3rd Year GNM ODISHA Community Health Nursing - II 2025
ODISHA NURSES & MIDWIVES EXAMINATION BOARD
THIRD YEAR ANNUAL EXAMINATION IN GNM-2025
Paper-II
(Community Health Nursing-II)
I. Solve answer question
OR
Answer :
a. What do you mean by NHM ? [3]
NHM (National Health Mission) is a Government of India public-health initiative
that subsumes the National Rural Health Mission (NRHM) and the National Urban
Health Mission (NUHM). Its goal is to provide universal access to equitable,
affordable and quality health care services that are accountable and responsive
to people’s needs, with special focus on maternal & child health (RMNCH+A),
communicable and non-communicable disease control, and strengthening primary
health care.
b. What are the objectives of NRHM? [5]
1. Reduce
maternal mortality and child mortality — improve safe motherhood and
child survival.
2. Increase
access to quality health care — strengthen sub-centres, PHCs, CHCs and
referral services in rural areas.
3. Improve
public health infrastructure & human resources — recruit, train
and deploy health staff including ASHAs/ANMs.
4. Control
communicable and non-communicable diseases — prevention, early
detection and treatment programs.
5. Ensure
community participation & decentralisation — strengthen Panchayati
Raj institutions and local health committees for ownership.
(Each objective aimed at making rural health services affordable, accountable
and functional.)
c. Write down the approaches and expected
outcomes of NRHM. [7]
Approaches (pick key ones — 4–5 brief points):
1. Health
system strengthening — upgrading infrastructure
(subcentres/PHCs/CHCs), drugs, diagnostics and referral linkages.
2. Human
resource management — recruiting and training personnel; introduction
of ASHA workers for community outreach.
3. Communitisation
/ Decentralisation — involving Panchayats, Village Health &
Sanitation Committees and Rogi Kalyan Samitis in planning and monitoring.
4. Flexible
financing & performance-based funding — untied funds at facility
level and intensified support for high-priority states.
5. Convergence
with other sectors — linking health with nutrition, sanitation, water
and education to address determinants of health.
Expected outcomes (brief, exam style — 3 points):
1. Improved
maternal and child health indicators — reduced MMR, IMR, and U5MR
through better antenatal, delivery and newborn care.
2. Increased
service utilization & access — higher institutional deliveries,
immunization coverage and use of primary care services.
3. Stronger,
accountable primary health system — functional PHCs/CHCs, empowered
community structures and better preparedness for public-health emergencies.
OR
a. Define Reproductive health. [3]
Answer (3 marks)
Reproductive health is a state of complete physical, mental
and social well-being in all matters relating to the reproductive system and
its functions and processes. It implies the capability to reproduce, the
freedom to decide if, when and how often to do so, and access to safe,
effective and acceptable methods of family planning and care during pregnancy,
childbirth and the postpartum period.
b. Write down the main components of RCH
programme. [5]
1. Family
planning services — contraceptive choice and counseling.
2. Safe
motherhood (maternal health) — antenatal, intranatal and postnatal
care; emergency obstetric care.
3. Child
health & immunization — newborn care, IMNCI and routine
immunization.
4. Prevention
& management of RTIs/STIs, including HIV.
5. Adolescent
reproductive health & education — school and community programs
for adolescent needs.
(These components aim to reduce maternal/infant mortality and improve
reproductive health overall.)
c. Elaborate RCH programme Phase-I & RCH
Programme Phase-II. [7]
RCH Phase-I (launched late 1990s — main features):
·
Focused on expanding family welfare and safe
motherhood services.
·
Emphasised client-centred service
delivery, improved quality and accessibility of existing services
(family planning, antenatal care, safe delivery, immunization).
·
Addressed RTI/STI and introduced community
awareness and counselling components.
RCH Phase-II (built on Phase-I — main features):
·
Aimed at scaling up &
institutionalizing quality maternal and child health services with
special focus on emergency obstetric care and referral systems.
·
Strengthened infrastructure, human resource
capacity, and referral linkages; introduced monitoring and outcome indicators
to reduce MMR/IMR.
·
Broadened focus to adolescent health,
RTI/STI control, and improving service delivery quality (training, essential
obstetric care, blood storage, improved supervision).
