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91 terms


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