Fundamentals of Nursing Weeks 1-6

WEEK 1: Chapters 1–4

I. The Role of the Nurse

Nurses assist individuals, families, and communities in attaining, maintaining, and restoring health.
They promote health, prevent illness, restore health, and help patients cope with disability or death.

Nursing Roles

• Caregiver: Direct patient care and comfort.

• Advocate: Protect patient’s rights and safety.

• Educator: Teach patients and families about health.

• Leader: Guide and influence others in the healthcare team.

• Researcher: Use and contribute to evidence-based knowledge.

• Collaborator: Work with other healthcare professionals for optimal outcomes.

Goal: Provide improved patient-centered care.

II. Current Trends in Nursing

• Changing demographics and increasing cultural diversity.

• More nursing roles outside hospitals (community, home care, schools).

• Rapid technological advances.

• Collaboration across healthcare providers.

• Growth in palliative care and alternative therapies.

III. Theoretical Foundations

Theory: Group of concepts describing patterns of reality (e.g., person, health, environment, nursing).
Concepts: Abstract ideas organized into symbols of reality.

IV. Nursing Research & Evidence-Based Practice (EBP)

Purpose: Improve care, develop discipline, guide policy, and refine education.

Types of Research

V. Evidence-Based Practice (EBP)

EBP = integrating best evidence, clinical expertise, and patient values/preferences to make clinical decisions.

Steps of EBP (PICOT)

1. Formulate clinical question (PICOT)

   • P – Patient/Population/Problem

   • I – Intervention

   • C – Comparison

   • O – Outcome

   • T – Time

2. Search for best evidence

3. Critically appraise the evidence

4. Integrate with clinical expertise and patient preferences

5. Evaluate outcomes

6. Disseminate results

VI. Holistic Nursing

Treating the patient as a whole person — mind, body, and spirit.
Involves physical, emotional, social, and spiritual care.

VII. Illness Concepts

Stages of Illness Behavior

1. Experiencing symptoms

2. Assuming sick role

3. Assuming dependent role

4. Recovery/Rehabilitation

VIII. Health & Wellness

• Health: Complete physical, mental, social well-being, not just absence of disease.

• Wellness: Active process of becoming healthy through lifestyle and habits.

IX. Health Disparities & Determinants

• Health Equity: Achieving highest level of health for all.

• Health Disparity: Preventable differences in health status linked to social/economic disadvantage.

Determinants:

• Economic stability

• Neighborhood/environment

• Education

• Food access

• Social support

• Health care access

X. Levels of Health Promotion

XI. Maslow’s Hierarchy of Needs

         Self-Actualization
        ↑ Esteem
        ↑ Love/Belonging
        ↑ Safety
        ↑ Physiological (base)

• Unmet needs → illness

• Fulfilled needs → health restored

• Nursing care aims to meet these patient needs

WEEK 2: Chapters 28, 32, 34

I. Patient Safety

Factors Affecting Safety

• Developmental Stage: Fetus to older adult (hazards vary)

• Lifestyle: Occupation, habits, substance use

• Environment: Home/work hazards

• Mobility & Sensory impairment

• Knowledge deficits

• Physical/Psychosocial health

Priority of Action: ABC – Airway, Breathing, Circulation

II. Elderly Risk Factors

• Falls, nocturia, incontinence

• Polypharmacy (drug interactions)

• Vision/hearing changes

• Decreased reflexes and temperature sensitivity

Morse Fall Scale

III. Ambulation & Mobility

Assisting to Ambulate

1. Dangle legs before standing

2. Watch for postural hypotension

3. Support weak side at waist

4. Walk when stable

Cane Use (COAL Rule):

• Cane Opposite Affected Leg

1. Cane → Weak leg → Strong leg

Crutch Gaits

IV. Restraints

• Chemical: Meds to control behavior

• Physical: Devices restricting movement

• Seclusion: Locked room, patient cannot leave

⚠ Doctor’s order required.

Complications: Immobility, pressure ulcers, breathing issues, circulation problems, psychological distress, death.

Alternatives:
Reorientation, bed alarms, family presence, reassurance, 1:1 sitter, fulfill needs.

V. Seizure Precautions

• Stay with patient

• Assist to floor, turn to side

• Support head

• Do not restrain

• Pad side rails

• Nothing in mouth

VI. Hygiene & Personal Care

• Assess physical/emotional status during care

• Use as time for full head-to-toe assessment

• Maintain privacy, safety, warmth

• Move clean → dirty, use gloves

Special Populations

• Bariatric: Dry folds well, use non-soap cleansers

• Incontinent: Frequent checks, gentle cleaning

• Infants: Never leave unattended

• Older Adults: Less frequent baths, avoid hot water

VII. Bed Making

• Raise bed to working height

• Do not place linen on floor

• Check for tubes, drains, and skin integrity

VIII. Mobility & Body Mechanics

Key Movements:

• Flexion, extension, abduction, adduction, rotation, dorsiflexion, plantar flexion, supination, pronation

Principles:

• Keep back straight, bend knees

• Hold object close

• Push rather than pull

• Face direction of movement

Safe Patient Handling:
Use gait belts, mechanical lifts, assist devices. Never lift manually without equipment.

