im = i Appendices 4 | “Nursing is one of the Fine Arts: had almost said the finest of Fine Arts.” —Florence Nightingale UPDATES ON COVID-19 ‘Spike slycoprotein(S) Envelope Hemegglutinin ‘esterase cimer (HE) History and Origin of Coronaviruses * Coronaviruses are large group of viruses that cause illness in ‘bumans and animals. * ‘The outbreak of Novel coronavirus disease (COVID-19) vas Initially noticed in a seafood market in Wuhan city in Hubei Province of China in mid-December, 2019. * A pneumonia of unknown cause detected in Wuhan, China was first reported to the WHO Country Office in China on Bist December, 2019. * The outbreak was declared a “Public Health Emergency of International Concern” by WHO on 30th January, 2020. ‘+ WHO declared COVID-19 pandemic on 11th March, 2020 Definition of COVID-19 Case © Confirmed Case: A person with laboratory confirmation of ‘COVID-19 infection, izespectve of clinical signs and symptoms. Viral Structure © Thecoronaviruses are made up of four structural proteins, namely, the spike (S), membrane (M), envelop (E) and nucleocapsid (N) proteins. * The spike (8) protein is protruding from the viral surface and is the most important for host attachment and penetration. Life cycle of Coronavirus Life Cycle has 4 Stages 1, Attachment 2. Penetration 3. Maturation, ‘4. Release of new infective materials for community transmission. [" S proton of vies binds to the host cel receptor |_ACE:2 via S-1 subunit Particles transported to the extraceluiar space ‘ia Golgi vesicles. ‘and exocylosis Protein biosynthesis. in the cytoplasm ae Ref: Porasher A. COVID-19: Current Understanding of its Pathophysiology, Clinical Presentation and Treatment. Postgraduate Medical Journal 2021;97:312-320. Epidemiology * Current available evidence for COVID-19 suggests that the ‘causative virus (SARS-CoV-2) has a zoonotic source closely related to bat-origin SARS-like coronavirus. * The severe acute respiratory syndrome (SARS) coronavirus-2 isa novel coronavirus belonging othe family Coronavirida. * Tis an enveloped RNA beta coronavirus related to the Severe ‘Acute Respiratory Syndrome (SARS) virus. ‘+ The virus has been shown to use the angiotensin-converting enzyme 2 (ACE2) receptor for cell entry. * Source of infection: The persons infected by the novel coronavirus are the main source of infection. Burden of Disease © Worldwide: * 85% ofpatientsare either asymptomatic or have mild symptoms * 15% have moderate to severe disease 1 59% require critical care * India "= 6.4% of ective Covid-19 cases need hospitalization * Intensive care treatment provided to about 3% of cases4 Appendices Mode of Transmission “+ The virus is transmitted via respiratory from person to person. {> nfection can also occur ifa person touches + Incubation period: The median incubation pei ‘+ Asperthe current evidence, the period of seer nse of apm and sep 10 8d Pathophysiology aE [SWE oer nba ma ino Target High - Sith Premium Edition Cytokine storm: IL-6 isthe major culprt ofthe host cals a Continuing veal replication results in loss oftype | and type I ung ‘cells (pneumocytes) | Diffuse resulting Ae epi Ota Snre AS) | Severity of Cases and Management Guidelines Clinical severity | Clinical presentation ‘+ Patients with upper respiratory tract symptoms (with or without fever) without shortness of breath of hypoxia droplets and aerosols ring OF ‘are collected «+ Aerowlized droplets are generated through coughing. seeHn Samples ate rs eropharynse «Direct contact with patient and its body uid including foe. tact with surfaces and frites. e * Indirect contact with surfaces ca wieedetet ty imitbertoudeshsorberejs ns ool 4” Gagner are Fo (range 2-14 days). ty arts 2 days * HAR El blateral ‘round gnosis adonal RT-PCR #1 Commend | yer respiratory t from the UPPET FeSPIEIOTY trae, ‘swabs. Thr cyngeal swabs. Thoat andy Laboratory Dia soar pet media (VIM) IEE ANDO sed patents expetorated spt, ee ower respiratory acts weg or detection, lar lavage from cD) 1 igh Reston CT CRON and gla nth : Sewn sion and lymphadenopathy Be Ae, accom 1 Increased D-dimer me soa Increased levels of AST and 1 Iaceat eves of C-Reactive Protein and Serum fern Clinical Features Rhinorthea, sore throat, of taste (ageusia) preceding the onset of respiratory symptoms, ‘Asper data from Integrated Health Information Platform (1H) Integrated Disease Surveillance Programme (IDSP), the comme ‘signs and symptoms reported are (as on 11.06.2020) = Fever (27%) = Cough (21%) * Sore throat (10%) © Breathlessness (8%) 1 Weakness (7%) * Running nose (3%) = Others 24% Risk Factors + Advanced age (age > 60 years) * Underlying noncommunicable diseases (immune-suppresi diabetes, hypertension, cardiac disease, chronic lung die cerebrovascular disease, Chronic kidney disease, and canct. ec ‘+ Home isolation and care 1 ghvscal distancing, indoor mask use, strict hand hygiene * Symptomatic i mutta) S2et™er hydration, antipyretic, antiussives, * Seekimmediate medical attention if there is: = breathing difficultyAppendices AS " 4 . Clinical severity | Clinical presentation 8 af jm oer sf 90-94% (88-92% in COPD patients) : 1 Respatory ate >24/mi, crOnrben suppor with target “ay restlessness 5 Nonrebrenhing ae maa sree 8 Sox te 53% on roma + awoke proing encouraged inal patents Py, 2 divided doses (or an equivalent dose of dexamethasone) usually s a duration of 5-10 days. : wt ‘+ Anticoagulation: Weight based conventional dose of prophylactic anctsnated hepa ot Low Molecdar Weight Heparin e, Enorapatn 0S mg/ dose SC 8D) not contraindicated mth «+ Monto for werk of breathing, Hemodynamic instability, change ‘nye requirement « Serial fe HRT chest to be done ONLY Hf there i worsening of symptoms «LBB monitoring CRP and D-dimer 42-72 rly CBG KF, UF 24-48 hice levels tobe done severe Anyone of ‘ADMIT in 1 Respkator rate >30/min 1 nespiatory support: consider noninvasive vetiation (helmet oF itn breathlessness facemask) in patients with increasing oxygen requirement 2.590, < 0% on rom ai «Consider use of High low Nasal Canula FNC patents wth 13) acy Increasing oxygen requirement. «Intubation should be prioritized inpatients with high work of breathing/If NIV Is nt tolerated. ‘+ Inj Methyiprednisolone 1-2 mg/kg V in 2 divided doses (or an ‘equivalent dose of dexamethasone) usualy for a duration of S-10 days. ‘Anticoagulation: Weight based intermediate dose