LPN 101 Comprehensive Final Study Guide PDF

**LPN 101** **Comprehensive Final Study Guide** **Chapter 1** **Evidence-Based Practice. What is it? How is it used in nursing?** **Best researched evidence to guide- clinical decision-making.** **Helps determine "best practices" "standards of care"** **Best practice "changes that have been ma...

**LPN 101** **Comprehensive Final Study Guide** **Chapter 1** **Evidence-Based Practice. What is it? How is it used in nursing?** **Best researched evidence to guide- clinical decision-making.** **Helps determine "best practices" "standards of care"** **Best practice "changes that have been made in medicine to create quality care of patients and improve patient wellbeing, based history of practice.** **Clinical practice guidelines** **EBP is formed by the jointing of "s" areas: best evidence, nursing expertise, and patient values.** **The EBM Triad: best external evidence, pt values and expectations, individual clinical expertise.** **Nurse Practice Acts. What are they? Laws: What are their primary purposes?** **The practice acts are designed to protect the public, and they define the legal scope of practice.** **1. Shall accept assigned responsibilities as an accountable member of the health care team.** **2. Shall function within the limits of educational preparation and experience as related to the assigned duties.** **3. Shall function with other members of the health care team in promoting and maintaining health, preventing disease and disability, caring for and rehabilitating individuals who are experiencing an altered health state, and contributing to the ultimate quality of life until death.** **4. Shall know and utilize the nursing process in planning, implementing and evaluating health services and nursing care for the individual patient or group.** **A, Planning: the planning of nursing includes: 1. Assessment/ data collection of health status of the individual pt, the family, and community groups. 2. Reporting information gained from assessment/ data collection. 3. The identification of health goals.** **B. Implementation: the plan for nursing care is put into practice to achieve the stated goals and includes: 1. Observing, recording, and reporting significant changes, which require interventions or different goals.** **2. applying nursing knowledge and skills to promote and maintain health, to prevent disease and disability, and to optimize functional capabilities of an individual pt.** **3. Assisting the t fand family with adl's and encouraging self-care as appropriate.** **4. carry out therapeutic regimens and protocols prescribed by personnel pursuant to authorized state law.** **C. Evaluations: The plan for nursing care and its implementations are evaluated to measure the progress toward the stated goals and will include appropriate persons and or groups to determine: 1, the relevancy of current goals in relation to the progress of the individual pt. 2, the involvement of the recipients of care in the evaluation process. 3, the quality of the nursing action in the implementation of the plan. 4, a re-ordering of priorities or new goal setting in the care plan.** **5. Shall participate in peer review and other evaluation processes.** **6. Shall participate in the development of policies concerning the health and nursing needs of society and in the roles and functions of the LPN.** **The Nursing Process: A circular process involving ongoing assessment, data analysis, problem identification (nursing diagnosis), planning, implementation, and evaluation.** **Chapter 2** **Holistic Approach to Care. What does this approach to care involve?** **Is an approach that considers the person's biologic, psychological, sociological, and spiritual aspects and needs.** **Maslow's Hierarchy of Needs: Physiologic Needs: Fundamental physical needs are essential to maintaining life such as: Oxygen, nutrition, elimination, safety, rest and comfort, hygiene, activity, sexual procreation.** **Safety and security such as: psychological comfort, assistance in meeting needs, comfortable environment.** **Love and belonging such as: loving, giving and receiving love, affection, intimacy sexual expression, social interaction, communication, human caring, family, community. Self-esteem such as: independence, motivation, competence, learning, exploration, leisure, roles, spiritual beliefs. Self- actualization such as: self-knowledge and acceptance, achievement, openness, flexibility, universal knowledge, aesthetics, artistic appreciation, talent.