Tamil Nadu HSE Second Year Nursing (General) cheat sheet

Vital sign reference ranges for adults: oral temperature 36.5–37.5 °C; radial pulse 60–100/min; respiration 12–20/min; blood pressure below 120/80 mmHg; oxygen saturation 95–100%.

Normal urine output in adults is 1,500–2,000 mL per 24 hours; output below 30 mL/hour (or under 400 mL/day) indicates oliguria and must be reported.

Stages of the nursing process in fixed order: Assessment, Diagnosis, Planning, Implementation, Evaluation (ADPIE).

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

Fall risk is scored with the Morse Fall Scale; a higher score requires documented fall precautions such as bed in low position and call bell within reach.

Intramuscular injection sites and maximum volumes: ventrogluteal (preferred, up to 3 mL), dorsogluteal (up to 4 mL, risk to sciatic nerve), deltoid (up to 1 mL), vastus lateralis (up to 3 mL in adults).

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

Sterile field rule: any object below waist level or out of direct line of sight is considered contaminated; sterile-to-sterile contact only.

Wound healing intention: primary intention for clean approximated surgical edges, secondary intention for open wounds healing by granulation, tertiary intention when closure is deliberately delayed.

Adult normal blood cell values: haemoglobin 13–17 g/dL (male) and 12–15 g/dL (female); total leucocyte count 4,000–11,000/mm³; platelet count 150,000–450,000/mm³.

Cardiac output equals heart rate multiplied by stroke volume; normal resting output is about 5 L/min.

Normal adult blood pH is 7.35–7.45; bicarbonate 22–26 mEq/L; arterial carbon dioxide 35–45 mmHg.

The nephron is the functional unit of the kidney (about 1 million per kidney); glomerular filtration rate averages 125 mL/min.

Cranial nerves: 12 pairs; the vagus (X) supplies thoracic and abdominal viscera; the facial (VII) supplies muscles of facial expression.

Bones of the adult skeleton number 206; the vertebral column has 7 cervical, 12 thoracic, 5 lumbar, 5 fused sacral and 4 fused coccygeal vertebrae.

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

The respiratory centre lies in the medulla oblongata and is driven mainly by rising arterial carbon dioxide, not falling oxygen.

Thyroid hormones (T3, T4) regulate basal metabolic rate; calcitonin lowers serum calcium while parathyroid hormone raises it.

Gram stain sequence: crystal violet (1 min) → iodine mordant → alcohol decolouriser → safranin counterstain; Gram-positive organisms retain purple, Gram-negative appear pink.

Bacterial growth phases: lag, log (exponential), stationary, decline; most antibiotics act on the log phase.

Autoclaving sterilises at 121 °C, 15 psi, for 15–20 minutes; it kills spores, which boiling at 100 °C does not.

Normal flora of the skin is dominated by Staphylococcus epidermidis; the colon is dominated by anaerobes such as Bacteroides and E. coli.

Universal precautions treat all blood and body fluids as potentially infectious; hand hygiene is the single most effective infection-control measure.

Notifiable diseases in India include cholera, plague, yellow fever, dengue, tuberculosis, polio and diphtheria; reporting is mandatory to the local health authority.

Sterilisation versus disinfection: sterilisation destroys all microorganisms including spores; disinfection reduces pathogens on inanimate objects but may not kill spores.

Immunoglobulin classes: IgM appears first in infection, IgG crosses the placenta and dominates in secondary response, IgA protects mucosa, IgE mediates allergy.

Hospital-acquired infection is defined as infection acquired 48 hours or more after admission and not incubating at the time of admission.

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

Basal metabolic rate is measured by indirect calorimetry; the Harris–Benedict equation estimates BMR from weight, height, age and sex.

Body mass index equals weight in kilograms divided by height in metres squared; 18.5–24.9 is normal, 25–29.9 overweight, 30 and above obese.

Protein requirement for healthy adults is 0.8–1.0 g/kg/day; pregnancy adds about 15 g/day in the second half and lactation about 20 g/day.

Fat-soluble vitamins are A, D, E and K and are stored in the liver and adipose tissue; water-soluble vitamins B-complex and C are not stored and excess is excreted.

Deficiency diseases: vitamin A - night blindness and xerophthalmia; vitamin D - rickets in children and osteomalacia in adults; vitamin C - scurvy; thiamine (B1) - beriberi; niacin - pellagra.

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

Therapeutic diets: diabetic diet restricts simple sugars and controls total carbohydrate; low-sodium diet for hypertension and cardiac failure; low-protein diet for chronic kidney disease.

Iodine deficiency causes goitre and cretinism; iodised salt is the standard preventive measure under the National Iodine Deficiency Disorders Control Programme.

Myocardial infarction triad: chest pain lasting over 20 minutes, ST-segment elevation or depression on ECG, and raised cardiac troponin; aspirin is given unless contraindicated.

Hypoglycaemia is blood glucose below 70 mg/dL with sweating, tremor and confusion; give 15 g fast-acting carbohydrate and recheck after 15 minutes.

Diabetic ketoacidosis presents with hyperglycaemia above 250 mg/dL, ketones, metabolic acidosis (pH below 7.30) and Kussmaul breathing; treatment is IV fluids, insulin infusion and potassium replacement.

Chronic obstructive pulmonary disease: give controlled low-flow oxygen (1–2 L/min) to retain hypoxic drive, and teach pursed-lip breathing.

Left-sided heart failure produces pulmonary oedema, orthopnoea and pink frothy sputum; right-sided failure produces raised jugular venous pressure, hepatomegaly and pedal oedema.

Post-operative care priorities: airway, pain control, early mobilisation, deep-breathing exercises, wound inspection and monitoring for deep vein thrombosis.

Stroke assessment uses the FAST mnemonic (Face, Arm, Speech, Time); thrombolysis with alteplase is considered within 4.5 hours of onset.

Hepatic encephalopathy is linked to raised ammonia; lactulose traps ammonia in the gut and lowers serum levels.

Tuberculosis treatment under DOTS uses directly observed therapy; sputum converts and the patient becomes non-infectious usually within 2–3 weeks of effective therapy.

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

Normal labour stages: first stage from onset of true labour to full cervical dilatation (about 12–18 hours in primigravida); second stage to delivery of the baby; third stage to delivery of placenta (up to 30 minutes); fourth stage is the first 2 hours after delivery.

Normal fetal heart rate is 110–160 beats/min; below 110 or above 160 requires repositioning the mother and urgent assessment.

Partograph plotting begins in active labour at 4 cm dilatation; the alert line and action line guide referral decisions.

Puerperal sepsis is infection of the genital tract within 42 days of delivery; fever of 38 °C or more on two occasions after the first 24 hours is significant.

Apgar score is recorded at 1 and 5 minutes after birth; five components (heart rate, respiratory effort, muscle tone, reflex irritability, colour) each scored 0–2, maximum 10.

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

Immunisation schedule in India: BCG, OPV-0 and hepatitis B at birth; pentavalent and OPV at 6, 10 and 14 weeks; measles-rubella at 9–12 months and 16–24 months; DPT booster at 16–24 months.

