RBSE Sec Voc Health Care cheat sheet

Anatomical position: standing erect, face forward, arms at sides with palms facing anteriorly; all directional terms assume this position.

Directional pairs: superior/inferior (above/below), anterior/posterior (front/back), medial/lateral (toward/away from midline), proximal/distal (nearer/farther from trunk attachment).

Body planes: sagittal divides left and right; coronal (frontal) divides anterior and posterior; transverse divides superior and inferior.

Eleven organ systems: integumentary, skeletal, muscular, nervous, endocrine, cardiovascular, lymphatic, respiratory, digestive, urinary, reproductive.

Vital sign adult reference ranges: temperature 36.1-37.2 C oral, pulse 60-100/min, respirations 12-20/min, blood pressure under 120/80 mmHg, SpO2 95-100%.

Four abdominal quadrants (RUQ, LUQ, RLQ, LLQ) are used for description; nine regions (epigastric, umbilical, hypogastric, etc.) give finer localization.

Homeostasis is maintained by negative feedback: a sensor detects deviation, a control centre compares it to a set point, and an effector reverses the change.

Levels of structural organization, smallest to largest: cell, tissue, organ, organ system, organism.

Bed bath sequence: face and neck first, then arms, chest, abdomen, legs, back, and perineal area last; change water when it cools or becomes soiled.

Pressure injury risk is assessed with the Braden Scale (six subscales: sensory perception, moisture, activity, mobility, nutrition, friction/shear); lower score means higher risk.

Reposition an immobile patient at least every 2 hours; inspect bony prominences (sacrum, heels, elbows, occiput, trochanters) at each turn.

Oral care for an unconscious patient: place in lateral position, use suction, do not use toothpaste or mouthwash, and perform at least twice daily.

When making an occupied bed, raise the bed to working height, lock the wheels, and use a draw sheet to roll the patient toward you rather than away.

Urinary output below 30 mL/h in an adult suggests inadequate renal perfusion and must be reported.

Normal adult urine is clear, pale yellow, and sterile; cloudiness, sediment, or foul odour suggests infection or dehydration.

Fowler position (head of bed 45-60 degrees) aids breathing; Trendelenburg (head down) is used only on specific medical orders.

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

Choking adult with effective cough: encourage coughing; with ineffective cough, give 5 back blows then 5 abdominal thrusts (Heimlich) and repeat.

Severe external bleeding: apply direct pressure with a dressing, add layers without removing soaked ones, and use a tourniquet only if direct pressure fails.

Burn first aid: cool with running water for about 20 minutes, remove jewellery and loose clothing, do not burst blisters, do not apply ice or oil.

Recovery position is for an unresponsive person who is breathing normally; it keeps the airway open and allows drainage of vomit.

Stroke screening (FAST): Face droop, Arm weakness, Speech difficulty, Time to call emergency services.

Snake bite: immobilize the limb at or below heart level, remove tight items, do not cut, suck, or apply a tight bandage, and transport urgently.

Fracture immobilization: splint the joint above and below the injury and check distal pulse, colour, and sensation before and after splinting.

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

Standard precautions apply to all patients regardless of diagnosis and include hand hygiene, gloves, gown, mask, eye protection, and safe sharps handling.

WHO five moments for hand hygiene: before touching a patient, before a clean procedure, after body fluid exposure risk, after touching a patient, after touching patient surroundings.

Alcohol-based hand rub is used for visibly clean hands; soap and water is required when hands are visibly soiled or after contact with spore-forming organisms such as Clostridium difficile.

Sterilization destroys all microorganisms including spores; disinfection reduces pathogens on inanimate objects but does not necessarily kill spores.

Autoclave standard cycle: 121 C at 15 psi for 15-20 minutes, or 134 C for about 3-4 minutes; indicator tape and biological spores verify efficacy.

Sharps safety: never recap a needle by hand, do not bend or break needles, and discard immediately into a puncture-resistant container filled to no more than three-quarters.

