Tamil Nadu HSE First Year Nursing (General) cheat sheet

Vital sign normal adult ranges: temperature 36.5-37.5 °C oral, pulse 60-100/min, respiration 12-20/min, blood pressure 120/80 mmHg, SpO2 95-100%.

Pulse sites in order of routine use: radial, brachial, carotid, femoral, popliteal, posterior tibial, dorsalis pedis; carotid is the last to disappear in cardiac arrest.

Stages of wound healing: haemostasis, inflammation (0-3 days), proliferation/granulation (3-21 days), maturation/remodelling (up to 1 year).

Pressure ulcer staging: Stage 1 intact skin with non-blanchable erythema; Stage 2 partial-thickness loss; Stage 3 full-thickness loss with visible fat; Stage 4 exposed bone, tendon or muscle.

Medical asepsis reduces organism transfer (handwashing, clean gloves); surgical asepsis destroys all organisms (sterile field, sterile gloves, autoclave at 121 °C, 15 psi, 15-20 min).

Positioning rules: Fowler and semi-Fowler for dyspnoea and cardiac failure, Trendelenburg for shock (contraindicated in head injury), lateral Sims for enema and unconscious patients.

Body temperature routes ranked by typical reading: rectal is 0.5 °C higher than oral, axillary 0.5 °C lower than oral; oral route avoided in children under 5 and in unconscious patients.

Intake-output rule: 1 mL of urine per kg per hour is adequate adult output; report output below 30 mL/hour or 400 mL/day as oliguria.

Adult skeleton has 206 bones: axial skeleton 80 (skull 22, hyoid 1, auditory ossicles 6, vertebral column 26, ribs 24, sternum 1) and appendicular 126.

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

Normal blood values: haemoglobin 13-17 g/dL (male) and 12-15 g/dL (female), RBC 4.5-5.5 million/mm³, WBC 4,000-11,000/mm³, platelets 1.5-4 lakh/mm³.

Cardiac conduction order: SA node (60-100/min) → AV node (40-60/min) → bundle of His → right and left bundle branches → Purkinje fibres (20-40/min).

Nephron is the functional unit of the kidney, about 1 million per kidney; glomerular filtration rate is normally 125 mL/min and filtration occurs by hydrostatic pressure.

Respiratory mechanics: inspiration is active (diaphragm and external intercostals), expiration is passive at rest; tidal volume 500 mL, vital capacity about 4,800 mL in adults.

Digestion sequence: carbohydrate digestion begins in the mouth (salivary amylase), protein in the stomach (pepsin with HCl), fat mainly in the small intestine with bile and pancreatic lipase.

Cranial nerves number 12 pairs; vagus (X) is the longest and supplies thoracic and abdominal viscera; facial (VII) controls facial expression and taste on the anterior tongue.

Adult CPR sequence: check response and breathing, call for help, 30 chest compressions at 100-120/min, depth 5-6 cm, then 2 rescue breaths; ratio 30:2, switch rescuer every 2 minutes.

Choking: for conscious adult give 5 back blows then 5 abdominal thrusts (Heimlich); for infants under 1 year use 5 back blows and 5 chest thrusts, never abdominal thrusts.

Recovery position is for an unconscious but breathing patient with no spinal injury; it maintains airway patency and prevents aspiration.

Haemorrhage control order: direct pressure with sterile pad, elevate limb, pressure on the supplying artery, then tourniquet as last resort; record tourniquet time.

Burns rule of nines in adults: head 9%, each arm 9%, each leg 18%, anterior trunk 18%, posterior trunk 18%, perineum 1%; cool with running water for 20 minutes, never apply ice or oil.

Fracture first aid: immobilise the joint above and below the fracture, check distal pulse, sensation and capillary refill before and after splinting.

Poisoning: conscious patient - do not induce vomiting with corrosives or petroleum products; unconscious patient - left lateral position, airway protection, shift to hospital with the container.

Snake bite first aid: keep patient calm and still, immobilise the bitten limb at heart level or below, remove rings and tight clothing, never incise, suck or apply a tight tourniquet.

Tuberculosis: causative organism Mycobacterium tuberculosis, spread by airborne droplet nuclei; diagnosis by sputum AFB smear, CBNAAT/GeneXpert and chest X-ray; treatment is DOTS with 2 months intensive plus 4 months continuation phase.

