RRB 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% on room air.

Maslow's hierarchy order for prioritisation: physiological → safety → love/belonging → esteem → self-actualisation; airway always precedes other needs.

Stages of wound healing: haemostasis (0-3 days), inflammatory (1-5 days), proliferative (3-24 days), maturation/remodelling (up to 1 year).

Pressure ulcer stages: I non-blanchable erythema; II partial-thickness loss; III full-thickness loss to fascia; IV to bone/tendon; unstageable when eschar covers the base.

Intake-output record: 1 mL urine ≈ 1 g weight; minimum adult urine output 0.5 mL/kg/hour (about 30 mL/hour); report output <400 mL/24 h as oliguria.

Six rights of medication administration: right patient, drug, dose, route, time, documentation; add right reason and right to refuse in modern practice.

Isolation precautions: contact for MRSA and C. difficile (soap and water, not alcohol, for spores); droplet for influenza and pertussis; airborne for TB, measles and varicella (N95, negative pressure).

Pulse sites in order of accessibility: radial, brachial, carotid, femoral, popliteal, posterior tibial, dorsalis pedis; count for a full 60 seconds when irregular.

Adult has 206 bones; axial skeleton 80 (skull, vertebral column, ribs, sternum), appendicular 126 (limbs and girdles).

Normal blood values: haemoglobin 13-17 g/dL (male) and 12-15 g/dL (female); RBC 4.5-5.5 million/µL; platelets 150,000-400,000/µL; WBC 4,000-11,000/µL.

Cardiac output = heart rate × stroke volume; normal 4-8 L/min; stroke volume about 70 mL.

Nephron is the functional unit of the kidney, about 1 million per kidney; glomerular filtration rate normally 125 mL/min; erythropoietin and renin are renal hormones.

Lung volumes: tidal volume 500 mL, vital capacity about 4,800 mL, residual volume about 1,200 mL; surfactant from type II alveolar cells prevents collapse.

Cranial nerves count 12; vagus (X) is the longest, supplying thoracic and abdominal viscera; facial (VII) controls most facial expression.

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

Hormones: insulin from pancreatic beta cells lowers glucose; glucagon from alpha cells raises it; ADH from posterior pituitary conserves water; aldosterone retains sodium.

Myocardial infarction triad: chest pain >20 minutes unrelieved by rest, ST elevation or depression on ECG, and raised troponin; give aspirin 300 mg chewed and oxygen only if SpO2 <94%.

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

Diabetic ketoacidosis: glucose >250 mg/dL, pH <7.3, bicarbonate <18 mEq/L, ketones positive, Kussmaul breathing; treat with IV 0.9% saline then insulin infusion, and replace potassium.

Hypoglycaemia is glucose <70 mg/dL; conscious patient gets 15 g fast carbohydrate and recheck in 15 minutes; unconscious gets IV dextrose or IM glucagon.

Stroke: thrombolysis with alteplase within 4.5 hours of onset; do not lower BP aggressively unless >185/110 mmHg before thrombolysis; FAST = Face, Arm, Speech, Time.

Chronic kidney disease stages by GFR: stage 1 ≥90, stage 2 60-89, stage 3a 45-59, stage 3b 30-44, stage 4 15-29, stage 5 <15 mL/min.

Burns: Parkland formula 4 mL × body weight (kg) × %TBSA of lactated Ringer's in 24 h, half in first 8 hours from injury; rule of nines: each arm 9%, each leg 18%, front trunk 18%, back 18%, head 9%, perineum 1%.

Hepatic encephalopathy is precipitated by GI bleeding, constipation, infection and hypokalaemia; lactulose titrated to 2-3 soft stools per day reduces ammonia absorption.

Naegele's rule: estimated date of delivery = first day of last menstrual period + 7 days − 3 months (+1 year).

Stages of labour: first (latent to 4 cm, active to full dilatation), second (full dilatation to birth), third (birth to placental delivery, normally <30 minutes), fourth (first 1-2 hours postpartum).

Normal fetal heart rate 110-160 beats/min; decelerations early = head compression, variable = cord compression, late = uteroplacental insufficiency.

Pregnancy-induced hypertension: BP ≥140/90 mmHg after 20 weeks; pre-eclampsia adds proteinuria ≥300 mg/24 h or organ dysfunction; eclampsia is seizures.

Magnesium sulphate for eclampsia: loading 4-6 g IV over 15-20 minutes, maintenance 1-2 g/hour; monitor reflexes, respiration ≥12/min and urine output ≥30 mL/hour; antidote calcium gluconate.

