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(COPY FOR STUDENTS 0ptional) HC Lab 1
Providing a Safe Environment
Nurses are knowledge workers whose main responsibility
is to provide safe and effective care within constantly evolving health care
systems. Patient safety is a collaborative goal that requires concerted efforts
from the patient and all members of the health care team. A primary concern of nurses is
awareness of what constitutes a safe environment for a particular person and
how this environment can be achieved. Nurses should focus attention on
preventing accidents and injury as well as on assisting the injured.
SPECIFIC HAZARDS TO SAFETY:
1. Fire-constant danger in
homes and hospitals. Common causes of
hospital fire are smoking in bed electrical equipment. A fire can burn only if
3 elements are present: sufficient heat to start the fire, combustible
material, and sufficient oxygen to support fire.
To
prevent fires:
· Enforce smoking
regulations. Post No smoking signs and inform visitors of ongoing O2
therapy
· Never allow a disoriented
or sedated patient to smoke without supervision.
· In areas where smoking is
allowed, provide ashtrays.
· Become familiar with the
location and operation of fire extinguishers. Know your hospitals fire code and
evacuation procedure.
To
prevent scalds and Burns:
(Scald-
is a burn from a hot liquid or vapor, such as steam; burn- results from
excessive exposure to thermal, chemical, electrical, or radioactive agents.
· Check the water
temperature before the patient enters the bath tub or shower
· Before filling a hot-
water bottle, test the water temperature; after filling it, tightly secure its
cap and check for leaks. Always insert a hot-water bottle, heating pad in a
protective cover before use. During infrared lamp treatment, evaluate tissue
condition frequently to avoid over exposure.
To
prevent electrical hazards:
· If the patient brings an
electrical appliance from home, follow hospital policy regarding its use. (Many
hospitals prohibit use of ungrounded personal appliances.)
· Inspect the power cord
and plug of all electrical equipment. Immediately report frayed cords, exposed
wirings or loose wall outlets. Use three pronged plug to ground equipment.
· If you feel a tingling
sensation when handling equipment, cords, or metal objects, report this
immediately, because it may signal current leakage. Watch for sparks smoke or
overheating during equipment use.
2. Fall- many falls of any
age can fall, but infants and the elderly are particularly prone to falling and
incurring serious injury.
To
prevent falls:
· Wipe up spilled liquids
and powders immediately. Post signs and instruct the patient to avoid freshly
washed or waxed floors.
· Tell the patient to wear
shoes or slippers with low heels and nonslip soles.
· Keep the patient’s bed in
a low position except when giving care. For the confused or pediatric patient,
always keep bed side rails raised.
· Before patient transfer,
lock the wheels of the bed, stretcher, wheelchair or commode. After transfer,
secure safety straps, if appropriate.
· Keep the call button, the
telephone, and personal items within the patient’s sight and reach.
· If ordered or necessary,
apply appropriate restraints to the confused, restless, or combative patient.
· Provide adequate
lighting. Reduce poor lighting and glare.
3. Poison- any substance
that Injures or kills through its chemical action when inhaled, injected,
applied, or absorbed in relatively small amounts.
Preventing
Poisoning:
· Place potentially toxic
agents, including drugs and cleaning agents out of reach for children
· Avoid storing toxic
liquids or solids in food containers such as soft drink bottles, jars or milk
cartons.
· Place labels, or warning
signs for every toxic or poisonous materials
FACTORS AFFECTING SAFETY
1. Life style- factors that place people at risk are:
unsafe work environments (danger from machinery, chemicals); high crime rates
in the neighborhood; access to guns and ammunitions, insufficient income to buy
safety equipment or make necessary repairs; access t o illicit drugs,
risk-taking behavior.
2. Mobility status- persons who have impaired mobility due
to paralysis, muscle weakness, and poor balance or coordination are obviously
prone to injury. Clients weakened by illness or surgery are not always fully
aware of their condition.
3. Sensory/Perceptual Alterations- accurate sensory
perception of environmental stimuli is vital to safety. People with impaired
touch perception, hearing, taste, smell, and vision are highly susceptible to
injury.
