Fundamentals of Nursing and First Aid

What to remember

• Vital signs are temperature, pulse, respiration and blood pressure. Know the normal adult values and how to measure each one correctly.
• Standard precautions protect both the patient and the worker. Hand hygiene, gloves, safe sharps disposal and clean equipment come first.
• In first aid, think of safety first, then airway, breathing and circulation. Call for help early and move the person to a health facility.

Nursing basics and vital signs

Nursing is care of the sick and the healthy to promote health, prevent disease and help recovery. A nurse observes, records and reports. Records must be clear, dated, timed and signed. Never write what was not done.

Normal adult vital signs

Temperature conversion: °F = (°C × 9/5) + 32. Worked example: 38°C = 38 × 1.8 + 32 = 100.4°F. And °C = (°F − 32) × 5/9; 104°F = 72 × 5/9 = 40°C. Armpit temperature reads about 0.5°C lower than oral; rectal reads about 0.5°C higher. A thermometer is shaken to below 35°C before use and cleaned with spirit or soap and water after use. Fever is a rise above normal; hypothermia is a fall below normal.

Pulse terms: tachycardia is above 100 per minute; bradycardia is below 60. Respiration terms: tachypnoea (fast), bradypnoea (slow), dyspnoea (difficult), apnoea (stopped). Systolic pressure is when the heart contracts; diastolic when it rests. Hypertension in an adult is persistent BP at or above 140/90 mm Hg. Pulse pressure = systolic − diastolic; for 120/80 it is 40 mm Hg.

Patient care procedures

Hand hygiene is the first and most important infection control measure. Use soap and water, or alcohol hand rub when hands are not visibly dirty. Wash before and after patient contact and after removing gloves.

Standard precautions: treat all blood and body fluids as infectious; use gloves, mask and apron as needed; handle sharps carefully; do not recap used needles; segregate waste by colour; clean spills with 1% hypochlorite solution.

Positions: Supine (flat on the back), prone (on the face), lateral (side), Fowler's (sitting at 45 to 60 degrees; helps breathing), Sims' (semi-prone; used for rectal examination and enema), lithotomy (legs apart and raised; used for vaginal examination and delivery), Trendelenburg (head low; for shock).

Bed making. Make beds with clean, wrinkle-free sheets to prevent bed sores. An occupied bed is made without moving the patient out of it. A bed sore (pressure sore) occurs over bony parts from pressure and moisture. Prevention: change position every 2 hours, keep skin clean and dry, use soft padding, and give good nutrition.

Giving medicines. Check the five rights: right patient, right drug, right dose, right route, right time. Read the label three times. Routes: oral, sublingual, rectal, topical, inhalation, and injection: intradermal (ID, into the skin, used for tests and BCG), subcutaneous (SC, under the skin), intramuscular (IM, into muscle) and intravenous (IV, into a vein). Common IM sites are the upper outer buttock and the vastus lateralis in the thigh; in infants the thigh is used. Sterile needles and syringes are used once only.

Calculations. Dose to give = (Dose ordered ÷ Dose in stock) × volume of stock. Example: 250 mg ordered, stock is 125 mg in 5 mL: (250 ÷ 125) × 5 = 10 mL. For IV drips: drops per minute = (Volume in mL × drop factor) ÷ time in minutes. Standard drop factor is 15 or 20 drops per mL for adult sets and 60 drops per mL for paediatric (micro-drip) sets. Example: 500 mL over 4 hours with a 20-drop set gives (500 × 20) ÷ 240 = about 42 drops per minute.

Other procedures. Intake and output charting; catheterisation (aseptic technique, to drain urine); enema (to clear the bowel); sponging for high fever (tepid water); hot and cold applications; oxygen therapy by mask or nasal prongs (humidify and no open flame); collection of specimens (clean, labelled, correct container). A patient is lifted and turned using the body mechanics method (bend the knees, keep the back straight).

Diets in hospital: liquid, soft, light and full diets. Observation includes appearance, appetite, sleep, bowel, bladder, pain and mood.

First aid: general rules

First aid is the immediate help given to an injured or sick person before medical help arrives. Aims: save life, prevent the condition from worsening, promote recovery. Steps: check that the scene is safe, check response (call out and tap the shoulder), call for help, and then check airway, breathing and circulation (ABC). Do not give anything by mouth to an unconscious person. Do not move a person with suspected spine injury unless there is danger. Reassure the patient.