** 1. **Physiologic** 2. **Safety and security** 3. **Love and belonging** 4. **Self-esteem** 5. **Self actualization** **Chapter 3** Nurse Practice Acts: These laws define the scope of nursing practice and provide for the regulation of the profession by a state board of nursing. Scope of Practice: includes the definition of nursing for the LPN and may include definitions for advanced practice nurses. Student Nurses: are held to the same standards a s licensed nurse. Delegation: is the assignment of duties to another person. National Patient Safety Goals: The joint commission has developed goals to promote specific improvements in pt safety. The goals attempt to provide evidence-based and expert based solutions to areas that have caused problems with pt safety is updated every year. SBAR: Hand off communication. Situation, Background, Assessment, and Recommendations. Legal documents/medical records: Property of the hospital, agency, or primary care provider- not the pt. Is confidential. HIPAA: Health insurance portability and accountability act. Requires the creation of regulations regarding pt privacy and electronic medical records. Failure to comply with the rules may lead to civil penalties. Consents: is permission given by the patient or their legal representative. Implied Consent: Assumed consent when during a life threatening emergency, consent cannot be obtained from the pt or family. Consent may be obtained by phone if it is witnessed by two people who hear the consent of the family member. Advance Directives AKA living will: is a consent that has been constructed before the need for it arises. It spells out a pts wishes regarding surgery and diagnostic and therapeutic treatments, clear directions for making decisions is the present if the pt suffers an accident or illness that renders the pt unresponsive or incompetent. Durable Power of Attorney: is a document that gives legal power to a health care agent (surrogate decision maker) who is a person chosen by the pt to follow the pts advanced directives and make medical decisions on their behalf. DNR (Do Not Resuscitate): are written by a physician when the pt has indicated a desire to be allowed to die if they stop breathing or their heart stops. In this situation, no cardiac compression or CPR would be started. Code of Ethics: a respect for human dignity and the individual, and provision of nursing care that is not affected by race, religion, lifestyle, or culture. A commitment to continuing education, to maintaining competence, and to contributing to improved practice. The confidential nature of the nurse- pt relationship, outlining behaviors that bring credit to the profession and protect the public. Competencies implies knowledge, understanding, and the skills that transcend specific tasks and is guided by a commitment to ethical and legal principles. **Chapter 4** Nursing Process (Table & Box 4.1) **Assessment** (data collection, recognize cues) **Data Analysis/ Problem Identification** ( analyze cues and form hypotheses, prioritize hypotheses) **Planning** (generate solutions) **Implementation** (take action) Evaluation (evaluate outcomes) Priority setting: Prioritizing involves placing problem statements/ nursing diagnoses or nursing interventions in order of importance. Life-threatening problems are high priority. Problems that threaten health or coping ability are of medium priority. Low priority problems are ones that do not have a major effect on the person if not attended to that day or even that week. Usually based on the adaptation of Maslows Law. **Chapter 5** Objective vs Subjective assessment data (Table 5.1) Know the difference: Subjective data: data obtained from the pt verbally that only the pt can describe or verify such as a headache, tingling in the feet, or shoulder pain. Objective data: Information obtained through the senses and hands on physical exam is objective. Are signs that are seen, heard, measured or felt by the person carrying out the assessment. Assessment/ The Interview: Assessments are ongoing. Interview is focused on gathering data, not a social interaction. 1. The opening, when rapport is established with the pt. 2. The body of the interview, when the necessary questions are presented. 3. The closing segment of the interview. After establishing rapport, discuss the purpose of the interview. Indicate the closing of the interview by stating, do you have any questions? Nursing diagnosis/Data Analysis (Table 5.2) Involves 3 parts 1. The pts problem or potential problem (how the pt is responding) 2. The causative or related factors, which can include the pathophysiology. 