UPMSP High School Health Care cheat sheet

Health is a state of complete physical, mental and social well-being, not merely the absence of disease (WHO definition).

Levels of care: primary (first contact, PHC/CHC), secondary (district hospital, specialists), tertiary (medical college, super-specialty referral).

In India, primary health care is delivered through sub-centres (1 per 5,000 population in plains, 3,000 in hilly/tribal areas) and PHCs (1 per 30,000 plains, 20,000 hilly).

Community Health Centre (CHC) norm: 1 per 80,000 population (30 beds), staffed by at least four specialists - physician, surgeon, paediatrician, obstetrician-gynaecologist.

ASHAs (Accredited Social Health Activists) are female community health workers, 1 per 1,000 population, linking households to the health system.

Team roles: ANM/MPW provides antenatal care and immunisation; pharmacist dispenses; lab technician performs diagnostics; ward boy/sanitary staff maintain hygiene and patient transport.

Referral is upward when the case exceeds the facility's capability; counter-referral sends the patient back with a treatment plan to the lower level.

National health programmes in India include NHM, RNTCP/NTEP (TB), NPCDCS (NCDs), and Mission Indradhanush (immunisation).

Skeletal system: 206 bones in the adult; axial skeleton 80 bones (skull, vertebral column, rib cage), appendicular 126 bones (limbs and girdles).

Vertebral column has 33 vertebrae in the child: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused), 4 coccygeal (fused).

Long bone structure: diaphysis (shaft), epiphysis (ends), periosteum (outer membrane), medullary cavity containing yellow marrow; red marrow is the blood-forming site.

Anatomical position: standing erect, face forward, arms at sides, palms facing forward.

Body planes: sagittal divides left/right, coronal (frontal) divides front/back, transverse divides upper/lower.

Directional terms: proximal nearer the trunk, distal farther; medial toward midline, lateral away; superior above, inferior below.

Abdominopelvic quadrants (RUQ, LUQ, RLQ, LLQ): liver and gallbladder lie mainly in RUQ; stomach and spleen in LUQ; appendix in RLQ.

Major organ locations: heart in mediastinum, lungs in thoracic cavity, kidneys retroperitoneal, bladder in pelvic cavity.

Normal adult resting values: respiratory rate 12–20/min, heart rate 60–100/min, blood pressure 120/80 mmHg, body temperature 36.5–37.5 °C (98.6 °F).

Cardiac output = heart rate × stroke volume; normal stroke volume is about 70 mL, giving roughly 5 L/min at rest.

Normal blood pH is 7.35–7.80 (arterial 7.35–7.45); bicarbonate and respiratory rate are the main acid-base buffers.

Digestion: carbohydrates begin breakdown in the mouth (salivary amylase), proteins in the stomach (pepsin), fats mainly in the small intestine with bile and lipase.

Kidney filtration rate (GFR) is normally about 125 mL/min; urine output below 400 mL/day is oliguria, below 100 mL/day is anuria.

Personal hygiene: handwashing with soap for at least 40–60 seconds; bathe daily; brush teeth twice daily; keep nails short and clean.

Menstrual hygiene: change sanitary pad every 4–6 hours; wash the genital area front to back; dispose of pads wrapped, never flushed.

Food hygiene: wash hands before cooking/eating, wash vegetables in clean water, boil or filter drinking water, cover cooked food to prevent flies.

First aid sequence: check scene safety, check responsiveness, call for help (108 in India), open airway, check breathing, check circulation, then treat.

Adult CPR: 30 chest compressions to 2 rescue breaths; compressions at 100–120/min, depth 5–6 cm, on the lower half of the sternum.

Recovery position (lateral) is used for an unconscious person who is breathing normally, to keep the airway clear.

Choking in a conscious adult: 5 back blows between the shoulder blades, then abdominal thrusts (Heimlich manoeuvre); repeat until the object is expelled.

Severe bleeding: apply direct pressure with a clean cloth, elevate the limb if possible, and use a tourniquet only when direct pressure fails.

Burns: cool with running water for at least 20 minutes, do not apply oil, toothpaste or ice, and do not burst blisters.