Oral rehydration solution for diarrhoea: give after each loose stool; zinc supplementation for 14 days reduces duration and recurrence.

Primary health centre covers a population of about 30,000 in plains and 20,000 in hilly or tribal areas; a sub-centre covers 5,000 and 3,000 respectively.

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

Epidemiological triad: agent, host and environment; disease occurs when these interact to favour transmission.

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

Home visiting steps: establish rapport, assess family health needs, plan with the family, provide care and health teaching, record and evaluate.

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

Bag technique: carry a clean bag with soap, towel, antiseptic, thermometer and records; wash hands, spread a clean paper, then use articles without contaminating the contents.

Community diagnosis uses tools such as family health survey, vital statistics and rapid survey; the community health nurse records births and deaths for local vital statistics.

National programmes relevant to community nursing include the National Health Mission, National Tuberculosis Elimination Programme, and National Programme for Prevention and Control of Non-Communicable Diseases.

ABCDE primary survey: Airway with cervical spine control, Breathing, Circulation with haemorrhage control, Disability (neurological), Exposure with temperature control.

Adult CPR: compressions at 100–120/min at least 5 cm deep, ratio 30 compressions to 2 breaths, switch compressor every 2 minutes; use an AED as soon as available.

Choking in a conscious adult: give up to 5 back blows then 5 abdominal thrusts (Heimlich manoeuvre), alternating until the object is expelled.

Severe external bleeding: apply direct pressure with a sterile pad, elevate the limb if no fracture, and use a tourniquet only when direct pressure fails.

Burns: cool with running water for 20 minutes, remove jewellery, cover with a clean non-adherent dressing; do not apply ice, butter or toothpaste.

Poisoning: identify the agent, do not induce vomiting after corrosive or petroleum ingestion, and contact the poison information centre.

Fracture immobilisation: splint the joint above and below the fracture before moving the casualty; check distal pulse, colour and sensation.

Snake bite: immobilise the limb below heart level, remove tight items, do not incise or suck the wound, and transport rapidly for antivenom.

Triage colour codes: red immediate, yellow urgent, green delayed, black deceased or expectant.

Informed consent requires the patient be competent, receive adequate information about risks and benefits, and consent voluntarily; consent is taken by the person performing the procedure.

Confidentiality is a core duty; disclosure is justified only with consent, by legal order, or to prevent serious harm to others.

The International Council of Nurses Code of Ethics has four elements: health promotion, illness prevention, restoration of health and alleviation of suffering.

Autonomy, beneficence, non-maleficence and justice are the four ethical principles; veracity and fidelity are supporting duties.

Advocacy means the nurse speaks for the patient's rights and preferences, even against institutional pressure.

Professional boundaries prohibit personal or financial relationships with patients and prohibit accepting gifts that could influence care.

Do-not-resuscitate orders require documented physician order and, where possible, patient or family participation; a nurse may not initiate one independently.

Reporting an incompetent or impaired colleague follows the chain of command and the nursing council's reporting requirements; silence is not ethical protection.

The Indian Nursing Council Act, 1947 established the Indian Nursing Council to regulate nursing education and maintain the register; state nursing councils register nurses locally.

The Nurses Registration Act and state council rules govern registration, renewal and removal of names for professional misconduct.

Legal terms: assault is threat of harm, battery is actual touching without consent, negligence is failure to give reasonable care, defamation is harm to reputation.

The Consumer Protection Act allows patients to claim compensation for deficiency in service; hospitals and nursing services fall within its scope.

Documentation is a legal record: record objectively, in chronological order, with date, time and signature; never alter a record retrospectively without proper correction procedure.

Incident reporting must be factual, timely and non-punitive; the report is not a substitute for documenting the event in the patient record.

Therapeutic communication techniques: open-ended questions, active listening, reflection, clarification, silence; avoid false reassurance, advising and changing the subject.

SBAR handover: Situation, Background, Assessment, Recommendation - a structured tool for safe transfer of patient information.

Body temperature measurement sites and offsets: oral and tympanic approximate core temperature; axillary reads about 0.5 °C lower; rectal about 0.5 °C higher.

Pulse deficit is the difference between apical and radial rates; count apical for a full minute and radial simultaneously in atrial fibrillation.

Blood pressure cuff width should be about 40% of arm circumference; a cuff too small falsely raises the reading.

Normal adult respiratory rate 12–20/min; count for a full minute, noting depth, rhythm and effort.

Hand hygiene with alcohol-based rub takes 20–30 seconds; with soap and water 40–60 seconds; follow the WHO five moments.

Positioning: Fowler's for breathlessness, Trendelenburg for shock (controversial), lateral for unconscious patients to protect the airway, and semi-prone for vomiting.

Hot and cold applications: cold reduces inflammation and oedema in the first 24–48 hours; heat increases blood flow and relieves muscle spasm after the acute phase.

Enema administration: position left lateral with knees flexed, insert tip about 7–10 cm for adults, and instil solution slowly.

The heart's conduction order: sinoatrial node → atrioventricular node → bundle of His → right and left bundle branches → Purkinje fibres.

Stroke volume depends on preload, afterload and contractility; increased preload (Starling's law) raises stroke volume until overstretch.

Normal lung volumes: tidal volume about 500 mL, vital capacity about 4,800 mL in adult males; residual volume cannot be exhaled.

The liver performs detoxification, bile production, glycogen storage and plasma protein synthesis including albumin and clotting factors.

The pancreas has exocrine acinar cells secreting digestive enzymes and endocrine islets of Langerhans secreting insulin, glucagon and somatostatin.

The menstrual cycle averages 28 days; ovulation occurs about 14 days before the next period; the corpus luteum secretes progesterone.

Blood groups: A has A antigen and anti-B antibody; B has B antigen and anti-A; AB has both antigens and no antibodies; O has no antigens and both antibodies.

The autonomic nervous system: sympathetic raises heart rate and dilates pupils (fight or flight); parasympathetic (vagus) slows heart rate and stimulates digestion.

Sterilisation methods: moist heat (autoclave), dry heat (hot air oven 160 °C for 2 hours), ethylene oxide gas, gamma radiation, and membrane filtration for heat-labile fluids.

Culture media: nutrient agar for general growth, MacConkey for Gram-negative and lactose fermentation, blood agar for haemolysis patterns.

Common pathogens and diseases: Mycobacterium tuberculosis - tuberculosis; Vibrio cholerae - cholera; Salmonella typhi - typhoid; Plasmodium - malaria; Candida albicans - candidiasis.

Antibiotic resistance arises from misuse; completing the prescribed course and culture-guided therapy reduce selection pressure.

Standard precautions apply to all patients; transmission-based precautions add contact, droplet or airborne measures for specific infections.

Airborne precautions require an N95 respirator, negative-pressure room and door closed; used for tuberculosis, measles and chickenpox.

Droplet precautions require a surgical mask within 1 metre; used for influenza, pertussis, diphtheria and meningococcal meningitis.

Vaccines: live attenuated (BCG, OPV, measles) induce strong lasting immunity but are avoided in immunocompromised patients; killed vaccines (DPT, hepatitis B) require boosters.

