Tamil Nadu HSE First Year Nursing (Vocational) cheat sheet

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

Normal adult resting values: pulse 60-100/min, respiratory rate 12-20/min, blood pressure about 120/80 mmHg, oral temperature 36.5-37.5 degrees Celsius.

Adult blood volume is roughly 5 litres; plasma is about 55 percent and formed elements about 45 percent (haematocrit).

Cardiac output equals heart rate multiplied by stroke volume; average resting output is about 5 litres per minute.

The right heart pumps deoxygenated blood to the lungs (pulmonary circuit); the left heart pumps oxygenated blood to the body (systemic circuit).

Gas exchange occurs in the alveoli by simple diffusion; oxygen moves down its gradient into blood, carbon dioxide moves out.

The nephron is the functional unit of the kidney: glomerular filtration, tubular reabsorption, and tubular secretion produce urine.

Bones store calcium and phosphorus; parathyroid hormone raises blood calcium, calcitonin lowers it.

The nursing process runs in five steps: assessment, diagnosis, planning, implementation, and evaluation; evaluation feeds back into reassessment.

Maslow's hierarchy orders needs: physiological first, then safety, love and belonging, esteem, and self-actualisation; lower needs are met first.

Vital signs are recorded on admission, before and after procedures or blood products, after falls, and at intervals set by policy or condition.

Body mechanics rules: keep the load close to the body, widen the base of support, bend the knees not the waist, and avoid twisting while lifting.

Pressure injury risk is staged from 1 (non-blanchable erythema) to 4 (full-thickness tissue loss); staging is done only after the wound is cleaned.

Intake and output records count all oral, tube, and intravenous fluids in, and urine, vomitus, drainage, and insensible loss estimates out.

Asepsis is medical (clean technique, reduces organisms) or surgical (sterile technique, excludes all organisms); sterile fields are never turned away from view.

Adult basic life support sequence: check responsiveness and breathing, call for help, start chest compressions at 100-120/min, depth 5-6 cm, ratio 30 compressions to 2 breaths.

Severe external bleeding is controlled by direct pressure, then packing or tourniquet if pressure fails; a tourniquet time must be recorded.

Choking with effective cough: encourage coughing; ineffective cough in a conscious adult: back blows and abdominal thrusts (Heimlich manoeuvre).

Recovery position is used for an unresponsive person who is breathing normally and has no suspected spinal injury.

Burns: cool with running water for about 20 minutes, remove jewellery and loose clothing, do not burst blisters, and cover with a clean non-adherent dressing.

Snakebite first aid: immobilise the limb, keep the patient calm and lying, remove constricting items, and transport to hospital; do not cut or suck the wound.

Fracture immobilisation splints the joint above and below the injury; check distal pulse, sensation, and colour before and after splinting.

Poisoning by mouth in a conscious patient: do not induce vomiting; identify the substance and contact the poison information centre.

Primary health care principles: equitable access, community participation, intersectoral coordination, appropriate technology, and a focus on prevention.

The three levels of prevention are primary (before disease), secondary (early detection and treatment), and tertiary (limitation of disability and rehabilitation).

Safe water for drinking should be free of coliforms; chlorination residual of about 0.2-0.5 mg/L at the tap indicates adequate disinfection.

Sanitation indicators include safe excreta disposal, refuse disposal, drainage, and protection of water sources from contamination.

Immunisation under the national schedule begins at birth with BCG, hepatitis B birth dose, and oral polio vaccine; schedules are followed by age.

Vector control for mosquitoes covers elimination of stagnant water, larvivorous fish, and personal protection such as nets and repellents.

Household food hygiene rules: wash hands, separate raw and cooked food, cook thoroughly, keep food at safe temperatures, and use safe water.

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

Balanced diet concept divides foods into energy-giving (cereals, fats), body-building (pulses, milk, meat), and protective (fruits, vegetables) groups.

Protein-energy malnutrition appears as marasmus (severe wasting, no oedema) or kwashiorkor (oedema, fatty liver, low serum albumin).

Deficiency diseases: vitamin A causes night blindness and xerophthalmia; vitamin D causes rickets in children and osteomalacia in adults; iron causes microcytic anaemia.

Iodine deficiency causes goitre and cretinism; iodised salt is the main preventive measure.

Breast milk is the ideal infant food for the first six months; colostrum is rich in immunoglobulin A and should not be discarded.

Therapeutic diets modify consistency, energy, protein, fibre, sodium, or specific nutrients; a diabetic diet controls total carbohydrate and distributes it across meals.

Antenatal visits are scheduled at least monthly in the first two trimesters, fortnightly at 28-36 weeks, and weekly thereafter until delivery.

Expected date of delivery is calculated from the first day of the last menstrual period using Naegele's rule: add 9 months and 7 days.

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

The three stages of labour are cervical dilatation, expulsion of the fetus, and delivery of the placenta; the third stage carries the highest risk of haemorrhage.

Exclusive breastfeeding for six months, then complementary feeding with continued breastfeeding up to two years.

