Management of Care

Right task, right circumstance, right person, right direction/communication, and right supervision. The RN remains accountable for the delegation decision and overall patient outcome.

Assessment, nursing diagnosis/analysis, planning, evaluation, initial teaching, and any task that requires nursing judgment, as well as care of unstable or unpredictable clients. AP may perform routine, standardized tasks for stable clients (vital signs, hygiene, ambulation, intake and output).

Airway, then breathing, then circulation. A patent airway comes first because without it the client cannot oxygenate, regardless of other problems. (For pulseless cardiac arrest, AHA BLS uses C-A-B instead.)

Physiological needs (oxygenation, fluids, nutrition, elimination, comfort) come first, then safety and security, then love/belonging, esteem, and self-actualization. Lower-level needs are met before higher-level psychosocial needs unless a psychosocial problem threatens safety.

The client with the acute (new, sudden-onset) problem, because acute changes are more likely to be unstable and life-threatening than long-standing chronic conditions that the client has adapted to. Example: new-onset shortness of breath outranks chronic, stable arthritis pain.

Protecting the client's rights and interests and supporting the client's right to make informed decisions, even when those choices differ from the nurse's or family's preferences. Advocacy includes speaking up for the client, ensuring they have the information they need, and escalating safety concerns.