Lesson 27: Principles of Delegation and Prioritization of Care

Nursing Process

Six-step systematic method for giving patient care; involves assessing, diagnosing, outcome identification, planning, implementing, and evaluating

Delegation

The process of transferring a selected nursing task in a situation to an individual who is competent to perform that specific task.

Prioritization

process of deciding which client needs or problems need to be attended to first; the nurse needs to prioritize in all caregiving situations.

Nursing Assessment

systematic and continuous collection and analysis of information about the client

subjective data

things a person tells you about that you cannot observe through your senses; symptoms... Statement about pain, fatigue, anxiety, nausea

A nurse planning client assignments for the day has an LPN and a nursing assistant on the nursing team. Which client should the nurse most appropriately assign to the LPN?

A client who is scheduled for an electrocardiogram and a chest radiograph A client with stable congestive heart failure who has early-stage Alzheimer disease A client who has been treated for dehydration who is weak and requires assistance with bathing A client with emphysema who is receiving oxygen at a rate of 2 L/min by nasal cannula and becomes dyspneic on exertion

Carol is assigning clients to her team members. Which client should Carol assign to the nursing assistant?

A. A client scheduled for a colonoscopy B. A client with an arteriovenous fistula in the right arm who is scheduled for hemodialysis C. A client who is stable but was treated with furosemide and oxygen therapy during the night for pulmonary edema D. A client who requires frequent ambulation with a walker and must be encouraged to maintain her independence in carrying out activities of daily living D. The client scheduled for a colonoscopy will require preparation for the procedure in addition to frequent observation after the colonoscopy. The client with an arteriovenous fistula will require predialysis procedures and assessment of the fistula for patency. The client with pulmonary edema who was treated with furosemide and oxygen therapy and is in stable condition will still require frequent assessments

A nurse planning client assignments for the day has an LPN and a nursing assistant on the nursing team. Which client should the nurse most appropriately assign to the LPN?

A. A client who is scheduled for an electrocardiogram and a chest radiograph B. A client with stable congestive heart failure who has early-stage Alzheimer disease C. A client who has been treated for dehydration who is weak and requires assistance with bathing D. A client with emphysema who is receiving oxygen at a rate of 2 L/min by nasal cannula and becomes dyspneic on exertion D. The nurse would most appropriately assign the client with emphysema to the licensed practical nurse. This client has an airway problem and has the highest priority needs of the clients presented in the options. The client who has been scheduled for testing, the client who needs assistance with daily needs, and the client who has early stage Alzheimer disease in addition to a stable cardiac problem can appropriately be cared for by the nursing assistant.

Carol has finished planning the assignments for the day, has provided a client report, and has given directions about client care to each member of the team. What other specific action does Carol perform?

A. Accountability for each assignment lies with the team member it was given to B. She must evaluate each team member's performance and each client's outcomes C. It is not necessary to follow up with each team member unless a client complains about care D. She must develop a written and specific time-management outline for each team member that identify the priorities of care for each client

At 7:45 a.m., Carol checks all of her clients. Sal is not experiencing any dyspnea, but he tells Carol that he is tired because he didn't get any sleep during the night. Judy tells Carol that she is beginning to experience abdominal discomfort and will need pain medication as soon as she is able to have it, at 8:30 a.m. Carla is still sleeping, and James tells Carol that he is restless and anxious about the cardiac catheterization. Place the following planned actions in order of priority, with 1 being the first priority and 4 the last.

A. Administering pain medication to Judy B. Waking Carla and helping her prepare for breakfast C. Talking to James about the cardiac catheterization procedure D. Asking the nursing assistant to help Sal with bathing C, D, A, B Carol would first spend time with James and talk to him about the cardiac catheterization procedure, because he is anxious about the procedure. Sal is fatigued and is not experiencing dyspnea, so it would be best to obtain assistance for him with bathing. This may be done once Carol has addressed James' concerns. Because Carla is sleeping, it would be best to allow her to continue resting, because she is not scheduled to see the radiologist until 11:00 a.m.; she could be awakened at 10 a.m. to prepare for the radiologist's visit. Pain medication would be administered at 8:30 a.m. if Judy needs it then.

Which action should Carol plan to take as she functions in the role of team leader?

A. Assigning herself the most difficult clients B. Assigning clients to each team member and coordinating each client's care plan C. Assigning the licensed practical nurse to take the vital signs of all of the clients D. Assigning the nursing assistants the tasks of replenishing the clients' water pitchers and changing beds C

Which of the following tasks should the nurse assign to a nursing assistant? Select all that apply.

