Basic Nursing 3rd Edition: Safety - Ch 21, Physical Activity & Immobility - Ch 29

Measures healthcare workers use to reduce exposure to radiation

*Remember: Time, distance, shielding *Organized care to reduce amount of time exposed to the patient *Prioritize care to be in close proximity to the patient only when absolutely necessary *Wear protective shielding, if available *Always wear a film badge

'Never Events,' AKA Serious Reportable Events or SREs

Never events are healthcare acquired complications that can: 1. Cause serious injury or death to a patient 2. Should never happen in a hospital. Ex.) foreign objects being left in a patient following surgery, serious pressure injuries, and symptoms resulting from poorly controlled blood sugar levels, blood clot after hip or knee replacement, One of the most serious and most preventable never events is that of falls.

Measures to prevent bringing workplace toxins into the home

-remove work clothing and shower, in an open air shower if possible, before leaving work -if facilities for showering are not available, patient advocacy may be appropriate -before entering the home, exposed workers who have not showered should remove their clothing, then immediately shower -When handling contaminated clothing or objects, wear gloves to reduce the risk of skin transmission -*laundering may not be effective in removing certain toxins from clothing

When the oxygen level of the blood falls, what is the effect on the ins?

-when inadequate oxygen enters the pulmonary blood circulation, hypoxemia results -poorly oxygenated blood is then circulated to the brain and other body organs, which can lead to acid in the blood, subsequently leading to cell damage and an overall poor state of health -In the brain, this can produce altered mental status, such as confusion

What are the defining characteristics for the NANDA-I diagnosis, Deficient Fluid Volume?

Change in mental state; decreased blood pressure, pulse pressure, pulse volume, skin turgor, tongue turgor, urine output, and venous filling; dry mucous membranes; dry skin, elevated hematocrit; increased body temperature, pulse rate, and urine concentration; sudden weight loss (except in third spacing); thirst: weakness

Injury risk by developmental stage: Older Adulthood

Injuries commonly r/t decreased muscle strength and joint mobility, slower reflexes, decreased ability to attend and respond to multiple stimuli, and sensory losses (e.g. vision & hearing) -Increased risk for falls, burns, car accidents, & other injuries

Injury risk by developmental stage: Middle Adulthood

Injuries commonly r/t lifestyle, stress, declining strength & stamina, and "weekend athletics"

Injury risk by developmental stage:

Injuries commonly r/t streets and driveways, outdoor play equipment, bodies of water (pool, ditch, etc)

Communication problems among healthcare personnel jeopardize what?

Patient safety

Pathophysiology of pneumonia

Pneumonia - --infection of the alveoli in the lungs --the inflammatory process results in edema in the alveoli and purulent fluid, leading to difficult exchanging carbon monoxide and oxygen in the lungs --Fever (result of the infectious process)

Demonstrate an understanding of ergonomics when working at the bedside and transferring patients

Position your feet with a wide base of support, point your feet toward the direction of the move, flex your knees and hips

The nurse is caring for an older adult at risk for falls. What should be included in the plan of care? Select all that apply. -Keep bed in highest position.? -Provide nonskid footwear.? -Keep call light within reach.? -Clear floor of obstacles.? -Keep bed wheels locked?

Provide nonskid footwear. -Keep call light within reach. -Clear floor of obstacles. -Keep bed wheels locked

The nurse responds to a client's call light to find a fire in the bathroom trashcan. The client yells, "I just wanted a cigarette; I didn't think this would happen." What should be the nurse's first action?

Relocate the client away from the fire

Assessment tool used for a "slightly confused home care client" to assess 1. Ability to safely live alone and 2. Perform activities of daily living

The safety assessment scale (SAS) primarily evaluates whether the cognitively impaired person is capable of: cooking, taking their medication, shopping, performing other ADLs

Case Study 1: The nurse caring for William gives William an injection of pain medication and then accidently sticks themself with the used needle. What measures can nurses take to prevent needlestick injuries? Select all that apply. -Advocating for needleless systems -Not recapping needles -Disposing of sharps immediately -Confirming that the sharps container is not overfilled -Not hand-passing sharps from one person to another

To prevent accidental needlesticks, nurses can take several measures. These include advocating for needleless systems, not recapping needles, placing the needle and syringe directly into the sharps container after use, discarding and replacing overfilled sharps containers, and not passing sharps from one person to the next.

Typical cause of fire in healthcare facilities

Typically related to anesthesia or electrical causes.

