LPNS 1115 Practical Nursing Lab Exam Review Study Guide

Unit 1: Assessment of the Healthy Patient

• Clinical Judgment Concept: Systematic Physical Assessment     - Objective #$1$: Demonstrate a systematic physical assessment on an adult in the laboratory setting.     - Equipment and Techniques:         - Vital Signs: Assessment includes temperature, respirations, blood pressure ($BP$), apical and radial pulse, and pulse oximetry.         - Cognitive/Neuro Assessment: Evaluation of Level of Consciousness ($LOC$), orientation, and pupils.         - Respiratory Assessment: Evaluating lung sounds and breathing patterns.         - Cardiovascular Assessment: Assessing heart sounds and peripheral pulses.         - Bowel/Bladder Assessment: Evaluation of elimination and abdominal health.         - Musculoskeletal Assessment: Assessing strength, range of motion, and mobility.         - Integumentary Assessment: Assessing skin integrity, color, and temperature.     - The 7 Starting Steps for All Procedures:         1. Verify order.         2. Gather equipment/supplies.         3. Perform hand hygiene.         4. Ensure patient privacy.         5. Introduce self.         6. Identify patient using $2$ identifiers.         7. Explain the procedure.     - The 6 Ending Steps for All Procedures:         1. Place patient in a comfortable position.         2. Put call light within reach.         3. Ensure side rails are up and the bed is lowered.         4. Clean up equipment and supplies.         5. Perform hand hygiene.         6. Complete documentation.     - Assessment Techniques and Order:         - General Order: Inspection, Palpation, Auscultation.         - Abdominal Assessment Exception: Auscultate before palpating to avoid altering bowel sounds.     - Systematic Reasoning: Assessment must be systematic to ensure no data is missed. If a patient is stable but assessment data seems inconsistent with status, the nurse must reassess.

• Clinical Judgment Concept: Normal vs. Abnormal Limits     - Objective #$2$: Recognize physical assessment data that is within normal limits ($WNL$) and outside of normal limits for the adult population.     - Expected Findings: Must know "normal" findings for cognitive/neuro, respiratory, cardiovascular, bowel/bladder, musculoskeletal, and integumentary systems using correct medical terms.     - Critical Vital Sign Ranges: Must know normal ranges for temperature, respirations, $BP$, apical/radial pulse, and pulse oximetry.     - Adequate Ventilation and Perfusion: Recognizing these signs serves as the basis for the concepts of Gas Exchange and Perfusion.

• Clinical Judgment Concept: Recording Assessment     - Objective #$3$: Record a complete head-to-toe assessment using correct medical terms.

• Clinical Judgment Concept: Individual Alterations in Technique     - Objective #$4$: Discuss alterations in assessment techniques to meet needs of individual patients.     - Age Groups:         - Elderly: May need to talk slower and take more time; may require family assistance if cognition is altered. Understand age-related changes that are "normal" for the elderly but might seem "abnormal" for a younger adult.         - Children: Use techniques based on developmental age; use appropriately sized equipment (e.g., smaller $BP$ cuff).     - Special Needs: Adjust for patients who are hard of hearing or have impaired cognition.     - Cultural Aspects: Techniques vary based on culture; be mindful of eye contact and touching preferences.

• Gas Exchange Concept     - Objective #$5$: Recognize alterations in gas exchange that need immediate response or increased level of care.     - Pathophysiology: Understand the structures involved and specifically where and how gas exchange occurs.     - Signs/Symptoms of Inadequate Gas Exchange: Cough, sputum, apnea, dyspnea, pain, changes in vital signs, adventitious lung sounds, abnormal posture, accessory muscle use, cyanosis, and pursed-lip breathing.     - Key Terms:         - Apnea: Absence of breathing.         - Dyspnea: Difficulty breathing.         - Bradypnea: Slow breathing rate.         - Tachypnea: Fast breathing rate.         - Hypoxia: Low oxygen in tissues.         - Orthopnea: Difficulty breathing while lying flat.         - Cyanosis: Bluish discoloration from lack of oxygen.         - Crackle/Wheeze: Adventitious lung sounds.         - Perfusion/Ventilation: Flow of blood/flow of air.

