I know you have heard it a thousand times by now. Nursing school is one of the hardest things you will ever do. It is so hard to understand this until you are in the thick of it, though. Although I was always a student with great grades I found myself struggling to keep up in nursing school. Luckily nursing fundamentals, the real beginning of nursing school, helps you get your bearings and get in your groove before things really start to pick up speed.
I quickly learned that learning aids and mnemonics are your best friend. It’s not that we aren’t smart. Of course, we’re smart, we wouldn’t be there if we weren’t. It’s simply that the massive amount of information coming at us won’t fit in our brains unless we have a little something to help glue it in there. There are so many great learning aids out there for nursing fundamentals. However, it will quickly overwhelm you if you don’t keep on top of things.
I’ve made what a group of the top three MUST KNOW concepts for students that will help you in all of your tests and studying for the NCLEX. (Yes, you really do want to start now.) Each is completely printable, pinnable, and ready for you to save and do whatever you wish with it. However, they are for personal use and not for resale or redistribution.
The Nursing Process (ADPIE)
This is one of the most important concepts for you to understand as a student and as a nurse. It will go so far to help you on your tests. When answering questions break each one down using this process. You have to start thinking in this way, and working through things with your “nurse brain”. It will make your life, and your tests so much easier. This process will help you to find which patients, either in clinicals or in test questions, need immediate care.
( When answering test questions be sure to read carefully to find which part of the nursing process the question is in. Often words in the question will give you a clue. ex : “priority”, “next”, “plan”, etc)
- Assess – Look at the information you have and collect any more data that you need. What do you know about the patient and the situation? What more do you need to know? This is where you get your Sherlock on.
- Diagnose – This is a nursing diagnosis. We find the problem. Remember to not use an actual medical diagnosis. We will talk about nursing diagnoses in detail soon as well as many other topics from fundamentals so be sure to subscribe!
- Plan – Set goals that are measurable and achievable for your patient. These must be goals that you can measure by tangible numbers such as ounces, days, steps, etc. Be realistic and empathetic of your patient’s abilities.
- Implement – Use nursing actions to achieve those goals you have set! We will be talking about nursing actions in detail soon so be sure to subscribe!
- Evaluate – Did you patient achieve the goals that you set? Why or why not? How can you help them achieve these goals? Are the goals too much for them? Is there a problem that you didn’t realize? Evaluate the outcome of your actions and plan and begin again.
Maslow’s Hierarchy of Needs
Maslow’s Hierarchy of needs is a concept that works from bottom to top. It identifies the basic needs of each of our patients from most important to (least? I don’t like using that word because I feel that they are all important…) important. Some parts of the pyramid are self-explanatory, and some are a little more difficult to grasp. However, once you get the basic concepts it proves to be a useful tool to use to answer test questions and prioritize your patients. The Hierarchy of Needs should be used after you have gone through the ADPIE process to identify which patients are in need of immediate care.
- Physiological – These are our most basic needs such as breathing, eating, excretion, sex, water, and homeostasis. The physiological needs are everything that our body needs to work properly.
- Safety – The safety needs are all the things that one needs to feel safe such as safety of body, home, property, employment, family, health, etc. One can heal better when they feel safe and secure. However, for example, if a patient is constantly worrying about the safety of a loved one at home then they are not going to heal as well.
- Belonging – Everyone needs to feel a sense of belonging, including having friends, family, and community. This also includes sexual intimacy. As nurses it is important for us to make sure that we discuss these things with our patients and address any issues that they may have with these areas. Has your patient had a surgery that has drastically altered their body image? Are they having concerns with their sexual life in regards to this? As a nurse it is our duty to discuss these concerns in a meaningful way.
- Esteem – All people should have a sense of self-esteem, and a feeling of confidence and self-respect. How can we as nurses help our patients feel confident? Although we may enjoy helping our patients it is important that we allow them to do things for themselves to instill a sense of confidence and achievement when able.
- Self-Actualization – Realization of one’s full potential is a wonderful thing. As a nurse, this is great to see in our patients. This may mean seeing our patients reach a recovery goal or a personal goal. It may mean something personal to the patient. Self-actualization refers to things. In essence, it is the patient being the best that they can be.
Priorities for Nurses
Nearly everything in a nurse’s day is about setting priorities. We must prioritize patients, tasks, and much more. At times that is hard to keep up with. Thankfully, there are a few tricks to keeping up with all that prioritizing that can get you through it a little easier.
- Priority One: Critical
- First and foremost we must make sure that the patient has a patent airway. If the airway is not patent anything else we do for them is moot. Use the head-tilt/chin lift or jaw-thrust technique depending on patient presentation.
- Secondly, we must make sure that the patient is breathing. Check for equal chest rise and fall. Record the rate, rhythm, and quality of respirations. Are there adventitious breath sounds? If the patient is not breathing begin rescue breaths.
- Check the patient’s circulation. The radial and carotid pulses are the main pulses to check. (DO NOT CHECK BOTH CAROTID PULSES AT ONCE ) Record the rate, rhythm, and quality of the pulse. What is the color, temperature, and condition of the skin? Is there any life-threatening bleeding that is visible? If no pulse is present begin CPR.
- Assess all other vital signs.
- Assess any labs that are critical to the patient’s current condition.
- Priority Two: Urgent
- Altered Mental Status is an urgent condition. This is any time that the patient has a change in their AVPU condition. Are they alert? Can they speak to you? Are they responsive to verbal commands? Do they respond to painful stimulus? Has the patient become completely unconscious?
- As a nurse it is important that we attend to a patient’s pain in an urgent and unbiased manner. In some areas they record pain as a 5th vital sign. We will be covering the pain scale in more detail soon. Assess the patient’s pain using the OPQRST method. The O stands for onset. This means asking when the pain began, or what the patient was doing when the pain began. P stands for provocation, or what the patient can do to make the pain better or worse. The Q refers to the quality of the pain. It is important to not give the patient words to use but to rather let them use their own words to describe how the pain feels, such as dull or stabbing. The S is severity. This is where the patient will use the common 1 through 10 number scale to rate their pain. Finally, the T refers to time. This is where you will ask the patient how long they have experienced the pain. All of this information should be reported to the MD in a timely manner and a nursing diagnosis and plan created to deal with the patient’s pain in addition to the medical diagnosis.
- Any untreated medical diagnoses that were not critical are handled in the urgent category. As we assess our patients we must treat any medical issues that are present in a timely and empathetic way.
- Priority Three: Normal
- Chronic health issues such as diabetes mellitus, arthritis, and others would fall under this category. These are not acute issues and would not be treated in the urgent category. While we might need to give an urgent treatment for an acute problem related to these conditions, the everyday treatment of these conditions falls under priority three.
- Education, activities, exercise, family time, religious activities, and all other patient activities that are not health related fall under priority three. While they are important to a holistic view of healing it is important to address medical issues first.