Question

Clara is a 78-year-old woman admitted two days ago for a resection of her intestines due to a
bezoar. Her postoperative course has been uncomplicated and her surgeon wants her to
ambulate three times per day the length of the hall. Selma, the RN on the post-surgery recovery
unit, has assessed Clara and determined that ambulating her is a task that appropriate for a
nursing assistant.
Selma approaches the nursing assistant, Sue, after report and says: “Sue, I need your
assistance to ambulate Clara. She needs to ambulate once per shift the length of the hall. I’d
like her to ambulate once before lunch and again around 3 pm. I’ve assessed her to be
relatively steady on her feet although she uses a walker at her nursing home. I believe that all
she needs is stand-by assistance when she walks. She should walk from her room to the
nurses’ station and back to her room. Clara has had her morning care and breakfast and is
ready to walk when you have time. When you walk with her, please stay with her the entire time
she is up. If you notice she is having trouble walking, becomes unsteady, light headed or dizzy,
assist her back to bed or into a chair and let me know. Do you have any questions or
concerns?”

Questions:
• What one key element in delegation did Selma forget in the delegation process when
delegating this task to Sue?
• What additional information should Selma have included in her instructions to make the
task clearer?
• If Sue leaves Clara alone to help another patient and Clara falls, whose responsibility is
it

Answer 1

Abdominal surgery is considered to be a major surgery. So the post operative care for intestine resection is significant. Mobility helps us perform activities of daily living, express emotions, and gratify basic needs, as well as sustain our health and enhance our body’s ability to heal and repair.

• In this situation ,Selma need to be with the patient and care giver and make sure that there is no obstacles in the room. The emergency equipments ,oxygen and crash cart should be ready in that room because the patient is in high risk for fall after abdominal Surgery. The patient should be on Continuous monitorization by using pulse oxymetry so that the nurse/care giver know the condition of patient is worsening or not.
• Selma must check her vital signs and saturation level before mobilization. The oxygen cylinder and emergency equipments must be ready for any sentinel events. Make sure that the surgery site is clear and there is no oozing out of any secretions. The cloth should be loosened around the wound before mobilization. The patient should be pain free prior to mobilization.
• If Sue leaves Clara alone to help another patient and Clara falls, the responsibility will come under both Sue and Selma.The care giver and nurse cannot leave the patient leave alone during this task. The caregiver must call for help if any other patient calls for help. If patient falls it is considered as a sentinel event which will cause major harm to the patient recovery and health.