prophylactic, ‘unfractionated heparin or Low Molecular Weight Heparin (e.g, Enoxaparin 0.5 mg/kg per dose SC 80). ‘Monitoring: Serial CKR; HRCT chest to be done ONLY if there is worsening of symptoms ‘© Lab monitoring: CRP and D-dimer 48-72 hrly; CBC, KFT, LFT 24-8 ly; IL-6 levels to be done. Source: AlIMS /ICMR-COVID-19 National tsk force guidelines dated May 17, 2021. "No active bacterial/fungal/tubercular infection. Emergency Use Authorization (EUA/Oftabel) (based on limited avaiable evidence and only in specific creumstances) * ‘Remdesivir (BUA) may be considered ONLY in patients with: * Moderate to severe disease (requiring SUPPLEMENTAL (OXYGEN), AND * No renal or hepatic dysfunction (eGFR 5 times ULN (Not an absolute contradiction), AND * Who ae within 10 days of onset of symptoms * Recommended dose: 200 mg IV on day 1 fb 100 mg IV OD fornext4 days g * Not to be used in patients who are NOT on oxygen support or PEL inhome settings ‘Toclizumab (Off-label) may be considered when ALL OF THE BELOW CRITERIA ARE MET ™ Presence of severe disease (preferably within 24~48 hours of ‘onset of severe disease/ICU admission. * Significantly raised inflammatory markers (CRP and/or IL-6). * Not improving despite use of steroids. ' Recommended single dose: 4~6 mg/kg (400 mg in 60 kg adult) {in 100 mL NS over 1 hour, Source: AIIMS/ICMR-COVID-19 National task force guidelines dated May 17, 2021. Infection Prevention Control Practices * At triage: Give suspect patient a triple layer surgical mask and direct patent separate area or an isolation oom if available ‘Apply standard precautions: Include use of Personal Protective Equipment (PPE), appropriate patient placement, prevention of sharp injury, safe biomedical waste management, cleaning and disinfection of equipment and environment ‘Apply droplet precautions ‘+ Apply contact precautions * Apply alzborne precautions when performing an aerosol ‘generating procedure.‘6 Appendices fe - d for the brain.” | ; tis likely to Be 9° r Eppocrates | i “food that is good for the hea! ; ; Tor covID-19 IN PREGNANC’ — € MANAGEME! oft _gnant woman with COVID-19 adi A : — * ‘Management pret \ sion . & + Pregnant women with COVID:19 with ‘comorbid heart aka nf wt 5 mm i = Houry oem to maintain SPO,79A% B+ tan shox invaprtm + THEODOR for ae : BP emerging evidences suggest that antenatal rey seta wansmisin motherto BAD) SPE ging = ‘RadlOer ged chest raography shoud a Ar prsent, there is no recorded evidence of ether so so rer es nied ee i i ce ama sng * Storia tly thatthe virus is teratogenic to potest the fetus pet eee 2 Thereisno evidence currently thatthe . ei S coviD- ‘strate curently nt en nda forMedial = * eer ae Ph IV fluid ‘management dy ola ot ‘Termination of Pregnancy 500 mand then sss ad vied er, ; to er infusion of % Antenatal ae saved to atend routine antenatal care at —_ witfurtherinfision TM se bith dg 12,20, 28 and 36 weeks of gestation, unless they meet current selfisolation criteria. + For women who had symptoms, appointments can be deferred for? days after the star of symptoms, unless symptoms become severe. Fetal kick count to be maintained ‘if women self-quarantined due to someone in the home is infected, appointments can be deferred for 14 days ‘© 1F & pregnant woman infected with COVID-19, antenatal Urasound for fetal growth surveillance is recommended after recovery * Anywoman mustbecontactedifroutine antenatal appointment ss delayed by 3 weeks + Intrapartum care * Delivery shouldbe preferably at tertiary care hospital * Maternal observations including temperature, Respiratory rate and oxygen saturations * Electronic fetal monitoring using cardiotocograph (CTG) * Hourly oxygen saturation during labor * Carein labor * ‘Titrate orygen therapy with the aim of oxygen saturation >949% * Investigate and treat as per the guidlines if the woman has signs of sepsis Continuous electronic fetal monitoring in labor is recommended * Ina symptomatic woman, an individualized decision should be made regarding shortening of 2 instrumental inh * madn * At present, there is no evden. ? or epidural anesthe Antion for spinal = If urgent delivery be expedited as normal, as normal. y ‘© Postnatal management ‘ie wrapocarily eparaing the wal + Facilities should consider temporarily separating the mai, viho has confirmed COVID-19 (or under investigation) fx her baby until the mother’s transmission-based precaution discontinued A separate isolation room should be available for the iis while they ae under investigation for COVID-19. "= If rooming in is practised due to mother’s wish, implementing measures to reduce exposure of newbom 0! virus (facemask, hand hygiene of mother, etc.) * ‘Breastfeeding ™ During temporary separation, mothers should be en: ‘to express their breast milk. The expressed breast milk: be fed to the newborn by a healthy caregiver ‘= If rooming in is practised, then the mother should pi facemask while breastfeeding. * Guidelines for OT * Elective obstetric procedures should be scheduled at thee! the operating list * Non-elective procedures should be carried in out in 3 obstetric theater (if availabl le) 7 ™ Number of staff sh¢ wuld be minim on 1um with appropriate PPE ‘Source: ICMR-National Institute for Research "tnd agro Heolth. Guidan Pandemie, °42" Management of Pregnant Women in COV tong asthe maternal condi, ‘_ & \ealth of body or of mind, is defeat. Health alone is VIO, 3 MUCORMYCOSIS (BLACK FUNGUS) Introduction © Mucormycosis (previously called zygomycosis) is a serious ‘but rare fangal infection caused by a group of molds called smucormycetes. ‘© These molds live throughout the environment but they mainly affect people who have compromised immunity (immunosuppressed patients) ‘+ ‘This infection most commonly affects the sinuses or the lungs after inhaling fungal spores from the alr. ‘= Ttean also oceur on the skin after a cut, burn, or other type of ssa Pc, Kin injury. nig TYPesof Mucormycosis mag * Rhinocerebral mucormycosis: 1 Alfects sinuses that can spread tothe brain. It is the most common type in people with uncontrolled bend ____ iets andi people who underwent eal ransplantaton Nag * Palmonary micormyeoss (affects lungs) als 1sthe most common ype people wih cancer andin people ‘who have had an organ transplant ora stem cell transplant. © Gastrointestinal mucormycosis thetd More common among young children than