Prioritization and Delegation Worksheet Assignment
Right Task / Right person / Right Circumstance
Assign the correct person/role to each task, choosing between RN, LPN, or AP (CNA). For the Circumstance Heading, note
...
Prioritization and Delegation Worksheet Assignment
Right Task / Right person / Right Circumstance
Assign the correct person/role to each task, choosing between RN, LPN, or AP (CNA). For the Circumstance Heading, note when and how each given task may not be appropriate to delegate to the assigned person/role.
Hayley Massey 5-26-2020
Task Person/Role Circumstance
Activities of daily living AP or CNA RN is needing to assess the patient cognitive by performing tasks, or if the patient isnt stable or strong enough to
perform ADL’s with an AP
Ambulating AP or CNA RN is needing to assess patient musculoskeletal system or
patient isn’t stable enough to ambulate with an AP
Tracheostomy care RN If your facility allows LPN to perform the task they may be delegated to perform it. As the RN and trach involves the airway and breathing I would prefer for me to perform the
task
Empty urinary catheter of a patient with CBI RN Emptying a foley cath could be perform my an AP, but with the continuous bladder infection the catheter should be assessed to make sure there is no blockage or other
complications
Suctioning RN Depending on the facility the LPN may be able to perform
this task, but with it interfering with breathing the RN should be there to assess
Feeding a blind patient AP The AP/CNA can perform this task. If there was a risk for
aspiration the RN should perform this task to assess for dysphagia
Positioning AP The AP can perform this take. The RN should handle this
task if there are wire or tubes that need to be handled or the
patient has a sore that needs to be assessed
Inserting urinary catheter LPN The LPN could perform this task. This should be handled by the RN if the patient is a difficult cath or if there is trauma to the perineal area. The RN may also consider the
patients individual risk for infection.
Checking nasogastric tube patency LPN An LPN can handle this task. The RN should handle this
task if there NG tube has had complications or if they suspect the NG tube has moved.
Medication administration LPN The LPN can handled this task for PO meds. The RN may
want to handle this task if the patient is an aspiration risk for PO meds, and if IV meds need to be administers
Sterile specimen collection AP The AP can perform this task (at my place of work we can) with urine. The RN may perform this task if the AP isn’t trained on the task, or if another kind of sterile sample is
needed (sputum, tissue)
Evaluating an ECG strip RN The RN should handle this because of the assessment factor
Vital signs on a new
admit RN The RN should handle the initial vital signs and assessment
Intake and output AP The AP is able to record intake and output. The RN should handle this is for medications and IV fluids, or if the RN
removed the food tray from the patient
Reinforcing discharge
teaching RN The Rn should handle education to coordinate it with the
assessment
Administration of Lasix (furosemide) LPN The LPN can administer this med if it is an oral med. IF the med is ordered for IV the RN should handle this
administration.
Prioritization
Write an example of each prioritization principle.
Prioritize systemic before local.
RN should treat anaphylactic reaction before assessing bee sting site.
Prioritize acute before chronic.
RN should assess sudden onset of chest pain before handling a blood sugar of 210 with a patient
who has Type II diabetes.
Prioritize actual problems before potential future problems.
Prioritize patient need for breathing treatment before prioritizing risk of infection
Prioritize according to Maslow’s Hierarchy of Needs.
RN should prioritize patient need for albuterol before fulfilling request for a warm blanket.
Recognize and respond to trends vs. transient findings.
The RN should be more aware of a patient’s increasing heart rate over a 12 hour shift than a
single elevated WBC.
Recognize signs of emergencies and complications vs. “expected client findings”
An RN should be concerned about a post-surgery patient with a low respiratory rate vs another
post op patient who is complaining of a pain level of 5 out of 10 .
Apply clinical knowledge to procedural standards to determine the priority action.
A patient needs to receive all their prescribed medications, but some medications are more a priority than others (heart medication, seizure medication, etc…)
Select the client from each group that the nurse should assess first after morning report and select a principle of prioritization that applies to that client.
Group A
A client receiving morphing sulfate via a PCA pump with respiration of 8/min.
Using Maslows, the patient who is on the border of respiratory depression should be assessed first.
A client 2 days postoperative right knee replacement who has not had a bowel movement. A client with a left below the knee amputation who is having difficulty with body image.
A client who has a heart rate of 110 beats per minute after an albuterol respiratory treatment
Group B
A client who has diabetes mellitus and whose capillary blood glucose is 190. A client 2 days postoperative colon resection with an oral temperature of 39.
The client is presenting with a sign of infection. The complication of infection is more a priority for the emergency side of compared to the other patients.
A client in Buck’s traction who refuses to take the daily prescribed stool softener. A client with cervical fusion needing to ambulate the length of the hallway.
Group C
A client who has chronic kidney disease and a creatinine level of 2.3
A client who is 2 hr. post cardiac catherization with capillary refill less than 3 seconds
A client with a swollen, reddened, and painful intravenous site after receiving antibiotics A client with expiratory wheezing after receiving intravenous contrast for CT scan.
Using Maslow’s this patient is having difficulty breathing which is higher on the needs level.
Case Studies
Please review and answer the questions for the following 3 Case Studies.
Case Study 1
You are assigned to care for the following three patients in the intensive care unit (ICU)There are two other RNs and two unlicensed assistive personnel (UAP) on duty to care for a total of 12 patients currently in the unit.
