Comprehensive Nursing Concepts – Exam Review Notes

Page 1

• Key Definitions
• Asepsis = absence of illness-producing microorganisms.
• Medical Asepsis (“clean technique”) ⇢ reduce number & spread of microbes.
• Examples : administering oral meds, managing NG tubes, hygiene.
• Surgical Asepsis (“sterile technique”) ⇢ eliminate all microbes.
• Examples : catheter insertion, OR procedures, parenteral meds.
• Hand-Hygiene Standards
• Routine care : wash ≥ 15 s.
• Visible soil : wash up to 2 min.
• Components : soap, running water, friction.
• Hand-Rub vs. Soap/Water
• Use soap & water if hands soiled, after body-fluid contact, restroom, before eating.
• Alcohol rub acceptable if hands appear clean.
• Hand-washing Steps

1. Wet hands, apply 3–5 mL soap, rub ≥ 15 s.

2. Rinse warm water.

3. Dry with clean towel & use towel to turn off faucet.
   • Surgical Sterility Rules
   • Only sterile items on sterile field.
   • Outer 1-in border is non-sterile.
   • Do not reach over / turn back on field.
   • Hold items ≥ 6 in above field to drop.
   • Air exposure, torn/wet packages → discard.

Page 2

• PPE Basics : masks, gloves, gowns, goggles.
• Personal hygiene : cover sneeze/cough, short nails, remove jewelry, secure hair.
• General Safety
• Encourage client/visitor hand hygiene.
• Floor = grossly contaminated; do not place items there.
• Bag moist linens in plastic; don’t shake.
• Cough etiquette : ≥ 3 ft distance; mask coughing clients.
• Sterile-Procedure Shielding : mask a coughing client; tissues nearby; never reach across field.
• Sterile-Glove Donning

1. Grasp folded cuff of dominant glove with non-dominant hand.

2. Insert dominant hand; then glove non-dominant.

3. Once gloved, only sterile touches sterile.
   • Influenza A + Pneumonia Care
   • Droplet precautions.
   • Likely orders : ABG, breathing tx, ↑ O _2 flow (SpO _2 90\% RA).
   • HOB elevated for lung expansion.
   • Monitor VS (RR, SpO _2 , Temp).
   • Lung sounds : bilateral rhonchi upper lobes; expect improved SpO _2 to 98\% on 3 L NC.

Page 3

• Infection Basics
• Infection = pathogen completes chain of infection.
• Nurse breaks chain via medical/surgical asepsis & standard precautions.
• Pathogen Types : bacteria (S. aureus, E. coli, M. tuberculosis), viruses (HIV, Hep B/C, HSV, SARS-CoV-2), fungi (Candida), prions, parasites.
• Herpes Zoster : latent varicella, erupts along dermatome.
• Immune Defenses
• Innate : skin, mucosa, enzymes, phagocytes; inflammatory response.
• Adaptive : B/T-lymphocyte antibody production; permanent immunity.

Page 4

• Chain of Infection Links : ① Agent ② Reservoir ③ Exit ④ Transmission ⑤ Entry ⑥ Host.
• Hand Hygiene = #1 Prevention : before, during, after client contact & task change.
• Stages of Infection : Incubation → Prodromal → Illness → Decline → Convalescence.
• Infection Risk Factors : poor hygiene, immunocompromise, devices, ↓ perfusion/O _2 , chronic disease.
• HAI Facts : common sites = urinary, surgical wound, resp, blood; common bugs = E. coli, S. aureus, Enterococci.

Page 5

• Systemic Infection S/S : fever, chills, diaphoresis, ↑ HR/RR, malaise, lymphadenopathy.
• Older Adult Atypical : agitation, confusion, incontinence.
• Inflammation Phases : ① redness/warmth/edema ② WBC+exudate (serous / sanguineous / purulent) ③ tissue repair/scar.
• Key Labs : WBC > 10{,}000/\mu L, ESR > 20 mm/hr, positive cultures, gallium uptake.
• Leukocytosis signals infection; e.g., infected pressure ulcer → notify provider & consider antibiotics.
• General Nursing Care : strict hand hygiene, immunize, oral & pulmonary hygiene, hydration, PPE.
• Isolation Tiers : Standard (ALL clients) + Transmission-Based (airborne <5 µm, droplet >5 µm, contact) + Protective.
• PPE Removal : gloves off first (most contaminated).

