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Zorluk: Çok zorAssignment, Delegation and Supervision

A multidisciplinary team including a registered nurse, a licensed practical/vocational nurse, and an assistive personnel is assuming care for clients on a trauma step-down unit. The registered nurse must rapidly distribute tasks following the morning handoff. Which of the following assignments are within the appropriate scope of practice for the designated team member? Select all that apply.

  1. Assigning the licensed practical/vocational nurse to perform a sterile dressing change on a 4-day-old external fixation pin site with minimal serous drainage.Cevap
  2. Directing the assistive personnel to empty and record the output from a closed-suction surgical drain for a client recovering from an exploratory laparotomy.Cevap
  3. C
    Delegating the licensed practical/vocational nurse to evaluate the respiratory status of a client with multiple rib fractures who just developed sudden tachypnea and restlessness.
  4. D
    Requesting the assistive personnel to obtain the initial set of vital signs on a client arriving directly from the emergency department following a motor vehicle collision.
  5. Instructing the licensed practical/vocational nurse to administer scheduled oral analgesics to a client with a stable pelvic fracture reporting moderate pain.Cevap
  6. F
    Assigning the licensed practical/vocational nurse to develop the comprehensive discharge education plan regarding signs of compartment syndrome.

Cevap

The appropriate assignments include having the licensed practical/vocational nurse perform a sterile dressing change on a healing pin site, having the assistive personnel record output from a surgical drain, and having the licensed practical/vocational nurse administer scheduled oral pain medication.
The correct delegation decisions strictly adhere to the scope of practice guidelines. The licensed practical/vocational nurse is safely assigned to perform a sterile dressing change on a healing, 4-day-old pin site and to administer scheduled oral analgesics to a stable client, as both are predictable tasks with established protocols. The assistive personnel is appropriately assigned to empty and record the output of a surgical drain, which is a routine data collection task that does not require clinical interpretation.

Adım Adım Çözüm

1
Analyze the acuity and stability of each client described in the task.
Identify clients who are unstable (e.g., sudden respiratory distress, new admission) versus stable (e.g., 4-day-old wound, routine drain care).
The registered nurse must retain care for unstable clients, as they require continuous assessment and immediate clinical judgment.
2
Determine if the task involves the core nursing process components of Evaluation, Assessment, or initial Teaching.
Identify tasks like evaluating sudden tachypnea or developing a discharge plan as core RN responsibilities.
Tasks requiring independent clinical judgment, complex assessment, or formulation of care/education plans cannot be delegated to LPNs/VNs or assistive personnel.
3
Evaluate the scope of practice for the licensed practical/vocational nurse for the remaining tasks.
Determine that administering oral medications to a stable client and performing sterile dressing changes on established wounds are appropriate.
LPNs/VNs are trained to perform specific procedures and administer medications to clients with predictable outcomes.
4
Evaluate the scope of practice for the assistive personnel for the remaining tasks.
Determine that emptying and recording drain output is appropriate, but taking initial vital signs on a new trauma admission is not.
Assistive personnel can perform routine, standard tasks that do not require clinical interpretation.

Anahtar Kavram

Delegation decisions must be based on client stability, the complexity of the task, and the strict legal scopes of practice for the RN, LPN/VN, and UAP, specifically retaining assessment, clinical judgment, and initial teaching for the RN.
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Assignment, Delegation and Supervision

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