II. Solve Answer Questions
OR
Answer :
a. Define Primary Health Care. [2 marks]
Primary Health Care (PHC) is essential health care made universally accessible
to individuals and families in the community through their full participation,
at a cost that the community and country can afford.
It forms the first level of contact between people and the national health
system, based on the principles of equity, community
participation, intersectoral coordination, and use of appropriate technology.
(Source: Alma-Ata Declaration, WHO, 1978; Government of India – MOHFW)
b. What do you mean by Public-Private Partnership (PPP)? [7 marks]
A Public-Private Partnership (PPP) is a
cooperative arrangement between government agencies
(public sector) and private entities (NGOs,
trusts, corporate bodies, or individuals) to deliver health
services, share risks, and utilize combined resources for public benefit.
Key Features / Explanation
(for 7 marks):
1. Definition:
Collaboration where both sectors contribute resources, expertise, and responsibility
to achieve public-health goals.
2. Purpose:
To improve availability, accessibility, efficiency, and quality of health
services—especially where government resources are limited.
3. Forms
of PPP in health sector:
o
Contracting out diagnostic/laboratory or housekeeping
services at PHCs/CHCs.
o
NGO involvement in RCH, immunization, family
planning, or disease-control projects.
o
Private hospitals partnering for free treatment
of BPL patients under government schemes.
4. Examples
in India:
o
Janani Suraksha Yojana
(JSY) — private institutions empanelled for safe delivery.
o
Chiranjeevi Scheme
(Gujarat) — private obstetricians provide free deliveries for
poor women.
o
Rashtriya Swasthya Bima
Yojana (RSBY) — insurance-based PPP model.
5. Advantages:
o
Better infrastructure & expertise
utilization.
o
Increased efficiency & accountability.
o
Extended reach to underserved areas.
6. Challenges:
o
Regulatory oversight, quality control, and
equitable service delivery.
7. Conclusion:
PPPs bridge gaps between demand and supply in health care and promote shared
responsibility between the government and private sector.
c. Write the schematic representation of Health Care Delivery
System in India. [6 marks]
Answer (Diagrammatic Format for exam):
CENTRAL LEVEL↓Ministry of Health and Family Welfare (MoHFW)↓Directorates General of Health Services (DGHS)↓STATE LEVEL↓State Ministry / Directorate of Health Services↓DISTRICT LEVEL↓Chief Medical & Health Officer (CMHO)↓BLOCK LEVEL↓Community Health Centre (CHC)↓PRIMARY LEVEL↓Primary Health Centre (PHC)↓SUBCENTRE LEVEL↓Sub-Centre (ANM, MPHW)↓VILLAGE / COMMUNITY LEVEL↓ASHA / Anganwadi / Village Health & Sanitation CommitteeExplanation:
·
The Indian health-care delivery system is
organized in a three-tier structure:
1. Primary
Level – Sub-centres & PHCs (first contact).
2. Secondary
Level – CHCs & district hospitals (referral services).
3. Tertiary
Level – Medical colleges, AIIMS, specialty hospitals (advanced
care).
OR
a. What is Demography? [3 marks]
Demography is the scientific
study of human population, especially with reference to its size,
structure, distribution, and changes due to births, deaths,
migration, and aging.
It provides data for planning and implementing health and development programs.
b. Write down the stages of Demographic Cycle. [5 marks]
The Demographic Cycle (Transition) describes the
changes in population growth as a country develops economically.
|
Stage |
Name of Stage |
Birth Rate |
Death Rate |
Population Growth |
|
I |
High Stationary |
High |
High |
Stable or slow growth |
|
II |
Early Expanding |
High |
Rapidly declining |
Fast growth |
|
III |
Late Expanding |
Declining |
Slowly declining |
Moderate growth |
|
IV |
Low Stationary |
Low |
Low |
Stable population |
|
V |
Declining Stage |
Very low |
Low or rising (aging) |
Decline in population |
India is presently in the Late
Expanding Stage of the demographic cycle.
c. As a Community Health Nurse, describe your role to control
population explosion in our country. [7 marks]
1. Health Education:
·
Educate couples and communities about the
effects of overpopulation on health and development.
·
Conduct awareness sessions on small family norms
and reproductive health.