Biomedical waste colour coding (common Indian practice): yellow for human anatomical and soiled waste, red for contaminated recyclable plastic, white translucent for sharps, blue for glass and metallic implants.

Energy values: carbohydrate 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g, alcohol 7 kcal/g.

Balanced diet energy split: about 50-60% carbohydrate, 10-15% protein, and 20-30% fat.

Basal metabolic rate (Harris-Benedict, metric): men 88.362 + 13.397 W + 4.799 H - 5.677 A; women 447.593 + 9.247 W + 3.098 H - 4.330 A, with W in kg, H in cm, A in years.

Body mass index = weight (kg) / height (m)^2; WHO categories: under 18.5 underweight, 18.5-24.9 normal, 25-29.9 overweight, 30 and above obese.

Fat-soluble vitamins A, D, E, K are stored in the liver and fat and can accumulate to toxic levels; water-soluble B and C are excreted and need daily intake.

Deficiency mapping: vitamin A - night blindness; vitamin C - scurvy; vitamin D - rickets/osteomalacia; iron - microcytic anaemia; iodine - goitre.

Daily fluid requirement is roughly 30-35 mL/kg body weight; insensible loss through skin and lungs is about 500-800 mL/day in adults.

Enteral feeding: elevate the head 30-45 degrees during and 30 minutes after feeding, and check gastric residual volume per protocol to reduce aspiration risk.

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

Recommended antenatal visits for an uncomplicated pregnancy: at least four, ideally in the first trimester, at 20-24, 28-32, and 36 weeks.

Danger signs in pregnancy requiring urgent referral: bleeding, severe headache with blurred vision, convulsions, high fever, reduced fetal movement, and leaking of fluid.

Exclusive breastfeeding is recommended for the first 6 months, then complementary feeding with continued breastfeeding up to 2 years.

Newborn weight: average birth weight about 2.5-3.5 kg; weight loss up to 10% in the first week is normal and regained by about day 10-14.

APGAR is scored at 1 and 5 minutes on Appearance, Pulse, Grimace, Activity, Respiration, each 0-2; 7-10 is generally reassuring.

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

Danger signs of newborn illness: not feeding, lethargy, fast breathing above 60/min, chest indrawing, fever, hypothermia below 36.5 C, and jaundice of the palms and soles.

Levels of prevention: primary (before disease, e.g. immunization), secondary (early detection, e.g. screening), tertiary (limiting disability, e.g. rehabilitation).

Incidence measures new cases in a population at risk over a period; prevalence measures all existing cases at a point in time.

Infant mortality rate = infant deaths under 1 year in a year / live births in the same year x 1000.

Maternal mortality ratio = maternal deaths / live births x 100,000, counting deaths during pregnancy or within 42 days of delivery.

National Health Mission programmes include RMNCH+A, the Universal Immunization Programme, and the National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke.

Mission Indradhanush targets full immunization of children under 2 years and pregnant women who are partially immunized or unimmunized.

Community Health Centre covers about 80,000-120,000 people, Primary Health Centre about 20,000-30,000, and a sub-centre about 3,000-5,000.

Cold chain: OPV and measles vaccines need -20 C or below at the storage level, while most other vaccines are kept at 2-8 C.

Prefixes: brady- slow, tachy- fast, hyper- high, hypo- low, dys- difficult or painful, a-/an- without, post- after, pre- before, sub- under.

Suffixes: -itis inflammation, -ectomy removal, -otomy incision, -ostomy opening, -algia pain, -emia blood condition, -uria urine condition, -megaly enlargement.

Root examples: cardi- heart, nephr- kidney, hepat- liver, pulmon- lung, gastr- stomach, oste- bone, derm- skin, neur- nerve, hem/hemat- blood.

Abbreviations: BP blood pressure, HR heart rate, RR respiratory rate, NPO nothing by mouth, PRN as required, PO by mouth, IV intravenous, IM intramuscular, SC subcutaneous.