Basic life support (CPR) in an adult: if there is no response and no normal breathing, call for help and start chest compressions at the lower half of the breastbone. Rate 100 to 120 per minute, depth about 5 to 6 cm, allowing full recoil. Ratio is 30 compressions to 2 rescue breaths. Use an automated external defibrillator (AED) as soon as one arrives. For an unconscious person who is breathing normally, place in the recovery position (on the side).

First aid for common emergencies

First aid box contains sterile dressings, bandages, adhesive plaster, scissors, safety pins, cotton wool, antiseptic, gloves, a thermometer and a splint. Bandages: roller bandage for limbs, triangular bandage for a sling, tailed bandage for the head. Wounds: clean with clean water, apply antiseptic and cover with a sterile dressing. Check tetanus immunisation status for any open wound.

Exam traps

• CPR ratio is 30 compressions to 2 breaths.
• Pulse is counted for one full minute in practice; respiration is counted without the patient knowing.
• Sims' position is used for enema; Fowler's for breathing difficulty; Trendelenburg for shock.
• Burns are cooled with running water, never with butter or ice.
• In snake bite, no cutting, sucking or tight tourniquet.
• Dog bite wounds are washed with soap and water for 15 minutes and left unstitched.
• Intradermal is into the skin; subcutaneous is under the skin.
• Rectal temperature is higher than armpit temperature.
• Tachycardia is above 100; bradycardia is below 60.
• Do not recap used needles.

One-liners

• 1. Normal adult pulse is 60 to 100 per minute.
• 2. Normal adult respiration is 12 to 20 per minute.
• 3. Normal BP is about 120/80 mm Hg.
• 4. °F = (°C × 9/5) + 32.
• 5. Five rights: patient, drug, dose, route, time.
• 6. Pressure sores are prevented by turning every 2 hours.
• 7. RICE means rest, ice, compression, elevation.
• 8. Chest compression depth in an adult is about 5 to 6 cm.
• 9. Unconscious breathing person goes in the recovery position.
• 10. Clean spills with 1% hypochlorite.
• 11. Cool burns for 10 to 20 minutes.
• 12. First aid aims: save life, prevent worsening, help recovery.

Practice questions

1. The normal adult pulse rate at rest is

   1. 100 to 140 beats per minute
   2. 30 to 50 beats per minute
   3. 120 to 160 beats per minute
   4. 60 to 100 beats per minute
   Answer

   D. 60 to 100 beats per minute

   Normal adult pulse is 60 to 100 per minute.

2. The normal adult respiratory rate is

   1. 12 to 20 per minute
   2. 25 to 35 per minute
   3. 4 to 8 per minute
   4. 40 to 60 per minute
   Answer

   A. 12 to 20 per minute

   12 to 20 breaths per minute at rest.

3. Normal adult blood pressure is about

   1. 80/120 mm Hg
   2. 120/80 mm Hg
   3. 90/40 mm Hg
   4. 160/100 mm Hg
   Answer

   B. 120/80 mm Hg

   Systolic over diastolic about 120/80.

4. What is 38°C in Fahrenheit?

   1. 98.6°F
   2. 100.4°F
   3. 96.8°F
   4. 102.0°F
   Answer

   B. 100.4°F

   38 × 9/5 + 32 = 68.4 + 32 = 100.4°F.

5. What is 104°F in Celsius?

   1. 40°C
   2. 42°C
   3. 38°C
   4. 36°C
   Answer

   A. 40°C

   (104 − 32) × 5/9 = 72 × 5/9 = 40°C.

6. What is 98.6°F in Celsius?

   1. 36°C
   2. 38°C
   3. 35.6°C
   4. 37°C
   Answer

   D. 37°C

   (98.6 − 32) × 5/9 = 37°C.

7. A BP of 130/80 mm Hg has a pulse pressure of

   1. 105 mm Hg
   2. 210 mm Hg
   3. 80 mm Hg
   4. 50 mm Hg
   Answer

   D. 50 mm Hg

   Pulse pressure = 130 − 80 = 50.

8. A pulse of 120 per minute in an adult at rest is called

   1. Apnoea
   2. Tachycardia
   3. Bradycardia
   4. Dyspnoea
   Answer

   B. Tachycardia

   Above 100 per minute is tachycardia.

9. Doctor orders 250 mg; stock is 125 mg in 5 mL. How much is given?

   1. 10 mL
   2. 2.5 mL
   3. 5 mL
   4. 20 mL
   Answer

   A. 10 mL

   (250 ÷ 125) × 5 = 10 mL.

