MARK KLIMEK AUDIO - - Knowledge - Confidence - Exam Proficiency - Y...

MARK KLIMEK AUDIO

LECTURES

• It takes 3 things to pass this NCLEX exam
• Knowledge
• Confidence
• Exam Proficiency

• You can’t apply what you don't know, but you have to be able to apply what you do

know.

- Go with majority: if something is 75% fatal, consider it fatal.

• If you try to learn everything you will master nothing.

Lecture 12 Prioritization, Delegation, and Staff Management Prioritizing patients

- With these questions you are trying to identify either:

• The highest priority clients
• The lowest priority clients

• The answers to prioritization questions always have four parts
• An Age
• A Gender
• A Diagnosis
• A Modifying Phrase

- Example: A 10-year-old male with hypospadias vomiting bile-stained emesis.

• 10 year old
• Male
• Hypospadias
• Vomiting bile-stained emesis

• The age of this client and their gender are irrelevant information.

• The diagnosis and this modifying phrase is important information.
• The modifying phrase is more important than this diagnosis.

- Example:

• A client with angina pectoris
• A patient with a myocardial infarction (MI)
• With just this diagnosis this MI patient is a higher priority.
• A client with angina pectoris with unstable blood pressure

• A patient with a MI having stable vitals
• With this modifying phrase this angina patient is a higher priority
• 4 Rules for prioritizing patients

• Acute is a higher priority than a chronic

- COPD

• CHF
• Appendicitis (highest priority, acute)

• Fresh post-op (within first 12 hours) is a higher priority than medical or

other surgical.

- COPD

• CHF
• Appendicitis
• 2 hours post op colectomy (Highest priority, 2-hours post-op)
• 2-day post op coronary bypass patient

• Unstable patients are a higher priority than stable patients.
• Words in an answer that makes a patient unstable or stable

Stable Unstable

• Use of this word stable - Use of this word unstable
• Chronic illness - Acute illness
• Post-op grater than 12 hours - Post-op less than 12 hours
• Local or regional anesthesia
• Lab abnormalities of an A or B level

- The phrase: “ready for discharge” or

“admitted 24 hours ago”

• Unchanged Assessments
• Experiencing this typical, expected

signs and symptoms of their illness with which they were diagnosed

- Applying Rule 3:

Example 1.

• General anesthesia in this first

12 hours

• Lab abnormalities of a C or D level
• The phrase “not ready for

discharge” or “newly admitted (less than 24 hours ago)” or “newly diagnosed”

• Changed assessments
• Experiencing unexpected signs and

symptoms

• A 16-year-old female with meningococcal meningitis who has had a

temperature of 40 0c since admission three days ago.

• Diagnosis is more severe but increased temp is expected (and 3 days

is past 24 hour mark)

• A 67-year-old male with irritable bowel syndrome (IBS) that has a spiked

temperature of 39.6 0c this afternoon.

• Diagnosis is less severe but increased temp is unexpected (and this

afternoon) he is now this higher priority patient. He could have a ruptured bowl and is going septic.

- 4 criteria for being unstable even if expected:

• Hemorrhage (even if expected)
• Temperatures over 40.5

0c (high risk for seizures)

• Hypoglycemia (regardless of sugar reading)
• No pulse or not breathing

• This is a tiebreaker between patients that are all high priority.
• The more vital this organ (in this modifying phrase) this higher

this priority.

• Brain
• Lung
• Heart
• Liver
• Kidney
• Pancreases

- Example:

• You have a 23-year-old male CHF patient with a potassium level of 6.6 and

no EKG changes.

• CHF (Chronic – low priority)
• Potassium level of 6.6 (level D – high priority) (heart)
• Asymptomatic (Stable - low priority)
• Unstable patient

• A Chronic renal failure patient with a creatinine of 25.4 and pink frothy

sputum.

• Chronic renal failure (Chronic – low priority)
• Creatinine of 25.4 (Level A and expected – low priority)
• Pink frothy sputum (unexpected – high priority) (lung)
• Unstable patient

• A patient with acute hepatitis with jaundice and increased ammonia level

who you cannot arouse.

• Acute hepatitis (Acute – high priority)
• Jaundice and increased ammonia levels (expected – low priority)
• Cannot arouse (unexpected – high priority) (brain)
• Unstable patient

• The third patient is most unstable because his brain is being affected.

Delegation of staff

- Do not delegate this following responsibilities to an LPN:

• Starting an IV
• Hanging or mixing IV medications
• Pushing IV push medications

• Administer blood or anything with central lines
• Cannot plan care for a patient
• Perform or develop teaching
• Cannot take care of unstable patients
• Cannot do this first of anything (RN needs to assess first)
• The following assessments
• Admission
• Discharge
• Transfer
• Assessment after a change in patient condition

• Do not delegate this following responsibilities to an aid (RCW)
• Charting (can chart about what they did, just not about this patient)
• Give medications (except for over this counter barrier creams)
• No assessments (except for vitals and blood sugar tests)
• Treatments (except for enemas)
• Any evaluations

- Do not delegate that following to this family members:

• Safety responsibilities
• Restraints
• Side rails

Intervening Inappropriate Actions of Staff

- Always 4 answers:

• Tell supervisor
• Confront them and take over immediately
• Confront at a later time
• Ignore it (never this right answer)

- When to tell this supervisor about inappropriate actions:

• When they engage in illegal activities

- When to confront then and take over immediately:

• When this patient or staff member is in immediate physical or

psychological harm.

- When to confront at a later time:

• When no body is in harms way and not illegal but simply inappropriate.