4th B.Sc. Community Health Nursing - II Summer - 2024

Fourth BASIC B.Sc. NURSING Examination, Summer - 2024
(Phase - II)
Community Health Nursing - II
(upto A.y. 2018-19. w.e.f. A.y. 2019-20 Admitted Batch)

Duration: 3 Hours

Max.Marks:75

Instructions:

1) Use black ball point pen only.

2) Do not write anything on the blank portion of the question paper. If written anything, such type of act      will be considered as an attempt to resort to unfair means.

3) All questions are compulsory.

4) The number to the right indicates full marks.

5) Draw diagrams wherever necessary. 

6) Distribution of syllabus in Question Paper is only meant to cover entire syllabus within the stipulated     frame. The question paper pattern is a mere guideline. Questions can be asked from any paper's            syllabus into any question paper. Students cannot claim that the question is out of syllabus. As it is        only for the placement sake, the distribution has been done.

7) Use a common answer book for all sections.

Section - A 

I. Short answer question (Solve any five out of six)

[5x5=25]

a) Tuberculosis drug 

b) Referral system 

c) Five year plan 

d) Organizational structure of primary health centre 

e) Benefits of ESI 

f) Maintenance of health records

a) Tuberculosis drug

• First-line anti-TB drugs: Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), Ethambutol (E), and Streptomycin (S).

• Used in combination to prevent drug resistance.

• Standard short-course: 6 months (2 months intensive phase + 4 months continuation phase).

• Given under DOTS (Directly Observed Treatment, Short-course) strategy.

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b) Referral system

• A three-tier link between community, primary, secondary, and tertiary health care.

• Ensures patients receive care at the most appropriate level.

• Types:

  1. Primary to Secondary/Tertiary – for advanced diagnosis/treatment.

  2. Secondary to Tertiary – for specialized care.

  3. Reverse Referral – for follow-up at a lower facility.

• Improves efficiency, prevents overcrowding in higher centers.

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c) Five year plan

• Government economic & social development program implemented in 5-year phases.

• In health sector, it sets targets for services, infrastructure, and manpower.

• Example:

  • 1st plan (1951–56): Focus on community development & PHCs.

  • 6th plan: National Health Policy formulated.

  • 12th plan: Universal health coverage emphasis.

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d) Organizational structure of Primary Health Centre (PHC)

• Medical Officer (MO) – head of PHC.

• Block Health Supervisor / Health Educator.

• Pharmacist.

• Staff Nurses.

• Health Assistants (Male & Female).

• ANMs, MPWs at sub-centres under PHC.

• Support staff (Lab Technician, Clerk, Driver, etc.).

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e) Benefits of ESI (Employees’ State Insurance)

• Medical benefits – free treatment for insured worker & family.

• Sickness benefits – cash payment during certified sickness (up to 91 days/year).

• Maternity benefits – paid leave & medical care.

• Disablement benefits – pension for temporary/permanent disability.

• Dependants’ benefits – pension to dependents in case of death at work.

• Funeral expenses – lump sum for funeral costs.

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f) Maintenance of health records

• Definition: Systematic documentation of patient’s health history, diagnosis, treatment, and follow-up.

• Purposes:

  • Continuity of care.

  • Legal evidence.

  • Research & statistics.

  • Evaluation of services.

• Types: Manual records, Electronic Health Records (EHR).

• Should be accurate, up-to-date, confidential, and preserved as per policy.

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II. Long Answer Questions (any one out of two)

[1x15=15]

a) Define occupational health. Discuss the measures of for health promotions for workers and role of         nurse in occupational health.

b) Define community health nursing. Scope of community health nursing. Role and responsibilities of         community health nurse

a) Occupational Health

Definition:

• WHO: “Occupational health deals with all aspects of health and safety in the workplace and aims to prevent ill health in workers due to their working conditions.”

• Focuses on promotion & maintenance of physical, mental, and social well-being of workers in all occupations.

