Medical-Surgical Nursing – LPN Flashcards

Flashcards at practical and vocational nurse depth for medical-surgical nursing. The focus is data collection, standard care of stable patients, reinforcement of teaching, and knowing which findings must be reported promptly to the registered nurse or provider.

Data Collection and Reporting

Findings that are always reported to the registered nurse right away

New or worsening confusion, new chest pain, sudden shortness of breath or falling oxygen saturation, a hard rigid abdomen, active bleeding, a temperature above the reported parameter, urine output under about 30 mL per hour, and any sudden change from the patient's baseline.

Most reliable measure of fluid gain or loss

Daily weight, taken at the same time each day, on the same scale, in similar clothing, after voiding. A gain or loss of 1 kilogram equals roughly 1 liter of fluid.

Signs of dehydration to collect

Thirst, dry mucous membranes, poor skin turgor, dark concentrated urine with low volume, rapid weak pulse, dizziness on standing, and weight loss.

Signs of fluid overload to collect

Weight gain, puffy or swollen ankles and sacrum, distended neck veins, crackles in the lungs, shortness of breath, and a full bounding pulse.

Why new confusion in an older adult is reported and not dismissed

It is often the first and sometimes the only sign of a new problem such as infection, low oxygen, dehydration, medication effect, or pain. It is never assumed to be normal aging.

Cardiovascular and Respiratory

When to hold digoxin in an adult

Hold and report when the apical pulse, listened to at the fifth intercostal space at the left midclavicular line and counted for a full 60 seconds, is below 60 beats per minute. Also report nausea, loss of appetite, vomiting, blurred vision, or yellow-green halos around lights, which suggest toxicity.

Teaching for a patient taking a blood pressure medication who feels fine

Keep taking it. High blood pressure usually causes no symptoms, and stopping the medication allows damage to the heart, brain, and kidneys to continue. Also teach standing up slowly to prevent dizziness and falls.

Daily home teaching for a patient with heart failure

Weigh every morning after urinating and before eating, limit salt, take medications as prescribed, balance activity with rest, and call the provider for a gain of 2 to 3 pounds in a day or 5 pounds in a week, or for increased shortness of breath.

Safe positioning for a patient who is short of breath

Sit the patient upright in high Fowler position or leaning forward on an overbed table. Lying flat makes breathing harder because abdominal contents press against the diaphragm.

Pursed-lip breathing and who benefits

The patient inhales through the nose and exhales slowly through pursed lips, as if blowing out a candle, taking about twice as long to exhale as to inhale. It keeps small airways open so trapped air can escape and helps patients with chronic obstructive pulmonary disease.

Correct order for using a rescue inhaler and a steroid inhaler

Rescue bronchodilator first, wait the instructed time, then the inhaled corticosteroid, then rinse the mouth to prevent thrush. Using a spacer improves delivery.

Rule about changing an oxygen flow rate

The flow rate is a prescribed order. The nurse does not increase or decrease it independently. If the patient is short of breath, reposition, stay with the patient, and report to the registered nurse.

Purpose of the incentive spirometer and how it is used

It prevents atelectasis and pneumonia by expanding the lungs. The patient sits upright, seals the lips around the mouthpiece, inhales slowly and deeply, holds for a few seconds, and repeats about ten times each hour while awake, splinting the incision with a pillow when coughing.

Postoperative and Wound Care

Most common cause of fever in the first 48 hours after surgery and the response

Atelectasis. The response is deep breathing, coughing, incentive spirometry, position changes, and early ambulation, and the finding is reported.

Timing that suggests a wound infection

Fever with increasing pain, redness, swelling, and purulent drainage, typically appearing on about the third to fifth day after surgery. Report promptly.

Dehiscence, evisceration, and the first action to take

Dehiscence is separation of the wound layers, and evisceration is protrusion of internal organs through the opening. Evisceration is an emergency. Cover the organs with sterile gauze moistened with sterile normal saline, keep the patient nothing by mouth, place the patient in low Fowler position with knees slightly bent, stay with the patient, and get help immediately. Never push the organs back in.

Signs of a blood clot in the leg that must be reported

Swelling in one calf or thigh, warmth, redness, and tenderness. Do not rub or massage the leg, and report it right away.

Simple measures that prevent blood clots after surgery

Early and frequent ambulation, ankle pumps and leg exercises, adequate fluids, applying compression devices or stockings as ordered, and avoiding pillows placed under the knees.

Chronic Disease Care

Treatment of hypoglycemia in an alert patient who can swallow

Give 15 grams of fast-acting carbohydrate such as 4 ounces of juice or regular soda or glucose tablets, recheck the blood glucose in 15 minutes, repeat if still low, then give a snack with protein if a meal is not due soon. Report the episode.

Signs of low blood glucose versus high blood glucose

Low glucose brings shakiness, sweating, fast heartbeat, hunger, irritability, and confusion, and comes on quickly. High glucose brings thirst, frequent urination, blurred vision, fatigue, and dry skin, and comes on gradually.

Foot care teaching for a patient with diabetes

Inspect the feet daily including between the toes, use a mirror or ask for help, wash with warm water tested by hand or thermometer and dry well, apply lotion but not between the toes, never go barefoot, wear well-fitting shoes, cut nails straight across, and report any sore, blister, or color change.

Correct way to take levothyroxine

In the morning on an empty stomach, at least 30 to 60 minutes before food, separated from calcium and iron supplements. It is taken for life and is never stopped because the patient feels better.

Teaching for oral iron supplements

Best absorbed on an empty stomach and with a source of vitamin C such as orange juice. Stools turn dark or black, which is expected. Increase fluids and fiber for constipation, and use a straw with liquid forms to protect the teeth.

Rule about an arm with a dialysis fistula

Never take blood pressure, draw blood, or start an intravenous line in that arm. Check for a thrill by touch and a bruit by listening each shift, and report immediately if either is absent.

Normal versus abnormal stoma appearance

Normal is beefy red and moist, with mild swelling expected right after surgery. Pale, dusky, purple, or black is abnormal and is reported immediately, because it means the blood supply is impaired.

Safety and Infection Control

Actions during a seizure

Stay with the patient, ease them down and protect the head, turn the head or body to the side, remove nearby objects, loosen tight clothing, and time the seizure. Never put anything in the mouth and never hold the limbs down. Afterward check breathing, take vital signs, and allow rest.

Feeding a patient at risk for aspiration

Sit the patient fully upright, allow unhurried small bites, use thickened liquids if prescribed, place food on the stronger side of the mouth after a stroke, check for pocketed food, and keep the patient upright for at least 30 minutes after eating.

Hand hygiene requirement for Clostridioides difficile

Wash with soap and water. Alcohol-based hand rub does not kill the spores. Gown and gloves are worn for room entry under contact precautions.

Personal protective equipment removal order

Gloves first because they are the most contaminated, then goggles or face shield, then gown, then mask or respirator, with hand hygiene performed at the end and any time hands become contaminated during removal.

Rule for patient-controlled analgesia

Only the patient presses the button. Family members and staff must never press it, because a sedated patient who cannot press the button is protected from overdose. Teach visitors this directly.

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