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FON Viva Preparation - 1st Year Nursing (INC Syllabus)

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UNIT I - Nursing as a Profession & History

Nursing is the art and science of caring for individuals, families, and communities to attain, maintain, or recover optimal health and quality of life. (Florence Nightingale defined it as "the act of utilizing the environment of the patient to assist him in his recovery.")

Florence Nightingale. She carried a lamp during night rounds in the Crimean War (1854-56) at Scutari Hospital.

1. Specialized body of knowledge 2. Formal education/training 3. Code of ethics 4. Service orientation 5. Autonomy and accountability 6. Professional organization 7. Research base

Indian Nursing Council - a statutory body under the Indian Nursing Council Act, 1947. It regulates nursing education standards, prescribes syllabi, and maintains a Central Register of nurses.

Sets uniform standards, prescribes syllabus, grants recognition to nursing schools/colleges, maintains central register, conducts equivalency assessments.

State Nursing Council (e.g., Maharashtra Nursing Council, Karnataka Nursing Council, etc.)

The INC Code of Ethics guides nurses to: maintain patient confidentiality, provide care without discrimination, act with integrity, maintain competence, and uphold patient rights.

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UNIT II - The Patient and Hospital Environment

An institution providing medical, surgical, and nursing care to sick and injured persons.

By ownership: Government, Private, Voluntary By function: Teaching, Non-teaching By specialty: General, Specialized (e.g., orthopedic, psychiatric, maternity) By size: Primary (6-30 beds), Secondary (31-100 beds), Tertiary (>100 beds)

A person who receives medical or nursing care, either in a hospital (inpatient) or outside (outpatient).

A room or area in a hospital with several beds accommodating patients.

An open ward design with beds arranged along both sides, named after Florence Nightingale, allowing easy visibility and ventilation.

Safety, comfort, cleanliness, adequate light, proper ventilation, noise control, privacy, and therapeutic atmosphere.

The efficient organization and supervision of physical facilities, personnel, equipment, and patient care activities in a ward.

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UNIT III - Admission, Discharge, Transfer

The official process of entering a patient into a healthcare facility for treatment.

1. Receive the patient warmly 2. Orient to ward/environment 3. Take nursing history 4. Physical assessment 5. Record vital signs 6. Label belongings 7. Explain hospital rules 8. Inform the doctor

A structured interview collecting data about the patient's health status, past medical history, allergies, medications, social history, and presenting complaints.

Formal release of a patient from the hospital after treatment.

1. Regular (medically fit) 2. Discharge against medical advice (DAMA/AMA) 3. Transfer to another facility 4. Death

Left Against Medical Advice - when a patient leaves without doctor's permission. A signed form is obtained.

Moving a patient from one unit/ward/hospital to another for further specialized care.

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UNIT IV - Vital Signs (TPR & BP)

Temperature, Pulse, Respiration, and Blood Pressure (TPR + BP). They reflect the body's basic physiological functions.

Oral: 36.5-37.5°C (97.7-99.5°F) Rectal: 0.5°C higher than oral Axillary: 0.5°C lower than oral Normal = 37°C / 98.6°F

• Fever/Pyrexia: >37.5°C (99.5°F)
• Hyperpyrexia: >40°C (104°F)
• Hypothermia: <35°C (95°F)

• Continuous: variation <1°C, stays above normal (e.g., typhoid)
• Remittent: variation >1°C, never touches normal
• Intermittent: temperature touches normal (e.g., malaria - tertian, quartan)
• Relapsing: fever-free periods
• Hectic/Septic: wide variation with chills and sweating

Adults: 60-100 bpm; Newborns: 120-160 bpm; Children (1-10 yr): 70-120 bpm

Bradycardia: pulse <60 bpm; Tachycardia: pulse >100 bpm

Radial (most common), Carotid, Brachial, Femoral, Popliteal, Dorsalis pedis, Temporal, Apical

Adults: 12-20 breaths/min; Newborns: 30-60/min; Children: 20-30/min

Tachypnea: >20 breaths/min; Bradypnea: <12/min; Apnea: cessation of breathing

Cyclic pattern of gradual increase then decrease in depth of breathing, followed by apnea. Seen in heart failure, brain injury.

