00:00
Hi, I'm Professor Lawes,
and in this one,
we're gonna go over the
Next-Gen Case Study format.
00:06
Now, I'm really excited
to do this with you.
00:09
It is not nearly as bad as you're
probably thinking it's going to be.
00:13
So, let's get started.
00:17
Now, we always started
presentations with a beautiful picture.
00:20
These won't be on the NCLEX.
00:22
What I want you to do though,
is to get in the
habit of picturing
and imagining what's
going on with your patient.
00:29
Picture the setting, picture the people,
picture the patient,
build all these
things in your mind.
00:36
It's not just a silly exercise,
it will really help
you focus your brain
and not make what we
call those silly mistakes.
00:44
So let's get started.
00:46
The nurse is assigned
to provide care for a client
with the team support of
a licensed practical nurse
and an unlicensed
assistant personnel.
00:56
Hey, wait a minute.
00:58
This is spelling out
a whole lot of people.
01:02
They're being very specific
here that you're the RN,
you have an LPN and a UAP.
01:10
This tells me you're
likely going to have
some delegation questions
somewhere in this case study.
01:15
So you'll probably have
some physical questions
about their health
and their vital signs.
01:20
But you're also going to have
some questions about delegation.
01:23
Now, in my experience of
teaching nursing schools,
I have noticed that this is a
challenge for nursing students,
it's often not covered in detail
very much in your courses.
01:35
So we want to give
you some pointers here
before we even get
into the case study.
01:40
Whenever you see the
titles listed in a question,
you always want to ask yourself,
"Who am I in the question?"
And on the NCLEX exam,
you will be the RN.
01:51
Who are the other people?
Well, here we've got an LPN and a UAP.
01:57
The next question,
do I delegate or supervise them?
And if you're the RN,
the answer is yes.
02:04
Okay, so when I see these titles,
I ask, "Who am I?"
The answer is the RN.
02:10
Who else is in the question?
LPN and UAP.
02:13
Do I delegate and
supervise them?
The answer is yes.
02:18
Now you're thinking,
"Come on Prof Lawes,
of course, we do the LPN.
02:21
No, other delegation questions,
we'll list options like nurse
manager or your peer.
02:28
On the NCLEX exam,
I do not delegate and supervise my peer.
02:32
If there's a problem with my peer,
then I go to my supervisor,
and my supervisor
will talk to the peer.
02:39
And this one,
we're dealing with people
and team members that
the RN directly supervises.
02:46
But when you see
those other questions,
and they have people you don't
directly delegate or supervise,
it will change the
answer to the question.
02:53
Okay, so you got it.
02:55
In this one, we've got an LPN,
which some of you may know as an LVN,
a licensed vocational nurse,
and a UAP which in your
hospital setting might be a tech
or an aide or a CNA
any of those titles.
03:08
But in NCLEX language,
you'll likely see LPN, LVN, and UAP.
03:14
Now,
let's get started into this question.
03:16
Remember,
use your mind to picture
what's going on and
the setting that we're in.
03:23
So first of all,
in a case study,
you're going to see on your screen,
the nurses notes.
03:28
Now,
this is something that you see,
throughout these NGN type
questions or these case study questions,
you also see them
on the bowtie.
03:37
So let's take a look
at what we have.
03:39
This is the place
I want you to stop.
03:43
And take a deep breath because the
worst thing you could do for yourself
is to panic because you're in
one of those case study questions.
03:51
So let's take a look
at what we have.
03:53
I've got an older adult,
and they present with drowsiness, dry skin,
dry mucous membranes, blurred
vision and confusion on the situation.
04:04
Okay, anytime we're
going through that,
that's a lot of
assessment information.
04:08
So you want to go back up and say,
"Is it normal or abnormal?"
So anytime a patient
communicate something to you
either with their words or with the
symptoms that they're showing you
that's really important
to focus your brain on.
04:22
So we know they're older, okay.
04:25
They have drowsiness.
04:27
Well, nothing in this
question up to this point
has told us why they
should be drowsy.
04:32
It's not like they're
waking up from anesthesia.
04:34
That would be like making
a whole story that isn't there.
04:36
So we're going to assume
anything aside from awake,
alert and oriented
is not normal.
04:43
So drowsy, that's not normal.
04:46
Dry skin?
Well, that seems kind of
odd that we would
notice it that's not
really normal either.
04:51
Dry mucous membranes?
That's not normal,
blurred vision, not normal,
and confusion,
again, not normal.
05:02
Now, here's a key note
about older clients.
05:04
On the NCLEX exam,
just because you have an older client,
doesn't mean it's okay
for them to be confused.
05:11
I teach students that
with any elderly person,
don't just assume
that they're confused,
ask why they're confused.
05:19
Look at all the information
in the data and see if
there's something that's
causing that confusion,
just don't take
it at face value.
05:26
So, we've established,
we have an older client,
and they've got some
abnormal assessment.
05:31
Now let's look at their history.
05:33
Okay, they have coronary
artery disease,
diabetes type 2,
hypercholesterolemia which means
they've got high
cholesterol in their blood,
hyper cholesterol and emia,
high cholesterol in the blood,
and hypertension,
elevated blood pressure.
