Safety and Infection Control: Practice Questions & Explanations

TRANSMISSION-BASED PRECAUTIONS are used in addition to standard precautions for clients with known or suspected specific infectious diseases. THREE TYPES based on route of transmission: (1) CONTACT PRECAUTIONS: for diseases spread by direct or indirect contact (touching the patient or contaminated surfaces); examples: MRSA, C. difficile, VRE, wound infections, scabies, head lice;

PPE: GLOVES and GOWN on entry; (2) DROPLET PRECAUTIONS: for diseases spread by large droplets (>5 microns) produced by talking, coughing, sneezing — travel ≤3 feet; examples: influenza, pertussis, meningococcal disease, group A strep, mumps, rubella.

PPE: SURGICAL MASK on entry; private room or cohorting; (3) AIRBORNE PRECAUTIONS: for diseases spread by SMALL particles (<5 microns) that remain suspended in air and travel longer distances; examples: TUBERCULOSIS (TB), VARICELLA (chickenpox), MEASLES (rubeola), SARS, MERS, COVID-19 (enhanced).

PPE: N95 RESPIRATOR (or higher, like PAPR) — must be fit-tested; NEGATIVE PRESSURE ROOM (AIIR — airborne infection isolation room) — air flows INTO the room (door kept closed) and is exhausted outside or HEPA filtered; door must remain closed; patient must wear surgical mask if transported through hallways.

Pn nursing responsibilities: apply and remove PPE correctly (donning: gown, mask/respirator, eye protection, gloves; doffing: gloves, eye protection, gown, mask last); perform hand hygiene before and after; maintain isolation room requirements; educate the client about isolation; reinforce respiratory hygiene.

Distinguish: N95 RESPIRATOR (airborne — filters 95% of airborne particles; requires fit-testing) vs. SURGICAL MASK (droplet — larger particles; no fit-test required).

The 10 RIGHTS OF MEDICATION ADMINISTRATION provide a framework for safe drug administration. Asking the client to state their name and date of birth verifies the RIGHT CLIENT (also called right patient).

The 10 rights: (1) RIGHT CLIENT: verify identity using TWO identifiers per Joint Commission standard (name + date of birth; name + medical record number; name + ID band); never rely on room number alone; ask the client to state their name (don't say 'Are you Mr. Smith?' — the client may say yes even if wrong); (2) RIGHT MEDICATION: verify the drug label matches the order three times (when taking from storage, when preparing, before administering); (3) RIGHT DOSE: verify the dose matches the order; calculate if converting; (4) RIGHT ROUTE: oral, IV, IM, SubQ, topical, etc.; verify order matches the available form; (5) RIGHT TIME: verify frequency and when last dose was given; (6) RIGHT DOCUMENTATION: document AFTER administration (not before); (7) RIGHT REASON: does this medication make sense for this client's diagnosis? (pharmaceutical knowledge); (8) RIGHT RESPONSE: assess effectiveness after administration (pain medication: did pain improve?); monitor for adverse effects; (9) RIGHT EDUCATION: client understands what the medication is for and its common side effects; (10) RIGHT TO REFUSE: client has the right to refuse medication; document refusal, notify provider.

Additional safety checks: HIGH ALERT MEDICATIONS (insulin, heparin, anticoagulants, concentrated electrolytes, opioids) require INDEPENDENT DOUBLE-CHECKS by two nurses before administration at most facilities; LOOK-ALIKE/SOUND-ALIKE (LASA) medications are a common source of errors; storage separation and labeling help prevent LASA errors. TWO-IDENTIFIER requirement is from The Joint Commission National Patient Safety Goals.

ASPIRATION PRECAUTIONS for dysphagic patients:

Positioning: HOB at 90 degrees (or highest angle tolerated) during all oral intake and for 30-60 minutes after meals — gravity helps move food toward the stomach.

