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Mark Klimek Prioritization, Delegation
Terms in this set (23)
Decide which patient is the sickest or the healthiest
Examples of prioritization questions are ones that start with
All four call lights are on, who to see first
• Disaster/mass casualty, who to discharge
• RN/LPN/AP tasks
• New graduate nurse
what variable do you ignore in prioritization?
What variable is very important in prioritization?
rule #1 for prioritization?
Acute beats chronic
In what situation will the ABC's not apply in prioritization?
Acute beats chronic
Rule #2 prioritization
FRESH POST OP (12 hours or less) beats medical or other surgical
Rule #3 prioritization
UNSTABLE beats Stable
Things that make a pt STABLE
Use of the word STABLE
A CHRONIC illness
Post-op MORE than 12 hours old
Local or regional anesthesia
Lab abnormalaties of an A or B (see "lab values" notes)
ready for/to be discharge, or admitted longer than 24 hrs ago.
Things that make a pt UNSTABLE
Use of the word UNSTABLE
Post-op LESS than 12 hours old
General anesthesia (for the 1st 12 hours)
A changed or changing assessment
Use of the phrase "newly or just admitted" or "newly diagnosed"
Lab values of a C or D (see "lab values" notes)
what do stable pts experience
Stable pts are experiencing the typical expected signs and symptoms of the disease with witch they were diagnosed. and for which they are receiving treatment
- REGARDLESS OF THAT SIGN'S SEVERITY
what do unstable pts experience
Unstable pts are experiencing unexpected signs and symptoms, complications.
These 4 are always UNSTABLE, as these can all lead to brain death:
High fever over 105 F
Pulseless or breathless
When do you prioritize for
Prioritize for the "right now" as opposed to the "5 minutes from now"
Should you prioritize by symptom severity alone
Rule #4-Tie breaker for stable vs unstable
the more vital the organ, the higher the priority
- Most vital is the brain
- Next is the lungs
Remember: Black Lipstick Has Left Kisses Passionately
What should you not delegate to an LPN
Starting an IV
Hanging or mixing IV meds
Giving IV piggyback meds
Giving a blood transfusion
Performing an admission, discharge, or transfer assessment
Develop a plan of care
Take or transcribe orders from an MD
Care for an unstable pt
Do the first of anything (dressing change, tube feed, vitals, ambulation, etc)
What can you not delegate to an aid (AP, UAP, etc)
Assessments (except for VS and accuchecks)
Treatments (except for SSE - soap suds enema)
Nurse may delegate ADLs, Beds, Bath, and the 2nd feeding onward
Do not delegate these to the family
Safety responsibilities: the family can only do what you teach them to do
• Document your teachings!!!!!!!
How do you intervene with inappropriate behavior of the staff? 4 options
Confront them and take over
Counsel them later on
Ignore it is ALWAYS WRONG!!!!!!
Is what they are doing illegal?
If so, tell the supervisor. If not, next question
Is what they are doing physically or psychologically dangerous to staff or pt?
If so, confront and take over, if not, next question
Is this behavior legal, harmless, but still inappropriate?
If so, counsel them later
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