Basics of fundamental of nursing

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The medical library does not contain a dedicated nursing textbook. I'll answer comprehensively from established nursing knowledge.

Fundamentals of Nursing - Complete Overview

Fundamentals of nursing is the foundation of all nursing practice. It covers the core concepts, theories, processes, and skills every nurse must master before specializing. Here is a structured breakdown of all major topics:

1. Definition & Philosophy of Nursing

Nursing is a profession focused on the care of individuals, families, and communities to attain, maintain, or recover optimal health and quality of life.

The ICN (International Council of Nurses) definition: "Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well, and in all settings."

Key components of nursing:

Caring - the core of nursing practice
Health promotion and disease prevention
Curative, rehabilitative, and palliative care
Advocacy for patients

2. Major Nursing Theories

Theorist	Theory	Core Concept
Florence Nightingale	Environmental Theory	Environment affects health; cleanliness and fresh air promote healing
Virginia Henderson	Need Theory	14 basic needs of the patient
Dorothea Orem	Self-Care Deficit Theory	Patients can care for themselves; nursing helps when they cannot
Callista Roy	Adaptation Model	Patient adapts to environment through 4 modes
Jean Watson	Theory of Human Caring	Caring is the essence of nursing
Hildegard Peplau	Interpersonal Relations Theory	Nurse-patient relationship is therapeutic
Martha Rogers	Science of Unitary Human Beings	Humans are energy fields in constant interaction with environment
Betty Neuman	Systems Model	Stress and reactions to stress

3. The Nursing Process (ADPIE)

The nursing process is a systematic, problem-solving approach to patient care. It has 5 steps:

A - Assessment

Collect subjective data (what the patient tells you) and objective data (what you observe/measure)
Sources: patient interview, physical examination, medical records, family
Types: Initial, Focused, Emergency, Time-lapsed

D - Diagnosis (Nursing Diagnosis)

NANDA (North American Nursing Diagnosis Association) format
Three-part statement: Problem + Etiology + Signs/Symptoms (PES format)
Example: Impaired gas exchange related to bronchospasm as evidenced by dyspnea and O2 sat 88%
Types: Actual, Risk, Health Promotion, Syndrome

P - Planning

Setting goals/outcomes (short-term and long-term)
SMART goals: Specific, Measurable, Attainable, Realistic, Time-bound
Prioritize using Maslow's Hierarchy of Needs (physiological needs first)
Care planning: individualized, holistic

I - Implementation

Carrying out the nursing interventions
Types: Independent (nurse-initiated), Dependent (physician-ordered), Collaborative (interdisciplinary)
Documentation of all actions

E - Evaluation

Assess whether goals/outcomes were met
Fully met, partially met, or not met
Revise care plan as needed

4. Maslow's Hierarchy of Needs (in Nursing Context)

Used to prioritize nursing care from most basic to highest:

Physiological - airway, breathing, circulation, food, water, shelter, sleep (HIGHEST PRIORITY)
Safety & Security - physical safety, psychological security
Love & Belonging - social relationships, sense of belonging
Esteem - self-esteem, recognition
Self-Actualization - achieving full potential (LOWEST PRIORITY in acute care)

5. Communication in Nursing

Types

Verbal - spoken/written words
Non-verbal - body language, facial expressions, touch, eye contact, posture
Therapeutic communication - purposeful, goal-directed communication

Therapeutic Communication Techniques

Active listening
Open-ended questions ("Tell me about your pain...")
Restating and paraphrasing
Clarifying
Focusing
Reflecting
Silence (giving time to think)
Summarizing

Barriers to Communication

Language differences
Noise/environment
Physical disability (hearing, vision)
Emotional state (anxiety, pain)
Cultural differences

6. Vital Signs

The "cardinal signs" of health status:

Vital Sign	Normal Adult Range	Key Notes
Temperature	36.5-37.5°C (97.7-99.5°F)	Oral most common; rectal most accurate
Pulse	60-100 bpm	Radial artery is most common site
Respiration	12-20 breaths/min	Count for full 60 seconds
Blood Pressure	120/80 mmHg (normal)	Korotkoff sounds; auscultatory method
Oxygen Saturation	95-100%	Pulse oximetry (SpO2)
Pain	0-10 scale	Called the "5th vital sign"

Terminology:

Tachycardia: HR > 100 bpm | Bradycardia: HR < 60 bpm
Tachypnea: RR > 20 | Bradypnea: RR < 12 | Apnea: no breathing
Hypertension: BP > 140/90 | Hypotension: BP < 90/60
Pyrexia/Fever: Temp > 37.5°C | Hypothermia: Temp < 36°C

