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What site are restraints most used?
ED/Psych emergency services
Explain how a long-term psych rehab facility will plan to increase the safety when a patient becomes violent to himself or others?
- Care/behavioral planning
- increased stabilization on medication
- varied diversionary activities and space
- higher number of staff
- diverse team approach
What are the 4 risks of physical restraints?
What does regression mean when someone is restrained?
- Either behavioral and cognitive regression
- Or, regression of rehabilitation goals
T or F: a patient who tries to punch you, but then stops and continues to yell menacingly should be put in restraints.
False: Only if they continue to be physically aggressive or come towards you with intent of hurting you.
T or F: Use of physical restraints may be written as a PRN or standing order for patients who are at high risk of assault and have a hx of assault.
False: In an emergency, a nurse may place a patient in seclusion or restraint but must obtain a written or verbal order as soon as possible thereafter. Orders for restraint or seclusion are never written as a PRN or as a standing order.
How long can each of these age groups be in a physical restraint before a new order needs to be placed? What is the maximum amount of hours a person can be restrained?
1. 18 or older
2. 9-17 years old
3. Under 9
- 1. 4 hours
- 2. 2 hours
- 3. 1 hour
- 24 hour max
How often are vitals signs and ROM monitored for a child in physical restraints?
Other than vitals and ROM, what else will you monitor for with someone under physical restraints?
Hydration, elimination, comfort, and other psychological and physical needs.
What must a patient demonstrate to be relieved of a physical restraint?
Patient must be able to follow commands and stay in control.
If there's a potential for violence to occur, list possible interventions that should be used before trying to put someone in physical restraints.
- increasing supervision
- reducing stimulation
- addressing paranoia and other contributing symptoms
- providing constructive diversion and outlets for physical energy
- de-escalating tension verbally
If someone who is escalating to become physically aggressive, should you acknowledge the patient's needs that are irrational or impossible to meet?
Yes, the patient needs reassurance that others are interested and willing to help
T or F: When de-escalating an angry patient, your eyes should meet theirs.
True: your eyes should be on the same level to decrease a sense of intimidation and communicate that you are speaking as equals.
1. Governs rational responses ___
2. Governs emotional responses ___
a. frontal cortex
This theme: "I do not deserve to be treated that way, she is doing it on purpose", comes from this theory.
Pattern of Interpretation:
List the 3 part cycle of violence and abuse
- 1. Tension building phase
- 2. Battering Phase
- 3. Honeymoon Phase
What will you possibly see with both the Perpetrator and victim during the tension building phase?
- Perpetrator BX: edgy, verbal digs, shoving, slapping
- Victim BX: internalizes blame (blames themselves), walking on egg shells to avoid escalation
What are Perpetrator and victim BX during the battering phase?
Perpetrator: attacks victim, this phase becomes longer and more frequent, or more intense
Victim: unbearable tension, victim may provoke perpetrator just to get it over with, victim often hides abuse
What are perpetrator and victim bx during the Honeymoon phase?
Perpetrator: contrite, sorry, loving behavior, only point where perpetrator blames himself, promises to change, acts like nothing happened after a while
Victim: wants to believe or does believe that things will change, reframes violence as "it means he cares"
What is Munchausen?
fake disease of child or someone a caregiver is in charge of to get attention