Nursing Fundamentals
Dose Calculation
Understanding the principles of dosage calculations, including metric conversions and dosage forms.
Importance of accurate calculations to prevent medication errors.
Common formulas used in dose calculations, such as dimensional analysis and ratio-proportion methods.
Case study example: Calculating the correct dose for a pediatric patient based on weight.
Tools and resources for ensuring accurate dose calculations, including calculators and reference guides.
1mg = 1000 mcg 1g = 1000 mg 1kg = 1000 g 1kg = 2.2 lbs
Medication Administration
the medication administration process, including the five rights: right patient, right drug, right dose, right route, right time.
Special considerations for administering medications via G-Tube including preparation and patient positioning.
interventions:
elevate the clients head of the bed to avoid aspiration
verify tube placement
Guidelines:
use liquid forms, if not available crush meds if appropriate
no sublingual meds
administer each med separately + do not mix meds with enteral feedings
flush tubing before and after 15-30 mL & flush with another 30-60 mL after instilling all meds
Safety protocols to follow during medication administration to minimize risks.
Case study example: Managing a patient with multiple medications and potential interactions.
Subcutaneous: Heparin/ Insulin (3/8 - 5/8 inch, 25-27 gauge needle or 28- 31 gauge insulin syringe - average size 45-90 angle - obese 90 angle
Intramuscular: needle size 18-25 gauge, 5/8-1.5 inch long, 90 angle, use a z-track method
Parental: use a tuberculin syringe solution less than 0.5 mL
Intradermal: fine-gauge needle 25-27 gauge, 5-15 angle, insert with the bevel up
Infection Control and Hygiene
Key principles of infection control, including hand hygiene, use of personal protective equipment (PPE), and sterilization techniques.
Understanding the chain of infection and strategies to break it.
Importance of maintaining hygiene in patient care to prevent healthcare-associated infections (HAIs).
Overview of sterile technique and its application in clinical settings.
Case study example: Managing a patient with a surgical wound and preventing infection.
Infection: risks- age (immature immune system, decrease in functions), impaired circulation and oxygenation
pus, pain, redness, fever chills, odor, increased pule/respirations, high WBC
Interventions- aseptic technique, optimal nutrition, adequate rest
Patient Assessment and Safety
Health Assessment Techniques
Differences between focused and comprehensive health assessments and when to use each.
Key components of a head-to-toe assessment, including vital signs, skin assessment, and neurological checks.
Techniques for conducting a thorough pain assessment, including the use of pain scales and patient interviews.
Importance of pulse assessment and understanding normal vs. abnormal findings.
Case study example: Assessing a patient with chronic pain and developing a care plan.
Prioritization and Delegation
Strategies for prioritizing patient care based on urgency and patient needs.
Understanding the role of delegation in nursing practice and when it is appropriate to delegate tasks.
do NOT delegate what you cannot EAT: evaluate, assess, and teach
you can delegate 2nd assessments, unstable patients
Five rights of Delegation:
task, circumstance, person, direction/communication, supervision/evaluation
Importance of collaboration with healthcare team members to ensure patient safety.
Ethical considerations in prioritization and delegation, including patient advocacy.
Prioritization:
safety, nursing process (ADPIE), patient needs, ABCs- airway, breathing, circulation, unstable, stable
assess first unless indicated
Case study example: Managing a busy unit and prioritizing care for multiple patients.
Professional Practice and Ethics
Professionalism and Advocacy
Definition of professionalism in nursing and its impact on patient care.
Key elements of patient advocacy and the nurse's role in supporting patients' rights and needs.
Overview of the nursing code of ethics and its application in clinical practice.
Importance of cultural competence in providing equitable care to diverse populations.
Case study example: Advocating for a patient with limited English proficiency.
Legal and Ethical Considerations
Overview of healthcare laws that impact nursing practice, including patient privacy and informed consent.
Responsibility- respect obligations
Accountability- setting out to accomplish the things you said you would do, willingness to accept responsibility for actions
Confidentiality- state of being kept secret or private
Autonomy- right to make one's own decisions
Beneficence- goodness for others without self interest
Fidelity- fulfillment of promises
Justice- fairness in delivery
Nonmaleficence- duty to do no harm
veracity- tell the truth
Negligence- failure to exercise appropriate care expected to be exercised in similar circumstances
Importance of maintaining professional boundaries and ethical decision-making.
Strategies for navigating ethical dilemmas in clinical practice.
Case study example: Addressing a conflict between patient autonomy and medical advice.