• Perfusion Concept     - Objective #$6$: Recognize alterations in perfusion that need immediate response or increased level of care.     - Circulation Basics: Involves veins, arteries, and capillaries. Any interruption alters perfusion.     - Signs/Symptoms of Inadequate Perfusion: Changes in heart rate and blood pressure, altered orientation, weakened pulses, cold extremities, pain, dyspnea, fatigue, and dizziness.     - Key Terms:         - Bradycardia: Slow heart rate.         - Tachycardia: Fast heart rate.         - Hypotension: Low blood pressure.         - Hypertension: High blood pressure.         - Edema: Swelling.         - Orthostatic/Postural Hypotension: Drop in $BP$ when standing up.         - Cardiac Output: Volume of blood heart pumps per minute.         - Ischemia: Inadequate blood supply to an organ.         - Stroke Volume: Volume of blood pumped from a ventricle per beat.

• Cognition Concept     - Objective #$7$ & #$8$: Explain how cognition affects physical assessment and recognize alterations needing immediate response.     - Assessment Priority: Cognition should be assessed first. If the patient cannot provide info, utilize family.     - Validation: Validate subjective data (what pt says) with objective data (what nurse sees).     - Alterations: Changes in orientation/$LOC$; pupils not equal, round, reactive to light and accommodation ($PERRLA$).     - Reflexes: Consensual reflex and nystagmus (involuntary eye movement).     - Assessment Tools: Glasgow Coma Scale ($GCS$) and Mini-Mental State Exam ($MMSE$).

Unit 2: Assessment and Medication Safety

• Safety Concept: Pharmacological Classifications     - Objective #$1$: Describe prototype drugs. Recognize classifications and basic drug information from the "Medications to Master" packet and Top $10$ Clinical Medications.

• Safety Concept: Lab and Assessment Parameters     - Objective #$2$: Discuss specific lab and assessment parameters.     - Assessment Prior to Admin:         - Respiratory meds: Check respirations, oxygen saturation, lung sounds.         - Cardiovascular meds: Check apical pulse and blood pressure.         - Safety Check: Assess if the patient can swallow safely.     - Common Lab Correlations:         - Warfarin: $PT/INR$.         - Insulin: Blood glucose.         - Digoxin: Digoxin level.         - Furosemide/Potassium Chloride: Electrolytes.

• Safety Concept: Pharmacokinetics Throughout the Lifespan     - Objective #$3$: Identify changes in pharmacokinetics.     - Absorption: Reduced $GI$ tract absorption in the elderly.     - Distribution: Decreased serum albumin in the elderly.     - Metabolism: Liver function is decreased in both infants (young) and the elderly.     - Excretion: Kidney function is immature in the young and decreased in the elderly.

• Safety Concept: Medication Administration     - Objective #$4$: Demonstrate safe administration using the $6$ Rights.     - The 6 Rights: Right patient, right medication, right dose, right route, right time, right documentation.     - The 3 Checks: Verify meds three times before administration.     - Medication Documentation: Includes marking the $MAR$ and the Controlled Substance Record for narcotics.     - Routes:         - Percutaneous: Absorbed via skin/mucous membranes (creams, lotions, ointments, transdermal patches).         - Enteral: Oral meds, sublingual ($SL$), and buccal tablets.         - Instillations: Eye drops/ointments, ear drops, nose drops/sprays.         - Inhalation: Nebulizers and inhalers.

• Safety Concept: PRN Medications and Documentation     - Objective #$5$, #$6$, & #$7$: Evaluate effects and document after administration.     - Nurse\'s Note for PRN: Must include subjective/objective data supporting the need, pharmacologic vs non-pharmacologic interventions (include time/dose), and effectiveness of the intervention.

