Nursing Essentials: Unit 1–3 Summary

Unit 1: Nursing Role and Scope of Practice

  • Objectives

    • Define nursing and relate to historical events and leaders.

    • Describe state nurse practice acts and legal scope of practice: 27252725 (Business and Professions Code) and 1443.51443.5 (California Code of Regulation) Standards of Competent Practice.

    • Review an established code of ethics and its role in guiding nursing practice and ethical decision making.

    • Recognize competencies related to knowledge, skills, and attitudes in practice.

    • Describe the role of the nursing student.

    • Identify outcomes and standards of competency, including the Basic Standards of Nursing Care.

    • Differentiate assault, battery, invasion of privacy, defamation, slander, and libel.

    • Define evidence-based practice (EBP).

    • Define professionalism and its relationship to nursing practice.

    • Compare accountability and responsibility.

  • ADN Program Concepts (Basic Standards/Elements)

    • Patient Centered Care

    • Teamwork and Collaboration

    • Evidence Based Practice

    • Quality Improvement

    • Safety

    • Informatics

    • Professionalism

    • Leadership

    • Communication

  • Professional Practice & Ethics

    • STATE legal scope of practice

    • Nurse Practice Act

    • Registered Nurse License

    • ANA Code of Ethics (moral principles)

  • Influences on Professional Practice

    • Roles: Caregiver, Communicator, Teacher, Client Advocate, Mandated Reporter, Informed Consent, Counselor, Change Agent, Leader, Manager, Case Manager, Research Consumer, Researcher, Service to Public, etc.

    • Moral principles: Autonomy, Beneficence, Nonmaleficence, Justice, Fidelity, Veracity

  • Role of the Student Nurse

    • Providing safe patient care within current scope

    • Advocate and companionship; CPET feedback to improve practice

  • Regulatory/Professional Organizations

    • BRN (California Board of Registered Nursing)

    • JCAHO/TJC (Joint Commission)

    • CMS (Centers for Medicare & Medicaid Services)

    • ANA (American Nurses Association)

    • NSNA (Nursing Students' Association)

    • Sigma Theta Tau

    • NCSBN (NCLEX information)

Unit 2: The Physical Health Assessment and Vital Signs

  • Objectives (overview)

    • Identify purpose of physical health assessment and Vital Signs, including pulse oximetry SpO2SpO_2, and pain as the 5th vital sign.

    • Describe measurement of blood oxygenation and documentation of pain.

    • Distinguish subjective vs objective data and learn the four physical assessment techniques.

    • Understand the physical exam sequence and how to perform vital signs.

  • Nursing Health History & Data Collection

    • Biographic data, allergies, home medications, medical/surgical history, family history, risk factors (alcohol, tobacco, substance use), social/psychological/lifestyle data.

    • Use of risk assessments and documentation tools.

    • Types of data: Subjective (symptoms) vs Objective (signs) and clinical manifestations.

  • Head-to-Toe Physical Examination

    • Types: Initial/Complete; Focused/problem-focused; Emergency.

    • Techniques: Inspection, Auscultation, Palpation, Percussion.

    • Focus areas by systems: General survey, mental status, HEENT, cardiovascular, respiratory, GI/GU, integumentary, musculoskeletal, neurologic.

  • Exam Techniques & Sequence

    • Inspection → Auscultation → Palpation → Percussion (order to minimize disruption in some systems).

    • Focused assessment by system; assess orientation (A&O x4), LOC, GCS, PERRL, CMS, circulation, motor, sensory.

  • Vital Signs & Related Measures

    • Vital signs: TT, PP (pulse), RR (respirations), BPBP, PainPain, SpO2SpO_2.

    • Temperature: Hyperthermia vs. Hypothermia; factors: age, circadian rhythm, activity, hormones, environment.

    • Pulse: bpm; tachycardia/bradycardia; avoid compressing both carotids simultaneously.

    • Respirations: rate/depth; tachypnea/bradypnea; assess effort and pattern.

    • Blood Pressure: systolic/diastolic; hypertension/hypotension.