Pressure Ulcers/Wounds
serous drainage- watery and clear, lightly yellow
sanguineous drainage- thick and reddish, brighter drainage
serosanguineous drainage: both serum and blood, watery- pale and pink
purulent- pus
purosanguineous- pus and blood
dehiscence- partial or total rupture (seperation)
evisceration- protrusion of visceral organs - moist towel
Stage 1- intact, nonblanchable skin
Stage 2- partial thickness skin with exposed dermis, reddish-pinkish bed without slough, eschar, or granulation tissue, intact or ruptured blister
Stage 3- full-thickness skin loss, visible adipose tissue possible granulation and epibole, some slough/eschar present, no exposed muscle, tendons, ligaments, cartilage, or bones
Stage 4- full-thickness skin and tissue loss, skin/tissue loss with cartilage, bone, fascia, muscle, ligaments, or tendon exposed in wound. epibole, tunneling, and undermining
Unstageable- obscured, full-thickness skin and tissue loss, no determination of stage because of eschar or slough obscures the wound bed, depth is unknown
surgical wounds cannot be staged*
Interventions:
keep skin dry, clean, and intact
keep head of bed at or below 30 degrees
raise heels
ambulate clients soon and often as possible
reposition ever 2 hours
encourage proper nutrition (at least 2,500 mL/day)
Pain Assessment: Wong-Bakers Faces scale, numeric scale
Pulse Assessment
note irregularities
count for 30 seconds * 2 or if irregular count for 60 seconds
Grade pulse intensity: - 0 no palpable pulse, 1+ faint, 2+ slightly diminished, 3+ normal, 4+ bounding
Normal pulse: 60-100 bpm
Adapting Health Assessment (Comprehensive vs Focused)
focused- detailed specific body systems or concern ex. abdominal pain or difficulty breathing
Comprehensive- covers a patients general status ex. patient history, physical exam, vital signs
Functional Ability
patients capacity to perform daily activities such as dressing, standing, and sitting, without assistance (measures physical, psychosocial, cognitive, and social abilities)
Interventions: pain management, exercise, early discharge
Clinical Judgment
process to analyze patient information, assess situations, make informed decisions by gathering data, questioning, and applying clinical knowledge
Sterile Technique
aseptic technique
prevention contamination and reduce risk of infection in a surgical or invasive procedure
hand hygiene, sterile field, donning sterile gloves
Elimination
factors:
age, diet (fiber requirement 25-38 g/day), fluids, physical activity, psychosocial factors, personal habits, positioning, pain, pregnancy, surgery/anesthesia, and meds
Flatulence- distention of bowel from gas accumulation
check for abdominal distention, encourage ambulation
Ostomies- temporary or permanent
colostomies- end in the colon
ileostomies- end in the ileum
loop- medical emergency/temporary, loop of bowel is supported on the abdomen with proximal stoma draining stool and distal stoma draining mucus
Double-barrel- two abdominal stomas, one in proximal/distal
Paralytic ileus- intestinal obstruction caused by reduced motility following bowel manipulation during surgery
Urinary: normal adult 1,000-2,000 mL/day
interventions: surgery, immobility, medications, and therapeutic diets)
factors: age, pregnancy, diet, immobility, psychosocial, pain, surgical, and meds
Oxygenation
pulse ox
raise head of bed
administer oxygen therapy
Perfusion
passage of bodily fluids, blood, through the circulatory or lymphatic system to an organ or tissue
signs of poor- skin color, capillary refill, temperature, weak or absent pulses, altered mental status, pain, urine output changes
potential causes- heart failure, shock, PVD, pulmonary embolism
nursing interventions- monitor vitals closely, evaluate extremities, fluid management, oxygen therapy, meds, positioning
CVA (stroke)
FAST - face drooping, arm weakness, speech difficulty, and time to call 911
sudden confusion, vision issues, severe headache, or numbness/tingling
ischemic- blood clot in artery
hemorrhage- bleeding in the brain, ruptured vessel
assess ABCs, Check BP, Administer o2, neuro assessment
complications- aspiration pneumonia, DVT, pressure ulcers, urinary incontinence
Interventions-
maintain a clear airway
monitor vitals
appropriate positioning
speech therapy
OT- adls
PT- mobility
bowel and bladder management
Hypertension
120-129 less than 80
risks; family history, age, race (African Americans), obesity, physical activity, smoking, diabetes, stress
can lead to- stroke, heart attack/failure, kidney disease, PVD, vision issues
Interventions-
weight management, regular exercise, smoking cessation stress reducer
PT ed: regular BP monitoring, adhere to meds, lifestyle changes
PVD (pulmonary vascular disease)
A condition that affects the blood vessels in the lungs, making it harder for blood to flow properly. This can lead to breathing problems and reduced oxygen supply to the body.
Signs and Symptoms: May include symptoms like leg pain while walking that resolves with rest, coldness in lower leg or foot, sores or wounds on toes, feet, or legs that won't heal, and changes in color of the legs.
Risk Factors: Common risk factors include smoking, diabetes, obesity, high blood pressure, high cholesterol, and age.
Complications: Can lead to serious complications such as infection, gangrene, or amputation if not managed properly.
Nursing Interventions:
Educate about lifestyle changes such as quitting smoking and maintaining a healthy diet.
Encourage regular exercise and foot care.
Monitor and manage blood pressure and glucose levels.
Culture
Collaboration in nursing is essential for providing comprehensive patient care. It involves working alongside other healthcare professionals to develop effective care plans. Key components include:
Interdisciplinary Teamwork: Engaging with doctors, pharmacists, social workers, and therapists to share knowledge and expertise.
Communication: Maintaining clear, consistent communication among team members to ensure patient safety and coordinated care.
Patient-Centered Care: Involving patients and their families in decision-making processes to respect their preferences and enhance their care experience.
Role Clarity: Understanding each team member's responsibilities and contributions to optimize team function.
Case study example: A nursing team collaborating with a physical therapist to establish rehabilitation goals for a post-surgical patient to improve recovery outcomes.</mark></p>