Michon Dohlman, MSN, RN Erin Larson, MSN, RN Maria Levy, BSN, RN Julie Stene , BSN, RN
Nursing Management of Clients with Stressors that Affect Safety NUR101 Fall 2010 LECTURE # 3 K....
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Transcript of Nursing Management of Clients with Stressors that Affect Safety NUR101 Fall 2010 LECTURE # 3 K....
Nursing Management of Clients with Nursing Management of Clients with
Stressors that AffectStressors that Affect Safety Safety
NUR101NUR101
Fall 2010Fall 2010
LECTURE # 3LECTURE # 3K. Burger, MSEd, MSN, RN, CNEK. Burger, MSEd, MSN, RN, CNEPPP By: Sharon Niggemeier RN MSNPPP By: Sharon Niggemeier RN MSN
Revised kburger806,707Revised kburger806,707
Therapeutic EnvironmentTherapeutic Environment
Safe environment = where one is Safe environment = where one is protected from physical and psychological protected from physical and psychological harm – harm – A basic human need according to A basic human need according to ____________?____________?
Place where participants can feel safe to Place where participants can feel safe to move toward common goalsmove toward common goals
Nurses need to identify potential risks Nurses need to identify potential risks and unsafe situations.and unsafe situations.
Client Factors that Affect SafetyClient Factors that Affect Safety
DevelopmentalDevelopmental MobilityMobility Sensory Sensory
PerceptionPerception KnowledgeKnowledge CommunicationCommunication Physical HealthPhysical Health Mental stateMental state LifestyleLifestyle
Common Safety Hazards in Common Safety Hazards in Health Care FacilitiesHealth Care Facilities
FallsFalls- accidental injury from pt. falls- accidental injury from pt. falls Equipment misuseEquipment misuse - - injury from injury from
improper use of equipment: Hoyer improper use of equipment: Hoyer lifts/IV pumps etc.lifts/IV pumps etc.
Procedural errorsProcedural errors – – medication medication errors, nosocomialerrors, nosocomial infections, infections, misidentificationmisidentification
Client-inherent accidentsClient-inherent accidents – – seizures, seizures, smoking, self-inflicted injuriessmoking, self-inflicted injuries
Safety @ the BedsideSafety @ the Bedside
Bed lowest position; wheels lockedBed lowest position; wheels lockedNo spillsNo spillsClutter-freeClutter-freeGood lightingGood lightingNecessary articles within reachNecessary articles within reachCall bell within reachCall bell within reachSide-rails up as appropriateSide-rails up as appropriate
Fall Prevention MeasuresFall Prevention Measures
Every client MUST be assessed for their Every client MUST be assessed for their RISK for FALLS upon admission and RISK for FALLS upon admission and dailydaily
Utilize a Utilize a Fall Risk Assessment ToolFall Risk Assessment Tool Fall Risks= history of falls, certain Fall Risks= history of falls, certain
medications, urinary/bowel urgency, in medications, urinary/bowel urgency, in addition to factors listed above.addition to factors listed above.
JCAHO National Patient Safety Goals
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What is the first step in preventing falls and What is the first step in preventing falls and injury?injury?