• Pain Concept and Management     - Objective #$8$, #$9$, & #$10$: Assess comfort and non-pharmacological interventions.     - WILDA Tool: Words, Intensity, Location, Duration, Aggravating/alleviating factors.     - PQRST Tool: Provocation, Quality, Region, Severity, Timing.     - Pain Scales: Numerical Rating Scale ($NRS$), Visual Analog Scale ($VAS$), $FLACC$ (for infants/non-verbal), Wong-Baker Faces scale.     - Medication Tiers: Ibuprofen/Acetaminophen for mild pain; Oxycodone for moderate to severe pain.     - Acetaminophen Safety: Total $24$-hour dose cannot exceed $4000\,mg$ ($4\,g$).     - Non-Pharmacological Methods: $TENS$ unit, Heat/cold, Relaxation, Biofeedback, Distraction, Guided imagery, Music, Massage.

Unit 3: Immunity, Cellular Regulation, and Tissue Integrity

• Immunity Concept     - Definition: "The normal physiological response to microorganisms and proteins as well as conditions associated with an inadequate or excessive immune response" (Giddens, $2021$ p. $209$).     - Objective #$1$: Recognize common immune responses.     - Innate Immunity (Non-specific/Fast):         - External: Intact skin and mucous membranes.         - Internal: Chemical barriers, phagocytosis (neutrophils and macrophages), inflammatory response, and fever.     - Acquired/Adaptive Immunity (Specific/Memory):         - Humoral: Antibody-mediated ($B\,lymphocytes$).         - Cell-Mediated: $T\,lymphocytes$.     - Classifications of Immunity Against Disease:         - Active Naturally Acquired: Acquire disease and survive it.         - Active Artificially Acquired: Immunizations.         - Passive Naturally Acquired: Maternal antibodies.         - Passive Artificially Acquired: Monoclonal antibodies.     - Testing: Skin testing (e.g., $TB$) and $CBC$ with differential (leukocytes).

• Healing Process Factors     - Objective #$2$: Explain factors affecting healing.     - Age: Changes in immune/integumentary systems.     - Comorbidities: Chronic diseases affecting perfusion/gas exchange (tissue repair needs oxygen and nutrients).     - Lifestyle: Nutrition, physical activity, hydration, and smoking.

• Biological Specimen Collection     - Objective #$3$: Demonstrate aseptic collection.     - Includes phlebotomy, stool, wound/throat cultures, sputum, and urine.     - Culture & Sensitivity ($C\&S$): Determines the organism and the appropriate antibiotic.

• Cellular Regulation Concept     - Definition: "All functions carried out within a cell to maintain homeostasis…" (Giddens, $2021$ p. $103$).     - Objective #$4$: Anemias and impact on healing.     - Anemia Pathophysiology:         1. Decrease in blood cell production (nutrition/megaloblastic).         2. Excessive destruction of $RBCs$.         3. Loss of $RBCs$ (bleeding/hemorrhage).     - Nutrients for RBCs: Iron, folic acid, Vitamin $B_{12}$, Amino acids, Vitamin $C$.     - Role of Organs: Kidneys produce erythropoietin; bone marrow contains stem cells for production.     - Labs: Complete Blood Count ($CBC$) monitors $RBC$, hemoglobin, hematocrit, and platelets.

• Electrolytes     - Objective #$6$ & #$7$: Identify normal ranges and sources.     - Comprehensive Metabolic Profile ($CMP$): Blood panel for Sodium ($Na^+$), Potassium ($K^+$), Calcium ($Ca^{+}$), Magnesium ($Mg^{+}$), Phosphate ($HPO_4^-$), and Chloride ($Cl^-$).     - MEMORIZE: Potassium and Sodium ranges.     - Sources: Primarily diet; replacement medications like Potassium Chloride ($KCl$).