Postpartum haemorrhage: >500 mL after vaginal birth or >1,000 mL after caesarean; uterine atony is the commonest cause; first action is uterine massage plus oxytocin.

Lochia sequence: rubra (days 1-3, red), serosa (days 4-10, pink-brown), alba (day 10 to 2-6 weeks, whitish).

Contraception effectiveness: combined oral pill failure about 0.3% with perfect use; copper IUD up to 10 years and is also emergency contraception within 5 days; condoms are the only method protecting against STIs.

APGAR scored at 1 and 5 minutes: Appearance, Pulse, Grimace, Activity, Respiration; each 0-2, total 0-10; score 7-10 normal, 4-6 moderately depressed, 0-3 needs immediate resuscitation.

Infant weight doubles by 5 months and triples by 12 months; birth weight averages 2.5-3.5 kg; length increases about 25 cm in the first year.

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

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

Normal paediatric respiratory rates: newborn 30-60, infant 30-53, toddler 22-37, preschool 20-28, school age 18-25 per minute.

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

Dehydration in children: mild <5% weight loss, moderate 5-10%, severe >10%; sign of shock is capillary refill >3 seconds; give 20 mL/kg isotonic saline bolus.

Kangaroo mother care: skin-to-skin contact, exclusive breastfeeding and early discharge; reduces hypothermia and mortality in low-birth-weight infants.

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

Infant mortality rate = infant deaths under 1 year per 1,000 live births in the same year; maternal mortality ratio = maternal deaths per 100,000 live births.

Levels of prevention: primordial (risk factor reduction), primary (immunisation, health education), secondary (screening, early diagnosis), tertiary (rehabilitation).

Epidemiological triad: agent, host and environment; for non-communicable disease the model is extended with risk factors and time.

Incidence counts new cases in a period; prevalence counts all existing cases at a point; prevalence ≈ incidence × duration for stable disease.

Cold chain: vaccines stored at +2 to +8 °C; OPV kept frozen at −20 °C; avoid freeze damage to DPT, hepatitis B and tetanus toxoid.

Herd immunity threshold = 1 − 1/R0; for measles (R0 about 12-18) this requires roughly 92-95% coverage.

National programmes to know: National Health Mission, Ayushman Bharat (PM-JAY ₹5 lakh cover per family per year), TB elimination target, and Mission Indradhanush for full immunisation.

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

Neuroleptic malignant syndrome: rigidity, fever >38 °C, autonomic instability, raised creatine kinase; stop antipsychotic, give dantrolene or bromocriptine, cool the patient.

Serotonin syndrome: agitation, clonus, hyperreflexia, fever, diarrhoea after SSRIs or MAOIs; stop serotonergic drugs and give supportive care or cyproheptadine.

Lithium therapeutic range 0.6-1.2 mEq/L; toxicity signs include coarse tremor, vomiting and ataxia; maintain sodium and water intake.

Delirium is acute, fluctuating and reversible with impaired attention; dementia is chronic and progressive with intact attention early; depression is a sustained low mood.

Alcohol withdrawal: tremor, sweating and anxiety at 6-24 hours, seizures at 12-48 hours, delirium tremens at 48-96 hours; treat with benzodiazepines and thiamine before glucose.

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

Mental health law in India: Mental Healthcare Act 2017 gives the right to confidentiality, advance directive, nominated representative, and decriminalises attempted suicide.

Gram-positive bacteria retain crystal violet and stain purple; Gram-negative decolourise and take the pink safranin counterstain.

Bacterial growth curve phases: lag, log (exponential), stationary, decline; generation time for E. coli is about 20 minutes in optimal conditions.

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

Universal/standard precautions apply to all body fluids except sweat; hand hygiene is the single most effective infection control measure.

Hepatitis B transmission risk after needlestick from an HBsAg-positive source is about 30% (higher than HIV at about 0.3%); give hepatitis B immunoglobulin and vaccine.

Common pathogens: Staphylococcus aureus (wound, food poisoning), Streptococcus pyogenes (pharyngitis, rheumatic fever), Mycobacterium tuberculosis (acid-fast, Ziehl-Neelsen stain), Vibrio cholerae (rice-water stools).

Malaria: Plasmodium falciparum causes cerebral malaria; vector is female Anopheles mosquito; dengue vector is Aedes aegypti, active by day.

Culture media: MacConkey for Gram-negative lactose fermenters (pink), blood agar for fastidious organisms and haemolysis, Löwenstein-Jensen for TB.

