CH12 Nurse Caring for A Posto

Discussion post: 

You are the nurse caring for a postoperative appendectomy patient who had surgery 6 hours ago. The following tasks need completing:

  • Assess the patient’s ability to drink clear liquids.
  • Determine the amount eaten.
  • Document the patient’s tolerance of clear liquids.
  • Assess the patient’s tolerance for sitting at the side of the bed.
  • Assess the patient’s tolerance for ambulating.
  • Document the patient’s tolerance for activity.
  • Assess the patient’s pain level.
  • Provide education about activity levels.

1) Which of the tasks can be delegated, and to whom can they be delegated? Please carefully consider your responses and read the assigned materials BEFORE posting. 

2) To whom could the tasks be delegated if your co-workers included the following: licensed practical nurse, medication aide and nursing assistant?

3) Select one of the tasks and develop an outcome. How would you evaluate the ability of the patient to achieve the outcome if the task was delegated to the appropriate person?

Initial discussion postings need to be a minimum of 250 words and have two references. You must respond to two peers and each response posting must be a minimum of 250 words each with one reference. No references older than 5 years old. Use APA 7th ed. format. Use correct grammar and spelling. When using reference put intextcitatio with page number. 

Resources: all attached below 

Book: Chapters 12 and 14. 

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol152010/No2May2010/Delegation-Skills.html 

POST 1

Which of the tasks can be delegated, and to whom can they be delegated?

Of the tasks listed, it would be essential for the RN to first complete a full head to toe assessment and provide any teaching that is needed to the patient, caregivers, or family members. The RN should be the one to complete the initial assessment due to having a postoperative appendectomy patient and the surgery only occurring 6 hours ago. A patient that is 3 days post appendectomy may allow for the RN to feel more comfortable delegating tasks to other individuals. Before delegating specific tasks, it is essential for an RN to review the five rights of delegation. This ensures that the patient will be safely taken care of and that the delegate is competent enough to complete this task and that it is under their scope of practice. Prior to delegating tasks to an LPN or nursing aide, it would be important to go over the circumstance. If the patient is stable, it would be acceptable to allow for delegation of tasks. “If the patient’s condition changes, the delegate must communicate to the licensed nurse, and the licensed nurse must reassess the situation and the appropriateness of the delegation” (NCSBN, 2015, p. 8). When delegating tasks, there is a key difference between the LPN and RN. “The LPN contributes to the development and/or updates the plan of care and reinforces patient teaching and discharge instructions” (Zerwekh & Garneau, 2021, p. 324). After the initial teaching by the RN is completed, it would be acceptable to delegate reinforcement of teaching or discharge instructions to the LPN. In addition, the RN can delegate to the LPN to assess or ask the patient their pain level, document the patient’s tolerance for sitting at the side of the bed, tolerance for ambulating, and tolerance of clear liquids. A nursing assistant can be delegated the task of determining the amount eaten by the patient. It would be up to the RN to provide initial education about activity levels and determine the patient’s ability to drink clear liquids before allowing them to be consumed.

2) To whom could the tasks be delegated if your co-workers included the following: licensed practical nurse, medication aide and nursing assistant?

After the RN completes the initial assessment, I can delegate the task of determining the amount that was eaten by the patient to the nursing assistant. I can delegate the patient’s tolerance of clear liquids, tolerance for sitting at the side of the bed, tolerance for ambulating, and pain level to the LPN. The medication aide would be able to administer medications to the patient if the administration of the medication is in their scope of practice.

3) Select one of the tasks and develop an outcome. How would you evaluate the ability of the patient to achieve the outcome if the task was delegated to the appropriate person?

One task is the patient’s tolerance for sitting at the side of the bed. The outcome for this would be that the patient can sit up without being short of breath or feeling dizzy. I would evaluate the ability for the patient to achieve this outcome by closely watching their oxygenation status, determining if they have any pain when sitting up, and if they become short of breath during the movement. The LPN can determine this for the patient and must ensure they pay close attention to details and are properly documenting what is occurring with the patient.

References:

NCSBN. (2015). National Guidelines for Nursing Delegation – NCSBN. Retrieved October 5, 2021, from https://www.ncsbn.org/NCSBN_Delegation_Guidelines.pdf.

Zerwekh, J. & Zerwekh Garneau, A. (2021). Nursing today: Transition and trends (10th ed.). Elsevier Saunders.

POST 2

1) Which of the tasks can be delegated, and to whom can they be delegated? Before delegating any tasks it is important to think of the five rights of delegation. A journal stated, “The American Nurses Association developed the five rights of delegation to assist nurses in making safe decisions. Five Rights of Delegation: Right task, Right circumstance, Right person, Right supervision, Right direction and communication” (Barrow & Sharma, 2021). When it comes to what can be delegated, I believe it is easier to discuss what cannot. In our text it states, “Nurses cannot delegate the following: In-depth assessments that identify needs and problems and diagnose human responses. Any aspect of planning, including the development of comprehensive approaches to the total care plan. Any provision of health counseling, teaching, or referrals to other health care providers. Therapeutic nursing techniques and comprehensive care planning” (Zerwekh & Zerwekh Garneau, 2021, p. 326). With this being said, what cannot be delegated includes: assess the patient’s ability to drink clear liquids, assess the patient’s tolerance for sitting at the side of the bed, assess the patient’s tolerance for ambulating, assess the patient’s pain level, and provide education about activity levels. What can be delegated includes: determine the amount eaten, document the patient’s tolerance of clear liquids and document the patient’s tolerance for activity.

2) To whom could the tasks be delegated if your co-workers included the following: licensed practical nurse, medication aide and nursing assistant? When it comes to determining how much food has been eaten, the nursing assistant can have this task delegated to them. They are allowed to determine I&O. When it comes to the documentation assignments, LPNs can perform these tasks.

3) Select one of the tasks and develop an outcome. How would you evaluate the ability of the patient to achieve the outcome if the task was delegated to the appropriate person? The task I had in mind was document the patient’s tolerance for activity, this task could be delegated to the LPN from the RN. It is important to document the full outcome. The outcome would be that the patient is able to ambulate down the hallway and back without showing signs of over exertion such as shortness of breath, guarding from discomfort and grimacing. To confirm that this was a proper evaluation, I could see the patient’s tolerance with my own eyes while the patient is ambulating.

Barrow, J. M., & Sharma, S. (2021). Five Rights of Nursing Delegation . StatPearls.

Zerwekh, J. A., & Zerwekh Garneau, A. (2021). Nursing Today: Transitions and Trends (10th ed.). Elsevier.

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