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A private wrong, by act or omission that can result in civil action


A patient does not want an IV, but you give it anyways

Intentional Tort

The unjustifiable attempt or threat to touch a person without consent resulting in fear of immediately harmful or threatening contact

Assault - touching need not actually occur

Unlawful, harmful, or unwarranted touching of another or carrying out of threatened physical harm

Battery - touching without consent is considered battery, regardless of intent or outcome

4 Requirements to be considered MALPRACTICE

1. It must be established that the nurse had a duty to the patient - Assignments
2. A breach of standards of care or failure to carry out that duty must be proven
3. The patient must suffer actual harm or injury
4. There must be a causal relationship between the breach of duty and the injury suffered

Standards of Care focuses on

The recipient of care
Guidelines by which the nurse should practice

Standards of Nursing Practice focuses on

The provider - the nurse




doing good for patient


to do no harm




obligation to be faithful


obligation to be fair

Defined by TJC as an unanticipated event that causes the death, or serious physical or .psychological injury to a person - not related to a patient's natural course of illness

Sentinel Event

Documentation for IV therapy should include

Type, length, and gauge of vascular access device
Date and time of insertion, # of attempts, identification of site, type of dressing, and identificationof the person inserting the device.
Patient's tolerance of insertion
Site condition and appearance
Site care
Patient understanding of therapies and procedures
Discontinuing therapy - catheter integrity, site appearance, dressing, patient tolerance

What kind of masksshould be worn while caring for a patient diagnosed with TB? When should the mask be removed?

N95 - Remove the mask as soon as you get OUT of the room.

Scope of Practice - the LPN may NOT initiate or maintain:

Blood/ Blood Components
Solutions of TPN - can't hang
Cancer therapeutic agents, chemotherapy, or anti-neoplastic agents
Investigational or Experimental drugs
CVC, PICC, Arterial lines, or any line which terminates outside the periphereal circulation
Any peripheral venous site other than the hand, forearm, and antecubital fossa
No IV PUSH meds - except normal saline or heparin flush
Iv piggyback - exception : antibiotic piggyback

LPN may not change the tubing on any line ...

that DOES NOT TERMINATE in a peripheral vein

LPN may not program or set any functions on a


LPN may inject

Normal Saline Flush or Heparin Saline flush in a peripheral vein

LPN may change

peripheral IV tubing

The LPN may start an IV in

Antecubital Fossa

LPN may MAINTAIN through a CVC or PICC line these meds

Dextrose 5% , Normal Saline, Lactated Ringers, Sterile water, NaCl 0.2% or 0.45 % solution, or specified solutions which contain vitamins or electrolytes

The LPN MAY perform

routine dressing changes at the insertion sie, peripheral venous, arterial, PICC & CVC

Contains the fluid inside the billions of cells within the body; Largest of the two compartments

Intracellular fluid

Contains any fluid outside the cell; Divided into interstitial and intravascular compartments.

Extracellular Fluid

Fluid betweein the cells or in the tissue
Ex: Lymph, CSF. and GI secretions

Interstitial Fluid

Plasma within the vessels

Intravascular fluid

Average daily water intake and output is

1500-2500 mL

Average output is

40-50 mL per hour...minimum of 30

Electrolytes that are not stored and must be consumed daily

Sodium, chloride, Potassium

No cellular energy is required to move substances from a high concentration to a low concentration

Passive Transport

Cellular energy is required to move substances from low concentration ot high concentration

Active Transport

The movement of particles in all directions through a solution or gas. Solutes move from area of higher concentration to an area of lower concentration, resulting in an equal distribution of solutes within the two areas


The movement of water from an area of lower concentration to an area of higher concentration


A solution of higher osmotic pressure
Pulls fluid from the cells - cells to vascular

**Hypertonic Solutions - ABOVE 375**

A solution of the same osmotic pressure
Expands the body's fluid volume WITHOUT causing a fluid shift

**Isotonic Solutions - 250-375**

A solution of lower osmotic pressure
Moves into the cell, causing them to enlarge

**Hypotonic Solutions - Below 250**

Anions (Negative charge)


Cations (positive charge)


A balance of cations and anions should exist, if not...

the body will not be in homeostasis

If a patient is receiving hypertonic solution, they are receiving it through


If O2 is going from arteries to capillaries


Normal Lab levels of sodium

135 to 145

Normal lab levels of potassium

3.5 to 5

Normal lab levels of chloride

95 to 105

Normal lab levels of calcium

9 to11

Normal lab levels of bicarbonate

22 to 26

Normal pH

7.35 - 7.45

pH less than 7.35


pH more than 7.45


Normal range of cO2


cO2 less than 35


cO2 more than 45


normal range of HCO3


HCO3 less than 22


HCO3 more than 26


Major source of sodium


Sodium levels less than 135 - can occur where there is sodium loss or a water excess. Holds onto water to increase sodium. Likely to have a potassium imbalance as well

