Question

The LPN is in the room of a client experiencing a medical emergency. The physician gives the LPN a verbal order for Adenocard IV (Adenosine) \(6 \mathrm{mg}\) rapid IV push. Which initial nursing action is appropriate? A. Administer the medication as ordered B. Inform the physician that this action is beyond your scope of nursing practice C. Find the medication, draw up the dosage ordered, and give to the charge nurse to administer D. Notify the nursing supervisor to the order

Short answer

Answer: The most appropriate initial nursing action is to find the medication, draw up the dosage ordered, and give it to the charge nurse to administer. This balances the need for prompt intervention during a medical emergency with ensuring the medication is administered by someone competent in performing the task within their nursing scope of practice.

Step-by-step solution

Evaluate Option A: Administer the medication as ordered

A nurse may feel pressure to act quickly during a medical emergency. However, it is still essential to consider the scope of nursing practice and ensure the action is within their abilities. While taking decisive action may seem appropriate, we need to further evaluate other options before deciding on this.

Evaluate Option B: Inform the physician that this action is beyond your scope of nursing practice

The nurse should always act within the scope of their nursing practice. If administering the ordered medication is considered outside the LPN's scope of practice, it is crucial to communicate this with the physician. It offers an opportunity for the physician to clarify the order or request assistance from other healthcare professionals who can administer the medication.

Evaluate Option C: Find the medication, draw up the dosage ordered, and give to the charge nurse to administer

If administering the medication is beyond the LPN's scope of practice, delegating the task to a charge nurse or a colleague with the appropriate skills might be a sensible approach to help the patient promptly. This option combines the LPN's prompt intervention while ensuring the medication is administered by someone competent in performing the task.

Evaluate Option D: Notify the nursing supervisor of the order

Notifying your nursing supervisor is essential during times of uncertainty. However, during a medical emergency, communication should be as efficient and straightforward as possible to save valuable time. Seeking guidance from your supervisor could be time-consuming and may not be the best approach given other choices.

Conclusion

From the analysis of the options, Option C appears to be the most appropriate initial nursing action in this situation. It balances the need for prompt intervention during a medical emergency with ensuring the medication is administered by someone competent in performing the task within their nursing scope of practice.

Key concepts

Scope of Nursing Practice

Understanding the scope of nursing practice is critical for every nurse, particularly when it involves making decisions in a high-pressure situation, like a medical emergency. The scope of practice is defined by a combination of state law, the nurse's own level of education and experience, and the policies of the healthcare facility where they work.

For example, Licensed Practical Nurses (LPNs) have certain limitations compared to Registered Nurses (RNs). They must often work under the supervision of an RN or physician, and certain tasks, like administering certain medications, may not be within their scope. It's vital for an LPN to know these boundaries to ensure patient safety and comply with legal and professional standards.

When an LPN is presented with an order that they believe falls outside their scope, they have a responsibility to voice their concern, as is stated in the solution's Step 2. This helps maintain the integrity of the healthcare system and protects the nurse from potential legal consequences.

Emergency Nursing Actions

In an emergency situation, nurses often have to make rapid, yet informed decisions. However, they must balance the urgency of the situation with their own competence and the legality of their actions. This is where emergency nursing actions come into play.

The steps provided in the solution exemplify the thought process a nurse should follow. The immediate reaction might be to administer the medication (as explored in Step 1 of the solution), but nurses must first assess whether it aligns with their scope of practice and competencies. Emergencies require a unique combination of quick thinking, clinical knowledge, and practical skills.

Every emergency action taken should be in the patient's best interest while also upholding the nurse's professional and legal responsibilities. Training in emergency protocols and ongoing education are central to ensuring that nurses can provide the best care in these high-pressure situations.

Administering Medication

The administration of medication is a cornerstone of nursing practice, but it is also an area fraught with potential risks. Nurses must adhere to the 'rights' of medication administration: the right patient, medication, dose, route, time, and documentation. Beyond these, they must be specifically trained and authorized to administer certain medications.

In the given scenario, the LPN must consider whether they are allowed to administer Adenocard IV (as deliberated in Step 1 and 3 of the solution). LPNs usually have a more restricted medication administration role than RNs. Factors like medication type, the patient's condition, and institutional policies determine whether an LPN can proceed.

If unsure, a nurse should never hesitate to seek clarification or assistance from a supervisor or another nurse with the authority to administer the drug, aligning with Option C in our solution.

Nursing Delegation

Effective delegation is an essential skill for nurses, which requires understanding what tasks can be assigned to others based on their qualifications and the current needs. Delegation in nursing maximizes the use of the healthcare team to ensure the best patient outcomes, as seen in Option C from the solution.

When delegating, it's paramount to note that the delegator is still ultimately responsible for the task. The LPN here must ensure that the person they are delegating to is not only competent in the skill but also legally permitted to perform it. The delegating nurse must also communicate clearly and provide all necessary information for the task to be completed safely.

In the scenario provided, delegating the task to a charge nurse with a broader scope of practice ensures the medication is administered quickly and legally, showcasing effective team dynamics and patient care.