adults, especially ‘premature and Low Birth Weight (LBW) infants | © © Cutaneous mucormycosis (affects skin) ‘= Most common form of mucormycosis among people who do not have weakened immune systems. © Disseminated mucormycosis. scot ® Occurs when the infection spreads through the bloodstream to ik _alfect another part the bod. 4# Types of Fungi that Commonly Cause Mucormycosis © Rhizopus species, Mucor species, Rhizomucor species, We? Syncephalastrum species, Cunninghamellabertholletiae, 4g epsom: spe, and Udine (ermedy Abie) 1 species gh Risk Factors rt * Diabetes, expecially wth ketoacidosis 0" © Organ transplant, stem cell transplant Appendices 7 =| 8 8 2 =| a sesary © 2 10 is victory’ + Cancer * Neutropenia + Long-term corticosteroid use + Iron overload of hemochromatosis + Skin injury + Prematurity and low birth weight Signs and Symptoms Ove-sided facial swelling, © Rhinocerebral mucormycosis: headache, nasal or sinus congestion, black lesions on nasal bridge or upper Inside of mouth that quickly become more severe and fever © Pulmonary mucormycosis: Fever, cough, chest pain and shortness of breath ‘= Cutaneous mucormycosis: Blisters or ulcers, and the infected trea may turn black. Other symptoms include pain, warmth, ‘excessive redness, of swelling around a wound ‘© Gastrointestinal mucormycosis: Abdominal pain, nausea and vomiting and gastrointestinal bleeding ‘+ Disseminated mucormycosis: Patients with disseminated infection inthe brain can develop mental status changes or coma Diagnosis Fluid sample from respiratory system for lab analysis, biopsy, CT scan of sinuses, lungs or other affected body parts. ‘Treatment Antifungal drugs: ‘= IV; Amphotericin B, posaconazole, or isavuconazole. = Oral:posaconazole, savuconazole. ® Other antifungal drugs, including fluconazole, voriconazole, and echinocandins, DO NOT work against fungi that cause mucormycosis. ‘© Surgery: Often, mucormycosis requires surgery to cut away the infected tissue. Note: Mucormycosis can’t spread between people or between people and animals. Source: Centers for Disease Control and Prevention (CDCI.AB Appendices 5 & g € 2 5 c & 2 3 & nL spit heating ie Brat 2 hells sen Uppares ON TUBERCULOSIS eee tum) and transportation tobe iy «sample caletion (Pet inimum $m) ‘= In 2020, the RNTCP vas nae A Nato ee apes in cold chain (quantity Program size the alm aan teint TB Inlay 205, «Prime Minster of India Inunced TB Free Ind campaign st ‘Delhi End TB Summit on 13% March 2018 «pds has commited to End TB by 2025, 5 years abead of he sfobal SDG target «+ Enimted Incidence of Taberculsiin 201915 (099Makh population) + Updates on Tab est, ‘Nucleic acd amplification tests (NAATS) have been used a8 1 diagnostic tool for tuberculosis (TB) 1 Cartrdge-based nucleic acid amplification test (CB NAAT) [nthe prefered ist dngnostictet in children extrapulmonary 1B, contact of Drug resistant TB patents, Smear Negative Falcon tube Chest X-ray postive patients. errr rey New OR Previously treated + The drugs are given daily «The dose of drugs are according to body weight + Fixed Dose Combination (FDC) tablets are used ‘* Noneed for extension of IP + CP may be extended by 12-24 weeks in certain forms of TB like CNS TB, Skeletal TB, Disseminated TB, etc. 26.9 lakh TB cases peer ea a) (a) HRE ‘Treatment Regimen Intensive Phase (IP) Treatment of TB-Adult Dee oe) Car lu Ue) 'H(75 mg), R (150 mg), Z (400 mg), Loan 8), H (75 mg), R (150 mg), € (275 mg) 25-34 2 3549 kg 3 : 50-64 kg. 4 : 65-75 kg. 5 ‘ 275 6 : 6 Nikshay Poshan Yojana ‘© 7500 at the beginning of each month for eve notifies © Direct Benefit Transfer only "7 nouhed 7B atin for the ful tetment period| Mag isin {i a ; ; (Lee : ‘l-health of body or of mind, is defeat. Health alone is victory.” e UPDATED QUESTIONS ON COVID-19 rita ee Et Bons wen ENP ee er mT. maeara fee eee Fossa ovalis Abecomes ~ Ligamentum arteriosum DV becomes — Ligamentum venosum UUrachus (Fibrous remnant) ~ Median umbilical igament Umbilical artery (distal part) forms + Medial umblical igament Solos Perreks Ductus arteriosus (OA) Foramen ovale (FO) Pulmonary v. Pulmonary a (65%) Ducts venosus (OV) ‘Get your study assessed with AML 4000+ Questions covering all subjects and Grand Tests focussing AlIMS NORCET 2022-23 TARGETHIGH Digital >Lite> Assess Yourself AAS AppendicesTotget High - Sith Premium Edition _ i, it as oF "Your body is a temple, but only if you treat it as. 008, POSITIONS | re eer ravens Ter CakEo ‘+ Physical examination It is a back-ying postion with arms onthe side esting, ‘+ Undergoing anesthesia ‘Supine Z, ‘+ Lung biopsy «Physical examination of abdominal and genital ny Dorsal recumbent Its also a back lying position, in this patient's head and shoulder may be elevated or re resting onside. Legs are apart with n a small pillow. Arms are resting, ee knees flexed and foot resting on the bed. PV examination —— ‘Shock patient Trendelenburg Patient is lying on the back with arms on the side. In this position bed is positioned in such a way that head of the bed is lower than foot of the ‘= Hypotensive patient ‘* Cord prolapse patient patient and there isno flexion a the waist level. ‘© To shift abdominal organ ‘upward during certain surgeries. * Air embolism {tis Just opposite to Trendelenburg position n this position, head of th To mini 'selevated than the foot level with no flexion at waist level, — eacactnoen reflex a TrendelenburgAppendices A-17 ce ere Sey re 5 ert ui 8 pce 3 Patient sling either on left or right side, with hip and knees flexed, top + Topromote lungand.cardiac — Tesin front ofthe bottom leg In this postion pressure, on back and cocoyx function g vealpe relteved and pressure is distributed along the scapula, lateral aspect + Torelieve pressure on back ‘fthe tum and the greater trochanter ofthe femur. and coccye + ‘fer ive biopsy ight teal pesto, ~| + Patient with pyloric stenosis after meals ght lateral to promote entry of food nto Stomach and intestine «uring seizure attack an ai embolism le lateral sins patients Wing on left side with semi-prone postion, one arm slecated Rectal amination behind the patient and other arm Is flexed at shoulder and elbow. Both legs» Administering erems are loxed atthe level of hip and knee but the upper legis more flexed and * To prevent aspction isdrawn upto the level of chest. Low Fowler's In ths postion, head ofthe ed is elevated at 30 with flexion