Thickened liquids: Per speech-language pathology recommendation, liquids may need to be thickened to honey or nectar consistency to prevent aspiration.

Texture-modified diet: Soft, chopped, or pureed foods as recommended.

Feeding technique: Small amounts at a time; slow pace; ensure each swallow is complete before the next bite; no talking while swallowing.

Oral hygiene: Keep mouth clean — oral bacteria in aspirated material cause aspiration pneumonia.

Suction: Suction equipment at bedside for patients at high risk.

Positioning never: Never feed a patient flat in bed — highest aspiration risk position. Most aspiration pneumonia cases involve nocturnal aspiration during sleep — head-of-bed elevation even at night (30 degrees minimum) reduces this risk.

Venipuncture preparation sequence: (1) Explain the procedure to the patient; (2) Gather supplies; (3) Position the arm; (4) APPLY TOURNIQUET (3-4 inches above proposed site); (5) SELECT the vein (palpate for resilience, direction); (6) RELEASE TOURNIQUET temporarily if taking more than 1 minute; (7) DON GLOVES (must be on before skin contact for blood exposure risk); (8) REAPPLY TOURNIQUET; (9) CLEANSE SITE with alcohol swab, using friction, for 30 seconds; (10) LET DRY (30 seconds — wet alcohol increases infection risk and stings); (11) PERFORM venipuncture. The key exam point: gloves go on BEFORE cleansing, not after. Cleansing a site with bare hands violates blood exposure precautions. Some questions ask which step is last — letting the alcohol dry completely is the final prep step before puncture.

Alcohol-based hand rub technique: Apply adequate amount (follow product instructions) to cover all hand surfaces; rub palm to palm; right palm over left dorsum with interlaced fingers; palm to palm with fingers interlaced; backs of fingers to opposing palms; rotational rubbing of thumbs; rotational rubbing of fingertips in opposite palm; continue until hands are COMPLETELY DRY — this ensures adequate contact time (typically 20-30 seconds).

Soap and water technique: Wet hands; apply soap; scrub minimum 20 seconds (the 'Happy Birthday' song twice); rinse; dry with single-use paper towel; use towel to turn off faucet.

When to use soap and water: When hands are visibly soiled; before eating; after using the restroom; after caring for C. diff patients (alcohol is ineffective against spores); after norovirus exposure. ABHR is preferred for most routine hand hygiene because it's more effective, faster, and causes less skin damage.

Medication calculation: Use the formula (Desired ÷ Have) × Volume: Desired: 75 mg. Have: 100 mg. Volume: 2 mL. Calculation: (75 ÷ 100) × 2 = 0.75 × 2 = 1.5 mL.

Verify with dimensional analysis: 75 mg × (2 mL / 100 mg) = 150/100 mL = 1.5 mL.

Nursing check: 1.5 mL is within the acceptable range for IM injection (typically up to 3 mL for large muscles, up to 1 mL for deltoid).

After calculating: Draw up 1.5 mL; visually verify the volume against the syringe markings; check the medication label a third time before injecting. Always show your calculation work on paper, especially for high-alert medications — a calculation error with insulin or heparin can be fatal.

SBAR (Situation-Background-Assessment-Recommendation) is the Joint Commission-recommended and nationally standardised format for healthcare communication, especially hand-offs.

Situation: Who the patient is, the immediate issue or reason for the communication ('Mr. Jones, Room 412, 68-year-old, is being transferred to the OR for laparoscopic cholecystectomy').

Background: Relevant history, allergies, current medications, medical history.

Assessment: Current vital signs, LOC, pain level, IV access, IV fluids running, bowel status, completed preoperative checklist.

Recommendation: What action is needed, anything the receiving team should monitor, any pending orders or concerns. SBAR reduces communication errors — studies show it reduces adverse events by up to 30% when consistently used. The pre-surgical hand-off specifically should include: identification, procedure, surgical site marked, allergies, current status, pending labs or orders, and patient's own understanding of the planned procedure.