7. Basic Nursing Skills & Procedures

Infection Control

Medical asepsis (clean technique) - reduces number of microorganisms
Surgical asepsis (sterile technique) - eliminates all microorganisms
Hand hygiene - single most effective measure to prevent HAIs
Standard Precautions - applied to ALL patients regardless of diagnosis
PPE: gloves, gown, mask, goggles/face shield
Transmission-based precautions: Contact, Droplet, Airborne

Wound Care

Types: incision, laceration, abrasion, pressure ulcer, surgical wound
Pressure Ulcer Staging (NPUAP):
- Stage I: Non-blanchable redness, skin intact
- Stage II: Partial thickness skin loss
- Stage III: Full thickness skin loss
- Stage IV: Full thickness tissue loss (bone/tendon visible)
- Unstageable: Obscured by slough/eschar
Wound healing: Primary, Secondary, Tertiary intention
Dressing types: dry, moist, occlusive

Medication Administration - The "10 Rights"

Right Patient
Right Drug
Right Dose
Right Route
Right Time
Right Documentation
Right Reason
Right Response
Right to Refuse
Right Education

Routes of administration: Oral (PO), Sublingual (SL), Intravenous (IV), Intramuscular (IM), Subcutaneous (SC), Intradermal (ID), Transdermal, Inhalation, Topical, Rectal

IV Therapy & Fluids

Isotonic solutions (same osmolality as blood): 0.9% NaCl, Lactated Ringer's, D5W
Hypotonic: 0.45% NaCl - moves fluid into cells
Hypertonic: 3% NaCl, D10W - pulls fluid out of cells

Catheter Care (Urinary)

Indwelling (Foley) catheter - remains in bladder
Intermittent catheter - inserted and removed
Suprapubic catheter - inserted through abdominal wall
Catheter-associated UTI (CAUTI) prevention: strict asepsis, maintain closed system, daily perineal care

8. Patient Safety

Safety Concepts

Never Events (serious preventable adverse events): wrong-site surgery, patient falls with injury, medication errors, pressure ulcers
The Joint Commission's National Patient Safety Goals (NPSGs):
- Identify patients correctly (2 identifiers)
- Improve staff communication
- Use medications safely
- Prevent infection
- Prevent patient falls
- Identify patient safety risks

Fall Prevention

Fall risk assessment tools: Morse Fall Scale, Hendrich II
Interventions: bed alarms, non-slip footwear, call bell within reach, bed in lowest position, adequate lighting

Restraints

Physical/chemical restraints: last resort
Require physician order, patient consent, regular monitoring
Check every 2 hours: circulation, skin integrity, positioning

9. Patient Positioning

Position	Description	Uses
Supine	Flat on back	Post-op, spinal anesthesia
Prone	Lying face down	ARDS, pressure relief
Lateral	Side-lying	Unconscious patient, prevents aspiration
Sim's	Semi-prone	Enema, rectal exam
Fowler's	Head elevated 45-60°	Respiratory distress, feeding
Semi-Fowler's	Head elevated 30-45°	Post-op, tube feeding
High Fowler's	90° sitting	Severe dyspnea
Trendelenburg	Head lower, legs elevated	Shock (controversial)
Reverse Trendelenburg	Head up, feet down	Reflux, head/neck surgery
Lithotomy	Supine with legs in stirrups	Gynecological exams, delivery

10. Elimination (Urinary & Bowel)

Urinary

Normal urine output: 30 mL/hour minimum (0.5 mL/kg/hr)
Normal daily urine: 1,000-2,000 mL
Oliguria: < 400 mL/day | Anuria: < 100 mL/day | Polyuria: > 2,500 mL/day

Bowel

Normal bowel movement: 3/day to 3/week
Constipation: hard, dry, infrequent stools
Diarrhea: frequent, loose/watery stools
Flatulence, Impaction, Incontinence
Ostomy types: Colostomy, Ileostomy, Urostomy

11. Nutrition & Hydration

BMI: 18.5-24.9 (normal); < 18.5 (underweight); 25-29.9 (overweight); ≥ 30 (obese)
Enteral nutrition - through GI tract (NG tube, PEG tube)
Parenteral nutrition - IV route (TPN - total parenteral nutrition)
Daily fluid requirement: approximately 30-35 mL/kg/day
Signs of dehydration: dry mucous membranes, decreased skin turgor, concentrated urine, tachycardia
Signs of fluid overload: edema, crackles in lungs, weight gain, JVD

