NU144CL Unit 2 Four-Patient Shift Plan Example

Who First, What Is Fixed, What Travels Together, What Gives Way: A Shift Plan for Four Composite Medical-Surgical Patients, Including a Woman on a Titrated Diltiazem Infusion and a Man Fasting for Surgery on Reduced Insulin

[Student Name]

Purdue University Global

NU144CL: Medical-Surgical Nursing II Clinical

Unit 2 Shift Plan

[Instructor Name]

[Date]

The patients are composite; times, ranges and doses are bracketed where illustrative, orders are the providers', and the student works under the assigned nurse and instructor.

The Assignment at 0700

Room 1: [Mrs. A.], 72, new atrial fibrillation, on a diltiazem infusion at [10] mg per hour, titrated per order to keep the heart rate between [60] and [110]; last rate [104]. Room 2: [Mr. B.], 58, day one after a left kidney removal for a tumor, pain pump with an opioid, a surgical drain, urinary catheter; pain [5] of 10 at 0600. Room 3: [Mr. C.], 66, type 2 diabetes, infected ulcer on the right foot, fasting since midnight for debridement at [1100], long-acting insulin reduced to [70] percent of his usual dose last night per order. Room 4: [Mrs. D.], 81, recovering from pneumonia, stable, awaiting transfer to inpatient rehabilitation at [1300].

Block One: First Contact, Ranked

1. Mrs. A. Her rate is near the top of its range, and a titrated infusion can need action within minutes. I check her rhythm, rate, blood pressure and the pump settings against the order first.

2. Mr. B. A pain pump is a high-alert opioid route, and the first day after kidney surgery carries bleeding risk, so his sedation level, breathing, drain output and urine output come next (Institute for Safe Medication Practices, 2024).

3. Mr. C. A fasting patient on insulin can drop his glucose before anyone notices, and he has a fixed surgery time.

4. Mrs. D. She is stable and her deadline is the afternoon, so a safety check is enough until later in the morning.

Block Two: Every Deadline in One Column

[0730] Glucose, Mr. C. [0745] Heart rate and blood pressure check after any titration, Mrs. A., then every [15] minutes for an hour after each change, as ordered. [0800] Drain and urine totals, Mr. B. [0830] Preoperative checklist started, Mr. C.: consent on chart, site marked by the surgeon, allergies, last intake, glucose. [0900] Medications for all four. [1000] Glucose, Mr. C.; checklist complete. [1030] Transport to the operating room, Mr. C. [1200] Lunch glucose rounds; post-procedure check if Mr. C. is back. [1300] Transfer of Mrs. D., with report called to rehabilitation at [1230]. Putting all four patients' deadlines in one column shows the collisions before they happen. The [1000] glucose and checklist for Mr. C. fall in the same half hour as a possible titration for Mrs. A., so I plan to finish Mr. C.'s paperwork by [0945].

Block Three: Trips Into Each Room

Room 1, each visit: rate, rhythm, pressure, infusion site, pump rate against the last order, and how she feels, since dizziness can come before low pressure. Room 2, each visit: pain score and sedation level together, breathing rate, pump history, drain output and color, urine output, dressing. Room 3, each visit: glucose symptoms, shakiness, sweating, confusion, foot dressing and the checklist item due at that time. Room 4, two visits: morning safety and medicines; late morning, discharge teaching and belongings, with her daughter if she arrives. Grouping checks by room cuts the number of trips and keeps related findings together, such as pain and sedation, which need to be read side by side because opioids affect both (Harding et al., 2023).

Block Four: Handed Over, With a Value to Return

To the nursing assistant: vital signs for Mr. C. and Mrs. D. at [0800]; report a systolic below [100], heart rate above [110] or a glucose symptom at once. Weighing Mrs. D. before breakfast. Walking Mrs. D. to the bathroom with a gait belt. Kept by me and my nurse: every check on Mrs. A., every assessment and every pump check on Mr. B., insulin decisions and the checklist for Mr. C., and Mrs. D.'s discharge teaching. Taking vital signs on a stable patient can be handed over; interpreting a titrated infusion cannot (National Council of State Boards of Nursing, 2016).

The Likeliest Break and What Slides

The likeliest break is Mrs. A.'s heart rate rising above [110] or her pressure falling below [90] systolic after a titration. If that happens, she has my full attention, and my nurse is told at once. What slides: Mrs. D.'s discharge teaching moves to [1130], since her transfer is not until [1300]. What does not slide: Mr. C.'s glucose and his surgery time, because hypoglycemia in a fasting patient on insulin is a safety risk, and a missed checklist can delay the operating room. If Mr. C.'s glucose falls below [70], that becomes the immediate priority alongside Mrs. A., and I ask my nurse to cover one while I treat the other per protocol.

A plan is tested not when the morning goes as written but when one patient pulls you away and you already know what can wait.

Checking the Plan at Midmorning

At [1000] I compare the plan with what has happened: Mrs. A.'s rate settled at [92] after one titration, Mr. B.'s pain is [3] with sedation level [1], Mr. C.'s glucose is [134] and his checklist is complete, and Mrs. D. has had breakfast. Anything unfinished is moved into the noon block, and my nurse hears the update in one minute. The check takes five minutes and keeps the afternoon from being a surprise.

References

Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.

Institute for Safe Medication Practices. (2024). ISMP list of high-alert medications in acute care settings. Institute for Safe Medication Practices.

National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14. https://doi.org/10.1016/S2155-8256(16)31035-3