This assignment asks you to make client care assignments for the shift and articulate the rationale as to why each client was assigned.
As the RN charge nurse, you are preparing to make assignments for the oncoming shift on the medical-surgical unit. There are a total of 10 adult clients. Besides yourself, there are the following staff:
Your unit has 12 beds. Currently, your census is 11, with one empty bed. Please include your assignments for the shift with your rationale for making those assignments. Include your personal role as the coordinator during this shift. You may wish to review course materials from Nursing 108 on delegation and supervision. Please adhere to the LPN practice in your state; for instance, in New York, LPN’s cannot do the initial assessment, but they can contribute and sign off on it. Please reference the National Guidelines for Nursing Delegation when completing this document.
The staff for the next shift includes:
Raul; an experienced RN.
Tara; an RN orientee assigned with Raul for the shift. It is her third day on the unit.
Monique; a supplemental RN. The last assignment in this unit was three weeks ago.
Dorothy; an experienced LPN.
Timmy; an experienced nursing assistant.
Val; unit secretary, split between your unit and the one next door as your secretary called in sick.
Please assign these patients to staff, being mindful of the scope of practice and ability levels of staff members. What nursing intervention is the top priority for each patient? Please indicate if the staff member is able to complete that priority independently, or if you (the charge nurse) need to assign it to another staff member.
Include information about how you will assign yourself and your support staff during the shift. Keep in mind that an empty bed will mean somebody will get admission during the shift.
Patients currently on unit:
#2201: PP, a 51-year-old female with T1DM (type one diabetes) who has ESKD (end-stage kidney disease). She was admitted for a revision of her A-V fistula. She has a temporary Hemodialysis catheter in place. She’s scheduled for hemodialysis this morning.
Assignment:
Rationale:
#2202: RP, a 72-year-old male patient with a CBI (continuous bladder irrigation) who is post-op from a TURP yesterday. He has had many clots passed through the CBI and has needed the catheter manually irrigated three times during the past shift.
Assignment:
Rationale:
#2203: empty bed.
Assignment:
Rationale:
#2204: MG, an 88-year-old female patient admitted two days ago with urosepsis. She’s currently getting IV antibiotics through a peripheral IV every eight hours. She has been incontinent of urine twice during the past shift. She is currently complaining about pain at the site of her IV.
Assignment:
Rationale:
#2205: MW, a 44-year-old female patient who had a cystoscopy yesterday for a biopsy of her bladder. Cancer is suspected. She is currently waiting for the provider to write her discharge orders so she can go home today.
Assignment:
Rationale:
#2206: JS, a 69-year-old male patient with uncontrolled hypertension and chronic kidney disease admitted last evening. He has a history of non-adherence to his medications at home and comes into the hospital every four to five months with chest pain, high BP readings, and weight gain. He’s been prescribed Lasix, Lisinopril, and metoprolol. His provider would like to send him home tomorrow. He has not been evaluated by the case-manager on your unit yet.
Assignment:
Rationale:
#2207: AM, a 21-year-old female patient with an acute kidney infection. She was admitted during the night. The patient currently has IV of NSS infusing at 100 ml/hr via peripheral IV and is complaining of 9 out of 10 back pain. Is febrile with a temp of 100.6 F
Assignment:
Rationale:
#2208: MS, a 60-year-old male patient with a renal calculi diagnosed by CT scan. Being medicated with IV Fentanyl every three hours for 10 out of 10 pain reported by the patient. Receiving IV fluids and needs assistance to the bathroom. Urine must be strained each time the patient voids.
Assignment:
Rationale:
#2209: SS a 72-year-old male admitted with hematuria. He is having diagnostic testing completed for renal carcinoma. The patient has a history of leukemia as a 40-year-old. This patient and his family are very upset by the diagnosis and the patient is intermittently tearful.
Assignment:
Rationale:
#2210: CT, a 55-year-old female admitted with community-acquired pneumonia. She is currently on 4 L NC and has a 02 saturation of 92% at rest. She is short of breath and has been ringing for the nurse frequently as she is frightened of dying when she gets SOB. She is receiving Levaquin IV every 24 hours for her pneumonia. This patient also has an ileal conduit with a drainage bag attached. She had her bladder removed ten years ago due to cancer.
Assignment:
Rationale:
#2211: RM, a 76-year-old male patient with cellulitis on his left shin. He’s on contact precautions for MRSA. He has been receiving continuous peritoneal dialysis at night, he’s assigned to your unit, as your staff has the training to use the PD equipment.
Assignment:
Rationale:
#2212: AF, a 40-year-old female patient with an intellectual disability from a group home setting. She was admitted with pyelonephritis during the night. She is scheduled for discharge today. She will need her IV discontinued and discharge instructions will need to be given to the patient and her caregiver.
Assignment:
Rationale:
Please also address the following questions in this document:
Who is the sickest patient? Please justify your response.
The LPN is sick and leaves; a float nurse comes onto the unit to pick up her assignment. Would you readjust the assignment at all? Please justify your response.
During your work this week, observe someone delegating. What went well and why? Please reference the National Guidelines for Nursing Delegation when addressing this question.
Evaluation
This assignment will be assessed using the Rubric. All assignments combined are worth 15% of your final grade; each assignment is worth 2.143%.
This activity is used to assess one or more general education career competencies (GECC). You will see additional rows in your rubric from your instructor along with assessments of Above/Meets/Does Not Meet Expectations for each competency. These rows do not factor into your grade.
This activity is used to formatively assess an end-of-program student learning outcome (EPSLO) for the associate degree in nursing. You will see additional row(s) at the bottom of your rubric from your instructor along with assessment levels of Proficient/Competent/Advanced Beginner/Novice for each EPSLO. These rows do not factor into your grade.