120/80 mmHg (systolic/diastolic). Hypertension: >140/90 mmHg. Hypotension: <90/60 mmHg

Temperature - Clinical thermometer/digital thermometer Pulse - Watch with seconds hand BP - Sphygmomanometer + Stethoscope Respiration - Observation (watch/count)

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UNIT V - Bed Making

Use good body mechanics, keep linen wrinkle-free, work from one side at a time, change linen when soiled, maintain privacy, ensure comfort.

1. Unoccupied/Closed bed 2. Open/Fan-folded bed 3. Occupied bed 4. Surgical/Post-operative/Anaesthetic bed (Pac-a-bed) 5. Cardiac bed (back rest) 6. Fracture bed 7. Amputation bed

A bed prepared for receiving a post-operative patient - top covers are folded to one side, easy to transfer patient from trolley. Also called Pac-a-bed.

Bed with back rest elevated 45° (semi-Fowler's) for cardiac patients to ease breathing.

Draw sheet, mackintosh (rubber sheet), cotton blanket, pillow and pillowcase, bottom sheet, top sheet, bedspread.

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UNIT VI - Personal Hygiene

Practices that promote cleanliness and health of the body, including bathing, oral care, hair care, nail care, perineal care, and eye care.

Cleaning the entire body of a bedridden patient while in bed, using warm water, soap, and washcloth.

Cleaning of the mouth, teeth, gums, and tongue to prevent infection and maintain comfort. Performed 2-3 times/day.

Stimulates circulation, relaxes muscles, prevents pressure ulcers, provides comfort.

Areas of localized injury to the skin and underlying tissue, usually over bony prominences, due to sustained pressure, friction, or shear.

• Stage I: Non-blanchable redness, skin intact
• Stage II: Partial thickness skin loss
• Stage III: Full thickness skin loss (fat visible)
• Stage IV: Full thickness, bone/tendon/muscle exposed

Sacrum, heels, hips (greater trochanter), elbows, shoulders (scapula), occiput, malleoli, spine.

2-hourly repositioning, pressure-relieving mattresses, keep skin dry and clean, adequate nutrition, passive exercises.

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UNIT VII - Positions

Head of bed elevated 45-60°. Used for patients with respiratory problems, post-op, NGT feeding. Semi-Fowler's = 30-45°. High Fowler's = 90°.

Patient supine, feet higher than head (bed tilted 15-30°). Used for shock, hypotension, some pelvic surgeries.

Patient on back, hips and knees flexed, legs in stirrups. Used for gynaecological examinations, catheterization, delivery.

Patient lies on left side with left arm behind, right knee flexed. Used for enemas, rectal examinations, unconscious patients.

Patient supine with knees bent and feet flat. Used for abdominal and vaginal examination.

Patient kneels with chest on bed. Used for rectal/sigmoidoscopic examination, to correct prolapsed cord.

Patient lying face down. Used after spinal surgery, promotes drainage of oral secretions, prevents aspiration.

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UNIT VIII - Elimination

Introduction of a catheter (tube) through the urethra into the urinary bladder to drain urine.

Foley/Indwelling catheter (has balloon, stays in), Robinson/Straight catheter (intermittent use), Suprapubic catheter (through abdominal wall)

Measured in French (Fr) gauge. Adults: 14-16 Fr (female), 16-18 Fr (male). 1 Fr = 1/3 mm diameter.

1-1.5 liters/day (approximately 0.5-1 ml/kg/hr). 30 ml/hr minimum is acceptable.

Oliguria: <400 ml/day; Anuria: <100 ml/day (no urine); Polyuria: >2500 ml/day

Introduction of fluid into the rectum and colon through the anus to cleanse the bowel or administer medications.

Cleansing enema (evacuant), Retention enema (oil, medicated), Return flow/Harris flush, Small volume/Fleet enema

Brown, soft, formed, cylindrical, 100-400g/day, frequency 1-3/day to 3/week.

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UNIT IX - Nutrition and Diet

Gavage feeding (tube feeding), gastric drainage, administration of medications, gastric lavage.