2. Family-Planning Services:
·
Motivate eligible couples to adopt appropriate
contraceptive methods (temporary/permanent).
·
Provide counseling and ensure informed choice.
3. Maternal & Child
Health Services:
·
Ensure antenatal, postnatal, and newborn care to
reduce infant and maternal mortality—important for smaller families.
4. Adolescent Education:
·
Promote adolescent reproductive health education
to delay marriage and first childbirth.
5. Community Mobilization:
·
Involve ASHAs, ANMs, and local leaders to spread
awareness and organize family-planning camps.
6. Record-Keeping &
Reporting:
·
Maintain eligible-couple registers,
contraceptive acceptance rates, and follow-up services.
7. Coordination:
·
Work with government, NGOs, and other sectors
(education, women’s welfare) to implement population-control measures
effectively.
Conclusion:
Community health nurses play a vital role in motivating families, providing
services, and creating awareness to stabilize the population and promote better
family health.
III. Write short notes on any three of the following.
Answer :
a. Small Family
Norm (5 marks)
Small
family norm means promoting the idea that a small family (2 children or
less) leads to better health, economic stability and improved quality of
life.
Key
points:
- Aims to reduce population
growth rate.
- Promotes late marriage,
birth spacing, use of contraceptives.
- Encourages “Hum Do,
Hamare Do” concept.
- Improves maternal &
child health outcomes.
- Implemented through IEC,
family planning clinics, ASHA/ANM counseling.
Benefits
of small family:
- Better nutrition &
education for children.
- Reduced maternal/infant
mortality.
- Less burden on national
resources.
b. School Health
Programme (5 marks)
School
health programme is a preventive & promotive health service for school
children to ensure their healthy growth and development.
Components:
- Health assessment: medical
check-up, screening for eye/ear defects, anemia.
- Immunization services.
- Health education — hygiene,
nutrition, puberty education.
- Mid-Day meal for nutrition
support.
- Treatment of minor ailments.
- Referral services for
special care.
- Maintenance of school health
records.
Importance:
- Early detection of disease.
- Builds lifelong healthy
habits.
- Prevents learning
disabilities caused by health problems.
c. Bhore
Committee (1946) (5 marks)
This was
the first major health planning committee in India (Chairman: Sir Joseph
Bhore).
Major
recommendations:
- Health services to be free
to all — no discrimination.
- Development of Primary
Health Centre system in 2 stages.
- Integration of preventive +
curative services.
- Strengthening medical
education & training.
Significance:
- Birth of the concept of comprehensive
PHC in India.
- Laid foundation for India’s
3-tier rural health system.
Bhore Committee = Father structure of PHC in India.
d. Indian Red
Cross Society (IRCS) (5 marks)
Founded
in 1920, voluntary humanitarian organization affiliated to International Red
Cross Movement.
Functions
/ Activities:
- Disaster relief (floods,
earthquakes, emergencies).
- Blood bank services &
voluntary blood donation.
- First aid training &
ambulance services.
- Maternity & child
welfare centres.
- Community health camps, TB
control, HIV/AIDS awareness.
- Support to refugees, victims
of war & accidents.
Nature:
- Neutral, non-political,
humanitarian service organization.
e. AYUSH (5
marks)
AYUSH
stands for:
Ayurveda, Yoga & Naturopathy, Unani, Siddha, Homeopathy.
It refers
to India’s traditional & complementary systems of medicine.
A separate Ministry of AYUSH was formed in 2014.
Objectives:
- Promote indigenous medical
systems.
- Standardize education,
training & research in AYUSH.
- Integrate AYUSH into
national health programmes.
- Ensure quality drugs through
pharmacopoeia standards.
Importance:
- Provides holistic &
cost-effective health care.
- Popular in rural areas and
chronic disease management.
IV. A. Write the responsibilities and role of a nurse in the following situations.
Answer :
a. Patient with Dog Bite (5 marks)
Nurse’s
Responsibilities:
- Wash wound immediately with
soap & running water for 10–15 minutes.
- Do not apply any tight
bandage or irritant material.
- Assess wound category (I /
II / III) as per WHO guidelines.
- Administer Anti-Rabies
Vaccine (ARV) as ordered.