• Determine who is a greatest riskDetermine who is a greatest risk
Who are the people @ greatest risk?Who are the people @ greatest risk?• Hx of fallsHx of falls• Impaired vision / hearingImpaired vision / hearing• Impaired gaitImpaired gait• Hx of CVAHx of CVA• CV disease ( postural hypotension )CV disease ( postural hypotension )
Fall Prevention MeasuresFall Prevention Measures
Assist with transferring and Assist with transferring and ambulatingambulating
Reduce visual/hearing impairmentsReduce visual/hearing impairmentsOrient client frequentlyOrient client frequentlyMaintain adequate lighting Maintain adequate lighting Use assistive devices and staff prnUse assistive devices and staff prnProper footwear and clothingProper footwear and clothing
Fall Prevention MeasuresFall Prevention Measures
Anticipate needs – Anticipate needs – toileting/bathingtoileting/bathing
Educate client and familyEducate client and familyExercise to strengthen musclesExercise to strengthen musclesChange client position slowlyChange client position slowly
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Identify OTHER fall prevention measuresIdentify OTHER fall prevention measures
• Check medication schedules (diuretics?)Check medication schedules (diuretics?)• Clutter free environmentClutter free environment• Keep needed items in reachKeep needed items in reach• Staff should move slowly around Staff should move slowly around
ambulatory patientsambulatory patients• Frequent reassessmentFrequent reassessment
Protective DevicesProtective Devices(Physical Restraints)(Physical Restraints)
Last resortLast resort Used when client Used when client
may cause harm to may cause harm to self or othersself or others
Used when Used when alternative alternative methods have methods have failed failed
MD order neededMD order needed
Must check 15min Must check 15min after applyingafter applying
Must check every Must check every 30 min30 min
Must REMOVE every Must REMOVE every 2 hours2 hours
Must DOCUMENT Must DOCUMENT behavior justifying behavior justifying restraint & failure of restraint & failure of alternative methods alternative methods
Types of Protective DevicesTypes of Protective Devices Posey vestPosey vest Limb immobilizerLimb immobilizer BeltBelt MittsMitts ElbowElbow Mummy wrapMummy wrap Geri chairGeri chair Side railsSide rails ChemicalsChemicals
AnyAny device device that prevents that prevents the pt. from the pt. from freely moving freely moving is considered a is considered a restraint or restraint or protective protective device !!device !!
Alternatives to RestraintsAlternatives to Restraints
Move client closer to nurse’s stationMove client closer to nurse’s station One-to-one monitoringOne-to-one monitoring Re-orient frequentlyRe-orient frequently Change/eliminate bothersome Change/eliminate bothersome
treatmentstreatments Make environment safe for exercise Make environment safe for exercise
and ambulationand ambulation Electronic alarm devicesElectronic alarm devices
Fall Risk AssessmentFall Risk AssessmentThink-Pair-ShareThink-Pair-Share
Complete Fall Risk Assessments on Complete Fall Risk Assessments on Case-Study Handout.Case-Study Handout.
Pair with a partnerPair with a partner
Share and discuss your assessmentsShare and discuss your assessments
Oxygen Safety Oxygen Safety
Avoid open flamesAvoid open flames
Post no smoking signsPost no smoking signs
Advise client and visitors of O2 safety Advise client and visitors of O2 safety measuresmeasures
Avoid oil based petroleum and synthetic Avoid oil based petroleum and synthetic fabricsfabrics
Check electrical equipment doesn’t emit Check electrical equipment doesn’t emit sparkssparks
Fire SafetyFire Safety A fire requires 3 A fire requires 3
elementselements
OxygenOxygen FuelFuel SparkSpark
Fire SafetyFire Safety
Greatest danger in a fire is Greatest danger in a fire is PANICPANIC so so stay calm!!!!!stay calm!!!!!
