Chapter 1
Leadership Case Study Answers
1. What type of staffing model is being used in this scenario?
There is no acuity score noted, so it is ratio-based. It is also considered “team” nursing given that there is also a CNA and an LPN/LVN on the team with the RN.
2. Which tasks can be delegated to the LPN/VN?
Room 102–insulin and IV fluids; Room 107–oxygenation management and IV antibiotics; Room 103–IV antibiotics, coughing and deep breathing, and oxygenation management; Room 108–IV fluids, NG irrigation, oxygenation, and oximetry; Room 105–preop IV antibiotics and IM medication; Room 110–oxygenation, IV antibiotics, and transferring them up to the chair for 20 minutes
3. Which tasks cannot be delegated to the LPN/VN?
Room 102–postop assessment and peripheral vascular assessment; Room 107–IV change and ABGs and respiratory assessment; Room 103–GI assessment; Room 108–IV push pepcid and PCA morphine and assessment of surgical site and dressing; Room 105–surgical consent; Room 110–respiratory assessment
4. Which tasks can be safely delegated to the CNA?
Collection of vital signs, I and O for Rooms 102 and 107, turn every two hours for Room 102, and reminder to do IS every hour for Room 108
5. Identify the highest priority client to see first. What are your top three priority tasks? Provide your rationale.
Room 103 is the priority client. The nurse should first assess the client’s current vital signs, as his blood pressure has been low, and his heart rate is high. The nurse should then evaluate the NG drainage as sanguinous is concerning because there is a risk that the client is bleeding internally. The nurse should also contact the provider to consider increasing IV fluids to support blood pressures and evaluate the concern for bleeding.
6. Plan your shift: Prioritize the remaining five clients in the order you will see first and your top three priority tasks for each.
| Clients in the prioritized order you will see them and the rationale for doing so | Top 3 priority tasks for each client |
|---|---|
| Room 102–First day postop with a nonpalpable pulse on the operative limb | Peripheral vascular assessment and pulse check with a Doppler
Assess for swelling, tenderness, and changes in skin color to check for deep vein thrombosis Complete a pain assessment in operative leg |
| Room 107–ABGs ordered and respiratory rate 24 with pulse ox 95% | Complete a respiratory assessment, including vital signs
Obtain ABGs Encourage client to be up to chair |
| Room 110–Client is dyspneic with exertion | Complete respiratory assessment
Assess dyspnea and oxygenation status and ensure oxygen level is appropriate to client IV antibiotics as ordered |
| Room 105–Surgery today and stay on time | Review preop checklist and ensure consent is ready
Assess client’s anxiety regarding procedure and educate client as needed Ensure preop antibiotic and IM meds are completed |
| Room 108–Stable postop | GI assessment and check surgical dressing
Assess placement and irrigate NG Administer IV pepcid and encourage IS use |
All of the answers to the interactive element are found within the element.