2026 Nursing Blueprint Quick-Review: Comprehensive Study Notes
Basics of Spirituality and Religion
Spirituality is a broad concept involving meaning, purpose, hope, and a sense of connection. It encompasses personal values, nature, relationships, and the search for or relationship with a higher power. Religion is more specific, often involving organized beliefs, rituals, and practices, alongside dietary rules and participation in a formal faith community. A client may identify as spiritual without belonging to a formal religious group, or conversely, may identify with a religion without adhering to every tradition associated with it.
Communication regarding spirituality should utilize open-ended questions. Potential inquiries include: “What gives you meaning or hope?” “Are there beliefs or practices that are important to your care?” and “How can we support you?” It is essential to never impose personal beliefs, engage in theological debates, or assume specific practices based solely on a religious label.
Assessment for spiritual distress is a critical nursing function. Signs of spiritual distress include hopelessness, guilt, anger, a loss of meaning, and isolation. If a client makes statements suggesting self-harm, direct assessment regarding safety is required.
Specific Religious Considerations
Judaism: Some clients may follow kosher dietary practices. This can involve the consumption of permitted foods and the strict separation of meat and dairy products, as well as specific food preparation methods. Inquire about specific dietary requirements, Sabbath observance, and prayer needs.
Islam: Clients may follow halal dietary practices, which include avoiding pork and alcohol. During the month of Ramadan, fasting is practiced from dawn to sunset. It is necessary to ask how fasting affects medications, nutrition, hydration, and medical treatments.
Hinduism: Dietary practices vary significantly among individuals. Many clients are vegetarian and may avoid beef, but others follow different practices. Always ask about individual food preferences and relevant treatment considerations.
Buddhism: Practice styles vary. Some clients prefer vegetarian foods, meditation sessions, or periods of silence. However, these preferences should not be assumed without confirmation.
Jehovah’s Witnesses: Some clients in this faith tradition decline blood transfusions and blood products. It is vital to clarify the client’s specific wishes, check for advance directives, identify acceptable medical alternatives, and involve the healthcare provider promptly.
Christian denominations and other faiths: Elements such as prayer, communion, fasting, modesty, dietary choices, or visits from clergy may be of importance. Avoid generalizations and ask the client directly about their needs.
Self-Concept and Therapeutic Interaction
Self-concept refers to an individual's overall perception of themselves. Self-esteem is defined as the perceived personal worth of the individual. Body image is the perception of one's own body and physical appearance.
To address self-concept, follow the CHOICE acronym: Client makes choices, Highlight strengths, Offer realistic goals, Involve the client, Communicate without judgment, and Encourage independence. For individuals with low self-esteem, nurses should help them identify personal strengths and set small, measurable, and achievable goals. Encouraging participation in care decisions and allowing the client to complete safe tasks independently supports self-worth.
Therapeutic communication is essential; for example, saying, ‐Tell me more about what concerns you.” Avoid negative behaviors such as false reassurance, judgment, excessive praise, taking over tasks unnecessarily, or promising a return to a “normal” state. Statements like ‐I am worthless” or ‐There is no reason to continue” require an immediate assessment for depression and self-harm risk.
Role-related issues can affect self-concept, including role overload (having too many responsibilities), role ambiguity (having unclear expectations), and role conflict (facing incompatible demands within roles).
Nutritional Guidelines and Special Diets
Clear-liquid diet: Consists of transparent liquids such as water, clear broth, gelatin, and clear juices. This diet does not provide complete nutrition and is not for long-term use.
Full-liquid diet: Includes milk, yogurt without pieces, pudding, custard, strained cream soup, gelatin, and nutritional supplements. No solid foods are permitted unless specifically ordered.
Dysphagia diet: Requires adherence to prescribed food textures and liquid consistencies. Do not automatically provide thin liquids to these clients.
Vegetarian variations include:
- Vegan: No animal products consumed.
- Lacto-vegetarian: Includes dairy.
- Ovo-vegetarian: Includes eggs.
- Lacto-ovo vegetarian: Includes both dairy and eggs.
During gastroenteritis, encourage small and frequent sips of fluid as tolerated. Monitor for hydration status, urine output, electrolyte levels, fever, presence of blood, and severe pain. For iron deficiency, consider causes such as blood loss, malabsorption, inadequate intake, increased physiological needs, or chronic disease. Note that Vitamin C improves the absorption of nonheme iron.