atthe level» To prevent aspiration during of waist. tube feeding + During increased cP | 3 ‘ Semi-Fowers inthis postion, head ofthe beds elevated to 45" with lesion at the level + To promote ung expansion of waist. ‘To relieve tension on surgical site following abdominal surgeries ‘Tracheoesophageal fistula Paracentesis Contd.E went the risk of mI # Topres choy nat the evel of WAS F Torelieve respiratory dint with flesot 1 nasogastric tube intubatg, ARDS fe asthma = coPD Emphysema { Pleural effusion ed ‘Descriptions err postions 4 Torelieve respiratory dee, © Thoracentesis & Pericarditis patient ‘ARDS Asthma = coPD + Emphysema with an overhead table eof abe, or sida Meas te comfort level of rent i sitting 0” i be provided to increase tnthis postin, pati tolean forward pitlows Wil the client ‘orthopneie postion ‘Torget High - Sixth Premium Edition al fo uth head tured to one side, to promote + To prevent aspiration irpilow or towel rolican © Recovery position after anesthesia «= To relieve pressure on the back and coceyx V ‘= Renal biopsy ‘* Neural tube defect, + Position after spinal surgery ‘and hemorrhoidectomy Prone position Patients ving on the abdomen ‘comfort, pillow can be used under head and a smal bbe used under the abdomen. LUthotomy Lying on back with legs flexed at hip and knee joint and legs are supported © Child birth with leg rest and strap. + Pelvic gynecological surgeries ‘© Transurethral Resection of Prostrate (TURP) Kneeches postion Patent ston th retson the nee nd ches with heads (Gmupecon|”_otenedontheead cow ted wing a pesto rhe patent welt; the abdomen re the abdomen ema un 2smalplon mabe cedure te chet Ithepoatn se vootnsion cers because pooling of blood nthe omega sd to one side, arms eso that they paraly, = taney ‘+ Lumbar laminectomyAppendices A19 a i “A surgeon should be young a physician old.” | French Provert Appendices INSTRUMENTS: ey ast tissue «As tissue forceps ae used for c12 8 fms organs and slippery or dense risus 3p electrosurgery ka + Used in gynecological operations to hold the tip of cervix '* This structure is similar to Alli’s forceps except ‘they are very long Arter forceps + Used for grasping, compressing, nd holding the end of an artery during ligation Right-angled artery '* Toisolate, encircle and ligate vessels or ducts, forceps especially those present in depths Kocher’ Forceps + Tohold securely superior thyroid pedicle vessels «Hold retracting cut ends of vessels in tough fibrous tissue ‘* Hold ribs during rb resection ‘© To cause artificial rupture of gestational membrane‘#20 Appendices + Udo gap dle ein nerve ed ‘They are frequently used with intestinal ang ' eee tate toce laparotomy procedures. E 2 é Safety Blades + Intended to be used with BP S g tr hand {sue separation, and other procedures the Co sttaecltande Fequice a sharp surgical blade to puncture ry 5 (asoknown as F Sonande or Bade Better 5 + Removal of unsightly warts Seen + To bur or coagulate the specific 3128 of tsa electrocautery Cheatle forceps * Used to remove sterilized instruments from " boilers and formalin cabinets. The forceps ae Placed ina container of methylated spirits when not in use. Deavers retractor * Used to hold back the abdominal wall during abdominal or thoracic procedures. Dover's towel ctip * Used to fix draping towels, * Used for fixing diathermy cables, suction tubes, ete, >re of the instruments Mortis double ended retractor ‘Mosquito artery ‘forceps or small artery forceps Appendices 21 Appendices Retraction of skin and tough fascia In operation involving a lot of dissection In superficial muscle pain which requires retraction, e., Hernioplasty, Thyroidectorny Fix drapes in a manner to expose operative field only Also used to fix tubing’s and cautery wire to drapes in a way that they don't fall eructures like abdominal wall ‘muscles and it gives wider space to work ‘As a hemostat, holding cut edges, to open up ‘abscess, hold free ends ofthe suture, hold cut tend of the sutures, breaking locul, etc.‘Sixth Premium Edition Target High - Fclosi Used to hold a suturing needle for closn iments 35 during suturing and SUE prea wounds durit ieee erry '* For incisions ell as blunt o'ssection .ed for sharp as we : * dae hs ane various tubing’s, surgical an dressings, gauze, sutures, etc. * Self-retaining retractors allow hands free Operation during a surgery * To instil irrigating solutions into the ear © Bisa scissor with Sharp pointed tips used duit ophthalmic surgery, P Ricollect expectorate from patient, fore collecti ing erent some disinfecting ees Should be poured inte the mug,Appendices ‘+ To hold cotton or sterile gauze piece with or without antiseptic solution to clean body part before medical, diagnostic or surgical procedure. ‘+ To hold tongue during oral surgeries without Tongue forceps causing any damage or injury tot. ++ To hold delicate structures such as blood ves. ‘Ancuryem needle Tae and nerves during procedures och + To create holes in body part, eg., to create holes before laparoscopic surgery. Proctoscope / * To examine anus, rectum and sigmoid colon. rectoscope Reflex hammer ‘+ To elicit deep tendon reflexes during neurological and physical examination to assess the functioning of central and peripheral nervous system. > 8 2 5 & 3 2424 Appendices Pras Peter tas a Kidney tray Target High - Sixth Premium Edition Thudichur nasal os Uses To colect waste material following stray procedure, % # These are the instruments which allow uy, depress the tongue and allow the Vstaat, ‘mouth and throat. . «+ Nowadays wooden type disposabic tongue ddepressors are commonly used ths tainly steel type tongue depressor. * Speculum widens the nasal cavity and allows the better visualization of nasal cavity during therapeutic and diagnostic procedures, * Used to hold tissue during procedures ” ‘sed nthe reconstruction of eyetid surgery[ood forceps ‘Tracheal dilator Magill forceps AMBU bag. Asepto singe een cd Appendices A-25 ‘= Adson Tissue Forceps are used for holding and ‘manipulating delicate tissues. These forceps have @ wide and flat thumb grasp area that is ‘commonly serrated. ‘Appendices Used to remove foreign body during ENT procedure © Used to widen the opening rade in the trachee during procedures lke tracheostomy and to keep the tracheal opening patent. «# Itisa righthanded instrument used to place ET tube correctly in laryngeal