05:52
Okay, so when I first
looked at these nurses notes,
I took a deep
breath until myself,
"Of course, you can do this
just slow down and be thorough."
I know that the abnormal
assessments in the beginning portion.
06:04
And next, I know their history.
06:06
So now let's start to put
all of these things together
and see what it's
going to ask us.
06:13
First up new information,
we're gonna take vital signs.
06:16
So you look at the vital
signs that we have there.
06:19
And you ask yourself
three questions.
06:21
Is it high, low or normal?
Okay, heart rate, 100 beats/min.
06:28
Okay, that's still technically
within the normal, right?
60-100 is still within normal.
06:36
But that's a little high,
most people don't run 100 beats.
06:39
So I'm going to
keep my eye on that.
06:41
Blood pressure,
whoa, yes, that's high.
06:45
Even though the patient
may be living with that,
this is really too high,
we'll get that diastolic 102.
06:53
That's when that
heart gets reperfused.
06:55
So 102 is not acceptable,
we're going to want to
do something about that.
06:59
And we'll consider
that as we go forward.
07:02
168 is also too high.
07:05
Remember, this patient on
top of everything else is diabetic.
07:09
And we want them
to have an even lower
blood pressure than
what we used to say,
we used to say 140 but now we're
cranking it down
to like 130 or lower.
07:18
So this is way too high.
07:20
Respiratory rate 20,
that's normal.
07:23
Temperature? That's normal.
07:26
So I have a heart
rate that's a little high,
a blood pressure
that is too high,
respirations,
they're a little fast,
but I'm not so worried about it.
07:34
And temperature is normal.
07:36
Okay,
that's what we're looking at,
is there any connection
to those vital signs
and what we know
about this patient already?
So you want to
think those through,
think if you have
any connections.
07:48
Now let's keep moving
on through this study.
07:52
All right, what you see on
the screen is very similar
to what you'll see when
you're taking the NCLEX.
07:57
We've already talked
about the question,
we've looked at
the nurses notes.
08:01
But I want you to
stop for just a minute
and kind of look
at the format here.
08:05
So when you're taking a test,
this might seem
intimidating to you
because it's got tabs.
08:10
Don't worry about it.
08:11
It's just the same strategies
that we have walked through.
08:15
So you see,
the first tab is nurses notes.
08:18
And behind that
tab are vital signs.
08:21
Now as you and I are
walking through this case study,
we're going to blow that up
so it's easier for you to see.
08:26
But I want you to be very
comfortable that this is the format
that you'll see the question on when
you're actually taking the NCLEX.
08:33
You've got the information on the left,
black bar through the middle,
and you'll have questions
that pop up on the other side.
08:40
Okays? So don't let
this intimidate you.
08:43
It's just a different way
to present questions
that you're used to answering.
08:47
It's just the format that
looks a little different.
08:50
So when you click on the tab,
you see we have nurses notes,
but if you click
on the second tab,
you'll see that we
have the vital signs.
08:57
All right. So clicking
back and forth,
you can click as many
times as you want.
09:03
You can go back and forth
as often as you need to,
but don't hyper focus on this.
09:08
Just do your best to be
thorough as you work through it
like we did when we
walk through these
and keep moving
through the case study.
09:17
Now you see on
the right hand side,
you've got some
directions and that's what
it'll look like when
you're taking the NCLEX.
09:23
So take a look at
those directions.
09:25
It is telling you to
click to highlight below
the findings that are
concerning to the nurse.
09:31
Okay, here's why this
matters to you.
09:34
The first time I tried all these questions,
I was really nervous.
09:37
Do you know what I
was worried about?
What if I miss one tiny word?
What if I don't check
something that they
wanted me to check and
I do check something...
09:45
You don't need any of that stress.
09:47
How the test is set
up is there's only
certain terms that
can be highlighted.
09:53
So don't let that
stress you out.
09:55
You'll see that they're
here in the same question.
09:57
Now where does all
this wording come from?
That's the nurses notes.
10:02
We saw those on
that previous tab.
10:05
So you don't need
to read it again
because you're very
familiar with what this is.
10:10
But when you're thinking
through the question,
go through it word by word.
10:14
Now remember,
we noted that drowsiness,
dry skin, dry mucous membranes.
10:19
Those are all abnormal,
blurred vision is abnormal.
10:22
That's why you spent that
much time kind of walking through
those nursing notes the
first time you looked at them.
10:28
So let's see what we should
highlight and what we don't need to.
10:32
So the first one is
drowsiness, dry skin,
dry mucous membranes,
they've kind of got those all together.
10:41
Now, first of all,
I know that's abnormal assessment.
10:44
Should that be concerning
to me, though?
Well, based on the patient's
history of diabetes,
that's why I'm concerned.
10:52
So the drowsiness could
be a sign of high blood sugar.
10:56
The dry skin and dry mucous
membranes could also be a sign
of the dehydration that can come
along with a high blood sugar.