Malaria: transmitted by female Anopheles mosquito; Plasmodium vivax has a 48-hour tertian cycle, P. falciparum is the most dangerous and causes cerebral malaria; vector control by indoor residual spray and larvivorous fish.

Dengue: Aedes aegypti bites during daytime; warning signs are persistent vomiting, abdominal pain, mucosal bleeding and platelet fall; avoid aspirin and NSAIDs.

Cholera: Vibrio cholerae spread by contaminated water; profuse rice-water stools cause rapid dehydration; treatment is oral rehydration solution and intravenous Ringer lactate, not antibiotics alone.

Leprosy: Mycobacterium leprae, spread by prolonged close contact, affects skin and peripheral nerves; multi-drug therapy with rifampicin, dapsone and clofazimine prevents deformity.

Hepatitis B transmission routes: blood, sexual contact and mother-to-child; vaccine is given at birth within 24 hours, and the virus is far more infectious than HIV.

Non-communicable disease risk factors: tobacco, alcohol, unhealthy diet, physical inactivity, obesity, raised blood pressure and blood sugar; hypertension is silent and defined as 140/90 mmHg or above.

Diabetes diagnostic values: fasting plasma glucose 126 mg/dL or more, 2-hour post-load 200 mg/dL or more, HbA1c 6.5% or more; normal fasting is below 100 mg/dL.

Energy values: carbohydrate 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g; 1 kcal equals 4.184 kJ.

Balanced diet proportions: carbohydrate 55-60% of energy, fat 20-30%, protein 10-15%; fibre 25-40 g/day for adults.

Protein-energy malnutrition: marasmus is severe wasting without oedema from overall energy deficit; kwashiorkor shows oedema, moon face and fatty liver from protein deficit with adequate energy.

Deficiency diseases: vitamin A - night blindness and Bitot spots; vitamin D - rickets in children, osteomalacia in adults; vitamin C - scurvy with bleeding gums; iron - microcytic anaemia; iodine - goitre.

Fat-soluble vitamins A, D, E and K are stored in the liver and need bile for absorption; water-soluble B complex and C are not stored and excess is excreted in urine.

Therapeutic diets: diabetic diet is low in refined sugar with high fibre and regular meal timing; renal diet restricts protein, sodium, potassium and fluid; hypertension diet is low sodium, under 5 g salt per day.

Food safety: danger zone 5-60 °C; cooked food kept above 60 °C or refrigerated below 5 °C; reheat leftovers once to at least 74 °C.

Exclusive breastfeeding for 6 months, complementary feeding from 6 months; colostrum is rich in immunoglobulin A and should never be discarded.

Normal pregnancy lasts 280 days or 40 weeks from the last menstrual period; expected date of delivery by Naegele rule: first day of LMP minus 3 months plus 7 days plus 1 year.

Three trimesters: first 0-12 weeks (organogenesis, greatest teratogen risk), second 13-28 weeks, third 29-40 weeks.

Antenatal visits under Indian guidelines: at least 4 visits, first before 12 weeks, then at 14-26, 28-34 and 36 weeks onward; check weight, BP, haemoglobin, urine albumin and fundal height.

Stages of labour: first stage from true labour to full dilatation (nullipara 12-16 h), second stage from full dilatation to birth of baby (up to 2 h), third stage delivery of placenta (up to 30 min).

APGAR score is assessed at 1 and 5 minutes after birth: Appearance, Pulse, Grimace, Activity, Respiration; each 0-2, total 10; score below 7 needs resuscitation.

Danger signs in pregnancy needing immediate referral: bleeding per vaginum, severe headache with blurred vision, convulsions, reduced fetal movement, leaking per vaginum, high fever.

Postpartum haemorrhage is blood loss over 500 mL after vaginal birth or 1000 mL after caesarean; the commonest cause is uterine atony, managed by uterine massage and oxytocin.

Child growth milestones: head control by 3 months, sitting without support by 6-8 months, walking by 12-15 months, speaking two-word phrases by 2 years.

Primary health care principles from the Alma-Ata declaration: equitable distribution, community participation, intersectoral coordination, appropriate technology and focus on prevention.

Levels of prevention: primary (immunisation, health education), secondary (early diagnosis and screening), tertiary (rehabilitation and disability limitation).

Cold chain: OPV and measles vaccine stored at -20 °C to -15 °C, most other vaccines at 2-8 °C; freeze-sensitive vaccines such as DPT, hepatitis B and TT must never be frozen.