- Give Rabies
Immunoglobulin (RIG) if category III bite.
- Tetanus prophylaxis (TT) if
immunization incomplete.
- Educate patient:
- complete full vaccine
schedule without missing a dose
- avoid touching wound /
scratching
- Document & report animal
bite as per policy.
b. Patient with Hyperglycemia (high
blood sugar) (5 marks)
Nurse’s
Responsibilities:
- Check capillary blood
glucose & vital signs.
- Monitor for symptoms:
polyuria, polydipsia, polyphagia, dehydration.
- Administer insulin or oral
hypoglycemics as prescribed.
- Maintain IV fluids to
prevent dehydration & electrolyte disturbance.
- Monitor urine glucose &
ketones (risk of DKA).
- Educate patient:
- diabetic diet & avoid
high sugar foods
- medication timing &
adherence
- daily exercise & foot
care
- Record input/output &
report sudden changes.
c. Patient Suffering From Heart
Stroke (Acute MI) (5 marks)
Nurse’s
Responsibilities:
- Provide immediate rest in
comfortable position (semi-Fowler’s).
- Monitor vital signs
continuously (BP, HR, SpO₂).
- Administer oxygen as
prescribed.
- Give prescribed drugs:
aspirin, nitrates, thrombolytics, anticoagulants (as ordered).
- Establish IV line and
maintain emergency equipment.
- Observe for arrhythmias,
chest pain severity, and complications.
- Provide psychological
support, reduce anxiety.
- Educate about cardiac diet,
medications & risk factor control after stabilization.
d. Patient with Dengue Fever (5
marks)
Nurse’s
Responsibilities:
- Monitor temperature chart
& vital signs frequently.
- Assess for warning signs:
bleeding, abdominal pain, restlessness, petechiae.
- Maintain adequate oral or IV
fluid therapy (to prevent shock).
- Avoid NSAIDs / aspirin due
to bleeding risk; provide paracetamol for fever.
- Observe intake–output,
hematocrit & platelet count trends.
- Provide mosquito bite
prevention (bed nets, repellents).
- Educate patient on signs requiring
emergency (bleeding gums, black stools).
- Maintain strict
documentation & alert doctor if deterioration.
e. Patient with Worm Infestation (5
marks)
Nurse’s
Responsibilities:
- Assess symptoms: abdominal
pain, itching, anemia, weight loss.
- Collect stool sample for
ova/parasite examination.
- Administer de-worming
medication as prescribed (Albendazole / Mebendazole).
- Reinforce hygiene habits:
- handwashing before meals
& after toilet
- wearing footwear
- proper nail cutting
- Promote safe drinking water
& proper cooking of food.
- Educate family on periodic
deworming (especially children).
- Encourage community
awareness to prevent reinfestation.
B. Fill in the blanks.
Answers:
|
Question |
Answer |
|
i |
1947 |
|
ii |
Vasectomy |
|
iii |
1997 |
|
iv |
Passive immunity |
|
v |
Hansen’s disease |
V. A. Write the full forms of the following abbreviations.
Answer
|
Abbreviation |
Full Form |
|
a.
ELISA |
Enzyme Linked Immuno Sorbent Assay |
|
b.
UNICEF |
United Nations International Children’s Emergency Fund |
|
c.
DPMR |
Disability Prevention and Medical Rehabilitation (Leprosy programme term) |
|
d.
UNESCO |
United Nations Educational, Scientific and Cultural Organization |
|
e.
HMIS |
Health Management Information System |
|
f.
JSSK |
Janani Shishu Suraksha Karyakram |
|
g.
ASHA |
Accredited Social Health Activist |
|
h.
UNDP |
United Nations Development Programme |
|
i.
NACO |
National AIDS Control Organisation |
|
j.
IDD |
Iodine Deficiency Disorders |
VI. B. Write True/False.
Answer
i. Rural Health Scheme 1977 was recommended by Srivastav Committee. — True
ii. Antiretroviral therapy is given to an HIV patient. — True
iii. Mudaliar Committee is known as Health Survey and Planning Committee. — True
iv. Home visiting is the backbone of Community Health Nursing. — True
v. Janani Suraksha Yojana was launched in 2005. — True
