Case Study
Concept: Managing Care
Exemplar: Delegation
Course: NUR 213
Delegation: A registered nurse (RN) has a group of ten clients on a medical surgical unit in an acute care setting. There is also assigned a licensed practical nurse (LPN) and unlicensed assistive personnel (UAP) to the same group.
The clients are as follows:
Room 101: A 48 year old female with breast cancer one day post bilateral mastectomy that has been crying all night and is asking that no visitors be allowed. She refuses to get out of bed and refuses to look at her bandages.
Room 102: A 92 year old male with dementia and pneumonia. He has a bed alarm and has a history of falls. He has a large list of medications to be administered daily crushed and in applesauce.
Room 103: An obese 72 year old female with a diabetic foot ulcer. Blood sugars have been 250-400 mg/dL since admission and her family continues to bring her food from fast food restaurants. She is on a calorie and carbohydrate restricted diet which she eats in addition to the food her family brings.
Room 104: A 36 year old male three days status post open spleenectomy following a motor vehicle accident. He is anxious to get home and back to work for fear he will lose his job. He is being discharged today. He is employed as a stone worker where he lifts heavy stones every day.
Room 105: A 54 year old female three days status post abdominal hysterectomy with subsequent dehiscence of wound 12 hours post op. The wound is being packed with normal saline soaked Nugauze three times a day.
Room 106: A 67 year old male with Clostridium Difficile and Vancomycin Resistant Enterococcus (VRE). He has been complaining of abdominal cramps and diarrhea all night. The stools have subsided and he has just gone to sleep.
Room 107: A newly admitted 55 year old female with anemia and possible gastrointestinal (GI) bleed that has not been assessed. She does not have an IV access. She will be receiving 2 units packed red blood cells (PRBC) ASAP.
Room 108: An 89 year old male with resolving pneumonia that is being discharged back to the nursing home later this afternoon. He requires turning, feeding, and bathing.
Room 109: A 49 year old male with hypertension and resolved stroke for possible discharge today.
Room 110: A 43 year old female with new onset Type II diabetes mellitus. She has met with the diabetic educator and has been checking her own blood sugars and ordering her own meals.
A) Which duties cannot be delegated therefore the RN must complete? Provide rationale.
B) What clients or tasks should be delegated to the LPN? Provide rationale.
C) What tasks should be delegated to the UAP? Provide rationale.
D) What is the RN’s responsibility before the end of the shift in reference to the delegated activities? Provide rationale.
E) Should the charge RN need to help with any of the days tasks? Why or why not?