Scenario: The Registered Nurse arrives to begin the shift on a busy medical-surg

Question

Scenario: The Registered Nurse arrives to begin the shift on a busy medical-surgical floor and discovers the other RN scheduled to work has called in sick. The patient census is 30. Two unlicensed assistive personnel (UAP) have been assigned to the unit. The RN is responsible for administering all patients’ medications during the shift. One of the patients who is very ill requires the use of transmission-based precautions for chicken pox.

The RN approaches the room to administer the medication, notes the sign about the type of transmission-based precaution for this patient and thinks “I don’t need to use the precautions”. The RN enters the patient’s room and hangs the intravenous medication. Upon leaving the RN thinks “See I was only in there less than 5 minutes and no harm done. The greater good is I can get the other medications out to patients that need them now.”

Consider the chain of infection as you prepare a response to this situation.

What are the implications of the RN’s decision about the application of transmission based precautions?

Are there any reasons that support the RN’s action?

Think about risk vs. benefit when formulating your response to the discussion board.

Using the principles of management and delegation, how might the RN have:

Approached the supervisor?

Assigned the staff?

Ensured safe patient outcomes?

Using nursing judgment develop a 3 part nursing diagnosis statement for the patient on isolation which includes one NANDA-I diagnosis, an etiology and the defining characteristics (nursing diagnosis + related to + as evidenced by).

One (1) assessment to validate the nursing diagnosis.

One (1) outcome statement (realistic, measureable and contains a time frame).

Explanation / Answer

The implications of the RN's decision are grave as small pox is an airborne disease. This disease is caused by variola virus that can remain suspended in the air for a long time. Thus, there is a high probability that the nurse may contract this disease and become a carrier of the infectious agent.

This disease is vaccine preventable. Thus, the only condition where the RN could be confident that she might not need the precaution was that she had been vaccinated againt the infectious agent.

Under such circumstances the RN must use her critical thinking, judgement and wisdom while following the five rights of delegation to be sure that the assignment she is undertaking is:

1.The right task

2. Under the right circumstances

3. To the right person

4. With the right directions and communications

5. Under the right supervison and evaluation.

The RN must have approached the supervisor beacuse according to the nursing practices it is the RNs duty to be answerable for personal actions if any. The RN must have undertaken organizational responsibilities and assigned suffucient staff with an appropriate staff mix who have the potential to control any kind of emergency situation.

The RN should have wore a mask or respirator to prevent herself from airborne infectious agents.

Nursing diagnosis statement:

1) Impaired skin integrity

2) Risk for infection due to damage to the skin

3) Lack of information about the steps that should be taken for effective recovery

"A malaria biologist"

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