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Measures for Health Promotion for Workers:

1. Pre-employment examination – assess fitness for specific job.

2. Periodic health check-ups – early detection of occupational diseases.

3. Safe working environment – proper lighting, ventilation, noise control.

4. Personal Protective Equipment (PPE) – helmets, gloves, masks, earplugs, safety shoes.

5. Health education – hygiene, safe handling of materials, first aid.

6. Vaccination – against tetanus, hepatitis B, etc.

7. Nutrition facilities – clean drinking water & healthy canteens.

8. Workplace ergonomics – prevention of musculoskeletal disorders.

9. Control of hazards – mechanical, chemical, biological, physical, psychological.

10. Rehabilitation – for injured or disabled workers.

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Role of Nurse in Occupational Health:

1. Health assessment – conduct pre-employment & periodic exams.

2. Health education – safety measures, first aid, personal hygiene.

3. First aid & emergency care – immediate care during workplace accidents.

4. Disease prevention – vaccination, surveillance, screening.

5. Record keeping – health records, accident reports.

6. Workplace inspection – identify hazards & report to management.

7. Rehabilitation & counseling – for injured workers and their families.

8. Liaison – between workers, management, and healthcare services.

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b) Community Health Nursing

Definition:

• WHO: “Community health nursing is the synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations.”

• It is nursing care given outside hospitals, focusing on prevention, promotion, and rehabilitation in the community.

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Scope of Community Health Nursing:

1. Health promotion – education, awareness, lifestyle modification.

2. Disease prevention – immunization, screening programs.

3. Care of sick – home visits, basic treatment, referral.

4. Maternal & child health – antenatal, postnatal, growth monitoring.

5. School health services – health check-ups, hygiene education.

6. Occupational health services – workplace visits, preventive programs.

7. Geriatric care – support for elderly at home/community.

8. Disaster nursing – relief services, emergency health camps.

9. Rehabilitation services – physical, vocational, psychological.

10. Environmental health – sanitation, safe water, waste management.

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Role and Responsibilities of Community Health Nurse:

1. Care Provider – nursing care to individuals, families, groups.

2. Educator – health awareness on nutrition, hygiene, disease prevention.

3. Counselor – emotional & psychological support.

4. Advocate – rights of community to health services.

5. Coordinator – link between community and health system.

6. Researcher – collect health data, participate in studies.

7. Supervisor – guide health workers, ANMs, ASHAs.

8. Planner – design community health programs.

9. Evaluator – assess effectiveness of services provided.

10. Emergency responder – provide care during epidemics, disasters.

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Section - B 

III. Short Answer Questions (any four out of five)

[4 x 5= 20]

a) Intersectoral coordination

b) Local endemic diseases in India

c) Collection and disposal of waste in community

d) Structure of World health organization

e) Food adulteration act

a) Intersectoral Coordination

• Definition: Collaboration between different sectors (health, education, agriculture, transport, water supply, etc.) to improve overall community health.

• Purpose: Efficient use of resources, avoiding duplication, and addressing determinants of health.

• Examples:

  • School health program – coordination between education & health department.

  • Safe drinking water – health + public works department.

  • Vector control – health + municipal corporation.

• Importance: Improves program effectiveness, community participation, and sustainability.

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b) Local Endemic Diseases in India

• Definition: Diseases constantly present in a specific geographic area or population.

• Examples in India:

  1. Malaria – widespread, especially in tribal & rural areas.

  2. Kala-azar (Visceral leishmaniasis) – Bihar, Jharkhand, West Bengal, UP.

  3. Filariasis – Bihar, Kerala, Tamil Nadu, UP.

  4. Leprosy – high prevalence in some states.

  5. Goitre (Iodine deficiency) – Himalayan belt, sub-Himalayan plains.

• Control measures: Immunization, vector control, health education, nutrition improvement.

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c) Collection and Disposal of Waste in Community

• Types of waste: Biodegradable, non-biodegradable, biomedical, hazardous.

• Collection methods:

  1. House-to-house collection using bins.

  2. Segregation at source (dry/wet waste).

  3. Community bins at fixed locations.

• Disposal methods:

  • Composting – for biodegradable waste.

  • Incineration – for biomedical waste.

