4th Year B.Sc. Community Health Nursing - I Summer

Fourth Basic B.Sc. (Nursing) Examination, Summer - 2023 (Phase-III)

COMMUNITY HEALTH NURSING (II)

(w.e.f. A.Y. 2018-2019 & 2019-2020 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) Principles of Community Health Nursing.

b) Health problems of India.

c) Aims and objectives of Health Education.

d) Principles of primary health care.

e) Vision 2020: The Right to Sight.

f) UNICEF.

a) Principles of Community Health Nursing

Equitable distribution – Health services should reach everyone, especially vulnerable groups.
Community participation – Involving people in planning, implementation, and evaluation.
Emphasis on prevention – Priority to preventive and promotive care over curative.
Appropriate technology – Simple, acceptable, and affordable technology for the community.
Intersectoral coordination – Collaboration between health and non-health sectors.

b) Health Problems of India

Communicable diseases – Tuberculosis, malaria, dengue, diarrheal diseases.
Non-communicable diseases – Diabetes, hypertension, cardiovascular diseases.
Nutritional problems – Protein-energy malnutrition, anemia, vitamin deficiencies.
Population explosion – High birth rate and population growth.
Poor sanitation and hygiene – Inadequate water supply, waste disposal issues.

c) Aims and Objectives of Health Education

Aims:

Promote healthy lifestyles and positive health behavior.
Prevent diseases and improve community health status.

Objectives:

Increase awareness about health problems.
Provide knowledge to make informed health decisions.
Develop skills for healthy living.
Motivate community participation in health programs.
Encourage utilization of available health services.

d) Principles of Primary Health Care (Alma-Ata, 1978)

Equitable distribution – Health care for all without discrimination.
Community participation – Involving people in decision-making and action.
Intersectoral coordination – Cooperation with sectors like agriculture, education, water supply.
Appropriate technology – Affordable, scientifically sound, and socially acceptable methods.
Focus on prevention – Emphasis on promotive and preventive care.

e) Vision 2020: The Right to Sight

Launched by WHO and International Agency for the Prevention of Blindness (IAPB) in 1999.
Goal – Eliminate avoidable blindness by the year 2020.
Target diseases – Cataract, trachoma, onchocerciasis, childhood blindness, refractive errors, low vision.
Strategies – Disease control, human resource development, infrastructure strengthening.
Impact – Significant reduction in preventable blindness worldwide.

f) UNICEF (United Nations International Children’s Emergency Fund)

Established – 1946, as a UN agency.
Headquarters – New York, USA.
Main focus – Health, nutrition, education, child protection, and emergency relief for children.
Key programs in India – Immunization, child nutrition, safe water supply, education for girls.
Role in health – Supports polio eradication, maternal and child health programs, and emergency response.

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

[1x15=15]

a) Define School Health Services. List the health problems of School Children. Explain the aspects of School Health Services.

b) Enumerate the various National health programme. List the objectives of RNTCP. Discuss the roles and responsibilities of a Community Health Nurse in RNTCP.

a) School Health Services

Definition:

School health services are preventive, promotive, curative, and rehabilitative health services provided to school children to promote their physical, mental, and social well-being, enabling better learning and development.

Health Problems of School Children

Nutritional problems – Anemia, undernutrition, vitamin deficiencies, obesity.
Communicable diseases – Scabies, impetigo, respiratory infections, diarrheal diseases.
Dental problems – Dental caries, gingivitis.
Eye problems – Refractive errors, squint, night blindness.
Ear problems – Otitis media, hearing impairment.
Behavioral & emotional problems – Hyperactivity, bullying, learning disorders.
Accidents & injuries – Playground injuries, road accidents.

