Tamil Nadu HSE Second Year Nursing (Vocational) cheat sheet

Normal adult vital signs: temperature 36.5–37.5 °C oral, pulse 60–100/min, respiration 12–20/min, blood pressure 120/80 mmHg, oxygen saturation 95–100%.

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

Stages of pressure ulcer: Stage 1 non-blanchable erythema; Stage 2 partial-thickness loss; Stage 3 full-thickness loss with visible fat; Stage 4 full-thickness with muscle, bone, or tendon exposed.

Medical asepsis reduces organism transfer (handwashing, clean gloves); surgical asepsis destroys all organisms (sterile gloves, sterile field).

Intramuscular injection sites: ventrogluteal is safest for adults; deltoid holds up to 1 mL; vastus lateralis is preferred in infants.

Five rights of medication administration: right patient, right drug, right dose, right route, right time.

Wound healing by first intention occurs in clean surgical wounds with approximated edges; second intention occurs in infected or gaping wounds with granulation.

Positioning rules: Fowler's or semi-Fowler's for dyspnoea, lateral for unconscious clients to prevent aspiration, Trendelenburg for shock, prone for some burns.

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

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

Normal blood values: haemoglobin 13–17 g/dL (male), 12–15 g/dL (female); RBC 4.5–5.5 million/µL; WBC 4,000–11,000/µL; platelets 150,000–450,000/µL.

Respiratory control centre lies in the medulla oblongata; the phrenic nerve (C3–C5) supplies the diaphragm.

Nephron is the functional unit of the kidney; glomerular filtration rate averages about 125 mL/min, and about 1.5 L urine forms daily.

Liver functions include bile production, glycogen storage, plasma protein synthesis, and detoxification of ammonia into urea.

Cranial nerves number 12; the vagus (X) is the longest, supplying thoracic and abdominal viscera.

Normal urine specific gravity is 1.010–1.025; kidneys regulate acid–base balance by reabsorbing bicarbonate and excreting hydrogen ions.

Gram-positive bacteria retain crystal violet and stain purple; Gram-negative bacteria lose it and stain pink with safranin counterstain.

Sterilisation kills all microorganisms including spores; disinfection destroys pathogens on inanimate objects but not necessarily spores.

Autoclaving standard cycle: 121 °C at 15 psi for 15–20 minutes; spore test organism is Geobacillus stearothermophilus.

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

Airborne precautions are required for pulmonary tuberculosis, measles, and varicella; use an N95 respirator and negative-pressure room.

Droplet precautions apply to influenza, pertussis, and meningococcal meningitis; standard surgical mask within 1 metre of the patient.

Hepatitis B and HIV spread by blood and body fluids; hepatitis A and E spread by the faecal–oral route.

Hand hygiene with alcohol-based rub is ineffective against spores (Clostridium difficile) and non-enveloped viruses; soap and water is required.

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

Basal metabolic rate rises with fever by roughly 10–13% per 1 °C above normal; it falls with starvation and hypothyroidism.

Protein requirement for a healthy adult is about 0.8–1 g/kg body weight per day; higher in pregnancy, lactation, and recovery from burns.

Deficiency diseases: vitamin A - night blindness and xerophthalmia; vitamin B1 - beriberi; vitamin C - scurvy; vitamin D - rickets and osteomalacia; iron - microcytic anaemia.

Iodine deficiency causes goitre and cretinism; iodised salt is the standard public health measure.

PEM appears as marasmus (severe wasting, weight-for-age below 60%) or kwashiorkor (oedema, low albumin, preserved appetite).

Diet modifications: diabetic diet limits refined sugars and distributes carbohydrate; renal diet restricts protein, sodium, potassium, and phosphorus; low-residue diet limits fibre.

Colostrum is rich in immunoglobulin A and protein; exclusive breastfeeding is recommended for the first 6 months, complementary feeding from 6 months.

Primary health centre covers about 30,000 rural people (20,000 in hilly terrain); a sub-centre covers 5,000 (3,000 in hilly areas).

