Nursing Prioritization: Handling Patient Care and Multidisciplinary Team Management

MODULE ONE (500 WORDS):

1. MODULE ONE (500 WORDS):-

On returning from your tea break you are met by several staff members who relate the following information to you concerning your patients.

i. Mrs Chew’s intravenous (IV) infusion has tissued, her IV fluids are running behind and she has missed her 14.00 hrs IV antibiotic.

ii. Mr Smith’s visitor has fainted.
iii. One of the staff toilets has blocked and is overflowing and waste is pouring out rapidly.

iv. Mr Esposito is scheduled to leave the ward now for his cardiac catheterisation and he has still not received his preoperative medication.

v. One of the surgical consultants (VMO) is waiting to discuss a medication error that happened

vi. As you are taking this handover, an elderly female post-operative patient collapses to the floor and is unconscious. She has had facial surgery. The other RN is busy with NUM role. Staff currently available on the ward to assist you in addressing these issues include: the ward clerk, an Enrolled Nurse who is currently undertaking her IV cannulation certificate but is not yet competent, and an AIN.

Using the above scenario:

1: In order of priority, identify which tasks you yourself will undertake and which tasks you will delegate.

2: Document your rationales in detail.

2. MODULE 2 (500 WORDS):-

Grant Thompson was a fit 37 year old man, a father of two young children and married for 14 years to Georgina. Grant was a truck driver who was involved in an MVA 6 months ago and suffered extensive injuries to his leg and a mild head injury. His recovery has been slow and he relies heavily on the use of a wheelchair but can now walk for short distances with the aid of a walker. Georgina wants Grant to come home and rehabilitate there. She has made some modifications to their home, ramps put in, handrails in the bathroom and toilet. The health care team is meeting to discuss this option. The team consists of the treating doctor, physiotherapist, and occupational therapist, NUM of the rehabilitation unit, social worker and psychologist. There is disagreement among the team as to whether Grant would be better to stay in hospital a bit longer or go home. The physiotherapist and the occupational therapist both feel that Grant still requires intensive treatment which can only be provided as an inpatient. The psychologist and the social worker have noted that Grant’s separation from his family and home.

MODULE 2 (500 WORDS):

Reading:

The “MND Australia Fact Sheet on Multidisciplinary Teams” outlines professional groups who could make up a multidisciplinary health care team for a patient with motor neurone disease (MND).

Please read this fact sheet, answer the following questions, and upload your answers on your

e-Portfolio on LEO. This forms part of your assessment for this unit.

1. What factors determine the professional groups on a health care team?

2. Who should lead the health care team?

3. Who is the most important member of the health care team?

4 environment has been having a negative effect on Grant, Georgina and their children. The treating doctor feels that we could treat Grant as an outpatient but it would mean he has to attend regular physiotherapy and occupational therapy sessions. You are the team designated leader of the health care team.

Discuss the following questions

1. What are the key issues in this dilemma?

2. What outcomes would be best for Grant and his family?

3. How would you guide the group in achieving this best outcome?

You are a Registered Nurse on the afternoon shift on a short-stay (24 hours) surgical ward. One other RN, an EN and three AINs are also on duty. The NUM is off sick and the other RN is acting as NUM as well as taking a patient load. The ward is full: there are 22 patients, 10 of whom went to surgery in the morning, and 8 are going on your shift. Half of these a patients have intravenous access and antibiotics at some time during your shift.

Using your knowledge and experience of various patient allocation models (e.g. total patient care, team nursing and task allocation), outline how you would allocate the staff to the patients. Include in your discussion your rationale for the model of allocation chosen and the scope of practice of the various staff

3. MODULE 3 :- ACTIVITY 1

You are working on the morning shift on the ward, and receive a patient from ED. The ED nurse provides you with the following handover, using the ISOBAR format. Further information about the ISOBAR format can be found on page 7 of this module. Please click on the handover link in LEO within Module 3 section, titled: ‘Module 3 Activity 2 Verbal
Handover’. Listen to this recording, and then please answer the following:

1. What further questions will you need to ask the nurse?

2. List specifically what further assessments you would complete when the patient arrives onto the ward

MODULE ONE (500 WORDS):

1)  The tasks that I will undertake and which I will delegate, in the order of priority are listed below:

 I will immediately attend to the unconscious elderly female post- operative patient who has collapsed. I will then call the MET.

 I will get an AIN to attend Mr. Smith’s unconscious visitor. I will also ask the AIN to call a code blue.

 I will ask the EN to call the treating team in order to resite Mrs. Chew’s the IV cannula. Once the IV is resited, once I have attended the elderly post operative patient, I will help the EN in giving recommencing fluid and IVAB.

 I will ask the EN to attend Mr. Esposito and give him the required pre operative medicines. I will also ask the EN to complete the handover procedure.

I will instruct the ward clerk to immediately attend to the problem of the overflowing staff toilet. I will also ask him to get in touch with the required services and to quickly get the situation under control.

  Once I have attended the other pressing problems, I will speak to the surgical consultant (VMO) and address the complaints that he has.

2) The most pressing issue out of the six issues presented in the question is that of the unconscious post operative patient. The condition of this patient requires immediate action because the patient is quite old. The condition of the patient can further deteriorate if she is not treated immediately. The potential risks associated with her age, changes in the physiology of her disease and the various drug interactions, further complicate her case (Kraft et al, 2015). The change in the condition of the patient is a cause of concern. The current condition of the patient falls under the disabled category and thus, it is very important to call the MET immediately (Eastern Health, 2011).

According to the hospital policies, a MET can only be called for inpatients. A code blue is employed in situations dealing with the collapse of outpatients, visitors or the staff (Eastern Health, 2011). Therefore, in this particular situation it was important that code blue was called. The immediate assessment of the visitor’s condition was important for ascertaining the actual reasons that led to her collapse. I allocated the AIN for this task so that the RN and the EN are free to attend to the other pressing issues which are outside the expertise of the AIN.

I am aware that the EN has not received her IV cannulation certificate and therefore is not yet competent to maintain and give IV fluids (Queensland Nursing Council, 2008). Therefore, I will not allow her to resite the IV herself and instruct her to call the treating team instead. Since, this will not take much time and she will be free to attend Mr. Esposito.
The major responsibilities of the EN are making assessments about the health status of the patient and carrying out the required interventions (Queensland Nursing Council, 2008). Therefore, administering the oral pre- operative medications falls within the scope of the EN.

Addressing the issues of the surgical consultant (VMO) is very important but it is not a pressing issue. Thus, I will talk to the VMO after I have dealt with the emergency situations that call for my immediate action.