Balanced diet proportions: about 50–60% of energy from carbohydrate, 10–15% from protein and 20–30% from fat.

Dietary fibre 25–30 g/day improves bowel function and lowers cholesterol; sources include whole grains, fruits and vegetables.

Sodium restriction: mild 2–3 g, moderate 1 g and strict 500 mg sodium per day; 1 teaspoon of salt is about 5–6 g.

Enteral feeding: check tube position, elevate the head of the bed 30–45°, and check residual volume per protocol; give at room temperature and flush the tube after feeds.

Parenteral nutrition is indicated when the gut cannot be used; monitor blood glucose, electrolytes and signs of central line infection.

Kwashiorkor is protein deficiency with oedema and a fatty liver; marasmus is overall energy and protein deficiency with severe wasting.

Anaemia in pregnancy is prevented with iron and folic acid supplementation (60 mg elemental iron and 500 mcg folic acid daily) under the national programme.

Food safety: keep hot food above 60 °C and cold food below 5 °C; reheat leftovers thoroughly; wash hands and utensils to prevent food-borne illness.

Asthma acute attack: sit the patient upright, give a short-acting beta-2 agonist by nebuliser or inhaler with spacer, oxygen to keep saturation above 94%, and corticosteroids.

Angina versus infarction: angina is relieved by rest or sublingual nitroglycerin within minutes; infarction pain persists and nitroglycerin gives little relief.

Hypertension grades: stage 1 is 140–159/90–99 mmHg; stage 2 is 160 and above/100 and above; hypertensive emergency has organ damage.

Chronic kidney disease: monitor creatinine, potassium and fluid balance; restrict protein, potassium and sodium; prepare for dialysis or transplant.

Post-operative deep vein thrombosis prevention: early ambulation, leg exercises, compression stockings and prescribed anticoagulants.

Chest drain care: keep the bottle below chest level, watch for bubbling and swinging, and never clamp without a physician's order.

Colostomy care: empty the bag when one-third to one-half full, inspect the stoma (should be pink and moist), and change the appliance per schedule.

Pain assessment uses a 0–10 numeric scale or Wong-Baker FACES scale; reassess after analgesia at the expected onset time.

Fractured hip: immobilise, monitor for fat embolism (confusion, petechiae, breathlessness) and prepare for traction or surgery.

Antenatal visits under Indian guidelines: at least four visits - first trimester, 14–26 weeks, 28–34 weeks and 36 weeks to term - with two tetanus-diphtheria doses.

Signs of pregnancy: presumptive (amenorrhoea, nausea, breast changes), probable (Chadwick's sign, Hegar's sign, positive pregnancy test), positive (fetal heart sounds, fetal movement, ultrasound visualisation).

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

Eclampsia management: magnesium sulphate for seizure prophylaxis, control blood pressure, and deliver the baby under specialist care; monitor for magnesium toxicity (loss of reflexes, respiratory depression).

Postpartum haemorrhage is blood loss over 500 mL after vaginal delivery or 1,000 mL after caesarean; uterine massage and oxytocics are first-line measures.

Neonatal resuscitation: dry and stimulate, position the airway, provide positive pressure ventilation if not breathing, and start chest compressions if heart rate stays below 60/min.

Growth monitoring: plot weight and height on charts; birth weight doubles by 5 months and triples by 1 year; head circumference grows about 1 cm/month in the first year.

Childhood milestones: sits without support at 6–8 months, walks alone at 12–15 months, speaks two-word phrases at 18–24 months.

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

Roles of the community health nurse: care provider, health educator, advocate, coordinator, epidemiologist and change agent.

Referral system: sub-centre to primary health centre to community health centre to district hospital; the nurse documents reason, findings and urgency.

School health programme components: health appraisal, immunisation, nutrition, first aid, health education and safe environment.

Occupational health: identify hazards (physical, chemical, biological, ergonomic, psychosocial), promote use of protective equipment and periodic health checks.

Epidemic investigation steps: verify the diagnosis, define and find cases, analyse by time, place and person, form a hypothesis, control and report.

Domiciliary midwifery: prepare a clean delivery kit, ensure a clean surface, clean hands, clean cord tie and clean blade; refer for any complication.

Health education planning: identify the target group, state objectives in measurable terms, choose channels (individual, group, mass), implement and evaluate.

National vector-borne disease control covers malaria, dengue, chikungunya, Japanese encephalitis and kala-azar; source reduction is the key community action.

Unconscious casualty with breathing: place in the recovery position (lateral), monitor breathing continuously and call for help.

Anaphylaxis: give intramuscular adrenaline 0.5 mg (0.5 mL of 1:1,000) into the anterolateral thigh, call for help, give oxygen and position supine with legs raised.

Hypoglycaemic emergency in a conscious patient: 15–20 g oral glucose; if unconscious, give IV dextrose or glucagon and never oral fluids.

Heat stroke: move to shade, remove clothing, cool actively with water and fans, and transport urgently; core temperature above 40 °C with altered consciousness is diagnostic.

Drowning: remove from water safely, start rescue breathing or CPR, and suspect cervical injury if diving was involved.

Electric shock: switch off the source before touching the casualty, then assess airway, breathing and burns, and monitor for cardiac arrhythmia.

Splinting and moving: use the log-roll technique for suspected spinal injury; never remove an impaled object, pad around it instead.

Emergency trolley essentials: oxygen, suction, bag-valve-mask, airway adjuncts, defibrillator, IV fluids, emergency drugs and a checklist for daily checks.

Tetanus prophylaxis after a wound: give toxoid booster if the wound is dirty and immunisation status is incomplete; consider immunoglobulin for high-risk wounds.

Nursing council disciplinary grounds include professional misconduct, negligence, criminal conviction and practising without registration.

Mandatory reporting duties include suspected child abuse, sexual assault, certain infectious diseases and medico-legal injuries such as stab or gunshot wounds.

Medico-legal case documentation: preserve evidence, record findings verbatim, do not remove clothing or objects without proper procedure, and inform police as required.

Ethical decision-making steps: identify the problem, gather facts, identify stakeholders and values, weigh options, decide, act and evaluate.

Resource allocation follows justice; triage and transparent criteria are used rather than personal preference.

Research ethics: informed consent, voluntary participation, confidentiality, right to withdraw and ethics committee approval.

Cultural and religious sensitivity: respect dietary restrictions, prayer needs and modesty preferences; involve family per the patient's wishes.

Conflict of interest: disclose any financial or personal interest that could bias clinical judgement or patient referral.

A nurse's scope of practice is defined by registration, qualification and institutional policy; performing procedures outside that scope creates personal liability.

Consent for minors: a parent or legal guardian signs; emergency treatment may proceed without consent to save life under the doctrine of necessity.

Restraint use is a last resort, requires a physician's order, must be the least restrictive option, and needs frequent monitoring and documentation.

Medical records are confidential; release requires patient authorisation or a court order; electronic records need secure access and audit trails.

Communication barriers: language, hearing loss, pain, anxiety and culture; use interpreters, hearing aids, written material and simple language.

