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LEADERSHIP AND PROFESSIONAL IDENTITY
NUR 2832
MODULE TWO – ASSIGNING, DELEGATING, & PRIORITIZING CARE
PROFESSOR: BETH ARMSTRONG
BY: JULIAN OU
JULY 18TH, 2021
Scenario You are assigned to six patients on the medical surgical unit working with an LPN/LVN and share a CNA with another RN. You are receiving report for your patients and need to identify what activities you will be assigning, delegating, supervising, and prioritizing for the shift.
Instructions Client number 1: 50-year-old male who had a heart attack and stent placed with normal
vital signsClient number 2: 46-year-old female with full-thickness burns to the leg who needs to have dressings changedClient number 3: 33-year-old male firefighter who has fallen and broken his right femur after surgery with pain in his legClient number 4: 18-year-old male with wheezing and labored respirations unrelieved by an inhalerClient number 5: 74-year-old female with new-onset dementia awaiting lab results Client number 6: 52-year-old female who has been recently diagnosed with diabetes type 2 and is getting discharged
1). Describe the patients you will be assigning to the LPN I would assign client #2 - the 46-year-old female with full-thickness burns and client #3 - with the broken RIGHT femur to the LPN. These two clients are the most medically stable, and their care needs do not immediately require the presence of an RN. For a patient whose condition is stable and predictable, and rapid change is not anticipated, the supervisor may provide supervision of the LPN without being physically present (KBN, 2018). Client #2 requires dressing changes; the task is not difficult, and the outcome is predictable. Client #3 is reporting pain, most likely related to his surgical procedure. Decisions to delegate nursing tasks, functions, and activities are based on the needs of the clients, the stability of the clients' conditions, complexity of the task, predictability of the outcome, and the available resources to meet those needs and the judgment of the nurse (Weberg, 2018).
- Look for unequal leg length. Could indicate dislocation/fracturing of shorter extremity.
- Notify RN immediately of s/sx of necrosis /infection to burns including malodorous, green purulent drainage, fever, severe edema, etc.
- Give meds as ordered: It is within the scope of practice of the LPN to administer medications to the clients. It is within the scope of licensed practical nursing practice to administer prescribed medication under the direction of a registered nurse (2018).
- Monitor for the efficacy of medication administration
- Monitor for ASEs of medications administered such as respiratory depression related to opioid medication to treat pain.
- Monitor VS and notify RN / MD of changes
CNA
Continue answering call lights as able
Assist clients with ordering meals and offer hydration and meals and snacks.
Assist with ADLs: Grooming, toileting, bathing, hygiene, feeding, dressing assist.
Obtain VS as needed or as instructed by the LPN or RN
Notify LPN or RN of any (sudden) changes to alertness or orientation or sudden decline of physical capabilities (i. going from one assist to two-person extensive assist with ambulating) of a client.
Notify LPN or RN of refusals of meals/snacks / hydration
Notify LPN or RN of no BM in three or more days
Be on the lookout for sudden and obvious changes to bodily function such as foul and concentrated urine.
4). List the clients and care from the highest to lowest priority
- Wheezing and labored respirations unrelieved by INH
- Post-op broken RIGHT femur
- Post-op MI
- Burns with dressing changes
- Dementia
- Type II DM and discharge Prioritizing patient care requires classifying patient conditions into high, intermediate, or low priority. High priority conditions or life-threatening ones include airway, breathing, circulation. Intermediate needs are non-life-threatening and non-emergent. Low priority needs are those not related to the patient’s illness (CINAHL, 2018). Following this logic, it is clear that the client in respiratory distress needs to be seen immediately, followed by the client with the broken femur, who is stable (non-emergent), but requires care for pain management in addition to being observed for obvious signs or symptoms of trauma, infection, or circulatory issues potentially related to the broken femur.
Resources
Kentucky Board of Nursing. (2018). KBN Connection: LPN Scope of Practice. Kentucky Board of Nursing.
Menella, H. (2018). Time Management Skills: Prioritizing Patient Care. CINAHL Nursing Guide.
Weberg, D., Mangold, K., Porter O'Grady, T., & Malloch, K. (2018). Leadership in Nursing Practice. Jones and Bartlett Learning.