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72 Cards in this Set

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Scope for LPN
assist in implementing a defined plan of care and to perform procedures according to protocol
assessment skills are directed at differentiating normal from abnormal
competence to care for physiologically stable clients with predictable conditions
"Scope" for UAP
assist in a variety of direct client care activities or tasks
perform indirect activities such as housekeeping, transporting people and stocking supplies
Steps of Delegation
1. Define the task
2. Match the task to the delegatee
a.Within scope
b. Know role expectations
3. Communicate clearly about expected outcomes and when the task should be done
4.Reach mutual agreement that all prior questions and problems are sorted and that the delegatee knows what to do
5. Supervise performance of task
6. Evaluate
7. Share feedback of delegatee
Five rights of delegation
Right task
Right circumstances
Right person
Right direction/communication
Right supervision
Nursing Care Delivery System
Functional/Task Nursing
Needs of clients are broken down into tasks
Tasks are assigned to various levels of health care workers according to licensure and skill
Example: RN gives medications and UAP give bed baths for one group of clients
Nursing Care Delivery System Team Nursing
Most common nursing care delivery system
A team of nursing personnel provides total care to a group of clients
Team leaders supervise client care teams, which usually consist of an RN, LPN, and UAP
Team leader reviews the client's plan of care and progress with team members during team conference
Nursing Care Delivery System Total Client Care Method
An RN is responsible for all aspects of care of one or more clients
The LPN may be assigned to assist the RN
Currently, this type of care is provided in areas requiring high level of nursing expertise, such as the critical care unit (CCU) or the post-anesthesia recovery unit (PACU)
Nursing Care Delivery System Primary Nursing
The RN maintains a client load of primary clients
The primary nurse designs, implements and is accountable for the nursing care of those clients during their entire stay on the unit
Nursing Care Delivery System
Practice Partnerships
An RN and an assistant (UAP, LPN, less-experienced RN, graduate nurse, or nurse intern) agree to be practice partners
Partners work together on same schedule with same group of clients
Senior partner directs the work of the junior partner within the scope of each partner's practice
Legally, a breach of the duty to provide nursing care to the client
Malpractice is professional negligence
The unintentional failure of an individual to perform or not perform an act that a reasonable person would or would not perform in a similar set of circumstances
Legal concepts of Negligence
Duty: nurses have a legal obligation to provide nursing care to clients
must meet a reasonable and prudent standard of care under the circumstances
must deliver care as any other reasonable and prudent nurse of similar education and experience would, under similar circumstances
Breach of duty: failure to provide expected, reasonable standard of care under the circumstances (includes errors of omission or commission)
Proximate cause:
relationship between the breach of duty and the resulting injury
the injured party must prove that the nurse's action or omission led to the injury
Damages: the injury and the monetary award to the plaintiff
LIving Will
identifies what a client wishes for their care should they become unable to communicate these wishes
Durable Power Of Attorney for Health Care decisions
the client has appointed a person to make decisions about their care if they are unable to do so.
this has been expanded to include identification of medications that may be given without any defibrillation attempts (comfort measures only)
Ethical Principles
Respect for others
Nonmaleficence - "do no harm"
Beneficence - do good and avoid evil
Veracity - the ethical duty to tell the truth
Fidelity - loyalty, faithfulness and honoring commitments
Stages of Infectious Process
Incubation period
Prodromal period
Illness period
Convalescent period
Standard Precautions
apply to
all body fluids, secretions, and excretions, except sweat, regardless of whether or not they contain visible blood
non-intact skin
mucous membranes
Contact Precautions
gown and glove for all contact
examples of opportunities for contact transmission: epidemiologically important organisms, e.g., VRE; excessive wound damage; fecal incontinence
Droplet Precaution
requires close contact (typically within 3 feet or less)
use of a standard surgical mask within 3 feet of the client is required
respiratory droplets are generated when an infected person coughs, sneezes, or talks, or during procedures such as suctioning, endotracheal intubation, cough induction by chest physiotherapy and cardiopulmonary resuscitation
examples of infectious agents transmitted through droplet route: group A streptococcus (for the first 24 hours of antimicrobial therapy), adenovirus, rhinovirus, Neisseria meningitis, pertussis, influenza virus
Airborne Precautions
microorganisms dispersed over long distances that remain infective over time and distance
use of special air handling and ventilation systems
wearing respiratory protection with NIOSH-certified N95 or higher level respirator for all health care workers
examples of microorganisms spread through airborne route: rubeola virus (measles), varicella-zoster virus (chickenpox), Mycobacterium tuberculosis
treated first: individuals who have life-threatening injuries that are readily correctable

