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Difficulty: HardAssignment, Delegation and Supervision

During the morning shift on a vascular surgery unit, a registered nurse (RN) coordinates care with an experienced licensed practical nurse (LPN/VN) and an unlicensed assistive personnel (UAP). Based on the current clinical status of the clients, which delegation decision by the RN is the most appropriate?

  1. A
    Assigning the LPN/VN to evaluate the peripheral pulses of a client 2 hours post-femoral-popliteal bypass who reports sudden, severe leg pain.
  2. B
    Directing the UAP to apply graduated compression stockings to a client who recently developed new-onset unilateral leg swelling and erythema.
  3. Assigning the LPN/VN to perform a scheduled sterile dressing change for a client with a chronic, stable diabetic foot ulcer.Answer
  4. D
    Delegating the LPN/VN to provide initial discharge instructions regarding signs of graft infection to a client who had an endovascular aneurysm repair.

Answer

The most appropriate delegation is assigning the LPN/VN to perform a scheduled sterile dressing change for a client with a chronic, stable diabetic foot ulcer.
The correct delegation is assigning the LPN/VN to perform a scheduled sterile dressing change for a client with a chronic, stable diabetic foot ulcer. The LPN/VN's scope of practice includes performing sterile procedures for clients with predictable outcomes. Because the wound is chronic and the client's condition is stable, this delegation is safe and appropriate.

Step-by-Step Solution

1
Analyze the delegation involving the post-bypass client with sudden, severe pain.
Sudden, severe pain shortly after a vascular bypass is a hallmark sign of acute arterial occlusion. This represents a critical, unstable condition.
Unstable clients with new, acute changes require advanced clinical judgment and initial assessment, which cannot be delegated to an LPN/VN.
2
Evaluate the UAP's task of applying compression stockings to the client with new unilateral leg swelling.
New-onset unilateral swelling and erythema are classic signs of a deep vein thrombosis (DVT).
The RN must perform a comprehensive assessment before delegating any interventions. Applying compression devices to an undiagnosed DVT could dislodge the clot, leading to a pulmonary embolism.
3
Assess the delegation of discharge teaching to the LPN/VN for the post-repair client.
Initial discharge instructions and teaching require assessing the client's learning needs and evaluating comprehension.
The core nursing process (Assess, Diagnose, Plan, Implement initial teaching, Evaluate) is strictly the responsibility of the RN and cannot be delegated.
4
Review the delegation of the sterile dressing change to the LPN/VN.
The client has a chronic wound and is clinically stable. The task is standardized with predictable outcomes.
LPN/VNs are trained in sterile technique and it is safe and appropriate to delegate this task for a stable client, satisfying the Five Rights of Delegation.

Key Concept

Delegation based on client acuity and scope of practice
Estimated Time:1m 30s
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Topics

Assignment, Delegation and Supervision

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