1. A 58 Y.O man, was admitted to the ICU after falling out of a tree onto a lit gas grill. He has partial- thickness burns on his face, neck, and upper trunk. He has undergone surgical repair of right tibia and left hip fractures as well as debridement of a severely lacerated right leg. His voice is slightly hoarse, and he is coughing up sooty sputum. He is receiving O2 at 4-L/min via nasal canula and his O2 saturation is 93%. His WBC count is 26,000/ml (26.4 x 10 with 80% neutrophils (10% bands).
2. A 35 Y.O. woman was transferred to the ICU from the clinical unit last evening with acute respiratory failure. She was diagnosed 2 days ago with AIDS and Pneumocystis jiroveci pneumonia (PCP). Prior to this hospital admission she had consistently refused antiretroviral therapy (ART) because she could not afford it. She was started on oral trimethoprim/sulfamethoxazole (Bactrim) and combination antiretroviral therapy. However, she was transferred to the ICU for intubation and mechanical ventilation. She is started on IV Bactrim and corticosteroid therapy.
3. 63 Y.O. woman with lung cancer, has been receiving chemotherapy on an outpatient basis. She completed her third treatment 5 days ago and has been experiencing nausea and vomiting for 2 days even though she has been using ondansetron (Zofran). She was initially admitted to the medical unit but was transferred to the ICU for closer monitoring after becoming severely hypotensive overnight. Her most recent blood pressure was 98/50.
Priority decision: which patient should you see first? Why?
I would go see patient number 3 first. Her episode of hypotension was more acute, and I would like to assess her and her trend of blood pressures. Patient number 2 is intubated and on a vent, but the explanation gave no data to show that she was unstable. Patient number 1 sounds like he has been in the ICU for a few days, and coughing up soot isn’t preferred, that is an expected finding.
Delegation decision: Which morning tasks should you delegate to the UAP?
a. Take blood pressure readings on #3.
b. Perform neurovascular checks on #.1
c. Document strict I/O on #3.
d. Provide oral care around the endotracheal tube for #2.
e. Titrate # 3 IV infusion rate based on her blood pressure reading.
When you enter #2 room, the ventilator alarms are going off. The UAP had just finished providing oral care and she tells you that the patient has become increasing agitated within the last 5 minutes. Which initial action would be most appropriate?
a. Suction #2 endotracheal tube.
b. Have the UAP stay with the patient while you obtain IV sedation for her.
c. Ask the UAP to describe exactly what she did when she was performing oral care.
d. Assess the ventilator to identify what alarm is going off and to make sure all connections are secure.
Case Study 2
Sam is a new nurse working the day shift on a busy medical-surgical unit. He asks his aide to walk the patient in Room 244 while he admits another patient. The patient in Room 244 is a postangioplasty, and it would be the first time he has ambulated since the procedure. Sam tells his aide to walk the patient only to the nurse’s station and back. He also says that if the patient’s heart rate rises more than 20 beats/min above the resting rate, the aid should stop, have the patient sit, and inform Sam immediately.
Did Sam appropriately delegate in this scenario?
I don’t believe he did. The AP can ambulate patients, but with this being the patient first time getting up after his procedure and the RN is asking the AP to assess the patient as he is ambulating is out of his scope.
If not, which of the rights of delegation was not followed? Why?
The right person, and the right task were not followed. It was out of the AP scope (wrong person) and not an appropriate task for the AP (wrong task)
The aid misunderstands Sam’s instructions and instead ambulates the patient in Room 234, who is 3 days post- hysterectomy and has been walking in the halls for 2 days.
Where did the breakdown in communication occur?
I would think there wasn’t a readback or recite what the nurse had asked the AP to do. The AP didn’t ask to clarify, and the RN didn’t ask for a readback
Who would be accountable for the outcomes if the patient in Room 234 had fallen and broken a hip during ambulation? Would it be Sam, who directed the aide to ambulate the patient in Room 244? Or would it be the aide, who ambulated the patient in Room 234?
Sam would be accountable. He delegated the task, but he is still responsible for the safety of the patient.
Case Study 3
Kim is a student nurse in her final medical-surgical rotation. Her patient has a new left forearm arteriovenous graft for dialysis. As part of her clinical assignment, Kim must select a task that could be delegated regarding the care of her patient. The instructor also requires Kim to include how she would communicate, supervise, and provide feedback to a nursing assistant. Kim describes how she could delegate the vitals to the nursing assistant. She states that shoe would ask if the assistant had ever taken vitals before, ask her to demonstrate the task, clearly state how often the vitals needed to be completed as well as parameters for the vitals, and provide feedback on the performance.
The instructor says that she is pleased with Kim’s thoroughness and allows her to delegate the vial signs to the nursing assistant, Janita, who accepts the task. After 3 hours, Kim notes the patient’s graft arm has decreased pulses and is coo to the touch. She asks Janita if she noticed the same findings. The assistant responds, “I thought it was strange that you asked me to check her blood pressure on her left arm, but I figured you knew what you were doing and had checked it with you instructor.”
What went wrong in this scenario?
From the explanation, Kim did not educate Janita on NOT taking blood pressures on the left arm. On Janita’s side, she thought something sounded strange, but didn’t clarify her confusion on the blood pressure
How were the five rights applied to this scenario?
There was an issue with the right communication. Janita still had questions about the procedure.
Who retains accountability for the outcome? Why?
The RN KIM still retains accountability for the outcome. It is her patient and she delegated the task, She had good teaching, and was under the impression that the aid was in full understand the responsibility still falls on the RN.
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