Breaking bad news: use a private setting, assess what the patient knows, give information in small amounts, allow silence and respond to emotion.

Assertiveness in nursing: use clear statements of concern with evidence (for example, using the CUS tool - Concerned, Uncomfortable, Safety issue) to escalate unsafe situations.

Documentation of refusal: record the patient's exact words, that risks were explained, who was present and that the physician was informed.

Oxygen therapy: humidify when flow exceeds 4 L/min by nasal cannula; a nasal cannula delivers roughly 24–44% oxygen at 1–6 L/min.

Suctioning: limit each pass to 10–15 seconds, pre-oxygenate, use sterile technique, and allow recovery between passes.

Urinary catheterisation: use sterile technique, insert about 7–8 cm in females and 20 cm in males, and secure the tubing to prevent traction.

Nasogastric tube placement is confirmed by pH of aspirate below 5.5 or X-ray; the auscultation of air method alone is unreliable.

Specimen collection: label with patient name, date and time; collect sputum in the early morning before food; collect urine midstream after cleaning.

Intravenous therapy: check for infiltration (cool, pale, swollen) and phlebitis (redness, warmth, pain along the vein); stop the infusion and report.

Blood transfusion: two nurses check the unit and identity, start slowly, observe for the first 15 minutes, and stop immediately if a reaction occurs.

Death care: place the body supine, close eyes, straighten limbs, remove tubes as ordered, identify the body and respect religious customs.

The nervous system divides into central (brain and spinal cord) and peripheral (somatic and autonomic); the autonomic system has sympathetic and parasympathetic divisions.

The brainstem consists of midbrain, pons and medulla; injury to the medulla is rapidly fatal because it contains the respiratory and cardiac centres.

The skin has three layers: epidermis, dermis and subcutaneous tissue; it regulates temperature, protects and synthesises vitamin D.

Normal urine composition: water, urea, creatinine, uric acid, electrolytes; glucose and protein in urine are abnormal.

The digestive sequence: mouth (salivary amylase on starch) → stomach (acid and pepsin on protein) → small intestine (main absorption) → large intestine (water absorption).

Hormones of the anterior pituitary include growth hormone, thyroid-stimulating hormone, adrenocorticotropic hormone, follicle-stimulating hormone, luteinising hormone and prolactin.

Muscle contraction follows the sliding filament theory: actin filaments slide over myosin using ATP and calcium.

The normal range for serum sodium is 135–145 mEq/L, potassium 3.5–5.0 mEq/L and calcium 8.5–10.5 mg/dL.

Sterile technique for dressings: wash hands, open sterile pack, use sterile forceps, clean from clean to dirty, and discard contaminated items.

Wound culture is taken from the wound base after cleaning away surface exudate; swab before starting antibiotics.

Bacteraemia versus septicaemia: bacteraemia is bacteria in blood; septicaemia is blood infection with systemic inflammatory response.

Fungal infections such as candidiasis are common after prolonged antibiotic or steroid use; maintain skin hygiene and monitor for oral thrush.

Hospital waste segregation: yellow for human anatomical waste and soiled items, red for contaminated recyclable plastics, white for sharps, blue for glassware.

Needle-stick injury first aid: wash with soap and water, do not squeeze the site, report immediately and start post-exposure prophylaxis per protocol.

Immunity types: active (vaccination or infection) takes weeks to develop and lasts long; passive (immunoglobulin, breast milk) is immediate but temporary.

Cold chain monitoring: use a vaccine vial monitor and a thermometer; discard vaccines exposed to freezing or excessive heat.

Protein-energy malnutrition assessment uses weight-for-age, height-for-age and weight-for-height; mid-upper arm circumference below 11.5 cm in children 6–59 months indicates severe acute malnutrition.

Vitamin A prophylaxis in India: 100,000 IU at 9 months with measles-rubella, then 200,000 IU every 6 months to age 5 years.

Breast milk provides immunoglobulins, especially IgA, and is the ideal first food; colostrum is rich in antibodies and should not be discarded.

Weaning foods should start at 6 months, be soft, energy-dense and hygienically prepared; continue breastfeeding alongside.

Low-residue diet reduces fibre for bowel rest before surgery or during exacerbation; high-fibre diet is used for constipation.

Calorie requirement in pregnancy adds about 350 kcal/day in the second trimester and 450 kcal/day in the third; lactation adds about 500 kcal/day.

Obesity management combines diet, physical activity and behaviour change; a deficit of about 500 kcal/day produces roughly 0.5 kg loss per week.

Fluid requirement in adults is about 30 mL/kg/day or 1.5–2 L/day, increased with fever, vomiting, diarrhoea and hot climate.

Stroke nursing: maintain airway, position head slightly elevated, monitor neurological status, prevent aspiration and begin rehabilitation early.

Epilepsy first aid: protect the head, turn to the side, do not restrain or insert objects in the mouth, time the seizure and record the pattern.

Head injury monitoring: use the Glasgow Coma Scale (eye 1–4, verbal 1–5, motor 1–6); a score of 8 or less indicates severe injury and airway protection.

Spinal cord injury: immobilise, monitor for neurogenic shock (hypotension with bradycardia) and prevent pressure injury with regular turning.

Peptic ulcer care: avoid NSAIDs, alcohol and smoking; test for Helicobacter pylori and give triple therapy as prescribed.

Cirrhosis: restrict sodium and protein in encephalopathy, monitor for ascites and bleeding varices, and avoid hepatotoxic drugs.

Thyroidectomy care: keep a tracheostomy set at the bedside, monitor for stridor and hypocalcaemia (tingling, cramps) from parathyroid injury.

Diabetes education: foot care, self-monitoring of blood glucose, recognising hypoglycaemia and sick-day rules for insulin adjustment.

Labour monitoring: record maternal pulse, blood pressure, temperature, contractions, fetal heart rate and cervical dilatation on the partograph.

Breech presentation: refer for specialist assessment; do not attempt vaginal delivery in a facility without surgical backup.

Cord prolapse: call for help, position the mother knee-chest or Trendelenburg, keep the cord warm and moist, and prepare for immediate delivery.

Newborn assessment: check breathing, heart rate, temperature, colour, reflexes and birth weight; initiate breastfeeding within one hour.

Neonatal jaundice: assess with Kramer's rule or bilirubin level; phototherapy is the main treatment; exchange transfusion is for severe cases.

Immunisation contraindications: severe allergic reaction to a previous dose or component; mild illness and fever are not contraindications.

Paediatric fluid calculation: maintenance fluid by Holliday-Segar rule - 100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg, and 20 mL/kg for each kg thereafter.

Childhood dehydration: assess skin turgor, sunken eyes, thirst and urine output; use ORS with zinc and refer if severe.

Family health nursing process: assess family structure and function, identify health problems, plan with the family, implement and evaluate.

Vital statistics: birth rate, death rate, infant mortality rate, maternal mortality ratio and life expectancy are core community indicators.

Screening programmes: blood pressure and blood sugar for adults, haemoglobin in pregnancy, and vision and hearing in schoolchildren.

Health education on sanitation: safe drinking water, hand washing with soap at critical times, safe disposal of excreta and vector control.