4. Level of awareness- Clients with impaired awareness
include lack of sleep, unconscious or semi- conscious, disoriented, hallucinations,
persons whose judgment is altered by disease or medications.
5. Emotional state- extreme emotional states can alter the
ability to perceive environmental hazards. Acutely anxious or angry person has
reduced perceptual awareness. Depressed persons may think and react to
environmental stimuli more slowly than usual.
6. Ability to communicate- people with diminished ability
to receive and convey information is also at risk for injury.
7. Knowledge of safety precautions- lack of knowledge
about unfamiliar equipments such as oxygen tanks, intravenous tubing and hot
packs is a potential hazard. Nurses need to teach and educate clients the
safety precautions in every procedure they are involved or undergo.
Nursing
Actions That Improve Patient Safety
1. Nurses need to be
knowledgeable about their healthcare facility’s policies and procedures
and always follow
them.
2. Nurses should
have open communication with one another as well as other healthcare
professionals. They should
not be afraid to question orders or medications that seem out of the
ordinary.
3. Nurses must
ALWAYS review the rights before giving medications.
4. Nurses need to be
involved in creating and updating reporting systems that avoid blaming
individuals but
rather encourage learning from the error, so that it can be prevented in the
future.
5. Nurses should
stay current with research that affects their area of practice, so that they
can
be involved in
evidenced-based decision making when taking care of patients.
6. Nurses should
stay current on all life saving certifications, such as CPR, BLS, and ALS, to
avoid missing new information that could affect patient safety.
7. Nurses ought to
be part of hospital committees that focus on making the healthcare system
safe, effective,
patient centered, and timely.
8. Nurses need to
encourage their patients and their families to read medication pamphlets and
ask questions if
they don’t understand something.
9. Nurses should
encourage their patients to ask their physicians or surgeons about what will
be done and the
possible side effects.
10. Nurses can
encourage their patients to seek a primary caregiver who can be kept informed
about their entire
health histories.
11. Nurses must
report all errors and “near misses” not only for the patient it affects but to
prevent it from
happening again.
Common Safety Devices/Equipments
Hospital Bed
(Semi-Electric/electric) - allow a bedridden patient to change position for comfort,
exercise or to eat, use an adjustable hospital type bed. A semi-electric
hospital bed is one with a manual height adjustment and with an electric head
and leg elevation adjustment. This bed adjusts with a touch of a button. All
beds come with a hand crank in case of power outage (side rails can be omitted
upon request).
Bed Rails
(Full Length) - Falling
from a bed is a potential hazard for anyone, but especially those who are weak
or have limited bed mobility. To prevent falls from a bed, bed rails are used.
Bed rails come in pairs, both full length and half-length.
Bed Handles
(Home Style) - This
innovative bed assist handle is designed for those requiring a little help for
moving, standing and transferring in and out of bed. Unlike fixed-style bed
rails, this bed handle can unlock and pivot out to provide better standing
support with less reaching and twisting. Simply slide the support frame between
the box spring and mattress, secure with safety straps and set the handle
height.
Safe-T-Pole -
provides a
sure grip anywhere you grab it. The Safe-T-Pole is made of heavy-duty, durable
steel with a special white coating that feels and looks good. Floor-to-ceiling
pole safely assists with standing, sitting, climbing stairs or transferring.
Trapeze (Free
Standing) - A
trapeze bar will enable the patient to change position, exercise or assist the
patient in moving in or out of bed. A free standing trapeze bar can be used
with a home style bed when a headboard is not available or with an easy chair,
sofa or other sitting service.
Trapeze (Bed
Mount)
- An important
patient room accessory, a trapeze bar is designed to help patients change
positions while in bed. A trapeze can aid in transfers from bed to chair with
minimum attendant assistance. This bed mounted trapeze unit has a wide range of
height adjustments and hand bar positions to maximize patient accessibility.
The unit can be installed quickly and easily on a hospital type bed.