Demonstrate the proper use of assistive mobility devices including canes, walkers and wheelchairs

Use the cane on the side opposite of the injury, pain, or weakness (unless instructed otherwise by a health care provider). Put all weight on the good leg. Move the cane with the bad leg a comfortable distance forward. Use the cane to help your bad leg support your weight and then step through with your good leg. Place the cane firmly on the ground before taking a step and ensure it is not too far ahead. Stand with toes halfway between the front and back wheels/tips. Roll or lift the walker a step length ahead. Place the walker firmly on the ground and make sure it is not too far ahead. Lean forward slightly, using the walker for upper body support. Take one step. Repeat It is important to follow basic safety precautions to decrease the risk of tipping over or falling out of the wheelchair. Avoid leaning forward - never bend forward beyond the armrests. Avoid bending over to reach objects on the ground - use a reacher or ask for assistance instead. Avoid reaching backwards over the top of the backrest. Never attempt to do a "wheelie". Make sure your wheelchair brakes or is locked in place when you are sitting still and especially when you are preparing for a transfer. Make sure the footrests are moved out of the way before transfers - never stand on them (Soh, 2016).

Some guidelines to follow to prevent falls include:

assessing all inpatients for falls risk upon admission and for patients at risk; repeating risk assessment every 8 hours and increasing frequency of monitoring; having the call light within reach; orienting the patient to surroundings; identifying medications that increase the risk for falling; and teaching fall prevention strategies.

Another risk factor for injuries in the healthcare setting is the use of restraints

can be in the form of a mechanical device, material, or equipment, such as a cloth vest or side rails, or in the form of a chemical restraint, which can be given to sedate the patient

What types of errors can occur during handoffs?

gaps in patient care, failures in patient safety, medication errors, wrong site surgery, patient deaths

Estimates place the number of deaths related to medical errors at :

more than 400,000 every year

Explain the causes of falls in the elderly, including polypharmacy.

poly pharmacy, or the use of multiple medications, is a risk factor for acute confusion, delirium, 1. History of falls 2. More than one medical diagnosis 3. Use of ambulatory aids (crutches, cane, walker) 4. Presence of IV or Heplock 5. Gait: normal, stooped, otherwise impaired 6. Mental status

Identify and document abnormal findings for patients with alterations immobility

recognize common musculoskeletal abnormalities

Distinguish the difference between safety reminder devices and restraints; determine when each is appropriate

restraint: device or method used for restricting a patient's freedom of movement or access to his body, with or without his permission. safety reminder devices: devices put in place to remind the patient they need assistance ambulating, such as a belt restraint, vest restraint, enclosed bed

Sources of noise pollution

traffic, planes, garbage trucks, construction equipment, lawn mowers, loud music

First action taken for a choking victim?

Determine whether the airway is occluded: can the person speak? cough? AKA ask them "Are you choking?"

What are some ways that the aging process makes the older adult more prone to injury?

-Physiological changes resulting in: change in strength and gait stability -Sensory losses (hearing and vision)

Causes of communication difficulties in the healthcare setting

-Lack of structure and standardization for communication -The existence of cultural differences in authority, gender, and race -Difference communication styles

Case Study 1: Carol recognizes her primary concern is for the care of Sonia, her client. After she's completed the dressing changes, she fills out a household safety assessment form. Which comments require further teaching for the safety of Sonia's grandchildren? Select all that apply. -"Billy is in a rear-facing car seat. Bobby wears a shoulder seat belt in the back seat." -"Both Billy and Bobby swim with water wings at the city pool." -"Billy still sucks his thumb and likes to put things in his mouth." -"Bobby's favorite toys are small bricks; he leaves them everywhere." -"Bobby loves his new skateboard."

-"Billy is in a rear-facing car seat. Bobby wears a shoulder seat belt in the back seat." -"Billy still sucks his thumb and likes to put things in his mouth." -"Bobby's favorite toys are small bricks; he leaves them everywhere." -"Bobby loves his new skateboard." Rationale: Rear-facing seats are safer for toddlers, like Billy, up to age 4 years; it is best for children to ride rear facing as long as possible and at least until they reach the height and weight maximum specified by the seat manufacturer. Bobby, at age 6, still requires a booster seat until he reaches a height of 4 ft 9 in. and is between the ages of 8 and 12 years. Water wings at a city pool are acceptable if there are lifeguards on duty. Because Billy likes to put things in his mouth, Bobby's bricks being left out is a concern because they pose a high risk for choking. Further inquiry is needed about Bobby's skateboard; for example, where does he ride it and does he wear a helmet?