Home-based newborn care: visit on days 1, 3, 7, 14, 21 and 28 for weight, feeding, cord care and danger-sign checks.

Community participation: involve local leaders, self-help groups and village health committees to plan and sustain health activities.

Disaster preparedness at community level: identify shelters, first-aid teams, safe water sources and communication channels in advance.

Occupational and environmental hazards: air pollution, pesticide exposure and unsafe water are assessed during community diagnosis.

Emergency triage categories: red immediate, yellow urgent, green delayed, black deceased; reassess patients as conditions change.

Shock management: lay the patient flat, raise the legs, keep warm, stop bleeding and give oxygen; do not give oral fluids.

Head injury first aid: do not remove a helmet if spinal injury is suspected; monitor consciousness and watch for clear fluid from nose or ears.

Fractured limb: cover an open wound with a sterile dressing, splint in the position found, apply ice wrapped in cloth and elevate if possible.

Abdominal injury: do not give food or fluids, do not push protruding organs back, cover with a moist sterile dressing and prepare for surgery.

Epistaxis: sit upright, lean forward, pinch the soft part of the nose for 10–15 minutes and apply a cold pack to the bridge.

Foreign body in the eye: do not rub, irrigate with clean water or saline, and refer for removal of embedded objects.

Emergency drug essentials: adrenaline, atropine, morphine, frusemide, hydrocortisone, dextrose, sodium bicarbonate and oxygen; check expiry dates daily.

Duty of care means the nurse must act reasonably and within competence; breach of duty causing harm supports a negligence claim.

The four elements of negligence: duty, breach, causation and damages; all four must be proved.

Vicarious liability: the employer may be liable for acts of employees within the scope of employment; the nurse remains personally accountable.

Whistle-blowing is justified when patient safety is at serious risk and internal channels fail; document facts and follow policy.

Respect for dignity includes privacy during care, addressing the patient by name, and involving them in decisions.

Euthanasia and assisted suicide are illegal in India; palliative care and pain relief are the ethical alternatives.

Organ donation requires consent, brain-death certification by the prescribed committee and transparency; the nurse supports but does not coerce.

Professional development: maintain registration, attend continuing education and update skills to remain competent.

Medico-legal case registration: preserve the register, record the patient's statement verbatim, and do not give an opinion beyond your competence.

Summons to court: attend as directed, carry original records, answer only what is asked, and never alter records after a summons.

Informed refusal: document that the patient was informed of risks, refused voluntarily and was advised of consequences.

Patient rights include information, privacy, second opinion, grievance redressal and access to records; the nurse protects these rights.

Telephone orders: repeat back, record the physician's name and time, and obtain written confirmation per policy.

Interdisciplinary communication: use clear, closed-loop communication for critical results and confirm understanding.

Cultural competence: ask about beliefs, use interpreters, avoid assumptions and adapt care to the patient's preferences.

Electronic health records: protect passwords, log out after use, and never share credentials; breaches are a legal and disciplinary matter.

Body mechanics: keep the feet apart, bend the knees, keep the load close and avoid twisting while lifting to prevent back injury.

Range-of-motion exercises: perform each movement 5–10 times, stop at pain and support the joint; prevent contractures in immobile patients.

Pressure injury staging: stage 1 non-blanchable redness; stage 2 partial-thickness loss; stage 3 full-thickness loss; stage 4 full-thickness with exposed bone or tendon.

Wound dressing choice: dry wounds need moist dressings; infected wounds need cleansing and prescribed antimicrobial dressing.

Fever management: tepid sponging, light clothing, antipyretics as prescribed and monitoring for febrile convulsions in children.

Sleep and rest: promote a quiet environment, reduce noise and light, and schedule care to avoid unnecessary waking.

Nutrition support: assist feeding, position upright, check for dysphagia and record intake and output accurately.

Infection control: clean equipment between patients, follow hand hygiene, and isolate patients with multidrug-resistant organisms as per policy.

Contraception: condoms also protect against sexually transmitted infections; oral pills are taken daily; intrauterine devices provide long-acting reversible contraception.

Antenatal investigations: haemoglobin, blood group, blood sugar, HIV, syphilis, hepatitis B and urine albumin at the first visit; ultrasound for dating and anomaly.

Fetal monitoring: intermittent auscultation every 30 minutes in the first stage and every 5 minutes in the second stage in low-risk labour.

Episiotomy care: keep the area clean and dry, change pads frequently, and report redness, discharge or fever.

Lactation support: correct latch and positioning prevent nipple trauma; feed on demand, at least 8–12 times in 24 hours.

Paediatric drug dosing is calculated by weight (mg/kg); always check the dose and use an appropriate measuring device.

Child abuse recognition: unexplained injuries, fearfulness, poor hygiene and inconsistent history require reporting to the appropriate authority.

Family planning counselling: discuss effectiveness, side effects, return to fertility and protection against infection before the couple chooses.

Health team at the primary health centre includes medical officer, community health nurse, auxiliary nurse midwife, pharmacist, laboratory technician and health workers.

Referral criteria for childbirth: previous caesarean, twins, malpresentation, pre-eclampsia and anaemia are high-risk and need institutional delivery.

Epidemiological measures: incidence is new cases over a period; prevalence is all existing cases at a point in time.

Outbreak control: isolate cases, treat, trace contacts, disinfect and educate the community.

Maternal and child health services: antenatal check-ups, safe delivery, postnatal care, immunisation and nutrition programmes.

National Health Mission focuses on reproductive, maternal, newborn, child and adolescent health plus non-communicable diseases.

Community health records: maintain registers for births, deaths, immunisation and antenatal care for accurate reporting.

Health education on tobacco and alcohol: brief advice at every contact reduces consumption and prevents non-communicable disease.

Cardiac arrest recognition: unresponsive, not breathing or only gasping, no pulse within 10 seconds; start CPR immediately.

Paediatric CPR: 15 compressions to 2 breaths for two rescuers; compression depth about one-third of chest depth.

Choking in an infant: 5 back blows then 5 chest thrusts; do not use abdominal thrusts in infants.

Burns estimation: rule of nines - head 9%, each arm 9%, each leg 18%, front trunk 18%, back trunk 18%, perineum 1%.

Chemical burns: irrigate with copious running water for at least 20 minutes and remove contaminated clothing.

Hypothermia: move to a warm place, remove wet clothes, insulate and give warm fluids if conscious; avoid rapid rewarming of extremities.

Emergency childbirth: prepare a clean surface, support the baby's head, check breathing, dry and wrap, and deliver the placenta for hospital assessment.

Documentation in emergencies: record time of collapse, interventions, drugs and response for legal and clinical review.

Accountability means being answerable for one's own actions and omissions; delegation does not transfer accountability.

Delegation rules: delegate tasks within the delegate's competence, provide clear instructions and supervise outcomes.

Informed consent for research: voluntary, without coercion, with the right to withdraw at any time.

Privacy and dignity: use screens, minimise exposure, and obtain permission before students observe care.

Truth telling: honesty about errors supports patient trust; disclose harm through the appropriate channel promptly.