HYPOnatremia - decreased BUN , dry mucous membranes, thirsty

Symptoms of hyponatremia

Muscle Weakness
Muscle Twitching
Decreased Skin Turgor
Tremor, seizures, or coma

Treatment of hyponatremia

Dietary replacement, can use enteral route, or parenteral route. Replace sodium and fluid losses as well as correcting other electrolye imbalances

Sodium levels greater than 145 Sodium excess or water loss. Causes fluid to shift from the cells to the interstitial spaces, resulting in cellular dehydration


Signs and symptoms of hypernatremia

Marked thirst, elevated body temperature, oliguria, swollen tongue, red, dry, and sticky mucus membranes. Severe= disorientation, irritability, hyperactivity when stimulated

Treatment of hypernatremia

Infusion of hypotonic solution
Use of diuretics

Recommended potassium intake per day

65 mEq per day

Neuromuscular changes - fatigue, weakness, anorexia, N, V, Irritability (early) increased sensitivity to digitalis, death caused by cardiac arrest, decreased bllod pressure, decreasesd bowel motility, rapid, weak, or irregular pulse

Signs and symptoms of Hypokalemia

Treatment of Hypokalemia

K+ Replacement -** never give K+ IV push** Monitior EKG rhythm

What is the major cause of hyperkalemia?

Renal Disease

What is the reversal for excess potassium?


Signs and symptoms of hyperkalemia

muscle weakness, nausea and diarrhea, oliguria, parethesia of the face, tongue, hands, and feet

Signs and symptoms of Hypocalcemia

Positive trousseau's sign and chvostek's sign
Altered cardiovascular hemodynamics**most dangerous** - laryngospasm and tetany like contractions, memory impairment, delusions, seizures( late symptoms)

Treatment of hypocalcemia

Hypocalcemia is treated with calcium gluconate or carbonate(TUMS)

contraction of a facial muscle in response to a light tap over the facial nerve in front of the ear

Chvostek's sign

a carpal spasm indused by inflating a blood pressure cuff above the systolic pressure for a few minutes

Trousseau's sign

Signs and symptoms of hypercalcemia

muscle weakness, Inccordination, lethargy, deep bone pain, flank pain, pathological fractures, constipation, anorexia, N, V, polyuria, polydipsia that leads to uremia, headache

Treatment of hypercalcemia

treat underlying cause(osteoporosis, bone cavitation, urinary calculi
Lasix to prevent fluid overload, hemodialysis, peritoneal dialysis, calcitonin temporarily lowers serum levels, biphosphonate

What is an example of a plasma colloid?


1 kg or 2.2 pounds =

1 L of body fluid

Signs and symptoms of FVD

Acute weight loss, N&V, increased HR, decreased BP, weak periphereal pulses, changes in mental status, disorientation, lethargy, dizziness, vertigo, sunken eyeballs, poor skin turgor, increased thirt, decreased urine output


fLUID REPLACEMENT - extreme caution to avoid fluid overload
Lactated ringers or 0.9 NaCl - isotonic solutions

Signs and symptoms of FVE


acute weight gain
changes in mental status
hypertension, tachycardia, bounding pulse, increased centarl venous pressure, and jugular venous distention, SOB, tachypnea, dyspnea, cough, crackles, edema

Treatment of FVE

fluid and sodium restriction
evaluate the pt. for potential fluid and electrolyte imbalances due to corrective therapy

Confusion, drowsiness, weakness, dyspnea, hyperkalemia
Lung diseases such as COPD and severe asthma
Airway obstruction

Respiratory Acidosis

Kussmaul's respirations - muscle weakness, malaise, headache,

Metabolic acidosis

common cause is hyperventilation, anxiety, fever
any lung disease that leads to SOB & hypoxia - pneumonia,
mental status change, pallor around mouth, tingling fingers, spasm of hand muscles

Respiratory acidosis

Treatment of respiratory acidosis

breathe intoa paper bag

sever sutained vomiting or NG suctioning(removes too much pH) - overdose of baking soda or antacids
symptoms: confusion, dyspnea, drowsiness, hypeerkalemia, weakness

Metabolic alkalosis

what are the 3 systems that work to keep the pH in normal range?

Blood Buffers

The ratio needed for homeostasis of carbonic acid to bicarbonate is....

1 part carbonic acid to 20 parts bicarbonate

Lungs job in acid base balance

speeds up or slows down respirations to increases or decrease carbon dioxide in the blood

Kidneys job in acid base balance

They excrete varying amounts of acid or base

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