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).

Journal Articles:

  • Blaney, W. (2010). Taking steps to prevent pressure ulcers. Nursing, 40(3), 44-47.
  • Blankenship, J.S., & Denby, A.S. (2010). Empowering UAP to champion pressure ulcer prevention. Nursing, 40(8), 12-13.
  • Dumont, C. & Nesselrodt, D. (2012).Preventing central line-associated bloodstream infections CLABSI.Nursing, 42(6), 41-46.
  • Hess, C.T. (2010). Performing a skin assessment. Nursing, 40(7), 66.
  • Jarousse, A. (2010). Infection prevention risk assessment. H&HN: Hospitals & Health Networks, 84(8), 1-5.
  • Moureau, N.L., & Dawson, R.B. (2010). Keeping needleless connectors clean, part 2. Nursing, 40(6), 61-63.
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