Cultural safety: recognise power differences and provide care respectful of the patient's identity and beliefs.

Professional boundaries: social media contact with patients and sharing identifying information are prohibited.

Ethical use of scarce resources: follow transparent criteria, avoid discrimination and document decisions.

Nursing documentation standards: record only what was done, when and by whom; avoid opinions and vague terms.

Correction of records: draw a single line, write 'error', initial and date; never erase or overwrite.

Confidentiality exceptions: statutory reporting, court order, public health reporting and protection of a vulnerable person.

Patient complaints: listen, acknowledge, document and escalate to the appropriate authority; do not argue or promise outcomes.

Informed consent elements: diagnosis, nature of procedure, risks, benefits, alternatives and consequences of refusal.

Communication with a dying patient: be honest, follow the patient's lead, allow silence and involve family as the patient wishes.

Interpreter use: use a trained interpreter, not a child or bystander, and maintain confidentiality.

Social media policy: never post patient images or identifying details; follow institutional policy and professional code.

Admission procedure: receive the patient, orient to the ward, record baseline data, check valuables and inform the physician.

Discharge planning: teach medication, wound care, follow-up date, warning signs and when to return.

Transfer of a patient: handover using SBAR, check identity, secure lines and accompany with records.

Measuring intake and output: record all oral, intravenous and tube feeds and all urine, vomit and drainage; report imbalance.

Specimen labelling: use two identifiers, note the time of collection, and send to the laboratory promptly.

Positioning for lumbar puncture: lateral with knees to chest and neck flexed to open the vertebral spaces.

Care of the dying patient: relieve pain, maintain hygiene, support family and respect cultural rituals.

Rehabilitation: encourage self-care, provide assistive devices and involve physiotherapy early.

The heart has four chambers; the left ventricle wall is thickest because it pumps against systemic resistance.

Coronary arteries arise from the aorta; the left coronary supplies the anterior wall and the right coronary the inferior wall and conduction system.

The alveoli are the site of gas exchange; surfactant from type II pneumocytes prevents alveolar collapse.

The kidney regulates acid-base balance, blood pressure (renin) and red cell production (erythropoietin).

The liver receives blood from the hepatic artery and portal vein; the portal vein carries nutrients from the gut.

The spinal cord ends at L1–L2 in adults; lumbar puncture is done below L3 to avoid injury.

The menstrual cycle is controlled by the hypothalamus, pituitary and ovary; oestrogen thickens the endometrium and progesterone maintains it.

The lymphatic system drains tissue fluid, transports fats and produces lymphocytes in lymph nodes, spleen and thymus.

Bacterial shapes: cocci (round), bacilli (rods), spirilla (spiral); arrangement includes clusters, chains and pairs.

Gram-positive cocci in clusters suggest Staphylococcus; in chains suggest Streptococcus.

Gram-negative diplococci in cerebrospinal fluid suggest Neisseria meningitidis; in urethral pus suggest Neisseria gonorrhoeae.

Acid-fast stain (Ziehl-Neelsen) identifies Mycobacterium tuberculosis; sputum is examined for acid-fast bacilli.

Malaria diagnosis: thick and thin blood films; rapid diagnostic tests detect antigens.

Typhoid diagnosis: blood culture in the first week, stool and urine culture later, and Widal test as supportive.

Dengue diagnosis: NS1 antigen in the first five days and IgM antibody later; monitor platelet count and haematocrit.

Hand hygiene compliance is improved by availability of alcohol rub, education and audit feedback.

Carbohydrate counting helps control blood glucose in diabetes; one carbohydrate exchange is about 15 g.

Glycaemic index ranks foods by blood glucose rise; low-GI foods include whole grains, legumes and most vegetables.

Saturated fat raises LDL cholesterol; unsaturated fats from nuts, seeds and vegetable oils are preferred.

Sodium and potassium balance affects blood pressure; increase fruit and vegetable intake and reduce processed foods.

Food groups: cereals and millets, pulses and legumes, milk and meat, fruits and vegetables, fats and oils, and sugars.

Nutritional assessment includes dietary history, anthropometry, biochemical tests and clinical examination.

Tube feeding complications: aspiration, diarrhoea, constipation and tube blockage; prevent with correct positioning and flushing.

Food fortification and supplementation are public health strategies to address micronutrient deficiencies.

Respiratory assessment: rate, rhythm, depth, breath sounds, oxygen saturation and use of accessory muscles.

Chest physiotherapy: postural drainage, percussion and vibration followed by coughing to clear secretions.

Pleural effusion: dullness on percussion, reduced breath sounds and tracheal shift away from the affected side in large effusions.

Pneumothorax: sudden breathlessness, chest pain and reduced breath sounds on the affected side; tension pneumothorax needs urgent needle decompression.

Cardiac monitoring: recognise ventricular fibrillation (no pulse, needs defibrillation) and ventricular tachycardia with a pulse (treat per protocol).

Fluid overload signs: raised jugular venous pressure, basal crackles, oedema and weight gain; slow the infusion and report.

Blood transfusion reaction: stop the transfusion, keep the line with normal saline, monitor vital signs and send the unit and samples to the blood bank.

Post-operative wound infection: redness, warmth, discharge and fever after 3–5 days; report and obtain a culture.

Antenatal anaemia: haemoglobin below 11 g/dL in pregnancy; treat with iron, folic acid and dietary advice, and refer if severe.

Gestational diabetes screening is done with an oral glucose tolerance test; control with diet, exercise and insulin if needed.

Pre-eclampsia: blood pressure of 140/90 mmHg or more after 20 weeks with proteinuria; monitor for headache, visual changes and epigastric pain.

Labour pain relief: non-pharmacological methods include breathing, position change and massage; pharmacological options require physician order.

Newborn resuscitation equipment should be checked before every delivery; dry, warm and stimulate first.

Breastfeeding contraindications are rare; mothers with HIV follow national guidance for replacement feeding where appropriate.

Paediatric weight estimation: age in years × 2 + 8 kg for children 1–12 years.

Childhood immunisation records should be checked at every visit and missed doses completed without restarting the schedule.

Community assessment methods: survey, interview, observation, records review and key informant discussion.

Health indicators: crude birth rate, crude death rate, infant mortality rate, under-five mortality rate and maternal mortality ratio.

Epidemiological study designs: descriptive (case report, cross-sectional) and analytical (case-control, cohort); experimental trials test interventions.

Screening test criteria: valid, reliable, acceptable, affordable and treatable condition.

Domiciliary care records: family folder, birth and death register, and immunisation card.

Community mobilisation: use local leaders, schools and religious places to spread health messages.

Water and sanitation: protect water sources, treat with chlorine, and promote latrine use to prevent diarrhoeal disease.

Referral feedback: request a report from the receiving facility to ensure continuity of care.

Primary assessment ABCDE and secondary assessment (history, head-to-toe examination, vital signs).

Haemorrhage control: direct pressure, elevation, pressure points and tourniquet as a last resort; record the time the tourniquet was applied.

Amputation: wrap the stump with a sterile dressing, place the amputated part in a clean bag and keep it cool, not directly on ice.

