Fundamentals of Nursing OLD

Fundamentals of Nursing OLD

Workbook

Workbook

In this comprehensive course, we delve into the intricacies of the NCLEX, offering a thorough exploration of each educational component essential for success. Our unique approach integrates asynchronous workbooks and classes, filled with detailed information on every aspect of the NCLEX exam.

Workbook
Workbook

Welcome to our classes, meticulously tailored to align with the Next Generation NCLEX standards. In these interactive classes, we employ the dynamic Computer Adaptive Testing (CAT) system, mirroring the actual exam environment to enhance your readiness.

📝

Study Notes

Please review these notes. They are designed to help you approach the material strategically and stay focused.

  • 1
    Read actively — highlight, annotate, or take notes as you go.
  • 2
    Identify key nursing principles — focus on safety priorities and procedures.
  • 3
    Connect theory to practice — imagine real clinical applications.
  • 4
    Study in focused sessions — 25–30 minutes, then a short break.
  • 5
    Summarize in your own words — write a short recap in your study notebook.
Vital Signs

Vital Signs

Heart Rate (HR)

  • Normal Range: 60-100 bpm.
  • Tachycardia: >100 bpm. May indicate fever, dehydration, or cardiac conditions.
  • Bradycardia: <60 bpm. Can occur in athletes or as a result of heart conditions or medications.

Blood Pressure (BP)

  • Normal Range: 120/80 mmHg.
  • Hypertension: >140/90 mmHg. Associated with risks of stroke, heart disease, and kidney issues.
  • Hypotension: <90/60 mmHg. May cause dizziness, fainting, or shock.

Respiratory Rate (RR)

  • Normal Range: 12-20 breaths per minute.
  • Tachypnea: >20 breaths/min. May indicate respiratory distress, fever, or metabolic acidosis.
  • Bradypnea: <12 breaths/min. Can result from opioids, brain injury, or metabolic conditions.

Temperature

  • Normal Range: 36.5°C – 37.5°C (97.7°F – 99.5°F).
  • Fever (Hyperthermia): >38.0°C (100.4°F). Commonly caused by infection or inflammation.
  • Hypothermia: <35.0°C (95°F). Results from prolonged cold exposure or medical conditions.

Oxygen Saturation (SpO2)

  • Normal Range: 95%-100%.
  • Hypoxemia: <90%. Indicates insufficient oxygen levels in the blood, often requiring supplemental oxygen.
Pain Assessment

Pain Assessment

PQRST Acronym

  • Provocation/Palliation:
    • What makes your pain better or worse?
    • Factors that provoke or relieve the pain.
  • Quality:
    • How would you describe your pain?
    • Is it sharp, burning, or throbbing?
  • Region/Radiation:
    • Where does it hurt?
    • Does it spread to another area?
  • Severity:
    • On a scale of 1 to 10, how would you rate your pain?
  • Timing:
    • When did the pain start?
    • Is it constant or intermittent?

Types of Pain Scales

  • Numeric Rating Scale (NRS):
    • Patients rate their pain on a scale from 0 (no pain) to 10 (worst pain imaginable).
  • Wong-Baker Faces:
    • A visual scale with faces ranging from a happy face (no pain) to a crying face (worst pain).
  • Visual Analog Scale (VAS):
    • A horizontal line where patients mark their pain intensity, from “No Pain” to “Worst Pain.”
  • FLACC Scale:
    • Behavioral assessment tool for non-verbal patients.
    • Observes Face, Legs, Activity, Cry, and Consolability.

Types of Pain

  • Acute Pain:
    • Sudden onset, usually associated with injury or surgery.
    • Resolves as the underlying cause heals.
  • Chronic Pain:
    • Persistent pain lasting longer than 3-6 months.
    • Often associated with conditions like arthritis or neuropathy.
  • Nociceptive Pain:
    • Caused by tissue damage or inflammation.
    • Includes somatic pain (localized) and visceral pain (organ-related).
  • Neuropathic Pain:
    • Caused by damage or dysfunction in the nervous system.
    • Often described as burning, shooting, or tingling pain.
  • Referred Pain:
    • Pain perceived in an area distant from its source.
    • Example: Shoulder pain from a heart attack.
  • Breakthrough Pain:
    • A sudden, temporary flare-up of pain.
    • Occurs despite ongoing pain management.