• Tissue Integrity Concept     - Definition: "The state of structurally intact and physiologically functioning epithelial tissues…" (Giddens, $2021$ p. $250$).     - Objective #$8$: Factors causing alteration.     - Healing Stages: Primary vs. Secondary intention; partial vs. full thickness.     - Pressure Injuries: Use the Braden Scale to assess risk. Categories include friction/shear, mobility, nutrition, etc.     - Nursing Interventions: Use the $SCC$ Wound Assessment Tool. Repositioning, nutrition support, and sterile dressing changes.     - Drainage Systems: Hemavac, Jackson-Pratt ($JP$), and Wound $VAC$.

Unit 4: Chronic Perfusion and Gas Exchange

• Perfusion (Long-term Constriction)     - Definition: "The flow of blood through arteries and capillaries delivering nutrients and oxygen to cells" (Giddens, $2021$ p. $363$).     - Structures: Arteries (oxygenated), veins (deoxygenated), atrium, valves, ventricles.     - BP Factors: Cardiac output, blood volume, peripheral resistance.     - RAAS: Renin-angiotensin-aldosterone system regulates $BP$.     - Hypertension & Heart Failure: Uncontrolled hypertension leads to heart failure. Treatment involves anti-hypertensives, sodium monitoring, and weight control ($1\,L\,of\,fluid = 1\,kg = 2.2\,lbs$).

• Gas Exchange (Long-term Constriction)     - Definition: "The process by which oxygen is transported to cells and carbon dioxide is transported from cells" (Giddens, $2021$, p. $179$).     - Functional Units: Alveoli for air exchange; Bronchioles made of smooth muscle.     - CNS Control: Sensitive to $CO_2$ changes.     - Conditions:         - Asthma: Chronic inflammation; treated with steroids.         - COPD: Includes chronic bronchitis and emphysema.     - Interventions: Incentive spirometer, peak flow meter, pursed-lip breathing, oxygen safety.     - Nutrition for COPD: High calories (due to work of breathing), fluids to liquefy secretions.

Unit 5: Mobility, Motility, Fluids & Electrolytes

• Mobility and Elimination     - Terms: Urinary stasis, dysuria, hematuria, anuria, urinary retention, peristalsis, constipation.     - Osteoarthritis ($OA$): Chronic disease process requiring mobility interventions.     - Post-op Mobility: Prevents complications like $DVT$/pneumonia after hip/knee replacement.     - Assessment: $CMS$ (Circulation, Movement, Sensation) and neurovascular assessments.     - Devices: $CPM$ (Continuous Passive Motion), specialty beds, mechanical lifts, walkers, canes.

• Elimination Interventions     - Non-invasive: Try before catheters or enemas.     - Catheters: Indwelling vs. intermittent (straight cath). Complication risk: infection.     - Laxatives: Understand mechanisms of action (Unit $5$ meds).     - Fecal Impaction: Digital removal may be required.

• Fluid and Electrolytes     - Mechanisms: Diffusion, Osmosis, Filtration, Active Transport.     - Fluid Balance: Intake and output ($I/O$) should be equal over $24$ hours.     - Calculations: Recorded in $mL$. Ounces to $mL$, pounds to $kg$.     - Fluid Volume Deficit ($Hypovolemia$): Assess for decreased skin turgor, lowered $BP$, and increased heart rate.     - Fluid Volume Excess ($Hypervolemia$): Assess for edema, weight gain, and lung crackles.

Unit 6: Hormone Regulation and Endocrine Disorders

• Hormone Regulation Concept     - Definition: "The physiological mechanisms that regulate the secretion and action of hormones…" (Giddens, $2021$ p. $124$).     - Glucose Regulation:         - The G's: Glucose, Glycogen (stored), Glucagon (released to raise blood sugar).         - Insulin: Hormone released to decrease blood sugar.     - Diabetes:         - Type 1: Absolute insulin deficiency.         - Type 2: Insulin resistance or impaired secretion.         - Hyperglycemia: High blood sugar.         - Hypoglycemia: Low blood sugar ($Priority!$). Recheck blood glucose in $15$ minutes after treatment.