treated last: individuals who have no injuries, or noncritical injuries, and who are ambulatory, as well as individuals who are dying or are dead
Erythrocyte sedimentation rate
>15-20 mm/h indicates inflammation
Highly C-Reactive Protein is a marker of...?
Chicken pox (varicella) incubation/transmission/S&S
incubation: 13- 17 days

Transmission; airborne, contact, objects

S/S: slight fever, malaise, anorexia, rash, macule>papule>vesicle, lymphadenopathy
Varicella Interventions
isolate until vesicles crusted

avoid aspirin may lead to Rye's disease

airborne and contact precautions at hospital
incubation time
2-5 days
Diphtheria transmission
direct contact with a carrier, infected client contaminated articles
Diphtheria S/S
Prodromal: common cold
low-rade fever, hoarseness, malaise, pharyngeal lymphadenitis;white/gray pharyngeal membrane
Diphtheria Interventions
contact & droplet precautions until two successive negative nose and throat cultures

complete bedrest; watch for resp distress and obstruction; provide humidification, suctioning, and tracheostomy prn

severe= sepsis and death
Pertussis( whooping cough) incubation
5-21 days usually 10
Pertussis Transmission
direct, droplet, contaminated articles
Pertussis S/S
Prodromal: upper resp infection for 1-2 weeks
severe cough with high pitched whooping sound, esp at night and lasts 4-6 weeks, vomiting
Pertussis Interventions
Hospital for infants; bedrest and hydration
Complications; pneumonia, wt loss, dehydration, hemorrhage, hernia, airway obstruction

Maintain high humidity and restful environment; suctionl and O2

Admin erythromycin and pertussis immune globulin
Rubella (german measles) incubation
14-21 days
Rubella S/S
Prodromal; none in children, low fever and sore throat in adolescent

Maculopapular rash appears first on face then rest of body

Symptoms subside first day after rash
Rubella Transmission
droplet and contaminated articles
Rubella Interventions
contact and droplet
risk of fetal deformity
isolate child from potentially pregnant women
antipyretcis and analgesics
rare complications of arthritis and encephalitis
Rubeola Incubation
10-20 days
Rubeola S/S
Prodromal: fever and malaise> Koplik's spots on buccal mucosa

Erythematous maculopapular rash with face first affected
Rubeola transmission
direct contact with droplets
Rubeola interventions
isolate until 5th day; maintain bed rest for first 3-4 days
Airborne and seizure precautions
antipyretics, dim light, humidifier
clean skin and hydration
Scarlet Fever Incubation time
2-4 days
Scarlet Fever S/S
Prodromal; high fever vomiting , chills, malaise ,enlarged tonsils covered with exudate, strawberry tongue
Rash: red tiny lesions that become generalized and desqumate; appears in 24 hrs
Scarlet Fever Transmission
droplet or contaminated articles , Group A nbeta-hemolytic streptococci
Scarlet Fever Interventions
Droplet precautions for 24 hours after start of antibiotics

