Need help understanding acute, chronic, stable, and unstable

  1. I know that:
    RNs take care of the most unstable acute or chronic client. (Assess, Teach, Eval)
    LPNs should care for chronic, stable patients. (pass meds, gather data, reinforce teaching)
    UAPs/CNAs can care for stable patients. (standard routine care, VS, urine sample, ADLs)


    Do you know of any websites that help me understand the differences? Verbally, i can say what each can do, but on my practice tests, i still don't seem to get it. ):

    Examples would be much appreciated!!
  2. 5 Comments

  3. by   psu_213
    I never was taught or used the acute, chronic, stable "rule" when answering a delegation question. Thinking about it now, it has its limitations. For example, an UAP can still empty a Foley bag of an acutely ill ICU patient. An LPN (at least in my state) cannot do an admission assessment on a new admit to LTC even if they are stable and only have chronic conditions.

    The idea of tasks is more on the right track. What can only an RN do? Assess, teach, IV meds, etc. What is an UAP allowed to do? VC, bathing, etc. Not to make their role seem insignificant, but LPNs are "left" with the stuff "in the middle" (again, my apologies if that sounded bad).
  4. by   Lev <3
    Acute - appendicitis - needs assessment and teaching of RN
    Chronic - COPD - LPN can give meds
    Stable - Patient who had stroke 5 days ago - past the point where there is risk for major complications and can give to LPN. If patient was 1 days post stroke would not give to LPN. If routine surgery, patient 2/3 days post op is stable and can be given to LPN.
    Unstable - Patient with increased ICP, new MI, new stroke, asthma attack - needs assessment and teaching of RN
  5. by   pongtipRN
    Anything that requires teaching, patients going into a procedure, admissions and transfers go to the RN. Unstable patients go to RN (patient reporting any pain needs to be assessed, SOB, starting new med, patient refusing meds, anything new onset)

    Patients that are stable and require tasks that need to be completed within scope of practice goes to the LPN. They may reinforce teaching. In my state, LPNs can administer IV meds, just not bolus or through PICC lines. RNs hang the first bag of solution. Ex. Suctioning, dressing changes, tube feedings, med pass.

    Tasks that assist the most stable patient goes to UAP. Ex. Changing briefs, emptying drainage bags, assisting with feeding (but not patients with risk of aspiration), assist with ambulation (stable patients), bathing, assisting in bedpan/commode, bed making, range of motion

    The RN delegates and is responsible for the assignment she/he delegates.
  6. by   ghansen99
    If a PT needs V/s every 4 hrs would this PT go to RN or LPN?
  7. by   pongtipRN
    Quote from ghansen99
    If a PT needs V/s every 4 hrs would this PT go to RN or LPN?
    As a RN, I would obtain the first set of VS and if stable, delegate to the LPN or CNA the subsequent VS. But it also depends on the patients condition. If the patient is immediate post-op, I as the RN would do the VS myself until the patient is stable. But if the patient has been post-op for the past week and has been stable, it should be safe for the LPN or CNA to obtain VS.