Numeric Rating Scale (NRS) (Example)

Types of IV Fluids

Types of IV Fluids

Hypertonic

  • Examples:
    • 5% Saline
    • 3% Saline
    • 5% Dextrose in 0.9% Saline (D5NS)
    • 5% Dextrose in 0.45% Saline (D5 ½ NS)
    • 5% Dextrose in LR (D5LR)
    • 10% Dextrose in Water (D10W)
  • Used For:
    • Cerebral edema (increased ICP)
    • Hyponatremia (low sodium levels)
    • Metabolic alkalosis
  • Contraindications:
    • Do not administer to clients with heart failure or renal failure due to the risk of fluid overload.

Isotonic

  • Examples:
    • 0.9% Sodium Chloride (NS)
    • 5% Dextrose in Water (D5W)*
    • Lactated Ringers (LR)
  • Used For:
    • Hypovolemia
    • Blood loss (hemorrhage, burns, surgery)
    • Dehydration (vomiting, diarrhea)
  • Contraindications:
    • NS is the only solution compatible with blood products.
    • Use caution in heart failure or renal failure patients.

Hypotonic

  • Examples:
    • 0.45% Saline (1/2 NS)
    • 0.33% Saline (1/3 NS)
    • 0.225% Saline (1/4 NS)
    • 5% Dextrose in Water (D5W)*
  • Used For:
    • Helps kidneys excrete excess fluids
    • Hypernatremia (high sodium levels)
    • Diabetic ketoacidosis (DKA)
  • Contraindications:
    • Do not administer to clients with increased ICP, burns, or trauma.
    • *D5W starts as isotonic and becomes hypotonic when metabolized.

Blood Types

Understanding Blood Types

Components of Blood

  • Plasma: 55% of total blood, contains water, ions, proteins, nutrients, and waste products.
  • White Blood Cells & Platelets: Less than 1% of total blood, essential for immunity and clotting.
  • Red Blood Cells (Erythrocytes): 45% of total blood, responsible for oxygen transport.

Centrifuge

  • A centrifuge is used to separate blood components based on their density. This step is crucial in laboratories before blood typing and transfusions.

Blood Types

Antigens and Antibodies

  • Antigens: Proteins on the surface of red blood cells (RBCs) that determine blood type.
  • Plasma Antibodies: Protect the body from “invaders” and are the opposite of the antigens found on RBCs.

Blood Type Compatibility

  • Type A: Has A antigens and B antibodies. Can receive A and O blood.
  • Type B: Has B antigens and A antibodies. Can receive B and O blood.
  • Type AB: Universal recipient; has A and B antigens but no antibodies.
  • Type O: Universal donor; has no antigens but both A and B antibodies.

RH Factor

What is RH Factor?

  • RH Positive: Blood contains the Rh protein. Can receive both Rh+ and Rh- blood.
  • RH Negative: Blood lacks the Rh protein. Can only receive Rh- blood.

Key Points for Blood Transfusions

Important Reminders

  • Before a transfusion, blood must be sent to the lab for typing and cross-matching.
  • Receiving incompatible blood can lead to serious transfusion reactions or even death.
  • Always verify blood type compatibility before administration.
Blood Transfusion

Blood Transfusion

Facts About Blood Transfusions

  • Administered by the RN.
  • Only normal saline (NS) can be used in conjunction with blood.
  • Type & screen and a crossmatch are good for 72 hours.
  • Blood must be hung (started) within 30 minutes from the time the blood is picked up from the blood bank.
  • All blood must be transfused within 4 hours of the time it was hung (started).
  • Blood should not be left in the room for more than 30 minutes before a transfusion is started.

Transfusion Reaction Symptoms

  • Increased heart rate
  • Itching/hives/rash
  • Back pain
  • Flushing
  • Respiratory distress

Nursing Actions for a Reaction

  • Stop the transfusion immediately.
  • Change the IV tubing down to the IV site (keep the IV open with normal saline).
  • Administer prescribed medications (antihistamines, steroids, vasopressors).
  • Notify the HCP & blood bank.
  • Do not leave the client alone (monitor vital signs and assess continuously).

The first 15 minutes are the most critical: The RN must stay at the bedside.

Vital signs: Monitor every 30 minutes to 1 hour.

Blood Products and Infusion Times

  • Packed Red Blood Cells (PRBCs): Infuse over 2-4 hours.
  • Fresh Frozen Plasma (FFP): Administer over 60-75 minutes.
  • Platelets: Infuse over 15-30 minutes.
Infection Control

Infection Control

Personal Protective Equipment (PPE)

Donning (Putting On PPE)

  • Step 1: Perform hand hygiene before entering the client’s room.
  • Step 2: Put on the gown.
  • Step 3: Place the mask or respirator.
  • Step 4: Put on goggles or a face shield.
  • Step 5: Finally, put on gloves, ensuring they cover the wrist of the gown.