Snake bite: immobilise the limb below heart level, remove rings and tight items, do not cut or suck the wound, transport to hospital immediately.

Fracture: immobilise the limb in the position found using a splint, check pulse and sensation beyond the splint, and never attempt to straighten a deformed limb.

Bed-making types: occupied bed (patient stays in bed), unoccupied bed (patient out of bed), post-operative bed (open bed with draw sheet ready for transfer).

Pressure ulcer prevention: reposition an immobile patient at least every 2 hours; inspect pressure points (sacrum, heels, hips, shoulders) each turn.

Positioning: Fowler's (semi-sitting, 45–60°) for breathing difficulty; supine (flat on back); lateral (side-lying); Trendelenburg (head-down) only on medical order.

Bed bath: wash face first, then arms, chest, abdomen, legs, back, and genital area last; change water when soiled and keep the patient covered.

Oral care for an unconscious patient: place on the side, use a mouth prop, perform with suction ready, and never instil fluid into the mouth.

Intake-output charting: record all fluids taken orally, by tube or IV, and all urine, vomit, stool and drain output; report a urine output below 30 mL/hour.

Bedpan and urinal use: warm the bedpan, place it under the buttocks with the wider end toward the head, and give privacy while staying within call.

Safe patient transfer: lock bed wheels, raise the bed to waist height, keep the patient's feet flat, and use a gait belt for assisted walking.

Hand hygiene: use alcohol-based hand rub for 20–30 seconds when hands are not visibly soiled; wash with soap and water for 40–60 seconds when soiled.

WHO's five moments for hand hygiene: before patient contact, before aseptic procedure, after body fluid exposure, after patient contact, after contact with patient surroundings.

Standard precautions apply to every patient: hand hygiene, gloves, gown, mask, eye protection, safe sharps handling, and safe waste disposal.

Biomedical waste colour coding: yellow (human anatomical waste, soiled dressings, expired medicines), red (contaminated recyclable plastic), white (sharps in puncture-proof container), blue (glassware, metallic implants).

Sharps: never recap a needle by hand; discard immediately into a puncture-proof, leak-proof white container filled to no more than three-quarters.

Sterilisation: autoclave at 121 °C and 15 psi for 15–20 minutes; boiling for 20 minutes is disinfection, not sterilisation.

Immunisation cold chain: most vaccines are stored at 2–8 °C; never freeze DPT, hepatitis B or tetanus toxoid; OPV is kept frozen at –20 °C.

Sanitation: safe disposal of human excreta, safe drinking water, and vector control are the pillars of environmental sanitation; ORS and handwashing prevent diarrhoeal spread.

Macronutrients: carbohydrates provide 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g; vitamins, minerals and water provide no calories.

Balanced diet: about 60% of energy from carbohydrates, 10–15% from protein, and 20–30% from fat, with fibre, vitamins and minerals included.

Protein-energy malnutrition: marasmus is severe wasting from overall calorie deficiency; kwashiorkor shows oedema, moon face and a distended abdomen from protein deficiency.

Deficiency diseases: vitamin A deficiency causes night blindness and xerophthalmia; vitamin C deficiency causes scurvy; iodine deficiency causes goitre; iron deficiency causes anaemia.

Iron-rich foods: green leafy vegetables, jaggery, dates, liver, meat and legumes; pair with vitamin C to improve absorption, and avoid tea with meals.

Nutritional assessment: weight-for-age (underweight), height-for-age (stunting), weight-for-height (wasting); MUAC below 11.5 cm in children 6–59 months signals severe acute malnutrition.

Community health indicators: infant mortality rate, maternal mortality ratio, birth rate, death rate, and life expectancy measure population health status.

National nutrition programmes in India include ICDS (anganwadi supplementary nutrition), mid-day meal scheme, and iodine fortification of salt.

Antenatal care: at least four visits (now promoted as eight contacts); check weight, blood pressure, haemoglobin, urine albumin/sugar, and fetal heart rate at each visit.

Danger signs in pregnancy: bleeding, severe headache with blurred vision, swelling of face and hands, high fever, reduced fetal movement, and convulsions - refer immediately.