12. Pain Management

Types of Pain

Acute: sudden onset, short duration, protective purpose
Chronic: > 3-6 months duration
Nociceptive: from tissue damage (somatic/visceral)
Neuropathic: from nerve damage
Referred pain: felt at a site different from origin (e.g., MI felt in left arm)

Pain Assessment Tools

NRS (Numerical Rating Scale): 0-10
VAS (Visual Analogue Scale)
Wong-Baker FACES Scale: for children/non-verbal
FLACC Scale: for infants/pre-verbal (Face, Legs, Activity, Cry, Consolability)
PAINAD: for dementia patients

WHO Analgesic Ladder

Step 1 (mild pain): Non-opioid - NSAIDs, Paracetamol
Step 2 (moderate pain): Weak opioid - Codeine, Tramadol
Step 3 (severe pain): Strong opioid - Morphine, Fentanyl

13. Documentation & Legal/Ethical Aspects

Documentation Principles (CHARTED/SOAPIE)

Accurate, complete, timely, legible, confidential
SOAP format: Subjective, Objective, Assessment, Plan
Incident reports for adverse events (not part of medical record)

Legal Concepts

Malpractice: negligent act by a professional
Negligence: failure to meet standard of care
Informed Consent: patient must be informed, competent, and voluntary
Confidentiality/HIPAA - protect patient privacy
Advance directives: Living will, Healthcare proxy/Power of Attorney

Ethical Principles in Nursing (BENEFAN)

Beneficence: do good
Non-maleficence: do no harm
Autonomy: patient's right to make decisions
Justice: fair treatment
Fidelity: keep promises
Veracity: truthfulness

14. Health Promotion & Disease Prevention

Levels of Prevention

Level	Focus	Examples
Primary	Prevent disease before it occurs	Immunization, health education, diet counseling
Secondary	Early detection and treatment	Screening (mammography, Pap smear, BP checks)
Tertiary	Minimize disability from existing disease	Rehabilitation, chronic disease management

15. Perioperative Nursing

Three Phases

Preoperative: patient preparation, consent, NPO status, teaching, pre-op checklist
Intraoperative: positioning, sterile technique, surgical team support
Postoperative: recovery room care, PACU monitoring, discharge planning

Post-op Assessment (ABC + DEF)

Airway, Breathing, Circulation
Dressings, Elimination, Fluid balance

Aldrete Score (post-anesthesia recovery)

Activity, Respiration, Circulation, Consciousness, Oxygen saturation
Score 9-10 = ready for discharge from PACU

16. Basic Life Support (BLS)

CAB sequence (updated from ABC):

C - Chest compressions: rate 100-120/min, depth 5-6 cm
A - Airway: head-tilt/chin-lift
B - Breathing: rescue breaths 2 breaths per 30 compressions (30:2 ratio)

AED: use as soon as available
Begin CPR within 10 seconds of recognizing cardiac arrest

17. Growth & Development Across the Lifespan

Stage	Age	Key Theorist	Core Task
Infancy	0-1 yr	Erikson: Trust vs. Mistrust	Forming attachment
Toddler	1-3 yr	Autonomy vs. Shame	Independence
Preschool	3-6 yr	Initiative vs. Guilt	Initiative, play
School age	6-12 yr	Industry vs. Inferiority	Learning, competence
Adolescence	12-18 yr	Identity vs. Role Confusion	Identity formation
Young adult	18-40 yr	Intimacy vs. Isolation	Relationships
Middle adult	40-65 yr	Generativity vs. Stagnation	Productivity
Older adult	> 65 yr	Integrity vs. Despair	Life review

18. Special Topics

Infection Prevention Highlights

Chain of infection: Agent > Reservoir > Portal of Exit > Mode of Transmission > Portal of Entry > Susceptible Host
Breaking any link prevents infection

Blood Transfusion

ABO compatibility: A, B, AB (universal recipient), O (universal donor)
Transfusion reactions: febrile, allergic, hemolytic (most severe)
Check 2 identifiers before transfusion; monitor closely for first 15 minutes

Nasogastric (NG) Tube

Verify placement: X-ray (gold standard), pH of aspirate (< 5.5 = gastric)
Never start feeding before confirming placement

Oxygen Therapy

Nasal cannula: 1-6 L/min (24-44% FiO2)
Simple face mask: 6-10 L/min (35-60% FiO2)
Non-rebreather mask: 10-15 L/min (60-95% FiO2)
Venturi mask: precise FiO2 delivery

This covers the major domains of fundamentals of nursing. Let me know if you want to go deeper into any specific topic - for example, the nursing process, medication administration, wound care, vital signs, or any clinical skill.

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