Module 1: Vital Signs and Pain

Introduction: Vital signs are foundational nursing data that reflect key physiological functions—temperature, pulse, respirations, and blood pressure, often alongside pain and oxygen saturation. This module explains each vital sign in depth, factors influencing them, and the significance of comprehensive pain assessment and management.

1.1 Learning Objectives

• Describe the physiological factors influencing temperature, pulse, respirations, blood pressure, and pain.
• Recognize and interpret normal vs. abnormal vital signs, including trending over time.
• Differentiate acute vs. chronic pain and develop appropriate nursing plans of care.
• Evaluate effectiveness of nonpharmacologic and pharmacologic interventions for pain.
• Demonstrate safe opioid administration and patient-controlled analgesia (PCA) usage.

1.2 Vital Signs

Body Temperature: Regulated by the hypothalamus balancing heat production (metabolism, muscle activity) and heat loss (skin vasodilation, sweating). Normal adult oral temperature is ~36.5°C–37.5°C. Fever, hyperthermia, and hypothermia each require specific interventions.

Pulse: Palpable bounding of blood in an artery per heartbeat. Normal is 60–100 bpm in adults. Assess rate, rhythm, strength, equality. Consider influences (activity, stress, meds).

Respirations: Observe rate (12–20/min for adults), depth (shallow, normal, deep), and rhythm. Tachypnea (>20) or bradypnea (<12) can signal underlying conditions. Correlate with oxygen saturation or ABGs if needed.

Blood Pressure: Force of blood on arterial walls, typically ~120/80 mmHg adult range. Assess for hypertension or hypotension, interpret in context (patient baseline, comorbidities).

Pain: The fifth vital sign, requiring thorough assessment (quality, intensity, location, timing, aggravating/alleviating factors) and individual care planning.

Visual #1: Vital Signs Normal Range Table

1.3 Pain Management

Acute vs. Chronic Pain: Acute pain is protective, short-term, typically resolves with healing. Chronic pain persists beyond normal tissue repair time, often >3–6 months, impacting quality of life.

Pain Assessment: Evaluate location, intensity (0–10 or faces scale), quality (sharp, dull), onset/duration, aggravating/alleviating factors, and associated symptoms (nausea, numbness).

Pharmacologic Interventions: Nonopioids (NSAIDs, acetaminophen) for mild pain, opioids for moderate-severe. Monitor opioid side effects (respiratory depression, sedation, constipation). PCA can give patient autonomy but requires careful nurse education.

Nonpharmacologic Methods: Heat/cold therapy, repositioning, relaxation techniques, guided imagery, TENS, massage.

Visual #2: Pain Assessment Mnemonic (PQRST)

1.4 Nursing Process & Evaluation

Assess vital signs and pain thoroughly. Formulate nursing diagnoses (e.g., Acute Pain related to surgical incision). Plan interventions, implement analgesics or non-drug methods, and re-evaluate for effectiveness. Documentation is key.

Module 2: Health Assessment

Introduction: A thorough health assessment combines subjective patient reports with objective findings (inspection, palpation, percussion, auscultation) to build a holistic picture of health status. Nurses differentiate between comprehensive head-to-toe exams and focused (acute) assessments targeting immediate concerns.

2.1 Learning Objectives

• Compare comprehensive vs. acute/focused assessments.
• Explain subjective vs. objective data, documenting each appropriately.
• Demonstrate IPPA technique (inspection, palpation, percussion, auscultation).
• Individualize assessments for specific diseases or conditions.

2.2 Comprehensive vs. Focused Assessment

A comprehensive assessment includes full health history (bio data, chief complaint, review of systems, family/social history) and physical exam. It’s typically performed on admission or annually in primary care. Focused assessments zoom in on relevant body systems (e.g., cardiac/respiratory for chest pain) to save time and address immediate problems.

2.3 Subjective vs. Objective Data

Subjective: Patient’s own words (“I feel dizzy,” “My pain is 7/10”), cannot be independently verified. Objective: Observed or measured (vital signs, lab results, visible lesions). Combine both for a complete picture.

2.4 Assessment Techniques

• Inspection: Observing general appearance, skin color, posture.
• Palpation: Checking texture, temperature, tenderness.
• Percussion: Tapping for resonance/dullness (used in advanced practice).
• Auscultation: Listening to heart, lungs, bowel sounds with a stethoscope.