Macronutrients and Nutritional Needs
Carbohydrates provide approximately and should generally comprise of daily caloric intake. Emphasis should be placed on whole grains, vegetables, fruits, and legumes.
Protein provides approximately , supporting tissue repair, immune function, enzymes, and fluid balance.
Fat provides approximately , serving as a concentrated energy source and supporting the absorption of fat-soluble vitamins , , , and .
Vitamin K is found in leafy greens like kale, spinach, and collard greens. Clients taking warfarin must maintain a consistent intake of Vitamin K and discuss any major changes with their prescriber. Iron-rich foods include meat, beans, lentils, fortified cereals, tofu, and dark leafy greens. Note that tea and coffee may reduce the absorption of nonheme iron when consumed during meals.
Healthy lifestyle choices involve balanced nutrition, regular movement, adequate sleep, preventive care, stress management, and correct medication adherence.
Tube Feedings and TPN
Before initiating enteral feeding, verify tube placement according to facility policy. Radiography is the standard for confirming the initial placement of a newly inserted tube. During feeding and for a period afterward, keep the head of the bed (HOB) elevated to at least .
Monitor for signs of aspiration, including coughing, choking, wet voice, dyspnea, cyanosis, decreased oxygen saturation, or abnormal lung sounds. If aspiration is suspected: stop the feeding immediately, position the client upright, assess the airway and breathing, and notify the provider or the rapid-response team.
Enteral tubes should be flushed as prescribed, typically before and after feedings or medication administration. Assess for nausea, vomiting, diarrhea, constipation, distention, or tube displacement.
Total Parenteral Nutrition (TPN) must be administered through the prescribed central or peripheral access using an infusion pump. Monitor the client for glucose levels, electrolyte balance, fluid balance, infection, and the insertion site. High-concentration TPN should not be stopped abruptly to avoid hypoglycemia. Use aseptic technique for all tubing and dressing care. Report signs of infection such as fever, redness, or drainage.
GI Elimination and Stool Assessment
A positive occult blood test indicates the presence of blood in the stool but does not identify the source. Melena refers to black, tarry, and sticky stools, which may indicate upper GI bleeding. Red stool may reflect lower GI bleeding or the ingestion of certain foods like beets; all such findings must be assessed.
Assess for signs of hemodynamic instability: weakness, dizziness, pallor, tachycardia, hypotension, and abdominal pain. Check for the use of anticoagulants or NSAIDs. Melena accompanied by epigastric pain or instability requires prompt notification of the provider. When collecting specimens, avoid contamination with urine, water, or cleaning products.
Bedpans, Enemas, and Bowel Management
Proper enema and bedpan procedures include providing privacy, hand hygiene, and the use of gloves. For enemas, the left lateral or Sims’ position is commonly used. If a client cannot retain the solution, assess their tolerance and consider the use of a bedside commode. Administer solutions slowly; stop or slow the flow if the client experiences severe cramping, pain, resistance, dizziness, or intolerance. Never force the tubing.
Constipation interventions include fluid intake, gradual fiber increase, movement, and regular toileting schedules. Factors contributing to constipation include medications (opioids, anticholinergics, iron), immobility, and low fiber/fluid intake. Daily laxatives should not be recommended without evaluating the underlying cause.
For diarrhea, use the DIARRHEA acronym for assessment: Duration/description, Intake and output, Antibiotics/exposures, Recent travel or contacts, Red flags, Hydration, Electrolytes, and Associated symptoms. Report red flags such as blood, black stool, severe pain, high fever, software hypotension, and reduced urine output.
Ostomy Care and Procedures
A healthy stoma appears red or pink, moist, and shiny. Abnormal colors such as dusky purple, gray, brown, or black may indicate impaired perfusion. Ileostomy output is typically liquid. High output levels increase risks for dehydration and electrolyte imbalance.
Empty ostomy pouches when they are - full. Peristomal skin should be cleaned and dried gently. The appliance opening must fit closely around the stoma without constricting it. Report sudden absence of output, excessive output, skin breakdown, or abnormal stoma color. Use the memory aid RED–WET–EMPTY (red/pink color, wet/moist texture, empty before too full).