Newborn assessment uses APGAR score at 1 and 5 minutes: appearance, pulse, grimace, activity, and respiration, each scored 0-2.

Child growth is monitored by plotting weight and height on growth charts; a flat or falling weight curve signals faltering growth.

Fever management: antipyretics, tepid sponging, fluids, and monitoring of temperature, pulse, and blood pressure; avoid cold sponging in shivering patients.

Oxygen therapy is titrated to the prescribed flow rate; humidify at higher flows and monitor for oxygen toxicity and carbon dioxide retention.

Post-operative care priorities: airway and breathing, circulation, wound and drain inspection, pain control, and early mobilisation to prevent deep vein thrombosis.

Signs of wound infection: increasing pain, redness, warmth, swelling, purulent discharge, and fever.

Fluid balance in dehydration is judged by skin turgor, mucous membranes, urine output, and pulse; a urine output below 0.5 mL/kg/hour suggests hypoperfusion.

Chest physiotherapy and deep breathing exercises prevent atelectasis and pneumonia in bedridden patients.

A patient with a cast needs neurovascular checks: colour, warmth, sensation, movement, capillary refill, and pulse distal to the cast.

Rights of medication administration: right patient, right drug, right dose, right route, right time, right documentation, and right to refuse.

The prescription is checked for legibility, dose, route, frequency, and allergies before preparation; unclear orders are clarified, never guessed.

Oral medicines are not given to an unconscious patient; the enteral route is used only with a confirmed tube position.

Adrenaline is the first-line drug in anaphylaxis, given intramuscularly into the anterolateral thigh.

Paracetamol overdose damages the liver; acetylcysteine is the antidote and is most effective when given early.

High-alert medicines such as insulin, heparin, and concentrated potassium require independent double checks and clear labelling.

Adverse drug reactions are reported through the pharmacovigilance system; the suspected drug is documented on the patient record.

The chain of infection has six links: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host; breaking any link prevents spread.

Hand hygiene is the single most effective measure; alcohol-based rub is used for routine care and soap and water when hands are visibly soiled or after contact with spores.

Personal protective equipment order: gown, mask, goggles, gloves on; gloves off first, then goggles, gown, and mask, followed by hand hygiene.

Standard precautions apply to all patients; transmission-based precautions are contact, droplet, and airborne.

Sterilisation kills all microorganisms including spores; disinfection reduces pathogens but may not kill spores.

Autoclaving uses saturated steam under pressure, typically 121 degrees Celsius at 15 psi for 15-20 minutes.

Needlestick injury: wash the site with soap and water, do not squeeze or suck, report immediately, and follow post-exposure prophylaxis protocol.

Therapeutic communication techniques include active listening, open questions, reflection, clarification, and summarising; false reassurance and advice-giving block disclosure.

Informed consent requires the patient to be competent, to receive adequate information about risks and benefits, and to decide voluntarily.

Confidentiality: patient information is shared only with those involved in care or as required by law; casual discussion of cases is a breach.

Professional boundaries require that nurses do not accept gifts that create obligation, do not enter financial relationships, and do not use patients for personal gain.

Documentation is a legal record; errors are corrected by a single line, initials, date, and the correct entry, never by erasure or overwriting.

Advocacy means acting in the patient's interest, including reporting unsafe practice through the proper channel.

Handover uses structured formats such as SBAR: situation, background, assessment, recommendation.

The medical record is a legal document; entries are made at the time of care, in ink, signed, and never altered retrospectively.

Nursing notes use objective, factual language and record what was observed and done, not opinions about the patient.

The problem-oriented record has four parts: database, problem list, initial plan, and progress notes (SOAP: subjective, objective, assessment, plan).

Records are retained for the period set by institutional and statutory policy; they may be required as evidence in court.

Confidentiality of records: access is limited to authorised staff, and release requires consent or legal authority.

Vital sign charts, intake-output sheets, medication charts, and falls risk assessments are part of the legal record.

Late entries are marked as late with the actual time of writing and the reason, not backdated.

Air pollution is measured as suspended particulate matter; PM10 and PM2.5 penetrate the respiratory tract and are linked to respiratory and cardiac disease.

Water pollution indicators include chemical oxygen demand, biological oxygen demand, and coliform counts; high coliform counts indicate faecal contamination.

Occupational hazards are physical (noise, heat, radiation), chemical (solvents, dusts, fumes), biological, ergonomic, and psychosocial.

Noise-induced hearing loss occurs with prolonged exposure above about 85 decibels; hearing protection and engineering controls are preventive measures.

Silicosis follows inhalation of silica dust; asbestosis and mesothelioma follow asbestos exposure; both are notifiable occupational diseases.

Ergonomic injury prevention: correct workstation height, neutral wrist posture, lifting with the legs, and regular breaks from repetitive tasks.

Biomedical waste is segregated at source into colour-coded containers; sharps go into puncture-proof containers, and waste is never mixed after segregation.

Occupational health services include pre-employment medical examination, periodic health checks, and provision of protective equipment.