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

Cell injury: reversible swelling and fatty change; irreversible injury shows membrane damage, mitochondrial failure and nuclear changes (pyknosis, karyolysis, karyorrhexis).

Neoplasia: benign tumours are encapsulated and well differentiated; malignant tumours invade and metastasise; TNM = tumour size, node involvement, metastases.

Pharmacokinetics ADME: absorption, distribution, metabolism (mainly hepatic CYP450), excretion (mainly renal); half-life = 0.693 × volume of distribution ÷ clearance.

Loading dose = target concentration × volume of distribution ÷ bioavailability; maintenance dose depends on clearance.

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

Digoxin therapeutic range 0.5-2 ng/mL; toxicity causes nausea, yellow-green visual halos and arrhythmias; hypokalaemia potentiates toxicity.

Aminoglycosides (gentamicin) are nephrotoxic and ototoxic; monitor peak and trough levels; vancomycin needs trough monitoring for MRSA.

Basal metabolic rate is about 1 kcal/kg/hour in adults; total energy need is BMR × activity factor (1.2 sedentary to 1.9 very active).

Balanced diet energy split: carbohydrate 50-60%, fat 20-30%, protein 10-15%; dietary fibre 25-30 g/day; protein RDA about 0.8 g/kg for adults.

Body mass index = weight (kg) ÷ height (m)²; underweight <18.5, normal 18.5-24.9, overweight 25-29.9, obese ≥30.

Deficiency diseases: vitamin A → night blindness and xerophthalmia; vitamin D → rickets/osteomalacia; vitamin C → scurvy; thiamine (B1) → beriberi; niacin (B3) → pellagra; iodine → goitre.

Diabetic diet: complex carbohydrates, high fibre, low glycaemic index; avoid refined sugars; renal diet restricts protein, sodium, potassium and phosphate.

First aid CPR for adults: 30 compressions to 2 breaths, rate 100-120/min, depth 5-6 cm, allow full chest recoil; use AED as soon as available.

Choking adult: up to 5 back blows then up to 5 abdominal thrusts; unconscious choking victim → start CPR.

Recovery position for an unconscious but breathing casualty; do not move a suspected spinal injury unless the airway is at risk; cool burns with running water for 20 minutes.

Management functions: planning, organising, staffing, directing and controlling (POSDCORB); Henri Fayol and Luther Gulick are the classic references.

Span of control: narrow spans suit complex or specialised work; wide spans suit routine work; a head nurse typically supervises 15-25 staff.

Patient classification systems (e.g., dependency levels I-IV) determine nurse-to-patient ratios; ICU 1:1 or 1:2, general ward 1:6.

Nursing audit measures quality of care against set standards; indicators include infection rate, fall rate, medication error rate and pressure ulcer incidence.

Delegation requires the right task, circumstance, person, direction, supervision and evaluation; the registered nurse retains accountability.

Recruitment steps: job analysis, job description, sourcing, selection, induction and orientation; performance appraisal follows probation.

Budget types: line-item, programme and zero-based budgeting; capital budget covers equipment and buildings, operating budget covers salaries and supplies.

Record keeping: incident reports are not part of the patient's clinical record; documentation must be factual, timed, signed and legible.

Four ethical principles: autonomy (respect patient choice), beneficence (do good), non-maleficence (do no harm), justice (fair distribution).

Informed consent requires capacity, adequate information, voluntariness and documentation; a minor under 18 usually needs a guardian unless emancipated or for emergency life-saving care.

Confidentiality can be breached only where legally required: notifiable diseases, court order, child or elder abuse, and serious risk to others.

Nursing councils in India are regulated under the Indian Nursing Council Act 1947; state councils maintain registration and can suspend or remove a nurse.

Professional misconduct examples: practising beyond competence, falsifying records, abandoning a patient, substance misuse on duty, and breaching confidentiality.

Advocacy: the nurse represents the patient's interests, including refusing to give a treatment the patient has declined after informed discussion.

DNR orders require documented physician order, patient or family consent and clear communication; they do not stop comfort care.

Ethical dilemma resolution: identify the problem, gather facts, consider options, apply principles and law, consult the ethics committee, act and review.

Indian Railways zones number 18 (including Kolkata Metro); the largest zone by route length is Northern Railway; headquarters of Western Railway is Mumbai (Churchgate).

Railway health services run zonal and divisional hospitals; the Railway Board is under the Ministry of Railways with the Chairman as chief executive.