Upper GI Endoscopy requires NPO status for - hours before the procedure. Verify consent and medication history (especially anticoagulants). Post-procedure, assess the gag reflex and airway protection before allowing oral intake. Monitor for complications like severe pain, fever, or bleeding. Use the memory aid NPO–GAG–WATCH.
Postoperative GI Concerns
Postoperative ileus is suggested by abdominal distention, decreased or absent bowel sounds, nausea, vomiting, and delayed flatus or stool. A rigid abdomen, fever, tachycardia, or hypotension requires prompt follow-up. Abdominal assessment follows a specific order: inspect, auscultate, percuss, and palpate. Do not assume abdominal pain is expected. Use the memory aid LOOK–LISTEN–FEEL–ACT.
Genitourinary (GU) Elimination and Infections
Signs of GU infection include dysuria, frequency, urgency, suprapubic discomfort, cloudy/foul-smelling urine, fever, chills, flank pain, and confusion. Fever with flank pain may indicate an upper urinary tract infection. Collect urine specimens before starting antibiotics. Encourage fluids unless contraindicated.
Catheter-associated urinary tract infection (CAUTI) prevention involves hand hygiene, maintaining a closed system, ensuring unobstructed flow, and prompt removal of the catheter.
Benign Prostatic Hyperplasia (BPH) symptoms include urinary hesitancy, a weak or intermittent stream, frequency, urgency, nocturia, dribbling, and incomplete voiding. BPH can lead to urinary retention. Assess for bladder distention and inquire about OTC medications like decongestants or anticholinergics, which can worsen symptoms. Monitor for orthostatic hypotension as a side effect of BPH medications.
Retention, Incontinence, and Catheter Care
Definitions:
- Frequency: Voiding more often than usual.
- Urgency: A sudden, difficult-to-delay need to void.
- Hesitancy: Difficulty starting the urine stream.
- Retention: Incomplete emptying of the bladder.
- Incontinence: Involuntary leakage of urine.
- Stress incontinence: Leakage during coughing, sneezing, or lifting.
- Anuria: Little to no urine production.
- Diuresis: Increased urine production.
A firm, distended bladder suggests retention. Management includes scheduled toileting, pelvic-floor exercises, and bladder scans. Do not restrict fluids solely to manage incontinence unless prescribed. Caffeine may contribute to frequency.
If no urine is in a catheter bag, check for kinks, dependent loops, or obstruction. The drainage bag must stay below the level of the bladder and off the floor. Perform perineal care with soap and water. When inserting a catheter, maintain strict sterile technique. Document the procedure, secure the catheter to prevent traction, and empty the bag using clean technique.
Sensory Alterations and Safety
Sensory impairment can involve vision, hearing, touch, taste, or smell. When interacting with vision-impaired clients, identify yourself before touching them and describe the environment specifically. Use the clock method to describe food locations on a plate. When speaking to hearing-impaired clients, face them directly, speak clearly at a normal volume (do not shout), and provide written information.
Safety for vision impairment includes clear pathways, improved lighting, and handrails. For diabetic neuropathy, clients must inspect their feet daily and avoid walking barefoot. For sensory overload—presenting as anxiety, irritability, or restlessness—reduce noise and limit interruptions.
For dysphagia with sensory impairment, monitor for coughing, pocketing, or choking. If aspiration is suspected, stop feeding and assess the airway.
Dosage Calculations
Calculate intake by summing all oral fluids, IV fluids, enteral formulas, medication liquids, and tube flushes.
Standard Conversions:
Formulas:
- Net fluid balance =
- Dose to administer =
- Number of tablets =
- Infusion rate () =
Rounding and Documentation Rules:
- Leading zero: Use , never .
- Trailing zero: Use , never .
- Rounding: Round final answers only. Nearest tenth means one digit after the decimal; nearest whole number means no decimals.
Final Test-Day Reminders
Prioritization should follow the sequence of Airway, Breathing, Circulation (ABC), safety, acute changes, and actual problems. When answering ‐Select All That Apply” (SATA), evaluate options independently. Matrix questions require classifying each row separately, and Bowtie questions focus on identifying the condition, priority actions, and outcomes.
Final memory aid: ASK–ASSESS–ACT–REASSESS.