National immunisation schedule: BCG, OPV-0 and hepatitis B birth dose at birth; then 6, 10 and 14 weeks for pentavalent, OPV and rotavirus; measles-rubella at 9-12 months and 16-24 months; DPT booster at 16-24 months.

Safe drinking water: chlorination residual free chlorine 0.2-0.5 mg/L; turbidity below 5 NTU; boiling is the simplest household disinfection method.

Sanitation standards: sanitary latrine should be at least 10 m from a drinking water source; refuse should be stored in covered bins and disposed by composting, burial or incineration.

Vector control measures: eliminate stagnant water for mosquitoes, cover water storage, use larvivorous fish, spray residual insecticide on walls, and use bed nets.

Vital statistics: crude birth rate is live births per 1,000 population per year; infant mortality rate is infant deaths under 1 year per 1,000 live births; maternal mortality ratio is maternal deaths per 100,000 live births.

Bacterial shapes: cocci (spherical), bacilli (rod), spirilla (spiral), vibrio (comma); Staphylococcus aureus appears in grape-like clusters, Streptococcus in chains.

Gram staining steps: crystal violet, Gram iodine, decolourise with alcohol, counterstain with safranin; Gram-positive retain purple, Gram-negative appear pink.

Sterilisation methods: autoclave 121 °C at 15 psi for 15-20 minutes (moist heat), hot air oven 160 °C for 2 hours (dry heat), flaming for loops, membrane filters for heat-labile fluids.

Disinfectants: 1% sodium hypochlorite for blood spills, 70% alcohol for skin and surfaces, glutaraldehyde 2% for instruments, carbolic acid is bacteriostatic at low strength.

Hand hygiene is the single most effective measure to prevent hospital-acquired infection; wash for at least 40-60 seconds with soap and water, or use alcohol rub for 20-30 seconds.

Universal precautions: treat all blood and body fluids as potentially infectious; use gloves, gown, mask and eye protection; never recap needles; dispose sharps in puncture-proof container.

Normal flora protects the host; opportunistic infection occurs when immunity falls, for example Candida after broad-spectrum antibiotics.

Immunity types: active immunity follows infection or vaccination and takes weeks to develop; passive immunity is transferred through placenta or breast milk and is temporary.

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

Routes ranked by onset: intravenous fastest, then intramuscular, subcutaneous, oral, topical; intravenous gives 100% bioavailability.

Common abbreviations: PO by mouth, IM intramuscular, SC subcutaneous, IV intravenous, BD twice daily, TDS three times daily, QID four times daily, HS at bedtime, SOS when required, PRN as needed.

Calculation formula: dose required = (desired dose ÷ stock strength) × stock volume; for example 250 mg needed from 500 mg in 5 mL gives 2.5 mL.

Intramuscular injection sites: ventrogluteal is safest for adults and children over 7 months, deltoid for small volumes up to 1 mL, vastus lateralis for infants.

Insulin is given subcutaneously, stored at 2-8 °C, never frozen; use a 45-degree angle in thin patients and rotate sites to prevent lipodystrophy.

Adverse drug reaction types: side effect, toxic effect, allergy, idiosyncrasy, tolerance and dependence; anaphylaxis needs adrenaline 0.5 mg intramuscular immediately.

Antibiotics must complete the prescribed course; antitubercular drugs are taken in combination to prevent resistance; paracetamol overdose causes liver damage.

Nursing ethics principles: autonomy (patient's right to decide), beneficence (do good), non-maleficence (do no harm), justice (fair treatment) and confidentiality.

Informed consent needs three elements: capacity to decide, full information about risks and benefits, and voluntary decision without coercion.

Professional boundaries: never accept gifts that influence care, never discuss patients outside clinical need, never post patient details on social media.

Therapeutic communication techniques: active listening, open-ended questions, restating, reflection, silence and clarification; closed questions are used to obtain specific facts.

Barriers to communication: jargon, leading questions, false reassurance, value judgement, changing the subject and giving premature advice.

Incident reporting: any medication error, fall or needle-stick injury is documented factually and reported immediately, regardless of blame, to prevent recurrence.

Confidentiality exceptions: when required by law or court, when the patient consents, and when there is serious risk to the patient or the public.

The Indian Nursing Council Act 1947 regulates nursing education and registration; nurses must practise within their scope and follow institutional protocols.