11:04
When your blood sugar is high,
then you end up urinating a lot.
11:09
And you end up dehydrated,
dry skin, dry mucous membranes
is an indication of dehydration which
is not a good sign for a diabetic client,
because it might be because
of their high blood sugar.
11:22
Now, other things can
cause it but you can see
all these clues are kind of
pointing to one perspective.
11:29
Blurred vision,
also associated with high blood sugar.
11:34
Now, lastly, we've got confusion
on the situation on this line.
11:38
Okay, so we know that
we've already checked
drowsiness, dry skin,
dry mucous membranes,
blurred vision, those are all things
that we say yes to highlighting.
11:50
Now, confusion on the situation.
11:53
That's also a sign
of a high blood sugar
and confusion here is
telling us this is a change.
11:59
So we would highlight that.
12:01
Now we've got some others
history of coronary artery disease,
and hyper cholesterol.
12:08
Now, I know they've got
these plays together.
12:10
But we're thinking about
these types of questions like,
what's impacting the
situation right now?
Does coronary artery
disease play a role?
Sure. But I'm not
really going to resolve
that or fix that here
in this situation.
12:22
High cholesterol?
Well, that's not great.
12:25
But that's more of
a long term problem.
12:28
So we're left with
diabetes and hypertension.
12:31
Should those be concerning?
Yes, we're going to highlight
those because diabetes
is likely what's giving
us all this confusion
and blurred vision,
we walk through that.
12:41
So we know they're going
to need probably some
better or more effective
blood glucose monitoring,
and hypertension,
we already established
that blood pressure is too high.
12:52
So pause for a minute,
take a look at the screen,
see the terms that we
highlighted and see if you
can explain to yourself
why we highlighted those.
13:02
After that, look at the ones
we chose not to highlight
and see if you can explain
why we didn't highlight those.
13:12
Okay, you did a great job.
13:15
You've made it through the
first part of the case study.
13:19
You feel better?
Now but that is
all the way done.
13:23
Well, let's go back to what
it looks like on your screen.
13:27
So you see that
we're on the left side,
we have the stem
of the question.
13:30
We have the nurses
notes under one tab,
the vital signs on the other.
13:34
Now we've got the next
question in the case study format.
13:37
It says the client is at risk for
experiencing what condition.
13:41
Now we have 1, 2,
3, 4, 5 options there.
13:47
This one is you're really
going to select all that apply.
13:51
So you can't just look
for the right answer
and then go on to the next one.
13:54
So we're gonna
work through these.
13:56
There's a lot of
H's there which has
absolutely nothing to
do with the question.
14:01
Alright,
so that's not a strategy for NCLEX.
14:03
It's just something my squirrel
brain notice as we're looking at these.
14:07
So the first one, hypoglycemia.
14:10
Do I think this patient is
experiencing hypoglycemia?
Well, if you have low blood sugar,
what do I know the symptoms are?
Fast heart rate, I know they're
gonna be shaky and irritable
and no, those don't really
sound like this patient
so I am not going to
check hypoglycemia.
14:30
Hyperglycemia, well,
that means high blood sugar.
14:34
Well, I've already established
they're drowsy, right?
They're dehydrated.
14:39
They're confused.
14:40
Yeah. The sound
more like hyperglycemia?
I'm going to check
hyperglycemia.
14:46
Heat exhaustion.
14:49
Where did that come from?
That stuff's gonna happen
to the NCLEX all the time.
14:54
Heat exhaustion, you would have
to have a really high temperature.
14:58
Look at the temperature,
you see there,
it's within normal limits.
15:02
So, yes, they would probably be
dehydrated with heat exhaustion
or they would be dehydrated
or heat exhaustion,
but their temperature
would have to be a lot higher.
15:10
So I am not going to
select heat exhaustion.
15:14
So, so far of the first three,
I have selected hyperglycemia.
15:18
Does that still make sense?
Yes, it does.
15:21
Now, diabetic ketoacidosis that's DKA.
15:27
Now that predominantly
happens with type 1 diabetics.
15:31
In this client,
are they type 1 or type 2?
Right, they're type 2.
15:38
See what if you couldn't
remember which one they were,
all you'd have to do is
click on that tab that says
nurses notes and you can
bring that right back up again.
15:46
Okay, so we've got DKA.
15:48
Nope,
this patient is a type 2 diabetic
and not likely to be
diabetic ketoacidosis.
15:56
Now, the last one,
see it right there?
Hyperglycaemic hyperosmolar
syndrome, HHS.
16:04
Does that happen
with type 2 diabetes?
Yes. I mean,
it takes a while to develop over time,
it happens,
you have a really high blood sugar,
all those symptoms,
your body's going to dump all fluids
trying to figure out what is
going on trying to maintain
homeostasis because of
that super high blood sugar.
16:25
So yes, that is a possibility.
16:28
Now what I want
you to do is to go back
and to look at the ones
that we have checked. Right?
Which one are the ones
that we have checked
and said, "Yes,
I'm going to highlight these."
We checked
hyperglycemia and HHS?
Does that make sense
with what we know to be true
about this patient's
symptoms and their history?
