Prioritization and Delegation in Nursing: Strategies for Effective Patient Care, Exams of Advanced Education

Download Prioritization and Delegation in Nursing: Strategies for Effective Patient Care and more Exams Advanced Education in PDF only on Docsity!

Mark Klimek Lecture 12 -

Prioritization/Delegation Questions And

Answers 2023

Which phrase is more important? - Correct Answer-Modifying phrase 4 Rules for Prioritization - Correct Answer-1. Acute beat chronic

2. Fresh post-op (first 12 hrs) beats medical or other surgical
3. Unstable beats stable
4. The more vital the organ, the higher the priority What makes a patient stable? - Correct Answer-1. Use of the word stable
5. Chronic illness
6. Post-op > 12 hours
7. Local or regional anesthesia
8. Unchanged assessment
9. Phrase: "To be discharged" or "Admitted longer than 24 hours ago"
10. Lab Values A/B *Stable patients are experiencing the expected signs and symptoms of the disease with which they have been diagnosed and for which they are receiving treatment What makes a patient unstable? - Correct Answer-1. Use of the word unstable
11. Acute illness
12. Post-op less than 12 hr
13. General anesthesia
14. Changed assessment
15. Phrase "Newly admitted" or "Newly diagnosed"
16. Lab Values C/D

• Unstable patients are experiencing unexpected, atypical signs and symptoms/complications What 4 patients are always unstable? - Correct Answer-1. Hemorrhage

2. Hypoglycemia
3. Fever ≥ 105
4. Pulselessness or breathlessness (witness = high priority unwitnessed scene = low priority) 3 Things that result in a black tag (unwitnessed scene) - Correct Answer-- Pulselessness

• Breathlessness
• Fixed and dilated pupils

(Even if they're breathing and have a pulse) Organs starting with most vital - Correct Answer-Brain -> lungs -> heart -> liver -> kidney -> pancreas What responsibilities would you not delegate to an LPN? i - Correct Answer-- Starting an IV

• Hanging or mixing IV meds
• Evaluating an IV site
• Giving an IV push/ PB meds
• Giving a blood transfusion or mess w/ central lines
• Performing assessments that require inferences/judgements (can gather data) can make observations about stable people but cannot make assumptions
• Plan of care
• Developing or performing teaching (can reinforce/review)
• Taking verbal orders from MD or transcribing orders
• Take an unstable patient
• Doing the first of anything
• Assessments: admission, discharge, transfer, or first one after a change What would you not delegate to a UAP (CNA/tech)? - Correct Answer-- Cannot chart, but may document what they did (not about the patient)
• Assessments: except for VS and accuchecks
• Meds and IVs: may apply OTC topical lotions and creams
• Treatments (except for enemas) *You may delegate baths, beds, and ADL's Do not delegate to family: - Correct Answer-Safety responsibilities. They can only do what you teach them to do. How do you intervene with inappropriate behavior of staff? - Correct Answer-1. Tell the supervisor

2. Intervene immediately
3. Counsel them later on
4. Ignore it. Just let it go (never the right answer) What 3 questions should you ask when dealing with inappropriate behavior from staff? - Correct Answer-1. Is what they're doing illegal? --> If yes, tell the supervisor
5. Is the patient or staff member in immediate danger of physical or psychological harm? --> If yes, intervene immediately
6. Is this behavior legal, not harmful, but simply inappropriate? --" If yes, counsel them later on Auscultating Heart Sounds - Correct Answer-- Aortic valve

--> 2nd intercostal space, right sternal border

• Pulmonary valve --> 2nd intercostal space, left sternal border
• Tricuspid valve --> 4th intercostal space, left sternal border
• Mitral valve --> 5th intercostal space, mid-clavicular line Psych guessing strategies - Correct Answer-- Best psych answer: the nurse will examine their own feelings about (so you don't counter transfer)
• Good answer: establish a trust relationship Nutrition guessing strategies - Correct Answer-- In a tie, pick chicken
• If no chicken, pick fish
• Never pick casseroles for children
• Never mix medications in children's food
• Before you mix medications in anyone's food, ask for permission!
• Toddlers = finger foods
• Preschoolers = leave them alone "One meal a day is okay" Pharmacology guessing strategies - Correct Answer-- Memorize side effects
• Pick a side effect in the same body system where the drug is working
• If it's PO, pick GI effect for SE OB guessing strategies - Correct Answer-- Watch FHR Never tell a kid that medicine is - Correct Answer-Candy Med-Sure guessing strategies - Correct Answer-Assess LOC first, then airway, breathing, circulation Peds guessing strategies - Correct Answer-1. Always give child more time to grow and develop

2. When in doubt, pick older age in child question
3. Pick easier task in age development question General guessing strategies - Correct Answer-1. Never choose an absolute
4. If two answers say the same thing THEN neither are right
5. If two answers are opposite THEN one is probably right
6. Umbrella strategy

• Which answer is more global? If they all look right, look for an answer that is so broad that when you do it, you do all the others

5. If there are 4 right answers and they ask you to pick the highest priority THEN do worst consequence game

• Take each answer and see what is the worst thing that could happen if you don't do it.
• WORST THING if you didn't do it = answer

When you're stuck between two answers, re-read the question If you are at a DEAD LOSS - Use Sesame Street Rule

• Right answer tends to be different than the others, wrong answers are similar bc they are all wrong so choose the one answer that stands out Don't be tempted to answer a question based on your ignorance instead of your knowledge. If you DON'T KNOW a word in the question, take what you dont know out of the question. Go with your gut answer! BOARDS WILL GIVE YOU THINGS YOU HAVE NEVER HEARD OF TO TEST YOUR COMMON SENSE, IT HAPPENS A LOT IN THE FIRST 10 QUESTIONS! Stay calm and use common sense! BE POSITIVE - Go in EXPECTING 265 Questions!