Your ability/knowledge to think and Your ability/knowledge to think and act quickly will save livesact quickly will save lives
Don’t yell FIREDon’t yell FIRE
Remember : Remember : R A C ER A C E
Fire Safety-RACEFire Safety-RACE
RR- Remove patients, visitors and staff - Remove patients, visitors and staff from immediate areafrom immediate area
AA- Alarm. Pull the fire alarm - Alarm. Pull the fire alarm
CC –Contain the fire. Close doors and –Contain the fire. Close doors and windowswindows
EE- Extinguish the fire only if it is safe - Extinguish the fire only if it is safe and practicaland practical
Fire SafetyFire SafetyOperating a Fire ExtinquisherOperating a Fire Extinquisher
PP- Pull the pin- Pull the pin
AA- Aim at base- Aim at base
SS- Squeeze - Squeeze triggertrigger
SS- Sweep from - Sweep from side to sideside to side
Fire safetyFire safety
Type Type ABC ABC fire extinguishers (common fire extinguishers (common in health facilities) used on any type of in health facilities) used on any type of firefire
Know how to Know how to reportreport a fire; each facility a fire; each facility differsdiffers
Be Be aware aware of fire alarms/fire exits/ fire of fire alarms/fire exits/ fire extinguishers extinguishers
Listen Listen to the sound of the alarm bells; to the sound of the alarm bells; this tells the location of the firethis tells the location of the fire
Don’t use elevators- use Don’t use elevators- use stairsstairs
Fire SafetyFire SafetyWhen the Fire Alarm SoundsWhen the Fire Alarm Sounds
Close all doorsClose all doors Clear hallwaysClear hallways Avoid unnecessary talking Avoid unnecessary talking
so instructions can be heardso instructions can be heard Place wet towels /sheets Place wet towels /sheets
at the bottom of closed doors at the bottom of closed doors
to contain fire/smoketo contain fire/smoke Turn on all lightsTurn on all lights
Fire Safety-EvacuationFire Safety-Evacuation
Horizontal Horizontal evacuation- move across evacuation- move across from one area to anotherfrom one area to another
VerticalVertical evacuation is moving down evacuation is moving down from one floor to anotherfrom one floor to another
Have Have ambulatory clientsambulatory clients hold hands hold hands and form a chain evacuating using and form a chain evacuating using stairs. stairs. Always escorted by staffAlways escorted by staff
Nonambulatory pt.Nonambulatory pt. need to be need to be carried or dragged using sheetscarried or dragged using sheets
Chemical SafetyChemical SafetyExposure to hazardous Exposure to hazardous chemicalschemicalsMaterial Safety Data Sheets Material Safety Data Sheets
(MSDS)(MSDS)You have the right to know what You have the right to know what
chemicals you could be exposed chemicals you could be exposed to and how to be treated if to and how to be treated if exposedexposed
Radiation SafetyRadiation SafetyPrivate lead-lined roomPrivate lead-lined roomStaff and visitors are Staff and visitors are
restricted in amount of time restricted in amount of time spent in roomspent in room
Distance is also maintained Distance is also maintained between client & staff/visitorsbetween client & staff/visitors
Use of dosimeters Use of dosimeters
Safety Precautions Safety Precautions Latex AllergyLatex Allergy
Health care workers at riskHealth care workers at risk Frequently hospitalized clients at riskFrequently hospitalized clients at risk Clients with hx of allergy to banana Clients with hx of allergy to banana
higher riskhigher risk Types of reaction – Types of reaction – immediate versus immediate versus
delayed hypersensitivitydelayed hypersensitivity Latex alert labeling Latex alert labeling Awareness of latex contentAwareness of latex content
Bioterrorism PreparednessBioterrorism Preparedness
Emergency Management PlanEmergency Management PlanA JCAHO mandateA JCAHO mandate
Epidemiologic Awareness:Epidemiologic Awareness:AnthraxAnthraxSmallpoxSmallpoxPlaguePlagueBotulismBotulism
NYS DOH NYS DOH FACT SHEETS
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What are the (4) major components of What are the (4) major components of an Emergency Management Plan?an Emergency Management Plan?
