A nurse is collecting data from a client who has dysphagia. The nurse should identify that the client needs a referral to which of the following inter professional team members?

Delegation in nursing involves assigning appropriate tasks to assistive personnel (AP) while maintaining accountability for patient care outcomes. Effective delegation requires communication, clarity of expectations, and mutual understanding of scope of practice. When an AP refuses an assignment, the nurse must assess the reason for refusal before taking further action. Open communication helps ensure patient safety while maintaining a functional and collaborative healthcare team.

Rationale:
A. Assigning the task to another AP may be appropriate only after understanding why the original AP refused the task. Without addressing the reason for refusal, the underlying issue may persist and compromise patient care or safety. The nurse must first clarify concerns before redistributing assignments.

B. Performing the task on behalf of the AP may be necessary in urgent situations, but it is not the first action when refusal occurs. This approach bypasses problem-solving and does not address potential scope-of-practice concerns or knowledge gaps. The nurse should first explore the reason for refusal before assuming responsibility for the task.

C. Reporting the AP to the risk manager is premature unless there is a pattern of unsafe behavior, negligence, or serious policy violation. A single refusal does not automatically indicate misconduct. The nurse should first engage in direct communication to determine whether the refusal is based on safety concerns or misunderstanding of the assignment.

D. Discussing the AP’s concerns about performing the task is the appropriate first action because it promotes open communication and identifies the reason for refusal. The AP may lack training, feel the task is outside their scope, or have safety concerns. Addressing these issues supports safe delegation, teamwork, and appropriate resolution before escalating further action.

A urostomy is a surgically created urinary diversion that allows urine to drain through a stoma into an external collection pouch. In the immediate postoperative period, close monitoring is essential to ensure adequate urine output, stoma viability, and early detection of complications such as obstruction or bleeding. Nursing care focuses on maintaining hydration, monitoring renal function, and assessing the stoma’s color and drainage characteristics. Early postoperative surveillance is critical for patient safety and recovery.

Rationale:
A. “Expect the client’s urine to contain clots for the first 24 hours.” Although slight blood-tinged urine may be expected after surgery, visible clots are not an anticipated finding and may indicate bleeding or obstruction. The urine should gradually clear rather than contain increasing clot formation. Presence of clots would require immediate assessment and intervention.

B. “Expect the stoma to appear pale until healing is complete.” A healthy urostomy stoma should be moist, pink to red, and viable, indicating adequate blood supply. A pale, dusky, or dark stoma suggests compromised perfusion and requires urgent evaluation. Continuous assessment of stoma color is essential in the postoperative period.

C. “We need to check the client’s urine output every hour.” Frequent monitoring of urine output is essential after urostomy creation to assess kidney function and ensure patency of the urinary diversion. Hourly output measurement helps detect early complications such as obstruction, dehydration, or decreased renal perfusion.

D. “We will keep the client’s fluid intake restricted until he is free of pain.” Adequate hydration is necessary to maintain urine flow, prevent mucus buildup, and reduce the risk of urinary tract obstruction. Restricting fluids can lead to dehydration and impaired kidney function. Pain is not an indication for fluid restriction in a postoperative urostomy client.