Nursing Essentials: Quick Reference for LPN & RN Students

Posted on Apr 9, 2025 in Medicine & Health

Nursing Essentials

Vital Signs:

• Temperature: Normal range 97.8°F – 99.1°F (36.5°C – 37.3°C)
• Pulse: Normal range 60-100 bpm
• Respiration Rate: Normal range 12-20 breaths per minute
• Blood Pressure: Normal range 120/80 mmHg
• Oxygen Saturation: Normal range 95-100%

Medication Administration:

• The Five Rights: Right patient, right drug, right dose, right route, right time
• Routes of Administration: Oral, IV, IM, Subcutaneous, Topical, Inhalation
• Common Medication Errors: Wrong patient, wrong dose, wrong time, wrong route

Cardiovascular System:

• Hypertension: BP > 140/90 mmHg
• Hypotension: BP < 90/60 mmHg
• Bradycardia: HR < 60 bpm
• Tachycardia: HR > 100 bpm

Respiratory System:

• Bradypnea: RR < 12 breaths per minute
• Tachypnea: RR > 20 breaths per minute
• Dyspnea: Difficulty breathing
• Hypoxia: Low oxygen levels in tissues
• Hypercapnia: Excess CO2 in the blood

Infection Control:

• Standard Precautions: Hand hygiene, gloves, mask, eye protection, gown
• Airborne Precautions: N95 mask, negative pressure room (e.g., TB, measles, varicella)
• Droplet Precautions: Surgical mask within 3 feet (e.g., flu, pertussis, meningitis)
• Contact Precautions: Gloves, gown (e.g., MRSA, C. diff, VRE)

Wound Care:

• Stages of Pressure Ulcers:
  • Stage 1: Non-blanchable redness
  • Stage 2: Partial-thickness skin loss
  • Stage 3: Full-thickness skin loss
  • Stage 4: Full-thickness skin and tissue loss
• Wound Healing Phases: Inflammatory, Proliferative, Maturation

Fluid & Electrolyte Balance:

• Hyperkalemia: High potassium (>5.0 mEq/L) – Can cause cardiac arrhythmias
• Hypokalemia: Low potassium (<3.5 mEq/L) – Can cause muscle weakness
• Hypernatremia: High sodium (>145 mEq/L) – Can cause dehydration
• Hyponatremia: Low sodium (<135 mEq/L) – Can cause confusion, seizures

Neurological Assessment:

• Glasgow Coma Scale (GCS): Assesses eye, verbal, and motor responses (Score 3-15)
• PERRLA: Pupils Equal, Round, Reactive to Light and Accommodation
• Cranial Nerves: 12 pairs responsible for sensory and motor function

Endocrine System:

• Diabetes Mellitus:
  • Type 1: Insulin-dependent
  • Type 2: Insulin resistance
  • Normal Blood Glucose: 70-110 mg/dL
• Hypoglycemia: Blood glucose <70 mg/dL – Symptoms: Sweating, dizziness, confusion
• Hyperglycemia: Blood glucose >180 mg/dL – Symptoms: Thirst, frequent urination, fatigue

Gastrointestinal System:

• Constipation: Infrequent or difficult bowel movements
• Diarrhea: Frequent, loose stools
• GERD (Gastroesophageal Reflux Disease): Acid reflux causing heartburn
• Peptic Ulcer Disease: Sores in stomach lining due to H. pylori or NSAIDs

Renal System:

• Oliguria: Low urine output (<400 mL/day)
• Polyuria: Excessive urine output
• Hematuria: Blood in urine
• UTI (Urinary Tract Infection): Symptoms include dysuria, urgency, and frequency

Reproductive System:

• Menstrual Cycle: Average 28 days; ovulation ~Day 14
• Pregnancy Trimesters:
  • First: 0-12 weeks
  • Second: 13-26 weeks
  • Third: 27-40 weeks

Emergency Situations:

• CPR (Cardiopulmonary Resuscitation):
  • Adults: 30 compressions to 2 breaths
  • Infants: 15 compressions to 2 breaths
• Anaphylaxis: Severe allergic reaction – Treat with epinephrine
• Shock: Symptoms include low BP, tachycardia, confusion

Legal & Ethical Considerations:

