Standard protocols Safety Restraints Proper body mechanics Moving positioning clients Range of Motion

1. Standard protocols Safety Restraints Proper body mechanics Moving & positioning clients Range of Motion

2. Standard Protocol for Nsg Interventions Verify physician orders (if dependent) or nursing care plan (if independent) Identify client Introduce yourself, including your title Explain procedure Assess client - interventions necessary? Gather equipment Wash hands

3. Adjust bed height, lower bed rail Provide privacy During skill, promote client involvement & assess client tolerance After skill, client in comfortable position, call light within reach, raise rails, lower bed Remove equipment, wash hands, & document

4. Safety

5. Safety Client health & wellness depend on safety In a safe environment, basic needs are met, physical hazards reduced, transmission of pathogens reduced, sanitation maintained, & pollution controlled (see Fundamentals) Incident report - legal documentation of any unusual occurrence/accident

6. 4 risks to client safety in health care setting falls (90% of all reported incidents) client accidents procedure related accidents equipment related accidents

7. Client at risk for falling 30% of people 65 & older in the community falls at least once a year Determine risk for falling Measures to prevent falls orient client to surroundings explain call bell system & keep within reach assess risk for falling

8. those at risk to fall, assign rooms near nurses� station instruct client to seek help when getting up answer call bell promptly keep bed in low position, side rails up if consent signed keep personal items within reach eliminate clutter

9. Lock wheels on beds, stretchers, w/c maintain toileting & ambulation schedule encourage family participation reorient confused clients as necessary

10. Safe staff behavior walk, don�t run keep to the right turn corners carefully use stretchers properly use brakes on beds, w/c, stretchers place elevators on hold when loading/unloading

11. Safe work spaces Adequate lighting smooth, dry floor surfaces electrical appliances with 3 prong plugs no smoking signs - oxygen supports rapid combustion furniture arranged for easy access no meds left at bedside NEVER RECAP NEEDLES

12. Fire Safety Read fire plan for your institution fire code �code red� or soft bell never use elevators doors close automatically 1st priority - remove patient to safe area report fire location help to contain fire/ await instructions

13. Latex Allergies As a health care professional, you will come into contact with latex products, most commonly gloves. Some individuals are allergic to latex proteins or the powders used in gloves. Reactions range from mild to life threatening. See School of Nursing guidelines.

14. Restraints

15. Restraints Any mechanical, physical, chemical or environmental method used to inhibit, limit or control an individual�s behavior or activity A temporary means to control behavior Professional standard for nurses - use least restrictive device that maintains adequate protection

16. Restraints used to prevent falls & wandering protect from self-injury (pulling out tubes) prevent violence toward others

17. Must have a physician�s order RN can put one in place based on his/her judgement, BUT must have a Dr�s order A.S.A.P. Reasons restraint being used must be clearly documented Explain what you plan to do & why to reduce anxiety & promote cooperation Restraints must be released q2hrs to assess & ROM

18. Types of Restraints Chemical - drugs & meds Nonrestraints - those that the client can release independently (wedge cushion, lap belt) Physical restraints - need consent form signed siderails - stop from rolling out, but not climbing over

19. Jackets & belts - confused & climbing over rails, used to restrain them to the bed. Sleeveless with cross over ties, allows relative freedom in the bed Arm & leg - limits patient movement!! See injuries to wrist & ankle tissue, use extra padding. Restrain in slightly flexed position, NEVER tie to bedrail Mitts - soft boxing glove used for those confused & pulling at tubes, wounds, rashes

20. Hazards of Restraints Pressure sore, pneumonia, constipation, incontinence, contractures Humiliation, fear, anger, decreased self-esteem Altered thought processes DEATH

21. Alternatives to Restraints �restraint free� policies - to ensure that patient live with dignity & make choices about their health more injuries with restraints than without alternatives include encourage family/friends to stay one-to-one at night remove bothersome treatments a.s.a.p

22. Position commode close to bed Place mattress on floor by bed leave rails down or use half rails reduce environmental noise call button within reach involve client in conversation - do not talk over them provide links to reality (tv, radio, calendar) use relaxation techniques provide exercise & ambulation use pressure sensitive beds

23. Body Mechanics

24. Body Mechanics Almost half of injuries sustained by nurses are back injuries - one of the major reasons for ill-health retirement from nsg Need to use proper body mechanics to to reduce risk of injury to the nurse & the client

25. Body mechanics are the coordinated efforts of the musculoskeletal & nervous systems to maintain balance, posture, & body alignment during lifting, bending, moving & performing ADLs. When the body is aligned, no excess strain is placed on the muscles, joints & tendons. Body alignment reduces strain on MSS, maintains muscle tone, & contributes to balance.

26. Body Balance Body balance is achieved when a wide base of support exists, the center of gravity falls within the base of support & a vertical line can be drawn from the center of gravity through the base of support

27. Lifting Objects When lifting an object, come close to the object, enlarge base of support, & lower the center of gravity

28. Without body balance, the center of gravity is displaced, which increases the force of gravity, & puts the person at risk for falls/injury

29. Body Mechanics for Health Care Workers When planning a move, arrange for adequate help Encourage client to assist Keep back, neck, pelvis, & feet aligned Flex knees, keep feet wide apart Position self close to object Use arms & legs, not your back Slide client using a pullsheet Tighten abdominal & gluteal muscles Coordinate by counting to 3 prior to moving client

30. Moving & Positioning

31. Moving & Positioning Clients Mobility - a person�s ability to move about freely Immobility - person unable to move about freely A person with impaired mobility, decreased sensation, & lack of voluntary muscle control can develop damage to the MSS while lying down

32. Benefits of Proper Positioning Maintains body alignment & comfort Prevents injury to musculoskeletal system (MSS) Provides sensory, motor, & cognitive stimulation Prevents strain on muscles Prevents pressure sores & joint contractures

33. Pressure sore, bed sore, decubitus ulcer - begin to occur within 24hr. A local area of tissue necrosis (death) caused when soft tissue is compressed btw. bony prominence & an external surface for a prolonged period of time

34. Joint contracture - form within a few days. Flexion & fixation of the joint caused by atrophy & shortening of muscle fibers