RESTRAINT USE — REGULATORY REQUIREMENTS:

Last resort: Restraints must be used only after less-restrictive alternatives fail (redirection, re-orientation, family presence, positioning, medication review, activity).

Physician order required: No nurse may initiate restraints without an order (except in emergency to protect from immediate harm — then get retroactive order within 1 hour).

Order expiration: Most states require new orders every 24 hours; TJC requires specific restraint re-evaluation every 24 hours.

Monitoring: Every 2 hours — circulation checks (pulses, sensation, warmth distal to restraint); skin integrity; position changes; offer fluids; provide ROM.

Documentation: Rationale; alternatives tried; type of restraint; client/family education; reassessment.

Prohibited: Restraints as convenience (staffing shortages); punishment; restraints that restrict breathing.

Legal/regulatory: CMS Conditions of Participation regulate restraint use in Medicare/Medicaid facilities; violations carry serious penalties.

Pn scope: Apply and monitor ordered restraints; exhaust alternatives; document; notify RN of any adverse findings.

TUBERCULOSIS — AIRBORNE PRECAUTIONS: TB spreads via AIRBORNE transmission — tiny droplet nuclei (<5 microns) that remain suspended in air for hours;

Required PPE: N95 respirator (minimum) — must be properly fit-tested for the individual nurse; surgical masks do NOT provide adequate filtration.

Negative pressure room: Air flows INTO the room from the hallway (negative pressure relative to corridor); exhaust air goes outside or through HEPA filtration; door kept CLOSED.

Surgical mask on patient: TB patients wear a surgical mask when transported outside their negative pressure room (to contain droplet nuclei they produce).

Additional precautions: Gown and gloves if contact with respiratory secretions.

Related airborne pathogens: Measles, varicella (chickenpox), disseminated herpes zoster — all require N95 and negative pressure.

Remember: AIRBORNE → N95 + negative pressure room; DROPLET → surgical mask + standard room; CONTACT → gown + gloves.

ACUTE HAEMOLYTIC TRANSFUSION REACTION (AHTR):

Mechanism: ABO incompatibility — transfused red cells are destroyed by recipient's antibodies; severe inflammatory cascade.

Symptoms: Lower back pain (classic — renal pain from haemoglobinuria); fever/chills; flushing; hypotension; haematuria.

Life-threatening: Can cause acute renal failure, DIC, shock, and death.

Immediate response: STOP the transfusion FIRST — every additional millilitre of incompatible blood worsens the reaction; keep IV line patent (NS); notify RN and blood bank immediately; vital signs; obtain urine specimen; keep blood bag and tubing for blood bank analysis; return blood unit to blood bank; anticipate: IV fluids (maintain renal perfusion); diuretics; vasopressors if needed; CONTRAST WITH FEBRILE NON-HAEMOLYTIC REACTION: Just fever and chills without back pain/haematuria — less serious.

Compare with allergic: Urticaria/hives — slow or stop transfusion, give diphenhydramine, may restart.

Anaphylaxis: Airway symptoms — stop permanently, epinephrine.

Key: ANY symptomatic blood reaction = STOP transfusion FIRST.

Safe IV medication administration:

Four rights for IV medications: Right drug, right dose, right patient, right time PLUS right rate for IV medications.

Safe IV rates: Critically important — many IV drugs must be administered over a specified time to prevent adverse effects; too fast = cardiac arrhythmias, hypotension, CNS toxicity.

Specific examples: Vancomycin: minimum 60 min for 1g (Red Man Syndrome if too fast); potassium IV: maximum 10-20 mEq/hr peripheral; IV calcium: slowly — cardiac arrest risk if rapid push; morphine IV push: typically over 4-5 minutes; furosemide IV: over 1-2 minutes; phenytoin: ≤50 mg/min.

Resources: Drug handbook (keep one at the bedside); clinical pharmacist (available by phone 24/7 in most hospitals); package insert; facility infusion guideline.

