Fundamentals of Nursing – LPN Flashcards

Rapid review flashcards for Fundamentals of Nursing at licensed practical or vocational nurse depth, emphasizing correct and safe performance of basic care skills, patient safety during assistance with activities of daily living, focused data collection, and reporting to the registered nurse.

Hygiene and personal care

In what order are body areas washed during a bed bath?

From clean to dirty and from head to toe, saving the perineum for last, using a clean portion of the washcloth for each area so organisms are not spread between regions.

In which direction is each eye washed, and why?

From the inner canthus to the outer canthus, with a separate portion of the washcloth for each eye. This avoids carrying organisms into the lacrimal duct and prevents cross contamination between eyes.

How is bath water temperature verified, and who is at highest risk for burns?

Test with a bath thermometer or the inner wrist before the patient enters, using roughly 43 to 46 degrees Celsius (110 to 115 degrees Fahrenheit) and always checking the patient's own tolerance. Older adults and patients with diabetes or peripheral neuropathy have reduced thermal sensation and are at highest risk.

What is the essential step after cleaning an uncircumcised male patient?

Return the foreskin to its natural position. Leaving it retracted can cause paraphimosis with swelling and vascular compromise. Perineal care in female patients is performed front to back.

How are dentures cleaned and stored safely?

Clean over a basin lined with a washcloth or partly filled with water so a dropped denture is cushioned, use cool or lukewarm water rather than hot water, which warps them, and store in a labeled container with water or denture solution when not in the mouth.

How is oral care performed for an unconscious patient?

Position side lying with the head turned to the side, keep suction immediately available, use only a small amount of fluid, and use a padded tongue blade or bite block rather than your fingers. Avoid lemon glycerin swabs and alcohol based rinses, which dry the mucosa.

What are the rules for foot care in a patient with diabetes?

Inspect daily including the soles and between the toes, wash with lukewarm water and mild soap, dry thoroughly between the toes, apply lotion elsewhere but not between the toes, never soak the feet, never use heating pads or hot water bottles, never go barefoot, and refer calluses, corns, and thickened nails to a podiatrist.

Mobility, transfers, and fall safety

How is a gait belt used correctly?

Apply it snugly around the waist over clothing, grasp it from underneath with both hands, keep the patient close to your center of gravity, and walk slightly behind and toward the patient's weaker side. Never lift a patient by the arms or under the axillae.

On which side is a cane held, and in what sequence is it advanced?

On the strong or unaffected side. Advance the cane and the weak leg together, then step through with the strong leg. The cane is held close to the body, and the patient stands upright rather than leaning over it.

What is the rule for stairs with an assistive device?

The strong leg goes up first and the weak leg goes down first, remembered as "up with the good, down with the bad." The cane or crutches move with the weak leg.

How is a standard walker used, and where should weight be borne on crutches?

The standard walker is lifted and set down about one step ahead with all four legs on the floor, then the patient steps into it without leaning over it or pulling up on it to stand. With crutches, weight is borne on the hands, not the axillae, and the axillary pad sits two to three finger widths below the axilla to prevent nerve injury.

Toward which side should a patient be transferred, and what is checked first?

Toward the stronger side. Lock the wheels, lower the bed, place the chair at a slight angle on the strong side, and dangle the patient at the bedside first to check for dizziness or orthostatic symptoms before standing.

What are the key principles of body mechanics?

Widen your base of support, bend at the knees and hips rather than the waist, keep the load close to your body, pivot your feet instead of twisting, push rather than pull when possible, raise the bed to waist height, and get help or a mechanical lift for dependent patients.

What should you do if a patient begins to fall while you are assisting?

Do not try to hold the patient upright. Widen your stance, pull the patient close, protect the head, and ease the patient down along your leg to the floor. Then call for help, stay with the patient, and do not move the patient until an assessment is done.

How often are patients repositioned, and how are heels protected?

At least every two hours in bed and at least every hour in a chair. Place pillows lengthwise under the calves so the heels float completely off the mattress. Never massage a reddened bony prominence and never use a donut cushion.

What do the Fowler positions and the Sims position mean?