IX. Anti-Embolic Stockings & SCDs

• Used to prevent DVT and venous stasis

• Requires physician order

• Apply to clean, dry legs

• Remove periodically for skin check

WEEK 3: Pharmacology (Chapter 30)

I. Drug Basics

• Generic name: manufacturer’s original name (e.g., acetaminophen)

• Trade name: brand name (e.g., Tylenol)

Drug Classifications:

• Pharmaceutical class: mechanism of action

• Therapeutic class: clinical purpose

II. Pharmacokinetics

First Pass Effect: Drug broken down in liver before reaching systemic circulation.

III. Medication Actions

• Therapeutic effect: intended result

• Adverse effect: harmful reaction

• Allergic reaction: immune response

• Tolerance: decreased response

• Toxicity: buildup due to slow metabolism

• Idiosyncratic: unusual/unexpected response

IV. Serum Drug Levels

• Therapeutic range: effective, non-toxic

• Peak: highest concentration (1 hr post-dose)

• Trough: lowest (30 min before next dose)

• Half-life: time to reach 50% concentration

V. Medication Orders & Rights

Order must include: patient name, date/time, drug, dose, route, frequency, prescriber signature.

11 Rights of Medication:

1. Right patient

2. Right medication

3. Right dose

4. Right route

5. Right time

6. Right reason

7. Right assessment

8. Right documentation

9. Right response

10. Right education

11. Right to refuse

3 Checks:

• When retrieving

• When comparing to MAR

• Before administering

VI. Routes of Administration

Oral: Slow onset, cannot use if NPO.
Sublingual/Buccal: Fast absorption, do not chew or swallow.
Topical: Apply to clean skin, rotate patches.
Nasal/Eye/Ear: Sterile technique, follow positioning.
Vaginal/Rectal: Maintain privacy, lubrication, correct positioning.
Inhalation: MDI, DPI, or spacer; bronchodilators act quickly.

VII. Parenteral Routes

Insulin Mixing (“Cloudy-Clear Rule”):

1. Inject air into cloudy

2. Inject air into clear

3. Draw up clear → then cloudy

VIII. Safety

• Never recap used needles

• Report needlestick injuries immediately

• Document all errors & incidents

• Always verify allergies, patient ID, and order

WEEK 4: IV Therapy & Blood Transfusions (Chapter 41)

I. Goals of IV Therapy

• Maintain fluid/electrolyte balance

• Administer medications/nutrition

• Replace blood volume

Types of Solutions:

• Crystalloids: Isotonic, hypotonic, hypertonic (e.g., Lactated Ringer’s)

• Colloids: Contain large molecules (albumin, blood)

• TPN: IV nutrition, central line only

II. IV Devices

DO NOT wet midline or central lines.

III. Site Selection

• Use distal veins first

• Avoid same-side as mastectomy/fistula

• No lower extremity IVs in adults

• Use ultrasound for difficult access

IV. Complications

V. Blood Transfusions

• Order, consent, and two RN verification required

• Use only 0.9% Normal Saline

• Begin slowly; major reactions occur within first 50 mL

• Must complete within 4 hours

Types:

• Autologous: Self-donated

• Allogenic: From another person

Reactions – Immediate Nursing Action

1. Stop transfusion

2. Keep IV line open with NS

3. Notify HCP & blood bank

4. Monitor vitals

5. Send blood & urine samples

WEEK 5: The Nursing Process (ADPIE)

I. Steps of ADPIE

II. Types of Assessment

• Initial: On admission

• Focused: Specific problem

• Emergency: Life-threatening issues

• Time-lapsed: Compare changes over time

• Triage: Prioritize urgency

III. Nursing Diagnosis

• Based on data clusters (symptoms & cues)

• Must be patient-centered and nonjudgmental
  Examples:

• Anxiety related to job loss

• Ineffective airway clearance due to secretions

IV. Planning & Outcomes

• Set goals with patient/family

• Prioritize needs

• Write SMART outcomes

• Involve interdisciplinary team

V. Implementation

• Perform interventions (evidence-based)

• Direct Care: physical/psychosocial (e.g., meds, wound care)

• Indirect Care: advocacy, infection control, charting

VI. Evaluation

• Measure progress toward goals

• Identify factors contributing to success/failure

• Document everything

WEEK 6: Concept Mapping

I. Purpose

A visual method for organizing patient data, connecting nursing diagnoses, goals, and interventions.
Promotes critical thinking and holistic understanding.

II. Steps

1. Collect patient problems/data

2. Connect and analyze relationships

3. Create a visual diagram

4. Identify key nursing concepts

III. Components

• Central concept (patient or problem)

• Branches for:

  • Nursing diagnoses

  • Goals/outcomes

  • Interventions with rationale

  • Evaluation of response

Goals: Broad statements
Outcomes: SMART, specific, measurable

✅ Key NCLEX Reminders

• EBP: Use PICOT and integrate patient preferences.

• Safety: Always ABC and fall prevention.

• Medication: Verify orders, apply 11 rights, and never leave meds unattended.

• IV Therapy: Check for infiltration and infection; monitor fluid balance.

• Nursing Process: Continuous reassessment; patient-centered approach.

• Concept Mapping: Links assessment → diagnosis → planning → intervention → evaluation.