Never: Guess; ask a non-pharmacist non-prescriber for dosing guidance; rely on memory alone for unfamiliar medications.

Pn scope: Know your resources; it is SAFE PRACTICE to call pharmacy — not a sign of weakness.

Who 5 moments of hand hygiene: (1) BEFORE touching the patient; (2) BEFORE a clean/aseptic procedure; (3) AFTER bodily fluid exposure risk; (4) AFTER touching the patient; (5) AFTER touching patient surroundings.

Key points: Hand hygiene AFTER GLOVE REMOVAL — gloves have micro-tears; hands can be contaminated during glove removal; gloves do NOT replace hand hygiene; ALCOHOL-BASED HAND RUB (ABHR): Preferred for most situations — 20-30 second application, rub until dry; MORE EFFECTIVE than soap for most pathogens.

Soap and water required: C. difficile (ABHR does not kill spores); when hands are visibly soiled; after using the toilet; before eating.

Duration: Soap and water = 40-60 seconds; ABHR = 20-30 seconds.

Compliance: Hand hygiene is the single most effective infection control measure; studies show 30-40% compliance among healthcare workers without systematic reminders — compliance saves lives.

Patient elopement/missing patient:

Definition: Elopement = patient leaves a healthcare facility without medical authorisation.

Risk assessment: Patients at risk: confused/demented; psychiatric patients; patients who have expressed desire to leave; impulsive or cognitively impaired patients.

Immediate response sequence: Brief immediate search of room, bathroom, hallways; call to charge nurse/supervisor to activate protocol (this takes <2 minutes while you're searching); facility-wide search initiated; security notified; depending on patient risk: police notified; family notified.

Documentation: Time last seen; circumstances; actions taken.

Prevention: Elopement risk assessment on admission; wander guards (door alarms for dementia patients); check-in procedures; monitoring high-risk patients.

Regulatory: Elopement injuries and deaths are sentinel events requiring immediate investigation and root cause analysis.

Never: Wait and hope the patient returns — every minute increases risk of harm to a confused or medically fragile patient who has left the facility.

MRSA — CONTACT PRECAUTIONS:

Transmission: Direct contact (touch) with infected wounds, skin, or colonised areas; indirect contact (contaminated surfaces and equipment); MRSA DOES NOT require special respiratory precautions (unless the patient has pneumonia with productive cough — then droplet may be added for respiratory secretion management, per facility protocol).

Contact precautions:

PPE: Gown + gloves upon ROOM ENTRY (not just when touching patient — MRSA contamination on all surfaces in the room); Private room or cohorted with another MRSA patient; Dedicated equipment stays in the room.

Hand hygiene: On entry and exit from the room.

Education: Family and visitors need teaching.

Decolonisation: In some cases, mupirocin nasal ointment and chlorhexidine washes ordered to reduce MRSA colonisation.

Signage: Contact precautions sign outside the door; document in medical record; notify receiving facility on transfer.

Removal of precautions: Per facility protocol; typically requires negative culture results; some patients remain MRSA-colonised indefinitely.

HAEMORRHAGE RECOGNITION — HAEMODYNAMIC RESPONSE: EARLY COMPENSATED HAEMORRHAGE (Class I-II, up to 1,500 mL blood loss): Heart rate INCREASES (tachycardia) — compensatory sympathetic response; Blood pressure may be maintained or slightly decreased; Anxiety, restlessness; Skin pallor, cool, diaphoretic; LATE DECOMPENSATED HAEMORRHAGE (Class III-IV, >1,500 mL): Blood pressure DROPS — compensatory mechanisms overwhelmed; Severe tachycardia (>120-140); Confusion, lethargy; Oliguria;

Classic early warning pattern: Rising HR + falling BP = haemorrhage until proven otherwise; CUSHING'S TRIAD: Rising BP + dropping HR + irregular respirations = INCREASED INTRACRANIAL PRESSURE — not haemorrhage.