3. Specific defining characteristics or the signs and symptoms. Problem statement=problem+etiology+signs and symptoms Planning/goals SMART: Planning the identification of health goals. A goal is a broad idea of what is to be achieved through nursing intervention. Short term goals are achievable within 7-10 days or before discharge. Long term are often relate to rehabilitation. Specific, Measurable, Achievable, Realistic, and Time- Bound. **Chapter 6** Implementation/interventions: Giving care and actions. Evaluation: once the interventions have been carried out, you must determine whether they are effective in helping the pt reach the expected outcomes. If the outcomes have been reached, the goals have been met. **Chapter 7** **Patient Confidentiality- Electronic Health Record** **General rules of documentation (Box 7.4) Also called "charting" is used to track the application of the nursing process. The nurse writes down observations made about the pt, notes and care and treatment that was delivered and adds the pts response. Documentation shows progress towards the expected outcomes listed on the nursing care plan and is useful for supervisory purposes to evaluate staff performance. PIE: Problem identification, Interventions, and Evaluation.** **Chapter 8** Factors Affecting Communication: Culture, past experience, emotions, mood, attitude, perceptions of the individual, and self- concept. Active listening: requires great concentration and focused energy. Listen for feelings as well as words. Can demonstrate interest, and a trusting relationship can be built. Can maintain eye contact without staring, gives the pt full attention, and makes a conscious effort to block out other distractions, does not interrupt and waits for the full message before interpreting what is said. Therapeutic communication techniques: communication that is focused on the pts needs promotes understanding between the sender and the receiver. Blocks to effective communication: Changing the subject, giving false reassurance, judgmental response, defensive response, asking probing questions, using cliches, giving advice, inattentive listening. Special considerations for older adults and children: SBAR (handoff report/physician communication) I- introduction S- situation B- background A- assessment R- recommendations R-readback **Chapter 9** Patient Education: Nurses teach pt about their disease or disorder, surgery, and self care. The disease process, Preoperative and postoperative care, Diagnostic tests and procedures, Information needed for self care and restoration. Prevention of illness and health promotion. Modes of learning: 1- visually through what they see (visual learning) 2- aurally, through what they hear (auditory learning) and 3- kinesthetically, by actually performing a task or handling items (kinesthetic learning) Assessment of Learning: to prepare a pt education plan, you must first know what pt needs to learn. What does the person need to know about the disease or condition. Factors affecting learning: poor vision or hearing, impaired motor function, illiteracy, and implored cognition, age, stress, illness, lack of support. Readiness to learn, motivation, cultural values and expectations. Implementing and evaluating plan: Establish a time when there is no interruptions. One on one or in a group setting. Pt should be comfortable, pain is under control, good lighting and they can see and hear adequately. Keep session short and involve the pt. Evaluation is critical to the success of the process. It involves giving and obtaining feedback from the pt regarding what was taught then using the feedback to determine whether effective learning has been in fact taken place. A return demonstration of a skill is one way of evaluating the pts learning. **Chapter 10** Leadership Styles: Laissez- faire- does not attempt to control the team and offers little if any direction. Assumes that the team members are competent and self directed and will do what needs to be done correctly and efficiently. Autocratic- tightly controls team members. Staff members are rarely consulted when decisions are being made "my way or the highway" the leader closely supervises the work of each staff member. When mistakes are made, they are quickly pointed out. Democratic consults with staff members and seeks staff participation in decision making. Team members are respected as individuals, and there is an open and trusting attitude. Part of the team, not above it. Accepts responsibility for the teams actions. Two Challenge Rule: voicing your concern at least twice to promote acknowledgment by the receiver. The first challenge is usually made in the form of a question the second challenge should provide support for the concern and may be presented by the presenting person making the initial challenge or by another team member. The rule ensures that the concern has been heard, understood, and acknowledged. CUS Technique: Concern, Uncomfortable, Safety. State your concern. State why you are uncomfortable. State the safety issue involved. Delegation 5 Rights: Delegate the right task, under the right circumstance, to the right person, with the right supervision and the right communication **Chapter 14** Cultural competence: Is a collection of beliefs, values, and assumptions about life that is shared and maintained by a group of people and transmitted intergenerationally. Culture