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FON exam 3
restraints and falls
| Question | Answer |
|---|---|
| restraint | physical devices or chemical means to limit a pts freedom and movement that cannot be easily removed by the pt |
| federal guidelines reinforce pt rights | restraints can only be used to protect the pt, staff, others requires an order from a HCP and face to face assessments |
| double check before restraining | valid reason or not valid reason restraint to discipline = ILLEGAL |
| then ask yourself | what else could i do instead or using a restraint? |
| things to do instead of using restraint | a 1 to 1, sitters constantly redirect unwanted behavior (expensive) CDM, camera's used to watch and say stuff to the pts (cheaper but unsafe) |
| false imprisonment | 4 rails up to they don't wander |
| physical devices that limit a patients movement | side rails (4) geri chairs with attached tray ankle, wrist, waist restraints mitts leathers chemical (meds) barricading doorway physical holding |
| negative affects of physical restraints | skin breakdown from irritation contractures from immobilizing joints incontinence depression/anxiety delirium aspiration death - getting trapped/wrapped around neck!! |
| ordering restraints | need an order from MD (PA or CRNP) within one hour - unless serious risk to you or pt (emergent) no restraints prn orders! orders need to be renewed q24 |
| how many types of restraints at once? | one type at a time, physical OR chemical |
| restraint orders should include | type of restraint, justification for the restraint, criteria for removal, what you did to avoid restraints |
| what must the order never be written for | PRN use |
| important things to remember regarding restraints | never spread eagle, side rails are restraints if all 4 are up, geri chairs can be a restraint |
| geri chair as a restraint | pt is unable to remove tray themselves or its not meal time |
| wrist restraint | never tied to rail!! only underneath the bed remove q2 to check skin, fit 2 fingers in can be broken |
| leather wrist restraint | only used in ER or in psych a particular type of restraint and requires lock and key should rarely be used, requires specific orders and assessments can't be broken |
| mitt restraint | used for pickers |
| restraint (behavioral) | chemical (haloperidol) given to agitated pts to control their behavior vit H need order and face to face eval |
| wrapping pts wrist and iv on hand | distracts pt because they can't see it not restraining their wrist make sure it's not too tight! |
| alternatives to restraints | is there something you could treat to avoid restraints?? rule out causes for agitation!! - underlying causes?? involve family in pts care - give them other things to do! reduce stimulation, noise and light distract and redirect use calm voice |
| electronic alarm system on a temporary basis | bed or position sensitive alarms to warn of unassisted activity allow restless pt to walk after ensuring enviro is safe use low height beds |
| ensure enviro is safe | floor mats on each side of bed, wedged pillows, assist with toileting at frequent intervals (regimes) |
| redirect pt | use therapeutic touch, play music or video, offer diversional activities |
| falls are | leading cause of fatal and non fatal injuries in persons 65 years and older |
| in the hospital, older adults are | 50% more likely to have a fall than younger pts |
| after a fall... | high risk for increase LOS, decreased mobility, increased mortality, increased likelihood for discharge to a long-term care facility |
| fall risk | never use restraints simply to prevent a patient from falling, physical restraints can increase poss of serious injury due to a fall |
| for fall risk pts, you should | give room near nurses station, give time when you are coming back, call bell/personal items within reach, hourly rounding, bed/chair alarms, non skid footwear/socks, alert staff to fall risk |
| when restraints are the last resort | first option is the least restrictive, must never be applied for the convenience of the staff, notify family member or contact person if pt is not able to |
| negative outcomes associated with restraint use | skin break down, contractures, incontinence, depression, delirium, anxiety, aspiration and respiratory difficulties, death |
| care of pt in restraints | routine toileting, circulation check q2 or more, two finger check for tightness, remove and do range of motion a2, food and water, proper documentation, attach to frame NOT side rail |
Created by:
leh195