Mark K – Prioritization and delegation
4 rules to prioritization
1. Acute beats chronic (it’s not ABC)
2. Fresh post op (12 hrs) beats medical or other surgical
3. Unstable beats stable “they will say ‘stable’ and ‘unstable’”
o Stable- chronic illness, post up greater than 12 hrs, local or regional anesthesia, lab
abnormalities of A or B, “ready for discharge” “to be discharged” “admitted longer than
24 hours ago” “unchanged assessment” “pts is experiencing Expected typical s/s with
which they were diagnosed” (doesn’t matter how bad the symptom is!)
o Unstable- acute, post op less than 12 hrs, GENERAL anesthesia, Lab abnormality of C
or D, “not ready for discharged” “newly admitted’ “newly diagnosed” or “admitted less
than 24 hrs ago” “changing/ changing assessment” “pts is experiencing UNexpected s/s”
Notes: below are unstable even if they are EXPECTED s/s
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Hemorrhaging- is always bad no matter expected or not! NOT bleeding
High fever
Hypoglycemia
Pulselessness or breathlessness, fixed and dilated pupil still breathing
4. The more the vital the organ the higher the priority
 Organ of modifying phrase
 Vital organ- brain, lung, heart, liver, kidney, pancreas
Delegation
LPN/LVN
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IV- CANNOT hang or mix IV meds, pushing IV meds but CAN maintain and document the flow
Cannot administer blood or mess w/ Central line
Not allowed to plan care, perform, or develop teaching but CAN reinforce teaching
Not allowed to take care of unstable patients
Not allowed the very first thing!
Not allowed following assessment
o Admission, discharge, transfer, 1st assessment after change
UAP/aid
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Not allowed charting- they can chart what they did but NOT about patient
Not allowed to give meds EXCEPT topical, OTC barrier cream
Not allowed to do assessments EXCEPT vitals and acu check (BG)
No treatment, can do enemas
Not anything first- even bed bath, first vitals
DO not delegate safety responsibility to family
Staff management
How do you intervene with inappropriate behavior of staffs?
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“Tell supervisor”
“Confront them and take over immediately”
“Approach later and talk to them right now”
ignore it (Never the answer)
If it’s illegal- Yes? – supervisor. No? - pts or staff member physical or mental harm/ danger? - Yes? confront them immediately
Illegal + harmful= confront first and supervisor
Not harmful + illegal= supervisor
Is this legal, not harmful but simply inappropriate- approach them later
Where is ascending/ descending colon in abdomen
APE To MEN- which intercoastal?
Aortic- 2nd right intercoastal space
Second left intercoastal
Tricuspid- 4th intercoastal space left sternal border
Mitral- 5th intercoastal space- mid clavicular line
Where is the pulses? Coratid
How do you guess?
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Knowledge, common sense, guessing strategies
Psych
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nurse will assess own feelings.
Establish a trust relationship
Diet
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Anything Chicken, fish NOT shellfish (lobster)
Never casserole for children
Never mix med in children’s food
Toddler it’s a finger food- hot dog, French fries
o Toddler chock on- hot dog and pop corn
Preschooler- Leave them alone- they eat when they are hungry
Pharmacology
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Side effects
o Pick a side effect in the same body effect that you are giving med
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If its PO- pick GI side effect
Never tell a child a medicine is candy
OB- check Fetal heart rate
Medsurge- first thing to assess- level of consciousness, ABC
 First thing you do NOW- establish an airway
o Peds
 Always give the child more time (don’t rush child development/ growth)
 When in doubt- call it normal
 When in doubt pick older age “what age should a child..?”
 When in doubt pick a easier task
 Normal, older, easier
Rule out absolutes- Never
Two answer same- they
If two answer is opp. One of them is right
Umbrella strategies- an answer that cover all other
1 patient- priority
o What is the worst thing that would happen?
Don’t memorize routes, frequencies, dosages