Post-surgical monitoring: Vital signs every 15 min × 4, then every 30 min × 4, then hourly — catch early deterioration; Assess incision/drain output; Assess urine output.

Pn scope: Monitor vital signs; report early warning signs; do not wait for obvious hypotension before notifying RN.

Medication error reporting:

Moral and legal obligation: All medication errors must be reported, regardless of apparent harm — this is a patient safety, legal, and regulatory requirement.

Immediate response: Assess patient for signs of adverse effects (vital signs, symptoms); report to RN and physician immediately with specific information (what was given, what was ordered, when, patient status).

Documentation: Document WHAT WAS ACTUALLY ADMINISTERED in the medical record — falsifying to show the correct dose is fraud; the incident report is separate from the medical record.

Incident report: NOT part of the medical record in most jurisdictions; used for quality improvement; typically not discoverable in litigation; DO NOT reference the incident report in the medical record.

Consequences of not reporting: The physician may unknowingly give subsequent orders based on the assumed correct medication; harm could result later; the nurse faces discipline and potential criminal charges for concealment.

Just culture: Modern healthcare uses a 'just culture' model — transparent reporting without automatic punishment for honest errors; learning-focused rather than blame-focused.

Cauti prevention bundle:

Indications: Only insert when medically necessary — review daily whether continued catheterisation is needed.

Insertion technique:

Sterile: sterile gloves, draping, catheter; cleanse with antiseptic; insert without contamination.

Closed drainage: Never disconnect catheter from drainage bag (without specific indication); use a preconnected closed system.

Drainage bag management: Keep below bladder level at all times; empty regularly (never allow to fill completely); do not place on floor; don't kink or obstruct tubing.

Care and maintenance: Daily periurethral cleansing (soap and water).

Avoid: Irrigation unless ordered for obstruction; routine catheter changes on schedule (change only when indicated: obstruction, soiled, malfunction).

Documentation: Date of insertion; indication; daily reassessment of continued need.

Impact: CAUTIs account for ~30% of all healthcare-associated infections; each CAUTI adds ~$600-700 in hospital costs and increases patient morbidity; many are considered 'never events' when proper protocols are followed.

Dosage calculation: Desired dose ÷ Available dose per unit = number of units. 0.25 mg (desired) ÷ 0.125 mg (per tablet) = 2 tablets.

Verification: 2 tablets × 0.125 mg = 0.25 mg ✓.

Medication safety checks: Always verify the calculation; if a calculation results in an unusual number of tablets (more than 2-3, or fractions of unscored tablets), double-check — it may signal an error; digoxin is a HIGH-ALERT medication — verify dose, check apical pulse before administration (hold if < 60 bpm), watch for toxicity; THE 'RIGHTS' of medication administration: right patient, right drug, right dose, right route, right time, right documentation, plus right reason, right response, right to refuse; calculation errors are a leading cause of medication errors — when in doubt, have a second nurse verify, especially for high-alert medications and pediatric doses.

TUBERCULOSIS — AIRBORNE PRECAUTIONS: TB spreads via tiny airborne droplet nuclei that remain suspended in air and travel on air currents.

Requirements: AIIR (Airborne Infection Isolation Room) — negative pressure relative to the hallway (air flows INTO the room, not out); minimum 6-12 air exchanges per hour; air exhausted outside or through HEPA filtration; N95 RESPIRATOR (fit-tested) or PAPR for anyone entering — a regular surgical mask is NOT sufficient for airborne precautions; keep the door closed; if the client must leave the room, they wear a surgical mask (to contain their droplets); OTHER AIRBORNE DISEASES (mnemonic 'My Chicken Hez TB'): Measles, Chickenpox (varicella), Herpes zoster (disseminated), TB.

