet training readiness: usually 18-24 months; signs include dry periods, awareness of wetness, interest in toilet.

Sleep: newborns sleep 16-18 hours/day; by 1 year about 12-14 hours including naps.

Nutrition: exclusive breastfeeding 6 months, complementary feeding from 6 months, family food by 1 year.

Safety: supervise at all times, use car seats, childproof home, keep small objects and medicines out of reach.

Stimulation: talk, read, sing, and play daily; responsive caregiving supports brain development.

Common illnesses: diarrhoea, ARI, fever, measles, malnutrition; early recognition and referral prevent complications.

Diarrhoea: ORS, continued feeding, zinc, referral for severe dehydration or blood in stool.

ARI: count breaths for full minute; fast breathing with cough indicates pneumonia.

Fever: tepid sponging, fluids, antipyretics as prescribed; no aspirin in children.

Immunisation: follow national schedule, maintain cold chain, record all doses.

Malnutrition: plot growth charts; MUAC under 11.5 cm indicates severe acute malnutrition.

Prevention: handwashing, safe water, sanitation, exclusive breastfeeding, complete immunisation.

Urgent referral: convulsions, inability to feed, persistent vomiting, chest indrawing, lethargy, severe dehydration.

Exclusive breastfeeding 6 months; complementary feeding from 6 months; continue breastfeeding to 2 years or beyond.

First foods: soft, energy-dense, iron-rich; one new food at a time to identify allergies.

Energy values: carbohydrate 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g.

PEM: marasmus (wasting, no oedema) vs kwashiorkor (oedema, distended abdomen, skin/hair changes).

Adolescence: high iron and calcium needs; vitamin C enhances iron absorption; tea/coffee inhibits.

Pregnancy: extra ~300-350 kcal/day in 2nd and 3rd trimesters; folic acid and iron priority.

Older adults: protein, calcium, vitamin D, fibre, fluids; reduced thirst raises dehydration risk.

Public health: iodised salt, iron-fortified staples, vitamin A supplementation.

DRABC: Danger, Response, Airway, Breathing, Circulation.

Severe bleeding: direct pressure, elevate limb, add layers if soaked; do not remove soaked dressings.

Burns: cool running water 20 minutes, remove jewellery, non-stick dressing; no ice, butter, toothpaste.

Choking adult/child: coughing, back blows, abdominal thrusts; infants: back blows and chest thrusts, no abdominal thrusts.

Poisoning: do not induce vomiting; keep container, note time/amount, contact poison centre.

Fracture/spinal injury: immobilise, do not move unless immediate danger.

Recovery position: unconscious breathing casualty on side.

Emergency numbers India: 112 all-in-one, 108 ambulance.

Active listening: eye contact, nodding, paraphrasing, reflecting feelings; avoid interrupting.

Open-ended questions invite fuller responses; closed questions confirm facts.

Informed consent: capacity, adequate information, voluntary agreement before procedures.

Confidentiality: share only on need-to-know basis; avoid public discussion of client condition.

Professional boundaries: no gifts creating obligation, no use of client belongings, no compromising relationships.

Client rights: dignity, privacy, choice, safety, right to refuse care; respect cultural/religious preferences.

Documentation: objective, timed, dated, signed; never alter records after the fact.

Mandatory reporting: report suspected abuse, neglect, or serious incidents per policy.