Doffing (Removing PPE)

  • Step 1: Remove gloves first.
  • Step 2: Remove protective eyewear.
  • Step 3: Remove the gown, rolling it inside out.
  • Step 4: Remove and discard the mask or respirator.
  • Step 5: Perform hand hygiene immediately after removing PPE.

Common Hospital-Associated Infections (HAIs)

  • CAUTI: Catheter-associated urinary tract infections.
  • SSI: Surgical site infections.
  • CLABSI: Central line-associated bloodstream infections.
  • VAP: Ventilator-associated pneumonia.
  • C. Diff: Clostridium difficile infections.
  • MRSA: Methicillin-resistant Staphylococcus aureus infections.

Key Points for Preventing HAIs

  • Practice meticulous hand hygiene at all times.
  • Use chlorhexidine washes as recommended.
  • Follow strict aseptic techniques during procedures.
  • Ensure proper cleaning and sterilization of equipment.
Transmission-Based Precautions

Transmission-Based Precautions

Standard or “Universal” Precautions

  • Description: General infection control to protect yourself and others from the spread of germs.
  • Equipment: Non-sterile gloves. If anticipating contact with body fluids, wear extra protection (goggles, mask, face shield, gown).
  • Used For: All patients.
  • Nursing Considerations:
    • Perform proper hand hygiene.
    • Use hand sanitizers on the way in and out of patient rooms.
    • Never use the same gloves/PPE for different patients.
Precautions

Contact Precautions

  • Description: Precautions taken to protect from infections mostly spread by touch.
  • Equipment:
    • Non-sterile gloves
    • Surgical gown
  • Used For:
    • Methicillin-resistant Staphylococcus aureus (MRSA)
    • C. Difficile
    • Drug-resistant organisms
  • Nursing Considerations:
    • Private room
    • Keep patient in room as much as possible
    • Visitors should avoid direct contact and wear gloves/gown
Droplet Precautions

Droplet Precautions

Droplet Precautions

  • Description: Precautions taken to prevent infection spread by sneezing, coughing, or talking (anything that can spread via droplets).
  • Equipment:
    • Surgical mask
  • Used For:
    • Adenovirus (pediatrics)
    • Pertussis (whooping cough)
    • Rubella
    • Diphtheria
    • Mumps
    • Bacterial Meningitis
  • Nursing Considerations:
    • Private room
    • Door can stay open
    • Patient must wear surgical mask outside of room (when going for imaging, procedure, etc.)
    • Visitors should stay 3 ft. away (droplets can travel!)
Airborne Precautions

Airborne Precautions

Airborne Precautions

  • Description: Precautions taken to protect against infections spread through particles which can stay in the air and travel.
  • Equipment:
    • Gown
    • Gloves
    • N95 respirator or respiratory hood
  • Used For:
    • Measles (Rubeola)
    • Tuberculosis
    • Varicella (chickenpox) & herpes zoster (shingles)
  • Nursing Considerations:
    • Private room with monitored negative air pressure & keep door closed
    • N95 respirator or respiratory hood (supplies air through a hose)
    • Patient must wear surgical mask outside of room (when going for imaging, procedure, etc.)
Neutropenic Precautions

Neutropenic Precautions

Neutropenic Precautions

  • Description: Precautions taken to protect immunocompromised patients with low neutrophil counts (neutropenia) from infections.
  • Equipment:
    • Gown
    • Gloves
    • Mask (for visitors and healthcare providers)
  • Used For:
    • Cancer patients undergoing chemotherapy
    • Bone marrow transplant recipients
    • Severe immune system suppression
  • Nursing Considerations:
    • Private room with HEPA filtration if available
    • Ensure strict hand hygiene before patient contact
    • Limit visitors to healthy individuals; no sick visitors allowed
    • Avoid fresh flowers, plants, or raw fruits and vegetables in the room
    • Patient must wear a mask when leaving the room for any reason
Diet Modifications

Diet Modifications

Constipation

  • Recommended: Increase fiber and fluids. Add fruits and vegetables to the diet.

Diarrhea

  • Recommended: Increase fiber and replace fluids and electrolytes to prevent dehydration.

Celiac Disease

  • Recommended: Follow a gluten-free diet. Avoid barley, rye, oats (unless certified gluten-free), and wheat (“NO BROW”).

Burns

  • Recommended: Increase protein and calories to support healing and tissue repair.

Acute Kidney Injury

  • Recommended: Protein-restricted diet with increased calories to minimize kidney strain.