Contrast: Droplet (flu, pertussis, meningitis) = surgical mask, larger droplets that don't travel far; Contact (C. diff, MRSA) = gown and gloves; LPN role: implement airborne precautions, wear N95, ensure negative-pressure room, educate visitors.

Post-fall protocol:

Sequence: (1) Ensure immediate safety; assess for injury (don't move if spinal injury suspected); assess level of consciousness, vital signs, pain, range of motion, any deformity; (2) Provide necessary care/stabilization; (3) Notify the RN and provider; (4) Document OBJECTIVE findings in the medical record (what you found, the client's condition, actions taken, who was notified) — factually, without speculation about cause or blame; (5) Complete an INCIDENT REPORT (occurrence/variance report) separately — this is an internal quality/risk management document.

Key point: The incident report is NOT part of the medical record and should NOT be referenced in the chart ('incident report completed' should NOT be charted) — they are kept separate for legal reasons; documentation should be factual and objective.

Fall assessment: Reassess fall risk; implement additional precautions; LPN role: ensure safety, assess, notify, document objectively, complete incident report per facility policy.

PPE DONNING SEQUENCE (putting ON): (1) GOWN first; (2) MASK or respirator; (3) GOGGLES or face shield; (4) GLOVES last (gloves go over the gown cuffs);

Mnemonic: 'Gown, mask, goggles, gloves'; DOFFING SEQUENCE (taking OFF) — reverse and based on most contaminated first: (1) GLOVES first (most contaminated); (2) GOGGLES/face shield; (3) GOWN; (4) MASK/respirator last (remove after leaving the room for respirators).

Why order matters: Donning order ensures proper coverage and that gloves seal the gown; doffing order removes the most contaminated items first while preventing self-contamination.

Hand hygiene: Perform before donning and after doffing (and during doffing if hands become contaminated); the doffing sequence is more commonly tested because errors during removal are the highest contamination risk; LPN role: don and doff PPE correctly to prevent transmission and self-contamination.

LATEX ALLERGY MANAGEMENT — PREVENTION IS PRIORITY: Create a LATEX-FREE ENVIRONMENT: latex-free gloves (nitrile, vinyl); latex-free equipment (BP cuffs, tourniquets, IV tubing, catheters, syringes); check all supplies for latex content;

Latex allergy alerts: Allergy band, chart flag, signage on the door.

Scheduling: First case of the day reduces airborne latex particles that accumulate from prior cases.

Cross-reactivity: Latex-allergic patients may react to certain foods (banana, avocado, kiwi, chestnut — 'latex-fruit syndrome').

Reaction severity: Ranges from contact dermatitis to anaphylaxis; have emergency equipment and epinephrine available; PREVENTION over reaction: The priority is preventing exposure, not just being ready to treat a reaction.

Healthcare workers: At higher risk for developing latex allergy due to frequent exposure; LPN role: verify allergy, ensure latex-free supplies, post alerts, advocate for first-case scheduling, monitor for reaction.

OXYGEN SAFETY — FIRE PREVENTION: Oxygen does not burn itself but VIGOROUSLY SUPPORTS COMBUSTION — fires burn hotter and faster in an oxygen-enriched environment.

Safety measures: NO SMOKING (post 'Oxygen in Use — No Smoking' signs); no open flames, candles, matches, lighters; avoid electrical equipment that could spark; no petroleum-based products (petroleum jelly, oil) near oxygen — use water-based lubricants; avoid wool/synthetic fabrics that generate static; ensure proper grounding of electrical equipment; keep oxygen sources away from heat; SECURE oxygen cylinders (can become projectiles if the valve breaks).

Home oxygen: Educate about the same precautions; keep oxygen away from stoves, heaters, and gas appliances.

Additional: Monitor for oxygen toxicity with high concentrations over time; for COPD patients, titrate carefully (target SpO2 88-92%); LPN role: ensure a safe oxygen environment, post warnings, educate the client and visitors, remove ignition sources.