It does.
16:52
We gave sound
rationale for why it was not
hyperglycemia,
heat exhaustion, or DKA.
16:58
So then you say I feel
comfortable with this.
17:01
I worked through this
in a systematic manner.
17:03
I'm going to keep moving on.
17:07
All right, now let's take a look at
the third part of this case study.
17:12
See on the left hand side of your screen,
you have those tabs,
you have the black
bar down the middle.
17:17
And on the right side,
you've got the third
type of question in
the same case study.
17:22
Now you'll see that we've got
some notes on the left hand side,
it says, "A serum blood
glucose is pending."
So we don't know
what it is right now.
17:32
But it's asking you there
the nurse will delegate
to the LPN the task
of and then you've got
that box with a drop down arrow.
17:40
Well,
below that you've also got the nurse
will delegate the
task of to the UAP.
17:46
So what we're gonna do
in this question is figure out
what's most appropriate to
delegate to an LPN and to a UAP?
Who am I in the question?
I'm the RN.
17:55
Now I want to show you what it
looks like when you're taking the test.
17:58
I just want to show you visually
what it will look like on the screen.
18:01
When you click that drop down arrow,
you see that?
You've got three options.
18:06
Let's do it again on
the second question,
just so you have a feel
for what it'll look like.
18:11
All right,
now let's break down the question.
18:12
We're going to blow
everything up bigger.
18:15
So you and I can work through
it and talk through it together.
18:17
But I want you to keep in mind,
this is the format that you'll see
on the NCLEX exam when
you're taking the actual test.
18:24
So we know that a serum
blood glucose is pending.
18:28
Now let's do,
first we've got the nurse
will delegate to
the LPN the task of.
18:34
Okay, so what are our options?
We can first option is
reinforcing the diabetic diet,
we can do reporting the
blood glucose over 300
to the nurse and entering
the admission data.
18:51
Okay. So I know who I'm
delegating to is the LPN.
18:56
So I'm looking for something
that's most appropriate for the LPN.
19:00
Now, we've got reinforcing the
diabetic diet, could they do that?
Oh yeah,
there's a key word they're reinforcing.
19:09
Now, initial assessment is
an RN only scope of practice.
19:13
Teaching is an RN
only scope of practice.
19:17
But reinforcing what
the RN has taught is fine.
19:21
So reinforcing the diabetic,
the LPN can do that.
19:24
So that's a likely a
probable answer for us.
19:27
But let's look at the other ones,
just in case, right.
19:30
You always want to do that.
19:32
Even if you think the first answer
that has got to be the right answer,
make yourself do the work
to eliminate the other answers
to be extra cautious in
selecting the right answer.
19:43
So second option
for the LPN reporting
a blood glucose
over 300 to the nurse.
19:51
Okay, could an LPN do that?
Well, it seems like they could,
but you would want to
report all the blood glucose
readings to the RN,
not just those over 300.
20:04
If you're waiting to report a
blood glucose until it's over 300,
we're really getting into
some problem territory.
20:10
So I like number one better.
20:12
And sometimes,
that's all you can do.
20:15
You can take a look
at the answer and see,
"Oh, I'm not essentially
clear on that."
But number 1 seems like a
much more straightforward task
that on the NCLEX exam
would be appropriate for an LPN.
20:27
So because the first
option is more appropriate
than number 2,
I'm going to rule out number 2.
20:33
Now the last one entering
the admission data.
20:38
Okay, now,
that's not appropriate for the LPN.
20:40
The nurse, the RN will enter
the initial admission data.
20:44
So when I look at
these three options,
the most appropriate one,
the most clear,
standardized task of
these three would be
reinforcing the diabetic diet.
20:56
That's what I would
check for the first one.
20:58
So in the drop down arrow,
that's the one I would select.
21:01
Now move on to the
second part of the question,
the nurse will delegate
the task of blank to the UAP.
21:08
Okay,
so that's like a CNA or a tech.
21:10
This isn't we've got what should
the nurse delegate to them?
Well, the LPN has a larger scope
of practice than the UAP does.
21:19
Let's take a look at
what our options are.
21:22
Okay,
assessing urine color during I & O.
21:25
Well,
the your UAP can they can report any
unusual colors like and
we would want them to.
21:31
If they're looking
at the patients here,
and they notice, like,
"That's not normal."
You would definitely want
them to tell the LPN and the RN,
but the actual
assessment of the color
would have to be done by an RN,
that's within their
scope of practice.
21:47
So here's a clue on the NCLEX.
21:49
A UAP, or an LPN can
recognize normal and abnormal,
anything beyond that, if it's abnormal,
they need to report it to the RN,
and the RN has to come
in and do an assessment.
22:01
So when you see the word
assess with an LPN or a UAP,
make sure you're very
careful with that is that
is typically part of the
are in scope of practice.
22:11
So we're back to you.
22:12
What about this?
Would this work for UAP?
Recording the vital signs.
22:17
Oh yeah, that's fine.
22:19
A UAP can obtain the
vital signs and record them,
here's when they can't.