• Mitigation – vulnerability, types of Mitigation – vulnerability, types of emergencies that might occuremergencies that might occur
• Preparedness – resource stockpilePreparedness – resource stockpile• Response – triage, reportingResponse – triage, reporting• Recovery – restoring essential svcsRecovery – restoring essential svcs
Seizure PrecautionsSeizure Precautions
Airway and suction at bedside of all Airway and suction at bedside of all clients with history and/or potential clients with history and/or potential for seizuresfor seizures
If seizure occurs; Protect Client!If seizure occurs; Protect Client!Lower to floor if necessaryLower to floor if necessaryClear surroundingsClear surroundingsProtect headProtect headAirway inAirway in
Bacteriologic SafetyBacteriologic Safety Preventing the spread of Preventing the spread of
microorganisms from person to microorganisms from person to personperson
The most effective way to prevent The most effective way to prevent the transmission of microbes is by:the transmission of microbes is by:
HAND HYGIENEHAND HYGIENE
HAND HYGIENEHAND HYGIENE
HAND HYGIENEHAND HYGIENE
Chain of Infection Chain of Infection
Process through which infection Process through which infection occurs:occurs:
Infectious agentInfectious agent ReservoirReservoir Exit from reservoirExit from reservoir Means of transmissionMeans of transmission Portals of entryPortals of entry Susceptible hostSusceptible host
Nursing Interventions to Break the Nursing Interventions to Break the Chain of InfectionChain of Infection
Control/Elimination of Infectious AgentsControl/Elimination of Infectious Agents Control/Elimination of ReservoirsControl/Elimination of Reservoirs Control portals of exit and entryControl portals of exit and entry Controlling/Preventing transmissionControlling/Preventing transmission Protecting susceptible hostProtecting susceptible host Promoting normal defense mechanisms Promoting normal defense mechanisms
with personal hygiene and good nutritionwith personal hygiene and good nutrition Encouraging proper immunizationsEncouraging proper immunizations
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What immunizations are routinely What immunizations are routinely recommended for the elderly?recommended for the elderly?
• PneumococcalPneumococcal• FluFlu
What immunizations are routinely What immunizations are routinely recommended for HCWs?recommended for HCWs?
• Hepatitis BHepatitis B• FluFlu
Stages of Infection Stages of Infection
IncubationIncubationPro-dromal (latent)Pro-dromal (latent)Full stage of illnessFull stage of illnessConvalescent PeriodConvalescent Period
AsepsisAsepsis
AsepsisAsepsis -All activities to prevent infection -All activities to prevent infection or break the chain of infectionor break the chain of infection
Medical AsepsisMedical Asepsis – “Clean Technique” – “Clean Technique” practices that decrease the number and practices that decrease the number and transfer of pathogenstransfer of pathogens
Surgical Asepsis Surgical Asepsis - “Sterile Technique” - “Sterile Technique” practices that keep objects free from practices that keep objects free from microbes microbes
Medical Asepsis Medical Asepsis HAND HYGIENEHAND HYGIENE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Personal groomingPersonal groomingCleanest to dirtiestCleanest to dirtiestDisposal practicesDisposal practicesConscientiously follow barrier Conscientiously follow barrier
precautionsprecautions
Surgical Asepsis Surgical Asepsis Object is sterile when all Object is sterile when all
microbes and spores have been microbes and spores have been destroyeddestroyed
Contamination occurs when a Contamination occurs when a non-sterile object touches a non-sterile object touches a sterile objectsterile object
Objects brought into contact with Objects brought into contact with broken skin should be sterilebroken skin should be sterile
Nosocomial InfectionsNosocomial InfectionsExogenousExogenousEndogenousEndogenous IatrogenicIatrogenic
Infection Control Infection Control Standard precautionsStandard precautions
Transmission Based precautionsTransmission Based precautions– ContactContact– AirborneAirborne– DropletDroplet
Standard PrecautionsStandard PrecautionsPractices used when Practices used when caring for caring for ALLALL patients patients when coming in contact when coming in contact with body fluids or with body fluids or secretionssecretions(except sweat), non-(except sweat), non-intact skin or mucous intact skin or mucous membranesmembranes
HandwashingHandwashing PPEPPE SharpsSharps Disposal PracticesDisposal Practices Safe injection Safe injection
practicespractices Respiratory Respiratory
Hygiene/Cough Hygiene/Cough EtiquetteEtiquette(CDC 2007 update)(CDC 2007 update)
Transmission Based Transmission Based PrecautionsPrecautions
In addition to using Standard PrecautionsIn addition to using Standard Precautions AirborneAirborne- used for client with infection - used for client with infection
spread through the air. spread through the air. (measles, varicella,TB, SARS)(measles, varicella,TB, SARS)
DropletDroplet-used for client with infection -used for client with infection spread thru large particles/droplets spread thru large particles/droplets (Influenza, pertussis, Group A strep)(Influenza, pertussis, Group A strep)
ContactContact used for client with infection used for client with infection spread by direct or indirect contact spread by direct or indirect contact (VRE, (VRE, MRSA, C-dificile)MRSA, C-dificile)
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What PPE is required for:What PPE is required for:Airborne?Airborne?Droplet ?Droplet ?Contact ?Contact ?
