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Nursing Management of Clients with Stressors that Affect Safety. NUR101 Fall 2010 LECTURE # 3 K. Burger, MSEd , MSN, RN, CNE PPP By: Sharon Niggemeier RN MSN Revised kburger806,707. Therapeutic Environment.

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Nursing Management of Clients with Stressors that Affect Safety

NUR101

Fall 2010

LECTURE # 3

K. Burger, MSEd, MSN, RN, CNE

PPP By: Sharon Niggemeier RN MSN

Revised kburger806,707


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Therapeutic Environment

  • Safe environment = where one is protected from physical and psychological harm – A basic human need according to ____________?

  • Place where participants can feel safe to move toward common goals

  • Nurses need to identify potential risks and unsafe situations.


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Client Factors that Affect Safety

  • Developmental

  • Mobility

  • Sensory Perception

  • Knowledge

  • Communication

  • Physical Health

  • Mental state

  • Lifestyle


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Common Safety Hazards in Health Care Facilities

  • Falls- accidental injury from pt. falls

  • Equipment misuse - injury from improper use of equipment: Hoyer lifts/IV pumps etc.

  • Procedural errors – medication errors, nosocomialinfections, misidentification

  • Client-inherent accidents – seizures, smoking, self-inflicted injuries


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Safety @ the Bedside

  • Bed lowest position; wheels locked

  • No spills

  • Clutter-free

  • Good lighting

  • Necessary articles within reach

  • Call bell within reach

  • Side-rails up as appropriate


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Fall Prevention Measures

  • Every client MUST be assessed for their RISK for FALLS upon admission and daily

  • Utilize a Fall Risk Assessment Tool

  • Fall Risks= history of falls, certain medications, urinary/bowel urgency, in addition to factors listed above.

  • JCAHO National Patient Safety Goals


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What is the first step in preventing falls and injury?

  • Determine who is a greatest risk

    Who are the people @ greatest risk?

  • Hx of falls

  • Impaired vision / hearing

  • Impaired gait

  • Hx of CVA

  • CV disease ( postural hypotension )


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Fall Prevention Measures

  • Assist with transferring and ambulating

  • Reduce visual/hearing impairments

  • Orient client frequently

  • Maintain adequate lighting

  • Use assistive devices and staff prn

  • Proper footwear and clothing


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Fall Prevention Measures

  • Anticipate needs – toileting/bathing

  • Educate client and family

  • Exercise to strengthen muscles

  • Change client position slowly


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  • Identify OTHER fall prevention measures

  • Check medication schedules (diuretics?)

  • Clutter free environment

  • Keep needed items in reach

  • Staff should move slowly around ambulatory patients

  • Frequent reassessment


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Last resort

Used when client may cause harm to self or others

Used when alternative methods have failed

MD order needed

Must check 15min after applying

Must check every 30 min

Must REMOVE every 2 hours

Must DOCUMENT behavior justifying restraint & failure of alternative methods

Protective Devices(Physical Restraints)


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Posey vest

Limb immobilizer

Belt

Mitts

Elbow

Mummy wrap

Geri chair

Side rails

Chemicals

Any device that prevents the pt. from freely moving is considered a restraint or protective device !!

Types of Protective Devices


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Alternatives to Restraints

  • Move client closer to nurse’s station

  • One-to-one monitoring

  • Re-orient frequently

  • Change/eliminate bothersome treatments

  • Make environment safe for exercise and ambulation

  • Electronic alarm devices


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Fall Risk AssessmentThink-Pair-Share

  • Complete Fall Risk Assessments on Case-Study Handout.

  • Pair with a partner

  • Share and discuss your assessments


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Oxygen Safety

  • Avoid open flames

  • Post no smoking signs

  • Advise client and visitors of O2 safety measures

  • Avoid oil based petroleum and synthetic fabrics

  • Check electrical equipment doesn’t emit sparks


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Fire Safety

  • A fire requires 3 elements

  • Oxygen

  • Fuel

  • Spark


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Fire Safety

  • Greatest danger in a fire is PANIC so stay calm!!!!!

