CNA Medical-Surgical LPN (MSPNC(C)) cheat sheet

Chain of command: LPN reports to RN or charge nurse; unresolved concerns escalate to nurse manager, then nursing supervisor, then risk management or administration.

Five rights of delegation (NCSBN): right task, right circumstance, right person, right direction/communication, right supervision/evaluation. LPN may delegate to UAP only tasks within UAP scope and only after assessment.

LPN cannot perform initial assessment, care planning, or evaluation; these are RN responsibilities. LPN contributes data, implements the plan, and reports changes.

Informed consent elements: competence, voluntariness, full disclosure of risks/benefits/alternatives, and understanding. Nurse witnesses signature; provider obtains consent.

Advance directives: living will addresses terminal-condition treatments; durable power of attorney for health care names a surrogate decision maker. Patient may revoke at any time, including while competent.

HIPAA permits disclosure without authorization for treatment, payment, operations, and as required by law (reportable communicable disease, abuse, court order). Minimum necessary standard applies.

Handoff using SBAR: Situation, Background, Assessment, Recommendation; include allergies, code status, fall risk, and pending results.

Incident reports are completed for unusual events, not placed in the medical record, and document objective facts only; the chart records the patient's status and care given.

Discharge planning begins on admission; Medicare requires a discharge plan addressing medications, follow-up, home equipment, and caregiver education.

Standard precautions apply to all patients: hand hygiene, gloves for contact with blood/body fluids, gown and mask when splash risk exists. Hand hygiene is the single most effective prevention measure.

Transmission-based precautions: contact (MRSA, C. difficile, scabies) - gown and gloves, dedicated equipment; droplet (influenza, pertussis, mumps) - surgical mask within 3 feet; airborne (TB, measles, varicella) - N95 respirator and negative-pressure room.

C. difficile requires soap-and-water handwashing because alcohol gel does not kill spores; use bleach-based cleaning.

Sterile field rules: items below waist or out of sight are contaminated; never turn away from the field; add items without reaching over the field.

Fall prevention: bed in lowest position, brakes locked, call light within reach, non-skid footwear, hourly rounding; apply yellow wristband per facility policy.

Restraint use requires a provider order, time-limited renewal (typically every 4 hours for adults), and monitoring of circulation, skin, and needs at least every 15 minutes.

Seizure precautions: pad side rails, keep suction and oxygen at bedside, do not restrain during seizure, turn to side after, time the event.

RACE for fire: Rescue, Alarm, Contain (close doors), Extinguish/Evacuate; PASS for extinguisher: Pull, Aim, Squeeze, Sweep.

Needlestick: wash with soap and water, report immediately, and follow post-exposure prophylaxis protocol; do not squeeze or scrub the site.

Adult immunization: influenza annually; Td/Tdap booster every 10 years; shingles vaccine at 50+; pneumococcal per age/risk; COVID per current schedule.

Colorectal cancer screening starts at 45 for average risk (colonoscopy every 10 years or stool test annually); mammography typically begins at 40-50 per guideline; cervical screening starts at 21.

Blood pressure categories: normal <120/<80; elevated 120-129/<80; stage 1 130-139 or 80-89; stage 2 ≥140 or ≥90 mm Hg.

Normal adult vital signs: temperature 36.5-37.5 °C (97.7-99.5 °F); pulse 60-100/min; respirations 12-20/min; SpO2 ≥95% on room air.

Weight gain in pregnancy: normal-BMI women about 11-16 kg (25-35 lb); folic acid 400 mcg daily preconception reduces neural tube defects.

Developmental milestones: head control ~3-4 months, sits unsupported ~6-8 months, walks ~12 months, two-word phrases ~24 months.

Osteoporosis prevention: weight-bearing exercise, adequate calcium (about 1,000-1,200 mg/day) and vitamin D, smoking cessation, limit alcohol.

Teaching is effective when the patient can state or demonstrate the skill (teach-back); evaluate learning rather than assuming it.

Maslow hierarchy order: physiologic, safety, love/belonging, esteem, self-actualization; lower needs are met first.

Kübler-Ross stages: denial, anger, bargaining, depression, acceptance; stages are not linear and may recur.

Therapeutic communication: open-ended questions, reflection, restating, silence, and clarification. Avoid false reassurance, giving advice, and 'why' questions.

Grief types: anticipatory (before loss), normal, complicated (prolonged and impairing function), disenfranchised (not socially recognized).

Delirium: acute onset, fluctuating, inattention, often reversible and caused by illness, drugs, or withdrawal. Dementia: gradual, progressive memory loss, consciousness intact.

Alcohol withdrawal timeline: tremor and anxiety 6-12 h, seizures 12-48 h, delirium tremens 48-96 h; monitor vital signs and use CIWA-based protocols.

Suicide risk increases with a specific plan, prior attempts, access to means, and hopelessness; ask directly and maintain safety precautions.

Anxiety levels: mild (increased alertness), moderate (narrowed perception), severe (cannot problem-solve), panic (loss of control, safety risk).

Abuse assessment: screen privately, document objective findings with body maps and quotes, and report per state mandatory-reporting law.

