PGIMER Nursing Officer cheat sheet

Normal adult vital signs: temperature 36.1–37.2 °C oral, pulse 60–100/min, respirations 12–20/min, BP <120/80 mmHg, SpO2 ≥95% on room air.

Myocardial infarction triad of biomarkers: troponin I/T rises 3–6 h after injury and stays elevated 7–14 days; CK-MB rises 4–6 h and normalises in 48–72 h; myoglobin rises earliest but is nonspecific.

Left-sided heart failure: pulmonary congestion, orthopnoea, PND, crackles, S3 gallop. Right-sided failure: JVD, dependent oedema, hepatomegaly, ascites.

Hypoglycaemia is treated with 15–20 g fast-acting oral carbohydrate if conscious; if unconscious give IV dextrose 25–50% or IM/SC glucagon 1 mg.

Stroke: thrombolysis window for IV alteplase is up to 4.5 h from last known well; permissive BP target before lysis is <185/110 mmHg.

COPD oxygen target is 88–92% SpO2 in those at risk of CO2 retention; asthma acute attack target is 94–98%.

DKA management order: isotonic saline first, then insulin infusion 0.1 unit/kg/h, potassium replacement once K+ <5.5 mmol/L and urine output confirmed.

Chest drain: never clamp a bubbling drain; >200 mL/h blood loss or sudden cessation of bubbling with deterioration suggests re-expansion or blockage - report immediately.

Stages of pressure injury: 1 = non-blanchable erythema; 2 = partial-thickness loss with dermis exposed; 3 = full-thickness loss with subcutaneous fat visible; 4 = full-thickness with fascia, muscle or bone exposed; unstageable = slough/eschar obscuring depth.

Braden Scale subscales: sensory perception, moisture, activity, mobility, nutrition, friction/shear; total 6–23, score ≤9 = very high risk.

Normal adult urine output is 0.5–1 mL/kg/h; oliguria is <400 mL/24 h, anuria <100 mL/24 h.

Vital-sign frequency rule: after surgery or invasive procedure, monitor every 15 min for the first hour, then every 30 min, then hourly until stable.

Six rights of medication administration: right patient, drug, dose, route, time, documentation (plus reason and refusal).

Intramuscular injection sites and maximum volumes: deltoid 1 mL, ventrogluteal 3 mL (preferred for adults), dorsogluteal avoided due to sciatic nerve risk.

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

Positioning rules: semi-Fowler 30–45° for dyspnoea and tube feeding; Trendelenburg is contraindicated in raised intracranial pressure; left lateral Sims for rectal enema.

Estimated date of delivery by Naegele's rule: first day of last menstrual period minus 3 months plus 7 days plus 1 year.

Stages of labour: first stage from onset to full dilatation (10 cm); second stage from full dilatation to birth; third stage from birth to placental delivery (up to 30 min active management); fourth stage first 1–2 h postpartum.

Normal fetal heart rate is 110–160 beats/min; late decelerations indicate uteroplacental insufficiency and require left lateral position, oxygen and stopping oxytocin.

Postpartum haemorrhage definition: ≥500 mL after vaginal birth or ≥1000 mL after caesarean, or any blood loss causing haemodynamic instability.

Magnesium sulphate for pre-eclampsia: loading dose 4–6 g IV over 20 min, maintenance 1–2 g/h; monitor deep tendon reflexes, respiratory rate ≥12/min and urine output ≥30 mL/h.

Rho(D) immunoglobulin is given to Rh-negative unsensitised mothers at 28 weeks and within 72 h of delivery of an Rh-positive infant.

APGAR is scored at 1 and 5 minutes on five items: appearance, pulse, grimace, activity, respiration; each 0–2, total 0–10.

Contraindications to combined oral contraceptives include migraine with aura, smoking over age 35, history of VTE, breast cancer and uncontrolled hypertension.

Paediatric weight formula (1–12 years): weight in kg = (age in years + 4) × 2.

Normal paediatric respiratory rates: newborn 30–60/min, infant 30–53/min, toddler 22–37/min, school age 18–25/min, adolescent 12–20/min.

Normal paediatric heart rates: newborn 100–160/min, infant 90–160/min, preschool 80–140/min, school age 70–120/min.

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

Infant dehydration signs: sunken fontanelle, absent tears, dry mucosa, decreased urine output <1 mL/kg/h, capillary refill >3 s, skin turgor loss.

Kawasaki disease diagnostic criteria: fever ≥5 days plus 4 of 5 - rash, conjunctivitis, oral changes, cervical lymphadenopathy, extremity changes; treat with IVIG and aspirin.

Nephrotic syndrome in children: heavy proteinuria, hypoalbuminaemia, oedema, hyperlipidaemia; first-line therapy is corticosteroid.

Immunisation schedule anchors (India UIP): BCG, OPV-0 and hepatitis B at birth; pentavalent at 6, 10 and 14 weeks; measles-rubella first dose at 9–12 months.

Primary health care principles (Alma-Ata 1978): equity, community participation, intersectoral collaboration, appropriate technology and focus on prevention.

