Unit wise question will come in final exam

Unit 1
Q, Define community health nursing ? ( 5)

Acc. To ANA 2000- definition

CHN is a synthesis of nursing and public health practices applied to promoting and preserving the health
of the population.
Treat “Population as a whole”.
FOCUS ON individual, family groups, community utilizing health promotion, health maintenance, health
education and management, coordination and continuity of care are used in a holistic approach Q

Q 2 Objectives :- (8)

AIMS OF CHN:-
 TO reduce the risk factors
 To improve quality of life
 To improve standard of living
 To strengthening the self care of individual
ROLE / FUNCTION OF COMMUNITY HEALTH NURSING (5) (7)
MANAGER : CHN9 community health nurse )
CHN TAKE THE MANEGERIAL ROLE IN THE COMMUNITY HEALTH NURSE like;-

 Organized and manages various programmes of health

 Being a CHN he,/she give her plan to district health officer for family planning ,
immunization. Etc
Evaluator : -
 Community health nurse after implementation of any project or health programmes
he/she evaluate the success or out come of progect / programme
 CHN evaluateof the effective ness of any programme
CONSULTANT
 COMMUNITY HELATH NURSE ADIVE IS TAKEN BEFORE START any health care
programme in community
 CHN renders the services for prevention of disease and promotion of health in the
community .

Coordinator :
 Community health nurse play important role in coordinating between the different
services in community .

Leadership : the nurse is direct , influence ,or persuades other to effect chnafe so as to
positively affect peoples health and moves them toward a goal
 Motivating people
 Directing activities
 Ensuring effective two way communication
 Resolving conflict

Q Explain in brief quality of community health nurse? (10)

 UNIT 2
Q1. Define family welfare (2)
 INDIA is 1 st country in the worlds that implemented the family welfare programme
Q2 Discuss the role of voluntary organization in family welfare services ? (5)
Q 3. Discuss about various health committee existing in india (10)
HEALTH COMMITTEES
 BHORE COMMITTEE ( 1946 )

This committee popularly known as the “ Health survey and developmental

committee. ‘’
chairemam
Joseph William Bhore
Q4. NUTRIONAL HEALTH PROBLEM IN INDIA ( 5)
ANS – EXPLIAN about – PEM , nutritional anemia , low birth weight , xerophthalmia,
iodine deficiency disorder ,
Q5. National health problem in India (5)

health problem
in India

enviromental Population problem

sanitation

communicable non nutrional

disease communicable problems
Ans -

Medical care problem

Q6 HEALTH PROBLEM IN SCHOOL CHILD (5)

SYMPTOMS :
 Unit 3
Q1 . UNDER 5 CLINIC / WELL BABY CLINIC (5)
COMPONENT OF UNDER 5 CLINICS (5)
 THE first 5 year
of the life form the foundation of child physical and mental growth
and development.
 The fact that 50% of the death in india occur among under 5 , point that need of
special attention toward this age group.
 Under the 5 clinic combines the concept of prevention , treatment , health
supervision, nutritional surveillance , and education into the system of health care

Aims and objective:

The aim and objective of the under 5 year clinic are depicted through the symbol.

1. Care in illness :- the apex of the symbol represent “ care and treatment of sick
children ‘’
Care in illness comprises of diagnosis and treatment of :
1. Acute illness
2. Chronic illness including physical ,mental, congenital and acquired abnormalities.
3. Disorders of growth and development
a) X ray and laboratory services
b) Referral services
2. Preventive care :-
3
Q.2 PHC / CHC/SC
OR
THREE TIER SYSYTEM OR (10)
OR
HEALTH CARE DELIVERY SYSYTEM IN INDIA (8)
Q 3 FUNCTION OF URBAN HEALTH CENTER / PHC /CHC ( 5)
Q 4. CONCEPT OF PHC ( 5)
Q 5. WRITE IN DETAIL THE FUNCTON OF COMMUNITY HEALTH
CENTER (7)

Primary health care in India

 In 1977, GoI launched Rural Health Scheme based on the principle of

“placing people’s health in people’s hand”
 Subsequently in the international conference of Alma- Ata(1978)the goal of “Health
for all” by 2000 through primary health care approach was set.
 Keeping in view WHO “Health for all” by 2000 GoI formulated National health policy
2002
 More recently GoI formulated NRHM and Indian Public Health
 Standards (IPHS) in this regards
 In order to provide quality care in the public health agencies of health care delivery
IPHS are being prescribed.
 These standards provides basic promotive, preventive and curative primary health
care to the community and……
 …….achieve and maintain an acceptable quality of care
 These standards would help monitor and improve functioning of the health care
delivery system
Rural Health care system in India
Community Health Centre
Community Health(CHC)
Centre (CHC)
A 30 bedded Hospital/ Referral unit for 4 no. of PHCs with specialized
A 30 bedded Hospital/ Referral unit for 4 no. of PHCs
Health Services, 100 VILLAGES., 80,0001,20,000 Population