For abdominal exams, the sequence is I-A-P-P (inspect, auscultate, percuss, palpate) to avoid altering bowel sounds.

2.5 Individualizing Assessment

Focus on the system(s) affected by the patient’s complaint or known condition—e.g., more frequent lung auscultation for pneumonia, thorough neuro checks for stroke. Document everything systematically (head-to-toe or problem-based).

Module 3: Immune & Asepsis

Introduction: Infection control and aseptic technique are critical to protecting patients and healthcare workers. This module covers the chain of infection, standard/transmission-based precautions, and nursing interventions to strengthen immune defenses.

3.1 Learning Objectives

• Identify risk factors for infectious diseases, especially in acute or long-term care.
• Explain the chain of infection and how to break each link.
• Demonstrate proper hand hygiene, PPE use, and isolation protocols.
• Discuss nursing interventions for immune-compromised patients.

3.2 Chain of Infection

There are six links: Infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host. Nurses disrupt these links via standard precautions, immunizations, disinfection, and protective equipment.

Visual #3: Chain of Infection Flow

Any break in this chain (e.g., hand hygiene, PPE, isolation) reduces infection risk.

3.3 Asepsis & Infection Control

Medical Asepsis (clean technique) vs. Surgical Asepsis (sterile technique). Adherence to hand hygiene, use of personal protective equipment, and correct disposal of sharps/linens drastically lowers HAIs (healthcare-associated infections).

3.4 Nursing Interventions

• Hand Hygiene: #1 strategy to prevent transmission.
• Use of PPE: Gloves, gown, mask, face shield as needed by contact/droplet/airborne precaution type.
• Environmental Controls: Disinfection, handling soiled items carefully, employee health (vaccinations, post-exposure prophylaxis).

Module 4: Study Skills and Test Taking

Introduction: Success in nursing school hinges on effective study habits, organizational skills, critical thinking, and strategic test-taking. This module addresses time management, learning styles, the nursing process in exam questions, and more.

4.1 Learning Objectives

• Apply self-assessment to maximize time usage and reduce procrastination.
• Develop general and subject-specific study techniques (mnemonics, concept maps).
• Use the nursing process (ADPIE) in scenario-based test items.
• Employ test-taking strategies for multiple choice and alternate-format (SATA, drag-and-drop) questions.

4.2 Time Management & Self-Assessment

Track current study habits (log daily activities). Evaluate efficiency vs. distractions. Use weekly planners, chunking large tasks, and maintain balanced breaks to prevent burnout. Prioritize tasks by urgency and importance (Eisenhower matrix approach).

4.3 Study Techniques & Critical Thinking

• Active Reading: Summarize sections in your own words, highlight key terms, create flashcards.
• Spaced Repetition: Review material at increasing intervals to enhance memory.
• Concept Mapping: Visual linking of concepts fosters deeper understanding, e.g., pathophysiology → signs/symptoms → interventions.
• Mnemonics: “RACE” (fire response), “OLDCARTS” (symptom assessment).

4.4 Test-Taking Strategies

Read the question stem carefully, note keywords (“first,” “best,” “priority”). Eliminate obvious distractors. Apply nursing process: often assess before implement. For SATA, treat each option as true/false. Manage anxiety through preparation, breathing exercises, pacing yourself.

4.5 Communication & Collaboration

Study groups can fill knowledge gaps if well-structured. Communicate clearly, summarize each other’s points, and stay on topic. Engaging in student nursing organizations or volunteering fosters leadership and professional growth.

Module 5: Neurological & Sensory

Introduction: Neurological and sensory integrity are crucial for safe, independent functioning. This module addresses the Glasgow Coma Scale, appropriate use of restraints, and assessing sensory deficits (vision, hearing, tactile) to prevent injury.

5.1 Learning Objectives

• Conduct a basic neuro exam (LOC, pupils, motor, sensation).
• Use the Glasgow Coma Scale to quantify consciousness level.
• Explain appropriate restraint usage and documentation.
• Adapt nursing care for patients with hearing/vision impairment to maintain safety.

5.2 Neurological Assessment & Glasgow Coma Scale

LOC: Check alert/orientation (person, place, time, situation). Changes can indicate rising intracranial pressure or delirium. The GCS sums eye opening (1–4), verbal response (1–5), and motor response (1–6). Normal is 15; 8 or less indicates coma.