Infant mortality rate = (deaths under 1 year in a year ÷ live births in the same year) × 1000.

Maternal mortality ratio = (maternal deaths in a year ÷ live births in the same year) × 100,000.

Levels of prevention: primordial (risk-factor avoidance), primary (pre-disease), secondary (early detection and treatment), tertiary (disability limitation and rehabilitation).

Cold chain: OPV stored at −20 °C, most other vaccines at 2–8 °C; avoid freezing of adsorbed vaccines such as DPT, hepatitis B and tetanus toxoid.

Epidemiological measures: incidence counts new cases; prevalence counts all existing cases; attack rate applies to a defined outbreak population.

Home visit sequence: establish rapport, assess family health, plan with family, implement, evaluate and record.

Screening test properties: sensitivity detects true positives; specificity detects true negatives; positive predictive value depends on prevalence.

Neuroleptic malignant syndrome: rigidity, hyperthermia >38 °C, autonomic instability, raised CK; stop antipsychotic, give dantrolene or bromocriptine, cool and hydrate.

Serotonin syndrome triad: mental status change, autonomic hyperactivity and neuromuscular abnormalities; onset usually within 24 h of serotonergic drug addition.

Lithium therapeutic range is 0.6–1.2 mmol/L; toxicity signs include tremor, ataxia, vomiting and confusion; monitor renal and thyroid function.

Clozapine requires regular white cell monitoring because of agranulocytosis risk; stop if neutrophil count falls below 1.5 × 10^9/L.

Alcohol withdrawal: use CIWA-Ar scoring, benzodiazepines as first-line, thiamine before glucose to prevent Wernicke's encephalopathy.

Electroconvulsive therapy indications: severe depression with psychosis or catatonia, treatment-resistant depression, life-threatening mania; consent and anaesthetic assessment required.

Delirium versus dementia: delirium has acute onset, fluctuating course and impaired attention; dementia is chronic, progressive with preserved consciousness.

Therapeutic communication: use open-ended questions, reflection and silence; avoid false reassurance, giving advice and asking 'why' questions.

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

Normal blood pH is 7.35–7.45; respiratory acidosis shows raised PaCO2, metabolic acidosis shows low HCO3− and low pH.

Nephron segments: glomerulus filters, proximal tubule reabsorbs about 65% of filtrate, loop of Henle concentrates, distal tubule and collecting duct act under aldosterone and ADH.

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.

Blood cell values: haemoglobin 13–17 g/dL in men and 12–15 g/dL in women; platelets 150,000–450,000/µL; WBC 4,000–11,000/µL.

Bone remodelling is driven by osteoclasts resorbing and osteoblasts forming bone; parathyroid hormone raises serum calcium, calcitonin lowers it.

Lung volumes: tidal volume about 500 mL, vital capacity about 4,800 mL, functional residual capacity about 2,400 mL; residual volume cannot be measured by spirometry.

Hormone sources: insulin and glucagon from pancreatic islets, cortisol from adrenal cortex, ADH from posterior pituitary, thyroxine from thyroid follicles.

Gram stain: Gram-positive organisms retain crystal violet (purple); Gram-negative take the safranin counterstain (pink).

Chain of infection: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host; break any link to prevent transmission.

Hand hygiene is the single most effective measure; use alcohol-based rub for 20–30 s and soap and water for 40–60 s, and soap when hands are visibly soiled or after C. difficile contact.

Sterilisation methods: autoclave 121 °C at 15 psi for 15–20 min; ethylene oxide for heat-sensitive items; glutaraldehyde 2% for high-level disinfection.

Needle-stick HIV transmission risk is about 0.3%; hepatitis B risk is up to 30% from an HBsAg-positive source; hepatitis C is about 1.8%.

Notifiable/airborne pathogens: Mycobacterium tuberculosis requires negative-pressure room and N95 respirator; varicella and measles also need airborne precautions.

Culture media: blood agar is enriched and shows haemolysis; MacConkey agar selects Gram-negative bacilli; Robertson's cooked meat medium for anaerobes.

Antibiotic resistance mechanisms: beta-lactamase production, efflux pumps, altered target sites and reduced membrane permeability.

Digoxin therapeutic range is 0.5–2 ng/mL; check apical pulse for a full minute and withhold if below 60/min in adults; hypokalaemia increases toxicity risk.

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

Heparin is monitored by aPTT (target 1.5–2.5 times control) and reversed by protamine sulphate; warfarin is monitored by INR (target 2–3) and reversed by vitamin K.

Antidotes: paracetamol - N-acetylcysteine; opioid - naloxone; benzodiazepine - flumazenil; organophosphate - atropine plus pralidoxime; warfarin - vitamin K.

High-alert medications include insulin, heparin, concentrated potassium, opioids and chemotherapy; require independent double-check and standard concentrations.

Vancomycin infusion must be given over at least 60 minutes to avoid 'red man syndrome'; monitor trough levels and renal function.

Loop diuretics act on the ascending loop of Henle and cause hypokalaemia, hypomagnesaemia and ototoxicity; monitor electrolytes and weight.

