help with delegation question

[nursepotter05, RN]

My leadership and management mid term is take home. The following is one of the questions, and I was wondering if anyone has any thoughts on it.

You are the charge nurse on the 7a-7p shift on an oncology unit. Immediatley after report(around 730AM), you are overwhelmed with the following information:

The nursing aide reports that Ms. Jones has become comatose. Although this is not unexpedted, her family members are not present, and you know they would like to be notified immediatley.

There are 3 patients who need 7:30 sub q insulin administration. One of these patient's 6AM glucose was 400.

Mr. Johnson inadvertantly pulled out his central line when he was turning in the bed. His wife the notified the medical receptionist by the call light and states she is appying pressure to the site.

The public toilet id overflowing and urine and feces are pouring out.

Breakfast trays arrived fifteen minutes ago and patients are using there call lights to askm where there breakfast is.

The medical director of the unit has just discovered that one of her patients has not been strated on a chemo drug she ordered 3 days ago. She is furious and demands to speak to you immediately.

You have the following personnel to delegate to: a medical receptionist, a nursing assistant, a RN who graduated two months ago and is not out of orientation, an LPN who has worked on the unit for ten years, and yourself. Decide who should do what and in what priority. Justify your decision.

I appreciate any help.

Thanks

[flaerman]

Okay, read your post and here is my reply:

1) Would explain to the MD that I a little busy and will be with in few minutes.

Why) This is not need ing to be dealt with at that exact moment.

2) Send the new RN into Mr. Johnson's room to assess the bleeding; for any

S/S SOB etc, mental status, whether or not there were IV's or meds that

were running and to stop them;, apply a dressing and put a call out to the

pt's MD; and report back to me.

W) This needs to be dealt with quickly by an RN

3)Have the LPN draw up the insulin doses, check for a sliding scale on the pt

with 400 glucose, and administer the insulin.

W)Insulin needs to be given so that pt's can eat.

4)Have Unit Secretary put call into into maintenance about the bathroom.

W)Nothing we can do about it until maint comes to fix it.

5) Have the LPN, RN, and assistant pass try trays, apologize for the inconve-

nience, offer to warm up anything that cooled while waiting.

W)Now we can feed everyone.

5)Now deal with medical director, apologize for the error, take responsibility

to look into the chart for the oder to find out who was on and missed it,

and assure her that chemo will started today if she stills wants it given.

W)Now you have time to deal with this problem and the MD to address the

issue.

6)Place a call to Ms. Jones family and notify them of the changes in her

condition.

w)Ms Jones condition is changed but not acute unless she did not have a

DNR in place then if not you would have made that call first.Assure the

family the vital are whatever and she is not in distress, but that they might

want to get in to the hospital.

All of the issues can be dealt with within a span of anywhere from a couple

to maybe 10-15 minutes by an experienced charge nurse. I am an RN with 20 yrs of experience and a lot of that in charge positions where I have learned

through to most important/critical things and then everything else in time.

Maybe someone else might do it differnetly but this is how I would done it.

flaerman :)

[CarVsTree]

Isn't asking for the answers to a mid-term exam cheating? Or are you allowed to have help.

[crb613, BSN, RN]

Isn't asking for the answers to a mid-term exam cheating? Or are you allowed to have help.

I would think with a take home test an instructor would know there are tons of resources & information available.