    • Orthostatic vitals: Supine → Sit → Stand; 3 minutes apart; declines of extSBP≥20 mmHgext{SBP} \geq 20 \,mmHg or extDBP≤−10 mmHgext{DBP} \leq -10 \,mmHg indicate orthostatic hypotension; HR increase ≥30\geq 30 bpm suggests hypovolemia.

    • MEWS (Modified Early Warning System): factors include RRRR, HRHR, SBPSBP, conscious level, and TemperatureTemperature to prompt escalation.

  • Pain as the 5th Vital Sign

    • Pain assessment tools: Visual Analog Scale, Wong-Baker Faces, Numeric Rating Scale (0-10).

    • OLD CART: Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Treatments.

    • Pain mechanisms: nociception (transduction, transmission, perception, modulation).

    • Pain classifications: nociceptive (somatic/visceral) and neuropathic; acute vs chronic.

    • Pain management: Pharmacological (Nonopioids/NSAIDs, Acetaminophen, Opioids, Adjuvants) and Nonpharmacological (heat/cold, massage, TENS, distraction, relaxation, imagery).

    • Barriers to pain management: tolerance, physical dependence, addiction; around-the-clock vs PRN dosing; need for reassessment and documentation.

  • Pain Assessment & Documentation

    • Documentation and regular reassessment are essential; use multidimensional tools.

  • Non-Pharmacologic Pain Management

    • Cutaneous stimulation, massage, heat/cold, acupressure, immobilization, distraction, relaxation, imagery, TENS.

  • Pharmacologic Pain Management

    • NSAIDs and nonopioids (e.g., Acetaminophen); Opioids (full/mixed/partial agonists) with ceiling effects and side effects.

    • Adjuvants (corticosteroids, antidepressants, antiseizure drugs, GABA agonists).

  • Pain Reassessment & Documentation

    • Reassess after interventions and document outcomes.

Unit 3: Nursing Process & Critical Thinking

  • Objectives

    • Identify steps of the nursing process and apply to patient care.

    • Distinguish subjective vs objective data; use data to describe problems.

    • Apply nursing process to patient records; understand NANDA diagnoses.

    • Explain critical thinking and its importance in nursing.

  • Critical Thinking in Nursing

    • Definition: directed, purposeful analysis; results in reasoned decisions.

    • Skills: ask questions, assess arguments, admit gaps, curiosity, open mind, seek evidence, lifelong self-assessment, adjust beliefs, read for evidence, problem-solve.

  • The Nursing Process (ADPIE)

    • Phases: Assessment, Diagnosis, Planning, Implementation, Evaluation.

    • Relationship to problem solving: systematic, evidence-based, cognitive and psychomotor skills.

  • Data & Diagnoses

    • Subjective vs Objective data; NANDA diagnoses are clinical judgements about responses to health problems.

    • Distinguish Nursing vs Medical diagnoses.

    • Use Maslow’s hierarchy to prioritize physiological needs before higher-level needs.

  • Planning & SMART Goals

    • Goals should be Specific, Measurable, Attainable, Relevant, Time-based (SMART).

  • Implementation & Interventions

    • Independent (nurse-initiated), Dependent (physician-initiated), Interdependent (collaborative).

  • Delegation & Supervision

    • Prioritization; delegate to LPN/UAP as appropriate; student nurses should discuss delegation with instructor before acting.

  • Nursing Care Plans

    • 5 steps: Assessment, Diagnosis, Planning, Implementation, Evaluation.

    • Documentation via SBAR for day-to-day communication.

  • Evaluation & Reflective Practice

    • Reassess outcomes; modify plan as needed; reflect on care for continuous improvement.

  • Evidence-Based Practice & Professional Accountability

    • Ground care in evidence; continuous learning; accountability and responsibility in practice.

  • Quick Reference: Nursing Process Steps (Overview)

    • Step 1: Assessment – gather, validate, organize data.

    • Step 2: Nursing Diagnosis – clinical judgement about health problems.

    • Step 3: Planning – set patient-centered, evidence-based goals.

    • Step 4: Implementation – perform interventions; document.

    • Step 5: Evaluation – determine outcomes and modify plan if needed.