Page 6

• Airborne : N95, negative-pressure (TB, measles, COVID-19).
• Droplet : surgical mask; diseases – influenza, pertussis.
• Contact : gloves/gown; MRSA, RSV.
• Medication : antipyretics; antimicrobials (monitor WBC/Temp; stress full-course completion).
• TB Precaution : airborne + N95 + negative room.
• MDROs : MRSA → vancomycin/linezolid.
• Nurse : obtain culture before antibiotics; educate no overuse.

Page 7

• Chain-Review : memorize six links for exam prep.
• Pathogen Virulence = disease-causing power.
• Detailed portal/mode/host examples (respiratory TB, GI C. diff, vector malaria, etc.).
• Adaptive Immunoglobulins : IgA, IgD, IgE, IgG, IgM – create memory.

Page 8

• Infection Risk Extras : alcohol, nicotine, malnutrition, steroids, chemo, HIV, HF, elderly.
• Assessment : fever/chills/sore throat; older adult confusion.
• Key Labs : WBC > 10{,}000; ESR > 20; cultures guide therapy.
• Nursing : identify travel/behaviors, asepsis, promote rest/nutrition, enforce immunizations.
• Transmission-Based Summary : Contact (gloves + gown), Droplet (mask), Airborne (N95).

Page 9

• Med-Resistant : MRSA, VRSA – stress culture-guided therapy.
• Herpes Zoster : unilateral vesicular rash, post-herpetic neuralgia; vaccine ≥ 60 y/o.
• Sepsis Basics : systemic infection → organ failure; treat with antibiotics, vasopressors.
• Vital Sign Norms : Temp, HR 60-100 bpm, RR 12-20, BP <120/80, SpO _2 95-100\%. • Heat Loss / Gain : conduction, convection, evaporation, radiation, diaphoresis. • Temperature Ranges : Oral 36-38^{\circ}C; Rectal +0.5^{\circ}C; Axillary -0.5^{\circ}C. • Fever vs. Hyper-/Hypothermia : >38^{\circ}C vs. dysregulation vs. <35^{\circ}C.

Page 10

• Oral Temp Contra : mouth surgery, mouth-breathing, hot/cold drinks.
• Pulse Details : scale 0-4, tachy >100 bpm, brady <60.
• Pulse Deficit = apical ‑ radial differences.
• Respiration Physiology : ventilation, diffusion, perfusion; chemoreceptors measure CO _2 .
• BP Equation : BP = CO \times SVR.
• Orthostatic Hypotension : drop when standing; assess.
• SpO _2 Norms : 95-100\%, COPD may tolerate 88\%.

Page 11

• Pain : rights to assessment / management; undertreatment → chronic pain & psych impact.
• Pain Types : Acute, Chronic, Nociceptive (somatic, visceral, cutaneous), Neuropathic.
• Pain Physiology : transduction → transmission → perception → modulation; substances ↑ pain (Sub P, prostaglandins) vs. ↓ pain (endorphins).
• Assessment : PQRST – precipitate, quality, region, severity 0-10, timing.

Page 12

• Non-Pharm Pain : CBT, TENS, heat/cold, distraction, relaxation, acupuncture.
• Pharm :
• Non-opioids : acetaminophen ≤ 4 g/day, NSAID GI risk.
• Opioids : morphine, monitor sedation/resp (<12 RR), constipation prophylaxis.
• Adjuvants : gabapentin, amitriptyline.
• PCA : only client presses button; common meds morphine, hydromorphone.

Page 13

• Client Safety Fundamentals : risk assess, involve client, incident reports.
• Fall Prevention : assess on admission & regularly; non-skid socks, bed alarms, low bed, good lighting.
• Ergonomics : breaks, lift devices, no twisting.
• Seizure Precautions : padded rails, suction/O _2 nearby, turn on side, nothing in mouth.
• Restraint Rules : last resort, provider order, time limits \le 4 h adult; assess q2 h.
• Fire Safety : RACE & PASS mnemonics; home O _2 → “No Smoking” sign + fire dept notify.