10. Order is 500 mg; stock is 250 mg per 2 mL. What volume is given?

    1. 4 mL
    2. 2 mL
    3. 8 mL
    4. 1 mL
    Answer

    A. 4 mL

    (500 ÷ 250) × 2 = 4 mL.

11. Order is 40 mg; stock is 20 mg per mL. What volume is given?

    1. 0.5 mL
    2. 2 mL
    3. 4 mL
    4. 8 mL
    Answer

    B. 2 mL

    40 ÷ 20 = 2 mL.

12. An IV set of 20 drops/mL runs 500 mL over 4 hours. The rate in drops per minute is nearest to

    1. 84
    2. 125
    3. 21
    4. 42
    Answer

    D. 42

    (500 × 20) ÷ 240 = 41.7, about 42.

13. An IV set of 15 drops/mL runs 1000 mL over 5 hours (300 min). The rate in drops per minute is

    1. 50
    2. 100
    3. 33
    4. 75
    Answer

    A. 50

    (1000 × 15) ÷ 300 = 50.

14. A paediatric micro-drip set delivers 60 drops per mL. For 100 mL in 2 hours (120 min), the rate in drops per minute is

    1. 12
    2. 25
    3. 50
    4. 100
    Answer

    C. 50

    (100 × 60) ÷ 120 = 50.

15. The CPR ratio of chest compressions to breaths in an adult is

    1. 5:1
    2. 15:1
    3. 60:4
    4. 30:2
    Answer

    D. 30:2

    Standard adult ratio is 30 compressions to 2 breaths.

16. Chest compression rate during adult CPR is

    1. 40 to 60 per minute
    2. 100 to 120 per minute
    3. 60 to 80 per minute
    4. 140 to 160 per minute
    Answer

    B. 100 to 120 per minute

    Rate of 100 to 120 per minute is standard.

17. A burn should first be cooled with

    1. Butter
    2. Clean running water for 10 to 20 minutes
    3. Ice
    4. Toothpaste
    Answer

    B. Clean running water for 10 to 20 minutes

    Cool running water limits tissue damage.

18. RICE in sprain management stands for

    1. Rub, ice, cover, exercise
    2. Rest, immersion, cold, elevation
    3. Rest, ice, compression, elevation
    4. Rest, iodine, cotton, exercise
    Answer

    C. Rest, ice, compression, elevation

    RICE is the standard sprain first aid.

19. Which position is used for rectal examination and giving an enema?

    1. Fowler's position
    2. Prone position
    3. Trendelenburg position
    4. Sims' position
    Answer

    D. Sims' position

    Semi-prone left lateral Sims' position is used.

20. Which position helps a patient with breathing difficulty?

    1. Fowler's position
    2. Supine flat
    3. Lithotomy position
    4. Sims' position
    Answer

    A. Fowler's position

    Sitting at 45 to 60 degrees helps breathing.

21. Which position is used for a patient in shock?

    1. Sitting upright
    2. Prone
    3. Trendelenburg or flat with legs raised
    4. Lithotomy only
    Answer

    C. Trendelenburg or flat with legs raised

    Raising the legs returns blood to the heart.

22. The correct first aid for snake bite is to

    1. Cut the bite and suck out venom
    2. Keep the person calm, immobilise the limb and go to hospital
    3. Give alcohol
    4. Tie a very tight tourniquet
    Answer

    B. Keep the person calm, immobilise the limb and go to hospital

    Cutting, sucking and tight tourniquets are harmful.

23. For a dog bite, the wound should be

    1. Washed with soap and running water for 15 minutes and left unstitched
    2. Stitched immediately
    3. Left alone with no wash
    4. Covered with chilli powder
    Answer

    A. Washed with soap and running water for 15 minutes and left unstitched

    Thorough washing reduces rabies virus; do not suture.

24. Which route is used for the BCG vaccine and skin tests?

    1. Intramuscular
    2. Rectal
    3. Intravenous
    4. Intradermal
    Answer

    D. Intradermal

    BCG is given into the skin (intradermal).

25. Which is the preferred IM injection site in infants?

    1. Abdomen
    2. Upper arm
    3. Anterolateral thigh
    4. Buttock
    Answer

    C. Anterolateral thigh

    The thigh muscle is largest and safest in infants.

26. A bed sore is best prevented by

    1. Rubbing the bony areas hard
    2. Keeping the patient flat for long periods
    3. Using a rough sheet
    4. Changing the patient's position every 2 hours
    Answer

    D. Changing the patient's position every 2 hours

    Relieving pressure prevents sores.

