Nursing Skills and Procedures – LPN Flashcards

Twenty-six rapid-recall cards for Nursing Skills and Procedures at practical and vocational nurse depth, covering foundational technique, infection control, and knowing when to notify the registered nurse.

Asepsis and Infection Control

Name four rules that keep a sterile field sterile.

The outer 1 inch border is contaminated; anything below waist level or out of sight is contaminated; moisture wicks organisms so a wet field is contaminated; never reach across the field or turn your back on it.

What is the difference between medical and surgical asepsis?

Medical asepsis, or clean technique, reduces the number of microorganisms and is used for hygiene and routine care. Surgical asepsis, or sterile technique, eliminates microorganisms and is required for catheter insertion, tracheal suctioning, and acute surgical wound dressing changes.

Which infection requires soap and water handwashing rather than alcohol-based rub, and why?

Clostridioides difficile. Alcohol does not kill spores, so friction with soap and water is needed for mechanical removal, along with gown and gloves and a bleach-based sporicidal cleaner.

Match the precaution to the disease

influenza, tuberculosis, methicillin-resistant Staphylococcus aureus.

Influenza requires droplet precautions with a surgical mask. Tuberculosis requires airborne precautions with a negative pressure room and a fit-tested N95. Methicillin-resistant Staphylococcus aureus requires contact precautions with gown and gloves.

What must always be done before and after every patient contact and procedure?

Hand hygiene. It is the single most effective measure for preventing health care associated infection.

Wound Care

In what direction is a wound cleansed, and how many gauze pads are used?

From least contaminated to most contaminated, meaning from the incision outward, using a new gauze for every stroke. A used gauze never returns to the wound.

What should be done if a dressing adheres to the wound bed?

Moisten it with sterile normal saline and remove it gently. Pulling a stuck dressing off tears away new granulation tissue, causes pain, and can cause bleeding.

Why is wound packing placed loosely?

Tight packing raises pressure in the wound bed, impairs perfusion, and delays healing. Packing material is counted in, counted out, and documented.

Describe serous, sanguineous, serosanguineous, and purulent drainage.

Serous is clear and watery and expected. Sanguineous is bright red fresh bleeding. Serosanguineous is pink and watery and common in the first 48 hours. Purulent is thick, opaque, yellow, green, tan, or brown and suggests infection.

Which wound findings should be reported to the registered nurse?

Purulent or malodorous drainage, spreading redness, increasing pain especially after the third postoperative day, fever, wound edges separating, and any bleeding that saturates the dressing.

What are the first nursing actions if the wound edges separate and tissue protrudes?

Stay with the client, position low Fowler with knees flexed, cover with sterile gauze moistened with sterile normal saline, never push anything back in, keep the client NPO, and notify the registered nurse and provider immediately.

Urinary Catheterization and Elimination

When is the balloon of an indwelling catheter inflated?

Only after urine returns, confirming the catheter is in the bladder. Inflating in the urethra causes trauma and can rupture it. Inflate with the prefilled sterile water syringe, never with saline.

How far is a catheter inserted for a female and for a male client?

About 2 to 3 inches in a female client and about 7 to 9 inches in a male client, or until urine returns. Then advance another 1 to 2 inches in the female, or to the catheter bifurcation in the male, before inflating.

What is done if resistance is met during catheter insertion?

Stop, do not force, and notify the registered nurse or provider. Forcing risks creating a false passage in the urethra.

What must be done after catheterizing an uncircumcised male client?

Reduce the foreskin back over the glans. Leaving it retracted can cause paraphimosis, a swelling emergency.

List four elements of routine indwelling catheter maintenance.

Keep the drainage bag below bladder level and off the floor, keep the closed system intact and the tubing free of kinks and dependent loops, secure the tubing to prevent traction, and perform perineal care with soap and water daily and after bowel movements.

Where is a urine specimen obtained from a client with an indwelling catheter?

From the needleless sampling port after disinfecting it, using a sterile syringe, with the tubing briefly clamped below the port. Never from the drainage bag and never by disconnecting the tubing.

Specimen Collection

What are the steps for a clean catch midstream urine specimen?

Cleanse the meatus front to back, begin voiding into the toilet, then catch the midstream portion without stopping the stream, avoid touching the inside of the container or lid, and transport promptly.

What invalidates a 24 hour urine collection?

Losing or discarding any void during the period. The first void is discarded to start the timing, all subsequent voids are collected, the final void at the end is included, and the specimen is kept chilled if required. A missed void means the collection restarts.

How is a sputum specimen best collected?

Early in the morning before eating, after rinsing the mouth with plain water rather than mouthwash, using several deep breaths and a deep cough. Saliva is not an acceptable specimen.

Enteral Feeding

What is the most important aspiration precaution during tube feeding?

Elevate the head of the bed 30 to 45 degrees during the feeding and for at least 30 to 60 minutes afterward.

How much water is used to flush a feeding tube and when?

About 30 mL of water before and after each feeding and each medication, between medications, and every four to six hours during continuous feeding. Warm water clears and prevents clogs; juice and soda do not.

Which medications must never be crushed for administration through a feeding tube?

Enteric-coated, sustained-release, and extended-release forms. Give medications one at a time in liquid form when available, and never add them directly to the formula bag.

What is the first action if a client coughs, chokes, or desaturates during a tube feeding?

Stop the feeding immediately, turn the client to the side, suction as needed, apply oxygen, and notify the registered nurse.

Oxygen and Injections

State the flow ranges for nasal cannula and simple face mask.

Nasal cannula 1 to 6 L/min, delivering about 24 to 44 percent. Simple face mask 5 to 10 L/min, delivering about 40 to 60 percent, with a minimum of 5 L/min required to flush exhaled carbon dioxide out of the mask.

Compare intradermal, subcutaneous, and intramuscular injections.

Intradermal: 5 to 15 degrees bevel up, 26 to 27 gauge, 0.01 to 0.1 mL, forms a wheal, no massage. Subcutaneous: 45 to 90 degrees, 25 to 27 gauge, up to about 1 mL, no aspiration. Intramuscular: 90 degrees, 20 to 25 gauge, 1 to 1.5 inch needle, up to 3 mL in a large adult muscle, using Z-track.

What are the rules for subcutaneous heparin and insulin administration?

Heparin goes into the abdomen at least 2 inches from the umbilicus at 90 degrees, with no aspiration and no massage. Insulin is given at 90 degrees with an insulin syringe, no aspiration and no massage, rotating sites within one anatomic region. When mixing, air into cloudy first, air into clear, then draw clear before cloudy.

Name findings during any procedure that require notifying the registered nurse right away.

A change from the client's baseline or anything outside the established plan of care: new or worsening pain, bleeding, absent catheter output with a distended abdomen, new shortness of breath or falling oxygen saturation, fever, purulent drainage, resistance during a procedure, or any suspected error.

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