Which statements by a nurse are correct when preventing needlesticks and blood exposure? Select all that apply. -"I always place my used needles into a puncture-proof, labeled container." -"I always recap my used insulin needles before disposing of them." -"I confirm that the sharps container is not overfilled before placing the syringe inside." -"It is okay to hand pass sharps if both people in the exchange are wearing gloves." -"I use needleless systems when available."

-"I always place my used needles into a puncture-proof, labeled container." -"I confirm that the sharps container is not overfilled before placing the syringe inside." -"I use needleless systems when available."

Case Study 1: William says to his nurse, "I guess I never really thought about how dangerous nursing can be" after learning of the needlestick. "Are injuries to nurses very common?" What would be correct responses by the nurse? Select all that apply. -"Most injuries to healthcare workers are preventable." ="Almost all nurses report chronic back pain." -"The only ones who suffer injuries are the bedside nurses." -"Several national organizations work to implement safety practices for nurses." -"Exposure to radiation and violence are also ways a nurse can be injured."

-"Most injuries to healthcare workers are preventable." -"Several national organizations work to implement safety practices for nurses." -"Exposure to radiation and violence are also ways a nurse can be injured." Rationale: Back injuries are most common in healthcare workers with over half—not almost all—reporting chronic back pain. The American Nurses Association's "Handle With Care" initiative has brought an awareness and changes to the problem. Needlestick injury is most common in nurses and housekeeping staff. The risk for infectious disease transmission is significant, and the federal Needlestick Safety and Prevention Act and OSHA standards require tracking of such injuries. Radiation exposure is most common in those working regularly in radiological diagnostic areas. Protective shielding and a film badge are required for prevention and tracking of exposures. Violence in healthcare can occur at any time with clients, families, or coworkers. Being aware and learning good communication skills can sometimes de-escalate these situations before injury occurs.

What are considered "never events?" SATA -An abdominal infection after a ruptured appendix surgery? -Administration of unmatched blood in an emergency situation? -Hypoglycemic episode after insulin administration? -Sponge left in a client after a hysterectomy? -Blood clot in the lungs after an orthopedic surgery?

-Administration of unmatched blood in an emergency situation -Hypoglycemic episode after insulin administration --Sponge left in a client after a hysterectomy

A nursing unit is receiving reports for five clients being newly admitted. Which client is at the highest risk for injury and best to place close to the nurse's station? -A 9-year-old child who is tearful -A 16-year-old adolescent who is depressed -A 62-year-old patient who is anxious -An 87-year-old patient who is confused

-An 87-year-old patient who is confused

The nurse is about to move a client who is large and unsteady from the bed to a chair. Which actions should the nurse take? Select all that apply. -Use a narrow base stance of support. -Apply a belt restraint. -Get additional help. -Clear the area of obstacles. -Place the client in restraints.

-Apply a belt restraint. -Get additional help. -Clear the area of obstacles.

Tips for preventing food poisoning

-Avoid food that has a foul odor or that might be spoiled -Avoid cross contamination (mixed use cutting surfaces) -Fully cook food -Mind safe food temperature ranges -Observe health dept grade at restaurants -Only use food safe containers for storage (avoid leaded crystal, pottery, etc)

Case Study 1: While discussing the surrounding community with Sonia, Carol learns that there are often drug dealers at the corner market, and there have been neighborhood drive-by shootings related to gang activity. What additional teaching should be included for the family? Select all that apply. -Avoidance of touching needles if found -Stressing a move to a different neighborhood -Purchase of a guard dog for protection -Proper handling of guns and gun safety -How to contact 911 for emergencies

-Avoidance of touching needles if found -Proper handling of guns and gun safety -How to contact 911 for emergencies Rationale: Living in an environment with drugs, gangs, and guns places the family at a higher risk for injury. It would be important for them to be aware of the illnesses that can be transmitted with dirty needles, how to make their home safe, and gun safety to prevent accidental shootings. It is not within Carol's purview to recommend the family move or purchase a guard dog.