inlet ‘tis also used to remove foreign bodies and throat packs. ‘* Artificial manual breathing unit or bag valve ‘mask unit used to provide positive pressure ventilation to those patients who all are breathing inadequately. Irrigation of wound or cavities. Conta.A26 ‘Appendices eee es rr ard stann te bone races Bone chisel © Used for cutting procedure ing surgery or ed for cutting bones duri Target High - Sixth Premium Edition Bone cutting forceps + Used for sizing dressing and remo: = circumferential bandages + Also used to cut plaster, fabric occ2sonally Punch biopsy forceps ‘+ To obtain biopsy from various body organs ‘+ Toremove embedded hair follicles, callous formations and tiny cysts or nodules Nelson inhaler * Used for steam inhalation purpose. Hot water nixed with medication is poured into the jar before inhalation. Laryngoscope ContAppendices A-27 ert ‘= Allows the visualization of the fundus of eye Appendices ¢ ‘ophthalmoscope! funduscore pefurscope + Allows the visualization cf inner 23° Jolles thyroid « Selfretaining thyroid retractor used in thyroid retractor ‘surgeries to retract skin. ie aus « It is used for ear examination and ear surgeries. ‘ural speculumBetta Name of the pis also known as righ Pee | ry retractor , «ing double-ended retractor With feng, handle used to retract small oF shalioy % Nainy ured during ast SEE ose skin. —_ , and counter traction. i ctor used during bag « Self-retaining retra ase surgeries, large bone and joint surgerie, a mastoid surgeries. anele retractor W Target High - Sixth Premium Edition ‘© Used in small surgical site. « Itis self-retaining retractor. * Itisa handheld retractor used for holding bas tissue from small, and superficial incisions ‘Balfour with bladder * Also known as balfour abdominal retractor blade retractor * Itisa self-retaining retractor * Used during specific abdominal procedures, cesarean sections and bowel resection. Kelly hemostat (Kelly © This instrument is a straight forms, * Used to clamp large blood vessels and to dis tissues, Vvailable as curved anda Appendices A-29 s aoe g > Use organ ae sects ots = =o | = have long shanks and short jaws with full and 8 on tnecaisretore 2 : Hon : Dee eeecece ere se eye apples ‘and to ensure good ligation. _ Unda ol ese se ding rece ps ce rece internet CT \coene + bresing rcp rth forceps used for plore ena naaslauwe ese sore process Debakey forceps ‘© A traumatic forceps used during vascular procedure to avoid tissue damage during manipulation.5 a = a F = —— it as one.” “Your body is a temple, but only if you free a strid Ala EQUIPMENT/INSTRUMENTS = \Ventilator/mechanical ventilator ‘Automatic external defibrillator (AED) CPAP mask Defibrillator Cardiac monitorAppendices 31 § g 5 a ¢ g Radiant warmer/open care system432 Appendices _—_—_———_ wa igh Frtered mane Neode leet & i a ‘Appendices Appendices “4p surgeon should be young @ physician old.” —French Proverb OBSTETRICS AND GYNECOLOGICAL INSTRUMENTS penne "st is used to measure the length and depth of the uterine cavity, + This instrument s used to collect PAP smear. The broad end is for vaginal sample collection and narrow end is for cervical sample collection ‘+ It's used to remove placental fragments and product of conception inside the uterus «= Also used as hemostatic clamp «# Ithelps to allow easy visualization of cervix ‘and vagina Contd.Paeetr san ie used t0 sap endometrial cy, uterine cavity to obtain samples 3 urerine: § s & £ & = «ets ued to prove eplotomy eg & of labor & episiotomy scissors second stage o 5 . It is used to perform episiotomies durig 7 delivery and labor + itis double bladed specu'um used a, ‘ins vaginal speculum, qmecological examination <2 examine we and cervix Ccsco’s speculum + Itisa selfretaining double-bladed vagea speculum used to examine vagina andere UCD removing hook * Itis used to remove the intrauterine contraceptive device Umbilical sissors/cord * Its used to cut the umbilical cord follow delivery of the babya g ‘copperT ing aging Umbilical cord lamp 7 Hegar dilator Uterine dressing forceps ne Appendices A39 ‘These are the cups used during assisted vacuum deliveries Appendices + Itis an intrauterine birth control device used for birth control and spacing ‘* Itis used to clamp the umbilical cord following delivery ‘= These are the dilators of varying sizes used to increase size from few milietres + These dilators are used to treat vaginismus and to increase cervical dlation ‘+ These dilators are also used to increase the size of stoma folowing colostomy « Itis used for packing uterine cavity «Its used to remove tissue and intrauterine devices during gynecological proceduresTarget High - Sixth Premium Edition Appendices Name of the instruments ‘Simpson perforator Fergussons tubular vaginal speculum Corner) « tis used to remove fetus or to perf fetus skull n an arrested labor where mother’s life is at risk. ‘+ Itisa tubular speculum used to diagnose vaginal and cervical conditions. ‘+ Used to remove fibroids from endometrium during myomectomy. * Used during appende sections and la back muscles. sctomy surgery, cesareit }Parotomy to hold and retract Contmio petertor Breech hook ‘Appendices 41 Used during labor to ease the delivery of ‘a new-born by grasping its scalp withthe smooth flattened blades ‘Appendices ‘+ Instrument used to rupture amniotic ‘membrane with minimal risk to mother and fetus. ‘+ Also known as cranioclast ‘They are heavy-toothed instruments used for breaking up the skull of fetus. ‘They are used as last resource in dificult labor or obstruct labor when the fetus died in the womb. * In dificult breech delivery, head or trunk of ‘the unborn fetus is extracted by inserting blunt hook around the neck or shoulder. ‘= In case of dead fetus with shoulder dystocia for bulk reduction of one or both clavicles are divided using this instrument. + These forceps are used to deliver head of the baby when its at 43 station. ‘¢ These forceps are used at the end of second stage when there is urgency to deliver in terms of fetal distress or maternal issues.A42 Appendices ] rad ray Butler “an expertis one who knows more and more about less On. TUBES AND CATHETERS = sa a tmuinordetoremore cs or Target High - sith Premium Ecfition Tube is placed in the trachea Establish and ee through mouth in order to maintain sirway Provide artificial ventilation. patency To prevent