NSG 280 Unit 3 Prioritization Project. Latest 2020/21

NSG 280 Unit 3 Prioritization Project. Latest 2020/21 Unit 3 Prioritization Project Step 1: You are the nurse manager on a new unit that will open today. This unit has 18 rooms, 10 are private rooms and 8 are double rooms. Two of the single rooms have negative pressure (601 & 602). The list below tells you what patients are being transferred to your unit. You need to assign patients to their new rooms. In your assigned work group, complete the room assignments for these patients noting rationale for why you assign each patient to a specific room. Submit to your faculty by due date. Diagnosis Additional Considerations SEX AGE Mr. L Right lobectomy – yesterday Has 2 chest tubes with minimal bubbling in the water seal bottle. Orders to ambulate to door and back again today. IV LR at 125ml/hour 126/86 P 84 R 16 T 99.2 M 49 Ms. D Post-operative dehiscence Wound infection for MRSA. Wet to dry dressing twice daily. Self-care with assistance 130/72 P 88 R 20 T 99.9 F 55 Mr. LD Legionnaire’s Disease Reports productive cough, shortness of breath. chest pain, nausea & vomiting IV of D5W @125 ml/hour B/P 128/84, T 101.4, P 100, R 24. Zithromax 500 mg as a single dose on Day 1, followed by 250 mg once daily on Days 2 through 5 M 23 Ms. S CHF Shingles – left sided abdominal rash with open lesions. Reports pain at rash site B/P 131/94, T 99.4, P 118, R 32 Pulse oximetry 86% Crackles in both bases of lung, SOB F 73 Ms. PT Cirrhosis Pulmonary tuberculosis 138/88 P 92 R 22 T 100.7 F 54 Ms. H DM UTI CHF Being admitted. BS 640mg/dl IV Normal Saline 0.9% @100ml/hr Change to D5W when glucose level is down to 250-300 mg/dl. Blood sugar every 2 hours 102/72 P108 R 24 T 98.9 F 72 Ms. T Thyroidectomy this am To come to floor from PACU 96/72 P 76 R 18 T 97.8 F 24 Mr. A Acute renal failure continuous cycler-assisted peritoneal dialysis (CCPD) started yesterday flank pain, N&V 112/80 P88 R 20 T 98.4 M 69 Ms. M Left Mastectomy Hemovac in place to be discharge in the am F 55 122/78 P 92 r 16 t 97.8 Ms. NM Neisseria meningitis IV cipro 400 mg I.V. q 12 h B/P 118/94, T 101.4, P 118, R 32 O2 via nasal cannula @ 2L/m F 22 Seizure precautions Mr. D Dehydration stool positive for Clostridium difficile IV LR 125 ml/hour 92/64 P 116 R 28 T 100.1 M 79 Mr. H Hepatitis A Incontinent of stool & urine Nausea & vomiting & fatigue B/P 128/94, T 99.4, P 118, R 32 M 89 Ms. G Guillain-Barre’ B/P 122/68, T 99.6, P 92, R 18 Bilateral leg weakness. No respiratory compromised at this time F 22 Ms. MI MI Coming from CCU Experiencing intermittent PVC 108/72 P 76 irreg R 16 T 98 F 61 Mr. B Laminectomy L3 & L4 One day post-op. Orders to ambulate today 134/88 P 92 R 20 T 100 M 52 Mr. C Colectomy with a colostomy One day post-op. NG tube 128/72 P98 R 20 T 97.9 axillary M 45 Ms. C Cervical cancer Radium implant. Foley catheter 114/72 P 76 R 18 T 98.8 F 55 Ms. Fx Fractured left femur External fixator applied two days ago Fat emboli. Oxygen via Venturi mask 132/92 P100 R 20 T 99.0 F 39 Mr. T TURP One day post-op Continual Bladder irrigation OOB today. IV to be d/c 128/88 P 92 R 16 T 99 M 71 Ms. R Rheumatoid Arthritis Noted to be in severe pain with the joints of both hands swollen, reddened and stiff. Unable to use upper extremities for self-help activities. 130/90 P 82 R 24 T 98.9 F 37 Mr. I I & D of infected left arm Has a history of drug use 3 years ago is still smoking. Is very demanding about his care; up and about on the unit. Watches the clock to see that his medications and every shift dressing changes are on time. 150/98 P 76 R 18 P 97 M 32 Mr. V Venous Stasis Ulcers Has venous stasis ulcers of lower right and left extremities, skin around the ulcers is thickened, brown without redness. Noted no palpable pedal pulses, 4+ pitting edema. Complains of severe pain. 142/90 P96 R 18 T 99.4 M 81 Ms. F Fever of Unknown Origin Just admitted from the Emergency Room. Lives locally but has been travelling with a church group for the past ten days. B/P 161/94, T 103.4, P 118, R 32. Complains of extreme fatigue. Blood, urine & sputum cultures have to be obtained F 19 ASSIGNING PATIENT ROOMS Room Patient Rationale for Assignment 601 Negative Pressure Ms. PT Patient has pulmonary tuberculosis and requires airborne precautions. 602 Negative Pressure Ms. F Fever of unknown origin after traveling; private room to provide safety to others until diagnoses. 603 Mr. LD Legionnaire’s Disease fall risk due to weakness. 604 Mr. H Patient having incontinence, nausea, and vomiting. Hepatitis A is spread fecal-oral and requires contact precautions. 605 Ms. NM Patient requires droplet precautions. 606 Ms. C Patient has radium implant, placed in private room to reduce risk of radiation exposure to visitors & other patients. 