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Difficulty: MediumAssignment, Delegation and Supervision

The registered nurse (RN) is planning care for a client who sustained an ischemic stroke 48 hours ago and has new-onset right-sided hemiparesis and dysphagia. Which of the following tasks can the RN safely delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)

  1. Perform passive range-of-motion (ROM) exercises on the affected extremities.Answer
  2. B
    Administer the client's first meal of pureed foods and thickened liquids.
  3. Empty the indwelling urinary catheter drainage bag and record the volume.Answer
  4. D
    Evaluate the client's ability to swallow small sips of water without coughing.
  5. Apply a moisture barrier cream to the client's intact sacral skin.Answer
  6. F
    Instruct family members on how to properly position the client's head during meals.

Answer

The tasks that can be safely delegated include performing passive range-of-motion exercises, emptying and recording catheter output, and applying moisture barrier cream to intact skin.
According to the principles of safe delegation, the RN can delegate routine, standard tasks with predictable outcomes to the UAP. Performing passive range-of-motion exercises, measuring output from an indwelling catheter, and applying moisture barrier cream to intact skin are all standard activities of daily living (ADLs) and basic care tasks. They do not require nursing assessment, clinical judgment, or evaluation.

Step-by-Step Solution

1
Analyze the client's current status and potential for harm.
The client is 48 hours post-stroke with hemiparesis and a new diagnosis of dysphagia, placing them at high risk for aspiration.
Safe delegation requires ensuring the client is stable enough for standard care without requiring continuous assessment during the task.
2
Evaluate each task against the legal scope of practice for a UAP.
Tasks that require clinical assessment, nursing judgment, evaluation, or client teaching must be excluded.
The RN is legally accountable for the nursing process and cannot delegate 'EAT' (Evaluate, Assess, Teach).
3
Select the standard, routine tasks with predictable outcomes.
Performing ROM, recording urinary output, and applying topical barrier cream to intact skin are appropriate to delegate.
These tasks involve basic hygiene, mobility, and data gathering, which do not require independent clinical decision-making.

Key Concept

Delegation of tasks to unlicensed assistive personnel (UAP) must exclude the nursing process (assessment, planning, evaluation) and health teaching. Tasks involving high-risk clients (e.g., initial feeding with dysphagia) must remain with the RN.
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Assignment, Delegation and Supervision

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