Triage Levels
You are triaging during a mass casualty event. You find a person with signs of head injury whose pupils are fixed and dilated, decorticate posturing, and shallow, irregular respirations. You classify this person as which triage category?
Expectant. (Lowest Priority/Comfort Measures)
Precautions used with every patient
Standard
Patient with chest pain
Patient's angry family member asking for water
Chest pain
Scheduled vitals for stable patient.
UAP
What is the difference between "assigning" and "delegating"?
Assigning is the process of transferring the authority, accountability, and responsibility of client care to another member of the health care team.
Delegating is the process of transferring the authority and responsibility to another team member to complete a task, while retaining the accountability.
You are triaging during a mass casualty event. You find a person who is ambulating unsteadily and appears confused. They have a third-degree burn to their upper back. You classify this person as which triage category?
Emergent (Highest Priority/Life-threatening injury requiring treatment)
The last item removed when doffing PPE
Mask
Child with 6/10 pain after appendectomy.
Child with sore throat and new onset difficulty swallowing.
Child with sore throat and new onset difficulty swallowing.
Tracheostomy care
Licensed (LPN ok)
Using the concepts of progressive discipline, what are appropriate interventions for a first infraction by an employee?
Informal reprimand
Manager and employee meet
Discuss the issue
Suggestions for improvement/correction
You are triaging during a mass casualty event. You find a person who is ambulating unsteadily and has superficial cuts to their hands. You classify this person as which triage category?
Non-urgent (Non-life threatening, no need for immediate attention)
Precautions for tuberculosis
Airborne
Priority action if patient reports new onset pain?
Assess, including:
Assess site of pain
Complete pain assessment (OLDCARTS or PQRST)
Vitals
Specimen collection
UAP
Leadership style where the formal leader does little planning and little decision-making. Informal communication structure. Informal leaders may guide work.
Laissez-faire
You are triaging during a mass casualty event. You find a person who cannot ambulate due to a broken leg, closed fracture. You classify this person as which triage category?
Urgent (Major injury, can wait 45-60 minutes for treatment)
Precautions for norovirus
Contact enteric
Patient with bleeding precautions pulls call light to ambulate back to bed.
Patient with bleeding precautions was given a safety razor by the UAP.
Patient with bleeding precautions was given a safety razor by the UAP.
Specimen collection when UAPs on the unit are not trained for the task
Licensed (LPN ok)
What is the first step if you receive a patient assignment you feel is unsafe or not appropriate?
Bring the unsafe assignment to the attention of the scheduling/charge nurse and negotiate a new assignment.
You are triaging during a mass casualty event. You find a person who has a closed femur fracture with signs of swelling and numbness in foot. You classify this person as which triage category?
Emergent.
What is difference between contact precautions and contact enteric precautions?
--Must wash hands with soap and water (no hand sanitizer)
--Must clean with bleach
The unit manager refuses a staff request to put chairs in the hallway outside rooms so family have a place to sit when the patient requests privacy during procedures. You know the reason for refusing this request is...
Hallways need to be kept clear in case there is need to evacuate.
Feeding patient who is at risk for aspiration
Licensed
True/False: When using assertive communication, you have the conversation regardless of location and emotional state of individuals involved.
False