encompasses a variety of learned behaviors, beliefs, attitudes, and norms that regulate social conduct and define the worldview of the members of a particular group. Common cultural values, practices and beliefs (Table 14.3) Asian Am. Yin and yang are the names given to other balancing forces affecting health, when they aree out of balance with each other, illness may occur. Acumassage (manipulating the energy flow) acupressure (compressing the flow) and acupuncture (inserting needles to interrupt the energy flow) are treatments used to restore balance between yin and yang. Hispanic Am Often seek help within the family first when ill. Some may seek the services of a curandero (folk healer) Wearing of religious objects and placing them in the home is common. African Am, Families are often multigenerational, close, and supportive. Members of the church may also be considered family. Family structure is often matriarchal (the mother is the head of the family) American Indians, believe in keeping a natural harmony between humans and the universe. The universe is made up of the individual, family, community, tribe, environment, and spirit world. Believe in the cyclic nature of birth, life, and death. Health care practices are linked to spirituality and living in harmony with the universe. The family and community provide strength and spiritual support in times of illness. European Am. Extended family support often disrupted by geographic distance. Older adults may need care outside the family because of lack of family proximity or the demands of family's employment. Arab Am. Food plays a central role in life. Caring in shown by offering food. Muslims do not eat pork, nor drink alcohol. Common bonds of group are Arabic language and the Islamic religion, although many Arab Americans are Christian. **Chapter 15** Common problems of the dying patient and nursing management: Anticipatory guidance. Anticipating death assists in preparing the family and pt by giving them guidance about physical changes, symptoms, and complications that may arise. End stage symptom management. Many expected symptoms such as pain, GI distress, dyspnea, fatigue, cough, death rattle, delirium, are related to metabolic changes at the end of life. Recognize the symptoms and be able to either alleviate them or help explain them to the pt and family. Pain control. There is no risk of addiction or of reaching a safety or effectiveness limit when narcs are increased in response to pain for the dying pt. Dyspnea and respiratory distress, constipation or diarrhea, anorexia, nausea, and vomiting, dehydration, delirium, altered skin integrity, weakness, fatigue, and decreased ability to perform ADLs, anxiety, depression, and agitation, spiritual disconnection and fear of meaningless. Physical signs of impending death: physically weak, body functions slow, appetite decreases, urine output decreases, vital signs change, pulse increases becomes weak and thready, blood pressure declines, skin mottled, cool, dusky, resp shallow irregular, death rattle. Advance Directive or living will: is a legal document that outines the pts wishes for healthcare preferences at the time when they may be unable to communicate their choice. A Durable power of attorney is a legal document that appoints a person (health care proxy) chosen by the pt to make health care decisions if the pt becomes incompetent or incapable of communication. DNR: do not resuscitate DNI do not intubate. Euthanasia & ANA Code of Ethics American Nurses Association: Euthanasia or assisted suicide are considered violations. **Chapter 16** Factors that increase susceptibility to infection (Table 16.3) Age, malnutrition, excessive stress or fatigue, low WBC, altered defense mechanisms, alcohol use, chronic illness, indwelling tubes, devices, or equipment, immunosuppressive treatment, chemo, steroid treatment. Body defenses against infection: Skin, inflammatory response, and immune response Hand hygiene Standard precautions: Hand hygiene, gloves, mouth, eye, and nose protection, gown, respiratory hygiene and cough etiquette, pt care equipment, environmental control, linen, prevention of needle sticks and other sharps related injuries, pt placement. PPE: Gown, mask, gloves, eyewear Infection control patient education for the home How is it different than a facility?: are not as stringent in the home as in the hospital because the ordinary home does not contain the many pathogens found in the hospital. 