Over Bed Table - An over bed table is a practical
and easy-to-use bed accessory that easily adjusts for comfort while reading,
writing or eating
Commode All-in-one - If the patient is unable to use
the bathroom facilities, a variety of bedside commodes are available. This
product contains Microban(R) protection that continuously resists the growth of
stain and odor causing mold, mildew and bacteria.
Transfer pads/sheets - Slides
easily on a bed sheet or stretcher pad, slippery coating keeps the patient from
sticking to the mover; Eases caregiver back strain by making the resident
easier to move toward the headboard
Intravenous Board- A simple wooden or plastic board
usually attached with tape to the patient’s forearm. It prevents bending and
dislocation of the intravenous (IV), arterial or CVP lines.
Call bell/buttons/alarms- simple buzzers or other signaling devices operated by
switches that require minimal pressure; for medical alerts, such as client
support or life alert
RADIOACTIVE MATERIALS
• irradiation
results from radioactive material, radiation sources, or radiation producing
machines. This radiation is produced internal or external to the body and may
or may not penetrate deep into the body, depending upon the radiation energy.
Personal
Protective Measures - External Radiation
1.
Time
a. Reduce Radionuclide
Handling
b. “Dry Runs”
c. Planning
2.
Distance
a. Tools
b. Separation from Radiation
3.
Shielding
a. Edges of Shield
b. Scatter Radiation
c. Proximity to Source
Personal
Protective Measures - Internal Radiation
1.
Good Hygiene
a. Mouth Habits
b. Food, Drinks, Chewing,
Smoking, and Cosmetics
Eating, chewing, drinking,
smoking, and application of cosmetics in any area where radioactive material is
used or stored. Remember that:
• Somebody’s lunch, drink,
or snacks may become contaminated with
• radioactive material and
the end result could be accidental ingestion.
2) Preparation of food or
drink in a lab is forbidden. There is always a risk of incorporating
radionuclides into the food or beverage.
3) Do your eating, drinking,
chewing (gum, tobacco, etc.) and/or smoking in a clean area away from the
laboratory.
4) Do not use laboratory paper
or glass containers for food or drink containers. These containers may have
residual radionuclide contamination, or an individual may accidentally ingest a
radioactive preparation thinking it is a foodstuff stored in a similar
container.
5) Do not store food in refrigerators
containing radioactive materials. Signage is available to post refrigerators
for “No Food or Drink” or “Only Food and Drink.”
6) Do not apply facial
cosmetics (make-up) in the laboratories. There is a risk of contamination of
these items and the potential for ingestion of radioactive materials.
7) Before leaving the
laboratory, wash your hands and leave your lab coat and gloves behind, along
with any radioactive material they may have collected.
• Surveys
Identification and control of contamination is one of the primary methods of
avoiding internal radiation dose.
a.
Self Contamination and Laboratory Surveys
b.
Laboratory Equipment Surveys
c.
Common Use Equipment Surveys
d.
Survey before Leaving
Decontamination
or Control of Contamination
Airborne
Hazards
• Initial control of
airborne radionuclide contamination is accomplished by:
a.
Recognition
b.
Preventative Steps
c.
Respirators
Protective
Clothing
• The use of gloves,
laboratory coats and other protective clothing minimizes the chances for the
ingestion or absorption of radioactive materials. In rare situations, the use
of suitable respirators might be recommended to prevent the inhalation of
volatile or airborne radionuclides.
a.
Gloves
• No unsealed radioactive
materials should be manipulated with the unprotected hand.
• Glove Removal
• Double Gloves for
Radioiodine
• Impromptu gloves
b.
Lab Coats
• Laboratory coats or
aprons are recommended to protect one’s personal clothing from contamination.
c.
Respirators
• Respirators are rarely
recommended as protective equipment against airborne radioactive material.
• d.
Protective Eyewear
e.
Open Sores/Wounds
Personal
Protective Measures - General
1.
Planning Work
2.
Knowledge of Radionuclides Being Used
3.
Training and Experience
• Lack of training and
experience can contribute to an accident or hamper one’s ability
4.
Fatigue and/or Emotional Factors
5.
Responsibility and Motivation
6.
Corrective Eyewear
7.