Medical record legal requirements: entries must be accurate, timed, dated, signed, legible, and free of abbreviations that are not approved locally.

Corrections: draw a single line through an error, write the correct entry, initial, and date it; never erase, overwrite, or use correction fluid.

SOAP note structure: Subjective (patient report), Objective (observations and measurements), Assessment (interpretation), Plan (actions and follow-up).

Confidentiality: patient information is shared only with the care team on a need-to-know basis; consent is required before releasing records to third parties.

The ten rights of medication administration include right patient, drug, dose, route, time, documentation, reason, response, to refuse, and right education.

Enteral routes: oral, sublingual (under the tongue, rapid absorption), buccal (between cheek and gum), and rectal.

Parenteral routes: intradermal (10-15 degrees, forearm), subcutaneous (45-90 degrees, abdomen/thigh), intramuscular (90 degrees, deltoid or gluteal), intravenous.

Common intramuscular sites: ventrogluteal (preferred for safety), dorsogluteal, deltoid (small volumes), and vastus lateralis (infants).

Six rights of drug administration checks are performed at three points: when removing from storage, when preparing, and when administering.

Antibiotic stewardship: complete the prescribed course, do not share antibiotics, and monitor for allergic reaction such as rash, swelling, or breathing difficulty.

Adverse drug reaction reporting goes to the national pharmacovigilance programme; document the drug, dose, reaction, timing, and outcome.

Antidote pairs: paracetamol - N-acetylcysteine; opioid - naloxone; benzodiazepine - flumazenil; warfarin - vitamin K; organophosphate - atropine.

Vital signs sequence: measure temperature, pulse, respiration, blood pressure, and oxygen saturation, and record on the chart with date and time.

Pulse assessment sites: radial (routine), carotid (emergency), brachial, femoral, popliteal, posterior tibial, and dorsalis pedis.

Blood pressure technique: patient seated and rested 5 minutes, arm supported at heart level, cuff bladder covering about 80% of arm circumference, and two readings averaged.

Injection preparation: verify the order, perform hand hygiene, clean the vial top, draw up the dose, expel air, and check for the correct drug and dose before injecting.

Urinary catheterization: use sterile technique, lubricate the catheter tip, insert until urine flows, inflate the balloon only after confirming urine return, and secure the tubing.

Wound dressing: clean from the least contaminated to the most contaminated area, use a new swab for each stroke, and dispose of soiled dressings in the correct waste stream.

Specimen collection: label the container at the bedside with patient name, ID, specimen type, and time; collect midstream urine after cleansing.

Internship logbook entries should record date, ward, procedure performed, supervisor signature, and reflection; competencies are assessed by direct observation.

Blood flow through the heart: right atrium, tricuspid valve, right ventricle, pulmonary valve, lungs, pulmonary veins, left atrium, mitral valve, left ventricle, aortic valve, aorta.

Normal cardiac output is about 5 L/min at rest (heart rate x stroke volume, roughly 70 beats/min x 70 mL).

Respiratory control centre is in the medulla oblongata; the primary stimulus to breathe is rising arterial carbon dioxide detected by central chemoreceptors.

Normal adult haemoglobin is about 13-17 g/dL in men and 12-15 g/dL in women; oxygen saturation reflects the percentage of haemoglobin bound to oxygen.

The nephron is the functional unit of the kidney; glomerular filtration rate in a healthy adult is about 125 mL/min.

Liver functions include bile production, detoxification, plasma protein synthesis (albumin), and storage of glycogen, iron, and vitamins A, D, and B12.

Bone remodelling involves osteoblasts (bone formation) and osteoclasts (bone resorption); calcium is regulated by parathyroid hormone and calcitonin.

The autonomic nervous system: sympathetic (fight or flight, raises heart rate and dilates pupils) and parasympathetic (rest and digest, slows heart rate).