What type of room is required for:What type of room is required for:Airborne?Airborne?Droplet ?Droplet ?Contact ?Contact ?
Isolation PrecautionsIsolation Precautions
MD orders isolationMD orders isolationBased on how pathogen is Based on how pathogen is
transmittedtransmittedRemain in isolation till 3 Remain in isolation till 3
negative C&Snegative C&SMeet the client’s psychological Meet the client’s psychological
needs due to isolationneeds due to isolationRole of Infection Control NurseRole of Infection Control Nurse
Isolation-Nursing ResponsibilitiesIsolation-Nursing ResponsibilitiesExplain to client why isolation is Explain to client why isolation is
neededneededPost signs outside doorPost signs outside doorGather suppliesGather suppliesTeach family proper donning of Teach family proper donning of
PPEPPE
Critical ThinkingCritical Thinking
Mrs. Niles is 83 years old and lives alone. Mrs. Niles is 83 years old and lives alone. She has difficulty walking and relies on a She has difficulty walking and relies on a church volunteer group to deliver lunches church volunteer group to deliver lunches during the week. Her fixed income limits during the week. Her fixed income limits her ability to buy food. Last week, Mrs. her ability to buy food. Last week, Mrs. Niles’ sister died. The two sisters had Niles’ sister died. The two sisters had been very close. been very close.
As a home care nurse, explain the factors As a home care nurse, explain the factors that might increase Mrs. Niles risk for that might increase Mrs. Niles risk for infectioninfection
Critical ThinkingCritical ThinkingA NOSOCOMIAL STORYA NOSOCOMIAL STORY
Ms Smiley was admitted to the hospital for foot Ms Smiley was admitted to the hospital for foot surgery. Her roommate, Mrs. Sneezy, was in surgery. Her roommate, Mrs. Sneezy, was in the hospital for an appendectomy. No one ever the hospital for an appendectomy. No one ever came to visit Mrs. Sneezy, yet she came down came to visit Mrs. Sneezy, yet she came down with the flu while in the hospital. None of the with the flu while in the hospital. None of the hospital personnel had the flu. Three days hospital personnel had the flu. Three days later, Ms Smiley was recuperating from her foot later, Ms Smiley was recuperating from her foot surgery. The wound on her foot is warm, red, surgery. The wound on her foot is warm, red, and oozing pus. Nurse Sensitive calls the and oozing pus. Nurse Sensitive calls the physician and informs him that the wound looks physician and informs him that the wound looks infected. He tells the nurse that during the infected. He tells the nurse that during the surgery his glove tore, and he orders antibiotics surgery his glove tore, and he orders antibiotics for Ms Smiley. The next day, Nurse Sensitive for Ms Smiley. The next day, Nurse Sensitive calls in sick to work. She has the flu.calls in sick to work. She has the flu.
Critical ThinkingCritical ThinkingA NOSOCOMIAL STORYA NOSOCOMIAL STORY
Fill in the blank with either:Fill in the blank with either:Exogenous OR Endogenous OR IatrogenicExogenous OR Endogenous OR Iatrogenic
Ms Smiley has a ________________nosocomial Ms Smiley has a ________________nosocomial infection.infection.
Mrs. Sneezy has a ______________nosocomial Mrs. Sneezy has a ______________nosocomial infection.infection.
Nurse Sensitive has a ____________nosocomial Nurse Sensitive has a ____________nosocomial infection.infection.