Environmental Factors
a. Proper Lighting
b. Proper Temperature
c. Cluttered Working Conditions
RESTRAINTS
• goal:
to
be as restraint-free as possible and to use the least restrictive means of
restraint possible to maintain patient safety.
• What
Are the Alternatives to Using Restraints?
a restrain free environment
• Assign nurses in pairs to
act as “buddies”
• Eliminating tubes and IVs
as soon as possible
• Family involvement
• Postural supports
• Diversional activities
such as TV, radio and activity aprons
• Other activities and
programs
• Room change
• Family Notification & Involvement
• When
and Why Are Restraints Used?
when patients are :
• confused or disoriented
• agitated, hostile or
abusive to staff and other patients
• risk of falling or
hurting themselves
• unable to be managed by
non-restraint methods.
• restraints
Are protective devices used to
limit the physical activity of the client or a part of the body.
Purpose:
Prevent client from injuring
self or others.
• Classifications
• Physical
restraints- are any manual method or
physical or mechanical device, material, or equipment attached to the clients
body; they can’t be removed easily and restricts clients movement
• Chemical
restraints
• Are medications such as
neuroleptics, anxiolytics, sedatives, and psychotropic agents used to control
socially disruptive behavior
• Behavior management
standard when the client is a danger to self and others
• Acute medical and
surgical care standard when temporary immobilization of a client is required to
perform a procedure
• Selecting
a restraint
5 criteria:
1. It restricts the client’s movement as little as
possible
2. It does not interfere with the client’s treatment or
health problem
3. It is readily changeable
4. It is safe for the particular client
5. It is least obvious to others.
• Kinds
of restraints:
• Mitt
or hand restraint
- Used to prevent confused
client from using their hands or fingers to scratch and injure themselves
• Limb
restraint
- Used to immobilize a limb
• Jacket
or vest (w/ straps that can be tied to the
bed frame under the mattress.
- Used to ensure safety of
confused or sedated clients in bed or wheelchairs
• Belt
or safety strap body restraints
- Used to ensure the safety of
all clients who are being moved on stretchers or in wheelchairs
• Applying
restraints:
Purposes:
1. To promote safety and prevent injury
2. To allow a medical / surgical treatment to proceed
without client interference
• Assessment:
Assess
- the behavior indicating the
possible need for a restraint
- Underlying cause for
assessed behavior
- What other protective
measures may be implemented before applying restraint
- Status of skin of which
restraint is to be applied
- Circulatory status distal
to restraints and of extremities
- Effectiveness of other
available safety precautions
• Planning:
• Review institutional
policy for restraints and seek consultation as appropriate before independently
deciding to apply a restraint.
• All other possible
interventions must have been tried
• The primary care
practitioner must be notified prior to using a restraint, unless there is a
danger to self and others.
Equipment:
Appropriate type and size of
restraint
• Implementation:
• Performance:
1. Introduce self and verify the clients identity. Explain
the procedure.
2. Perform hand hygiene and observe appropriate infection
control procedures
3. Provide client privacy if indicated
4. Apply the selected restraint.
•
Belt Restraint (safety belt)
• Determine that the safety
belt is in good order
• If the belt has a long
portion and a shorter portion, place the long portion of the belt behind
(under) the bed ridden client and secure it to the movable part of the bed
frame.
• Attach the belt around
the client’s waist, and fasten it at the back of the chair.
• Or if the belt is
attached to a stretcher, secure the belt firmly over the clients hips or
abdomen
• Jacket
restraint
• Place vest on client,
with opening at the front or the back
• Pull the tie on the end
of the vest flap across the chest, and place it through the slit in the
opposite side of the chest.
• Use a half-bow knot to
secure each tie around the movable bed frame or behind the chair to a chair
leg.
• Fasten the ties together
behind the chair using a slip or quick release knot.
• Ensure that the client is
positioned appropriately to enable maximum chest expansion for breathing
• Mitt
restraint
• Apply the commercial
thumb less mitt to the hand to be restrained. Make sure the fingers can be
slightly flexed and are not caught under the hand.