Who five moments for hand hygiene: (1) BEFORE touching a client; (2) BEFORE a clean/aseptic procedure; (3) AFTER body fluid exposure risk; (4) AFTER touching a client; (5) AFTER touching client surroundings (even without touching the client).

Hand hygiene method: Alcohol-based hand rub for routine decontamination (faster, more effective for most organisms, less drying); SOAP AND WATER when hands are visibly soiled, after using the restroom, and for spore-forming organisms (C. diff, anthrax — alcohol doesn't kill spores).

Technique: Alcohol rub — apply, rub all surfaces until dry (15-30 sec); Soap and water — wet, lather, scrub all surfaces 20+ seconds, rinse, dry, turn off faucet with towel.

Importance: Hand hygiene is the single most effective measure to prevent healthcare-associated infections; LPN role: perform hand hygiene at all five moments, use the correct method, model and promote compliance.

MEDICATION RECONCILIATION — CATCHING INTERACTIONS: Warfarin (anticoagulant) + aspirin (antiplatelet) = significantly increased bleeding risk; this combination requires provider awareness and may be intentional (some cardiac conditions) or an oversight from separate prescribers.

Priority: Recognize the interaction; notify the provider to confirm intent before administering; do not simply give both without clarification.

Medication reconciliation: Comparing the client's current medications across transitions of care (admission, transfer, discharge) to identify and resolve discrepancies — duplications, omissions, interactions, dosing errors; a National Patient Safety Goal; HIGH-RISK INTERACTIONS to know: anticoagulant + antiplatelet (bleeding); ACE inhibitor + potassium (hyperkalemia); multiple QT-prolonging drugs (dysrhythmia); MAOIs + many drugs/foods.

Involve: pharmacist for complex reconciliation.

Safety culture: Catching these is exactly why reconciliation exists; LPN role: participate in reconciliation, recognize potential interactions, notify the provider, advocate for client safety.

NG TUBE MEDICATION SAFETY — VERIFY PLACEMENT: Before instilling ANY medication or feeding through an NG tube, VERIFY PLACEMENT to ensure the tube is in the stomach, not the lungs (a dislodged tube in the airway could cause aspiration of medication/feeding into the lungs — potentially fatal).

Verification methods: Check the external tube length marking against the documented baseline; aspirate gastric contents and check pH (gastric pH typically ≤ 5); X-ray is the gold standard for initial placement; observe aspirate characteristics; the auscultation 'whoosh' test alone is NOT reliable; MEDICATION ADMINISTRATION via NG: Verify placement; check tube patency; use liquid forms when available; crush only compatible tablets (never crush enteric-coated or extended-release); administer medications separately, flushing between each (prevents interactions and clogging); flush with water before and after (typically 15-30 mL adult); keep head of bed elevated; LPN role: verify placement before every use, administer correctly, flush appropriately, monitor for complications.

Seizure precautions:

Bedside equipment: Suction equipment (to clear secretions and maintain airway); oxygen (for post-ictal hypoxia); padded side rails; bed in LOW position.

During a seizure: Protect from injury — do NOT restrain; do NOT put anything in the mouth (the old 'bite block/tongue blade' teaching is WRONG and dangerous — can break teeth, obstruct airway, injure the mouth); turn the client to the side (recovery position) to prevent aspiration if possible; protect the head (cushion); loosen tight clothing; note time, duration, and characteristics of the seizure; clear the area of hazards; AFTER (post-ictal): Maintain airway, suction if needed, provide oxygen, reorient gently, allow rest, assess for injury.

Document: Onset, duration, type of movements, level of consciousness, incontinence, post-ictal state.

Never: insert objects in the mouth, restrain the client, leave the client alone.

Call for help: Notify RN/provider; status epilepticus (continuous/repeated seizures) is an emergency; LPN role: implement precautions, protect during seizure, monitor, document, never restrain or insert objects.