Question

Please assign these patients to staff, being mindful of the scope of practice and ability levels of staff members? The staff for the next shift includes: • Raul; an experienced RN. • Tara; an RN orientee assigned with Raul for the shift. It is her third day on the unit. • Monique; a supplemental RN. The last assignment in this unit was three weeks ago. • Dorothy; an experienced LPN. • Timmy; an experienced nursing assistant. • Val; unit secretary, split between your unit and the one next door as your secretary called in sick. Patients currently on unit: #2201: PP, a 51-year-old female with T1DM (type one diabetes) who has ESKD (end-stage kidney disease). She was admitted for a revision of her A-V fistula. She has a temporary Hemodialysis catheter in place. She’s scheduled for hemodialysis this morning. #2202: RP, a 72-year-old male patient with a CBI (continuous bladder irrigation) who is post-op from a TURP yesterday. He has had many clots passed through the CBI and has needed the catheter manually irrigated three times during the past shift. #2203: empty bed. #2204: MG, an 88-year-old female patient admitted two days ago with urosepsis. She’s currently getting IV antibiotics through a peripheral IV every eight hours. She has been incontinent of urine twice during the past shift. She is currently complaining about pain at the site of her IV. #2205: MW, a 44-year-old female patient who had a cystoscopy yesterday for a biopsy of her bladder. Cancer is suspected. She is currently waiting for the provider to write her discharge orders so she can go home today. #2206: JS, a 69-year-old male patient with uncontrolled hypertension and chronic kidney disease admitted last evening. He has a history of non-adherence to his medications at home and comes into the hospital every four to five months with chest pain, high BP readings, and weight gain. He’s been prescribed Lasix, Lisinopril, and metoprolol. His provider would like to send him home tomorrow. He has not been evaluated by the case-manager on your unit yet. #2207: AM, a 21-year-old female patient with an acute kidney infection. She was admitted during the night. The patient currently has IV of NSS infusing at 100 ml/hr via peripheral IV and is complaining of 9 out of 10 back pain. Is febrile with a temp of 100.6 F #2208: MS, a 60-year-old male patient with a renal calculi diagnosed by CT scan. Being medicated with IV Fentanyl every three hours for 10 out of 10 pain reported by the patient. Receiving IV fluids and needs assistance to the bathroom. Urine must be strained each time the patient voids. #2209: SS a 72-year-old male admitted with hematuria. He is having diagnostic testing completed for renal carcinoma. The patient has a history of leukemia as a 40-year-old. This patient and his family are very upset by the diagnosis and the patient is intermittently tearful. #2210: CT, a 55-year-old female admitted with community-acquired pneumonia. She is currently on 4 L NC and has a 02 saturation of 92% at rest. She is short of breath and has been ringing for the nurse frequently as she is frightened of dying when she gets SOB. She is receiving Levaquin IV every 24 hours for her pneumonia. This patient also has an ileal conduit with a drainage bag attached. She had her bladder removed ten years ago due to cancer. #2211: RM, a 76-year-old male patient with cellulitis on his left shin. He’s on contact precautions for MRSA. He has been receiving continuous peritoneal dialysis at night, he’s assigned to your unit, as your staff has the training to use the PD equipment. #2212: AF, a 40-year-old female patient with an intellectual disability from a group home setting. She was admitted with pyelonephritis during the night. She is scheduled for discharge today. She will need her IV discontinued and discharge instructions will need to be given to the patient and her caregiver.

Answer 1

This is a discussion note on medical unit specialized in care of patients with kidney and urinary tract infection with total bed strength of 12beds with one empty bed with 7 members of unit team which include a clinical coordinator, 1 experienced RN, 1supplemental RN, 1RN oriented, 1 experienced LPN,1 experienced nursing assistant and 1 unit secretary.

- As a clinical coordinator, before responsibilities it is mandatory to follow five right of delegation which include:

1. Right task

2. Right circumstances

3. Right person

4. Right direction

5. Right level of supervision.

Certain delegation error such as under delegation, over delegation and improper delegation.

- The clinical coordinator will monitor the duties of RNs, LPN and nursing assistants on duty and provide feedbacks when necessary post evaluation.

- The first patient PP would be RN Raúl to complete preoperative preparation for hemodialysis. Tara would help Raúl with revision of AV fistula and would make the patient comfortable and assess the elimination, nutrition and fluid status of the patient and also check the blood glucose of the patient was she is a case of type 1 DM.

- RP who is in the first postoperative day of TURP would assign to monitor who is supplemental RN for continuous monitoring of vital signs and output chart and also assess clots and continue bladders irrigation. Dorothy an experienced LPN would assist monitoring in charting irrigation and vital parameters.

- Raul would be delegated for preparation of any new admission to the empty bed 2203.

- MG, who is complaining of pain at IV site would be assigned to Dorothy, an LPN to check for any IV complication and maintain IV stable so as to continue IV antibiotics next 8^th hour.

- MW who is waiting for discharge today would be assigned to Monique who proceed with her discharge preparations along with Val, unit secretary.

- JS a patient who is a known case of CKD with non-adherence to medications would be assigned to Monique to provide health education on drug compliance and discharge and follow up and to monitor for medication side effect.

- AM would be assigned to Dorothy to monitor vital signs and pain assessment and report to Raúl if needed. MS who needs assistance would be assigned to Timmy for elimination need and Dorothy would asses the urine whiles straining and help Raúl to administer IV medication.

- SS would be assigned to Raúl for counselling as he and his family is upset with diagnosis.

- CT would be attended by Monique for counselling on her fear of death related to shortness of breath and Dorothy would check ileal conduit and Timmy would assist Dorothy to empty drainage bag.

- RM would be assigned to Raúl along with Tara for post-operative care of peritoneal dialysis. AF would be taken care by Monique for discharge preparation along with VAL and provide discharge instruction. Timmy would remove IV and stabilized patient.

FOR ANY DOUBT POST A QUESTION IT WILL BE HIGHLY APPRECIATED.