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Difficulty: MediumAssignment, Delegation and Supervision

A charge nurse on an inpatient oncology unit is reviewing the team's patient care distribution for the shift. The team consists of a registered nurse (RN), a licensed practical/vocational nurse (LPN/VN), and an unlicensed assistive personnel (UAP). Which of the following care distribution decisions made by the RN are appropriate? Select all that apply.

  1. Having the LPN/VN administer scheduled oral analgesics to a client with bone metastasis experiencing stable, chronic pain.Answer
  2. Asking the UAP to assist a client with severe chemotherapy-induced fatigue with bathing and feeding.Answer
  3. C
    Transferring the initial admission assessment of a client arriving from the emergency department with neutropenic fever to the LPN/VN.
  4. D
    Requesting that the UAP educate a family member on proper infection control protocols for a client with acute leukemia.
  5. Allocating routine tracheostomy care and suctioning for a stable client recovering from a total laryngectomy to the LPN/VN.Answer
  6. F
    Entrusting the LPN/VN to evaluate a client's respiratory response 30 minutes after receiving a newly prescribed intravenous opioid.

Answer

The appropriate care distribution decisions include having the LPN/VN administer scheduled oral analgesics, asking the UAP to assist with bathing and feeding, and allocating routine tracheostomy care to the LPN/VN.
The correct options align with established scope of practice guidelines. LPN/VNs are capable of administering oral medications to stable clients and performing routine sterile procedures like tracheostomy care. UAPs are properly utilized for assisting with routine activities of daily living, such as feeding and bathing.

Step-by-Step Solution

1
Analyze each delegated task against the RN scope of practice (often remembered by the acronym EAT: Evaluation, Assessment, Teaching).
Identify tasks that involve initial assessment, clinical judgment, teaching, or evaluation of new interventions.
These tasks must remain with the RN and cannot be safely delegated.
2
Evaluate the assignments delegated to the UAP.
Assisting with feeding and bathing for a fatigued client is appropriate, but educating a family member on infection control violates the teaching restriction.
UAPs can perform standard, unchanging activities of daily living for stable clients.
3
Evaluate the assignments delegated to the LPN/VN.
Administering oral medications and performing routine tracheostomy care for stable clients are appropriate. Performing initial admission assessments and evaluating responses to newly prescribed IV medications are not.
LPN/VNs care for stable clients with predictable outcomes and can perform sterile procedures, but they cannot perform initial comprehensive assessments or evaluate complex clinical responses.

Key Concept

Delegation and Scope of Practice (EAT: Evaluation, Assessment, Teaching)
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Topics

Assignment, Delegation and Supervision

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