1:10 bleach and water can be used to disinfect. Frequent damp dusting and vacuuming. **Chapter 17** Healthcare Associated Infections and Prevention: Infections transmitted to a person while receiving health care services. Prevent: hand hygiene before and after care. Deep breath, cough effectively at least every 2 hours, bed rest turn, use correct aseptic technique for cleansing skin. Transmission-based precaution requirements (Box 17.1) Airborne precautions: measles (rubella) varicella (including disseminated zoster) pulmonary tuberculosis, severe acute resp syndrome (SARS) Droplet precautions: meningitis, pneumonia, and epiglottis, meningitis, pneumonia and sepsis, diphtheria, pertussis, pneumonic plague. Contact: C-dif, herpes, impetigo, abscesses, cellulitis, pressure injuries, scabies, staph, ebola Needle Stick Injuries General principles regarding isolation (Box 17.2) floors are contaminated, minimize dust, protect pt from drafts, establish contaminated and clean zones, anything brought in isolation must not be removed except in proper containers, not touch eyes or nose, never shake linen, change loves, provide clean area for supplies, keep water in room, use the room clock for vitals, monitor won level of resistance to infection. Infection prevention in the home (Box 17.4) Wash hands often, routinely clean surfaces, handle and prepare food safely, get immunized, use antimicrobials appropriately, be careful with pets, avoid contact with wild animals. **Chapter 18** Body mechanics (guidelines Box 18.1) obtain help whenever possible, ask pt to help if able, bend or flex at knees, use greatest number of muscles possible, use thigh, arm, or leg muscles rather than back muscles, use a wide base support. Keep feet about shoulders with apart, use smooth coordinated movements, avoid jerking or sudden pulling motions, keep elbows and work close to your body, work at the same level or height as the object to be moved. If possible, pull objects toward you rather than pushing or lifting. Directly face the object or person to be moved, keep your trunk straight, do not twist when lifting or pulling. Use your arms as levers when pulling the pt toward you. Lock the elbows and rock back on your heels, using the weight of your body to move the pt. Patient positioning: Supine- back, fowlers 60-90 degrees, Semi fowlers 30-45, Low fowlers 15-30. Side lying or lateral, Sims variation of side laying used for rectal exam. Prone: pt laying face down. Dorsal recumbent: on back, knees up and apart. Lithotomy position: on back with legs up in stirrup. Knee chest position: pt face down with head turned to side butt up. -Lifting and transferring patients: requires the use of proper body mechanics and positioning principles. Some pt may be independent or need minimal assistance. Others may be completely dependent, needing to be transferred to a char etc. **Chapter 19** Pressure injury risk factors and prevention. What is the most important intervention?: Immobility, inactivity, moisture, malnutrition, advanced age, altered sensory perception, low mental awareness, friction and shear, dehydration, obesity, edema. Excellent nursing care is the main factor in prevention. **Chapter 20** Nursing actions to promote patient safety (Box 20.3) Orient pt and family to the room, assess pt gait and risk for falls, evaluate pt drug regimen for side effects that may increase risk of falls, keep bed in low position, put mat on floor if high risk for fall, toilet pt on a reg schedule, lock bed wheels, provide a night light, nonskid slippers, answer call lights quickly, tell pt when you will next check in, comfort, encourage use of grab bars, place high risk or restless pt in room close to nurse station, stay with pt who is confused, agitated, or unsteady, restrict fluids after 6pm, provide activities, wheel chair brakes are locked, change of shift safety checks, Protective devices (legal issues, alternatives, documentation, principles) **Chapter 25** Signs and symptoms of dehydration: dizzy, confused, cool, dry skin, dark, concentrated urine, decreased blood pressure, decreased urine production, dry cracked lips and tongue, dry mucous membranes, elevated temp, flat neck veins when lying down, increased pulse, poor skin turgor, ortho hypotension, thick saliva, thirst, weak, thready pulse, weak. fluid volume excess: weight gain, crackles in lungs, slow bounding pulse, elevated blood pressure, edema. Major electrolytes, normal range, and function: Sodium 135-145 hypo- cns and neuromuscular changes mental confusion, headache, altered level of consciousness, anxiety, coma, anorexia, nausea, vomiting, cramps, seizures, decreased sensation. Hyper- Dry mucous membranes, loss of skin turgor, intense thirst, flushed skin, elevated temp, weak, lethargy, irritable, twitching, seizure, coma, low grade fever, intracranial bleeding. Potassium 3.5-5 hypo- abdominal pain, gas distention of intestines, cardiac arrhythmias, weak, decreased reflexes, urinary retention, confusion, ecg change, increased urinary ph. Hyper- weak, hypotension, paresthesia's, paralysis, cardiac arrhythmias, ECG changes. Calcium 8.4-10.6 hypo- paresthesias, seizure, spasms, tetany, and spasm, Chvostek sign, trousseau sign, cardiac