Poisoning: call the poison information centre, bring the container, and do not give milk or induce vomiting after corrosives.

Insect sting anaphylaxis: remove the stinger, apply a cold pack and give adrenaline if there are systemic signs.

Emergency oxygen: use a non-rebreather mask at 10–15 L/min for critical patients; titrate to saturation.

Defibrillation: apply pads, ensure everyone is clear, deliver a shock and resume CPR immediately for 2 minutes.

Emergency evacuation: stabilise the casualty, immobilise fractures and transport with monitoring.

Advocacy includes protecting the patient from unsafe practice and speaking up when care falls below standard.

Informed consent for a minor: parents or guardians decide; the child's assent is sought when developmentally appropriate.

Confidentiality in teaching: anonymise case details in presentations and discussions.

Ethical use of restraint: only when necessary, least restrictive, time-limited and reviewed regularly.

Respect for autonomy includes honouring a competent patient's refusal even when the nurse disagrees.

Professional honesty: admit mistakes, report incidents and participate in root-cause analysis.

Cultural and religious care: accommodate dietary and ritual needs within safety limits.

Continuing education and reflective practice maintain competence and ethical awareness.

Legal capacity: a competent adult can consent or refuse; a minor or person with impaired capacity needs a guardian or legal representative.

Emergency exception to consent: treatment may be given without consent to save life or prevent serious harm.

Documentation of adverse events: record objectively, notify the physician and file an incident report per policy.

Court testimony: a nurse may testify as a witness of fact; expert opinion requires qualification.

Patient property: record valuables, store securely and return with signature.

Communication with an agitated patient: stay calm, keep a safe distance, use short sentences and call for help if needed.

Interpreters and consent: consent must be obtained in a language the patient understands.

Social media and confidentiality: never post patient photographs or identifying details, even in private groups.

Vital signs frequency depends on the patient's condition; record on admission, before and after procedures, and when there is a change.

Pain is the fifth vital sign; assess with a validated scale and reassess after intervention.

Positioning to prevent pressure injury: turn every 2 hours, use pressure-relieving devices and keep skin clean and dry.

Wound cleansing: use normal saline; clean from clean to dirty and from the centre outwards.

Bandaging: apply evenly, check circulation distally and avoid tight bandages that restrict blood flow.

Urinary output measurement: record volume and colour; report haematuria, oliguria or anuria.

Medication errors: report immediately, monitor the patient and complete an incident report.

Patient education: assess readiness, use simple language and confirm understanding by teach-back.

The respiratory system includes the upper airway (nose, pharynx, larynx) and lower airway (trachea, bronchi, bronchioles, alveoli).

The diaphragm is the main muscle of inspiration; it contracts and flattens to increase thoracic volume.

The cardiovascular system: arteries carry blood away from the heart, veins return it, and capillaries allow exchange.

The nervous system uses neurons and synapses; neurotransmitters include acetylcholine, dopamine and serotonin.

The endocrine system uses hormones; the pancreas, thyroid, adrenal and gonads are major glands.

The musculoskeletal system includes bones, joints, muscles, tendons and ligaments; joints are classified as fibrous, cartilaginous and synovial.

The urinary system: kidneys, ureters, bladder and urethra; the bladder holds about 300–500 mL before the urge to void.

The reproductive system: testes produce sperm and testosterone; ovaries produce ova, oestrogen and progesterone.

Bacteria reproduce by binary fission; generation time varies from 20 minutes to hours.

Viruses need living cells to replicate; antibiotics do not act on viruses.

Fungi include yeasts and moulds; Candida and Aspergillus are common hospital pathogens.

Protozoa cause malaria, amoebiasis and giardiasis; helminths cause worm infestations.

Sterilisation of surgical instruments: autoclave or hot air oven; chemical sterilants for heat-sensitive items.

Infection control bundles reduce catheter-associated urinary tract infection, central line infection and ventilator-associated pneumonia.

Antimicrobial stewardship: prescribe only when indicated, choose the right drug and dose, and review after culture results.

Vaccine storage: keep the cold chain intact and record temperature twice daily.

Macronutrients provide energy and building blocks; micronutrients are vitamins and minerals needed in small amounts.

Water is essential for transport, temperature regulation and excretion; dehydration causes thirst, dark urine and confusion.

Protein quality: animal proteins are complete; plant proteins can be combined to provide all essential amino acids.

Fatty acids: essential fatty acids are linoleic and alpha-linolenic acid; they must come from the diet.

Dietary assessment tools: 24-hour recall, food frequency questionnaire and food diary.

Nutrition in surgery: optimise nutrition before operation; early feeding after surgery reduces complications.

Food allergies and intolerances: identify triggers, read labels and provide alternatives.

Public health nutrition: fortification, supplementation, dietary diversification and education.

Post-operative complications: atelectasis, pneumonia, wound infection, deep vein thrombosis, urinary retention and ileus.

Pre-operative preparation: consent, fasting, skin preparation, bowel preparation if ordered, and removal of dentures and jewellery.

Anaesthesia recovery: monitor airway, breathing, circulation, consciousness and pain; watch for nausea and vomiting.

Pain management: multimodal analgesia, assess and reassess, and use non-pharmacological methods.

Wound healing: keep the wound clean, change dressings per protocol and monitor for infection.

Mobility: early ambulation prevents complications; assist and monitor for dizziness.

Nutrition after surgery: start with clear fluids and progress as tolerated.

Patient education before discharge: wound care, medication, follow-up and warning signs.

Antenatal exercise and rest: moderate exercise is safe in uncomplicated pregnancy; avoid supine position in late pregnancy.

Labour onset signs: regular painful contractions, show, rupture of membranes and cervical changes.

Stages of labour and duration: first stage up to 18 hours in primigravida, second stage up to 2 hours, third stage up to 30 minutes.

Postnatal care: monitor bleeding, uterine involution, breastfeeding and emotional wellbeing.

Newborn screening and examination: check for congenital anomalies, feeding and weight gain.

Paediatric emergency signs: unable to feed, convulsions, lethargy, fast breathing and severe dehydration require urgent referral.

Immunisation schedule and catch-up: follow national guidance and record doses.

Family planning after childbirth: discuss options and timing, including lactational amenorrhoea and contraception.

Community health nursing process: assess, diagnose, plan, implement and evaluate at community level.

Health education methods: individual counselling, group discussion, demonstration, role play and mass media.

Epidemiological triangle and web of causation explain disease occurrence.

Screening and early detection: organise camps, use simple tests and refer positive cases.

Community participation and intersectoral coordination improve programme success.

Home visiting and referral ensure continuity of care.

Record keeping and reporting: maintain registers and submit reports on time.

Evaluation of community programmes: use indicators such as coverage, utilisation and outcome.

Emergency assessment: airway, breathing, circulation, disability and exposure; reassess regularly.

Basic life support sequence: check response, call for help, open airway, check breathing, give 2 rescue breaths if trained, start compressions.

Defibrillation: use an AED as soon as available and follow voice prompts.

Haemorrhage and shock: control bleeding, keep warm, raise legs and give oxygen.

Fracture and spinal injury: immobilise and use log-roll for transfer.