Confirm tube placement (aspiration of gastric contents, pH test, X-ray), check residual volume, maintain head elevation at 30-45°, flush tube before and after feeding.

A diet specifically planned to treat a disease or medical condition (e.g., diabetic diet, low-sodium diet, low-fat diet).

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UNIT X - Medications Administration

A substance used in the prevention, diagnosis, treatment, or cure of disease.

5 Rights: Right Drug, Right Dose, Right Patient, Right Route, Right Time Additional rights: Right Documentation, Right Reason, Right Response, Right to Refuse

Oral, Sublingual, Buccal, Parenteral (IV, IM, SC, ID), Topical, Transdermal, Inhalation, Rectal, Vaginal, Ophthalmic, Otic, Nasal

IM (Intramuscular): needle at 90°, 2-3 ml, sites - deltoid, gluteus, vastus lateralis SC (Subcutaneous): needle at 45°, up to 1 ml, sites - abdomen, upper arm, thigh

Deltoid, Dorsogluteal, Ventrogluteal, Vastus lateralis (rectus femoris in infants - Z-track method)

Skin is pulled laterally 1-1.5 inches before injection, then released after withdrawal - prevents drug leakage into subcutaneous tissue. Used for iron, Vitamin B12.

Injected into the dermis at 10-15° angle. Used for allergy testing, Mantoux (TB test). Site: inner forearm.

Direct injection of medication into a vein over 1-5 minutes.

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UNIT XI - Wound Care & Dressings

A break in the continuity of any tissue of the body.

Open/Closed; Acute/Chronic; Incised, Lacerated, Abrasion, Contusion, Puncture, Gunshot, Surgical

1. Hemostasis (0-3 hrs) 2. Inflammatory (1-4 days) 3. Proliferative (4-21 days) 4. Maturation/Remodeling (21 days-2 years)

• Primary intention: clean wound, edges approximated (sutured) - minimal scarring
• Secondary intention: wound left open, heals by granulation
• Tertiary/Delayed primary: wound left open initially, then closed later

Dehiscence: separation/bursting open of wound edges Evisceration: protrusion of abdominal organs through dehisced wound (emergency!)

Complete elimination of microorganisms and their spores from equipment and the environment. Used in surgeries, invasive procedures, catheterization, dressing changes.

Medical asepsis (clean technique): reduces number and spread of microorganisms Surgical asepsis (sterile technique): eliminates all microorganisms including spores

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UNIT XII - Infection Control

Invasion of body tissue by pathogenic microorganisms causing disease.

1. Infectious agent 2. Reservoir 3. Portal of exit 4. Mode of transmission 5. Portal of entry 6. Susceptible host

Contact (direct/indirect), Droplet, Airborne, Vector-borne, Vehicle (food, water)

Infection control measures applied to ALL patients regardless of diagnosis - includes hand hygiene, PPE (gloves, gown, mask), proper waste disposal.

1. Before touching a patient 2. Before aseptic procedure 3. After body fluid exposure risk 4. After touching a patient 5. After touching patient surroundings

Sterilization: destruction of ALL microorganisms including spores Disinfection: destruction of most pathogenic microorganisms (NOT spores)

Physical: Autoclaving (steam under pressure, 121°C/15 psi/15 min), Dry heat (160-180°C/1-2hr), Boiling, UV radiation Chemical: Glutaraldehyde (Cidex), Ethylene oxide gas, Formaldehyde

Steam sterilization at 121°C, 15 psi for 15 minutes (or 134°C, 30 psi for 3-5 min). Used for surgical instruments, linen.

Infection acquired in a healthcare setting that was not present on admission (develops >48 hours after admission).

• Protective/Reverse: protects immunocompromised patient from environment
• Source/Standard: prevents spread of infection from patient
• Airborne: TB, chickenpox, measles
• Droplet: influenza, meningitis, pertussis
• Contact: MRSA, VRE, C. difficile

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UNIT XIII - Heat and Cold Applications

Vasodilation, increased blood flow, relaxes muscles, relieves pain, promotes healing, increases metabolic rate.