22:24
If it's a new admit,
they cannot do that,
because that's part of
an initial assessment.
22:29
And coming into your unit,
as an brand new patient,
you've never met them before,
that's an admit.
22:35
But so your patient goes for an exam,
like they go for a heart cath,
and they come back, or they go
for a CAT scan, and they go back.
22:42
In NCLEX world,
the RN needs to go into the room,
assess the patient and
taking initial vital signs
upon the patient's return
to the unit is only for an RN.
22:52
I wonder your NCLEX exam
because I think we all know,
in real practice UAPs
do this all the time,
however, we're talking about
how to you pass the NCLEX?
And that's what we're
focused on today.
23:04
So could they record
the vital signs as UAP?
Yep, sure could.
23:09
Let's not forget
option number 3,
though,
monitoring the IV fluids.
23:15
Now, that's kind of odd, right?
Because UAPs can't start IVs.
23:20
They can't hang IVs,
they can't adjust the rate of IVs.
23:23
So this would have to less
likely be monitored by an RN.
23:28
Now, in some states,
an LPN might be able to do that,
but always err on the
side of extra safety.
23:35
So between assessing
the urine color during I & O,
recording vital signs and
monitoring the IV fluids,
which one do you think is
the most straightforward option
within the safe scope
of practice of a UAP?
You got it.
23:51
It's recording the vital signs.
23:54
So take a look at the screen.
23:55
You see there,
we finished those answers.
23:57
The nurse will
delegate to the LPN
the task of reinforcing
the diabetic diet.
24:03
The nurse will
delegate the task of
recording the vital
signs to the UAP.
24:07
Does that make sense?
Sure, it does.
24:11
And that's it.
24:12
We're done with the third
part of these questions.
24:15
Now, let's move on to the fourth
kind of section of this case study.
24:19
You've got physicians orders.
24:21
So it says,
start normal saline fluid at 200 miL/hour.
24:25
Start insulin analogue
regular at 0.1 U/kg/h.
24:30
And titrate down
using the titration scale.
24:33
And that would be
something that would be typical
in the hospital where
you're practicing.
24:37
Monitor urine output.
24:39
And perform urine dipsticks
and blood glucose testing.
24:43
Okay,
so your dipstick is when you take a stick
and legitimately dip
it in a patient's urine.
24:49
They'll kind of tell
you what's going on.
24:51
And then blood glucose testing.
24:54
In this case,
would be a finger stick blood sugar.
24:56
That's what we're
looking at there.
24:58
Okay, so you got it.
24:59
You're in dipstick,
fingerstick blood sugar,
that's what we have
moving forward.
25:03
Now, what you have on
your screen is exactly what
it will look like when you're
taking the NCLEX exam.
25:10
This is starting to be familiar,
isn't it?
On the left side,
you see information
about the patient,
a bar separating it.
25:17
On the right side,
you got the question
that we're going to answer.
25:21
So looking at the left side,
these are the things you and I
have already walked through,
look through the
right side and you see
which question we're
going to address.
25:31
Now, let me read that for you.
25:33
For each anticipated task,
which tasks can the RN
consider to be
delegated to the LPN
by indicating whether the
statement exemplifies a task
within the LPN scope of
practice or is not within the LPN?
You know, I'm telling you,
when I'm stressed,
and when I'm taking a test,
I'm always stressed.
25:52
And I see all those words,
I take a nap
in between there,
it's too much.
25:57
So I know reading it
once is not enough for me.
26:00
And it's really not
enough for most people.
26:03
So I want to go back
and translate this
NCLEX ease language
that nobody speaks like.
26:08
So for each anticipated task,
okay, for each task on here,
which tasks can the RN consider
to be delegated to the LPN?
So I can see we've
got a list of tasks here,
I need to see which one
can be delegated to the LPN
by indicating whether
statement exemplifies a task
within the LPN
scope of practice,
or is not within the
LPN scope of practice.
26:32
Ah, that makes sense.
26:34
So on the left,
we've got these tasks, right?
And then we've got the column next to it,
and a third column.
26:39
The second and third column
is where I'm going to click
a checkbox to indicate whether
it is within their scope of practice
or not within their
scope of practice.
26:49
So who am I?
The RN.
26:52
Who am I talking
about delegating to?
The LPN.
26:55
So I'm looking for
things that are within
their scope,
or not within their scope.
26:59
Okay, so first one, place a hat in
the bathroom for urine collection.
27:04
I know it sounds kind of funny
if you're not a nursing student,
but you guys know,
we're not taking a
ball cap and hanging
it up in the bathroom.
27:11
What that is,
is that plastic receptacle
that you put in the
toilet so that the urine
will drop into that
and we can measure it.
27:19
Can the LPN place a hat in
the bathroom for urine collection?
Absolutely.
27:24
This is something that will assist
the RN and it's not an assessment.
27:27
They're just literally putting the plastic
hat in the bathroom for urine collection.
27:31
This is within the
scope of an LPN.
27:34
And that's the box
you would check.
27:38
All right,
first one out of the way,
you understand how
this is going to work.