Motor Function: Evaluate strength 0–5 scale (5 = normal). Compare bilateral. Check for drift or involuntary movements.

Sensory Checks: Light touch, pinprick, proprioception. Document numbness, tingling (paresthesia).

5.3 Restraints & Safety

Physical restraints are a last resort to prevent harm. Always try alternatives (sitter, bed alarm, reorientation). If used, apply per policy, ensuring fit (two-finger slack), frequent checks for circulation/skin integrity, and scheduled release for ROM. Document reason, times, ongoing assessments thoroughly.

5.4 Sensory Deficits & Risk

Vision or hearing impairment heightens fall risk or miscommunication. Provide adequate lighting, clear pathways, assistive devices (hearing aids, glasses). Reorient patients with cognitive changes frequently. Encourage family involvement to reduce confusion.

Module 6: Musculoskeletal

Introduction: The musculoskeletal system underpins mobility, posture, and ADL performance. This module reviews factors altering mobility, body mechanics to prevent injury, and assistive device usage (canes, crutches, walkers) to promote safety.

6.1 Introduction & Learning Objectives

• Identify factors affecting mobility (age, chronic disease, environment).
• Assess joint ROM, muscle strength, fall risk, and musculoskeletal function thoroughly.
• Implement interventions to prevent immobility complications (contractures, DVT, pressure sores).
• Demonstrate correct body mechanics and safe patient transfer techniques.

6.2 Factors Affecting Mobility

• Age: Older adults face reduced bone density, muscle mass; risk of osteoporosis, fractures.
• Lifestyle: Sedentary habits cause deconditioning; obesity stresses joints.
• Physiological: Arthritis, post-op restrictions, neurological conditions (Parkinson’s) limit movement.

6.3 Assessment & Prevention

Check posture, gait, alignment, ROM, muscle tone, and do a fall risk scoring (Morse Fall Scale). Reposition bed-bound patients q2h to prevent complications. Encourage active or passive ROM, adequate nutrition, hydration.

6.4 Body Mechanics & Assistive Devices

When lifting, keep a wide base of support, bend at knees, hold load close to body. Use mechanical lifts or get help for heavy or uncooperative patients. Correct usage of canes (strong side), crutches (2–3 fingerwidths under axilla), walkers (lift or wheel) fosters independence while reducing falls.

Module 7: Hematology

Introduction: Hematology covers blood cell counts, clotting mechanisms, and labs guiding interventions. Nurses watch CBC, BMP, and coagulation studies, responding to abnormal values with bleeding precautions, DVT prophylaxis, or fluid/electrolyte management.

7.1 Learning Objectives

• Identify components of CBC (RBC, WBC, platelets), BMP (electrolytes, BUN, creatinine), and coag studies (PT/INR, aPTT).
• Interpret abnormal labs and correlate with clinical signs (fatigue, bleeding, infection).
• Implement nursing interventions (e.g., bleeding precautions, anticoagulant monitoring, fluid repletion).
• Recognize risk factors and prevention for DVT (Virchow’s Triad).

7.2 Basic Lab Tests

CBC: RBC count (oxygen-carrying capacity), WBC count (infection or immunosuppression), platelets (clotting). BMP: Electrolytes (Na, K, Cl, CO₂), glucose, renal function tests (BUN, creatinine). Coag Studies: PT/INR for warfarin, aPTT for heparin, low platelets for potential hemorrhage.

7.3 Abnormal Findings & Interventions

• Low Hemoglobin/Hematocrit: Assess for anemia; watch for SOB, fatigue. Might need iron or blood transfusion if severe.
• High WBC: Could indicate infection; check fever, localized signs, antibiotic therapy.
• Thrombocytopenia: Platelets <150k → bleeding precautions (soft toothbrush, no IM injections if possible).
• Elevated INR/PTT: Risk of bleeding; hold or adjust anticoagulants, watch for bruising or hematuria.

7.4 DVT Prevention

Encourage mobility, compression stockings, SCDs. Administer prophylactic heparin or LMWH if indicated. Identify unilateral leg swelling, pain, warmth for early detection. If DVT present, elevate limb, avoid massaging area, watch for pulmonary embolism signs.