607 Mr. D C-Diff requiring contact precautions. 608 Ms. S Open shingles requiring airborne precautions. 609 Ms. D MRSA contact precautions 610 Mr. B 1-day post-op, low grade fever ordered to ambulate today. 611A Ms. T S/P Thyroidectomy within 24 hours 611B Ms. R Stable condition currently, needs assistance with ADL’s 612A Ms. G Stable condition but Guillain-Barre which makes her a fall risk. 612B Ms. MI Requires ongoing nursing assessment and telemetry monitoring. 613A Mr. L Due to empty beds on unit placed in room by self to allow room for medical equipment. 613B Ms. H Requires ongoing nursing assessment and telemetry monitoring. 614A Ms. M Stable currently, awaiting d/c in morning. 614 B Mr. T Stable post-op with a low-grade temp. 615A Mr. C 1-day post-op, stable patient. 615B Mr. V No Pedal Pulse, Extreme Pain. 616A 616B Mr. A Stable patient that can accept roommate if another admission arises, placed in room by self for dialysis equipment. 617A 617B Mr. FX Needs telemetry and pulse-ox monitoring, stable at present time. 618A Mr. I Due to being up and about on unit and demanding behavior patient placed in private room *(to)**** disturbing other patients. 618B Step 2: Your staff consists of the following. Which staff members are you going to assign as a team? Which patients are you going to assign to which team member? 1. RN for two years, on telemetry unit. 2. RN for 5 years, on a medical surgical unit. 3. RN, new grad, on a medical surgical unit. 4. LPN for 10 years, on a medical surgical unit. 5. LPN for 1 year, in nursing home. 6. 1 CNA with 5 years of experience. 7. 1 CNA with 2 years of experience. Team 1: RN (2yrs), LPN(1yr), CNA (10yrs) Team 2: RN(5yrs), CNA(5yrs) Team 3: RN (new grad), LPN (10yrs) Provide rationales for your decisions about patient assignment to staff members. 1. RN for two years, on a telemetry unit 2. RN for 5 years, on a medical surgical unit 3. RN, new grad, on a medical surgical unit 4. LPN for 10 years, on a medical surgical unit 5. LPN for 1 year, in nursing home 6. 1 CNA with 5 years of experience 7. 1 CNA with 2 years of experience RN for two years *Ms. MI- Cardiac Experience *Mr. LD- Cardiac Experience *Ms. NM- V/S unstable at present time *Mr. L- Med-surg experience *Ms. S- CHF (possible fluid shift) needing telemetry. RN for 5 years *Mr. A- Started CCPD therapy yesterday and experiencing complications, more suitable for this RN. *Ms. F- unstable V/S and requires experienced RN. *Ms. Fx- cardiac experience, has potential for decline. ((*Ms. C- Provides new grad with experience with radium implant)))**** *Ms. Pt- stable patient, given to RN new grad *Ms. M- provides new grad experience with teaching. *Mr. B- provides new grad with med-surg experience. *Mr. C- Provides new grad experience with NG tube, colostomy and med-surg experience. *Ms. H- patient has potential for decline and requires RN for experienced assessment and monitoring. this RN to alleviate workload of other RN LPN for 10 years *Ms. T- Med-surg experience *Mr. V- Med-surg experience *Ms. G- stable patient, only needs assistance with ADL’s but has potential to decline due to disease process. *Mr. T- requires CBI monitoring s/p TURP. *Mr. D- stable at this time requiring rehydration therapy. LPN for 1 year • Mr. I- requires scheduled medications and wound care • Mr. H- stable patient at present time, risk for dehydration • Ms. R- needs assistance with ADL’s. • Ms. D- LPN has med-surg experience and can provide wound care CNA for 5 years 1CNA -5-year experience (?) CNA for 2 years 1CNA -2-year experience (?) RN for two years • Mr. LD- chest pain & SOA • Ms. NM- increased temp, b/p, pulse, respirations • Ms. MI- intermitted PVC’s which can lead to dysrhythmia • ***Low grade temp*** • Mr. L- most stable of patients at this time • Ms. S- decreased O2 RN for 5 years • Ms. F- unstable V/S requiring immediate assess. • Mr. A- flank pain, N&V, after starting CCPD • Ms. Fx- Fat emboli with O2 per venti-mask • Ms. Pt- ****** • Ms. C- radium implant and foley catheter monitoring. RN new grad • Mr. B- increased temp. • Mr. C- has NG tube to monitor. • Ms. M- stable patient with plans of discharge. • Ms. H- unstable glucose, and increased respirations. LPN for 10 years • Mr. V- no palpable pedal pulses, requires further assessment. • Ms. T- post-op assessment • Ms. G- stable at present time • Mr. T- requires monitoring of CBI and foley catheter. • Mr. D- potential for hypovolemic shock LPN for 1 year • Mr. H- unstable v/s, due to patients age patient at risk for dehydration and other complications • Mr. I- requires pain medications and wound care • Ms. R- severe pain • Ms. D- requires wound care CNA for 5 years CNA for 2 years