Delegation question

  1. Hello everyone,

    Im a second year student and i am having trouble with delegation and responisibility questions. Im doing a case study where I am a Charge nurse adn when returing from dinner (3-11 shift) I am present with the following informations. All the other RN's are busy but I have myself, a ward clerk and aIV certified LPN at hand. Ok if anyone can help I would be truely grateful

    I have 6 patients and here are their situations:

    1. Mr. Murphy's IV has infiltrated. She is behind in her IV fluids and she has missed her 6 pm antibiotics. I know that the infusion should be stopped, iv discontinued and sterile dressing applied to the site after cafeul insprection to determine the extent of the infiltration. Then i know that the IV should be started in a new site. Now my question would be what do I do about the missed antibiotics and loss of time with the IV fluid? I know I would assigned the LPN for this task.

    2. A visitor has fainted. I would assign the ward clerk to assist this patient. I would have him check the person's airway, breathing and circulation. If necessary, begin rescue breathing and CPR. Loosen tight clothing around the neck, Keep the person lying down for at least 10 - 15 minutes, preferably in a cool and quiet space, If vomiting has occurred, turn the person onto their side to prevent choking, Raise the person's feet above the level of the heart (about 12 inches).

    3. The public tiolet is overflowing and waste is pouring out rapidly. This is a biochemical hazard and immediately needs to be taken care of. I just do not know who I would assign this to. The warrd clerk?

    4. Three patients have not recieved their dinners trays and it is now 7pm. I believe the task would be assigned to the ward clerk.

    5. The OR has just called and they are on their way to take MR. Smith for a cardiac catherization. His preoperative meds have not been givien. The charge nurse would take this task. We havent reached the cardiac lectures yet, and Im not able to find anything similar to this in my text but I would imagine you have to tell the OR to wait since you may need to oder the pre-op med. Im not sure how this situation would ne handle. Any help?

    Lastly, Dr. Russo is waiting to discuss a medication error that was made two weeks ago. The charge nurse would have to handle this task. Why? Because she oversees the nursing staff on the floor.

    As for list each in order or priority..I believe it would be ..

    FAinting (#2), IV (#1), The OR (#5), The toilet (#3), Dinners (#4), and Dr. Russo (#6)

    would that be correct??

    Thank you in Advance,
    Mimi
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  2. 3 Comments

  3. by   meandragonbrett
    The ward clerk should not be assessing somebody who is potentially in cardiac or respiratory arrest. Either the RN or LPN should be tending to this patient.
  4. by   smk1
    Quote from meandragonbrett
    The ward clerk should not be assessing somebody who is potentially in cardiac or respiratory arrest. Either the RN or LPN should be tending to this patient.
    Wouldn't you call 911 because it is a visitor and not a patient and have any BLS certed staff member support ABC's until they arrive or stabilize and wheel them to ER? I'm wondering about the legalities of this situation
  5. by   truern
    Quote from mimi1jb
    hello everyone,

    im a second year student and i am having trouble with delegation and responisibility questions. im doing a case study where i am a charge nurse adn when returing from dinner (3-11 shift) i am present with the following informations. all the other rn's are busy but i have myself, a ward clerk and aiv certified lpn at hand. ok if anyone can help i would be truely grateful

    i have 6 patients and here are their situations:

    1. mr. murphy's iv has infiltrated. she is behind in her iv fluids and she has missed her 6 pm antibiotics. i know that the infusion should be stopped, iv discontinued and sterile dressing applied to the site after cafeul insprection to determine the extent of the infiltration. then i know that the iv should be started in a new site. now my question would be what do i do about the missed antibiotics and loss of time with the iv fluid? i know i would assigned the lpn for this task.
    have the iv certified lpn restart this iv. document that the patient was without iv access and document the time the antibiotic was given.

    2. a visitor has fainted. i would assign the ward clerk to assist this patient. i would have him check the person's airway, breathing and circulation. if necessary, begin rescue breathing and cpr. loosen tight clothing around the neck, keep the person lying down for at least 10 - 15 minutes, preferably in a cool and quiet space, if vomiting has occurred, turn the person onto their side to prevent choking, raise the person's feet above the level of the heart (about 12 inches).
    the charge nurse should do an initial assessment of the visitor. if that person requires cpr, then you'd call a code.

    3. the public tiolet is overflowing and waste is pouring out rapidly. this is a biochemical hazard and immediately needs to be taken care of. i just do not know who i would assign this to. the warrd clerk?
    anybody can turn off the water at the toilet, then call maintenance and housekeeping.

    4. three patients have not recieved their dinners trays and it is now 7pm. i believe the task would be assigned to the ward clerk.
    the ward clerk would call for replacement trays and make up some snack trays to hold them over until dinner trays arrive.

    5. the or has just called and they are on their way to take mr. smith for a cardiac catherization. his preoperative meds have not been givien. the charge nurse would take this task. we havent reached the cardiac lectures yet, and im not able to find anything similar to this in my text but i would imagine you have to tell the or to wait since you may need to oder the pre-op med. im not sure how this situation would ne handle. any help?
    not sure what's up with your hospital, but at mine we don't do heart caths in the or. regardless, any pre-meds would have been sent up when they were ordered. lpn could administer them.

    lastly, dr. russo is waiting to discuss a medication error that was made two weeks ago. the charge nurse would have to handle this task. why? because she oversees the nursing staff on the floor.
    dr russo would have to wait. why is dr russo here after dinner anyway??

    my list of priority would be:

    visitor (charge nurse would check visitor first)
    or (lpn would administer pre meds)
    toilet (ward clerk could turn off water and call mainenance)
    iv (lpn would restart iv)
    dinners (ward clerk would call for replacement trays)
    dr russo (charge nurse would discuss med error w/md)

    as for list each in order or priority..i believe it would be ..

    fainting (#2), iv (#1), the or (#5), the toilet (#3), dinners (#4), and dr. russo (#6)

    would that be correct??

    thank you in advance,
    mimi
    the only "do me firsts" i see are the visitor, the or, the toilet, and the iv...and practically all of them can get addressed at the same time. shouldn't take the lpn any time at all the give the pre meds and then move on to the iv.

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