aspiration Tube passes through urethra Urinary drainage Into bladder in order to drain urine. It has got two lumens ‘one for connecting the urinary bag and other for inflating the balloon, vein ails isertedintothe _& tv administration of yi-or the tips connected to” uide the cannula inserted into the WV administration of vein, drugs Cannula is a medical device laced inside a vein to provide venous access, itis available in Harlous gauges (14-24 gauge, (Hg StaBe to Yellow), lengths 2-44 mm), compostions, and * Tocreate venous access=z sete Pita drainage catheter ‘ube cheestomy tube Exopnapel baton. ‘cast baleen intaton sopnagea baon ‘caste btaon ————\ Appendices A43 tesa devee ured icreate« Tocreate patent irway during procedures and in airway ® “emergency situations where ET " Intubation acl or fled Pre Appendices Iticatubeinsertedintothe —* Toprwdetoon.ave stomach via nostri menicine 1 Forpastrs'2 ‘Risa three-way catheter with 2 balloons, one bacon wil «+ patient with massive i esophageal venceal restin the esophagus ard bleeding ‘other inthe stomach. Infated balloon helps to contol variceal bleeding pigtail catheters inserted into * To remove unwanted the body under strict aseptic body fluid from technique with the purpose of | anorgan, cavity or removing unwanted body fuids abscess from an organ cavity or abscess Its locking tp looks tke pi tall ‘and it has got several holes ‘which facilitate drainage. Placed in common ile duct» Todraintile during GB surgery oF in radiology attached toa drainage bag but not sutured in. tis an external port that is place into ‘common bile duct and extends outside the body. The ports an teasy access to allow drainage of bile and stone from the bile duct Itisa tube inserted directly into» Tocreate patent the trachea via surgical ncsion airway ‘on trachea. + Prolonged intubation '» Upper airway ‘obstruction «+ Inability to intubate ContTarget High - Sixth Premium Edition Appencee. reer Instruments CCombi-tube (or) double lumen airway tube Gastrostomy tube (PEG tube) "Nasojejunal (ni) feeding tube Butterfly scalp vein cannula (winged infusion set) fendotrach, tis 2 type of eal tehich is used in tracheal ye — vena horacic surgery tt, oie uring V and ves: Pemaipate OU conditions to sch” esaioon selective, one-sided vente either the right or the lef lig” a weer nmat cut rosin Fitaton Pot mal meet HL pros pors — Peeesophagel cu atl po —% + PEG—Percutaneous Endoseny Gastrostomy «isa flexible feeing tube pa, through the abdorrinal wala. the stomach. PEG allows nutri, uid a medications to be put det, the stomach, bypassing the may and esophagus. Feeding ‘ube ‘Stomach in cross-section ‘+ Ni feeding tubes are frequent Used for long-term enteral nti * Itis primarily used for venepuncture. * It consists of a: ™ Hypodermic needle = TWo bilateral flexible wings * Flexible small bore transparet" tubing (20-35 cm long) A connector (female Leur)rreeway Foley catheter ‘uprapubic eatheter Red rubber catheter picture ofthe instruments Appendices Aa ‘+ Compared to rubber catheters, sllicone catheters cause less injuries and reduce substantially ‘Appendices inrtation of the urinary mucosa tis recommended for patients requiring longterm indwelling urinary catheters Just like two-way Foley catherir one connector of the three-way cainsrer is used to drain the urine while the other is used to inflate the balloon ‘The thie channel allows for ‘continuous bladder irrigation that helps in removing debris and biood clots. ++ {Ris inserted into the bladder through a incision in the abdomen, 2 few inches below the umbilicus. «Red rubber catheters are used like other straight catheters. The catheter is inserted through the ‘urethra into the bladder. ‘* Red rubber catheters are designed to be used once and then thrown away. Contd. pE Appendices a & Name of the mused to extract BOY Sein, pein seh as mucus oF S83 fFOM the suction catheter upper airway. ’ 1s inhas color coded COMMECOS for fast size identification. Picture of the instruments Target High - Sixth Premium Edition Catheter made up of metal. Metalic catheter # Waterproof pouch used to collect co waste from the bowel. (stoma bag or ‘ostomy bag) Bakri baloon ‘© The Bakri Balloon is a silicone, obstetrical balloon specifically designed to treat postpartum hemorrhage (PPH). Get ADD ONs in MALL MNCs TARGETHIGH Digital pers eis YayiPr! iNMords are the most powerful drug used by the mankind Rudyard Kipling ‘Appendices RECENT UPDATES ON COMMUNITY HEALTH NURSING rant tetravalent dengue vaccine developed by Sanofi Pasteur. ‘Dengue vaccine cia (CYD-TDV) is a live recomt as Pens Spproved In Mexico Tor marketing in December 2015. Tundste (Sept 2018), India has not approved Dengyaxiafor marketing inthe country due to pending clinical ‘Mission Parivar Vikas Family planning services. (wey) ‘CHHAYA (Centchroman) Pradhan Mantri Surakshit Matritva ‘Abhiyan (PMSMA) Mother's Absolute Affection (MAA) Pneumonia vaccine Measles-Rubella Campaign Rotavirus vaccine HPV vaccines New 7 drugs Fam ng ee fry sti (FR23) spread over 7 states In India (UP, Bihar, Rajasthan, MP, Chhattisgarh, Iharkhand and Assam). re eer yacht substantially increase the acess to contraceptives and family planing services in these 145 dtc. Key points ee pntare program: Injectable contraceptives at sub center level in 245 focus districts 3 incentizing ASHAS @ €100/doue and beneficiary @ €100/dose Ormeloxifene (Centchroman) sa non-hormanal, non-steroidal orl contraeative It sone ofthe selective estrogen receptor modulators. ‘alabe in 30 mg tablet. hale abet shouldbe taken twice a week (Sunday and Wednesday) fr frst 3 months and then once a weekly (every Sunday). Far pls taken on the 1 day ofthe period (or the fst Sunday after first day of period). Other barrier methods (Condom) should be used forthe frst month, MSNA was launched on june 9, 2016. ‘The objective of the program is to boost the health care facilities for pregnant women, especially the poor women. Frees be provided ire health check-up and treatment for free on 3° day of every menth, These facies were made avaliable at all Government hospitals. MAA was launched in August 2016, Merton promotion, protection and support of breastfeeding practices through heath services ‘Components of MAA Include: F Community level interventions: Capacty building 1 Health fcity strengthening 2 Monitoring Single largest nfetious