27:41
Let's go on with the second one.
27:43
Ask the UAP to
perform the urine dipstick
and finger stick blood sugar.
27:48
Is that within LPN
scope of practice?
Can the LPN ask
the UAP to do those?
Well,
is that in the UAP scope of practice?
Yeah, they can do a
fingerstick blood sugar,
and they can do
a urine dipstick.
28:01
At the hospital, they've been
trained on that it's standardized.
28:04
Can the LPN delegate to the UAP?
They sure can.
28:09
So this would be within the
LPN scope of practice, okay?
And the UAP will let the
LPN know what the results are.
28:16
And the LPN will
discuss with the RN.
28:18
I know it seems like a lot of
people talking to everybody,
but in NCLEX world,
that's how it works.
28:24
Now the next one,
assess the urine color and consistency.
28:30
There's the a word assess
the urine color and consistency.
28:35
Is that part of the
LPN scope of practice?
In NCLEX world,
this is only for the RN,
because of the
assessment that's necessary.
28:45
So on this one, you would check,
not within the scope of the LPN.
28:50
Measure the urine output.
28:53
Is this within the LPN
scope of practice?
Yeah, they can do that.
28:57
This item, this will help the RN
and it's not an assessment task.
29:01
So I would check
LPN scope of practice.
29:04
Now, I know what
you're thinking like,
"My goodness, Prof Lawes,
this is going to take us forever."
The first time you do it, it will.
29:13
But you see all I'm
forcing myself to focus
my brain every time
being intentional.
29:18
That's how you don't
make silly mistakes.
29:21
You know, the information,
I just want to make
sure you take credit for it.
29:25
And a stressed brain
doesn't think as clearly,
so you want to
make sure you take
the extra safety
measures to do that.
29:32
So let's finish this out.
29:34
Start normal saline fluid at 200 mL/h.
29:38
Is that within the LPN
scope of practice?
We'll start normal saline fluid - that's an IV - at
200 mL/hour. iIs that in NCLEX world,
within the LPN
scope of practice?
No, this should be done by the
RN because it's involving an IV.
29:57
Document the insulin start time
and the client
response to the insulin.
30:02
Okay,
is that within the LPN scope of practice?
Well,
let's go back and determine why or why not
documenting insulin start
time and the client response.
30:14
Hey, insulin is a really
high risk medication.
30:18
This is something that kid,
if not handled correctly,
can cause severe damage to the
client from a super low blood sugar.
30:26
In fact, that's our biggest risk
with insulin is hypoglycemia.
30:31
So this type of assessment is way
outside of an LPN scope of practice.
30:37
On the NCLEX exam,
remember, I told you,
I know that if you're
a practicing LPN,
you may have already done this.
30:44
But in NCLEX world,
you have to think about
their rules,
not your real life practice.
30:50
Last one, ask a UAP to obtain a
blood glucose and current weight.
30:57
Okay, so ask the UAP to obtain a
blood glucose and current weight.
31:02
Is that within the LPN scope of
practice to delegate to a UAP?
Yep, can they get a blood glucose?
Yep, it'll have to be a
fingerstick blood sugar.
31:11
And can they get
the current weight?
Yes, that's totally within
the practice of an LPN.
31:18
And again, that information we
pass back to the LPN and to the RN.
31:23
Alright, so step back,
look at your answers.
31:26
You only had one of two answers.
31:28
It is within the LPN
scope of practice,
or it's not unhealthy
and scope of practice,
read back through
them one more time,
and see if it makes
sense to you.
31:44
Okay, stop.
31:45
Before you think about
changing an answer,
really caution yourself.
31:49
If we went through it
thoroughly the first time,
you better have a really strong
rationale to change your answer.
31:55
Why am I telling you this?
Because I am a
chronic answer changer.
31:59
Back when we took paper exams,
I would erase
my scantron so many times,
by the time I handed it in,
you could see through it,
it was so thin.
32:07
So answer changing can
really be a dangerous thing.
32:10
Don't check an
answer till you're sure.
32:13
And you can give rationale
on why you're checking it,
then when you go back,
it's just to make sure one last check.
32:19
But you should
rarely have to go back
and change multiple
answers. Okay?
Now we're at the fifth type
of question in this case study.
32:27
So when you hear people
talk about these questions,
hey,
there are six questions and everyone.
32:31
See, it's not quite as scary
as they've tried to make it out.
32:35
We've gone through
these questions one by one,
you've already done four types,
or four steps in this
six step case study.
32:42
So here we are
back again at what
the screen is going
to look like for you.
32:46
On the left hand side,
you've got the tab,
the physician orders.
32:49
On the right hand side,
you've got the stem of the question
and look, this time,
you have three column choices.
32:56
So one column is a task,
and then you have three options.
33:01
Is it an LPN, a UAP, or neither?
Okay, so let's blow
this up a little bit.
33:07
But remember, this is what it'll
look like for you on the screen.
33:10
I see, not nearly as
scary as everyone
has tried to make it out to be.
33:15
So we're gonna blow this up big.
33:17
Let me read the
question for you.
