📋 New Lesson 16

Fundamentals of Nursing

Nursing process, vital signs, medical terminology, hygiene, mobility, and clinical judgment.

Nursing Process

The Nursing Process — ADPIE

Step	What You Do	Key Point
Assess	Collect subjective and objective data	ALWAYS the first step
Diagnose	Identify nursing diagnoses	RN role — LPN contributes data
Plan	Set goals and outcomes	RN initiates — LPN implements
Implement	Carry out nursing interventions	LPN's primary role
Evaluate	Determine if goals were met	Reassess and revise

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NCLEX Rule: Assessment is ALWAYS first unless the patient's airway, breathing, or circulation is already compromised.

Vital Signs

Vital Signs — Normal Ranges

Vital Sign	Adult Normal	Critical Values
Temperature	36.1–37.2°C (97–99°F)	Fever >38.3°C \| Hypothermia <35°C
Pulse	60–100 bpm (apical)	Brady <60 \| Tachy >100
Respirations	12–20 breaths/min	<12 or >20 = intervene
BP (Adult)	120/80 mmHg	Hypertension ≥130/80 \| Hypotension <90/60
SpO2	95–100%	<90% = emergency
Pain	0 = no pain	5th vital sign — always assess

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Before any cardiac medication: Check apical pulse for 1 full minute. Hold and notify if <60 bpm (digoxin, beta blockers, diltiazem).

Medical Terminology

Essential Medical Terminology

Prefix/Suffix	Meaning	Example
Brady-	Slow	Bradycardia = slow heart
Tachy-	Fast	Tachypnea = fast breathing
Hypo-	Below normal / low	Hypotension = low BP
Hyper-	Above normal / high	Hyperglycemia = high glucose
-emia	Blood condition	Anemia = low blood (cells)
-uria	Urine condition	Hematuria = blood in urine
-ostomy	Surgical opening	Colostomy = opening in colon
-ectomy	Surgical removal	Appendectomy = remove appendix
Peri-	Around	Perioperative = around surgery
Post-	After	Postpartum = after birth

Clinical Judgment

Clinical Judgment — How to Think Like a Nurse

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NCLEX Clinical Judgment Model (NCSBN):
1. Recognize Cues → 2. Analyze Cues → 3. Prioritize Hypotheses → 4. Generate Solutions → 5. Take Actions → 6. Evaluate Outcomes

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Recognizing Patient Deterioration: Look for change from baseline — sudden confusion, new shortness of breath, dropping BP, rising HR, decreased urine output, or change in mental status are RED FLAGS regardless of diagnosis.

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ABC Priority Rule: Airway → Breathing → Circulation → Safety. When unsure which patient to see first, go to the one with ABC compromise first.

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Modifying Phrase Rule: ALWAYS read the entire question. Words like "sudden," "new," "acute," "unrelieved," or "worsening" change your answer — these indicate the HIGHER priority patient.

📖 Study Notes

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Nursing Process mnemonic — ADPIE: Always Do Plan It Exactly. Assessment first — ALWAYS.

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Objective vs Subjective data: Objective = what you OBSERVE (BP, temp, breath sounds). Subjective = what the patient TELLS you ("I feel dizzy").

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Vital sign memory: Normal adults — HR 60–100, RR 12–20, BP 120/80, Temp 98.6°F (37°C), SpO2 95–100%.

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Critical VS to memorize: RR <10 = respiratory emergency. Urine output <30 mL/hr for 2 hrs = call provider. BP <90/60 = shock protocol.