Evolve Case Study Management of Surgical Unit

The charge nurse for the previous night shift is giving verbal report to Ms. Hatch and the oncoming staff nurses. During the report, one of the UAPs interrupts to state that a client is vomiting. How should Ms. Hatch respond?
Request that a night shift nurse staff RN go to the room to evaluate the situation
After the UAP leaves the area, the night charge nurse states, ¨that UAP is incompetent. She can’t figure out anything on her own.¨ As the day shift charge nurse, how should Ms. Hatch respond?
Your concern needs to be addressed with the unit manager.
After receiving report, Ms. Hatch makes client care assignments for the nursing staff. Which client can be assigned to a PN rather than an RN?
A 2 day postop client with an abdominal incision and JP drain
Which additional client should be assigned to the same PN?
Experiencing hypoactive bowel sounds 2 days post op after colon resection (expected finding)
Ms. Hatch learns that one of the day shift nurses will be 30 minutes late. How should the care assignments be managed until the nurse arrives?
Assign an additional client to each of the day shift staff nurses

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When making initial rounds, the charge nurse should see which case first?
A postop client with a trach who has signs of a tracheoesophageal fistula
Before starting rounds, Ms. Hatch learns from the PN that the client with a history of syncope is threatening to get out of bed alone and go to the restroom. At the same time, the client with the possible fistula has an oxygen level of 80%. Besides the charge nurse and PN, a UAP is available. How should the charge nurse respond this information?
Assess the client with the possible fistula while the PN assists the other client to the restroom
Once the immediate priorities are managed, Ms. Hatch assesses the client with continuous bladder irrigation and notes that the drainage bag is full, but there is no urine in the return tubing. The client’s bladder is distended and reports having serve bladder pain. How should Ms. Hatch delegate tasks to respond to this situation?
While the RN irrigates the tubing, the UAP can empty the urine drainage bag
Continuing to make rounds, Ms. Hatch observes that the pre-op client with prolonged PTT is lethargic with pale, diaphoretic skin. BP is 70/40. When assisting the nurse to care for this client, the UAP can be assigned which task?
Position the client as directed
The HCP prescribes immediate transfusion of 2 units of PRBC. Which task can be delegated to the UAP?
Obtain vital signs and report to nurse before transfusion
A female client is schedule for surgery in 4 hours. The breakfast trays arrive on the unit with a tray for the pre-op patient. The primary nurse notes that there is no prescription regarding NPO status. Which action should the nurse implement?
Hold the tray and contact the surgeon for clarification
After the meal situation is resolved, the client reports to the primary nurse that she feels uneasy about the procedure. What is the best initial response by the nurse?
Tell me what is making you feel uneasy.
Which finding in a pre-op client warrants an immediate change in care assignments so that an RN assumes care rather than a PN?
Dyspnea and a cough that produces frothy, white sputum
Since the RN will assume care of this additional patient, Ms. Hatch selects another client for the PN. Which client?
Needing an indwelling catheter inserted after surgery
The PN is reassigned to care for the pre-op client and obtains the supplies necessary for a catheter. The PN tells Ms. Hatch that she has inserted catheters into females, but not males. What actions should the charge nurse implement?
Go with the PN to supervise the procedure
Which task may be delegated to the UAP?
Apply TED stockings
The primary nurse enters the client’s room and observes that his TED stockings are down below his knees. The UAP states, ¨I know I applied them correctly, he must have pulled them down while I was getting him a clean gown.¨ How should the nurse respond?
¨Let’s work together to reapply the stockings while I talk to the client about the purpose of TEDs¨
Ms. Hatch overhears the primary nurse assign the UAP to take the vital signs of the preop client and report back any problems. How should Ms. Hatch respond?
Advise the nurse of the responsibility to review all vital signs
What approach should Ms. Hatch use when introducing a new change?
Explain the need to implement this change in policy
After introducing a new change, one nurse expresses concern. How should Ms. Hatch respond?
I will bring your concern to the attention of the wound care team
Ms. Hatch observes a post-op client with a cold pack. The skin under the pack is pale and the client reports the cold pack has been in place for over 4 hours. After removing the pack, what action should Ms. Hatch take next?
Consult with the nurse
How should Ms. Hatch respond to the nurse who blames the problem on the UAP?
You are responsible for monitoring tasks delegated to the UAP
Both sides are angry. What action should Ms. Hatch implement to ad in the resolution of the conflict between them?
Encourage both to practice effective communication with on another
The post-op client with which condition is most safe to transfer to the skilled care unit?
Knee surgery requiring continuous use of passive ROM therapy
How should the charge nurse best utilize available staff during the process of transferring one client to the skilled care unit while admitting another client awaiting emergency surgery?
The UAP can assist the PN in transferring the client to the skilled care unit while the RN admits the client awaiting surgery
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