t13. Leadership & Mgmt
the nurse can witness the client's signing of the consent form; this differs from
"obtaining consent."
atypical pain
(jaw or arm), shortness of breath, indigestion, nausea, dizziness, and cold sweats.
*** the HCP should return and provide additional teaching.
- accepting a birthday gift of a gold bracelet frm pt -soliciting a wealthy pt to invest in a company -staying after work hours and drinking wine with a pt
NOT considered crossing a boundary
- making a visit to the hospital after a pt has surgery -offering to pray together if a pt so wishes -sending a sympathy card to family after a pt dies
*** emergency department nurse is obligated to make a report for which situations? Select all
- to the authorities that an elderly client has suspicious bruising but denies caregiver abuse -to the med examiner of a death following trauma, even if the family refuses autopsy -to the supervisor that an oncoming health care provider has the smell of alcohol on the breath
UAP can assist pt's wi
-ADL -morning hygiene -documenting I&O -taking vital signs of a stable client -swaddling a neonate -
UAP scope of practice
-ADLs -hygiene -linen change -routine, stable vital signs -documenting I&O -Positioning
*** The postpartum nurse receives report on 4 mother-baby couplets. Which tasks can be delegated to unlicensed assistive personnel? Select all
-Assisting the mother with morning hygiene -documenting I&O on the mother -obtaining an axillary temp on the neonate -swaddling the neonate after diaper changes
RN scope of practice
-clinical assess -initial pt edu -discharge edu -clinical judgement -initiating blood transfusion
LPN scope of practice
-monitoring RN findings -reinforcing edu -routine procedures (cath) -most med admins -ostomy care -tube patency & enteral feeding -specific assessments (lung sounds / bowel sounds / neurovasc checks )
when deligating to the UAP or LPN, the RN should consider the
5 rights of delegation
*** office nurse receives 4 telephone messages. Which client should the nurse call back first?
68-y o wom wi left sided jaw pain, diziness, and nausea who thinks it is an infection related to routine teeth cleaning yesterday
*** 1:00 AM routine fingerstick (glucose monitoring) test for a client was delegated to the unlicensed assistive personnel (UAP) by the registered nurse (RN). At 11:15 AM, the client tells the nurse that no one checked the blood level. The nurse should take what action first?
Ask the UAP about the situation
Right direction/ communication
Delegator needs to provide clear instructions; must include specific client concerns & observations to be reported back or recorded Delegatee should verbalize understanding & have opportunity to ask questions
Right person
Delegator should assess competency prior to delegating Delegatee must have the appropriate knowledge, skills & abilities
name of the representative to make health care decisions for the client
Durable POA for health care
cannot be delegated ?
Elements of the nursing process 1. Assessment, 2. Planning, and 3. Evaluation 4. Tasks requiring nursing judgment
delegated to UAP ?
Helping the mother with morning hygiene, documenting intake and output, taking vital signs of stable clients, and swaddling the neonate
when to contact mgmt ?
If a pattern of neglect arises or if the UAP is belligerent and refuses the delegation
an advance directive is also called
Living Will
1-2 days after influenza vaccination.
Minor expected adverse effects can occur
Right supervision/ evaluation
Monitor, evaluate & intervene as needed Delegator retains ultimate accountability for task
atypical angina symptoms
Older individuals, diabetic clients, and women
responsibility for initial client teaching and demonstration of home care.
RN
responsible for any care requiring clinical judgment
RN
right circumstances
Relatively stable client; noncomplex task Adequate staffing, resources & supervision available
Initially, the RN should
SOLELY attempt to handle this situation (wi out administrative assistance )
assist the mother with bathing the neonate.
UAP
right task
Within delegatee's scope of practice Routine, frequently recurring task; minimal potential risk Established sequence of steps; requires little to no modification for individual clients Predictable outcome
advance directive makes clear
a client's health care wishes (eg, do not resuscitate
power of attorney (POA) designates
a representative to act on a person's behalf.
RN is a mandatory reporter of elder _________
abuse
(UAP scope of practice
activities of daily living
UAP can assist wi/ ?
activities of daily living, documenting intake and output, positioning, and taking the vital signs of STABLE clients.
RN should assess caregiver interaction with the newborn to identify
any attachment issues.
take home : Women with myocardial ischemia and acute myocardial infarction (AMI) often have
atypical pain and nonspecific symptoms.
pt wi r shoulder pain and difficulty raising the arm above the head after playing baseball 2 days ago...indicates ?
b/c it was a specific event, the signs indicate a rotator cuff injury.
brassy (barking) cough most likely has croup, which
can be life-threatening and needs urgent assessment.
