Priority, Delegation, and Staff Management

Question 1

Priority questions will include what 4 characteristics?

Which 2 don’t matter?

Answer 1

1. Age
2. Gender
3. Diagnosis
4. Modifying Phrase - most important always pay more attention to the modifying phrase.

Age and Gender do not mater in priority questions.

Question 2

What are the 4 rules of priority?

Answer 2

1. Acute Beats Chronic
2. Fresh Post OP ( 12hrs) - Beats Medical / Other Surgical.
3. Unstable Beats Stable
4. Things that are ALWAYS unstable if expected.
   (hemorrhage, fever > 105, Hypoglycemia, pulselessness and breathlessness.)

Question 3

What are STABLE words to look for in a question?

Answer 3

1. Use of the word STABLE
2. Chronic illness
3. Post OP > 12 hrs
4. Local or Regional Anastasia
5. Lab Abnormalities of A or B
6. Phases “ ready for discharge”
7. Unchanged Assessment
8. Experiencing typical expected S/S of disease with which they were diagnosed.

Question 4

What are UNSTABLE words to look for in a question?

Answer 4

1. Use of the word UNSTABLE
2. Acute illness
3. Post OP < 12 hrs
4. General Anastasia ( 1st 12 hrs)
5. Lab abnormalities C or D
6. Phases “ not ready for discharge”, “ newly admitted” “newly diagnosed”, admitted < 24 hours ago
7. Changing Assessment
8. Unexpected S/S of disease, which they were diagnosed.

Question 5

Which PT. is the highest priority ?

1. 16 yr old with meningococcal meningitis, has had a temp of 103.8 since admission 3 days ago.
2. 67 yr old male with IBS spiked a temp of 103 this afternoon.

Answer 5

2. 67 yr old male with IBS spiked a temp of 103 this afternoon.

Acute
Assessment status changed- fever 103
Unexpected S/S of IBS
everything’s unstable

Question 6

List 4 things that are ALWAYS unstable if expected.

Answer 6

1. Hemorrhage - dont confuse with bleeding, with bleeding use rule expected of unexpected.
2. Fever > 105 even if expected = seizure
3. Hypoglycemia - even if at 8
4. Pulselessness and Breathlessness.

Question 7

What are the 3 things that result in a black tag unwitnessed accident.

Answer 7

1. Pulselessness
2. Breathlessness.
3. Fixed and dilated pupils -Even if they are still breathing you leave them alone - lowest priority.

Question 8

When you don’t know the answer use the breaker only guess. The more vital the organ the higher the priority
( the organ which is used the the modifying phrase). Place the order of priority for vital organs.

Answer 8

1. Brain
2. Lungs
3. Heart
4. Liver
5. Kidney
6. Pancreas

Question 9

Do not delegate the following to an LPN

Answer 9

1. Starting an I.V.
2. Hanging or mixing I.V. meds
3. Pushing I.V. Pushing Meds - they can maintain and doc.
4. No blood or central line flushing, dressing etc.
5. No care planning only implement.
6. Cannot perform or develop teaching - only reinforce
7. No unstable pts.
8. No firsts of anything - i.e. vitals after surgery
9. No assessments -Admission, discharge, transfer, or first assessment after there has been a change.

Question 10

Do not delegate the following to an UPA

Answer 10

1. Charting re: pt
2. No meds except topical over the counter barrier cream
3. No assessments, except for vitals and acu check
4. No TX. except enema
5. Safety responsibility to family- cannot delegate responsibility to a family member, but you can delegate to to a sitter, because they are taught and you document teaching them.

Question 11

What can you delegate to a UPA

Answer 11

1. ADL’s , but not the first

2. Can do more in long term care b/c pts are stable.

Question 12

How do you deal with inappropriate behavior of staff?

Answer 12

1. Tell supervisor
2. Confront and take over immediatly
3. Talk them later
4. Ignore it

Follow theses rules:
1. Is what they are doing illegal? If yes, pick #1 tell supervisor. If no, then ask…..

2. Is anyone is harms way? If yes, pick #2 confront and take over. If no, then ask….
3. Is this behavior not illegal, not harmful, but inappropiate pick #3.

Question 13

List the valves of the heart and where they are located?

Answer 13

Aortic - 2nd intercostal space RIGHT sternal border.
Pulmonic - 2nd intercostal space LEFT sternal border.
Erbs Pt. - 3rd intercostal space left lower sternal border.
Tricuspid - 4th intercostal LEFT sternal border
Mitral - 5th intercostal space in the mid clavicular line.

Question 14

Where do you locate the apical pulse?

Answer 14

5th mid clavicular line

Question 15

If you have to guess at a question what are the 3 steps you should follow?

Answer 15

1. Use your knowledge
2. Use your common sense
3. Guessing strategy

Question 16

What are some of the basic nutrition rules?

Answer 16

• Baked chicken
• Fish, but not shell fish.
• Never pic casserole for kids.
• Never mix medications in pt. food
• For toddlers pick finger foods.
• Preschoolers - leave them alone, they may only eat 1 meal a day, they eat the same thing every day and they eat when they are hungry.

Question 17

What are some Pharm. tips?

Answer 17

Know side effects

Do not memorize dosage, routes, frequency.

If you know what a drug does, but don’t know side effects pick a side effect in the same location where the drug is working. i.e. heart drug = tachycardia, intestine = diarrhea.

If you don’t know what the drug is and if its PO. Pick a G.I. intestine.

Never tell a child meds are candy

OB: pick fetal heart rate

MED/SURG- FIRST thing to ASSESS is LOC FIRST then ABCD

MED/SURG - FIRST thing you do? ESTABLISH AIRWAY!

Question 18

What are the 3 Rules Growth and Development.

Answer 18

Always give the child more to grow and develop.

1. When in doubt call it normal.
2. When in doubt pick the older age of the 2 it could be.
   (i. e walk 12-14 mths pick 14 give more time).
3. Pick easier task-give the child more time to do the easier task. i.e. rollover vs. sitting up - pick roll over b/c its easier.

” Normal, older easier”

• In GD answers will always be right

Question 19

What are some things to remember for General Guessing Questions?

Answer 19

1. Rule our absolutes if your guessing.
2. If 2 answers are the same i.e bowel sounds and borborygmi neither of them are right.
3. If 2 answers are opposite then one of them is right.
4. Umbrealla strategie - pick the answer that is more global look for the umbrella answer it covers all the other answers.
5. If the question gives you 4 right answers and asks you to prioritize needs of the patient. Play the worst consequences game. i.e Which of the following is the highest priority when caring for a suicidal patient?
6. Tranquillizer
7. Orient to unit
8. Put pt. on suicidal preacautions
9. Not introducing to staff
   Pick # 3 = DEATH!
10. When your stuck b/w 2 answers re: read question answer is likely in the question.
11. Sesame Street rule: Its the rule you use when nothing else works - the right answer tends to be the one that is different than the rest.
12. When you get a question and you don’t know what its talking about take that part out of the question and then answer with common sense.
13. Stick with your gut! unless you can prove another answer is superior.