Corticosteroid therapy must not be stopped abruptly because of adrenal suppression; taper doses and monitor blood glucose and infection signs.

Basal metabolic rate is measured in the resting state; total energy expenditure adds activity and thermic effect of food (about 10% of intake).

Protein provides 4 kcal/g, carbohydrate 4 kcal/g, fat 9 kcal/g and alcohol 7 kcal/g.

BMI = weight in kg ÷ (height in m)²; underweight <18.5, normal 18.5–24.9, overweight 25–29.9, obese ≥30 kg/m².

Nitrogen balance: positive in growth and recovery, negative in catabolism, burns and malnutrition; 1 g nitrogen corresponds to about 6.25 g protein.

Deficiency diseases: vitamin A - night blindness and xerophthalmia; vitamin D - rickets and osteomalacia; thiamine - beriberi; niacin - pellagra; iodine - goitre.

Iron absorption is enhanced by vitamin C and inhibited by phytates, tannins and calcium; iron-rich foods include liver, legumes and green leafy vegetables.

Enteral feeding is preferred over parenteral when the gut works; check residual volume, head elevation 30–45° and tube position before each feed.

Therapeutic diets: diabetic - controlled carbohydrates and fibre; renal - restricted protein, sodium, potassium and phosphate; cardiac - low sodium, low saturated fat.

Management functions: planning, organising, staffing, directing and controlling; leadership differs from management by inspiring rather than administering.

Span of control is the number of subordinates reporting to one manager; narrow spans suit complex, high-acuity units.

Maslow's hierarchy: physiological, safety, love and belonging, esteem, self-actualisation; lower needs generally must be met first.

Herzberg's two-factor theory: hygiene factors (salary, policy, working conditions) prevent dissatisfaction; motivators (achievement, recognition) create satisfaction.

Nursing audit compares actual care against set standards using structure, process and outcome indicators.

Patient assignment methods: functional, team, primary nursing and case method; primary nursing gives one nurse 24-hour accountability for a small group.

Staffing formula: number of nurses = (average daily census × hours of care per patient) ÷ productive hours per nurse per day.

Incident reporting is non-punitive and should be completed within 24 hours; sentinel events require root cause analysis.

Bloom's taxonomy cognitive levels: knowledge, comprehension, application, analysis, synthesis and evaluation; psychomotor domain uses Simpson's levels.

Lesson plan components: objectives, content, teaching methods, audiovisual aids, time allocation and evaluation.

Research process order: problem identification, literature review, hypothesis, design, sampling, data collection, analysis, interpretation and dissemination.

Levels of evidence: systematic reviews and meta-analyses at the top, then randomised controlled trials, cohort, case-control, case series and expert opinion.

Validity types: internal validity shows cause-effect; external validity shows generalisability; reliability is consistency of a measure.

Sampling: probability methods (simple random, stratified, cluster, systematic) allow generalisation; non-probability methods (convenience, purposive, quota) do not.

Informed consent requires disclosure, comprehension, voluntariness and competence; participants may withdraw at any time without penalty.

Descriptive statistics: mean for interval data, median for skewed data, mode for nominal data; standard deviation measures spread around the mean.

World Health Organization was founded on 7 April 1948; World Health Day is observed on 7 April each year.

International Nurses Day is observed on 12 May, the birthday of Florence Nightingale; the Nightingale Training School opened at St Thomas' Hospital in 1860.

India's National Health Policy was last revised in 2017; Ayushman Bharat launched in 2018 with Health and Wellness Centres and PM-JAY insurance cover.

National Health Programmes include the National Programme for Control of Blindness, Revised National TB Control Programme (now NTEP), and the National Mental Health Programme (1982).

Indian nursing regulatory body is the Indian Nursing Council, established by the Indian Nursing Council Act of 1947.

Red Cross was founded by Henry Dunant in 1863; the International Council of Nurses was founded in 1899.

Sustainable Development Goal 3 targets good health and well-being; SDG 6 covers clean water and sanitation.

World AIDS Day is 1 December; World TB Day is 24 March; International Day of the Nurse is 12 May.

Number series and coding-decoding questions are solved by identifying the rule first, then verifying it against at least two terms.

Blood relation rule: draw a family tree with gender symbols; 'brother of my father' is uncle, 'daughter of my sister' is niece.

Direction sense: track turns on a coordinate grid; a left turn after facing north means facing west.

Ratio and proportion: if a:b = c:d then ad = bc; for mixtures, use the alligation rule (cheaper quantity ÷ dearer quantity = difference of prices).

Computer basics: RAM is volatile working memory; ROM is non-volatile; cache sits between CPU and RAM for speed.

Common keyboard shortcuts: Ctrl+C copy, Ctrl+V paste, Ctrl+X cut, Ctrl+Z undo, Ctrl+S save, Ctrl+P print, Ctrl+F find.

OSI model has seven layers: physical, data link, network, transport, session, presentation, application; TCP works at transport layer.

Data units: 1 byte = 8 bits, 1 KB = 1024 bytes, 1 MB = 1024 KB, 1 GB = 1024 MB; a spreadsheet file typically uses .xlsx extension.