Nursing 172 W1D1

Scope of Practice

• LPN vs. RN:

  • LPNs (Licensed Practical Nurses) can contribute to care plans by implementing delegated tasks from RNs but cannot initiate care plans independently. This is primarily due to the educational differences and scope of practice defined by state regulations.

  • LPNs are not permitted to diagnose medical conditions nor set up specialized intravenous lines such as Peripherally Inserted Central Catheter (PICC) lines or central lines, which require advanced training and skills typically given to RNs (Registered Nurses), Nurse Practitioners (NPs), or physicians.

IV Access Types and Placement

• Central Line:

  • A central line terminates in the superior vena cava and is ideally inserted through veins in the neck (jugular) or chest (subclavian). This access device is utilized for long-term treatments, particularly when other IV access is not viable.

  • Only RNs, NPs, or physicians hold the authority to insert or remove a central line due to its complexity and associated risks, including pneumothorax and infection.

• PICC Line:

  • A PICC line, or Peripherally Inserted Central Catheter, is generally placed in the upper arm, with its tip residing in the superior vena cava. This type of line is appropriate for prolonged administration of intravenous medications or for patients requiring frequent blood draws.

  • LPNs cannot place or remove a PICC line; only RNs with specialized training may place it, adhering to strict infection control protocols.

• Peripheral IV:

  • LPNs are authorized to insert peripheral IVs, provided they are less than 3 inches long and inserted below the antecubital fossa (the region of the inner elbow).

  • Appropriate sites for insertion include various veins in the forearm and hand, where the risk of complications such as infiltration and phlebitis remains lower.

Procedures and Responsibilities

• Medications:

  • LPNs have the capability to administer a variety of medications, including:

  • Oral medications, ensuring accurate dosages and patient understanding.

  • Subcutaneous and intramuscular injections with precise techniques to reduce discomfort and anxiety for patients.

  • IV medications (like antibiotics) after the initial bag containing vitamins or electrolytes has been administered by an RN, ensuring collaborative practice and safety.

  • LPNs can flush IV lines with saline or heparin, maintaining the patentcy of the line and preventing complications.

• Emergency Actions:

  • In emergency situations where a patient experiences distress (e.g., allergic reactions or respiratory issues), LPNs are equipped to stop any potentially harmful medication immediately and alert the appropriate medical personnel (RN or physician), ensuring prompt intervention and patient safety.

Patient Management

• Flushing vs. Pushing:

  • Flushing: Refers to the process of cleaning out the IV line with saline prior to administering medications or fluids, which is crucial to ensure no residual medication affects the new treatment.

  • Pushing: Involves the rapid administration of medications via IV, which requires careful monitoring for adverse reactions, ensuring timely assessment post-administration.

• Antibiotics:

  • Common antibiotics utilized include penicillin, known for treating various infections, and vancomycin, used for resistant bacterial infections.

  • LPNs should remember the mnemonic "You live in a house of SIN" to recall that many antibiotics share the suffix "-cin," aiding in safe medication administration and communications.

Pediatric Patients (Little Timmy)

• Procedures:

  • In pediatric care, LPNs are permitted to administer oral medications and provide subcutaneous or intramuscular injections as prescribed.

  • They are prohibited from starting IVs or administering medications unless a pre-existing IV is in place, emphasizing the importance of risk management with pediatric patients.

  • LPNs may adjust the rate of fluid flow in accordance with physician orders, ensuring appropriate fluid management depending on the child's clinical needs.

Legal Standards and Ethics

• Malpractice:

  • Malpractice claims revolve around four key elements:

  • Duty: The recognized responsibility for patient care and adherence to legal standards.

  • Breach of Duty: Occurs when a healthcare professional fails to fulfill their responsibilities adequately.

  • Injury: Harm or damage resulting to the patient due to the breach of duty.

  • Causation: The direct link demonstrating how the breach of duty led to the patient's injury, establishing liability.

• Reporting:

  • Accurate documentation and timely reporting of any incidents or near-misses are crucial in healthcare settings to foster learning and prevent recurrence of similar occurrences in the future, enhancing overall patient safety.

Patient Safety

• National Patient Safety Goals:

  • Vital goals include promoting effective communication among staff, ensuring safe medication practices, preventing mistakes such as incorrect patient identification, and fostering an environment emphasizing overall patient safety throughout the healthcare facility.

• Root Cause Analysis:

  • The process of investigating sentinel events to identify underlying causes allows healthcare facilities to create strategies that mitigate risk and prevent future harm, enhancing patient safety protocols.

Fluid Management

• Isotonic Solutions:

  • Examples include 0.9% sodium chloride (normal saline), often used in cases of blood loss or trauma as they maintain blood volume and electrolyte balance without shifting fluid in or out of cells.

• Hypotonic Solutions:

  • These solutions lower blood pressure by pulling fluid from the vasculature into cells, which can be indicated for certain clinical scenarios but are contraindicated in conditions like increased intracranial pressure due to the risk of cell swelling.

• Hypertonic Solutions:

  • Serve to increase blood pressure by drawing fluid from within cells into the vascular space, making it inappropriate for patients with hypertension as it may exacerbate the condition.

Surgical Protocols

• Time Out Procedure:

  • This critical safety measure involves a thorough verification process ensuring correct patient identification, surgical site, and procedure verification before any surgical intervention, thereby reducing the risk of errors.

Collaboration in Care

• Strong emphasis is placed on the importance of multidisciplinary collaboration among RNs, physicians, and various healthcare professionals to uphold the highest standard of patient care, facilitating a comprehensive and patient-centered approach.

Ethical Terms

• Autonomy, Beneficence, Non-maleficence, Veracity, Fidelity, Justice:

  • Understand and uphold the following ethical principles:

  • Autonomy: Acknowledging and respecting a patient’s right to self-determination and informed choice.

  • Beneficence: Commitment to act in the patient’s best interest, ensuring their well-being and improvement of their condition.

  • Non-maleficence: The ethical obligation to do no harm, advocating for patient safety at all times.

  • Veracity: Upholding honesty and transparency in all aspects of patient care, establishing trust.

  • Fidelity: Being faithful to commitments made to patients and providing consistent care and support.

  • Justice: Ensuring fairness in the distribution of healthcare resources and equitable treatment for all patients, regardless of background.