[nursex2007]

hey if you had these three pts...with a nursing assistant and a charge nurse how would you delegate and time manage each pt on a 8 hour shift....


PV Insuff.
NIDDM. BKA
(L). POD #2.

2000 cal ADA diet. Assist sponge bath. Enc. In-bed exercises: UE and LE. Stand at bedside. Trans to chair with walker BID. BS Commode. Trapeze.
VS and Circ Checks qid. Cap. BS ac & hs. Systems review, esp. breath sounds, skin, BM. Monitor incision for infection during dsg changes (MD will do 1st change). Bed cradle. Dsg change BID (noncompressive). Clean incision with NS.


IM or Oral opioid.PRN. Sliding scale insulin ac & hs. Laxative PRN. Antispasmodic (phantom limb pain). Stool softener. Hypnotic PRN.
Begin post-op teaching (wound care, pain mgt, rehab program, meds, complications). Reinforce ROM and strengthening exercises for UE and LE. Emotional support. Assess support systems.
Previous Shift Rapid

VS: T 101 @ 4 AM & 100.8 @ 6 AM BP 150/90 P 88 R 22 Pain 7/10 @ 4:30 AM Lab Work: AC 90 glucose90
IV: New order to Start IV of D5 ½ NS @ 100cc/hr Procedures: CXR ordered for today & request sent.
Intake: 500cc (Oral) Incision/Wound Care: L BKA dsg dry & intact.
Output: 400cc (urine) Meds: Tylenol @ 4:30 AM for Temp
Pulmonary Status: Crackles bilaterally at lung bases Antibiotics IVPB q 6 to be started as soon as med comes from Pharmacy Vicodin @ 5:30 AM with pain relief





Pt #2
62 y/o male

DX: CHF;Renal Insufficiency
Hx of stroke with R-sided weaknes. HD:4

.Complete bath. Turn with asst q 2 hrs. Falls Prevention Protocol (Fell 2 days ago). Foley to gravity drainage. I&O. Continue ECG monitoring.
PT /Rehab-R sided-weakness
VS q4h. Daily Weight. Dsg change (Hydrocolloid) R shin Q 3 days. Oxygen 4L/NC


Digoxin
Lasix
Tenormin
IV: Cont at 75cc/hr.
Tylenol PO or RECT for temp>101.
PCA: Morphine Sulfate
Age & Culture specific intervention. Offer emotional support to pt/family. Discuss possibility of home hlth with MD/Social Worker.
Previous Shift Rapid Report Sheet
VS: T 101.8 @ 6 AM BP 118/70 P 64 R 32 Pain: 2/10 Lab Work in am: Basic Metabolic Panel, CBC & Diff, Prealbumin
IV: #6 D5½NS with 10 meq K @ 75cc/hr. 200cc left to go to 9AM Procedures:
Intake: 700cc (IV) plus 200cc (oral) Incision/Wound Care: R shin dsg dry & intact.
Output: 450cc Meds: PO Tylenol @ 6:30 AM.
Pulmonary Status: Crackles at lung bases. Morphine Sulphate: PCA
Other: Physical Therapy this AM
SPEAKS CANTONESE ONLY.

Pt #3

81 y/o female


Total Hip Replacement Hx of CHF. POD #1



Clear liquids as tolerated. Dangle at bedside. Cough & deep breathe (C&DB) q 2h. Hip Precautions. Trapeze on bed.



VS qid. Circ checks Q 4h. I&O. Foley. Assess dsg & drain q 4h. Skin and pain assessment IS (Incentive spirometer) Q2h WA. Pulse ox q 4 hr or prn. Thigh-hi TEDs. MD to change OR dsg.
IV @ 100cc/hr. Heparin sq q 12 hrs. Lasix qd in am. Digoxin q am. Muscle relaxant PRN. Morphine PCA. Stool softener q AM. Antiemetic PRN.
Review post-op teaching (IS, C&DB, pain mgt., positioning & hip precautions). Reinforce exercise program. Assess support systems.
Previous Shift Rapid Report Sheet

VS: T 97 BP 146/80 P 64 R 16 Pain: 2/10 Lab Work: CBC, PT drawn at 6:00 am.
IV: #2 D5½NS @ 100cc/hr. 200cc left to go to 9AM Procedures:
Pulled out IV just now and no time to restart.
Intake: 800cc (IV) Incision/Wound Care: R Hip dsg dry & intact.
Output: 600cc (Foley), 75cc (Hemovac) Meds: PCA
Pulmonary Status: Lungs Clear Other: Physical Therapy to assess this AM

[Hoozdo]

Originally Posted by nursex2007

hey if you had these three pts...with a nursing assistant and a charge nurse how would you delegate and time manage each pt on a 8 hour shift....

You are going to have to be more specific with your question if you want someone to reply. The answer would be a term paper with the question you are asking.

[SAHStudent]

I don't know how to answer this except to say...

Have NA do everything she can do.

You do what you can do.

Charge nurse does what you can't do.

That's about how it works in the real world.