Mark Klimek Review Delegation

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Mark Klimek Review Delegation
Concepts of Medical Surgical Nursing (Galen College of Nursing)
StuDocu is not sponsored or endorsed by any college or university

Downloaded by Karima Jones (fatimajafar2003@hotmail.com)
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Mark Klimek Review: Prioritization and Delegations

and Staff Management
Prioritization
*Decide which patient is the sickest and the healthiest*
Age, Gender, Diagnosis, and modifying phrase “Most Important” (Age and
Gender are irrelevant) only pay attention to age in pediatrics!!
Rule 1:
Acute beats Chronic! Example: Appendicitis, COPD, CHF; the higher priority is the
appendicitis patient!
Rule 2:
Fresh post op “12 Hours and less” beats Medical or other surgical! Example: 2-hour
post choley will beat anything else; No matter what the procedure is if you aren’t
under 12 hours in you are not more important
Rule 3:
Unstable Beats Stable!
Things that make a patient Stable:

Ready for Discharge “To Be discharged” , Admitted longer than 24 hours ago,
Unchanged assessments, Experiencing the typical expected signs and symptoms of
the disease with which they were diagnosed, use of the word Stable, Chronic illness,
Post op greater than 12 hours, local or regional anesthesia, Lab abnormalities of an
A or B level
Things that make a patient Unstable:

Not ready for discharge, newly admitted, newly diagnosed, admitted less than 24
hours ago, changed assessments, experiencing unexpected signs and symptoms,
use of the word unstable, acute illness, post op less than 12 hours, general
anesthesia “Within the first 12 hours”, Lab abnormalities of a C or D level
4 things that make you unstable always are: Hemorrhage, High fevers over
105 (Can cause the patient to seize), Hypoglycemia (Low blood glucose),
pulseless or breathless (Only low priority at the scene of an unwitnessed
accident)

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3 things that are labeled a “black tag” in an unwitnessed accident:

Pulseless, Breathless, and fixed and dilated pupils
Rule 4:
Tie Breaker: The More vital the organ the higher priority!
Order of organs: Highest to Lowest Priority
Brain
Lung
Heart
Liver
Kidney
Pancreas
Delegation:
A RN cannot delegate a LPN to start a IV, Hang or mix IV meds, Pushing IV push
meds (Can: maintain and document the flow of a IV med), cannot administer blood
or mess with central lines “No flushing or changing the dressing”, cannot plan care
(Only RN can do a plan of care, The LPN can implement it), cannot perform or
develop teaching (Can reinforce teaching), cannot take care of unstable patients,
cannot do the first of anything (The RN do assessment and care plans first then the
LPN can), cannot do the assessments of admission, discharge, transfer, or the first
assessment after there has been a change (The RN does the assessment after a
change)
Do not delegate these to a UAP, Tech or Aide: Charting (can chart what they
did but nothing about the patient), cannot give meds; except for topical, OTC, and
barrier creams, cannot do assessments; except for vitals and accu-checks (Always
do your OWN VS AND ACCUCHECKS), cannot do treatments; except for enemas,
cannot catherize a patient, cannot do the first of anything
You can Delegate an Aide to: ADLs
Do not delegate safety to the families!!! The family can help with care once
they are taught and the doctor ok’s it, it must be documented!
Nurse Management:
When do you intervene when a staff member is being inappropriate?

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Always ask yourself:

Is what they are doing is illegal? Yes, Tell the supervisor,
Is anyone the patient or staff member in harms ways? Yes, Confront immediately
Is this behavior legal, not harmful but simply inappropriate? Yes, Approach them
later and counsel them
KNOW YOUR QUADRANTS WITH THE BODY SYSTEMS AND THE HEART
VALVES!!!
Aortic: 2nd intercostal space at the right sternal border
Pulmonic: 2nd intercostal space at the Left sternal border
Tricuspid: 4th Intercostal space at the left sternal borer
Mitral: 5th intercostal space in the mid clavicular line
Quadrants 4: know which organs are in what quadrant

Know where the pulses are located!!!
Guessing Strategies:
Knowledge
Common Sense
Guessing Strategies
Physch Questions:
The nurse will exam their own feelings about something…
Establish a trust relationship
Nutrition Questions:
Anytime pick chicken first (Nothing Fried)
Fish (Not Shellfish)
Never pick casserole for children
Never mix medication in a child’s food

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Always ask permission to mix meds and food

Toddler foods: Finger foods (Toddler can choke on hotdogs and popcorn)
Preschoolers: Leave them alone one meal a day is good (They aren’t growing how
they were before in a toddler stage)
Pharmacology Questions: (Amikacin: Treats infections; Antibiotic, IV piggy back)

Remember Side Effects
Do not remember dosage, frequency, and routes
If you know what a drug does, but do not know the side effects: Pick a side effect in
the same body system where the drug is working (Example: GI med- Diarrhea,
Cardiac- Tachycardia, CNS med- Drowsiness)
If you have no clue what the drug is… Look to see if its PO- Pick a GI side effect
Never tell a child that medicine is candy
OB/GYN:
Check fetal HR
Med Surge:
First thing to assess is the level of consciousness
First thing to do if you are guessing establish an airway
Pediatric:
Growth and Development
Always give the child more time to grow and develop
1. When in doubt; call it normal
2. When in doubt; pick the older age
3. When in doubt; pick the easier task
General:
Rule out Absolutes
If two answers say the same thing neither answer is right

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If two answers are opposite one of them is probably right

The umbrella strategy: an answer that covers all the others without saying it
If the question gives you 4 right answers, prioritize
When stuck between two answers, go back and reread the question
Sesame Street Rule: Only remaining option when nothing else works; wrong
answers share things in common, the right answer is unique
Do be tempted to answer a questions off your ignorance versus your knowledge
If something feels right, more than likely it is, Don’t change your answers if the
other answer is not superior!!!
3 Expectations you are not allowed to have (Negativity will make you fail)
1. Do not expect 75 or 85 questions, expect 265 questions (Set your brain up for
the entire exam)
2. Do not expect to know everything
3. Do not expect everything to go right

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lOMoARcPSD|8045324

Mark Klimek Review Delegation

Concepts of Medical Surgical Nursing (Galen College of Nursing)

StuDocu is not sponsored or endorsed by any college or university

Mark Klimek Review: Prioritization and Delegations

Things that make a patient Stable:

Things that make a patient Unstable:

Downloaded by Karima Jones (fatimajafar2003@hotmail.com)

3 things that are labeled a “black tag” in an unwitnessed accident:

Downloaded by Karima Jones (fatimajafar2003@hotmail.com)

Always ask yourself:

Quadrants 4: know which organs are in what quadrant

Downloaded by Karima Jones (fatimajafar2003@hotmail.com)

Always ask permission to mix meds and food

Pharmacology Questions: (Amikacin: Treats infections; Antibiotic, IV piggy back)

Downloaded by Karima Jones (fatimajafar2003@hotmail.com)

If two answers are opposite one of them is probably right

Downloaded by Karima Jones (fatimajafar2003@hotmail.com)

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