Learn Nursing fundamentals from scratch
1What nursing fundamentals cover
Nursing fundamentals are the skills every nurse uses on every shift: assessing a patient, keeping them safe, preventing infection, communicating well and acting ethically.
Nurses organise their work with the nursing process, a cycle of five steps:
- Assessment: collect information by observing, measuring and asking.
- Nursing diagnosis: name the patient’s problems or needs, such as “risk of falls”.
- Planning: set goals and choose interventions. Good goals are SMART: specific, measurable, achievable, realistic and time-bound.
- Implementation: carry out the care.
- Evaluation: check whether the goals were reached, then assess again.
Four ethical principles guide decisions: autonomy (respect the patient’s own choices), beneficence (do good), non-maleficence (do no harm) and justice (treat people fairly).
Care is person-centred: it fits the patient’s needs and wishes. A competent adult must give informed consent, and their information stays confidential unless there is a serious risk of harm or a legal duty to share it.
Self-check Which step of the nursing process comes first?
- Assessment
- Implementation
- Nursing diagnosis
- Planning
Answer: Assessment. Every later step depends on the data collected in the assessment. Starting with planning or care is the classic mistake: you would act before knowing the problem.
2Vital signs and early warning scores
Vital signs show how the body is coping. Learn these normal ranges for a resting adult:
- Respiratory rate 12–20 breaths per minute.
- Heart rate 60–100 beats per minute. Count an irregular pulse for a full 60 seconds.
- Blood pressure about 120/80 mmHg. The systolic pressure is the first tapping sound you hear as the cuff deflates.
- Temperature about 36.5–37.5 °C.
- Oxygen saturation (SpO₂) usually 94–98%, or 88–92% in patients at risk of retaining CO₂, such as some people with COPD.
- Level of consciousness: alert, or the Glasgow Coma Scale (GCS) from 3 to 15, where 15 is fully alert.
A rising respiratory rate is often the first sign that a patient is getting worse. It is also the vital sign that is most often skipped.
Early warning scores such as NEWS2 give points for each abnormal vital sign and add them up. A score of 5–6 needs an urgent review; 7 or more needs an emergency response.
Measure carefully. A cuff that is too small, or an arm hanging below heart level, gives a falsely high blood pressure.
Fluid balance compares what goes in with what comes out over 24 hours:
fluid balance = total intake − total output
Self-check Over 24 hours a patient takes in 2000 mL and has an output of 2500 mL. What is the fluid balance?
- +2500 mL
- +500 mL (positive balance)
- 4500 mL
- −500 mL (negative balance)
Answer: −500 mL (negative balance). Intake minus output: 2000 − 2500 = −500 mL. Subtracting the other way gives +500 mL, which would wrongly suggest fluid retention; 4500 mL adds the two numbers.
3Safety and infection prevention
Infection prevention. Standard precautions apply to every patient, whether or not an infection is known. They include hand hygiene, personal protective equipment (PPE) and the safe handling of sharps and waste.
- Clean your hands at the WHO “five moments”: before touching a patient, before a clean or aseptic task, after possible contact with body fluids, after touching a patient and after touching their surroundings.
- Use soap and water when hands are visibly dirty or after contact with diarrhoea; otherwise alcohol rub is fine.
- Remove PPE in an order that protects you: gloves first (most contaminated), then gown or apron, then eye protection, then mask, with hand hygiene at the end.
Medicines. Check the “rights” every time: right patient, right drug, right dose, right route, right time, and record what you gave. Check the patient’s identity before each dose, not only on admission.
Skin. Pressure ulcers form when pressure cuts off blood supply. Assess the risk with a tool such as Waterlow or Braden, and reposition bed-bound patients regularly. Red skin that does not blanch when pressed is a category 1 pressure ulcer.
Falls and moving. Assess fall risk, keep the call bell and walking aids within reach and use good lighting. When moving a load, keep it close to your body, bend your knees and avoid twisting.
Communication. Open questions (“How are you feeling today?”) invite more information than closed ones. The teach-back method asks the patient to explain the advice in their own words. Empathy means understanding the patient’s feelings; sympathy means feeling sorry for them.