Page 14

• Data Collection & Health History : subjective vs. objective, ROS, therapeutic interview techniques.
• General Survey Items : appearance, body structure, mobility, behavior, VS.
• Head/Neck Exam : CN V, VII, XI tests; lymph node order; thyroid & trachea midline.
• Eye Tests : Snellen, EOM (CN III, IV, VI), PERRLA.
• Ear : Whisper, Weber, Rinne (CN VIII).
• Mouth/Throat : tonsil grading +1-+4, CN IX,X gag, CN XII tongue.

Page 15

• Thorax/Lung : AP < transverse (1/3-1/2), sounds – bronchial, bronchovesicular, vesicular; adventitious crackles, wheezes, rhonchi, rub.
• Heart Auscultation Sites : A 2RICS, P 2LICS, Erb 3LICS, T 4LICS, M 5LMCL. S1 = AV close; S2 = semilunar close.
• Abdomen : inspect → auscultate → percuss → palpate; bowel sounds norm q5-20 s; dull liver, tympany bowel.
• Pulmonary Post-Op : DB&C prevents pneumonia; secretions → risk.

Page 16

• Integument : ABCDE melanoma, edema scale 1+-4+, turgor, cap refill <3 s.
• PVD Cold Feet : provide socks; avoid massage/heating pad.
• Musculoskeletal : gait, ROM, strength 5/5, spine curves, age-changes (↓ bone mass).
• Neuro : LOC, orientation, Romberg, DTR scale 0-4+.

Page 17

• Hygiene Care : complete vs. partial bath, oral care q2 h unconscious, foot care DM (lukewarm water, inspect daily), perineal front-to-back.
• Older Adult Skin : dry, thin → less frequent baths.

Page 18

• Sleep : 3 NREM + 1 REM cycles (REM 20-25\% total). Needs – infants 9-15 h, adolescents 9-10 h, adults 7-8 h. Poor sleep → obesity, HTN, CVA.
• Sleep Disorders : insomnia, apnea (obstructive vs. central), narcolepsy, hypersomnolence.
• Promotion : routines, limit caffeine \ge 4 h pre-bed, CPAP for apnea.

Page 19

• Sensory Deficits : vision, hearing, taste, neuropathy.
• Hearing Impairment : face client, speak clearly, don’t shout.
• Vision Loss : announce presence, describe environment, clear path.
• Diabetic Foot : never barefoot, inspect daily.
• Sensory Deprivation/Overload : provide meaningful stimuli vs. reduce stimuli.

Page 20

• Home Safety Across Ages : aspiration, suffocation, poisoning, falls, firearm safety, burn prevention.
• Older Adult : home hazard eval, remove rugs, grab bars.
• Passive Smoke : ↑ CA, CAD risk; kids → ear/lung infections.
• CO Poisoning : detectors; proper ventilation.

Page 21

• Ergonomic Principles : center of gravity = pelvis; widen base; object close; bend knees; lift ≤ 35 lb solo; request help.
• Continuous Restraint Care : doc q2 h, ROM exercises, renew order q24 h.
• Client Positions : Semi-Fowlers 15-45^{\circ}, Fowlers 45-60^{\circ}, High 60-90^{\circ}, Prone, Lateral, Trendelenburg.
• OT Referral : rheumatoid arthritis self-feeding difficulty.

Page 22

• Disaster Planning : internal vs. external; TJC drills; nurse triage classes I-IV (emergent → expectant).
• Fire RACE/PASS ; severe weather protocols (move away from windows, blankets).
• Bioterror / Chemical : PPE, decon, airway first.

Page 23

• Pressure Injury Staging : 1 non-blanch erythema; 2 partial dermis; 3 full-thickness fat visible; 4 muscle/bone; Unstageable covered; Deep tissue maroon.
• Color Wound Classification : red = healthy, yellow = slough, black = eschar.
• Wound Healing Phases : Inflammatory 3-6 d, Proliferative 3-24 d, Maturation >21 d.
• Dressings : gauze, non-adherent, hydrocolloid, hydrogel, alginate.
• Complications : dehiscence/evisceration (cover sterile moist gauze), hemorrhage, infection.
• **Braden ≤ 18 = risk; reposition q2 h.