cause of death among underfe cldren worldwide. Streptococcus pneumoniae is the mast common cause of bacterial pneumoni she cecond common cause of pneumonia. ni Jcommended vaccine for pneumonia is Pneumococcal Conjugate Vaccines (PCV-13). PCV is frozen sensitive vaccine. Discard frozen. Favs POV for pneumonia was launched by Minister of Health and Family Welfare, } PNadda at Mandlin Himachal Pradesh on May 2017. Invenstfeation of 1 and 2 dose of measles vaccination coverage was undertaken under Mission Indradhanush from the year 2015. eae abella vaccination campaign was launched at Bangalore, Karnataka in February 2017, Started nS states (karnataka, Tamil Nadu, Puducherry, Goa and Lakshadweep), Rotavirus is the leading cause of acute severe diarrhea in under-fve children worldwide, Rotavirus vaccine was launched under Universal Immunization Programme on March 26, 2016. Touached in four states (Odisha, Himachal Pradesh, Andhra Pradesh and Haryana) in the first phase. Prevention of cervical cancer s best achieved through immunization of lls, prior to sexual debut, 3 types of HPV vaccine: Bivalent, Quadrivalent, Nonavalent HPV vaccine, BEDAQUILINE and DELAMANIO. SoA Satoler GeeraT Tid} approved Bedaquline 20mg tablet (14.12015) and Delamanid 50 mg tablet (2.82017) forthe treatment of Tuberculosis under RNTCP program fr treatment ofT8 patents with speci indications. childrenember. | do and I understand.” § : *Confuclus E 1 see and rer E yr ond | forget. ITY IMMUN : i HEALTH PERSONNEL/CENTERS IN CO! a £ ‘OR g NORMS F 2 Pree koe & 3500 3 5000 3 100,000 Bone Pharmacist uae . , es Rural: Village with 2 ponulation of 1. oe ith Activist) Urban: 1000-2500 population ‘One Anganwadi Worker P4020 ce Village with a population of 1000 owt ig wth opin 00 once Plains: 1,20,000 — Hilly/tribal areas: 80,000 Plains: 30,000 one Hilly/tribal areas: 20,000 5000 in plans ee 3000 in hilly/tribal areas “Nurses are the heart of healthcare.” —Donna Wilk Cardilio. COLD CHAIN METHODS AND EQUIPMENT Erna ea Walk-in-freezer(WIF) 15 to-25°¢ National, State and Regional vaccine store Walkcin-Coolers (WiC) — 2tog'C Government medical store depo, state and regional vaccines Deep Freezer (OF) “1S to-25°C District level and above For freezing of ce packs at sub-district levels District and sub-district level a ‘eelined refrigerator (LR) 2to °C Domesticrefrigerator 2 to gc Private clinic, Nursing home (Front load refrigerator) Cold boxes Fully frozen ice packs are placed Used for ‘Tansportation of vaccine in all peripheral centers ‘at bottom and sides Vaccine carriers ‘fully frozen ice packs are used Used for. eutieach section and can carry 16 to 20 vials ata tim Day cartier fully froten ice packs are used Can GMT 640 Bvialsforfew hours, mainly used in « nearby ses eerAppendices A-49 iPr! 3 2 z “1 learnt a long time ago that minor surgery is when they do s the operation on someone else, not you.” o Bil Watton | DEMOGRAPHY IN INDIA ~ | - 2 otstaistes Demographic Trends in india - 2017 > Co -pgetve mortality ate 43 per 1000 ve births Crude death rate 6.4 per 1000 i = a 28 per 1000 We bah Total fertility rate 22. (Ref: NFHS-4 (2015-16) eae eee Net reproduction rate 108 i © penal mortality ration 167 per 3,00,000 lve births feiaed etson ain Fn wv) Ute expectancyin males 65.8 years | stateswith Highest and Lowest Indicators of Vital Ue epectancyin females 69.3 -sratstics sexrato 943 females per 1000 males* | Population density 382 persa. km \ Uteracy rate 73% ‘oudesinh Highest Bihar 268 meet tae “Source: Census 2011, SRS Statistical Report 2017, Office of the 3 | Paeal_LOWEst_ Andaman Mesbar 17g Gone and Cans Commissioner nd erage 204) Kerala 143 Most common causes of: i Mateenal Mortality: Hemorrhage (38%) CudeDeath Highest" Odlsha 78 Neonatal Mortality : Prematurty/preterm (35%) fate Infant Mortality :Prematuriylow bith weight (35.9%) com ) lowest Dee! oad Death (all ages) Cardiovascular disease (23.5%) avenge 64) ‘afant Mortality Highest Madhya Pradesh a7 Demographic Data—India 1 fate Number of districts 640 | ates lowest _ Goa 8 Urban population :3LU% - aeage3t Eligible couples 19% : ery Paety (08) 83% Sour: SAS Statistical Report 2017, Office ofthe Registrar General inden children 138 ‘nd Census Commissioner, India Lowest population density: Arunachal Pradesh (17/sqkm) Highest ex ratio Kerala (1084 females per 1000 males) | Highest population density: Dehi (11297/sqkm) Highest literacy rate + Kerala (94%) Lowest iteracy rate = Bihar (64%) | Most common method: Condom (48.1%) of family planning Realtime Exam Approach & ‘National Level Ranking ———— by AMLI ii» ted, remember practice, eam Practice, Practice & Practice TARGETHIGH Digital450 Appendices “4 sad soul can kill you quicker than a germ. John Steinbeck RAND OBJECTIVES REVIEW OF HEALTH PROGRAMS IN INDIA, LAUNCH YEA! =| Target High - Sixth Premium Edition Ce aed National Anti-Malarla Program and converted to National Malaria Eradication Program Urban Malaria Scheme National Filarla Control Program Kala-azar Control Program ‘National Leprosy Control Program National Leprosy Eradication Program National Tuberculosis Control Program Revised National Tuberculosis Control Program (RNTCP) National AIDS control Program National Program for Control of Blindness Iodine Deficiency Disorders Program National Rural Health Mission ‘National Guinea Worm Eradication Program National Caner Control Program National Mental Health Program ‘National Program for Control and Treatment of Occupational Diseases Integrated Disease Surveillance Project ‘National Water Supply and Sanitation Program ‘To eradicate malaria once and for all from the country 1953 1958 mission in town and eves 1971 To reduce or interrupt malaria transmission , includes vector control through antarat 1955 filaril control strateay in ious Sst peratons source reduction, detection and tea ofan carrier leavar Sof kala-aza 1990-1981 Tobring down the incidence rate of kal 1955 _Toacheve contrat ofleprosy trough erly detection of cases nd dapsone monotherapy a anal poy Erdeaton rogram ws aunched conti of the National Leprosy Control Program of 1962 ‘oreduce the TB inthe community to that level when it eases tobe publichealth problem 1992 1987 “To prevent further transmission of HIV, to decrease morbidity and morality associated with HIV infection and to minimize the soo- ‘economic impact resulting from HIV