Tetanus toxoid: two doses in the first pregnancy, one booster in later pregnancies; give iron-folic acid tablets daily from the second trimester for 180 days.

Eclampsia is convulsions with high blood pressure in pregnancy; management includes magnesium sulphate, dark quiet room, airway protection, and urgent referral.

Stages of labour: first stage from onset of true contractions to full cervical dilatation (10 cm); second stage from full dilatation to birth of the baby; third stage to delivery of the placenta.

Newborn care: dry and wrap immediately, delayed cord clamping, skin-to-skin contact, initiate breastfeeding within one hour, and give vitamin K injection.

Exclusive breastfeeding for the first six months, then complementary feeding from six months while continuing breastfeeding up to two years.

Child immunisation schedule (India): BCG, OPV-0 and hepatitis B at birth; pentavalent, OPV and rotavirus at 6, 10 and 14 weeks; measles-rubella and vitamin A at 9 months.

Routes of administration: oral, sublingual, topical, inhalational, intramuscular (IM), subcutaneous (SC), intravenous (IV) and rectal; IV acts fastest, oral slowest.

The 'rights' of medication: right patient, right drug, right dose, right route, right time, and right documentation.

Common drug classes: analgesics (paracetamol) for pain and fever; antibiotics (amoxicillin) for bacterial infection; antihypertensives (amlodipine) for high blood pressure.

Paracetamol adult dose is 500–1000 mg every 4–6 hours, not exceeding 4 g in 24 hours; overdose causes liver damage.

ORS preparation: one packet dissolved in one litre of clean water; discard after 24 hours; give small sips frequently - never use a concentrated mix.

Antibiotic resistance: complete the full prescribed course, never share or self-medicate antibiotics, and never use leftover antibiotics.

Adverse drug reactions: watch for rash, swelling, breathing difficulty, vomiting and reduced urine output; stop the drug and report to the prescriber immediately.

Storage: keep medicines in a cool dry place away from sunlight and out of children's reach; check expiry dates and discard expired medicines in yellow bin.

Temperature sites: oral, axillary (0.5 °C lower than oral), rectal (0.5 °C higher than oral), and tympanic; normal oral temperature is 36.5–37.5 °C.

Pulse: count for a full minute; assess rate, rhythm, volume and character; tachycardia is above 100/min in adults, bradycardia below 60/min.

Respiration: count for one full minute without the patient noticing; observe rate, depth, rhythm and effort; normal adult rate is 12–20/min.

Blood pressure: inflate the cuff 20–30 mmHg above the point where the radial pulse disappears; systolic is the first sound (Korotkoff I) and diastolic the last (Korotkoff V).

Fever grading: low-grade up to 38 °C, moderate 38–39 °C, high 39–41 °C, hyperpyrexia above 41 °C.

Malaria presents with cyclical fever with chills and rigors; dengue with high fever, severe body ache and a falling platelet count; typhoid with step-ladder fever.

Tuberculosis: cough for more than two weeks, evening fever, night sweats, weight loss; sputum test and chest X-ray confirm; DOTS treatment is free.

Dehydration signs: dry mouth, sunken eyes, loss of skin turgor, reduced urine, and in infants a sunken fontanelle; give ORS and refer if severe.

Effective communication elements: active listening, eye contact, simple language, open-ended questions, and confirming the patient's understanding by asking them to repeat.

Confidentiality: a patient's health information is shared only with the care team and only as needed; disclosure without consent is a breach of ethics.

Informed consent: the patient must be told the procedure, risks, benefits and alternatives in a language they understand, then agree voluntarily.

Patient rights include privacy, dignity, information, a second opinion, refusal of treatment, and access to their own records.

Professional boundaries: never accept gifts of significant value, never discuss a patient outside work, and never use a mobile phone to photograph a patient without consent.

Workplace safety: follow universal precautions, report needle-stick injuries immediately, keep immunisation (hepatitis B) up to date, and know the fire exit route.

Needle-stick injury action: wash with soap and water, do not squeeze the wound, apply antiseptic, report at once, and start post-exposure prophylaxis as advised.

Ergonomics: lift with bent knees and a straight back, keep the load close to the body, and ask for help with heavy patients to prevent back injury.