• Remove the mitt at
regular intervals if it is to be worn for several days.
• Assess the client’s
circulation to the hands shortly after the mitt is applied and at regular
intervals.
• Wrist
or ankle restraint
• Pad bony prominences on
the wrist or ankle if needed to prevent skin breakdown.
• Apply the added portion
of the restraint around the ankle or wrist.
• Pull the tie of the
restraint through the slit in the wrist portion or through the buckle.
• Attach the end of the
restraint to the movable portion of the bed frame
• infants
• Elbow restraints – are
used to prevent infants or small children from flexing their elbows to touch or
reach their face or head, esp. after surgery
• Mummy restraints- is a
special folding of a blanket or sheet around the infant to prevent movement
during a procedure such as gastric washing, eye irrigation or collection of a
blood specimen
5. Adjust the plan of care as
required
6. Record on the clients chart
the behavior indicating the need for the restraint and their outcomes, and the
time of the primary care providers was notified of the need for restraint. Also
record:
ü The type of restraint,
time, and the goal why it is applied.
ü Clients response
ü Time removed and skin
care given
ü Any other assessment and
intervention
ü Explanation given to the
client and SO
• Evaluation
• Perform a detailed follow
up of the need for the restraints and the client’s response. Relate these
findings to previous data if available.
• Evaluate circulatory
status of restrained limbs
• Evaluate skin status
beneath restraints
• Remove the restraints as
soon as they are no longer needed and document.
• Report significant
deviations from normal to the physician.
SEIZURE PRECAUTIONS
Seizure
- a sudden onset of excessive electrical discharges in one or more areas of
the brain
- it
can be develop at anytime during a person’s life and can occur at anytime.
- Clients
may be prone due to permanent or temporary medical conditions such as drug
reactions, epilepsy or extreme fever
• Classification:
• PARTIAL
(focal) – involve electrical discharges from one area of the brain
• GENERALIZED
– affects the whole brain
• SEIZURE
PRECAUTIONS
• Are safely measures taken
by the nurse to protect clients from injury should they have a seizure.
• IMPLEMENTING
SEIZURE PRECAUTIONS
• PURPOSE:
To
protect the client from injury
• ASSESSMENT:
Ø Assess
history of seizures during the admission assessment
• PLANNING:
Review emergency procedures as a respiratory arrest or other
injury can result from a seizure
• Equipments:
• Blankets
or other linens
• Oral
suction equipment
• Oxygen
equipment
• IMPLEMENTATION:
• Prior
to performing the procedure, introduce self and verify the client’s identity
using agency protocol
• Perform
handwashing and observe appropriate infection control procedures.
• Provide
client for privacy
• Pad
the bed of any client who might have a seizure
• Put
oral suction equipment in place and test to ensure that it is functional
• If
a seizure occurs:
ü Remain
with the client and call for assistance
ü If
the client is not in bed, assist the client to the floor and protect the head
in your lap or on a pillow. Loosen any clothing
ü Turn
the patient to lateral position if possible.
ü Do
not insert anything into the clients mouth
ü Time
the seizure duration.
ü Move
items in the environment to ensure the client does not experience an injury
ü Observe
the progression of the seizure, noting the sequence and type of limb
involvement . Observe skin color
ü Apply
oxygen
ü Use
equipment to suction the oral airway if the client vomits or has excessive oral
secretions
ü Administer
anti convulsant medications, as ordered.
ü When
seizure subsided, assist client to a comfortable position.
ü Reorient.
Explain what happened. Reassure the client. Provide hygiene as necessary. Allow
the client to verbalize feelings about the seizure.
ü Document
the event in the client record using forms supplemented by narrative notes when
appropriate.
• Life span considerations:
• INFANTS
- about 24%
of children experience seizures, mostly during infancy
a. Determine oxygenation. Apply
O2 if pulse oximetry reading is less than 95%
b. Children who have frequent
seizures may need to wear helmets for protection.
• CHILDREN
- febrile
seizures occur more than in adults and are usually preventable through
antipyretics and tepid baths
- children on anti convulsant
medications should wear a medical identification tag
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