COPD

  • Recommended: Small, frequent meals with increased calories and fat. Avoid large meals to reduce respiratory effort.

Pancreatitis

  • Recommended: Small, frequent meals with reduced fat to minimize pancreatic stimulation.

Vomiting or Diarrhea

  • Recommended: Replace fluids and electrolytes to prevent dehydration.

Gallbladder Issues (Cholecystitis)

  • Recommended: Low-fat diet to reduce gallbladder workload.

Underweight

  • Recommended: Increase protein, calories, and fat to promote weight gain.

Hyperlipidemia

  • Recommended: Follow a heart-healthy diet. Reduce saturated fats and increase intake of fruits, vegetables, and whole grains.

Hypertension

  • Recommended: DASH diet. Increase fruits, vegetables, and whole grains. Reduce sodium intake.

Cystic Fibrosis

  • Recommended: High-fat and high-sodium diet to meet metabolic demands.

Kidney Stones

  • Recommended: Increase fluid intake. Avoid foods high in oxalates (e.g., spinach, chocolate, nuts).

Heart Failure

  • Recommended: Fluid restriction. Follow a heart-healthy, low-sodium diet.

Sickle Cell Anemia

  • Recommended: Increase fluids to prevent dehydration. Ensure a balanced diet with sufficient calories and protein.

Clients with Ostomies

  • Recommended: Increase fluid intake. Avoid foods that cause gas or odors (e.g., onions, broccoli, spinach).

Gout

  • Recommended: Avoid purine-rich foods (e.g., seafood, shellfish, organ meats).

Cirrhosis

  • Recommended: Protein-restricted diet. Avoid alcohol and ensure adequate calorie intake.

Ulcerative Colitis

  • Recommended: Low-residue diet to minimize bowel irritation.
Acid-Base Balance

Acid-Base Balance

Key Normal Values

  • pH: 7.35 – 7.45
  • CO2: 35 – 45 mmHg
  • HCO3 (Bicarbonate): 22 – 26 mEq/L

Determining Acid-Base Imbalance

  • If pH < 7.35, the imbalance is acidotic.
  • If pH > 7.45, the imbalance is alkalotic.
  • To determine if it is metabolic or respiratory:
    • If pH and HCO3 move in the same direction, it is metabolic.
    • If they move in opposite directions, it is respiratory.

Examples

  • Example 1: pH 7.3 (Acidotic), HCO3 20 (Metabolic) → Metabolic Acidosis
  • Example 2: pH 7.58 (Alkalotic), HCO3 32 (Metabolic) → Metabolic Alkalosis
  • Example 3: pH 7.22 (Acidotic), HCO3 35 (Respiratory) → Respiratory Acidosis

As the pH Goes, So Goes My Patient

  • If pH is low:
    • Everything is low, except potassium → Hyperkalemia
    • Symptoms: Bradycardia, lethargy, hyporeflexia, constipation, bradypnea, low BP
  • If pH is high:
    • Everything is high, except potassium → Hypokalemia
    • Symptoms: Tachycardia, irritability, hyperreflexia, diarrhea, seizures

Alkalosis

  • pH > 7.45
  • Symptoms: Tachycardia, HTN, seizures, hyperreflexia (3+, 4+), diarrhea
  • Nursing Intervention: Suctioning for seizures

Acidosis

  • pH < 7.35
  • Symptoms: Bradycardia, lethargy, hyporeflexia, constipation, low BP
  • Nursing Intervention: Ventilate with Ambu bag (respiratory arrest)
  • Remember: “Kussmaul” is the only acid-base imbalance causing metabolic acidosis with Kussmaul respirations

Key Questions to Ask

  • Is it lung-related? If yes, it is respiratory.
  • Are they underventilating? Pick acidosis (pH < 7.35).
  • Are they overventilating? Pick alkalosis (pH > 7.45).
  • If not lung-related, it is metabolic:
    • Prolonged vomiting/suctioning: Alkalosis
    • Everything else: Metabolic Acidosis
Delegation

Delegation

5 Rights of Delegation

  • Right Task: Task is within the scope of practice for that particular individual.
  • Right Circumstance: Patient is stable, and the situation is appropriate.
  • Right Person: The person accepting the task is appropriate.
  • Right Directions & Communication: Provide clear instructions, communicate the time frame, task, and report expectations.
  • Right Supervision & Evaluation: The nurse oversees, follows up, and verifies documentation.