• Thyroid Regulation     - Hormones: $TSH$ (Thyroid Stimulating Hormone), $T_3$, $T_4$.     - Role of Gland: Pituitary gland regulates thyroid function.     - Diet: Iodine and protein are essential for thyroid health.

• Pharmacology and Safety     - Insulin Types: Must know onset, peak, and duration.     - Dosing: Basal (long-acting), Bolus (mealtime), Sliding Scale (correction dose based on current glucose).     - Counter-Regulatory Hormones: Cortisol, Epinephrine, and Glucagon (all increase blood glucose).     - Injections: Sites and techniques for Intradermal ($ID$), Subcutaneous ($SQ$), and Intramuscular ($IM$).     - Sick Day Rules: Continue insulin even if not eating, monitor glucose more frequently, check urine for ketones.     - Effective Education: Patients should maintain normal weight, stable glucose, and be free of complications.

Unit 1: Assessment of the Healthy Patient

• Clinical Judgment Concept: Systematic Physical Assessment
    - Objective #1: Demonstrate a systematic physical assessment on an adult in the laboratory setting.   - Equipment and Techniques:
      - Vital Signs: Assessment includes temperature, respirations, blood pressure (BP), apical and radial pulse, and pulse oximetry.     - Cognitive/Neuro Assessment: Evaluation of Level of Consciousness (LOC), orientation, and pupils.     - Respiratory Assessment: Evaluating lung sounds and breathing patterns.     - Cardiovascular Assessment: Assessing heart sounds and peripheral pulses.     - Bowel/Bladder Assessment: Evaluation of elimination and abdominal health.     - Musculoskeletal Assessment: Assessing strength, range of motion, and mobility.     - Integumentary Assessment: Assessing skin integrity, color, and temperature.
    - The 7 Starting Steps for All Procedures:
      1. Verify order.
      2. Gather equipment/supplies.
      3. Perform hand hygiene.
      4. Ensure patient privacy.
      5. Introduce self.
      6. Identify patient using 2 identifiers.
      7. Explain the procedure.
    - The 6 Ending Steps for All Procedures:
      1. Place patient in a comfortable position.
      2. Put call light within reach.
      3. Ensure side rails are up and the bed is lowered.
      4. Clean up equipment and supplies.
      5. Perform hand hygiene.
      6. Complete documentation.
    - Assessment Techniques and Order:
      - General Order: Inspection, Palpation, Auscultation.
      - Abdominal Assessment Exception: Auscultate before palpating to avoid altering bowel sounds.
      - Systematic Reasoning: Assessment must be systematic to ensure no data is missed. Reassessment is essential when assessment data is inconsistent with a patient’s stable status.

Unit 2: Assessment and Medication Safety

• Clinical Judgment Concept: Normal vs. Abnormal Limits
    - Objective #2: Recognize physical assessment data within normal limits (WNL) and outside of normal limits for adults.   - Expected Findings: Understand normal findings for cognitive/neuro, respiratory, cardiovascular, bowel/bladder, musculoskeletal, and integumentary systems using correct medical terms.
    - Critical Vital Sign Ranges: Know normal ranges for temperature, respirations, BP, apical/radial pulse, and pulse oximetry.
    - Adequate Ventilation and Perfusion: Signs serve as the basis for gas exchange and perfusion concepts.

• Clinical Judgment Concept: Recording Assessment
    - Objective #3: Record a complete head-to-toe assessment using correct medical terms.

• Clinical Judgment Concept: Individual Alterations in Technique
    - Objective #4: Discuss alterations in assessment techniques for individual patient needs.
    - Age Groups:
      - Elderly: Communicate slowly, allow more time; family assistance may be needed for cognition.
      - Children: Use age-appropriate techniques; size equipment accordingly (e.g., smaller BP cuff).
      - Special Needs: Adjust for patients with hearing impairments or cognitive difficulties.
      - Cultural Aspects: Be mindful of variations in assessment techniques based on culture.