Glyburide is used to treat
cause significantly low blood sugar if ingested by a client who does not have diabetes, especially a child.
never seek personal gain (eg
ccepting gift worth >$20, asking for financial investment/loan
+++ nurse in the emergency department receives 4 clients. Which client should the nurse see first?
child who is confused and irritable and whose parent claims two glyburide pills are missing
However,
client seems to be stable so the child wi glyburide should be seen first
child requires immediate intervention b/c hypoglycemia can result in
coma and or death
When the completion of a delegated task is questioned, the nurse should first
confirm its completion with the designated personnel.
hypoglycemia is likely since the child displays signs of
confusion irritability
characteristic angina symptoms
crushing, substernal type of chest pain
As part of an advance directive, the client may
designate a representative to make health care decisions for the client -
important for the nurse to make the extra effort to
determine what has occurred,
POA makes decisions for a client only when the client is no longer able to make them, the nurse first needs to
determine what type of POA is in place
nurse is legally prohibited from sharing health information with
employers or family members without the client's permission.
minor adverse effects after an influenza vaccination include :
flulike symptoms (eg, fever, aching, itching at the injection site)
ngestion of antidiabetic drugs
glyburide, glipizide, glimepiride) by a nondiabetic client (eg, child) is an emergency as severe hypoglycemia can result in coma and/or death.
For the sake of client safety, nurses should immediately report impaired or intoxicated
health care workers, regardless of their position
appropriate to occasionally visit a previous pt in a different setting like ?
hospital nursing home
pt wi suspected rotator cuff inj
imaging nsaids phys therapy
nurse is required to report
impaired coworker, a suspicious death, and elder abuse to appropriate authorities
what you should NOT do ?
inform the RN manager perform the test yourself review the fingerstick procedure with the UAP
power of attorney (POA) includes
medical and financial
buttock abscess
must be dealt with with in 12 hours but not an emergency
according to HIPPA, can a pt's reason for an ER visit be communicated to the pt's employer ?
no , not without permission
++ HCP's responsibility to
obtain informed consent and explain the procedure's risks, benefits, and alternatives to the client.
what kind of questions can be answered by the RN ?
ordinary question about general care or health care teaching
+++ Several graduate nurses tell the nurse manager that they are unfamiliar with the various cultural practices of the clients on their assigned unit. Which leadership strategy is best for the nurse manager to implement to assist the graduate nurses in developing cultural competency?
provide the graduate nurses with a workshop designed to teach about cultures encountered at work
regardless of client wishes reportable sexually transmitted diseases , but it is a violation to share this info with
pt's family or spouse
advanced directive (living will) describes
pt's health care decision (like a dnr)
power of attorney (POA) designates
representative to act on a person's behalf in the event that the individual becomes incapacitated.
immune thrombocytopenia
serious risk for bleeding pt should be assessed for internal bleeding following an injury (esp the head)
child with immune thrombocytopenia has shoulder pain ...
shoulder pain is NOT a symptom assoc wi life-threatening bleeding ( so pt is not the top priority )
pt wi urge incontinence who started on solifenacin 2 days ago and reports constipation and dry mouth
solifenacin (vesicare) is a cholinergic antagonist prescribed to treat sxs assoc wi an overactive bladder - common side effect include dry mouth and constipation
in addition, performing the test may
subject the pt to an extra needlestick - and this doesn't make the UAP accountable to complete the tasks that were delegated
*** shift report, the night charge nurse tells the day charge nurse that the night unlicensed assistive personnel (UAP) is totally incompetent. What is the best response
suggest that the night nurse discuss concerns with the nurse manager
RN should report deaths that meet medical examiner reporting guidelines
suspected to be the result of a crime, trauma, or suicide
*** After talking to the client, the health care provider (HCP) tells the registered nurse that the client's signature is needed on the consent form that has been filled out. While the nurse is obtaining the signature, the client states, "I'm not clear on what is included in the low-fat diet that I'll be on after the cholecystectomy." What action should the nurse take?
teach the pt about a low - fat diet
If the client had a question about the procedure, or the risks, alternatives, or outcomes, then
the HCP should be contacted to provide additional teaching to the client.
If the client has a question about the proposed procedure/surgery,
the HCP should return and provide additional teaching.
always consider if
the action would be appropriate to include in the medical record
When a caregiver's performance is below the standard of care needed to provide safe and quality care to clients,
the appropriate authority should be notified so that the situation can be handled.
medical examiner has the legal authority and obligation to perform an autopsy independent of
the family's wishes
client reports symptoms thought to be related to a dental problem, but
the nurse needs to gather more information. The symptoms can indicate a cardiac medical emergency (myocardial ischemia or acute myocardial infarction) that requires immediate evaluation and intervention.
+++ The nurse caring for a terminally ill client asks if the client has an advance directive. The client states, "I already have a power of attorney." What is the best response by the nurse?
there are many types of POA's. Let's clarify if your POA can make health care decisions for you
nurse should first
verify the accuracy of the client's statement
the nurse can
witness the client's signature and provide normal teaching.
is it appropriate to send a card to acknowledge a family's loss
yes b/c it is "therapeutic"
