Question

John is a new nurse, still in orientation with a preceptor, on the intermediate care unit. These patients are currently on the unit:

230—A 48-year-old admitted yesterday evening with an acute myocardial infarction; waiting for an angiogram

231—A 72-year-old patient with chronic congestive heart failure; taking multiple medications for blood pressure

232—A 51-year-old patient who had a coronary artery bypass graft 3 days ago; waiting for discharge

233—A 54-year-old patient in the ED with a medical diagnosis of uncontrolled atrial fibrillation; waiting for admitting orders

John is caring for the patients under the supervision of Dana, his preceptor, who is also the day shift charge nurse. He has completed the first assessment and is looking at the medications for his patients. He notes multiple medications ordered for bed 231, new medications ordered for bed 230, and medication teaching needed for bed 232. As he makes the notations to himself, Dana gives him the abnormal lab values for the patients, with instructions to notify the attending physicians. She also reminds him of the admit waiting in ED. The nursing assistant points out that the patient in 232 is very impatient; he is waiting for his diet and medication instructions so that he can be discharged. At this point, John becomes frustrated trying to juggle all of the demands on his time.

1. Identify the resources available to John regarding available personnel to whom he might delegate tasks.

2. Of those individuals identified as resources, what tasks could be delegated to each person?

3. Write at least one appropriate outcome for each patient and identify the right person to assist John in achieving the outcomes. Describe how John would evaluate the outcome?

4. Which of the patients can John delegate assessment to a licensed practical nurse?

Answer 1

1.The resources available to John in an intermediate care unit are

• Licensed Practical nurse :They can be helpful in administration of medication ,health education to patient on medication, diet,follow up etc.,can assist the RN in all procedures ,be an advocate for the patient, acts as a coordinator between patient and the RN
• Certified Nursing Assistant :They can be helpful in doing the basic procedures like patient care ,vitals recording, bed making etc.,
• House keeping personnel :They can be helpful in cleaning and preparation of a room for patients

2.The LPN can be assisted to health educate the patient in 232 who is awaiting a discharge and is waiting for his medications and diet explanations

The CNA can assigned to prepare the patient for angiogram by taking vitals,pre op preparation like (changing into OT gown,removing any metals in the body,put a top knot)

The nurse John has to report the abnormal report to the concerned physician and carry out the order

The housekeeping staff can be assigned to prepare a room to admit a new patient

3.230:The preop preparation to be done with the help of CNA

Outcome:patient is prepared for the procedure

Evaluation :Patient exhibiting a hope and shifted to angiogram

231.LPN can assist in making the patiet understand about the new drugs

Outcome :patient should be able to demonstrate the use,action,effects ,interaction about the drug

Evaluation :able to explain about the drug

232:LPN to assist in medication and diet explanation, Housekeeping to shift the patient and clean the room

Outcome :patient understands about the medication and diet

Evaluation :patient gets a smooth discharge

4.The LPN can be assigned to patients in room no 231 and 232