Module 8: Integumentary

Introduction: The skin and its appendages are vital for protection, temperature regulation, and sensation. This module addresses wound classification, phases of healing, and pressure ulcer prevention using the Braden Scale.

8.1 Learning Objectives

• Perform a comprehensive skin assessment and identify risk factors for breakdown.
• Distinguish types of wounds (superficial, partial, full thickness) and stages of pressure injuries.
• Use the Braden Scale to predict pressure sore risk and initiate preventive measures.
• Describe basic wound care and dressing principles for different depths.

8.2 Wound Classification & Healing

Acute vs. Chronic Wounds: Chronic (e.g., diabetic foot ulcer, pressure ulcer) may have delayed healing. Healing Phases: Inflammatory, proliferative (granulation tissue), maturation (scar formation). Good nutrition and blood supply are critical.

Visual #4: Braden Scale Radar (Spider) Graph

Each category scored 1–4; total ≤18 indicates higher risk. Intervene with repositioning, support surfaces, barrier creams.

8.3 Nursing Interventions

• Repositioning q2h to avoid constant pressure on bony prominences.
• Skin Care: Keep skin clean/dry, especially if incontinent. Use mild soap, pat dry, apply barrier creams.
• Supportive Devices: Pressure-relieving mattresses, foam wedges, heel protectors.
• Wound Care: Clean with noncytotoxic solutions, debride necrotic tissue, choose dressing (hydrocolloid, foam, alginate) based on wound characteristics.

Module 9: Gastrointestinal

Introduction: The GI system handles digestion, nutrient absorption, and elimination. Nurses address constipation, diarrhea, nausea/vomiting, and promote nutritional well-being. This module covers GI assessment, interventions for bowel alterations, and feeding assistance.

9.1 Learning Objectives

• Conduct a proper GI assessment: inspection, auscultation, percussion, palpation in that order.
• Identify etiologies and management of constipation, diarrhea, nausea/vomiting.
• Evaluate malnutrition or dehydration risk and implement supportive measures.
• Collect stool specimens correctly (occult blood, culture).

9.2 GI Assessment

Inspection: Note abdominal contour (flat, distended), visible peristalsis, scars. Auscultation: Listen in all quadrants for normal/hyper/hypoactive sounds. Percussion: Tympany over gas, dullness over organs or fluid. Palpation: Light to deep for tenderness, masses.

9.3 Common Alterations

Constipation: Infrequent or hard stools, often from low fiber/fluid intake or meds (opioids). Increase fiber, fluids, activity, consider stool softeners. Diarrhea: Frequent loose stools; manage hydration, identify infection or malabsorption. Nausea/Vomiting: Possibly from GI irritation, meds; treat with antiemetics and rest GI tract if needed.

9.4 Nursing Interventions

• Enemas, Laxatives if constipation severe, monitoring for electrolyte shifts.
• Stool Specimens: Occult blood test (FOBT) for hidden blood. Culture if infection suspected.
• Nutritional Support: Encourage small frequent meals, upright positioning, consult dietitian if malnourished.

Module 10: Genitourinary

Introduction: The GU system excretes waste, maintains fluid/electrolyte balance. Nurses frequently manage incontinence, retention, UTIs, and catheter care. This module covers GU assessment, assisting with toileting, and avoiding catheter-related infections.

10.1 Learning Objectives

• Assess normal vs. abnormal voiding patterns; measure I/O accurately.
• Differentiate stress, urge, overflow, and functional incontinence; implement interventions.
• Discuss UTI prevention, signs/symptoms, and nursing interventions.
• Perform correct catheterization and maintenance, reducing CAUTIs.

10.2 GU Assessment

Subjective: Usual voiding frequency, dysuria, hematuria, urgency, incontinence. Objective: Observe color, clarity, odor of urine, measure volume. Use bladder scanner for retention or post-void residual checks.

10.3 Alterations in Voiding

• Incontinence: Stress (cough/sneeze leakage), urge (overactive bladder), overflow (incomplete emptying), functional (mobility/cognitive barrier).
• Retention: Possibly from obstruction (BPH), anesthesia, or neuro issues. Intermittent cath if needed.
• UTI: Dysuria, frequency, urgency, possible fever. Encourage fluids, front-to-back perineal care, remove Foley ASAP.