• Informed Consent: Patient understands risks, benefits, and alternatives
• HIPAA: Protects patient privacy and health information
• Advance Directives: Living will, durable power of attorney
• Negligence: Failure to provide proper care leading to harm

Major Study Guide: Med-Surg Exam 1

1. Roles and Functions of LPN/LVN vs. RN

• LPN/LVN Responsibilities:
  • Monitor patient health
  • Administer medications
  • Provide basic nursing care under supervision
  • Teach patients
  • Communicate effectively
  • Collaborate with the healthcare team
  • Advocate for patients
  • Delegate tasks within scope of practice
• RN Responsibilities:
  • Assess, plan, and provide care independently
  • Supervise LPNs/LVNs
  • Provide advanced care (e.g., IV therapy, complex patient management)

2. Nurse Practice Act and Standards of Practice for LPN/LVN

• Defines the scope of practice
• Establishes requirements for licensure and continued competency
• Ensures quality and safety in nursing care

3. Quality and Safety in Nursing

• QSEN: Focus on quality and safety in patient care, including:
  • Patient-Centered Care
  • Evidence-Based Practice (EBP)
  • Teamwork and Collaboration
  • Safety
  • Informatics
  • Quality Improvement
• National Patient Safety Goals (NPSG): Identify and mitigate risks to patient safety.

4. Healthy People 2030

• Aims to promote high-quality, longer lives free of preventable diseases.
• Focuses on health equity, eliminating health disparities, and creating healthy environments.

5. Health Care Financing

• Medicare: Federal insurance for those 65+ or with certain disabilities.
  • Parts: A (Hospital), B (Medical), C (Medicare Advantage), D (Prescription Drugs)
• Medicaid: State and federal program for low-income individuals
• Insurance Types:
  • Managed Care (HMOs, PPOs)
  • Diagnosis-Related Groups (DRGs): A classification system for hospital reimbursement based on diagnosis

6. Delegation and Supervision

• Five Rights of Delegation:
  1. Right Task: Task within UAP’s scope.
  2. Right Circumstance: Appropriate setting and patient condition.
  3. Right Person: Task assigned to qualified UAP.
  4. Right Direction/Communication: Clear instructions and expectations.
  5. Right Supervision/Evaluation: Monitor outcomes, provide feedback.

7. The Nursing Process

• Assessment: Gather subjective and objective data.
• Diagnosis: Formulate nursing diagnoses based on assessment data.
• Planning: Develop care plan with measurable goals.
• Implementation: Provide care as per plan.
• Evaluation: Evaluate outcomes and revise plan as necessary.

8. Critical Thinking and Clinical Judgment

• Critical Thinking: Purposeful, informed decision-making based on evidence and clinical reasoning.
• Clinical Judgment: Applying critical thinking to clinical situations to determine outcomes and interventions.

9. Fluid and Electrolyte Balance

• Isotonic Fluids (e.g., 0.9% NS, Lactated Ringer’s):
  • Same osmolality as blood, used to hydrate without causing fluid shifts.
• Potassium (Range: 3.5-5.0 mEq/L):
  • Hypokalemia: Muscle weakness, arrhythmias
  • Hyperkalemia: Muscle weakness, arrhythmias, monitor ECG
  • Foods High in Potassium: Bananas, oranges, spinach, potatoes
• Magnesium (Range: 1.3-2.1 mEq/L):
  • Hypomagnesemia: Muscle weakness, arrhythmias, seizures
  • Hypermagnesemia: Bradycardia, respiratory depression
• Calcium (Range: 8.5-10.5 mg/dL):
  • Hypocalcemia: Muscle cramps, seizures, Trousseau’s Sign
  • Hypercalcemia: Weakness, confusion, constipation
• Sodium (Range: 135-145 mEq/L):
  • Hyponatremia: Nausea, confusion, seizures
  • Hypernatremia: Thirst, confusion

10. Acid-Base Balance

• Blood pH Range: 7.35-7.45
• PaCO2 (Normal: 35-45 mmHg): Respiratory component, reflects CO2 retention or loss.
• PaO2 (Normal: 80-100 mmHg): Oxygen level in arterial blood.
• HCO3 (Normal: 22-26 mEq/L): Bicarbonate level, reflects metabolic balance.
• Acid-Base Imbalances:
  • Metabolic Acidosis: Diabetic ketoacidosis, renal failure
  • Metabolic Alkalosis: Vomiting, antacid overuse
  • Respiratory Acidosis: Hypoventilation, COPD
  • Respiratory Alkalosis: Hyperventilation, anxiety

11. Ethical and Legal Practice

• Adhere to Nurse Practice Act and Code of Nurses.
• Respect HIPAA guidelines and patient confidentiality.
• Legal Aspects: Understand scope of practice, patient rights, and professional boundaries.