Bed rest while febrile
Analgesics for sore throat
Fluids and soft diet
Penicillin and erythromycin
Mono Incubation
4-6 weeks
Mono S/S
malaise, fever, enlarged lymphs, sore throat, flulike aches, low grade temp

usually in 15-30 yr/olds
Mono Transmission
direct contact with oral secretions
Mono Interventions
Avoid sharing saliva for 3 months, treat with rest and nutrition, strenuous exercise is to be avoided or spleen will rupture
Complications: encephalitis & spleen rupture
Tonsillitis (Streptococcal) S/S
fever, white exudate on tonsils

Positive culture GpA strep
Tonsillitis Interventions

Complications: rheumatic fever, glomerulonephritis
Mumps Incubation
14-21 days
Mumps S/S
malaise, headache, fever, parotid gland swelling
Mumps transmission
direct contact with saliva, droplet
Mumps interventions
isolation before and after swelling
soft, bland diet

Complications: deafness, meningitis, encephalitis, sterility
Hepatitis Diet
Low in fat, high in calories, carbs, and protein; no alcohol
Hepatitis Meds
Vitamin K (Aquqa MEPHYTON)
Antivirals: interferon and lamivudine
Post exposure Hep B vaccine
Syphilis Symptoms
Stage 1: painless chancre that disappears in 4 weeks

Stage 2: Copper colored rash on palms and soles; low grade fever

Stage 3: cardiac & CNS dysfunction
Syphilis Interventions
Treat with Penicillin G IM or erythromycin if PCN allergy
Ceftriaxone and tetracyclines for non preggers

Abstinence until treatment complete
Gonorrhea Symptoms
Thick discharge
Females: usually asympt, but may have purulent discharge, dysuria, and dyspareunia (painful sex)

Males; painful urination, yellow/green discharge
Gonorrhea Treatment
IM Ceftriaxone (Rocephin)
1 time PO doxycillin BID for 1 week; azithromycin (Zithromax)

Penicillin with Probenecid, Spectinomycin if allergic to rocephin

monitor for PID
Herpes Symptoms
painful vesicular genital lesions
difficulty voiding
recurrent during stress, infection, and menses
Herpes treatment
sitz bath
Chlamydia symptoms
Men-dysuria, freq.urination, watery discharge

Women-may be asymptomatic, thick discharge with acrid odor, pelvic pain, yellow discharge; painful menses
Chlamydia interventions
Notify contacts, may cause sterility, treat with azithromycin, doxycycline, erythromycin
Genital Warts (condylomata acuminata) Symptoms
Initially single, small papillary lesion spreads into large cauliflower like cluster on perineum and genitals; may itch or burn
Genital warts interventions
curettage, cryotherapy with liquid nitro or podophyllin resin
Kerotolytic agents
avoid sex until lesions healed
May lead to genital dysplasia or cervical carcinoma
Atypical, pigmented, or persistent warts should be biopsied
notify contacts
Aspirin (Salicylate) Poisoning Assessment
Tinnitus, n/v, sweating , dizziness, headache

change in mental status, fever hyperventilation (resp alk) > metabolic acidosis, and resp acidosis, bleeding and hypovolemia

Toxicity begins at doses of 150-200 mg/kg; 4 grams may be fatal to child
Aspirin poisoning interventions
induce vomiting; initiate gastric lavage with activated charcoal
maintain IV hydration and I/O, skin turgor, fontanels
reduce temp with tepid water baths or hypothermia blankets; prone to seizures
Vitamin K for bleeding disorder
IV sodium bicarb enhances excretion
Tylenol (acetminophen) Poisoning Assessment
first 2 hours n/v, sweating, pallor, hypothermia, slow-weak pulse

Toxicity begins at 150 mg/kg
Tylenol poisoning treatment
induce vomiting
N-acetylcysteine( Mucomyst) =antidote; must be effective in 8-10 hours; must be given w/in 24hrs
Lead toxicity assessment
irritability, sleepiness, n/v, abd pain, poor appetite
dec.activity, Increase ICP

Blood level less than or equal to 9 mcg/dL is normal
Lead toxicity interventions
chelating agents, calcium disodium, succimer, deferoxamine( desferal)

maintain hydration, id source and tell parents