2. Unlicensed assistive personnel: any personnel to whom nursing tasks are delegated and who work in settings with structured nursing organizations.

Transcription

1 XVIII. A. General Information: The judgments that you make in about coordinating and facilitating client care situations have to be based on knowledge. You MUST know your content, and then you can move on to coordination of care. B. Definition: 1. Assignment: the distribution of that each staff member is responsible for during a given shift or work period. You can t do everything that the client needs by yourself; you must assign some of the other workload to an unlicensed assistive personnel or another PN. Assignment of task to the proper personnel will not only provide the best care possible, but also the most and effective care. You will be a better for your client if you remember cost containment when you make client assignment decisions. 2. Unlicensed assistive personnel: any personnel to whom nursing tasks are delegated and who work in settings with structured nursing organizations. a. UAP s can perform tasks on clients in uncomplicated situations. b. Tasks like, simple, repetitive, common activities that do not require nursing judgment such as hygiene, feeding, ambulation. Everyday things! 3. Supervision: a. You must to see that the nursing tasks that you assign are done properly. b. You must communicate a frame and the of the task. 232 Copyright protected. Reproduction prohibited without authorization and release by Hurst Review Services.

2 You ve got to tell people what you want done, and what you want done by a particular time. 1. Provide directions and expectations of how you want the task to be performed and define the findings you wish. 2. We need to ask these three questions after an assigned task is completed: Was the task done? Was the task done in the proper frame? Were the client s met? 3. Don t assume someone is to do something just because of their job description. 4. When you identify a weakness you are supposed to it to the RN. 5. You must learn the and weaknesses of the people you are working with. This will help you assign to the personnel and improve client care. 6. If you are if the UAP can perform the procedure, go with them yourself. Be sure no harm is done to the client. D. Tasks that can be assigned or delegated to the LPN: 1. First, what is the LPN s role in the nursing process? a. The RN never delegates. b. The LPN can assist the RN in collection but that is not assessment in the NCLEX world. c. The LPN cannot do any form of, or evaluation. 2. The must do the admission history. If someone else, such as an LPN collects the admission data, the RN must validate sign off on the admission history form. 3. Can the LPN implement tasks on the plan of care? Copyright protected. Reproduction prohibited without authorization and release by Hurst Review Services. 233

3 4. Can a LPN devise a teaching plan for a newly diagnosed diabetic? 5. What type of clients should the RN delegate to the LPN? a. An unstable client is medically fragile and requires a level of care of emergency intervention or monitoring unstable vital, sudden change in blood sugar or neuro checks. b. A client can be and stable at the same time. Don t let a complex chronic diagnosis make you think the client is unstable and has to be seen only by the RN. c. Always consider a new admit. NCLEX Critical Thinking Exercise: Which of the two clients could the PN accept as an assignment? 1. A newly diagnosed diabetic who has a quarter-sized foot ulcer. Pedal pulses are present but weak and morning glucose is 200 mg/dl. 2. A post-partum client who delivered 12 hours ago. Her blood pressure was 118/70 mm Hg at 8 am; now at 10 am her blood pressure is 140/80 mm Hg. d. Can the LPN perform any tasks in an unstable situation? In a code the PN can do tasks like: blood pressure, obtain the crash cart, basic CPR. C. Tasks that can be assigned or delegated to the UAP: 1. What type of clients can the PN assign to the Unlicensed Assistive Personnel? The same activity may in each situation. We know that feeding a healthy client who has two broken arms is different than feeding a client who has dysphagia; bathing a weak client is not the same as bathing a client who is severely burned. So, if there is ever a degree of potential, the PN must retain the task, no matter how routine it is. 2. You will need to determine which order you would go see an assigned group of clients. Which client do I have the amount of time to work with? Which client is in the most danger? 234 Copyright protected. Reproduction prohibited without authorization and release by Hurst Review Services.

4 E. Practice Questions: 1. A nurse in a rehabilitation facility receives a change-of-shift report four assigned clients. In which order would the nurse attend these clients? 1. A client who has new-onset confusion. 2. A client who has questions about being discharged tomorrow. 3. A client who needs an insulin injection before breakfast. 4. A client requesting pain medication for post-operative pain rated at a 6 on a 0 10 scale. 2. A licensed practical nurse (LPN) is planning client assignments prior to the beginning of a shift. Which client assignments would be appropriate for an unlicensed assistive personnel (UAP)? Select all that apply. 1. A new postoperative client who requires dressing changes. 2. A three day post-operative client who needs assistance with ambulation. 3. A diabetic client who requires sliding scale insulin. 4. A client who requires a 24-hour urine collection. 5. A client who is under suicide precautions. 3. You have a client with pneumonia requiring the following interventions. Which action could be assigned to an unlicensed assistive personnel? o 1. Monitor the sputum for changes o 2. Offer fluids between meals o 3. Teach family to record intake and output o 4. Assess respiratory rate with ambulation Copyright protected. Reproduction prohibited without authorization and release by Hurst Review Services. 235

5 4. An immune-suppressed client is placed in protective isolation. Which tasks can be assigned to unlicensed assistive personnel? Select all that apply. 1. Take vital signs every two hours 2. Report temperature greater than 100.4º F 3. Monitor white blood cell count 4. Teach good hand washing technique 5. Display Protective Isolation on client s door 6. Plan daily care to minimize client exposure 5. Which client could be assigned to an LPN/LVN working under the supervision of an RN? o 1. Client with abdominal pain scheduled for a CT scan. o 2. Client being discharged with home oxygen. o 3. Client with post-op wound infection taking oral antibiotics. o 4. Client with vomiting that is receiving intravenous electrolyte solutions. 6. A newly admitted client gives a nurse a pile of legal documents stating, Put these in my chart. The nurse carefully reviews each document. Which documents should the nurse identify as an advance directive and place in the client s medical record? Select All That Apply. 1. Living will 2. Last will and testament 3. Patient s Bill of Rights 4. Durable power of attorney for health care 5. Health Insurance Portability and Accountability Act 236 Copyright protected. Reproduction prohibited without authorization and release by Hurst Review Services.

6 7. A nurse in an inpatient facility is serving as an advocate for a client who is being prepared for surgery. Which communication by the nurse is the best example of advocacy? o 1. Convincing the client to accept medical treatments that the health care team recommends for the client. o 2. Respecting the client s rights and facilitating communication between the client and the health care team. o 3. Reassuring the client that a surgical procedure will be successful and will achieve the desired outcome. o 4. Encouraging the client to refuse medical treatment that the nurse believes to be unnecessary. 8. A police officer brings a confused and agitated client to an emergency department. The client s urine is sent for a stat urine drug screen and the police officer asks the nurse for a copy of the results, believing that the client is under the influence of an illegal substance. Which action indicates that the nurse understands the Health Insurance Portability and Accountability Act (HIPAA)? o 1. The nurse provides a copy of the client s urine drug screen to the police officer as requested. o 2. The nurse obtains permission from the health care provider to provide a copy of the client s urine drug screen to the police officer. o 3. The nurse leaves the client s drug screen results on the counter and walks away, thus allowing the officer possible access to the document. o 4. The nurse refuses the police officer s request because the client is unable to consent to the release of personal medical information. Copyright protected. Reproduction prohibited without authorization and release by Hurst Review Services. 237