Fundamentals Exam 2 Study Guide (Sprig 2026)

What is nutrition?

The process of taking in and using food for growth, repair, and maintenance of health.

Why is nutrition important?

Supports healing, immune function, energy, and prevents complications.

Who is at risk for poor nutrition?

Older adults, chronically ill, post-op patients, cancer patients, dysphagia, low income.

Signs of poor nutritional status

Weight loss, muscle wasting, fatigue, dry skin, hair loss, edema, low albumin.

What labs assess nutrition?

Albumin, prealbumin, hemoglobin, electrolytes.

Therapeutic diets

• Low sodium → HTN

• Diabetic diet → blood sugar control

• Pureed → dysphagia

• High protein → wound healing

What is enteral feeding?

Feeding through the GI tract (NG tube, PEG tube).

Benefits of enteral nutrition

Maintains gut function, safer, cheaper.

What is parenteral nutrition (TPN)?

Nutrition given IV (bypasses GI tract).

When is TPN used?

Non-functioning GI Tract

Risks of TPN

Infection, hyperglycemia, electrolyte imbalance.

Modes of EBP in nutrition

• Standard recommendations based on research

• Used to guide nutrition care for specific diseases

1. Diabetic diet guidelines for blood glucose control

2. Low-sodium diet for hypertension

Why is caring important in nursing?

Builds trust and improves patient outcomes.

What is therapeutic presence?

Being physically and emotionally available to the patient.

How can nurses show caring through touch?

Holding a hand, gentle contact (when appropriate culturally).

What is therapeutic listening?

Actively listening without interrupting or judging.

Benefits of listening to patients

Builds trust, improves communication, reduces anxiety.

What is cultural competence?

Ability to provide care that respects cultural differences.

Steps to cultural competence

• Awareness

• Knowledge

• Skill

• Encounters

• Desire

Cultural acceptance

• Beliefs

• Values

• Diet

• Communication style

• Health practices

Why is cultural assessment important?

Helps provide individualized, respectful care.

What is cultural congruent care?

Care that fits the patient’s beliefs and lifestyle.

Outcomes of congruent care

Better compliance, satisfaction, and health outcomes.

How does spirituality affect health?

Provides coping, meaning, and emotional support.

Nursing interventions for spiritual health

• Offer chaplain

• Respect beliefs

• Provide quiet time

• Active listening

What is pain?

An unpleasant sensory and emotional experience.

Steps of pain transmission

• Transduction- The process of converting a painful stimulus into electrical signals in the nerves.

• Transmission- The process of sending the electrical signals from the periphery to the spinal cord and then to the brain.

• Perception- The brain's recognition and interpretation of the pain signals, leading to the experience of pain

• Modulation- The body's ability to alter the pain signals through various mechanisms, including the release of endorphins and other neurochemicals.

What factors influence pain?

Age, culture, anxiety, past experiences, environment, support system.

Components of pain assessment

• Location

• Intensity (0–10 scale)

• Quality (sharp, dull, burning)

• Duration

• Timing

• Aggravating/relieving factors

Difference between acute and chronic pain?

• Acute → short-term, protective

• Chronic → long-term (>3 months)

Noiceptive pain

Tissue injury (aching, throbbing)

Neuropathic pain

Nerve damage (burning, tingling)

Referred pain

Pain felt in a different location than source

Nursing diagnosis for pain

Acute pain or chronic pain

Goal for pain mangement

Reduce pain to acceptable level (patient-defined)

How do you evaluate pain care?

Reassess pain after intervention

Priority before giving pain meds.

Assess pain level

Types of analgesics

• Non-opioids (acetaminophen)

• Opioids (morphine)

• Adjuvants (antidepressants)

Priority after giving opiods

Monitor respiratory rate

Analgesic

Medications used in the management and treatment of pain.

Non-pharmacologic pain interventions

Heat/cold, repositioning, relaxation, distraction

Barriers to pain management

Fear of addiction, poor assessment, cultural beliefs

Consequences of untreated pain

• Delayed healing

• Anxiety/depression

• Increased HR/BP

• Poor quality of life

Who is at risk for infection?

• Elderly

• Infants

• Immunocompromised

• Chronic illness

• Post-surgery patients

Signs of local infection

• Redness

• Swelling

• Warmth

• Pain

• Drainage

Signs of systemic infection

• Fever

• Fatigue

• Elevated WBC

• Chills

What are 6 links of chain of infection?

• Infectious agent- pathogen

• Reservoir- where it lives

• Portal of exit- sneeze, cough, (how it enters)

• Mode of transmission- direct/indirect contact

• Portal of entry- shaking hands

• Susceptible host- no immunity

Inflammation/ Infection rule

• You can have inflammation w/o infection

• You can have infection w/ inflammation

Incubation period (Infection)

Time from exposure to a pathogen (bacteria, virus, fungi) until the first symptoms appear

Prodromal Stage

Early stage of a disease, characteristic symptoms appear

• Often marked by mild, non-specific symptoms like low-grade fever, fatigue, or irritability

Illness Stage

Peak symptoms and high contagion

• Crucial for diagnosis and treatment planning

Convalescence

The final phase of an infection, illness, or surgery, where the body recovers, repairs damage, and returns to its previous state of health.

• Acute symptoms subside during this time, though lingering fatigue and weakness can last from days to months. Patients may still be contagious.

How to stop infection?

Break any link in the chainprioritize frequent handwashing with soap and water for 30 seconds, keep vaccinations current, and avoid close contact with sick individuals

Inflammation

• Redness

• Swelling

• Pain

• Tenderness

• Loss of function

Types of transmission

• Direct contact

• Indirect contact

• Droplet

• Airborne

What are standard precautions?