infection 1976 To reduce the prevalence of blindness from 1.4% to 0.3% 1962 To reduce the incidence of goiter through fortification of common 1995 ‘To eradicate polio by providing additional polio drops in December a January every yea on fixed days Sth Apri!2005 To improve rural health cae delivery system 1984 Toreduce the disease significantly in the affected area 1975-76 To prevention, early diagnosis and treatment of cancer 1982 To-ensure mental healthcare services to all, especially the commun at rsk and underprivileged sections ofthe population, to encourage apalcation of mental health knowledge in general heslth care and social development, 1896-1999 To prevent, contol and treatment of occupational heath problems Nov 2008 omit oH inane att warring signals of impending outbreaks and help Ina an efectve response inatimely manner in urban ander 1954 70 Provide safe water supply and adequate drainage facilities for th entire urban and rural population of the countryAppendices 4-51 Il 8 20 g 2 a “We first make our habits and then our habits make us.” 2 —John Dryden VITAMINS: FUNCTIONS, SOURCES AND DEFICIENCY DISEASES : = EEE om E Vitamins «Contributes tothe production of retinal Liver, egg, butter, cheese, whole milk, © Night blindness “ae eee uecees as een wees (etal) Required forthe normal functioning of some rots sucha earot 1 o's spet mt ang ‘epithelial and glandular tissues + Corneal xerosis, met «+ Supports growth especialy skeletal growth + Keratomalac «ies aninfectve . amin (25 + Promotesintestna absorption of calcium and uve, egg yok, butter, cheese, *SSay ginydrony phosphate exposure to sunlight ‘hoecaleerl) Stimulates normal mineralization SNeermits normal growth Csteomalacia Continay ” Vitamin€ Antioxidant property Vegetable oil, cotton seed, sunflower ceases (Tocopherol) seed, egg yolk, butter Vitamin Stimulates orhelpsin the production of certain Green leafy vegetables, Prolonged blood clotting anticoagulant factors Cow's ik time Vitamin 81 This vitamin i essential forthe oxidative pathway Whole grain cereals, wheat, yeast,» Beriberi (Thiamine) of glucose pulses, oilseed and nuts © Wernicke’s ‘Meat, fish egg, vegetables and fruits encephalopathy contain only small amount anno, iain 82+ Fundamental lin cellar oxtation Mik, eg, ver, green leafy Angular stomatitis (Ribofavin) + Maintains the integrity of mucocutaneous vegetables, structure. + Essential for metabolism of carbohydrate Meat, poultry, ish legumes, Pellagra characterized '* Essential for the normal functioning of skin, ‘groundnut by 4Ds intestinal and nervous tissue (© Diarrhea * Dermatitis * Dementia * Death ont ae Important for the metabolism of carbohydrate Mil liver, meat, eg8 yolk, fish, Peripheral neuritis eA (redone) andanin acd wholegrain cereals, legumes and eet vegetables Vitamin 8S Specific role in the biosynthesis A ganas losynthess of cortcosteroids p Pr acid) Vitamin 1, amin eoopeates with foteln the synths of Mes fh gil cheese Megalobastc anemia oe (Pernicious anemia) {Vitamin c Cs * Antioxidant and plays an important roe in its ai ge” Uscorbic acd)" tase ondaton Oran cereable, reshmen ah, aa * Synthesis of collagen vegetable, fresh meat, fish,; at love.” po small things with groct er HEALTH. PLANNING IN INDIA a he chairman « Sir Joseph Bhore wast segenae Coin ‘hore Committee hed : - 2 Abo know Mops te development of National Pow «Comes trcventive and curative series at al levels 5 in 2 stages nt of primary healthcare in 2 5 ceoaie vhs several ostems of medicine with allopathic system and evolution ofan integr,, Integra 1948 Chopra Committee Fe alapeite ¥ Panchayati Rajat village, block and district lev] «© Recommended setting up of 3 Tier system of ym of Health Services. Target High - Sixth Premium Edition 1957 tawant al Meta Commitee ee «com mn ashealth survey and planing co 3952 Madalar Commitee re rarthe aengthening of exsing primary healthcare centers before new centers wee blshed ; Strengthening ofthe district hospital with specialist services to serve as central base of region services Integration of medical and health services as recommended by Bhore committee Constitution of all ndia Health Service on the pattern of indian Administrative Services Chadha Committee» Monthly home visit should be implemented through basic health workers 1963 F ‘+ The workers were envisaged as multipurpose workers to look after additional duties of collect of vital statistics and family planning, n addition to malaria vigilance ‘The family planning health assistants were to supervise 3-4 of these basic health workers 1965 Mukherjee * Separate staff for the family planning program Committee * The committee also recommended to delink malaria activities from family planning 1966 Jain Committee 1 bed per 1000 population, 50 beds hospital at taluka level Health insurance for large population coverage The committee worked out the details of the basic health services which should be providedt 1966 Mukherjee Committee the block level, and some consequential strengthening required at higher levels of administra 1967 Jungalwalla * Integration of health services from top to bottom, similar seniority and unified cader to be Committee implemented ‘+ Elimination of private practice by government doctors 1972-73 Kartar Singh * The Government of India constituted a committee in 1972 known as the Committee of Committee ‘Multipurpose Workers under health and family planning under the chairmanship of Kartar Si 1974-75 Sian “me cagernment of India Inthe Ministry of Health and Family Planning had in November 1974 setup "Group on M " Commitee” O" Medical Education as Support Manpower” popularly known as the Shrivastav 1977 Rural Heath Scheme z 2 a 3 2 3 8 3 3 Z j zZ 2 z 7 = Scheme in 1977 ec Thema alm of program was to train community health workers tea Programs ane eal for heath for all by 2000 AD and to outline with that as the shit five-year plan cade 2 peaerbing of Primary urban health services~ Health post in urban slums. Basic health and Family welfare servi made avallable within 1-3 km of dwelling, with services to be it 3 i: fe available withi iwelling, 1983 krishnan committee 1986 Balaj Commitee, “Expert committee . : for ming reuewer * Establishment of heath scence unten and Moveggatcton + Vocationalation of education at 100 nee) mts © Cary out realistic heath manpower survey ee 3 i 3 & ith regards to health,