33:19
The nurse has several tasks
that are needed for this client.
33:23
For each task below,
click to specify
which task is
delegated to the LPN,
the UAP or neither more than
one choice can be
selected per task.
33:34
Okay, cool.
33:35
This tells us a
ton of information.
33:37
So I'm the RN,
I've got a whole checklist
of things that need to be done.
33:42
I either need to
identify one or two,
or three,
but it can't be all three.
33:50
Okay, that sounds way more
confusing than even when we started.
33:53
So let me clarify for you.
33:56
It says click to
specify which task
is delegated to the LPN,
the UAP, or neither.
34:04
So when you look at the task,
it could be LPN and UAP.
34:09
It could be just the
LPN or it could be
not an appropriate
task for either.
34:16
Now the only way it wouldn't
be an appropriate task
for either would be if
only the are in can do it.
34:22
Okay,
so let's work through these.
34:24
I promise it'll start to
click and make more sense
as you have the opportunity
to work through this.
34:29
Okay,
discuss ways to decrease blood glucose.
34:34
Now,
is that appropriate for the LPN?
Well, if I'm going to discuss
ways to decrease blood glucose
that's going to be
kind of talking about
the treatment and
evaluating that.
34:45
No, that is not within a scope of
practice of an LPN that is only an RN.
34:50
So not the LPN scope,
not the UAP,
so I'm going to check
the box neither or neither,
however you would
prefer to say it.
34:59
So discussing ways to
decrease the blood glucose
would be more of an
RN scope of practice.
35:05
Okay, now we just get
to work through the rest
of the task list to answer
this part of the question.
35:11
Notify the health care provider,
the HCP of the
blood glucose result.
35:17
Is that within the scope of practice
for the LPN when we have an RN?
No, that would be something
the RN would do.
35:26
So if it's above the scope
of an LPN in NCLEX world,
then it's definitely not
appropriate for UAP.
35:34
So I'm going to check
neither or neither.
35:37
Again, however you
prefer to say it.
35:40
So, so far,
we've got neither, neither,
or neither,
neither or neither, neither.
35:44
Whatever you got my point,
you know, what we're doing.
35:47
Third one, obtain vital signs
during intravenous infusion.
35:53
Okay, is that within the
scope of practice for an LPN
to get vital signs during
intravenous infusion?
Yeah, that'd be fine.
36:01
An LPN couldn't get the vital
signs if it was an initial assessment,
but nothing in here tells
me it's initial assessment.
36:08
So don't make things up.
36:09
Just know that, yes, that would
be within an LPN scope of practice.
36:14
Now,
let's take the second column,
would this be within the
scope of practice of a UAP?
Again, yeah, it would.
36:23
So for this one,
I'm going to check
both the LPN box
and the UAP box.
36:28
Okay,
now just starting to make more sense,
kind of getting the hang
of it feeling good, excellent.
36:34
The next choice is assist
the client with diet choices.
36:38
Okay,
so is it within the scope of practice
to help the patient
with diet choices?
Yeah, it is.
36:47
So you're not ordering the diet.
36:50
The RN doesn't order the diet,
the healthcare provider
orders what diet the
patient should be on.
36:55
So you would just be
helping the patient as an LPN,
pick the choices that they
want for their meals that day.
37:01
And LPN, that's completely
within their scope of practice.
37:05
So I would check that box.
37:07
What about UAP?
Is this something that's
within their scope of practice
to assist the client
with diet choices?
Exactly, as long as they're
following the diet choices
that are within the
ordered diet by the HCP,
this is both of them.
37:24
So I would check LPN and UAP.
37:28
Measuring I & O,
is this within LPN scope of practice?
But you're probably saying,
"I've never seen an
LPN measure the I & O,
that's always the UAP
on the unit where I work."
It doesn't matter.
37:41
Is it within the scope
of practice of an LPN?
Is it safe for them to do that?
Absolutely. So we're
going to check the LPN box.
37:49
UAP, can they measure I & O?
They sure can.
37:52
And they would
report that to the RN.
37:54
So again,
we'll check both LPN and UAP.
37:59
Next, educate the client.
38:02
Okay, before I even go further,
that word right there,
educate the client on
the condition that
indicates a strong teaching.
38:12
So can an LPN teach a client?
No, they cannot,
they can only reinforce
the teaching that the
RN has already done.
38:21
So you'll see that language
and the NCLEX exam,
reinforce the teaching,
those type of words will be used
or another word that
means to reinforce.
38:29
But it will clearly
indicate to you that
the teaching has
already been done.
38:33
The LPN or even the UAP are just
reinforcing what the nurse has taught.
38:38
So educate the client
on the condition is outside
of the focus for an LPN
outside of the focus for a UAP.
38:46
So it is the neither,
neither answer.
38:49
It's not appropriate for them,
because only the RN can do that.
38:53
Now, we're at the last one.
38:55
Obtain the next fingerstick,
blood sugar or glucose.
39:00
So is that within
the scope of practice
for an LPN to do a
fingerstick blood sugar?
Sure, is, they can do that.
39:07
So I would check the LPN box.