Common sources of carbon monoxide poisoning (CO)

-Burning fuel: wood, oil, gas, natural gas, kerosene, coal -Poorly ventilated or obstructed furnace -Running car in an unventilated garage -Lawnmowers, charcoal grills, gas water heaters, camp stoves, lanterns, gas ranges, gas ovens -Nonconventional heating in the winter

Case Study 1: Two weeks later, Carol learns that William has been hospitalized for a fractured hip due to a fall. She visits him in the hospital and observes which safety measures in place to prevent injury? Select all that apply. -Call light within reach -Slippers have nonskid soles -Four side rails up on the bed to prevent him from -getting up -Bed alarm turned off because it's daytime -Raised toilet seat in the bathroom

-Call light within reach -Slippers have nonskid soles -Raised toilet seat in the bathroom Rationale: The prevention of injuries and falls is important, especially in a high-risk client such as William. Nonskid slippers, a raised toilet seat and having the call light nearby are all ways to prevent falls. The use of four side rails is considered a restraint and not allowed without a healthcare provider's order. The bed alarm will also prevent falls and should be turned on at all times, not just at night

Nursing interventions are in place to prevent complications from (examples)

-Foreign objects left in patients during surgery -Air embolism -Symptoms resulting from poorly controlled blood glucose levels -Surgical site infections -Deep vein thrombosis or pulmonary embolism

How should older adults be screened to determine whether a comprehensive falls evaluation is necessary?

-Get up & Go test if indicated, -Timed Up & Go test

Universal sign for choking

-Hands at the throat, or grasping neck between thumb and index finger

Most common poisonous agents ingested by children

-Household cleaners: oven cleaner, drain cleaner, toilet cleaner, and furniture polish -Medicines: cough & cold, vitamins, pain meds, antidepressants, anticonvulsants, iron tablets (look like M&Ms) -Indoor plants: poinsettia, dieffenbachia, philodendron -Cosmetics: hair relaxer, nail products, mouthwash -Pesticides -Kerosene, gasoline, lighter fluid, other chemicals -Alcohol -Wild plants and mushrooms -Pesticides & rodent poison

Major causes of injuries from motor vehicle accidents (MVAs)

-Improper use of car seats and seat belts -Injury from air bags, esp. with children in the front seat

Conscientious nursing interventions can prevent "never events," such as

-Incompatible blood transfusions, severe pressure ulcers, falls, infections r/t catheters, infections r/t IV catheters

Case Study 1: As the nurse prepares to help William get out of bed for the first time after surgery, which safety measures should be taken? Select all that apply. -Place skid-resistant shoes on William. -Place a belt restraint tightly around William's waist. -Get additional help. -Clear the area of obstacles. -Place a skid-free rug at the side of the bed.

-Place skid-resistant shoes on William. -Place a belt restraint tightly around William's waist. -Get additional help. -Clear the area of obstacles. Rationale:In this situation, both William and the nurse are at risk for injury. It is important for there to be adequate help, a belt restraint, skid-resistant shoes, and a clear area for ambulation. Placing a skid-free rug will not help as William moves off the rug.

A nurse is caring for a client who is at high risk for falling. The client is weak and confused. What are actions the nurse can take when caring for this client? Select all that apply. -Repeat fall risk assessment every 8 hours. -Place call light within reach. -Request a social service consultation. -Identify medications that increase falling risk. -Restrain the patient to the bed.

-Repeat fall risk assessment every 8 hours. -Place call light within reach. -Identify medications that increase falling risk.

Case Study 1: As an older adult, which age-related changes contribute to William's risk for injury? Select all that apply. -Risk-taking behavior -Sensory losses -Slowing of reflexes -Decreased mobility -Increased cognitive awareness

-Sensory losses -Slowing of reflexes -Decreased mobility Rationale: An individual's risk factors for injury include impairment in lifestyle (smoking, alcohol ingestion, risk-taking behaviors), decreased cognitive awareness (confusion), sensory and perceptual status (loss of senses), impaired communication (language barriers), impaired mobility, slowing of reflexes, physical and emotional well-being (depression, helplessness), and safety awareness (reduced cognitive awareness).

Case Study 1: Carol, a home healthcare nurse, is caring for a family from a low-income area. Four generations of the family live in this small, two-bedroom apartment, including William, 81 years old; his daughter, Sonia, 51 years old; her daughter Lily, 28 years old; and Lily's sons, Bobby, 6 years old, and Billy, 2 years old. Sonia was recently discharged from the hospital with a healthcare-acquired infection of her surgical wound and requires routine dressing changes. As Carol enters the home she visually scans the environment. Which observations are most concerning? Select all that apply. -Several throw rugs on the floor -A space heater on the floor -Empty beer cans on the coffee table -Open medication bottles next to the television -A smoke detector hanging open in the kitchen

-Several throw rugs on the floor -Open medication bottles next to the television -A smoke detector hanging open in the kitchen -A space heater on the floor

Important developmental considerations when providing a safe environment for a preschool child?

