Delegation Case Study Worksheet

UNIT 4 – DELEGATION CASE STUDY You have just arrived for your shift on the cardiovascular unit. You will be working the 1500 – 0300 shift. You have been assigned 5 patients. You are responsible for the safe care of these 5 patients. You will be working directly with the following individuals:  1 LPN – this individual will be working directly with you in caring for your 5 patients and will also be assisting one other RN with their nursing assignment.  1 CNA – this individual is responsible to assist with the care of 10 patients on the unit. 5 of these patients are yours. The following was given to you and your team during nursing report:  George Stanley – 70 year old male who is 5 days post-op coronary bypass surgery X 5. Pacing wires were discontinued 4 hours ago with no problems noted at this time. Patient is ambulating without O2 and has had no cardiac arrhythmias. Patient still requiring oral pain medication Q 6 hours. Discharge teaching is needed. Patient to be discharged in the AM.  John Richards – 62 year old male who presented to the ER 22 hours previously with an ST elevated MI. Patient has had 2 coronary stents placed. Arterial femoral line is still in place and needs to be removed within the next 2 hours. IV nitro has been discontinued and patient is not complaining of any chest pain.  Violet Smith – 40 year old female admitted 3 hours previously with cardiac arrhythmias due to possible cocaine and alcohol consumption. Patient is currently stable, with no signs of cardiac arrhythmias. Vital signs and patient assessment is Q30 minutes for the next 4 hours and then Q1 hour for the next 24 hours.  Diane Johnson – 65 year old female who received a coronary angiogram 12 hours earlier. No CAD was noted. Patient has had femoral lines removed and has ambulated once. She still needs to ambulate one more time this evening. Discharge teaching has been completed but the patient has had multiple questions relating to heart disease. Patient is to be discharged in the AM.  William Bowers – 72 year old diabetic male. Patient presented to the ER by private vehicle 8 hours previously, complaining of 7/10 chest pain and difficulty breathing. O2 and IV nitro is running. Patient currently has had no ST elevation and rates his pain 2/10. Morphine IV push has been ordered. Bed rest has been ordered until coronary angiogram in the AM. Patient teaching for angiogram needs to be completed. Delegation Questions 1. Please triage the above patients in order of severity. Think of possible problems that have been reported to you and what problems may occur on your shift. John Richards, William Bowers, George Stanley, Violet Smith, and then Diane Johnson. I put them in this order related to their diagnoses an if they were stable. All of the patients are currently stable, but I would want to see my patients who have had a heart attack or came in complaining of a heart attack first. A couple of my patients are being discharged so eventually I will need to do discharge teaching but because that is not my priority it can wait. Possible problems could be that one or more of my patients could crash or have not been accurately diagnosed according to patient complaints. The challenge will be managing all the patients according to their needs. 2. What specific assignments will you as the RN complete? Please explain why these responsibilities should not be delegated. The RN will complete removing the arterial femoral line from John Richards, discharge teaching, and assessments of all the patients. These responsibilities can not be delegated because they are not withing the LPN or UAPs scope of practice. 3. List 3 possible problems that could arise with each of your 5 patients. George Stanley: post op bleeding, blood clots resulting in heart attack, and infection. John Richards: temporary vascular occlusion, thrombosis, ischemia. Violet Smith: Unseen cardiac arrhythmias, anxiety and paranoia, restlessness, irritability, and aggression related to possible withdrawal. Diane Johnson: Dehydration, constipation, and incontinence related to possible immobility. William Bowers: Heart attack, nephropathy, and low or high blood sugars. 4. How will you complete and delegate the following tasks and to which team member will the following tasks be delegated? (you can select more than one person for a task) Vital signs Blood glucose ADLs Applying restraints if needed Pharmacy ordering of meds and IV fluids Signing off Dr. orders Assist Dr. with insertion of central line Ambulate patient Pain medication administration IV assessment and maintenance Administer IV meds, IV push, hang piggybacks Set up and maintaining skeletal traction        RN    LPN            CNA Administer oral meds, IM, or SubQ Patient teaching Apply cold or warm moist packs Suction Trach Patient shift assessment Removal of femoral lines and the 15 minutes of direct pressure over the femoral site. Patient assessments and Vital signs of patient #3 Wound care and sterile dressing change Refilling water jugs Removing warm or cold packs Answering call lights                        