Primary Health Centre (PHC)

A Referral unit for 4-6 Subcentres; 4-6 bedded manned with a Medical Officer in-
charge and 14 subordinate paramedical staff no. of PHCs with specialized Health
Services., 30-40 VILLAGEs , 20,000-30,000 population

Sub Centre (SC)

Most peripheral contact point of community with Primary Health
Care system; manned with one MPW(M) and MPW(F) , 5-6 villages., 3,000-5000
population

 The health care infrastructure in rural areas has been developed

as a three tier system and is based on the above population
norms.
jj
 Sub Center
 The most peripheral and first contact point between the primary health care system
and the community.
 The Ministry of Health & Family Welfare is providing
100% Central assistance
 They are established on the basis of
 One SC for every 5,000 pop in general and…
 One SC for every 3,000 pop in hilly, tribal and backward areas
 Each Sub-Centre is manned by one Male and one female Health
Worker.
 One Lady Health Worker (LHV) is entrusted with the task of
supervision of six Sub-Centers.
Subcenters
The subcenter (SC) is the most peripheral and first contact point between the primary
healthcare system and the community.
Each SC is manned by two paramedical workers :
A health care worker female and male
 Primary Health Center
 PHC is the first contact point between village community and the
Medical Officer.
 The PHCs were envisaged to provide an integrated curative and
preventive health care to the rural population with emphasis on
preventive and promotive aspects of health care.
 The PHCs are established and maintained by the State Governments.
 At present, a PHC is manned by a Medical Officer supported by 14
paramedical and other staff.
community and the Medical Officer.
 The PHCs were envisaged to provide an integrated curative and
preventive health care to the rural population with emphasis on
preventive and promotive aspects of health care.
 The PHCs are established and maintained by the State Governments.
 At present, a PHC is manned by a Medical Officer supported by 14
paramedical and other staff.

There were approximately 25,600 PHCs functioning in india as of end of 2017

KIT AT PHC LEVEL
 Community Health Center (CHC)
 These were established by upgrading the primary health centers
 CHCs are being established and maintained by the State Government.
 centers,each community health center should cover a
population of 8000 to 1.2 lakh
 It is manned by four medical specialists i.e.
Physician, Gynecologist and Pediatrician and….
……supported by paramedical and other staff
 It has 30 in-door beds with one OT, X-ray, Labour Room and Laboratory
facilities.
It serves as a referral centre for 4 PHCs and also provides facilities for obstetric care and
specialist consultations
As per the latest available data (beginning of 2018) there were 5624 CHC’s functioning in
india .The CHC are designed to provide referral services to india .
These are designed to provide referral health care for four PHCs thus catering to a
population of 80,000 in tribal and 1,20,000 in plain areas.
 Functions of CHCs
 Care of Routine and Emergency Cases in Surgery
 Dressings, I&D, and surgery for Hernia, Hydrocele, Appendicitis etc.
 Emergencies like Intestinal Obstruction, Haemorrhage, etc.
 Other management including nasal packing, tracheostomy,
foreign body removal etc.
 Fracture reduction and putting splints/plaster cast.
 Conducting daily OPD.
 Care of Routine and Emergency Cases in Medicine
 Daily OPD
 Handling all the emergency and routine cases
 Maternal Health
 Minimum 4 ANC check ups including Registration & associated services
 1st visit: Within 12 weeks—preferably as soon as pregnancy
 2nd visit: Between 14 and 26 weeks
 3rd visit: Between 28 and 34 weeks
 4th visit: Between 36 weeks and term
 24 hr delivery services including normal and assisted delivery and cesarean
section
 Managing labour using Partograph.
 Minimum 48 hours of stay after delivery, 3-7 days stay post delivery for
managing Complications
 Newborn Care and Child Health
 Essential Newborn Care and Resuscitation
 Counseling on Infant and young child feeding
 Routine and emergency care of sick children
 Full Immunization of infants and children against VPDs
 Management of Malnutrition cases.
 Family Planning
 Counseling, provision of Contraceptives, NSV, Laparoscopic Sterilization
Services and their follow up.
 Safe Abortion Services
 All National Health Programmes delivered through CHCs
 School health services
 Others
 Blood storage facility
 Essential laboratory services
 Referral (transport) services
 Maternal Death review (MDR)
Q 6. Describes brief health care delivery system in india ( 8 ) ans is sir ki ppt
Q7 . Elist the records maintained in sub centre ? (2)
Q8. Describes health organisation setup at distric level and its function (8)
function of panchayat raj institution
Q 9. ROLE OF ANGANWADI WORKER (5)
Q. 10. SHORT NOTES ON ASHA ( 5)
Q.11
Q.12 MTP ACT (5)
 Medical Termination of Pregnancy (MTP) Act,1971
DEFINITION :
ABORTION : - The termination of pregnancy before the period of viability OR
Expulsion / extraction of all or any part of placenta or membrane , without any
identifiable fetus