27. Which is a part of the five rights of medication?

    1. Right price
    2. Right route
    3. Right insurance
    4. Right colour
    Answer

    B. Right route

    Patient, drug, dose, route and time.

28. The first step in any first aid situation is to

    1. Make sure the scene is safe
    2. Give water
    3. Move the patient immediately
    4. Give tablets
    Answer

    A. Make sure the scene is safe

    Rescuer safety comes first.

29. A nose bleed is managed by sitting up, leaning forward and

    1. Pinching the soft part of the nose for about 10 minutes
    2. Lying flat
    3. Blowing the nose hard
    4. Tilting the head back
    Answer

    A. Pinching the soft part of the nose for about 10 minutes

    This controls bleeding and prevents swallowing blood.

30. The best way to clean hands that are visibly dirty is

    1. Alcohol rub only
    2. Soap and water
    3. Wiping on a towel
    4. Rinsing with cold water only
    Answer

    B. Soap and water

    Alcohol rub is not enough for dirty hands.

31. Statements: 1. Armpit temperature reads lower than oral. 2. Rectal temperature reads higher than oral. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    Both are correct.

32. Statements: 1. Pulse is counted for one full minute in practice. 2. Respiration is counted without telling the patient. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    Both are good practice.

33. Statements: 1. Used needles should be recapped. 2. Sharps go in a puncture-proof container. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    B. 2 only

    Never recap used needles.

34. Statements: 1. Butter should be applied on a burn. 2. A burn should be cooled with clean running water. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    B. 2 only

    Butter traps heat and causes infection.

35. Statements: 1. An unconscious breathing person is put in the recovery position. 2. Fluids are given by mouth to an unconscious person. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    Nothing is given by mouth to an unconscious person.

36. Statements: 1. In electric shock, switch off the power first. 2. Touch the victim with bare hands before switching off. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    Touching first puts the rescuer in danger.

37. Statements: 1. Bradycardia is a pulse below 60. 2. Tachycardia is a pulse above 100. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    Both are standard definitions.

38. Statements: 1. Hypertension is persistent BP at or above 140/90. 2. Systolic pressure is the pressure when the heart rests. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    Diastolic is when the heart rests.

39. Match the term with its meaning: 1. Dyspnoea, 2. Apnoea, 3. Tachypnoea. Which set is correct?

    1. 1 difficult breathing, 2 fast breathing, 3 absent breathing
    2. 1 absent breathing, 2 difficult breathing, 3 fast breathing
    3. 1 fast breathing, 2 absent breathing, 3 difficult breathing
    4. 1 difficult breathing, 2 absent breathing, 3 fast breathing
    Answer

    D. 1 difficult breathing, 2 absent breathing, 3 fast breathing

    Standard respiratory terms.

40. Match the position with its use: 1. Lithotomy, 2. Sims', 3. Fowler's. Which set is correct?

    1. 1 vaginal examination, 2 breathing difficulty, 3 enema
    2. 1 breathing difficulty, 2 enema, 3 vaginal examination
    3. 1 enema, 2 vaginal examination, 3 breathing difficulty
    4. 1 vaginal examination, 2 enema, 3 breathing difficulty
    Answer

    D. 1 vaginal examination, 2 enema, 3 breathing difficulty

    Lithotomy for vaginal examination and delivery.

41. Match the injection route with the site: 1. Intradermal, 2. Subcutaneous, 3. Intramuscular. Which set is correct?

    1. 1 into muscle, 2 under the skin, 3 into the skin
    2. 1 into the skin, 2 into muscle, 3 under the skin
    3. 1 under the skin, 2 into the skin, 3 into muscle
    4. 1 into the skin, 2 under the skin, 3 into muscle
    Answer

    D. 1 into the skin, 2 under the skin, 3 into muscle

    Routes are named after the layer used.

42. Statements: 1. Sprains are treated with RICE. 2. A fracture should be moved and massaged. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    A fracture is immobilised, not massaged.

43. Statements: 1. Heat stroke needs rapid cooling. 2. Fainting is managed by lying flat with legs raised. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    C. Both 1 and 2

    Both are standard first aid.

44. Statements: 1. First aid aims to save life. 2. First aid replaces medical treatment. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    First aid is immediate help until medical care.

45. Statements: 1. Spills of blood are cleaned with 1% hypochlorite. 2. Gloves are not needed for handling body fluids. Which is/are correct?

    1. 1 only
    2. 2 only
    3. Both 1 and 2
    4. Neither 1 nor 2
    Answer

    A. 1 only

    Gloves are needed for body fluids.