Unit 3: Immunity, Cellular Regulation, and Tissue Integrity

• Gas Exchange Concept
    - Objective #5: Recognize alterations in gas exchange requiring an immediate response or increased level of care.
    - Pathophysiology: Understand structures involved in gas exchange.
    - Signs/Symptoms of Inadequate Gas Exchange: Cough, sputum, apnea, dyspnea, pain, changes in vital signs, adventitious lung sounds, abnormal posture, accessory muscle use, cyanosis, pursed-lip breathing.
    - Key Terms:
      - Apnea: Absence of breathing.
      - Dyspnea: Difficulty breathing.
      - Bradypnea: Slow breathing rate.
      - Tachypnea: Fast breathing rate.
      - Hypoxia: Low oxygen in tissues.
      - Orthopnea: Difficulty breathing while lying flat.
      - Cyanosis: Bluish discoloration from lack of oxygen.
      - Crackle/Wheeze: Adventitious lung sounds.
      - Perfusion/Ventilation: Flow of blood/flow of air.

• Perfusion Concept
    - Objective #6: Recognize alterations in perfusion requiring an immediate response or increased level of care.
    - Circulation Basics: Involves veins, arteries, and capillaries; any interruption alters perfusion.
    - Signs/Symptoms of Inadequate Perfusion: Changes in heart rate, blood pressure, altered orientation, weakened pulses, cold extremities, pain, dyspnea, fatigue, dizziness.
    - Key Terms:
      - Bradycardia: Slow heart rate.
      - Tachycardia: Fast heart rate.
      - Hypotension: Low blood pressure.
      - Hypertension: High blood pressure.
      - Edema: Swelling.
      - Orthostatic/Postural Hypotension: Drop in BP when standing.
      - Cardiac Output: Volume of blood heart pumps per minute.
      - Ischemia: Inadequate blood supply to an organ.
      - Stroke Volume: Blood volume pumped from a ventricle per beat.

Unit 4: Chronic Perfusion and Gas Exchange

• Cognition Concept
    - Objectives #7 & #8: Explain how cognition affects physical assessment and recognize alterations needing immediate response.
    - Assessment Priority: Cognition is assessed first. Family assistance may be needed if the patient cannot provide information.
    - Validation: Validate subjective data with objective data.
    - Alterations: Changes in orientation/LOC; pupils not equal, round, reactive to light and accommodation (PERRLA).
    - Reflexes: Consensual reflex and nystagmus (involuntary eye movement).
    - Assessment Tools: Glasgow Coma Scale (GCS) and Mini-Mental State Exam (MMSE).

Unit 5: Mobility, Motility, Fluids & Electrolytes

• Mobility and Elimination:
    - Terms: Urinary stasis, dysuria, hematuria, anuria, urinary retention, peristalsis, constipation.
    - Osteoarthritis (OA): Chronic disease process requiring mobility interventions.
    - Post-op Mobility: Crucial to prevent complications like DVT/pneumonia after hip/knee replacements.
    - Assessment: Circulation, Movement, Sensation (CMS) and neurovascular assessments.
    - Devices: CPM (Continuous Passive Motion), specialty beds, mechanical lifts, walkers, canes.

Unit 6: Hormone Regulation and Endocrine Disorders

• Elimination Interventions:
    - Non-invasive approaches should be attempted before resorting to catheters or enemas.
    - Catheters: Understand indwelling vs. intermittent (straight cath) differences and the associated infection risks.
    - Laxatives: Know the mechanisms of action as taught in Unit 5.   - Fecal Impaction may require digital removal.

• Fluid and Electrolytes:
    - Mechanisms include diffusion, osmosis, filtration, and active transport.
    - Fluid Balance: Intake and output (I/O) should be equal over 24 hours.
    - Calculations: Documented in mL; understanding conversions from ounces to mL and pounds to kg.
    - Fluid Volume Deficit (Hypovolemia): Assess for decreased skin turgor, lowered BP, and increased heart rate.
    - Fluid Volume Excess (Hypervolemia): Assess for edema, weight gain, and lung crackles.