PRIORITIZATION questions( Airway, breathing, circulation)

DELEGATION questions( TRANSFER OF RESPONSIBILITY TO ONE OF YOUR SUBORDINATES

BUT YOU CANNOT TRANSFER ACCOUNTABILITY)

5 rights of Nursing delegations:

1) Right person:

❖ Feeding: Unlicensed assistive personnel

❖ Patient has issue with swallowing: Registered nurse

❖ Post-Op: Registered nurse

❖ Assisting patient with restroom: Unlicensed assistive personnel

❖ Injections: LPN- administering medication and oral/injectable narcotics,(Excluding IV

medications), ( depending on which type of injection) Ex: Chemo: RN

❖ IV fluids injections: RN

❖ Emergency drugs:RN

❖ Insulin and Heparin: LPN

2) Right Task

❖ Bathing the patient, that’s a task: Unlicensed Assistive personnel

❖ Showering: UAP

❖ Planning: RN

❖ Wound care stage 2: LPN (not chronic)

❖ Evaluation:RN

❖ Cardiac arrest: RN

❖ Post-Mortem care: UAP

❖ Identification of dead body: RN

❖ Assessment: RN

❖ Administration of flu Vaccine: LPN

❖ Assisting patient to the restroom: UAP

❖ Oral care: UAP

❖ Tracheostomy care;Suctioning; inserting a urinary catheter; administering enteral

feeding; checking NG tube patency :LPN

3) Right Communication

If I’m going to assign something to you, it should be specific. Give directions

EX: Feed the patient, make sure the head of the bed is 90 degrees.

4) Right Circumstance

➢ If I say vital sign in a hospital setting, it should be assigned to UAP. But if the

patient becomes unstable, now the RN will do the vital signs. It all depends on the

circumstance

➢ EX: Feeding: UAP can do it, but if the patient can’t swallow, now the RN will

have to do

➢ it because of Dysphagia

5) Right Supervision/Evaluation

● EX: Feeding a patient: UAP is doing it but RN will evaluate how much was

consumed by the patient. You reassess as a nurse

● The LPN, The New Nurse, Float Nurse, and The Graduate Nurse gets the most

stable patients with expected outcomes. The RN gets the most unstable patients.

● Rn assignment: do not delegate; assessment, teaching, or nursing judgement, new

post-op patients.

KNOW YOUR LAB VALUES: Blood glucose: 70-100 mg/dL Hgb- 12-16/17g/dL; BUN: 8-21mg/dL

 Creatinine: 0.5 -1 mg/dL(F) Hct - 42% - 52% (M)

 Creatinine: 0.6 -1.2 mg/dL(M) Hct - 37% - 47% (F)

 WBC - 5000 - 10,000mm^3 Albumin: 3.5 - 5 g/dL

 Prealbumin: - 12 - 42mg/dL Cholesterol level: less than 200mg/dL

 Triglycerides: less than 150

LAB SKILL QUESTIONS

1.HOW do YOU verify FEEDING TUBE PLACEMENT? Tube placement must be verified by x-ray

before the initial feed is given. This is a Clean Technique.

2. How often do you check Pts. glucose level when giving Parenteral Nutrition? Check glucose

level every 4 to 6 hours until stable, then at least daily. Do not hang for more than 24 hours.

3. What is the correct position Pt. is placed during nasogastric feeding? A high-fowler’s position,

pillow behind head and shoulders.

4. Instruct Pt. to sip and swallow water as you slowly advance the tube. Swallowing closes the

epiglottis, so that the tube does not go into the trachea.

5. How do you position a patient when administering enema? Left-side lying (Sims position) with the

right knee flexed. Elevate HOB slightly, AVOID SEMI-FOWLER’S POSITION.

6. How do you raise the level of the container to give Enema solution? Slowly raise the level of the

container to 30 to 45 cm ( 12-18 in.) above the level of the hips. SLOW STEADY RATE OF INFUSION,

DECREASES CRAMPING AND INCREASES THE PTs. ABILITY TO RETAIN THE SOLUTION.

7. Enema is a Clean Technique.

8. What is the important lab-test that you need to check if a Pt, is suspected of having protein

malnourishment/undernourishment especially for the elderly? Prealbumin level and Protein levels.

9. What test do you do if the Dr. tells you to stop your TPN/PPN abruptly? Blood glucose test.

10. PEG FEEDING: elevate HOB at least 30 degrees/ upright position.

DOSAGE AND CALCULATION questions

THERAPEUTIC COMMUNICATION questions; NEVER ASK WHY QUESTIONS e.g “ why did you give

your child away” Instead encourage dialogue by saying “ Tell me more”

Techniques for therapeutic communication;

● Active listening; being attentive to what the patient is saying, verbally and non-verbally,

sit facing the client, open posture, lean toward the client, eye contact and relax

● Sharing empathy and the ability to accept and understand another person’s reality. E.g

say “ It must be very frustrating to know what you want and not able to do it”

● Sharing feelings; nurses helps clients express emotions by making observations,

acknowledging feelings, and encouraging communication, giving permission to express

“negative’’ feelings and modeling positive feelings

● Using touch; the most potent form of communication

● Silence;

● Clarifying; to check whether understanding is accurate, or better understand, the nurse

restates an unclear message to clarify the sender’s meaning. E.g “ I’m not sure I

understand what you mean”

● Focusing

More rules of Therapeutic communication NEVER;

● Ask ‘why’

● Offer your opinion

● Give false reassurance

● Ask closed ended questions

● Change the subjects

● Minimize the patient feelings

ASKING OPEN-ENDED QUESTIONS: “TELL ME MORE”

Phases of communication

Orientation phase;

❖ Building trust/rapport

❖ Interview

❖ Finding out what is wrong with the patient

❖ Explaining that you will be the nurse for the period

❖ In the Orientation phase, you tell them when the relationship will end- not in the

TERMINATION phase ( esp., Psych patients, because they get attached easily)

❖ Working phase;

❖ Doing interventions

❖ doing something for the patient

❖ Giving or providing treatment which was ordered by the doctor, giving medications

❖ Termination phase;

❖ End of care

❖ End of the working relationship

❖ Evaluation

Nursing Care Process (chapters 2, 3, 4, 5, 6, 7)( IT’s a 5 step problem solving approach for the

patient’s need).

 ADPIE- ASSESSMENT, DIAGNOSIS, PLANNING, IMPLEMENTATION, EVALUATION.

● Subjective and objective data

Subjective: (Symptom data) the patient tells you/ reports. E.g.” I am having a headache”.

Objective: (signs data) What you observe e.g. the patient is holding her head and crying.

● Types of assessment – (initial, focused, comprehensive, special needs assessment)

Initial Assessment: One time on initial patient contact.

Focused Assessment: You focus on the patient’s chief complaint e.g If patient’s BP is low the focus

would be Cardiac assessment.

Comprehensive Assessment: You assess patients from head to toe.

NOTE: Always do focused assessment before comprehensive assessment.

Special needs (based on facility protocol)

Functional Assessment: Assessing patient’s ability to do ADL’s

Form Assessment: Psychological assessment .e.g. Check suicidal risk.

● Types of Nursing Diagnosis

A. Actual: When you say actual, you already have the problem.

B. At risk: You only have the risk factor.

C. Possible: You have all the risk factors , but you still have to gather more information, you don't

have enough data. and patient tells you

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