Question

Case Study: Delegation

It is the beginning of the evening shift on a step-down unit. Your team for the evening includes you (the RN), another RN, one LVN, and one UAP. Here are the patients on the unit:

Room 1A: 50-year-old female with ovarian cancer. Had an argument with her husband and is asking that all visitors be restricted.

Room 1B: 88-year-old female with dehydration. Is now confused, and a urine sample is needed to rule out a urinary tract infection (UTI).

Room 2A: 44-year-old male admitted with a nonhealing abdominal wound after gastric bypass. The wound has a negative pressure wound therapy system that needs to be changed this shift.

Room 2B: 78-year-old male with bacterial endocarditis who will be returning to the nursing home to continue his IV antibiotics. Needs transfer form completed, assistance with dinner, and a bath.

Room 3A: 35-year-old male going for an IV contrast CT. Received call from radiology that transportation is on its way to pick up the patient; patient does not have any IV access.

Room 3B: 18-year-old male admitted for 23-hour observation for mild concussion after falling at an ice rink. Patient is ready for teaching prior to discharge.

Room 4A: 22-year-old female with SIADH on fluid restriction. Current fluid restriction is 200 mL for evening shift and 100 mL for night shift. Family has brought in multiple food items as well as her favorite sodas to drink.

Room 4B: 25-year-old female with PID. Needs to receive IV antibiotics, and a weight is required to prepare the proper dose.

Question 1: Describe what a UAP and LVN can do.

Question 2: What determination do you need to make before assigning care of the patient in Room 2A?

Question 3: Which tasks must be completed by you and the other RN? List in order of priority with rationale for each room.

question 4: Which tasks may be delegated to the LVN/LPN? List in order of priority and provide your rationale for each room.

Question 5: Which tasks may be delegated to the UAP? List in order of priority and provide your rationale for each room.

Question 6: What specific feedback does the RN need from the LVN and UAP regarding their assigned tasks?

Question 7: What care delivery model is described in this scenario?

Question 8: The UAP informs you that the patient in 1B has a fever of 102° F. After performing an assessment, you decide to call the health care provider. How would you use SBAR to communicate with the provider?

Answer 1

1.The Unlicensed assistive personnel can do the following like

• Taking or monitoring vital sigms
• Weight checking
• Mobilising the patient
• Helping in activities of daily living
• Observe the patient status ,on case if any abnormal changes report to the RN.

The Licensed practice nurses can do the following

• Monitor patient
• Monitor vitals
• Administer medication
• Can do simple procedure
• Can do catheter insertion
• Wound dressing can be done by them
• Can meet the personal hygiene of the patient
• To health educate

2.The determination which has to be done before assigning care to this patient is

• Ensure the ability of the assigning staff's capability of doing wound care

3.The tasks which has to be completed and prioritised are

• 1A.Ensuring the patient requests are considered (Restrictions of visitors can reduce the rate of infection )(seventh)
• 1B .Mental status examination and GCS assessment to know the patient status. Assessing for any need if laboratory works to rule out the cause of confusion (First)
• 2A.Assessment of the wound for any infection (Sixth)
• 2B.Administer antibiotics ,then form Completion and meeting basic needs(Fourth)
• 3A.Insert IV line and prepare patient for transfer (Third )
• 3B.Discharge advice (tenth)
• 4A. Monitor IO chart(nineth)
• 4B.Antibiotic administration (Second)

4.The task delegation are

UAP: Monitor weight

Help in activities of daily living

Transfer the patient when to CT department

Inform the family members not to give any drinks or food without RN advice

LVN: Administer antibiotics to 4B

Insert IV and shift and prepare patient to transfer

Wound dressing has to be done

Collect urine sample

Providing support to 1A patient

Discharge advice