MTP Act: Objectives/ AIMS

 To improve the maternal health scenario by preventing large number of unsafe
abortions and consequent high incidence of maternal mortality & morbidity
 Legalizes abortion services
 Promotes access to safe abortion services to women
 To protection to medical practitioners who otherwise would be penalized under the
Indian Penal Code (sections 315-316)

Legal framework
 The MTP act the highlights the approved condions and sutable
condidates, place and qualififaction require from the medical practioner to
terminate pragnancies..

PRACTIONER
QUALIFICATION

MTP SUITABLE
PLACE CONDIDAT
ACT ES

CONDIDATE
S

MTP Act: Application / CONDITION FOR MTP

Medical:- Where a pregnant wowan has a serios medical disease and continuation of
pregnncy could endanger her life like: heart disease , severe hypertention , gdm, cancer ,
epilepcy and psychiatric ilness
Eugenic:- where a continuation of pregnancy could lead to substantial risk to newborn
leadind to sereous physical/mental handicapt eg: chromosomal abnormality , rubella
Humanitarian: Pregnancy caused by rape
Socioeconomic: when the enviornment could lead to injury to the mother.
Contraceptive failure device: Contraceptive failure in married couple

Consent

MTP Act: Place for conducting MTP

 A hospital established or maintained by Government
Or
 A place approved for the purpose of this Act by a District-level Committee
constituted by the government with the CMHO as Chairperson
Who can perform MPT :-
a) MTP rules: training requirement – 1
For termination up to 12 weeks:
– A practitioner who has assisted a registered medical practitioner in performing 25 cases
of MTP of which at least 5 were performed independently in a hospital established or
maintained or a training institute approved for this purpose by the Government
 b) MTP rules: training requirement – 2
For termination up to 20 weeks
– A practitioner who holds a post-graduate degree or diploma in Obstetrics
and Gynecology
– A practitioner who has completed six months house job in
Obstetrics and Gynecology

A practitioner who has at least one-year experience in practice

of Obstetrics and Gynecology at a hospital which has all facilities

A practitioner registered in state medical register immediately before

commencement of the Act, experience in practice of
Obstetrics and Gynecology not less than three year
Q.13 Female foeticide / female foeticide act ( 5)
What is Foeticide?
The term FOETICIDE means killing the FOETUS in the mother’s womb.
This practice is mostly confined to female gender and female foeticide is the major topic of
concern in today’s society, especially in developing countries like India.

Incidence:- The country which stands first Afghanistan.

• Followed subsequently by Congo, Pakistan.
• India ranked 4th most dangerous place for women primarily due to female foeticide.
• The country with least female foeticides is Namibia in Africa.

Social causes of female foeticide:

 Money: girls are considered a financial obligation
 Poverty
 Lack of proper education
 Future speculations : marriage, dowry
 Mindset: age old traditional practices
 Obsession for son
 Gender discrimination
 Female is considered as greater responsibility than a male mainly
due to security issues
FEMALE FETICIDE IN INDIA
 The child sex ratio has dropped from 945 females per 1000 males in 1991 to 927
females per 1000 males in 2001.
 Estimated that 50 million girls and women are ‘missing’ from India’s population
because of termination of the female foetus.
 Female foeticide in India increased by 49.2%.

Consequences:-
• Decrease in female population
• Adverse effect on women’s health mentally, emotionally and physically
• Women are abused and sexually exploited
• Leads in women trafficking
• Women are kidnapped, bought and sold for marriage

• Suicide rates in women will increase

THE PRENATAL DIAGNOSTIC TEST ACT (PNDT ACT) OF 1994
 This Act was enacted in the year 1994 in all of the states in India , but it came into
force in the year 1996.
 Through this Act the use of pre-natal diagnostic techniques is prohibited and
regulated.
 PNDT Act was amended in 2003 with its main aim to to ban the use of sex-selection
techniques as well as the misuse of pre-natal diagnostic techniques for sex-
selective abortions .
 More than 21,600 centres conducting pre-natal diagnostic procedure have been
registered.
The Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection)
Act 2003
• To provide for the prohibition of sex selection, before or after conception
Salient Features Of The ACT
 Use of PNDT only allowed on medical grounds & not for determination of sex
 PNDT can be conducted only by clinics registered under the Act
 No person conducting prenatal diagnostic procedure shall communicate to pregnant
women or her relatives, the sex of the foetus by words or signs or any other method
 Clinics involved in advertisement (conducting sex determination) are liable for
punishment
 Declaration on each report that he/she has neither detected nor disclosed the sex of
foetus to pregnant woman or to any body
 Offence under PNDT are cognizable, non-bailable and non compoundable
 Clients and their relatives asking for sex determination are also punishable