10.4 Nursing Interventions

• Bladder Training: Timed voiding, Kegel exercises.
• Catheter Use: Indwelling for accurate I/O or chronic retention. Maintain closed system, bag below bladder level, daily evaluation of need.
• Patient Education: Adequate fluid intake, hygiene, recognizing infection signs, medication adherence.

Module 11: Cardiovascular

Introduction: Cardiovascular function ensures tissue perfusion via effective pumping of the heart and patent vessels. This module addresses basic CV assessment, recognizing arrhythmias (sinus brady/tachy), and managing hypertension/hypotension.

11.1 Learning Objectives

• Conduct a focused CV exam (apical pulse, peripheral pulses, BP, skin color, edema).
• Delineate sinus bradycardia vs. tachycardia causes and management.
• Identify and respond to hypertension (stages) or hypotension (orthostatic checks).
• Implement nursing interventions (antiembolism stockings, SCDs, lifestyle counseling) to promote cardiac health.

11.2 Cardiovascular Assessment

Inspection/Palpation: Note skin color, JVD, edema, capillary refill (<2 secs normal). Palpate peripheral pulses for amplitude and equality. Check for edema (pitting vs. non-pitting).

Auscultation: Use the 5 key sites (Aortic, Pulmonic, Erb’s, Tricuspid, Mitral). S1 (“lub”) closure of AV valves, S2 (“dub”) closure of semilunar valves. Extra sounds (S3, S4) or murmurs may indicate dysfunction.

11.3 Altered Cardiac Function

• Sinus Tachycardia: HR >100. Check underlying cause (fever, anxiety, dehydration).
• Sinus Bradycardia: HR <60. Could be normal in athletes or pathologic with conduction disorders.
• Hypertension: “Silent killer.” Monitor lifestyle factors, meds (ACE inhibitors, diuretics, beta-blockers).
• Hypotension: <90/60 or a significant drop from baseline. Assess for dizziness, potential shock states.

11.4 Risk Factors & Nursing Interventions

Modifiable (smoking, obesity, sedentary, high sodium diet) vs. Non-modifiable (family history, age, gender). Nurses promote healthy diet, stress management, medication adherence, routine screenings, and venous return support (TED hose, SCDs).

Module 12: Respiratory

Introduction: The respiratory system’s main goal is effective gas exchange (O₂ in, CO₂ out). Nurses regularly check respiratory rate, pattern, lung sounds, and intervene with oxygen therapy or airway management to correct hypoxia and prevent complications.

12.1 Learning Objectives

• Perform a thorough respiratory assessment (inspection, palpation, percussion, auscultation).
• Recognize common alterations: hypoxia, atelectasis, carbon monoxide poisoning.
• Safely administer oxygen using various devices and monitor effectiveness.
• Teach breathing exercises (pursed-lip, incentive spirometry) and smoking cessation.

12.2 Respiratory Assessment

Inspection: Note rate/depth, accessory muscle use, chest shape (barrel, scoliosis). Palpation: Check expansion symmetry, tenderness. Percussion: Resonance vs. dullness. Auscultation: Normal (vesicular, bronchovesicular, bronchial) vs. adventitious (crackles, wheezes, rhonchi, stridor).

12.3 Common Alterations

• Hypoxia: Restlessness, ↑RR, ↑HR; late sign = cyanosis. Provide O₂, address underlying cause.
• Atelectasis: Alveolar collapse. Encourage deep breathing, incentive spirometry post-op.
• Carbon Monoxide Poisoning: Binds hemoglobin, normal pulse ox reading but low O₂ to tissues. Symptoms include headache, confusion, “cherry red” skin. High-flow O₂ or hyperbaric therapy needed.

Visual #5: Oxygen Delivery Devices Comparison

12.4 Nursing Interventions

• Positioning: Semi-Fowler’s or Fowler’s to improve expansion. Orthopneic if severe distress.
• Breathing Exercises: Pursed-lip slows exhalation, beneficial in obstructive diseases. Incentive spirometer prevents atelectasis.
• Chest Physiotherapy: Percussion, postural drainage to loosen secretions. Suctioning if airway compromised.
• Smoking Cessation: Minimizes ongoing lung damage. Provide resources, support groups, nicotine replacement if needed.

Conclusion: Respiratory assessment and prompt intervention for issues like hypoxia or airway obstruction are central to safe patient care. Nurses are key educators on oxygen device usage, smoking cessation, and breathing techniques that optimize lung function.