Aspects of School Health Services

Health appraisal
- Periodic medical check-ups by health professionals.
- Screening for vision, hearing, dental, and physical growth.
Treatment & follow-up
- On-site treatment of minor ailments.
- Referral to hospitals for specialized care.
Prevention of communicable diseases
- Immunization programs (as per national schedule).
- Health education on hygiene and sanitation.
Nutritional services
- Mid-day meal program.
- Growth monitoring and nutritional counseling.
Control of environmental hazards
- Safe drinking water, clean toilets, proper ventilation, adequate lighting.
First-aid & emergency care
- First-aid kits and trained staff for emergencies.
Health education
- Awareness programs on hygiene, nutrition, puberty, and personal safety.
Mental health services
- Counseling services for emotional and behavioral issues.

b) National Health Programmes & RNTCP

Various National Health Programmes (Examples)

National Tuberculosis Elimination Programme (NTEP, earlier RNTCP)
National Vector Borne Disease Control Programme (NVBDCP)
Universal Immunization Programme (UIP)
National Leprosy Eradication Programme (NLEP)
National AIDS Control Programme (NACP)
National Mental Health Programme (NMHP)
Reproductive, Maternal, Newborn, Child & Adolescent Health Programme (RMNCH+A)
National Programme for Control of Blindness & Visual Impairment (NPCBVI)
National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)
Janani Suraksha Yojana (JSY)

Objectives of RNTCP (Revised National Tuberculosis Control Programme)

Achieve at least 85% cure rate of newly detected smear-positive TB cases.
Detect at least 70% of estimated new smear-positive TB cases.
Reduce TB incidence, prevalence, morbidity, and mortality.
Provide free and quality TB diagnosis and treatment to all.
Prevent the emergence of drug-resistant TB through proper treatment adherence.

Role and Responsibilities of a Community Health Nurse in RNTCP

1. Case Detection

Identify and refer suspected TB patients for sputum examination.
Conduct active case finding in high-risk groups.

2. Diagnosis Support

Assist in sputum collection and transportation to microscopy centers.
Ensure laboratory reports reach patients promptly.

3. Treatment & DOTS (Directly Observed Treatment, Short-course)

Act as a DOT provider or supervise DOT providers.
Ensure correct drugs are taken regularly and on time.

4. Follow-up & Monitoring

Monitor treatment progress.
Identify and manage side effects or complications.

5. Health Education

Educate patients, families, and communities about TB prevention, treatment adherence, and stigma reduction.

6. Record Keeping & Reporting

Maintain patient treatment cards and registers.
Submit monthly and quarterly reports to higher authorities.

7. Community Mobilization

Conduct awareness campaigns about TB symptoms and the importance of early diagnosis.
Collaborate with NGOs, local leaders, and self-help groups.

8. Drug Resistance Prevention

Ensure completion of full treatment course to prevent MDR-TB.
Support contact tracing and prophylaxis if required.

Section - B

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

[4 x 5= 20]

a) Intra Uterine Devices.

b) Principles Home visiting

c) Kartar Singh Committee, 1973

d) Panchayat Raj.

e) Disaster preparedness.

a) Intra Uterine Devices (IUDs)

Definition: Small, T-shaped devices inserted into the uterus to prevent pregnancy.

Types:

Non-medicated – e.g., Lippes Loop.
Copper-bearing (Cu-IUDs) – e.g., CuT 380A, CuT 375.
Hormonal IUDs – e.g., LNG-20 (Mirena).

Mechanism of Action:

Prevents fertilization by affecting sperm motility and viability.
Alters endometrium, preventing implantation.

Advantages:

Long-term, reversible, cost-effective.
No daily action required.

Side effects:

Irregular bleeding, cramps, pelvic infection (rare).

b) Principles of Home Visiting

Purposeful – Visit must have a clear objective (care, education, follow-up).
Planned – Prepared in advance considering the family’s needs.
Regularity & Flexibility – Visits should be regular but adaptable.
Involvement of family – Encourage family participation in care.
Use of available resources – Utilize local health services and materials.
Confidentiality – Maintain privacy of family information.

c) Kartar Singh Committee, 1973

Objective: To study multipurpose health workers in rural health services.
Key Recommendations:
- Replace Auxiliary Nurse Midwives (ANMs), Basic Health Workers, and Malaria Workers with Multi-Purpose Health Workers (male and female).
- One sub-center for every 3,000–3,500 population.
- Each sub-center to be manned by one male and one female MPHW.
- Integration of health and family planning services at grassroot level.

d) Panchayat Raj

Definition: A system of local self-government in rural areas, enabling community participation in governance.
Three-tier structure:
- Gram Panchayat – Village level.
- Panchayat Samiti – Block level.
- Zila Parishad – District level.
Constitutional basis: 73rd Constitutional Amendment Act, 1992.
Functions: Rural development, sanitation, water supply, health programs, record maintenance.
Significance: Strengthens decentralization, people’s participation, and local accountability.

e) Disaster Preparedness

Definition: Planning and organizing resources to effectively respond to disasters and reduce their impact.
Components:
- Risk assessment and hazard mapping.
- Early warning systems.
- Training of personnel and community awareness.
- Stockpiling of emergency supplies.
- Development of evacuation plans.
Goals:
- Minimize loss of life, injury, and damage.
- Ensure quick, coordinated, and effective response.
Role of health sector: Medical care, disease prevention, mental health support, and rehabilitation.