Self-check To which patients do standard infection control precautions apply?
- Only to patients in isolation rooms
- Only to patients with a known infection
- Only to patients with open wounds
- To all patients
Answer: To all patients. Many infections are not yet known or cause no symptoms, so standard precautions are used for everyone. Limiting them to known infections is the mistake the word “standard” is meant to prevent.
4The ABCDE approach
When a patient is unwell, or a question asks what you do first, use the ABCDE approach. You assess in this order and treat each problem before you move on:
- Check that the area is safe and whether the patient responds. If they are unresponsive and not breathing normally, call for help and start CPR.
- A – Airway: is it open? Can the patient talk? Listen for noisy breathing.
- B – Breathing: respiratory rate, SpO₂, chest movement and effort.
- C – Circulation: pulse, blood pressure, capillary refill, skin colour and temperature, urine output.
- D – Disability: level of consciousness (ACVPU or GCS), pupils and blood glucose.
- E – Exposure: look at the whole body for bleeding, rashes, wounds and swelling, and measure temperature.
Then escalate using SBAR: Situation, Background, Assessment, Recommendation. Document what you found and did, and reassess.
5A worked example
Work through the case in ABCDE order. Try to say the next step before you open it.
Worked exampleTwo days after hip surgery, Mr Jansen is newly confused. His respiratory rate is 26/min, SpO₂ 91% on room air, heart rate 112/min, blood pressure 98/60 mmHg and temperature 38.6 °C. What do you do, and in which order?
1Several vital signs are abnormal at the same time, and the confusion is new. This gives a high early warning score, well above 7, so this is an emergency, not a routine observation round.
2He is talking, so the airway is open. His breathing is fast and SpO₂ is low: sit him upright and give oxygen as prescribed or per local policy, aiming for 94–98%.
3Fast pulse and low blood pressure suggest poor circulation. Check capillary refill and urine output, make sure there is intravenous access, and give fluids as prescribed.
4Assess his level of consciousness and check his blood glucose. Look at the wound and the rest of the body: the fever with these signs suggests a possible infection (sepsis).
5Call the doctor or the rapid response team at once using SBAR. Then repeat the observations and record everything.
Answer Treat it as an emergency: assess and treat in ABCDE order, escalate straight away with SBAR, and reassess often.
6Common mistakes
- Acting before assessing. Questions that ask what you do “first” usually want an assessment or a life-saving step.
- Treating circulation before the airway. An airway problem kills fastest, so A always comes before B and C.
- Ignoring the respiratory rate, which often changes first.
- Looking at one number instead of the trend and the whole patient.
- Thinking that delegating a task also hands over accountability. The nurse who delegates stays accountable for the decision to delegate.
- Trusting a normal SpO₂ in carbon monoxide poisoning. The probe cannot tell carbon monoxide from oxygen on haemoglobin.
Self-check A drowsy patient has gurgling, noisy breathing, SpO₂ 90% and a blood pressure of 95/60 mmHg. What do you address first?
- Measure the blood pressure again with a larger cuff
- Record the values and recheck in four hours
- The airway: position the patient and clear secretions
- The blood pressure: start the prescribed fluids
Answer: The airway: position the patient and clear secretions. Gurgling means the airway is partly blocked, and A comes before C. Starting with the blood pressure skips the most urgent problem; waiting four hours ignores a deteriorating patient.
7How exam questions look
- Easy (key terms and facts): normal values, definitions and principles. The normal respiratory rate, the first step of the nursing process, what non-maleficence means.
- Medium (applying the concepts): choosing the right action. Writing a SMART goal, removing PPE in the right order, calculating a fluid balance, measuring blood pressure correctly.
- Hard (cases and analysis): a patient scenario. You set priorities with ABCDE, respond to a rising early warning score, or apply consent, capacity and confidentiality.
For hard questions, ask what threatens the patient most right now. Choose the safe action that deals with that threat, then escalate.
Learn it step by step in the appLearn it step by step in the app