arrhythmia, wheezing, dyspnea, difficulty swallowing, colic, and cardiac fail. Hyper- anorexia, abdominal pain, constipation, polyuria, confusion, renal calculi, pathologic fractures, and cardiac arrest. Magnesium: 1.3-2.1 hypo- insomnia, hyperactive reflexes, leg and foot cramps, twitching, tremors, seizures, cardiac arrhythmias, Chvostek and trousseau sign, vertigo, hypo calcemia and kalemia. Hyper hypotension, sweating, flushing, nausea, vomit, weak, paralysis, resp depression, cardiac dysrhythmia. ABG normal ranges PH 7.35-7.45 Pco2 35-45 Hco2 22-26 Acid-base imbalances, causes, signs and symptoms (Table 25.5) Resp acid- slow shallow resp, hypoventilation, resp congestion or obstruction, can be due to copd, severe pneumonia, or excessive sedation, resp muscle weakness. Metabolic acid- Shock, diabetic ketoacidosis, lactic acidosis, kidney failure, diarrhea, starvation. Resp alkalosis- hyperventilation caused by anxiety or pain mechanical ventilation. Metabolic alkalosis- vomiting, prolonged gastric suction, hypokalemia, medications, diuretics, antacids, bicarbonate mineralocorticoids. I&O -- nursing considerations: **Chapter 26** Fiber- 21-38 g per day Food sources for fiber- (Table 26.1) apple, banana, orange, cantaloupe, grapefruit, strawberries, grains and cereals, veggies, legumes. Major functions of vitamins (Table 26.4) fat soluble A, E, K, D water: B, C Food sources of calcium, Potassium, Sodium (Table 26.6) Calcium milk products, dark green leafy veg, soy beans, sardines, salmon tofu hard water Potassium: apricots, banana, oranges, grapefruit, grean beans, broccoli, carrots, potatoes, meat, milk, peanut butter, legumes, molasses, coffee, tea, cocoa, tomato and oj Sodium: Salt, processed foods Nutritional needs throughout the lifespan- Older Adults: the group most at risk for inadequate nutrition. Nutrient requirements do not change with aging except in the presence of disease or illness, although calorie needs decrease each decade after age 50 Signs and symptoms of malnutrition (Table 26.8) **Chapter 27** Substance Related Disorders and Nutrition: substance use interferes with food intake by decreasing appetite, financial resources for food and substituting calories in alcohol or calories in food. Also may lead to impaired absorption and reduced storage and use of nutrients along with increased metabolic needs. Cardiovascular Disease and Nutrition: focused on reduction of saturated and trans fat, cholesterol, sodium intake, and red meats. HIV/AIDS Nutrition Assisted feeding Nursing considerations regarding NG insertion, care, and removal (Skill 27.2- Inserting an NG) Principles of enteral feedings (Box 27.3) **Chapter 28** Signs and symptoms of hypoxia (Table 28.1) Sit up to breathe, complains of cant breath, memory lapse, mental dullness, restless, increased bp, p, resp, later: decreased pb, p, arrhythmia, use of accessory muscles, stridor, cyanosis, muscle retractions. Oxygen administration: by cannula, mask, tent catheter. Is a colorless, tasteless, and odorless gas. Is considered a drug, needs an order, flammable. **Chapter 31** Types of pain: acute pain- usually associated with a injury, med condition, or surgical procedure. Short duration, example: burns, f=bone fractures, muscle strains. Chronic pain may continue for months or possibly years. Associated with ongoing conditions such as arthritis and back problems. Nociceptive pain involves injury to tissue in which receptors called nociceptors are located. May be found in skin, joints, or organ viscera. May be caused by trauma, burns, or surgery. NSAIDs Neuropathic pain- usually associated with a dysfunction of the nervous system- specifically, a abnormality in processing sensations. Pain receptors in the body become sensitive to stimuli and send pain signals more easily. Pain assessment/pain scales: Numeric 0-10, Faces pain scale, FLACC (face, legs, activity, cry, consolability) neonatal infant pain scale (NIPS) (CRIES)- crying requires oxygen to maintain saturation, increased vital signs, expression, and sleeplessness. (PIPP)- Premature infant pain profile. Medical methods of pain control: Oral, IV, IM, PCA Analgesic medications. 1- nonopioid pain meds, 2- cyclooxygenase-2 (COX-2) inhibitors, 3- narcotics or opioids, and 4- adjuvant analgesics. Categories of analgesic medications (Table 31.2) **Chapter 32** What are Complementary Health Approaches? Those therapies that are not currently considered part of conventional medical practice can be either in conjunction with or in place of conventional medical treatment. Role of LPN in complementary and alternative therapies: Nurses should be knowledgeable about the various types so that basic info can be given to pt if they ask. It is vital for health care providers to know whether pt are taking otc herbals or homeopathic substances because they mat interact with prescription meds.