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

[1x5=15]

a) Define Occupation health. List the Occupational health hazards. Explain the role of Occupation Health Nurse.

b) Define Reproductive child health. Discuss the Components of RCH programmed. Describe the emergency obstetric care provided under the RCH programmed.

a) Occupational Health

Definition

Occupational health is the promotion and maintenance of the highest degree of physical, mental, and social well-being of workers in all occupations by preventing work-related diseases, injuries, and hazards.
(WHO definition)

Occupational Health Hazards

1. Physical hazards:

Noise, vibration, heat, cold, poor lighting, radiation.

2. Chemical hazards:

Dust, fumes, vapors, gases, solvents, acids, pesticides.

3. Biological hazards:

Bacteria, viruses, fungi, parasites from handling animals, plants, or infectious materials.

4. Mechanical hazards:

Moving machinery, poor tools, sharp instruments, unsafe equipment.

5. Psychosocial hazards:

Work stress, long working hours, job insecurity, poor interpersonal relationships.

6. Ergonomic hazards:

Poor posture, repetitive movements, heavy lifting, improper workstation design.

Role of Occupational Health Nurse

1. Health surveillance:

Conduct pre-employment and periodic medical check-ups.
Identify early signs of occupational diseases.

2. Health education:

Train workers on personal hygiene, protective equipment use, and hazard prevention.

3. First aid and emergency care:

Provide on-site treatment for injuries and arrange referrals.

4. Prevention & control of hazards:

Participate in workplace safety programs.
Promote the use of protective devices.

5. Record keeping & reporting:

Maintain employee health records, accident reports, and hazard logs.

6. Rehabilitation:

Assist injured workers in returning to work.
Coordinate physiotherapy or vocational rehabilitation if needed.

7. Counseling & support:

Address stress, mental health concerns, and lifestyle guidance.

b) Reproductive Child Health (RCH)

Definition

Reproductive Child Health is an integrated approach that aims to provide comprehensive health care to women, children, and adolescents, focusing on reproductive health, safe motherhood, child survival, and adolescent health.

Components of RCH Programme

1. Maternal health services:

Antenatal care (ANC) – minimum 4 visits, tetanus toxoid, IFA supplementation.
Intranatal care – skilled birth attendance, clean delivery.
Postnatal care – follow-up visits, counseling.

2. Child health services:

Immunization (UIP).
Management of common childhood illnesses.
Growth monitoring & nutrition programs.

3. Family planning services:

Spacing methods – condoms, OCPs, IUCDs.
Permanent methods – sterilization.
Counseling services.

4. Adolescent health services:

Education on puberty, nutrition, reproductive health.
Prevention of early marriage and teenage pregnancy.

5. Control of reproductive tract infections (RTIs) & sexually transmitted infections (STIs):

Early diagnosis, treatment, and partner management.

6. Safe abortion services:

Provided under the Medical Termination of Pregnancy (MTP) Act.

Emergency Obstetric Care under RCH

1. Basic Emergency Obstetric Care (BEmOC): (at PHC level)

Administration of parenteral antibiotics, oxytocics, and anticonvulsants.
Manual removal of placenta.
Assisted vaginal delivery.

2. Comprehensive Emergency Obstetric Care (CEmOC): (at FRUs/CHCs/District Hospitals)

All BEmOC services plus:
- Cesarean section.
- Blood transfusion facilities.
- Management of severe obstetric complications (eclampsia, obstructed labor, postpartum hemorrhage).

3. Referral services:

24×7 ambulance availability.
Linkage between PHC, CHC, and district hospitals.

4. Skilled Birth Attendant training:

Training of ANMs, nurses, and midwives for safe delivery practices.