LPN duties in a hospital

Ang_RN · Jun 29, 2008

titers are test they run on your blood to determine immunity. that is what I know thus far

Fiona59 · Jun 30, 2008

Hospital duties depends on where you are working and how fully your employer allows your scope of practice to be used.

I work to full scope in my health authority. Having said that in my hospital I cannot administer vaccinations. I can start an IV, administer iv meds (except those going into a central line and certain chemo drugs). I am the second nurse for blood hangs, cann't pierce the bag but once it's up and running the responsibility is mine. Wound care, documentation, talking with the family, suture/staples removal. Trained to but the hospital won't permit NG inserts.

Pretty much everything.

MzGurl · Jun 30, 2008

Thanks fiona59 that really gave me an outlook on what to expect. I look up to all u good lpns who love ur career and are willing to help gid advice and answer questions for others so thanks again

Melinurse · Jun 30, 2008

Every state and employer has different standards or duties the LPN can do within an acute care facility. I was an LPN for 5 years in the hospital I still work at. I did the assessments( never the admit or first post-surgical ), neuro checks, co-sign for blood, witness wasting of narcotics, pass meds except IV titrated/drips, no IV push!, could start IV and d/c, foley insert/removal, monitor restraints ( not initiate ), hang IV meds and fluids, monitor I&O, could not take orders from MD, no NG tubes, tube feedings, colostomy/ileostomy care, patient teaching except meds and discharge teaching. I could tell patient what meds I was giving them, but if they wanted detailed answers I had to get the RN.Your facility may be different. I hear most hospitals use LPNs more as a CNA than as a nurse. But I don't know this for sure. I read in Nursing Magazine that there may be a come back of using LPNs more in hospitals.:yeah:I hope it is true.

Daytonite, BSN, RN · Jun 30, 2008

i worked for many years with lpns and lvns in hospitals since nursing assistants were not utilized to do patient care at the time. they did everything that the nurse practice act allowed (i worked in 3 different states as well as for the federal government who pretty much has their own set of rules). they assessed patients although we rns had to follow along to confirm their findings, gave medications, including ims and prns, suctioned and assisted doctors with and did all kinds of nursing procedures. they did not make patient care assignments (unless we had a rare instance where there were nursing assistants that they could delegate some of the patient care to), did not call mds and talk with them about patient problems, nor were they allowed to take orders from physicians. they were allowed to regulate the flow of ivs but could not hang iv fluids, start any iv fluids or give iv medications (our state law). lpns were often the scrub nurses on the surgical teams in the ors who were working directly in the sterile fields with the surgeons setting up the surgical tables with the instruments that were going to be needed before surgery began and then putting them in the surgeon's hands during the operation.

my mother was an lpn who worked in icu and ccu for years. her job duties were exactly what i posted in the above paragraph. when there were also procedures and code blues (and they had plenty of those in the units) she assisted. she loved the excitement of being in the center of all that constant chaos unlike me.

the rules are a tad different for lpns/lvns who work in nursing homes, but the state nurse practice acts clearly delineate them.

http://stats.bls.gov/oco/ocos102.htm - about lpn nursing from the u.s. department of labor
http://www.nursingprograms.com/licensed-practical-nurse-vocational-practical-nurse - licensed practical nurse - vocational practical nurse

in california, the lvn schools are required by the state board to teach the following content in their course of instruction:

anatomy and physiology
nutrition
psychology
normal growth and development
nursing fundamentals
nursing process
communication
patient education
pharmacology, which shall include:
- knowledge of commonly used drugs and their action
- computation of dosages
- preparation of medications
- principles of administration
[*]medical-surgical nursing
[*]communicable diseases, which shall include but not be limited to human immunodeficiency virus (hiv)
[*]gerontological nursing
[*]rehabilitation nursing
[*]maternity nursing
[*]pediatric nursing
[*]leadership
[*]supervision
[*]ethics and unethical conduct
[*]critical thinking
[*]culturally congruent care
[*]end-of-life care

your state will have a similar cirriculum. iv therapy is something in the state where i now live that requires separate training and certification beyond what is taught in lvn school.

titer - (page 1961, taber's cyclopedic medical dictionary, 18th edition) standard of strength per volume of a volumetric test solution. (page 1529, webster's new world dictionary of the americqan language, collegiate edition) a standard strength or degree of concentration of a solution as established through measuring how much of a substance must be added to produce a given reaction.

titer levels are diagnostic tests involving immunoglobulin reactions. titers measure the antibodies present in a person's system. you may see the word "assay" or just "serology" in the title of a lab test in place of the word "titer" when these types of tests are being performed.

what you may not know if you haven't had a physiology course is that complement is a very special group of proteins that are found throughout our body and in our body fluids. they play a huge role in our immunity to disease. complement proteins are enzymes that kill invading organisms by lysing them. lyse means "to destroy". these enzymes, kind of like special forces, attach to the outer cell membrane of invaders and pretty much slit the outer cell membrane in order to break the invader cell apart so its contents, or guts, spill out. pretty gory if you happen to be there. the body detects this foreign debris which sets off the inflammation and b-cell-mediated response in our body that gets the war against the invasion underway (if you want to know the rest of the story, read about the inflammation response: https://allnurses.com/forums/f50/histamine-effect-244836.html).

in the test for whole complement titer, total complement or hemolytic titration assay (these are all the same test) sheep red blood cells that have been coated with a microbial antibody are mixed with a patient's serum (in the lab, of course!). if enough complement is present in the patient's serum, then 50% of the sheep red blood cells will be lysed (the determined reaction). this 50% figure, the standard titer, has been determined to indicate that an adequate level of complement is present in the person's serum to provide them with adequate protection against invading organisms. if the result is below 50% it indicates the patient may have an autoimmune disease, some type of chronic long-term infection that is depleting its stores of complement, or there is an inherited genetic boo-boo because of the complement proteins not being replicated correctly or not at all. an elevated titer over 50% means that an acute (rapid onset) immune response is currently underway.

specific viral titers have been more difficult to determine which is why complement titers are often tested first to look for the presence of acute, active immune response going on. viral titers would be highest in the earliest stages of a viral disease, but there are few blood tests, if any that i know of, for viral cultures like there are to detect for the presence of bacteria. and how many viruses do we know of where we don't catch them until the patient is way past the initial early stage? (aids) however, a few tests for some specific viral antibodies, not the actual virus, have been developed such as hepatitus b (hbv), hiv, and rubella (german measles) to name a few. luckily, we have vaccines for some of them. you may be required to have one or more of them done as part of your physical exam process for entry into nursing school. they will show whether or not you've had the disease and have current active protection against it.

sorry if i got away with the explanation, but felt it would help in explaining it all. immunity and the inflammation response and the signs and symptoms it produces comes up time and time again in nursing practice, so an understanding of it is critical.