Pressure injury staging: stage 1 non-blanchable erythema; stage 2 partial-thickness loss with dermis exposed; stage 3 full-thickness with subcutaneous fat visible; stage 4 extends to fascia, muscle, or bone; unstageable covered by slough/eschar.

Reposition at least every 2 hours; use a 30-degree lateral tilt and keep head of bed ≤30 degrees when possible to reduce shear.

Nutrition: clear liquid (water, broth, gelatin), full liquid (adds milk, custards), soft, and regular diets; NPO means nothing by mouth including ice chips.

Dysphagia interventions: upright at 90 degrees, chin tuck, small bites, thickened liquids per order, and recheck for pocketing after meals.

Pain scales: numeric 0-10 for adults, Wong-Baker FACES for children, PAINAD or FLACC for nonverbal or cognitively impaired patients.

Nonpharmacologic comfort: repositioning, heat/cold, massage, distraction, relaxation breathing, and oral care; oral care reduces ventilator-associated pneumonia.

Urinary catheter care: keep bag below bladder, off the floor, and empty at half full; perineal hygiene daily; remove as soon as no longer indicated.

Bowel elimination: normal stool frequency ranges from 3 per day to 3 per week; constipation management includes fluids, fiber, mobility, and scheduled toileting.

Sleep hygiene: consistent schedule, limit caffeine and screens, dim lights, cluster nighttime care to reduce awakenings.

Six rights: right patient (two identifiers), drug, dose, route, time, documentation; add reason and to refuse when applicable.

IV flow rate (mL/h) = total volume (mL) ÷ time (h). Drop rate (gtt/min) = (volume × drop factor) ÷ time in minutes.

Dosage formula: desired dose ÷ available dose × quantity = amount to administer. Verify pediatric and high-alert doses with a second nurse.

High-alert medications (insulin, heparin, opioids, concentrated electrolytes) require independent double-check and standardized concentrations.

Insulin onset: rapid-acting 15 min, short-acting (regular) 30 min, intermediate (NPH) 1-2 h, long-acting (glargine) no peak; only regular insulin is given IV.

Heparin antidote is protamine sulfate; warfarin antidote is vitamin K; opioid antidote is naloxone; benzodiazepine antidote is flumazenil.

Therapeutic drug levels: digoxin 0.5-2 ng/mL; check apical pulse for a full minute and hold if <60/min in adults.

Parenteral routes: intradermal 5-15 degrees (TB test), subcutaneous 45-90 degrees, intramuscular 90 degrees (deltoid, ventrogluteal), IV per access.

Blood transfusion: first 15 minutes at slow rate with the nurse at bedside; stop immediately for fever, chills, flank pain, or urticaria and maintain IV access with normal saline.

Laboratory critical values: potassium <2.5 or >6.5 mEq/L, sodium <120 or >160 mEq/L, glucose <40 or >500 mg/dL, hemoglobin <7 g/dL require prompt notification.

Early signs of increased intracranial pressure: change in level of consciousness, headache, vomiting, pupil changes; late sign is a Cushing response (hypertension, bradycardia, irregular respirations).

Postoperative priorities: airway, breathing, circulation, then pain, wound, and thromboembolism prevention; early ambulation and sequential compression devices reduce DVT risk.

Hypoglycemia signs: shakiness, diaphoresis, tachycardia, confusion; if conscious give 15 g fast-acting carbohydrate and recheck glucose in 15 minutes.

Signs of hypoxia: restlessness, confusion, tachycardia, tachypnea, then bradycardia and cyanosis; pulse oximetry lags behind clinical change.

Fall risk factors: age, prior falls, sedatives, orthostatic hypotension, gait or vision impairment, and urinary urgency.

Preoperative checklist: consent signed, NPO status, allergies, site marking, removal of jewelry/dentures, and verification of labs.

Extravasation: stop the infusion, do not remove the catheter immediately, aspirate per protocol, and apply the antidote or cold/warm compress per policy.

Shock: tachycardia, hypotension, tachypnea, cool clammy skin, decreased urine output, and altered mentation; treat cause and support perfusion.

Heart failure: dyspnea, orthopnea, crackles, edema, weight gain; nursing actions include semi-Fowler position, oxygen, daily weights, and fluid/sodium limits.

COPD: use pursed-lip breathing and low-flow oxygen (1-2 L/min) targeting SpO2 about 88-92%; monitor for somnolence indicating CO2 retention.

Diabetic ketoacidosis: glucose >250 mg/dL, pH <7.30, bicarbonate <18, ketones, Kussmaul respirations; treat with IV fluids, insulin, and potassium replacement.

Acute kidney injury: oliguria <400 mL/day, rising creatinine and BUN, hyperkalemia; monitor electrolytes and fluid balance.

Stroke: sudden facial droop, arm weakness, speech difficulty; note time of symptom onset because thrombolysis has a limited window.

Asthma exacerbation: wheezing, accessory muscle use, prolonged expiration; a silent chest is an ominous sign of severe obstruction.

Sepsis: suspected infection plus altered mentation, tachypnea, and hypotension; report promptly because early antibiotics and fluids improve outcomes.