Used for all patients (hand hygiene, gloves)

Contact precautions

MRSA, VRE, C. diff, wounds

PPE:

• Gloves

• Gown

Key points:

• Hand hygiene (soap & water for C. diff)

• Dedicated equipment

Droplet precautions

Used for: Flu, COVID, meningitis

PPE:

• Surgical mask

• (Gloves + gown if needed)

Key points:

• Wear mask when within 3–6 feet of patient

Airborne precautions

Used for: TB, measles, chickenpox

PPE:

• N95 respirator

• (Gloves + gown if needed)

Key points:

• Negative pressure room

Special precautions

C. diff:

• Gloves + gown

• Soap & water ONLY (no sanitizer)

TB:

• N95 mask

• Negative pressure room

COVID/Flu:

• Surgical mask (sometimes N95 depending on policy)

Wound care (drainage):

• Gloves + gown

Suctioning / splashes likely:

• Gloves + gown + mask + eye protection

PPE (donning)

• Gown

• Mask/respirator

• Goggles/face shield

• Gloves

PPE (doffing)

• Gloves

• Goggles/face shield

• Gown

• Mask
  👉 Hand hygiene LAST

Pain/ Infection (Memory Tip)

• Assess → Medicate → Reassess (Pain)

• Break the chain (infection)

What is oxygenation?

A: The process of delivering oxygen to tissues and removing carbon dioxide.

What systems are involved with oxygenation?

Respiratory + cardiovascular systems

Structures of resp. system

Nose → pharynx → larynx → trachea → bronchi → lungs → alveoli

What happens in the alveoli?

Gas exchange (O₂ in, CO₂ out)

What carries oxygen in blood?

Hemoglobin

What negatively affects oxygenation?

• Smoking

• Infection (Pneumonia)

• Immobility

• Obesity

• Pain

• Anxiety

• Aging

• Environmental factors (Pollution)

Early signs of hypoxia

• Restlessness

• Anxiety

• Tachycardia

• Tachypnea

Late signs of hypoxia

• Cyanosis

• Confusion

• Bradycardia (late)

• Decreased LOC

Priority assessment for oxygenation?

Airway, breathing, SpO₂

Oxygenation Nursing Interventions

• Position (High Fowler’s)

• Oxygen therapy

• Encourage deep breathing/coughing

• Incentive spirometer

• Suction if needed

What position improves oxygenation?

High Fowler’s

What is perfusion?

Flow of blood through arteries/ capillaries delivering nutrients and oxygen to cells

Components of perfusion

• Heart

• Arteries

• Veins

• Capillaries

Blood flow pathway

Heart → arteries → capillaries → veins → heart

Cardiac Output

Amount of blood pumped by the heart per minute

What negatively affects perfusion?

• Hypertension

• Atherosclerosis

• Diabetes

• Smoking

• Obesity

• Aging

• Immobility

Signs of poor central perfusion

• Chest pain

• Hypotension

• Decreased urine output

• Altered LOC

Signs of poor/peripheral perfusion

• Cool, pale skin

• Weak pulses

• Delayed cap refill (>3 sec)

• Edema

Priority assessment of for perfusion

Vital signs, pulses, capillary refill

Priority interventions for for perfusion

• Monitor BP and HR

• Administer fluids/meds

• Oxygen if needed

• Positioning (legs elevated if appropriate)

• Encourage mobility

Oxygenation/ Perfusion Order

Oxygenation	Perfusion
Air & lungs	Blood & heart
O₂ exchange	O₂ delivery
SpO₂	BP, pulses
Breathing problem	Circulation problem

Priority Tip (Oxygenation/Perfusion)

Oxygenation ALWAYS comes before perfusion
(Think ABC: Airway → Breathing → Circulation)

What is protection?

Prevents the body from suffering harm/injury:

• Skin integrity

• Immune system

• Inflammatory response

1st Line of Defense

Skin and mucous membranes

Stroke Volume (SV), Cardiac Output (CO), Ejection Fraction

• Stroke volume (SV): Volume of blood pumped per beat (approx. 70–100 mL),

• Cardiac output (CO): Total volume pumped per minute- usually 4–8 L/min.

• Ejection fraction (EF): % of blood pumped out with each beat (SV/end-diastolic volume), with 50-70% being normal

2nd Line of Defense

Inflammation and immune response

3rd Line of Defense

Antibody-mediated (adaptive immunity)

What weakens protective mechanisms?

• Aging

• Poor nutrition

• Stress

• Chronic illness (diabetes)

• Smoking

• Immobility

• Medications (steroids, chemo)

Signs of tissue integrity

• Skin breakdown

• Pressure injuries

• Delayed wound healing

Protection Nursing Interventions

• Hand hygiene

• Skin assessment

• Repositioning (q2h)

• Wound care

• Nutrition (protein!)

Healthcare System Changes:

(How do changes affect nursing)

• More workload

• Focus on quality & safety

• More documentation

• Use of technology (EHR)

How does spirituality affect patients?

• Helps coping

• Reduces stress

• Provides meaning and support

How can nurses support spiritual health?

• Active listening

• Respect beliefs

• Offer chaplain services

• Provide privacy for prayer

What risks affect LGBTQ+ patients?

• Discrimination

• Lack of access to care

• Mental health issues

• Increased risk of STIs

• Fear of seeking care

How to provide care for LGBTQ+ patients?

• Use correct pronouns

• Avoid assumptions

• Provide a safe environment

• Maintain confidentiality

What is fluid balance?

Maintaining proper amount of fluid in the body (intake = output)

What are electrolytes?

Minerals in the body that carry an electrical charge (Na⁺, K⁺, Ca²⁺)