Scope of Practice

  • RN (Registered Nurse):
    • Unstable clients
    • Starting blood products
    • Sterile procedures
    • IVs & IV medications
    • Initial teaching, assessment, and planning
  • LPN/LVN (Licensed Practical/Vocational Nurse):
    • Stable clients
    • Monitoring RN’s findings and gathering data
    • Specific assessments
    • Reinforce teaching
    • Routine procedures (e.g., catheterization, ostomy care)
    • Tubes and enteral feedings
  • CNA or UAP (Unlicensed Assistive Personnel):
    • Routine, stable vital signs
    • ADLs (Activities of Daily Living): Feeding (without aspiration risk), positioning, ambulation, hygiene care
    • Documenting input/output (I&Os)
    • Transporting patients

Never Delegate

  • Initial Assessment: This must always be performed by an RN.
  • Planning of Care: Includes creating the nursing care plan.
  • Evaluation of Care: Includes determining if goals are met or if changes are needed in the care plan.
  • Teaching: Initial teaching or education that requires assessment of understanding.
  • Unstable Patients: Direct care for patients with unpredictable conditions.
Nursing Ethics & Law

Nursing Ethics & Law

Informed Consent

  • Description: A written legal document between the patient and the health care provider, leading to an agreement for treatment, surgery, or care.
  • When is it Needed?
    • Before non-emergent surgeries
    • Administration of blood products
    • Procedures requiring anesthesia, sedation, or radiation
    • Any invasive procedures
    • Procedures that pose risk to the patient
  • Provider’s Role:
    • Explain all components of the procedure (benefits, risks, complications, and recovery)
    • Answer all patient questions before the consent is signed
  • Nurse’s Role:
    • Be present during the patient’s signature
    • Act as a witness
    • Clarify what the provider said
    • Document and upload the signed consent

Advance Directives

  • Description: Documents that give direction in advance about personal medical care wishes when the patient is unable to make those decisions.
  • Types of Advance Directives:
    • Living Will: Exact directions for care if the patient is unable to make choices.
    • Durable Power of Attorney (DPOA): A trusted person makes medical decisions for the patient if they are incapacitated.
  • Components:
    • Resuscitation status (DNR, full code)
    • Intubation
    • Life-saving measures
    • Comfort-focused care
    • Treatment & hospitalizations
    • Delegation of medical decisions
  • Nursing Considerations:
    • Discuss advance directives during patient admission
    • If a directive exists, ensure it is on file and signed
    • Advise on code status and patient wishes
Population Groups

Population Groups and Cultural Considerations

Health Care Disparities

Health care disparities refer to differences in health care access and outcomes experienced by certain population groups. Vulnerable groups often face higher risks, limited access to care, and increased morbidity and mortality compared to the general population.

  • Vulnerable Groups: Minority groups, uninsured individuals, those living in poverty or homelessness, people with chronic health problems and disabilities, immigrants, refugees, individuals with limited English proficiency, incarcerated individuals, and members of the LGBTQIA community.
  • These groups require focused nursing care to address their unique needs and reduce disparities.

Cultural Considerations

Orthodox Jewish Clients

  • May follow a kosher diet: No shellfish, no pork, and no mixing of meat and dairy.
  • Require wrapped utensils that they may unwrap themselves.

Islamic Clients

  • Follow halal dietary rules: No alcohol, no pork, and meat prepared according to religious guidelines.
  • Observe Ramadan: Fast during daylight hours.
  • Pray five times a day and may interpret illness as the will of Allah.
  • May require a female provider for women and prefer alternative therapies.

Jehovah’s Witness Clients

  • May refuse blood products due to religious beliefs.

Seventh-Day Adventist Clients

  • Typically lacto-ovo vegetarians (consume dairy and eggs but no meat).
  • Avoid pork, alcohol, and caffeine.

Asian American Clients

  • May prefer stoicism when in pain and involve extended family in care decisions.
  • May value physical distance from healthcare providers and avoid prolonged eye contact.

Latino American Clients

  • View illness as a sign of weakness or punishment.
  • Extended family often participates in decision-making and may wish to be present at the hospital.

Chinese Clients

  • Often avoid discussing death, as it is viewed as hopeless.
  • May prefer alternative therapies or herbal remedies.

End-of-Life and Postmortem Care

  • End-of-Life Care: Respect cultural preferences for death rituals and practices. For example, Muslims may want the body prepared by washing and wrapping it in white cloth, while others may have specific family traditions.
  • Postmortem Care: Conducted with respect and dignity, accommodating religious and cultural rituals whenever possible.

Now that you have explored the fundamentals of this lesson, it’s time to test your understanding. Practice with questions specifically designed to reinforce your knowledge and prepare you for real-world scenarios. Remember, practice makes perfect!