Infant mortality rate = (deaths under 1 year ÷ live births in the same year) × 1,000.

Maternal mortality ratio = (maternal deaths ÷ live births) × 100,000.

National immunisation schedule: BCG, OPV-0, and hepatitis B at birth; pentavalent and OPV at 6, 10, and 14 weeks; measles–rubella first dose at 9–12 months and second at 16–24 months; DPT and OPV boosters at 16–24 months.

Vitamin A prophylaxis: 100,000 IU at 9 months with measles vaccine, then 200,000 IU every 6 months up to 5 years.

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

Epidemiological triad is agent, host, and environment; incidence counts new cases, prevalence counts all existing cases at a point in time.

Domiciliary midwifery and referral transport are core functions of community health workers; ASHA links households to the sub-centre.

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

Normal labour has three stages: first stage from onset to full cervical dilatation, second stage from full dilatation to birth, third stage from birth to expulsion of placenta (usually within 30 minutes).

Pregnancy-induced hypertension is diagnosed when blood pressure is 140/90 mmHg or higher after 20 weeks with proteinuria; eclampsia adds convulsions.

Antepartum danger signs requiring urgent referral: bleeding per vaginum, severe headache with blurred vision, reduced fetal movement, leaking of fluid, fever.

Fetal heart rate is normally 110–160 beats/min; it is best auscultated over the fetal back.

Apgar score assesses heart rate, respiratory effort, muscle tone, reflex irritability, and colour at 1 and 5 minutes; each 0–2, total 10.

Exclusive breastfeeding should begin within one hour of birth; colostrum acts as the first natural vaccine.

Puerperium lasts 6 weeks after delivery; lochia progresses from rubra (red) to serosa (pink) to alba (white).

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

Recovery position is used for an unconscious person who is breathing; it maintains a clear airway and prevents aspiration.

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

Severe bleeding: apply direct pressure with a clean pad, elevate the limb, and apply a pressure bandage; a tourniquet is a last resort.

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

Fracture immobilisation: splint the joint above and below the fracture; check distal pulse, sensation, and capillary refill before and after.

Snake bite: immobilise the limb below heart level, remove rings and tight clothing, and transport to hospital; do not incise, suck, or apply a tight tourniquet.

Poisoning by mouth in a conscious patient: do not induce vomiting after ingestion of corrosives or petroleum products; shift to hospital with the container.

Informed consent requires capacity, adequate information, comprehension, and voluntariness; it may be withdrawn at any time.

Confidentiality: patient information is disclosed only with consent or where law requires notification (for example, notifiable diseases, medico-legal cases).

Autonomy respects the patient's choice; beneficence means acting for the patient's good; non-maleficence means doing no harm; justice means fair distribution of care.

Nursing councils regulate registration and professional conduct; practising without registration is an offence.

Advocacy means the nurse speaks for the patient's rights and safety, including reporting unsafe practice through proper channels.

Negligence is failure to meet the standard of care; it requires duty, breach, causation, and damage.

Veracity means telling the truth to the patient; fidelity means keeping promises and remaining loyal to the patient.

Euthanasia and assisted suicide are not part of accepted nursing practice; the nurse provides palliative care and comfort.

Communication elements: sender, message, channel, receiver, feedback; noise is any interference that distorts the message.

Therapeutic communication techniques include open-ended questions, reflection, restating, silence, and clarification; advice-giving, false reassurance, and changing the subject are non-therapeutic.

SBAR handover format: Situation, Background, Assessment, Recommendation.

Verbal orders must be written down, read back to the prescriber, and countersigned within the locally defined time.

Nursing records are legal documents: write in ink, never erase or use correction fluid, correct errors with a single line, initial, and date.

Record objective findings, time, and signature with designation; late entries are marked as such.

Use standard abbreviations only; ambiguous abbreviations such as 'U' for unit or 'q.d.' are avoided to prevent medication errors.

Incident reports are completed for any adverse event or near miss and are not filed in the patient's chart; they support system improvement.