Ayushman Bharat has two pillars: Health and Wellness Centres (now Ayushman Arogya Mandir) and PM-JAY insurance cover of ₹5 lakh per family per year.

National Health Policy 2017 targets: raise government health expenditure to 2.5% of GDP and reduce out-of-pocket expenditure to 25%.

National Health Mission combines NRHM (rural) and NUHM (urban); launched as NHM in 2013 by subsuming NRHM.

Notifiable diseases in India include cholera, plague, yellow fever, dengue, and COVID-19; reporting is mandatory to the local health authority.

WHO was founded on 7 April 1948 (World Health Day); headquarters in Geneva; India is in the South-East Asia Region.

Key Indian health bodies: ICMR (research), NCDC (disease control, Delhi), AIIMS (tertiary care), NABH (hospital accreditation), CDSCO (drug regulation).

Series rule: check differences, then ratios, then squares/cubes; e.g., 2, 6, 12, 20, 30 follows n(n+1).

Coding-decoding: apply the same shift to each letter; A=1 to Z=26 lets you convert letters to numbers and back.

Blood relation: draw a family tree; vertical line for generation, horizontal for siblings; 'only son of my mother' when speaker is male means himself.

Direction sense: net displacement uses Pythagoras; a person walking 3 km north then 4 km east is 5 km from the start.

Syllogism: a conclusion follows only if true in every possible Venn diagram of the premises; 'some A are B' does not imply 'some B are A' is false - it does imply it is true.

Odd-one-out: test for common property (all prime, all squares, all with same digit sum); the exception is the answer.

Seating arrangement: fix one definite position, then place others relative to it; 'facing north' means left is west.

Calendar: ordinary year shifts 1 day, leap year 2 days; a century has 5 odd days (100 years) and 400 years have 0.

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

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

Speed = distance ÷ time; convert km/h to m/s by multiplying by 5/18; average speed for equal distances = 2xy/(x + y).

Work: if A finishes in a days and B in b days, together they take ab/(a + b) days; use LCM of days for unit work.

Ratio and proportion: if a:b = c:d then ad = bc; mixture replacement reduces quantity by (1 − x/total)^n.

Computer basics: CPU = ALU + control unit + registers; RAM is volatile, ROM is non-volatile; 1 KB = 1024 bytes, 1 MB = 1024 KB.

Input devices: keyboard, mouse, scanner, microphone; output: monitor, printer, speaker; both: touchscreen, modem.

Common shortcuts: Ctrl+C copy, Ctrl+V paste, Ctrl+X cut, Ctrl+Z undo, Ctrl+S save, Ctrl+P print, Alt+F4 close window; MS Word extension .docx, Excel .xlsx.

Number series: test constant difference, then constant ratio, then alternating or two interleaved series.

Alphabet positions: A=1, E=5, J=10, O=15, T=20, Y=25; reverse position = 27 minus forward position.

Syllogism with 'all A are B' and 'all B are C' gives 'all A are C'; 'no A is B' and 'all B are C' gives 'no A is C'.

Blood relations: 'maternal uncle' = mother's brother; 'paternal aunt' = father's sister; 'cousin' shares grandparents, not parents.

Direction puzzles: track net north-south and east-west separately, then apply Pythagoras for shortest distance.

Coding: if letters are reversed (A↔Z), the code of CAT is XZG; check mirror codes before shift codes.

Ranking: total = rank from top + rank from bottom − 1; if two people swap ranks, the change reveals total strength.

Statement-assumption: an assumption is something unstated but necessary for the statement to hold; reject restatements and extreme claims.

Average = sum ÷ count; if every value increases by k, the average increases by k; combined average uses weighted sums.

Profit and loss: profit% = profit ÷ cost price × 100; selling price = cost price × (100 + profit%) ÷ 100; discount is always on marked price.

Time and distance with trains: time to cross a pole = train length ÷ speed; to cross a platform = (train length + platform length) ÷ speed.

Pipes and cisterns: net rate = fill rate − leak rate; time = 1 ÷ net rate; a leak that empties in b hours has rate −1/b.

Simple interest doubles a sum when R × T = 100; triples when R × T = 200.

Memory units in order: bit < byte < KB < MB < GB < TB; 8 bits = 1 byte; 1 GB = 1024 MB.

Operating system functions: process management, memory management, file system and device control; examples are Windows, Linux, macOS, Android.

Internet basics: IP address identifies a device, DNS converts domain names to IP, HTTP/HTTPS transfers web pages, email uses SMTP to send and POP3/IMAP to receive.