Mark K Lecture 12: Prioritization, Delegation, Staff Management, Guessing Strategies

Prioritization Question Parts (4)

age

gender

dx

modifying phrase

Which two of the 4 parts of a prioritization question are irrelevant

age and gender

age is important if the whole question is pediatric specific*

Of all 4 parts of a prioritization question which is most important

the modifying phrase

Ex ?: Two patients: one has angina the other has MI which one will you prioritize?

The one with the MI

What are the 4 rules for prioritization?

1) Acute beats chronic

2) Fresh post-op (12 hours) beats medical or other surgical

3) Unstable beats stable

4) Tie-breaker rule: Brain, Lung, Heart, Liver, Kidneys, Pancreas

What are the 4 things that make you unstable even if they are expected?

hemorrhage (but not bleeding)

high fevers over 105-> seizure risk

hypoglycemia -> can lead to brain damage

pulseless or breathless

ex: V-fib or asystole

exception: at the scene of an unwitnessed accident (with multiple victims) pulseless and breathless patients are LOW priority because they are likely dead

Mass casualty BLACK TAGs

pulseless

breathless

fixed and dilated pupils

What is the tie breaker rule?

If the above 3 rules result in a tie breaker;

the more vital the organ, the higher the priority

1- brain

2- lung

3- heart

4- liver

5- kidney

6- pancreas

DO NOT delegate these to an LPN

cannot start an IV

cannot hang OR mix meds

cannon push IV meds

LPNS can ONLY maintain an IV and document the flow

they cannot administer blood- no flushing or changing the dressing of one either

cannot make a care plan (they can implement it though)

cannot perform or develop teaching (can reinforce it though)

cannot take care of unstable patients

cannon perform the first of anything (no admitting new patients/ first assessment)

DO NOT delegate the following responsibilities to a UAP

charting (no assessments of patients)

medication administration

assessments (except for vitals and accu-checks)

treatments (except for enemas)

ADLs when it is the patient's 1st time doing them

What are the 4 answers for staff management questions?

tell supervisor

confront them and take over the task the staff is implementing immediately

talk to them later

ignore it (never pick ignore- it is the wrong answer)

If the staff is doing something illegal you...

tell the supervisor

If the staff is NOT doing something illegal- ask if anyone is in immediate of physical or psychological harm?

if it is, confront immediately

If no one is in harm's way ask if the behavior is inappropriate and ...

if it is, talk to that staff at a later time about the incident

Auscultation Over the Heart Valves (mnemonic to remember order)

A PET M

aortic, pulmonic, erb, tricuspid, mitral

Aortic valve is located

in the 2nd intercostal space, right of the sternal border

Pulmonic valve is located

in the 2nd intercostal space, left of the sternal border

Erb point is located (rarely tested)

in the 3rd intercostal space, left of the sternal border

Tricuspid valve is located

in the 4th intercostal space, left of the sternal border

Mitral valve is located

in the 5th intercostal space at the midclavicular line

Apical pulse is the same location of what valve?

Mitral (5th intercostal space at the midclavicular line

In psych nursing when you need to guess...

pick "I will examine my feelings"- this prevents countertransference OR pick "establish a trust relationship"

For a nutrition question when you need to guess...

when all else fails go with baked not fried

if no chicken, pick fish but not shellfish

never pick casseroles for children

do not mix meds in kids food

pick finger foods for toddlers

for preschoolers leave them alone - one meal a day is ok

For a pharm question when you need to guess...

memorize S/E

if you know what the drug does, but do not know the S/E how do you proceed?- pick the S/E in the same body system the drug is working

For CNS drugs pick drowsiness

if you have no idea and the drug is PO pick GI side effect

For an OB question and you have to guess...

pick check fetal heart rate

For a med/surge question and you have to guess...

what is the first thing to assess? - check LOC NOT airway

what is the first thing you DO?- establish airway

For pediatric growth and development and you have to guess...

Always "give the child more time"

when in doubt call it normal

when choosing between two ages pick the one that in older

when in doubt pick the easier task

NORMAL, OLDER, EASIER!

General assessment questions when you have to guess...

rule out absolutes

if two answers are opposite one is right

umbrella answers (answers that covers all the others)

Prioritization of patient needs when you have to guess...

chose the answer that have the WORST outcome if you DON'T do it

The Sesame Street Rule

when nothing else works look at the answer choices to see which one looks different from the others