Mary has been an RN for 7 years and has worked in several different units throughout the hospital. John, RN
John has been a nurse for only one month. Sarah, LPN
Sarah has been an LPN for the past 3 years and has not done her IV certification course. Amy, CNA
Amy has been an assistant for the past 5 years.
Patient #1: A 47-year-old woman admitted from the recovery room at 2:15am after an emergency open cholecystectomy. Vital signs are stable; she is experiencing postoperative nausea and vomiting. She is receiving intravenous morphine on a PCA pump and antibiotics IV every 6 hours. She is also on a maintenance IV drip. The T-tube is draining a moderate amount.
i. Assign specific roles to members and ensure with each member the clarity of performance of roles assigned to them.
ii.Ensure prescribed antibiotics are given using the intravenous route at the correct time.
i.Chart the patients vital signs rationale is to help monitor the vital trends to ensure early identification of patients deteriorating needs. Roles include;
i. Reassure the patient on the side effects of anesthesia that may lead to feelings of nausea and vomiting post operatively.
ii.Monitor the I.V morphine infusion ensuring correct rate and dosage administration.
i.Recording the contents and amount present in the t tube drainage and emptying the T-tube drainage.
Patient #2: A 20-year-old woman admitted two days ago with abdominal pain, fever and nausea. She had a endoscopic cholecystectomy last night and is due for her first bandage change this afternoon. Role includes;
i.Explaining the procedure to the patient and obtaining consent for change of dressing.
i.Ensuring patient privacy during the procedure to enhance comfort and privacy. Role includes;
i.Ensuring the right equipment is present for change of dressing.
ii. Performing the change of dressing. Role includes;
i.Ensuring proper disposal of used equipment.
Patient #3: A 76-year-old man in respiratory isolation to rule out tuberculosis. Third morning sputum for AFB is needed. Vitals are stable; and he is independent of his iADLs but has some physical limitations that he is appreciative of help.
i.Delegate roles to John, Sarah and Amy on the procedure of sputum collection.
i.Collecting and labeling the specimen for analysis. Role includes;
i.Explain the procedure of sputum collection to the patient.
ii. Assist John in specimen collection and labelling. Role includes;
i.Ensuring the patient is in a properly aerated room.
ii.Ensure timely delivery of specimen to the laboratory
Patient #4: An 60-year-old man with congestive heart failure (CHF). This patient is a DNR. Family is present with the client. Respirations are shallow; blood pressure is beginning to decline at the end of the last shift.
i.Ensuring all team members understand the do not resuscitate protocols (Said A, 2016).
i.Accurately document patient vitals and provide adequate interventions to ensure provision of nursing care even at the time of death. Role includes;
i.Provide counselling to the family on death and dying to provide understanding of loss of life. Role includes;
i.Ensure patient comfort at the time of declining health status to ensure proper provision of care.
Patient #5: A 60-year-old woman admitted 3 days ago with left lower lobe pneumonia. She is receiving intravenous antibiotics, oxygen at 3 Liters N/C. She spiked a fever to 39.5 C. overnight; acetaminophen was administered. She receives piggyback antibiotic every 6 hours.
i.Administartion of intravenous medications at the correct times and dosages.
i.Ensure proper documentation of patients vitals to ensure monitoring. Role includes;
i.Ensuring John accurately documents vital signs and mentors him regarding deviations from the normal findings. Role includes;
i.Ensuring patient comfort and aiding in performance of activities of daily life to enhance patients independence.
Patient #6: An 82-year-old man admitted 10 days ago with a urinary tract infection. The infection resolved. He is now waiting for long-term care placement. He requires assistance with ADLs and ambulates with assistance also.
i.Delegate the specific roles to the team and ensure all team members are at per with their tasks.
i.Ensure proper hygiene for the patient and adequate nutrition for the patient. Role includes;
i.Providing counselling on coping with changes in life capabilities. Role includes;
i.Assisting the patient in performing activities of daily life and maintaining hygiene.
Patient #7: A 36-year-old woman scheduled for a bowel resection at 10:00am She is NPO and has an intravenous maintenance infusion running. Bowel preparation is complete and preoperative teaching is done. The consent needs to be signed and the operating room checklist must be completed. Her pre-medications must also be administered when called by the OR. Roles include;
i.Explaning to the patient the type of procedure to be performed, the expected outcomes and informing the operating doctor of the patients eligibility to sign the consent form.
i.Signing of the operating room checklist.
ii.Wheeling and handing over the patient to the theatre nurse. Role includes;
i.Ensure pre-operative medications are collected and ready for administration. Role includes;
i.Labelling the patients valuables and ensuring safety of patients valuables.
Patient #8: A 55-year-old man in the cardiac interventional lab having an angiography done. He will be prescribed bed rest on return and will have a sandbag on his groin to prevent bleeding while his heparin level is monitored during the day. His vital signs and groin site will be checked frequently when he returns. Roles include;
i.Explaining to the patient the need for total bed rest and reduced activity. Role include;
i.Hourly monitoring of the groin and vitals for the first 8 hours then four hourly monitoring. Role includes;
i.Blood withdrawal for heparin level checks. Role includes;
i.Assisting the patient with activities of daily life.
Ferguson L., Cioffi J. (2018). Team Nursing. Experiences of Nurse Managers in Acute Care Settings. Australian Journal of Advanced Nursing. (28). 4.
Said A N., Mriayyan M. (2019). Do Not Resuscitate: An Argumentative Essay. Journal of Palliative Care Medicine. (254) 2165-7386.