Low or semi Fowler is 30 to 45 degrees, Fowler is 45 to 60 degrees, and high Fowler is 60 to 90 degrees, which best supports lung expansion and eating. Sims is a semiprone left side lying position with the upper leg flexed, used for enemas and rectal suppositories.

Vital signs and data collection

What are the adult normal ranges for vital signs?

Temperature about 36.5 to 37.5 degrees Celsius (97.7 to 99.5 degrees Fahrenheit) orally, pulse 60 to 100 beats per minute, respirations 12 to 20 breaths per minute, blood pressure below 120 over 80 millimeters of mercury for normal, and oxygen saturation about 95 to 100 percent on room air.

How are respirations counted accurately?

Count without telling the patient, ideally while appearing to continue taking the radial pulse, because awareness changes the rate and depth. Count for a full minute if the pattern is irregular or the patient is an infant.

What must be done before taking an oral temperature?

Wait 15 to 30 minutes after the patient has had hot or cold liquids, smoked, or chewed gum. Always document the route used, because rectal readings run higher and axillary readings run lower than oral.

When is the pulse counted for a full minute?

Whenever the rhythm is irregular, when the patient is an infant, and always when assessing the apical pulse before giving digoxin. Hold digoxin and notify the registered nurse if the adult apical rate is below 60 beats per minute.

Which arm should be avoided for blood pressure measurement?

An arm with a dialysis access, an intravenous infusion, a cast or injury, or on the side of a mastectomy with lymph node dissection. A cuff that is too narrow or applied over clothing gives a falsely high reading.

Elimination

How is an enema administered to an adult?

Place the patient in the left lateral Sims position, lubricate the tip, insert about 7.5 to 10 centimeters (3 to 4 inches) toward the umbilicus, and instill slowly with the container about 30 to 45 centimeters (12 to 18 inches) above the anus. Stop and reassess for cramping, dizziness, or palpitations, and never force against resistance.

What are the rules for indwelling catheter drainage bag placement?

Keep the bag below the level of the bladder at all times, hang it on the bed frame and never on a movable side rail, never let it rest on the floor, keep the tubing free of kinks and dependent loops, secure the tubing to the thigh, and keep the drainage system closed.

What urine output should be reported to the registered nurse?

Less than about 30 milliliters per hour in an adult, or 0.5 milliliters per kilogram per hour. Also report cloudy, foul smelling, or bloody urine, and any new complaint of burning or urgency.

What is a normal stoma, and when is the pouch emptied?

A healthy stoma is pink to red, moist, and slightly raised, and may bleed slightly with cleansing. Empty the pouch when it is one third to one half full to prevent leakage and detachment. Report a dusky, purple, or black stoma to the registered nurse immediately, because it indicates impaired circulation.

Comfort, safety, and reporting

What are the rules for applying heat or cold?

Always use a barrier between the device and the skin, limit application to about 15 to 20 minutes, and check the skin frequently. Use heat for muscle spasm and stiffness and cold for acute injury, swelling, and inflammation. Use extra caution with impaired sensation, older adults, and confused patients.

What precautions reduce aspiration risk during meals?

Sit the patient fully upright, allow rest before the meal, minimize distractions, offer small bites and unhurried pacing, avoid talking while swallowing, check for food pocketed in the cheeks, and keep the patient upright for at least 30 to 60 minutes afterward.

What checks are required for a patient in restraints?

Assess circulation, sensation, movement, and skin every 15 to 30 minutes per policy, and release the restraint at least every 2 hours for range of motion, repositioning, toileting, and fluids. Secure ties to the movable bed frame with a quick release knot, never to a side rail. Report cool, dusky, or numb extremities immediately.

Which findings must be reported to the registered nurse promptly?

Any change from the patient's baseline, new confusion, chest pain, difficulty breathing or oxygen saturation below the ordered parameter, a fall, new or worsening pain, new nonblanchable redness over a bony prominence, coughing or a wet gurgly voice with food or fluid, urine output below the ordered minimum, unexpected bleeding, and any medication error.

What information belongs in an SBAR report to the registered nurse?

Situation, the immediate concern; background, the relevant history and current treatment; assessment or data collected, including vital signs and observed changes; and recommendation or request, what you believe the patient needs or what you are asking the registered nurse to do.

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