hi i have a similar problem. i'm actually a first year student. this is my first time here so i wasn't sure if i had to start a new thread and if so i'm so sorry. my scenario is as follows on a unit, there is a staff nurse, a lpn and a uap. the lpn is iv certified which i know means she is able to main and start ivs but cannot hang piggybacks or give iv push meds. she is able to give all other medications except iv meds. the rn can obviously give all meds. the uap can generally bath, feed and provide other care that does not require a license.
ok the rn, the team leader, divides the workload at the start of the shift, between 3 members (yourself, the lpn and the upa). there are 13 patients.
some facts before we start:
the lpn is 26, mother of 4 preschoolers and her husband is a city bus driver.
the uap is 53, a grandmother with no children living with her at home, a widow and states her works keeps her "happy".
ok now here are the patients assigned to us... and i will try to explain assessments, procedures and basic care needs to the best of my ability.
room, name, age, diagnosis and condition (and some additional information):
401. mrs. jones, age 33, mastectomy for ca and 2 days post op/ fair. mrs. jones needs instructions regarding her post op activities and has begun to talk about her prognosis. the nurse would take this patient and tell her about post-mastecomy exercises preformed 3 times days for 20 minutes a time until full range of motion is restored (usually taking 4-6 weeks). these exercises may include wall hand climbing, rod or broomstick lifting, rope turning or pulley tugging. ongoing assessment of the patients concerns related to the diagnosis of cancer, the consequences of surgical treatment, and the fear of death is important in determining her progress in adjusting and effectiveness of her coping strategies. you should encourage questions, provide information of postoperaterive care and promote a sense of control. exercises are initiated on the second post op day to increase circulationa dn muscle strength, prevent joint stiffness and contractures and restore full rom.
402. mrs. redford, 55, back pain, pelvic tract/ good. this can be given to the lpn since he has already been assessed thus "pelvic tract good". the lpn can provide the analgesics, promote rest, and stress reduction by possibly providing a massage and relaxation. relieving pain by reducing stresson the back muscles and have him change positions ffrequently. diaphramatic breathing may also help by reducing muscle tension. guided imagery (which i just used in clinicals) allows them to "focus on a happy place" . aid in phycial mobility and in using proper body mechanics.
403- mrs. worley, 46, cholecystectomy, 2 days post op/ good. mrs. worley requires frequent changes (every 2-3 hrs) of her laproscopic site dressing due to a high volume of serious drainage. this can be assigned to the lpn since many lpn's at my clinical change the dressing and it's the 2 day. would this be correct?
404-1 mrs. smith, 83, parkinson's/cvd/htn, fair. mrs. smith requires assistance with feeding at mealtime. this would be assigned to the uap since it is only assistance with feeding.
404-2 mrs. dewey, 26, pid, good with d/c today. the nurse would take this patient.
i know that pid is pelvic inflammatory disease but i am not able to find anything in that chapter with d/c what is that?
405-1 mr. arthur, 71, metastic ca, poor/ semicoma/ iv. mr. arthur is no longer able to turn himself in bed. the lpn should take this patient since she is lv certified and know which position to turn the patient.
405-2 mr. vines, 34, r/o peptic ulcer, good/ ugi today. mr. vines states that being in the same room with a critically ill patient makes him upset and he has asked to move to a new room. the patient would be transported to the vacant room and take care of by the uap.
406- 2 ms brown, 24, d&c, to or this am. i don't know what d&c means but since the patient is going to be taken to the or this should be assigned to the nurse.
407-1 mrs. west, 41, mi, fair with heplock telem and is 1 day out of icu. the nurse should take this patient since the lpn is not about to give meds iv push.
408-1 mr. niles, 21, open redct femur from auto accident, 3 days post op/ fair. mr. niles is depressed because he feels his football career is over. the uap can take care of this client since it 3 days post op and fair condition.
408-2 mr. ford, 44, gastrectomy, 1day post op/ iv/ fair. there have been problems with mr. ford's iv and nasogastric tube. both will need to be replaced today. the patient's status is fair therefore the rn should take care of this client. although the lpn is certified to place the iv she is not for the ng tube placement.
409-1, mrs. land, 42, depression, fair with ba enema today. mrs. land began to talk with you today about her husband's recent death. the prep for the barium enema will result in mrs. land having frequent toileting needs today. the nurse it to administer the enema. she would prepare the patient by emptying and cleansing and advise the patient to increase her fluid intake to assist in eliminating the barium.
would these assessments, procedures and basic care be correct?
blue breeze. j
Nov 3, '07
Where I work LPNs can do everything but hang blood and push IV meds, so I don't know how much help I could give except "D/C" is discharge, so that pt should be leaving today and D&C is Dilation and Curettage, which is mechanical removal of the lining of the uterus by dilation of the cervix and scraping.Sorry I couldn't help more, surely Daytonite will be along soon!