-Supervision of outside play, ie on playground equipment -Street safety -Rationale: The preschooler is less prone to false than the toddle, but other types of injuries increase because preschooler play includes more outside activities

The nurse knows that falls most often occur in hospitals and long-term care facilities during which time frames? Select all that apply. -Early mornings -Midafternoons -Weekends -Nights -Holidays

-Weekends -Nights -Holidays

The nurse is teaching a group of parents of toddlers about safety. What should be included in the presentation?

-appropriate car seat use, -water safety -cut foods such as meats, cheeses, and grapes into small bites, -safely store chemicals -safely store firearms and teach toddlers how to react to them

Safety measures to reduce equipment-related injuries in the healthcare facility

-ask for advice when unsure about equipment operation -make sure equipment is/has been properly inspected -watch for equipment malfunction -make sure rooms aren't cluttered with equipment -Be aware of and follow facility policies regarding patient's equipment brought from home (hair dryers, electric razors, radios) "should be inspected for proper grounding and safe cords"

Preventing back injuries

-consistently use assistive devices when moving patients in and out of bed -use good body mechanics -get help when moving patients or lifting heavy objects

Choking prevention: safety measures for young children

-inspect toys for small, removable parts -store plastic bags away from young children in a secure place -Avoid giving the child large, round chunks of meat (i.e. whole hot dogs) -Refrain from giving children hard candy, chewing gum, nuts, popcorn, grapes, marshmallows, or peanuts

Activities to reduce fires in the home

-never leave burning candles unattended -store matches and cigarettes in a locked area -install and maintain smoke detectors -place extinguishers in kitchens or workshops

Discuss nursing care of a patient after a fall

-perform a post-fall assessment to identify possible causes, monitor patients closely for 48 hours after a fall

Safety measures that decrease the risk of burns for children

-place pot handles toward the back of the stove -place guardrails in front of radiators and fireplaces -avoid warming infant formula and food in the microwave -Check the temperature of the formula and food carefully before giving it to the child -Stress the danger of open flames to the child -Always check bathwater temperature for children and set water heater temperature low enough to prevent scalds -Have children wear protective clothing and sunscreen outside

Risk factors that are assessed on the Morse Fall Scale

1. History of falls 2. More than one medical diagnosis 3. Use of ambulatory aids (crutches, cane, walker) 4. Presence of IV or Heplock 5. Gait: normal, stooped, otherwise impaired 6. Mental status

What measures, in order, should you take if a fire occurs in a hospital

1. Rescue the patients 2. Move the patients away from the area 3. Sound the alarm and attempt to confine the fire only if it is safe to do so

What is SBAR?

A structured communication technique designed as a strategy for clear communication based on a statement of the situation, background, assessment, and recommendations related to a clinical issue

Statistics show that falls occur more frequently when?

At night, during weekends, and holidays

Some of the risks for healthcare workers include:

Back injuries, needlestick injuries, excess radiation exposure, and violence

Case Study 1: As Carol and Sonia are discussing safety, Carol shares that based on age group, drowning is the second leading cause of death for which family member? Billy - 2 Bobby - 6 Lily - 28 Sonia - 51 William - 81

Billy - 2 Rationale: Drowning is the second leading cause of death for children age 1 to 4 years, just behind motor vehicle accidents. Motor vehicle accidents are also the leading cause of accidental deaths in school-age children and adolescents. The leading cause of accidental death in adults is unintentional poisoning, and in the older adult it is falls.

Discuss safety measures to prevent hazards in the healthcare setting

Culture of safety - environment where all staff work together to create a safe unit, disclose errors without fear, and address any safety concerns. Key components: Team empowerment, Communication, Transparency, Accountability

Describe the nurse's role in Fire & Disaster Safety in the healthcare setting

In the event of a fire or disaster, the nurse's role is to first rescue the patient, next remove the patient from the hazard, and then sound the alarm

A nurse is a new employee in a facility learning about The Joint Commission's Patient Safety Goals. What is in included within these goals? -Minimization of patient falls? -Elimination of never events? -Infection prevention? -Requirement of advanced technologies?

Infection prevention

Demonstrate the use of proper body mechanics when providing patient care

Stand with your feet apart to create a sturdy foundation. Bend at your knees instead of your waist. Keep your neck, back, hips, and feet aligned when you move; avoid twisting and bending at the waist