Page 24

• Bowel Elimination : factors age, diet (fiber 25-38 g), fluid 2.7-3.7 L, activity.
• Constipation vs. Diarrhea ; hemorrhoids mgmt.
• Enemas last-resort; bag height affects pressure.
• Ostomies : loop, double-barrel, ileostomy. Stoma pink/moist.

Page 25

• Urinary : incontinence types (stress, urge, overflow, functional, reflex, transient).
• Bladder training, Kegels, monitor I&O (<30 mL/hr alert).
• Diversions : ileal conduit, nephrostomy, Kock pouch, neobladder.
• CAUTI prevention : no kinks, closed system, peri-care.

Page 26

• CAM Categories : whole medical (TCM, Ayurveda), biologic (herbs – aloe, chamomile, garlic, ginkgo), body-manipulative (massage, chiropractic), mind-body (meditation, yoga), energy (Reiki), movement (Pilates).
• Nurse Role : understand, integrate safely, teach interactions.

Page 27

• Pharmacokinetics : Absorption → Distribution → Metabolism (liver) → Excretion (kidney).
• Therapeutic Index (low TI = monitor drug levels), Half-life.
• Routes : oral (first-pass), SL/buccal bypass liver, topical, inhalation, IV immediate.
• Safe Med Rights : client, drug, dose, time, route, documentation, education, assessment, evaluation, refuse.
• Error Reporting : assess client, notify provider, incident report (not in chart).

Page 28

• Prescription Types : routine, single, stat, now (within 90 min), PRN. Missing unit (“mg”) must be clarified.
• Med Reconciliation : compare home vs. orders at transitions.
• Error-Prone Abbrev : MSO4, µg, trailing zeros.

Page 29

• Dosage Conversions : 1 mg = 1000 µg; 1 g = 1000 mg; 1 kg = 2.2 lb; 1 tsp = 5 mL; 1 tbsp = 15 mL.
• Rounding : <1 → hundredth; >1 → tenth.
• Examples : Lamivudine 150 mg ÷ 100 mg/tab → 1.5 tablets.

Page 30

• IV Rates : \dfrac{mL}{hr} = \dfrac{Total\ Volume}{Time\ (hr)}; gtt/min = \dfrac{Volume \times Drop\ Factor}{Time\ (min)}.
• Bolus : large-gauge 18. Pain at site → remove & restart elsewhere.
• Complications : infiltration, phlebitis, fluid overload (slow rate, diuretic), cellulitis.
• Blood Transfusion : baseline VS, stay first 15 min; reaction → stop blood, start NS, save bag, notify.

Page 31

• ABG Interpretation :
• pH 7.35-7.45, PaCO _2 35-45 mm Hg (resp), HCO _3^- 22-26 mEq/L (metabolic).
• COPD risk → resp acidosis; pH 7.30/HCO _3 18 = metabolic acidosis; pH 7.60/PaCO _2 21 = resp alkalosis.
• Electrolytes :
• Na^+ 136-145 mEq/L; K^+ 3.5-5; Ca^{2+} 9-10.5 mg/dL; Mg^{2+} 1.3-2.1.
• Hypermagnesemia >2.1 → notify if 3 mEq/L.
• Fluid Balance : FVD S/S tachy, ortho hypotension, ↑ Hct/BUN; FVE S/S HTN, edema, crackles, ↓ Hct.

Page 32

• Airway/Oxygen : early hypoxia = restlessness, tachycardia, tachypnea; late = cyanosis, brady.
• O _2 Devices : NC 1-6 L (24-44\%), Simple mask 5-10 L (35-60\%), NRB 10-15 L (80-95\%), Venturi precise 24-60\%. 2 L NC ≈ 28\% FiO _2 . Proper NRB bag partially inflated.
• Interventions : SpO _2 <90\% → verify probe/site, raise HOB, DB&C, adjust O _2 . Pursed-lip breathing = inhale nose, exhale slowly pursed lips.
• Chest Physiotherapy : percussion, vibration, postural drainage; suction ≤ 15 s pass; hyperoxygenate beforehand.
• Tracheostomy : oral care q2 h, trach care q8 h, spare tube/obturator bedside; accidental early decannulation = emergency.