39:10
What about a UAP?
Can they do a
fingerstick blood glucose?
Sure, it can.
39:15
That's something that trained
and checked often in the hospital.
39:18
So you would check
both LPN and UAP.
39:21
Okay, now step back,
and enjoy your work.
39:25
Now,
I want you to go back and say,
"Why did I check
neither on the first one?"
Why did I check neither
on the second one?
Work through each
one of these tasks,
just so you feel certain
about your choices?
Everything look good?
Well, we did this one together,
and don't you wish we
could do the NCLEX together.
39:49
But they're not really
intergroup projects.
39:51
So here you go.
39:53
This is what you would do
when you're all by yourself,
standing strong,
taking your NCLEX exam.
39:58
Once you feel confident that,
"Yep, that represents
my answers and I
have explanations why."
You get to go on to the
last part of the case study.
40:07
This is awesome.
40:08
Okay,
by now you know the format.
40:11
On the left hand side,
you've got the information.
40:13
On the right hand side,
you've got the part
that we're going to
interact with or the question.
40:18
And on this one,
we've got the three columns.
40:21
The left side is kind of
the task at first column,
then you have effective delegation
and ineffective delegation.
40:28
Okay, so this kind of gives me a
clue on what we're going to look at.
40:32
I'm going to blow
this up bigger for you.
40:34
So this is what it will look like
when you're taking the NCLEX.
40:38
Let's kind of focus in
on those key points.
40:41
Here's the question,
which items indicate
the LPN and UAP
successfully completed
the assigned task?
For each needed task,
click to specify if the task assigned
by the RN was correctly
delegated by the LPN or the UAP.
41:00
Wow, okay,
that's a lot of stuff.
41:03
So I would have to stop
back up and think through this.
41:05
So I'm looking for
the items that say,
successfully completed the assigned
tasks for each of the needed tests.
41:14
Click to specify if the
task assigned by the RN
was correctly delegated
by the LPN or UAP.
41:22
Okay, so we've got effective
delegation or ineffective delegation.
41:26
Okay, what we're looking for is,
they're going to say
in the left hand column,
what the RN delegated.
41:32
And you're going to
check if that's appropriate
for the RN to delegate that,
that would be effective delegation,
or if it's inappropriate
for the RN to delegate it,
that would be
ineffective delegation.
41:44
Let's work through them.
41:45
So look how many we have,
1, 2, 3, 4, 5 of these.
41:50
Obviously, we're going to
start with the first one at the top.
41:53
The LPN recorded vital
signs during the IV infusion.
41:58
Is this effective delegation
or ineffective delegation?
Can the LPN record vital
signs during IV infusion?
They can.
42:08
So we're going to check
the effective delegation box
that's within their
scope of practice.
42:15
Now, what about this at
the RN delegated that
the UAP assisted client
to make menu choices?
Well, these are sounding familiar,
aren't they?
Right, we've just got this
thing here to get you
used to the types of
questions that you'll have.
42:28
So is that effective delegation
for the UAP to do that?
You got it.
42:33
The UAP can
assist the client with
making their food
choices on the menu.
42:38
So this is an example of effective
delegation or correct delegation.
42:44
The LPN provides diabetic
education on the condition.
42:48
Is this effective
delegation for the LPN
to provide diabetic education?
You know the answer, no,
the LPN cannot do the initial teaching.
42:58
Nothing on here indicates the
LPN is reinforcing the teaching.
43:01
So this is ineffective
delegation.
43:06
UAP measured the fluid
intake and urine output.
43:09
Is that effective delegation by the
RN for the UAP to measure that?
Yes, it's effective delegation.
43:17
The UAP can measure the
intake and output of a client.
43:22
Discharged teaching
provided by the LPN.
43:25
Is that effective
delegation by the RN?
Okay. Do you see what we're
doing every time you think like,
"Why do you keep repeating
what the question is?"
Because what I've seen
most often in students
when they get a question
wrong and they knew the content
is that because they weren't
careful about making sure
they were answering the
same question all the way down
each of those examples,
halfway through, they flip,
and they start answering
the reverse, so don't do that.
43:52
That's another silly way
to get a question wrong.
43:56
So discharge teaching
provided by the LPN.
43:59
Is that correct
delegation by an RN?
No, it is not.
44:04
Because an LPN cannot do
initial teaching, assessments,
and the teaching that's
needed at discharge.
44:11
So they can't do teaching,
assessments or evaluations.
44:15
Discharged teaching falls
under special teaching,
because you're sending
them home to be safe.
44:21
And that's why an LPN cannot
admitted or discharged a client
that's only within an RN scope
of practice in NCLEX world.
44:29
So step back,
take a look at your answers.
44:32
I want you to pause
for a minute and see,
"Does this make sense?"
"Why did you pick each
one of those answers?"
Okay, that's it.
44:47
You have wrapped
up that question.
44:49
Congratulations.
44:51
You made it all the way
through the case study
in the Next-Gen format.
44:55
You've got it.
44:56
Just be consistent and thorough,
move from left to right
and you can do this.
45:02
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