fundamentals of nursing

1. Introduction to Nursing

  • Definition: Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations.

  • Roles of a Nurse:

    • Caregiver

    • Communicator

    • Educator

    • Advocate

    • Manager/Leader

    • Researcher

  • Nursing Process (ADPIE):

    • Assessment: Gather subjective and objective data.

    • Diagnosis: Analyze data to identify patient problems (nursing diagnoses).

    • Planning: Develop a plan of care, set goals/outcomes, and select interventions.

    • Implementation: Carry out the planned interventions.

    • Evaluation: Determine if goals were met and revise the plan as needed.

2. Legal and Ethical Considerations

  • Ethics: Principles guiding behavior.

    • Autonomy: Patient's right to make decisions.

    • Beneficence: Act for the good of others.

    • Non-maleficence: Do no harm.

    • Justice: Fairness in treatment and resource allocation.

    • Fidelity: Loyalty and commitment.

    • Veracity: Telling the truth.

  • Legal Aspects:

    • Nurse Practice Acts: State laws regulating nursing practice.

    • Standards of Care: Guidelines for practice; measure against reasonable and prudent nurse.

    • Torts:

    • Intentional: Assault, battery, false imprisonment.

    • Unintentional: Negligence (malpractice).

    • Informed Consent: Patient's agreement ($\$>18 years old, minor for certain conditions) to a medical procedure or treatment after being fully informed of risks, benefits, alternatives, and consequences of refusal.

3. Health Assessment

  • Components:

    • Health History: Subjective data (chief complaint, past medical history, social history, family history).

    • Physical Examination: Objective data (inspection, palpation, percussion, auscultation).

  • Vital Signs: Indicators of physiological status.

    • Temperature: Normal range (36.1∘C−37.2∘C)(36.1^\circ C - 37.2^\circ C) or (97∘F−99∘F)(97^\circ F - 99^\circ F). Routes: oral, rectal, axillary, tympanic, temporal.

    • Pulse: Normal adult range (60−100)(60-100) bpm. Sites: radial, carotid, apical.

    • Respirations: Normal adult range (12−20)(12-20) breaths/min.

    • Blood Pressure (BP): Normal adult (<120/80) mmHg. Systolic (ventricular contraction), Diastolic (ventricular relaxation).

    • Pain: "5th5^{th} vital sign"; subjective, assessed using scales (e.g., 0−100-10).

4. Patient Safety and Infection Control

  • Safety: Preventing falls, medication errors, hospital-acquired infections, and other adverse events.

    • Fall Prevention: Orienting to surroundings, call light within reach, appropriate lighting, clear pathways, bed in lowest position, frequent rounds.

    • Restraints: Used only as a last resort, require a physician's order, and regular assessment.

  • Infection Control:

    • Healthcare-Associated Infections (HAIs): Infections acquired during healthcare delivery.

    • Chain of Infection: Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host.

    • Hand Hygiene: 1st1^{st} line of defense; handwashing with soap and water or alcohol-based hand rub.

    • Personal Protective Equipment (PPE): Gloves, gowns, masks, eye protection.

    • Standard Precautions: Apply to all patients; hand hygiene and PPE when needed.

    • Transmission-Based Precautions:

    • Contact: Gown and gloves (e.g., MRSA, C. diff).

    • Droplet: Mask (e.g., influenza, pertussis).

    • Airborne: N95 respirator (e.g., TB, measles, varicella).

5. Medication Administration

  • Rights of Medication Administration (6 Rights):

    • Right Patient

    • Right Medication

    • Right Dose

    • Right Route

    • Right Time

    • Right Documentation

  • Routes of Administration:

    • Oral (PO)

    • Parenteral (IM, SubQ, IV, ID)

    • Topical (skin, mucous membranes)

    • Inhalation

  • Calculations: Dose ordered / Dose on hand * Quantity = Amount

6. Documentation and Communication

  • Documentation: Legal record of care.

    • Principles: Accurate, factual, complete, current, organized, confidential.

    • Methods: Electronic Health Records (EHR), Narrative, Charting by Exception, Problem-Oriented Medical Records (POMR).

  • Communication: Essential for patient care and teamwork.

    • Therapeutic Communication: Client-centered, promotes trust and rapport.

    • SBAR: Standardized communication for hand-off reports.

    • Situation

    • Background

    • Assessment

    • Recommendation

7. Basic Patient Care

  • Hygiene: Bathing, oral care, perineal care, hair care, nail care.

  • Mobility and Immobility: Repositioning, range of motion (ROM) exercises.

  • Nutrition: Assessing dietary needs, assisting with feeding, special diets.

  • Elimination: Bowel and bladder care, specimen collection, ostomy care.

8. Wound Care

  • Wound Healing Phases: Hemostasis, inflammatory, proliferative, remodeling.

  • Types of Wounds: Acute, chronic, pressure injuries.

  • Wound Assessment: Location, size, depth, tissue type (granulation, slough, eschar), exudate, periwound skin.

  • Dressings: Promote healing, protect wound, absorb exudate.