Unit-8 Physical safety

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Author:
finess00
ID:
41191
Filename:
Unit-8 Physical safety
Updated:
2010-10-10 20:27:27
Tags:
Nursing
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Description:
Potter/Perry
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  1. Physical Assesment risk factors
    • 1. Life span issues
    • 2. Life style
    • 3. Mobility & health status
    • 4. Communication ability
    • 5. Environmantal factors
    • 6. Cognitive awareness
    • 7. Sensory/Preception alterations
    • 8. Emotional state
  2. Calculating risks tools
    • Morse fall scale
    • Hendrich II fall Risk Model
  3. Nursind diagnoses for physical safety
    • Risk for injury
    • Risk for falls
  4. Planning and implementation for physical safety
    • Prevention
    • Use of Restraints
  5. What should you try prevent
    • Scalds & burns- prevent at home and hospitals
    • Fire- if there is a fire use RACE or SAVE
    • Falls- never leave a weak/dizzy client alone
  6. Types of use of restraints
    • Physical
    • Chemical
    • Emotional
  7. Physical restraints
    • To prevent cl from hurting self or others, for safety
    • Never a substitue for nursing care
    • If applied,
    • Inform family
    • Check cl at least every 30 mins
    • Remove every 2 hours and check circulation movement and sensation.
    • Document time, reason, cl response, education, and care.
    • Reasses every shift prn
  8. Chemical restraints
    use of medication
  9. Emotional restraints
    threats and verbal abuse
  10. Evaluation of physical safety
    • Alternatives to restraints
    • Client Response
    • Communication of data
  11. ALternatives to restraints
    • Correct underlying problems
    • Pay attention to tubing
    • Minimize combativeness
    • Minimize fall risk & wandering
    • Bed /chair alarm
  12. Common legal problems
    • Client falls
    • Improper use of equipment
    • Failure to provide enough monitoring (failure to rescue)
    • Failure to communicate
  13. Communication of data includes
    • Common legal problems
    • Purpose of cl records
    • Types of Documents
    • Chart forms
    • Guidelines for recording/reporting
  14. Types of documentation
    • Narritive- organize using DAR, Data, Action, Response
    • Sourse oriented (SOMR)
    • Problem Oriented (POMR)
    • Charting by exception- WNL, WDL
    • Critical pathways- mapping where the cl should be
    • computer/informatics
  15. Types of POMR
    SOAPIE, PIE

    • Subjective
    • Objective
    • Assessment
    • Planning
    • Implementaion
    • Evaluation

    • Problem
    • Intervention
    • Evaluation
  16. What to use when Hand off report
    • SBAR
    • Situation
    • Background
    • Assessment
    • Recommend
  17. Signatures
    First inital, last name, title
  18. Errors/mistakes entries
    draw line through, write error or ME above, date & inital it.

    Write Late entry, if someone charted before your time
  19. incidents/ occurrence reports
    do not mention litigations in charts
  20. sentinel events
    • unexpected incidents causing or risking death or serious injury.
    • Many involve an in depth investigation

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