A. Colostomy irrigation B. Continuous tube feeding C. Urine specimen collections D. Stool specimen collections E. Ambulating a client who is unsteady F. Feeding a client who has difficulty swallowing food and fluids C, D, E The nurse must keep in mind the skills of the health care team member and the needs of the client to make the most appropriate assignment. In this case, the appropriate tasks for a nursing assistant would be to collect urine and stool specimens and to ambulate the client who is unsteady. The nursing assistant is trained to perform these activities. Colostomy irrigation and tube feedings are not performed by unlicensed personnel. The client having difficulty swallowing food and fluids is at risk for aspiration.

A registered nurse orienting a new nursing graduate provides the graduate with ideas that will help him/her with time management. Which tips should the registered nurse provide? Select all that apply.

A. Keeping a log of daily activities takes too much time and is not at all useful. B. Jot quick notes during the day and perform all client documentation at the end of the day. C. Make client rounds at the beginning of the work shift and collect assessment data on each assigned client. D. Avoid delegating tasks to others, because others may think that the graduate can't manage the assignment. E. Try anticipating a client's needs before care so that all necessary supplies and items may be brought to the client at one time. C, E The nurse should also plan to document task completion and necessary client data throughout the day rather than waiting until the end of the day, delegate tasks when appropriate, and keep a daily hour-by-hour log to help provide structure to the tasks that must be accomplished.

The next day, Carol's report sheet for her client assignment reads as follows: Sal DeCarlo, 56 years old, was admitted to the hospital at 6:30 AM with respiratory distress and a fever of 101.8°F. Bilateral pneumonia was diagnosed after chest radiography. He is receiving oxygen by nasal cannula, and intravenous antibiotics will be started after a sputum specimen is obtained. James Fiore, 65 years old, was admitted to the hospital 2 days ago. He has a diagnosis of angina pectoris. His condition is stable, and he is scheduled for a cardiac catheterization at 1 PM. Judy Sharon, 62 years old, underwent abdominal surgery yesterday. The nurse who gives report to Carol notes that Judy has received pain medication as needed every 4 hours and that she is due to receive her next dose at 8:30 AM. Carla Sorenson, 65 years old, was told yesterday that she has inoperable lung cancer and will need to undergo radiation therapy. The nurse who gives report to Carol notes that Carla received a prescribed sedative at bedtime and has slept soundly through the night. Carla is scheduled to meet with the radiologist at 11 AM. Which action should Carol plan to take first after receiving report from the night nurse?

A. Preparing the pain medication for Judy Sharon B. Obtaining a sputum specimen from Sal DeCarlo C. Talking to Carla Sorenson about what to expect when she meets with the radiologist D. Assisting James Fiore with morning care and helping him prepare for the cardiac catheterization B

A nurse assigned to care for a client with chronic obstructive pulmonary disease (COPD) reviews the client's care plan. Which of the following should the nurse identify as a priority concern for the client?

A. Weight gain related to an increase in appetite B. Loneliness related to a lack of support systems C. Fear related to the outcome of the disease process D. Inability to clear respiratory tract because of excessive mucus production D- Maintaining a patent airway is always the first priority. Loneliness and fear involve psychosocial needs and would be considered after physiological needs are addressed. The client with COPD is most likely to experience a decrease in nutrition due to the increased metabolic effects that occur.

ACCOUNTABILITY

Assuming only the responsibilities that are within one's scope of practice and not engaging in activities in which competence has not been achieved.

SBAR

S: Situation B: Background A: Assessment R: Recommendation Method to communicate among healthcare providers and documents

"five rights" of delegation

Right task, right circumstances, right person, right direction or communication, right supervision or feedback.

The nurse should also use the ABCs

airway, breathing, and circulation — as a guide when determining priorities; client needs related to maintaining a patent airway are always the priority.

Delegated to a nursing assistant (assistive personnel).

basic skin care, range-of-motion exercises, ambulation, grooming, and hygiene measures

licensed practical nurse (LPN) or licensed vocational nurse (LVN) may perform the tasks that a nursing assistant is allowed to perform and may also perform certain invasive tasks

dressing changes, suctioning, urinary catheterization, administration of oral medications and subcutaneous and intramuscular injections, and piggyback (secondary medications)).

The registered nurse may perform the tasks that an LPN or LVN is allowed to perform and is responsible

for assessment, care planning, initiation of teaching, and administration of intravenous medications.

Maslow's Hierarchy of Needs theory

identifies the levels of physiological needs, safety, love and belonging, self-esteem, and self-actualization (basic needs are met before other needs in the hierarchy are attended to) should be used by the nurse as a guide in determining priorities.

objective data

information that is seen, heard, felt, or smelled by an observer; signs. Ex. Capillary refill, BP, ,easure edema