Dry heat: hot water bottle, heating pad, heat lamp, infrared lamp Moist heat: hot compress, sitz bath, steam inhalation, fomentation

Vasoconstriction, reduces bleeding/edema, decreases pain, reduces inflammation, lowers temperature.

Ice bag, ice collar, cold compress, cold sponge, tepid sponge bath (for fever)

27-37°C (80-98°F) - lukewarm water to reduce fever by evaporation.

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UNIT XIV - Specimen Collection

Urine (routine, culture, 24-hr), Stool (routine, occult blood, culture), Blood (venipuncture), Sputum (AFB, culture), Throat swab, Wound swab

Patient voids first portion of urine (flushes urethra), then collects midportion in sterile container. Used for culture and sensitivity.

All urine collected over 24 hours in a container (usually with preservative). Used for creatinine clearance, protein, hormones.

Early morning (first specimen), before meals, deep cough after deep breathing, collected in sterile wide-mouthed container. Minimum 3 ml.

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UNIT XV - First Aid

Immediate, temporary assistance given to a person who is sick or injured before professional medical help arrives.

D - Danger (ensure scene safety) R - Response (check consciousness) A - Airway (open and clear) B - Breathing (check and support) C - Circulation (check pulse, control bleeding)

Cardiopulmonary Resuscitation. Adults (AHA 2020): 30 compressions : 2 breaths. Rate: 100-120 compressions/min. Depth: at least 2 inches (5 cm).

Abdominal thrusts used to dislodge a foreign body obstructing the airway (choking). Hands clasped below the sternum, thrust inward and upward.

R - Rest, I - Ice, C - Compression, E - Elevation

A break in the continuity of a bone.

Closed/Simple (skin intact), Open/Compound (bone protrudes), Comminuted (multiple fragments), Greenstick (incomplete, in children), Stress, Pathological

Immobilize the limb, do not straighten, apply splint, treat for shock, transport safely.

Cool with running cool water (15-20 min), do NOT use ice/butter, cover with clean cloth, do not burst blisters, seek medical help for major burns.

Head = 9%, Each arm = 9%, Chest/abdomen (front) = 18%, Back = 18%, Each leg = 18%, Perineum = 1%

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UNIT XVI - Documentation & Reporting

Accuracy, completeness, timeliness, legibility, objectivity, confidentiality

A written plan that guides the nursing care of a patient - includes nursing diagnosis, goals, interventions, and evaluation.

ADPIE: Assessment, Diagnosis, Planning, Implementation, Evaluation

Nursing diagnosis: identifies the patient's response to actual or potential health problem (e.g., "Impaired skin integrity related to immobility") Medical diagnosis: identifies the disease (e.g., "Diabetes mellitus")

Actual, Risk/Potential, Wellness/Health promotion, Syndrome

Subjective: what patient says/feels (symptoms) Objective: what the nurse observes/measures (signs)

A quick-reference card file kept at the nurses' station with basic patient information, current orders, and care plan.

An order given by the doctor verbally (in person or by phone) and transcribed by the nurse. Must be countersigned by the doctor within 24 hours.

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UNIT XVII - Basic Nursing Concepts

(Base to top): 1. Physiological 2. Safety and Security 3. Love and Belonging 4. Esteem 5. Self-actualization

Care that addresses physical, psychological, social, cultural, and spiritual needs of the patient.

"A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." (WHO, 1948)

Sign: objective, measurable, observable by others (e.g., fever, rash) Symptom: subjective, felt by patient only (e.g., pain, nausea)

Acute: sudden onset, short duration, usually reversible Chronic: gradual onset, long duration (>3 months), may be irreversible

Process of restoring a person to optimal functioning after illness or injury.

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KEY PRACTICAL SKILLS EXAMINERS TEST

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COMMON VIVA MISTAKES TO AVOID

1. Confusing medical asepsis with surgical asepsis
2. Mixing up normal values for different age groups
3. Forgetting the 5 Rights before any medication question
4. Not knowing the difference between signs and symptoms
5. Confusing stages of wound healing with types of healing
6. Forgetting to mention safety/body mechanics in any procedure
7. Not knowing when to use isolation types (airborne vs droplet vs contact)

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QUICK REVISION - IMPORTANT NORMAL VALUES

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