Poisoning and bites: identify the agent, do not induce vomiting after corrosives and transport urgently.

Burns: cool with running water, cover with a clean dressing and do not apply home remedies.

Documentation and handover: record interventions and response using SBAR.

Ethical principles: autonomy, beneficence, non-maleficence, justice, veracity and fidelity.

Informed consent: competence, information, voluntariness and documentation.

Confidentiality: protect patient information; disclose only as legally required.

Advocacy: protect patient rights and safety.

Accountability: answerable for own actions and delegation.

Professional boundaries: avoid personal relationships and conflicts of interest.

Cultural sensitivity: respect beliefs and adapt care.

Continuing competence: maintain registration and update skills.

Legal framework: Indian Nursing Council Act, state nursing councils and institutional policies.

Negligence elements: duty, breach, causation and damages.

Documentation: accurate, timely, objective and signed.

Consent: informed and voluntary; emergency exception applies.

Confidentiality: release records only with authorisation or legal order.

Communication: SBAR, closed-loop communication and teach-back.

Incident reporting: factual and timely; not a substitute for clinical documentation.

Professional conduct: follow code of ethics and institutional policy.

Nursing process: assessment, diagnosis, planning, implementation and evaluation.

Vital signs: temperature, pulse, respiration, blood pressure and oxygen saturation.

Infection control: hand hygiene and standard precautions.

Medication safety: six rights and documentation.

Wound care: sterile technique and dressing selection.

Patient positioning and mobility: prevent pressure injury and contractures.

Fluid balance: record intake and output and report imbalance.

Patient education: assess readiness and use teach-back.

Body systems: integumentary, musculoskeletal, cardiovascular, respiratory, digestive, urinary, nervous, endocrine and reproductive.

Homeostasis: maintain stable internal environment through feedback loops.

Cell structure: nucleus, cytoplasm, organelles and cell membrane.

Tissues: epithelial, connective, muscle and nervous.

Blood: plasma, red cells, white cells and platelets.

Respiration: exchange of oxygen and carbon dioxide in alveoli.

Digestion: mechanical and chemical breakdown and absorption.

Excretion: removal of metabolic waste by kidneys, lungs, skin and bowel.

Microorganisms: bacteria, viruses, fungi, protozoa and helminths.

Infection chain: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry and susceptible host.

Sterilisation and disinfection: methods and indications.

Immunity: innate and acquired; active and passive.

Vaccines: live and killed; storage and schedule.

Laboratory diagnosis: culture, microscopy, serology and molecular tests.

Antimicrobial resistance: causes and prevention.

Hospital waste management: segregation and disposal.

Nutrients: carbohydrates, proteins, fats, vitamins, minerals and water.

Balanced diet: energy and nutrient requirements across age groups.

Deficiency diseases: causes, signs and prevention.

Therapeutic diets: diabetes, hypertension, renal and liver disease.

Nutritional assessment: anthropometry, biochemistry, clinical and dietary.

Enteral and parenteral nutrition: indications and complications.

Food safety and hygiene: prevent food-borne illness.

Public health nutrition: fortification and supplementation.

Assessment: history, physical examination and diagnostic tests.

Common conditions: cardiovascular, respiratory, gastrointestinal, renal, endocrine and neurological.

Nursing interventions: monitoring, medication, wound care and rehabilitation.

Complications: early recognition and management.

Patient education: self-care and lifestyle modification.

Post-operative care: airway, pain, mobility and wound care.

Emergency management: ABCDE and specific conditions.

Rehabilitation and follow-up: continuity of care.

Antenatal care: history, examination, investigations and advice.

Labour: stages, monitoring and complications.

Postnatal care: mother and newborn assessment.

Newborn care: resuscitation, feeding and immunisation.

Child health: growth, development and common illnesses.

Family planning: methods and counselling.

High-risk pregnancy: identification and referral.

Paediatric emergencies: recognition and first aid.

Community assessment: demography, health status and resources.

Health programmes: national and state programmes.

Epidemiology: measures and study designs.

Health education: planning and methods.

Home visiting and referral: continuity of care.

Maternal and child health services: antenatal, delivery and postnatal.

Immunisation: schedule and cold chain.

Record keeping and reporting: vital statistics and registers.

Primary assessment: ABCDE.

CPR: adult and paediatric.

Haemorrhage and shock: control and support.

Fractures and spinal injury: immobilisation.

Burns: cooling and dressing.

Poisoning and bites: first aid and referral.

Triage: categories and priorities.

Documentation and handover: SBAR.

Ethical principles: autonomy, beneficence, non-maleficence, justice, veracity and fidelity.

Informed consent: elements and documentation.

Confidentiality: protection and exceptions.

Advocacy: patient rights and safety.

Accountability: own actions and delegation.

Professional boundaries: personal and financial.

Cultural sensitivity: respect and adaptation.

Continuing competence: registration and education.

Legal framework: Indian Nursing Council Act and state councils.

Negligence: elements and prevention.

Documentation: standards and correction.

Consent: informed and voluntary; emergency exception.

Confidentiality: release of records.

Communication: SBAR, closed-loop and teach-back.

Incident reporting: factual and timely.

Professional conduct: code of ethics and policy.

Nursing process: ADPIE.

Vital signs: normal ranges and measurement.

Infection control: hand hygiene and standard precautions.

Medication safety: six rights.

Wound care: sterile technique.

Positioning and mobility: prevention of complications.

Fluid balance: intake and output.

Patient education: teach-back.

Body systems and functions.

Homeostasis and feedback.

Cell and tissues.

Blood and circulation.

Respiration and gas exchange.

Digestion and absorption.

Excretion and fluid balance.

Endocrine and reproductive function.

Microorganism types.

Infection chain and transmission.

Sterilisation and disinfection.

Immunity and vaccines.

Laboratory diagnosis.

Antimicrobial resistance.

Hospital waste management.

Infection control precautions.

Nutrients and balanced diet.

Deficiency diseases.

Therapeutic diets.

Nutritional assessment.

Enteral and parenteral nutrition.

Food safety.

Public health nutrition.

Nutrition across life stages.

Assessment and diagnostic tests.

Common medical conditions.

Nursing interventions.

Complications and emergencies.

Patient education.

Post-operative care.

Rehabilitation.

Follow-up and continuity.

Antenatal care.

Labour and delivery.

Postnatal care.

Newborn care.

Child health and development.

Family planning.

High-risk pregnancy.

Paediatric emergencies.

Community assessment.

National health programmes.

Epidemiology.

Health education.

Home visiting and referral.

Maternal and child health services.

Immunisation and cold chain.

Records and reporting.

Primary assessment ABCDE.

CPR adult and paediatric.

Haemorrhage and shock.

Fractures and spinal injury.

Burns.

Poisoning and bites.

Triage.

Documentation and handover.

Ethical principles.

Informed consent.

Confidentiality.

Advocacy.

Accountability.

Professional boundaries.

Cultural sensitivity.

Continuing competence.

Legal framework.

Negligence.

Documentation.

Consent.

Confidentiality.

Communication tools.

Incident reporting.

Professional conduct.