INTRODUCTION
• The prenatal diagnostic techniques (Regulations and Prevention of Misuse) Act,1994
has been amended to make it more comprehensive.
The amended act and rules came into force with effect from April 2003 and PNDT Act
renamed as Preconception and Prenatal Diagnostic Technique(prohibition of sex
selection) Act ,1994 to make it more comprehensive
REASONS FOR THE AMENDMENT;-
• G.O.I. has amended the PNDT Act to PCPNDT Act keeping in view the emerging
technologies for selection of sex before and after conception and problems faced in
working of the act.
PROBLEM:- India had lost over 10 million girls because of femal foeticide in last 20 Years
• 2 million females are killed before or at birth simply because of their sex.
• 35 % Districts in India have lower Child sex ratio than
National Average.
AIM :-
• The act provides for the prohibition of sex selection before and after conception
and for the regulation of prenatal diagnostic techniques for the purpose of
detecting genetic abnormalities or metabolic disorders or chromosomal
abnormalities or congenital malformations or sex linked disorders and for prevention
of their misuse for sex determination leading to female foeticide and for matters
connected therewith.
PURPOSE:-
• PCPNDT can be used for detection of abnormalities:
 Chromosomal Abnormalities
 Genetic Metabolic Diseases
 Haemoglobinopathies
 Sex-linked genetic diseases
 Congenital abnormalities
 Any other abnormalities
CONDITIONS TO BE FULFILLED
 Age of pregnant women is above 35 years
 Two or more spontaneous abortions
 Pregnant women has been exposed to drugs, radiation, infection or chemicals
 Family history of physical deformities
 Any other condition
ESSENTIAL COMMUNICATIONS
• Explanation of all known side/ after effects & test procedures
• Written consent in prescribed form & its copy given to her
• Not to disclose sex of the fetus by words, signs etc.
• Display prominently in local language that disclosure of sex of fetus is
prohibited under law.
• Registration certificate to be displayed prominently in the clinic.

REGULATION OF PRENATAL DIAGNOSIS

TECHNIQUES
• PERSONS
• PLACES
• DIAGNOSTIC TECHNIQUES:- USG
• Foetoscopy
• Sampling & analysis of amniotic fluid chorionic villi blood
PLACES:-
• Genetic Counselling Centre
• Genetic Clinic
• Genetic Laboratory
A. Genetic Counselling Centre:-
• An institute
• Hospital
• Nursing home
• Any place by whatever name called which provides genetic counselling to patients.
B. Genetic Clinic :
• A clinic
• Institute
• Hospital
• Nursing home
• Any place by whatever name called which is used for conducting pre-natal diagnostic
procedures.
C. Genetic Laboratory:-
A laboratory; and
• Includes a place where facilities are provided for conducting analysis or tests of
samples received from Genetic Clinic for pre-natal diagnostic test.
PERSONS:-
Gynaecologist
A. Medical Geneticist
B. Paediatrician
C. Registered Medical Practitioner
D. Laboratory technician
E. Radiologist
F. Sonologist or Imaging Specialist
• Beti Bachao, Beti Padhao Scheme:- The Govt. of India has launched the BETI
BACHAO, BETI PADHAO Scheme recently on 22nd January, 2015, mainly aiming at
generating awareness and improving efficiency of delivery of welfare services for
women. The govt. proposed Rs. 150 crores to be spent by the Ministry of Home
Affairs on this scheme to increase the safety of women in large cities.
'Sukanya Samriddhi Yojna :- 'Sukanya Samriddhi Yojna’ is a small deposit scheme for
girl child, launched as a part of the ‘Beti Bachao Beti Padhao' campaign, which would
fetch an attractive interest rate and provide income tax rebate.
'Sukanya Samriddhi Account' can be opened at any time from the birth of a girl child
till she attains the age of 10 years, with a minimum deposit of Rs 250. A maximum of
Rs 1.5 lakh can be deposited during a financial year.
The account can be opened in any post office or authorised branches of commercial
banks.
 The scheme primarily ensures equitable share to a girl child in resources and savings
of a family in which she is generally discriminated as against a male child.
• International Day of the Girl Child:- It is an international observance day declared by
the U.N.
• Otherwise called “Day Of The Girl”
• OCTOBER 11, 2011 (1st Day Of The Girl)
• This day supports more opportunity for girls and increases awareness of gender-
inequality faced by girls world-wide.
•