  • Sanitary landfill – for non-biodegradable waste.

  • Recycling – paper, plastic, metals.

• Importance: Prevents disease, controls pests, improves environmental hygiene.

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d) Structure of World Health Organization (WHO)

• Headquarters: Geneva, Switzerland.

• Structure:

  1. World Health Assembly – decision-making body, meets annually.

  2. Executive Board – 34 health experts, implements Assembly decisions.

  3. Secretariat – headed by Director-General, manages daily operations.

  4. Regional Offices – 6 regions (e.g., SEARO in New Delhi for South-East Asia).

  5. Country offices – coordinate WHO activities in member countries.

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e) Food Adulteration Act

• Full name: Prevention of Food Adulteration (PFA) Act, 1954 (now replaced by Food Safety and Standards Act, 2006).

• Purpose: Protect consumers from unsafe, substandard, and adulterated food.

• Key provisions:

  1. Standards for food quality & safety.

  2. Prohibition of sale of adulterated food.

  3. Regular inspection & sampling.

  4. Penalties for violation.

• Importance: Ensures safe food supply, prevents food-borne diseases, safeguards public health.

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IV.    Long Answer Questions (any one out of two)

[5x5=25]

a) Define school health. Explain the need for school health services. Explain the role and                              responsibilities of community health nurse in school health programme

b) Define primary health care. Write principles of primary health care. Write role of nurse in sub centre

a) School Health

Definition:

• WHO: “School health refers to services provided to protect, promote, and maintain the health of school children and staff.”

• It includes health appraisal, disease prevention, health promotion, and health education for school-going children.

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Need for School Health Services:

1. Early detection of health problems – vision defects, hearing loss, anemia, dental issues.

2. Prevention of communicable diseases – immunization, hygiene education.

3. Nutritional improvement – mid-day meal program, nutrition education.

4. Promotion of healthy habits – hygiene, exercise, mental health awareness.

5. Reduction of absenteeism – through better health status.

6. Better academic performance – healthy children learn better.

7. Health record maintenance – for continuous monitoring.

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Role & Responsibilities of Community Health Nurse in School Health Programme:

1. Health appraisal: Conduct regular medical check-ups, vision & hearing screening.

2. Immunization: Organize vaccination drives as per national schedule.

3. First aid & emergency care: Provide immediate care for injuries/illness.

4. Health education: Teach hygiene, nutrition, personal safety, mental health.

5. Referral services: Refer children with health problems to higher centers.

6. Nutrition programs: Support mid-day meal and nutrition supplementation.

7. Record keeping: Maintain individual health records for students.

8. Parental involvement: Conduct meetings for awareness on child health.

9. Environmental hygiene: Inspect sanitation, safe drinking water, clean classrooms.

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b) Primary Health Care

Definition:

• WHO (Alma-Ata, 1978): “Primary health care is essential health care made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford.”

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Principles of Primary Health Care:

1. Equitable distribution – health services for all, especially underserved areas.

2. Community participation – involvement of people in planning & delivery.

3. Intersectoral coordination – collaboration with sectors like education, agriculture, water supply.

4. Appropriate technology – affordable, acceptable, and locally suitable health technology.

5. Accessibility & affordability – care must be physically reachable and economically viable.

6. Prevention & promotion – focus on health education, prevention, and early treatment.

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Role of Nurse in Sub-Centre:

1. Maternal & child health care: Antenatal, postnatal care, safe deliveries.

2. Immunization services: As per Universal Immunization Programme (UIP).

3. Family planning services: Counseling, distribution of contraceptives.

4. Health education: Nutrition, hygiene, disease prevention.

5. Treatment of minor ailments: Fever, diarrhea, wounds.

6. Disease surveillance: Report notifiable diseases to higher centers.

7. Environmental sanitation: Promote safe water, waste disposal, vector control.

8. Home visits: For follow-up, health promotion, and patient care.

9. Record maintenance & reporting: Immunization registers, birth & death records.

10. Community mobilization: Involve ASHAs, AWWs, and local leaders in health activities.

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