12. Infection Control and Precautions

• Infection Chain: Pathogen → Reservoir → Portal of Exit → Mode of Transmission → Portal of Entry → Susceptible Host
• Contact Precautions: MRSA, VRE, C. difficile
• Airborne Precautions: TB, measles, chickenpox
• Universal Precautions: Always wear gloves, gowns, masks as needed.

13. Holistic Care

• Address physiological, psychological, social, cultural, and spiritual needs.
• Therapeutic Nurse-Patient Relationship: Build trust, use empathy, provide pain control, communicate effectively.

14. Patient Education and Communication

• Teach about medication adherence, potential side effects, and when to seek help.
• Therapeutic Communication: Use active listening, clarify information, provide emotional support.

15. Ethical Dilemmas and Decision Making

• Understand autonomy, beneficence, non-maleficence, and justice.
• Handle ethical dilemmas with informed consent, patient advocacy, and respect for rights.

Key Terms to Remember

• EBP: Evidence-Based Practice
• QSEN: Quality and Safety Education for Nurses
• HIPAA: Health Insurance Portability and Accountability Act
• DRG: Diagnosis-Related Groups
• NPSG: National Patient Safety Goals
• NANDA-I: North American Nursing Diagnosis Association International

Where Can LPNs Work?

• Hospitals:
  • Outpatient surgery
  • Intermediate care unit (step-down unit)
  • IV therapy team
  • Emergency department
• Long-term care (nursing homes)
• Ambulatory care
• Rehabilitation services
• Hospice
• Group homes
• Assisted-living facilities
• Homes for developmentally disabled individuals
• Home health care
• Private offices
• Military
• Dialysis centers
• Jails and prisons

Delegation Considerations for Nurses

• Know the scope of practice
• Be aware of staff competency and experience

Types of Patient Data

• Subjective Data: Information given by the patient that cannot be measured (e.g., pain, nausea, emotions).
• Objective Data: Observable and measurable data (e.g., vital signs, lab results, wounds, skin color changes).

Maslow’s Hierarchy of Needs

1. Physiological Needs – Basic survival (breathing, food, water, sleep, warmth). Always prioritize these first!
2. Safety & Security – Fall precautions, infection control, safe environment, job and financial security.
3. Love & Belonging – Emotional support, relationships, preventing social isolation.
4. Esteem – Dignity, confidence, self-respect, independence.
5. Self-Actualization – Personal growth, education, creativity.

In nursing, always address PHYSIOLOGICAL and SAFETY needs first before moving up the hierarchy!

Fluid & Electrolyte Balance

Functions of Fluids in the Body:

• Transport nutrients and waste
• Regulate body temperature
• Maintain blood volume and pressure
• Facilitate digestion and elimination
• Cushion joints and organs

Fluid Regulation Mechanisms:

• Kidneys (main regulators)
• Hormones (ADH, aldosterone, ANP)
• Thirst mechanism

Fluid Distribution in the Body:

• Intracellular fluid (ICF) – Inside cells (~⅔ of body water)
• Extracellular fluid (ECF) – Outside cells (~⅓ of body water), includes:
  • Interstitial fluid (between cells)
  • Intravascular fluid (blood plasma)
  • Transcellular fluid (CSF, synovial, peritoneal, pleural fluids)

Electrolyte Imbalances & Symptoms:

Common IV Fluids & Uses:

Acid-Base Imbalances

Treatment: Correct underlying cause + manage fluids and electrolytes!

IV Therapy Management & Complications

Steps in Managing an IV Infusion:

1. Verify order & patient identity.
2. Choose correct IV fluid & site.
3. Maintain aseptic technique.
4. Monitor for complications.
5. Document & assess fluid status regularly.

Complications of IV Therapy & Prevention:

Study Tip: Focus on prioritization, safety, and understanding concepts instead of just memorization!