Walkthrough: Management of Care Q5 – NCLEX-RN®

00:00 The nurse is caring for an adolescent with a possible diagnosis of a cervical spinal cord injury following a sports injury. Which action by the unlicensed assistive personnel is contraindicated? Okay, let's unpack that one. First sentence. The nurse is caring for an adolescent with possible diagnosis of cervical spinal cord injury following a sports injury. Okay. So what do I have there is I have people. So the nurse, that's an RN in NCLEX world, is caring for an adolescent, okay I know this is teenager, with a possible diagnosis. Okay, so I don't know it for sure but I know this client has a possible diagnosis of spinal cord injury, right, from sports. So, I'm taking care of a kid who we think might have a spinal cord injury. Which action by who, which action by the unlicensed assistive personnel is contraindicated? Okay, who is in the question? A nurse and a UAP. Who delegates and supervises who? The RN, the nurse delegates and supervises the UAP so it's my job to be able to recognize what's an appropriate task for UAP, what's an inappropriate task for UAP. So, after you look at our 4-answer choices what I want you to think about one of these should not be done so I'm looking for the action that is the most unsafe or wrong for this client for a UAP to do. So it's outside of their scope of care and it might actually put the patient in danger. Okay, so, you're going to see 4 options.

01:40 You know the drill, writing down number 1, number 2, number 3, number 4 on your scratch paper. As you're eliminating answer choices, cross through them and say why then pause the video as you're doing that process, come back, we'll walk through it together. Hey, welcome back. Sometimes it feels weird smiling when we're talking about all these horrible things that I have talk into people but I'm smiling because I am excited that you are studying with us. That is so cool.

02:17 Because this is why we're here to help you be successful in school and therefore we want you to be really great healthcare providers, right, on the team that you're really looking at delivering healthcare with the team. So, let's do it because I don't want you to think I was happy because this kid might have a spinal cord injury.

02:36 So, 4 answer choices, I'm looking for one which is contraindicated. So, is it contraindicated for a UAP to maintain the head in a neutral position? Hmm, with spinal cord injury, that's a good thing so I don't think that's one I'm going to eliminate but I'm not sure yet. Is it appropriate for a UAP to remove protective gear? Okay, well protective gear, oh yeah we're not. That's not a good idea no matter who you are, definitely not for UAP. So between number 1 and number 2, I'm going to throw out number 1 because we always want to maintain the head in the neutral position that's to keep that spinal cord aligned to avoid further injury.

03:24 So, I know now I can get rid of number 1. Number 2, I'm leaving in for right now.

03:30 Number 3, cuts off restrictive clothing. Is it contraindicated for a UAP to cut off restrictive clothing? Okay, would that put this person in danger? Not more than number 2 so get rid of that. Remember, don't make movies. Don't make movies, look at just what it's saying and think about what does that answer choice literally mean. Don't think "Well I probably like cinema and try and cut up" nope. It just says cuts off restrictive clothing. Now number 4, place a blood pressure cuff on the arm. So, is that contraindicated or would that be a risk for this patient? Well, compared to number 2, no. Number 2 is the one that is the most, right, contraindicated for a UAP to do because until we can rule the spinal cord injury out, keeping them immobilized and keeping them safe is the most important thing that you want to do. Right? Because we don't want to further extend their injury.

04:34 So, you don't want to take off their helmet or any other protective equipment like I, you know, a cervical neck brace. No, until we know for sure what you're dealing with. So, the RN would be the one who would make sure the assessment is done, make things are going on, work with the physician or the nurse practitioner to make sure that we're safe to do any type of movement with this client. So how'd you do? Feel good about that one? Feel not so good about that one? Make sure you're thinking about "What can I take from this question and apply to other questions?" Remember, know who you are in the question, know who else is in the question. Keep in mind if you delegate or supervise them and then that last sentence. Right? That last sentence it was asking you for "Which is contraindicated for the UAP?" meaning it's either not within their scope of practice or it's going to harm the patient. And this one, no one should take that protective gear off until we have an official diagnosis and it would not be appropriate for the UAP to be the first one to do that.