172 Final Exam Study Guide

National Patient Safety Goals

• List of guidelines to prevent harming patients.
• Examples:
  • Hand hygiene.
  • Verify medication using a day up bar.
  • Confirm patient identity with name and date of birth.
  • Effective use of alarms.
  • Effective communication with coworkers.
  • Time out before surgical procedures.
  • Ensuring correct and safe surgical procedures.
  • Maintaining patient safety, including suicide precautions and isolation precautions.

Malpractice

• Four components:
  • Duty
  • Breach of duty
  • Injury
  • Causation
• Malpractice is not always a sentinel event, and a sentinel event is not always malpractice.

Sentinel Event

• Extreme harm to a patient. Examples:
  • Surgical instruments left in the body.
  • Extravasation requiring extended hospitalization and surgical intervention.
  • Vegetative patient found to be pregnant, indicating sexual assault.

Tonicity

• Categories:
  • Isotonic
  • Hypotonic
  • Hypertonic

Isotonic Solutions

• Refill the tank and replace lost fluids to maintain fluid volume and, consequently, pressure.
• Fluid volume is directly related to pressure: Fluid Volume \uparrow = Pressure \uparrow

Hypotonic Solutions

• Pulls fluid from the vasculature into the cells, causing them to swell.
• Contraindicated in patients with increased intracranial pressure, head trauma, or stroke.
• Should not be given to patients with low blood pressure.

Hypertonic Solutions

• Pulls fluid from the cells into the circulatory system, increasing blood pressure.
• Contraindicated in patients with elevated blood pressure.

Types of Solutions

• Isotonic: 0.9% saline, lactated ringers, D5W (5% dextrose in water), 5% albumin.
• Hypotonic: Solutions less than 0.9% saline (e.g., 0.45% saline).
• Hypertonic: Solutions greater than 0.9% saline, D10.

Fluid Volume Deficit

• Leads to hypotension and tachycardia.
• Dry skin and mucous membranes.
• Decreased urine output and kidney function, resulting in dark, concentrated urine.

Fluid Volume Overload

• Can cause pedal edema due to the heart's inability to process fluid effectively.
• Can lead to difficulty breathing, crackles in the lungs, low oxygen saturation, and increased respiratory rate.
• Can progress to respiratory arrest.

Conversions

• 1 \text{ mL} = 30 \text{ cc}

Electrolytes

Potassium

• Excreted in urine.
• Renal failure patients cannot excrete potassium, leading to electrolyte imbalances and the need for dialysis.

Magnesium

• Closely related to potassium levels.
• Affects heart function.

Calcium

• Hypocalcemia:
  • Can cause laryngeal spasms, potentially leading to airway obstruction and death.
  • Indicators: Chvostek’s and Trousseau’s signs.

Scope of Practice (LPN)

• Adult patients:
  • Can administer oral, subcutaneous, intramuscular, and rectal medications.
  • Can start peripheral IVs from the antecubital fossa down (less than three inches).
  • Can flush with normal saline and heparin.
  • Can start approved fluids, antibiotics, anti-infectives, anti-fungals, and anti-tubercular medications.
  • Cannot administer IVs straight to the jail.
• Cannot administer:
  • Titrated medications.
  • Heparin drips.
  • Insulin drips.
  • Cardiac medications.
  • G.I. medications.
• Can remove pre-existing peripheral IVs from the antecubital fossa down (less than three inches) if there are signs of infection, phlebitis, infiltration, or extravasation.
• Can change dressings.
• Can stop any medication causing harm.
• With a physician's order, can increase or decrease the rate of flow of a basic fluid.
• In Ohio, LPNs can access ports when trained appropriately, using a non-coring needle.

Spiking and Priming IV Bags

• Purpose: To remove air bubbles from the IV bag and tubing.
• Key components: Spike and the part connecting to the patient.
• If any part is contaminated, the entire setup must be replaced.

Documentation

• All actions must be documented with initials, date, and time.
• Examples: changing dressings, hanging bags, changing tubing, starting IVs.

Arterial Blood Gases (ABGs)

• Components: pH, PCO2, and bicarbonate (HCO3).
• Determine if pH is acidic or basic, then match it with the corresponding system.
• No compensation: Only one system (respiratory or metabolic) is affected.
• Partial compensation: Both systems are affected, but pH is still abnormal.
  *Complete compensation: pH is normal, and both systems are affected; determine if pH is closer to acidic or basic to identify the primary issue.

Infections related to IVs

• Central lines: increased risk for infection. Change every seven days unless there is evidence of infection such as follicles, then its every 48 hours.
  • Inserted in the subclavian area or internal jugular (avoid groin due to contamination).
  • Tunnel or implanted ports are placed under the skin and allow for normal activity once healed.
• Phlebitis:
  • Mechanical: movement.
  • Bacterial: bacteria.
  • Chemical: medication or cleansing agent.
  • Post-infusion: infection after removal.
• Phlebitis Scale:
  • 0: No symptoms.
  • 1: Redness with or without pain.
  • 2: Redness, pain, swelling.
  • 3: Redness, pain, swelling, palpable cord.
  • 4: All of the above + purulent drainage.

Complications

Infiltration

• Basic fluid (e.g., normal saline) escapes the vein into surrounding tissue.
• Area is cool, swollen, and may be painful.
• Treatment: Stop infusion, elevate extremity, monitor, and manage pain.

Extravasation

• Infiltration of a vesicant (medication that causes tissue damage or necrosis).
• Treatment: Stop infusion, leave IV in place, disconnect tubing, contact pharmacist and doctor for antidote, administer antidote to create a barrier around the site.

Tubing Changes

• Primary tubing: Every 96 hours.
• Secondary tubing: Every 24 hours.
• Peripheral IV tubing: Every 72-96 hours, same as the central line.

Additional Considerations

• If a patient shows signs of respiratory depression or altered mental status, stop the infusion.
• Epidural catheters can be filled with antibiotics, chemotherapy, or pain medications, used in hospitals or home care, and discontinued when treatment is complete.
• Prioritize airway, breathing, circulation, safety, and infection control.