Which action may be delegated to the nursing assistive personnel nap regarding the care of a patient with a tracheostomy?

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Providing Tracheostomy Care

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1.#How#can#the#nurse#best#minimize#a#patient’s#risk#for#infection#during#

tracheostomy#care?#

#A.#Adhere#to#sterile#technique#when#appropriate.#

B.#Frequently#assess#for#signs#of#local#or#systemic#infection.#

C.#Monitor#for#indications#that#tracheostomy#care#is#needed.#

D.#Instruct#nursing#assistive#personnel#(NAP)#to#report#any#changes#in#

color#or#odor#of#tracheal#drainage.#

Rationale:#Adherence#to#sterile#technique#is#the#most#important#factor#

in#minimizing#the#patient’s#risk#for#infection#during#tracheostomy#care.#

Proper#assessment#is#important#but#will#not#reduce#the#patient’s#risk#for#

infection#during#tracheostomy#care.#Monitoring#the#patient#for#

indications#that#tracheostomy#care#is#needed#will#not#reduce#the#

patient’s#risk#for#infection.#Although#the#NAP#would#be#instructed#to#

report#changes#in#tracheal#drainage,#such#notification#will#not#minimize#

the#patient’s#risk#for#infection.#

2.#Which#nursing#action#shows#the#most#effective#planning#for#emergency#

care#of#a#patient#with#a#tracheostomy?#

A.#Having#a#spare#oxygen#mask#at#the#patient’s#bedside#

#B.#Keeping#an#obturator#and#a#tracheostomy#tube#at#the#patient’s#

bedside#

C.#Reviewing#the#agency’s#policy#regarding#tracheostomy#care#

Snapshot: This article reviews the scope of practice for different types of nurses and nursing assistants, and tasks that may and may not be delegated to different types of personnel. Delegation is a central feature of contemporary nursing practice, and a key component of professional academic nursing knowledge.

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Delegation Overview

• Delegation is the act of transferring responsibility and accountability to another person to carry out a task while maintaining accountability for the action and the outcome.
• RN’s must delegate numerous tasks, and delegation is a core nursing responsibility. Nurses most frequently delegate tasks to LPN’s (Licensed Practical Nurses) and to unlicensed assistive personnel (UAP).
• In deciding when and what to delegate, RN’s must take a number of factors into account, including the scope of practice required for the task, the complexity and predictability of the task, the potential for harm, and level of critical thinking required to perform the task.
• Delegation is important for both practical and academic reasons. It is a core “real world” nursing skill, and it is also a major focus of the NCLEX-RN exam.

RN’s (Registered Nurses)

It is within an RN’s scope of practice to:

• Independently assess, monitor and revise the nursing plan of care for patients of any kind
• Initiate, administer, and titrate both routine and complex medications
• Perform education with patients about the plan of care
• Admit, discharge and refer patients to other providers
• Delegate appropriate tasks to both LVN’s and UAP’s

Tasks that an RN may, therefore, perform include the ability to:

• Initiate and administer blood to a patient
• Administer high risk medications, including heparin and chemotherapeutic agents
• Give IV medications and medications administered via IV push
• Independently monitor and titrate medications
• Perform any tasks that may be performed by LVN’s or UAP’s

LPN’s (Licensed Practical Nurses)

It is within an LPN’s scope of practice to:

• Assist the RN by performing routine tasks with predictable outcomes
• Assist the RN with collecting data and monitoring client findings
• Reinforce an RN’s patient teaching, but not perform independent patient education or assessments
• Perform any of the tasks that UAP’s (Unlicensed Assistive Personnel) are permitted to perform (see below)
• Delegate tasks to UAP’s (Unlicensed Assistive Personnel)

Tasks that an LPN may, therefore, perform include the ability to:

• Administer medications that are not high-risk
  • For example, LPN’s may administer standard oral medications, but not medications such as heparin or chemotherapeutic agents
  • Note: some states do not permit LVN’s to administer intravenous medications of any kind
• Administer a nasogastric (NG) tube feeding
• Perform wound dressing changes
• Monitor blood products
  • LPN’s may not, however, initiate the infusion of blood products; only an RN may initiate the infusion
• Do tracheostomy care
• Perform suctioning
• Check nasogastric tube patency
• Administer enteral feedings
• Insert a urinary catheter

With further education and certification only, LPN’s may administer:

• Maintenance IV fluids
• IV medications via piggy-back
• Monitor infusions of IV fluids

It is not within an LPN’s scope of practice to: 

• Administer high risk medications of any kind (such as Heparin and chemotherapeutic medications)
• Administer IV push medications of any kind
• Titrate medications of any kind
• Independently provide patient education (about medications, disease processes, etc.)
• Perform or chart admissions of patients, or to discharge patients

UAP’s (Unlicensed Assistive Personnel)

It is within a UAP’s scope of practice to:

• Assist patients with activities of daily living (ADL’s), including:
  • Eating
  • Bathing
  • Toileting
  • Ambulating
• Perform routine procedures that do not require clinical assessment or critical thinking, such as:
  • Phlebotomy (except for arterial punctures)
  • Take vital signs
  • Monitor intake and output (of food and drink, urine, etc.)

It is not within a UAP’s scope of practice to:

• Perform assessments
• Delegate tasks
• Perform patient education
• Perform tasks that require clinical expertise, including ‘routine’ tasks such as:
  • Administering medications
  • Administering tube feedings
  • Performing wound care or dressing changes

Which situation can be delegated to nursing assistive personnel nap in regard to endotracheal tube care?

What must the nurse do when performing tracheostomy care?

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