  • Your ability/knowledge to think and act quickly will save lives

  • Don’t yell FIRE

  • Remember : R A C E


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Fire Safety-RACE

R- Remove patients, visitors and staff from immediate area

A- Alarm. Pull the fire alarm

C–Contain the fire. Close doors and windows

E- Extinguish the fire only if it is safe and practical


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Fire SafetyOperating a Fire Extinquisher

P- Pull the pin

A- Aim at base

S- Squeeze trigger

S- Sweep from side to side


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Fire safety

  • Type ABC fire extinguishers (common in health facilities) used on any type of fire

  • Know how to report a fire; each facility differs

  • Be aware of fire alarms/fire exits/ fire extinguishers

  • Listen to the sound of the alarm bells; this tells the location of the fire

  • Don’t use elevators- use stairs


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Fire SafetyWhen the Fire Alarm Sounds

  • Close all doors

  • Clear hallways

  • Avoid unnecessary talking

    so instructions can be heard

  • Place wet towels /sheets

    at the bottom of closed doors

    to contain fire/smoke

  • Turn on all lights


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Fire Safety-Evacuation

  • Horizontal evacuation- move across from one area to another

  • Vertical evacuation is moving down from one floor to another

  • Have ambulatory clients hold hands and form a chain evacuating using stairs. Always escorted by staff

  • Nonambulatory pt. need to be carried or dragged using sheets


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Chemical Safety

  • Exposure to hazardous

    chemicals

  • Material Safety Data Sheets (MSDS)

  • You have the right to know what chemicals you could be exposed to and how to be treated if exposed


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Radiation Safety

  • Private lead-lined room

  • Staff and visitors are restricted in amount of time spent in room

  • Distance is also maintained between client & staff/visitors

  • Use of dosimeters


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Safety Precautions Latex Allergy

  • Health care workers at risk

  • Frequently hospitalized clients at risk

  • Clients with hx of allergy to banana higher risk

  • Types of reaction – immediate versus delayed hypersensitivity

  • Latex alert labeling

  • Awareness of latex content


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Bioterrorism Preparedness

  • Emergency Management PlanA JCAHO mandate

  • Epidemiologic Awareness:AnthraxSmallpoxPlagueBotulism

  • NYS DOH FACT SHEETS


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What are the (4) major components of an Emergency Management Plan?

  • Mitigation – vulnerability, types of emergencies that might occur

  • Preparedness – resource stockpile

  • Response – triage, reporting

  • Recovery – restoring essential svcs


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Seizure Precautions

  • Airway and suction at bedside of all clients with history and/or potential for seizures

  • If seizure occurs; Protect Client!Lower to floor if necessaryClear surroundingsProtect headAirway in


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Bacteriologic Safety

  • Preventing the spread of microorganisms from person to person

  • The most effective way to prevent the transmission of microbes is by:


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HAND HYGIENE

HAND HYGIENE

HAND HYGIENE


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Chain of Infection

  • Process through which infection occurs:

  • Infectious agent

  • Reservoir

  • Exit from reservoir

  • Means of transmission

  • Portals of entry

  • Susceptible host


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Nursing Interventions to Break the Chain of Infection

  • Control/Elimination of Infectious Agents

  • Control/Elimination of Reservoirs

  • Control portals of exit and entry

  • Controlling/Preventing transmission

  • Protecting susceptible host

  • Promoting normal defense mechanisms with personal hygiene and good nutrition

  • Encouraging proper immunizations


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What immunizations are routinely recommended for the elderly?

  • Pneumococcal

  • Flu

    What immunizations are routinely recommended for HCWs?

  • Hepatitis B

  • Flu


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Stages of Infection

  • Incubation

  • Pro-dromal (latent)

  • Full stage of illness

  • Convalescent Period


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Asepsis

Asepsis -All activities to prevent infection or break the chain of infection

  • Medical Asepsis– “Clean Technique” practices that decrease the number and transfer of pathogens

  • Surgical Asepsis - “Sterile Technique” practices that keep objects free from microbes


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Medical Asepsis

  • HAND HYGIENE!!!!!!!!!!!!!!!!

  • Personal grooming

  • Cleanest to dirtiest

  • Disposal practices

  • Conscientiously follow barrier precautions


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Surgical Asepsis

  • Object is sterile when all microbes and spores have been destroyed

  • Contamination occurs when a non-sterile object touches a sterile object

  • Objects brought into contact with broken skin should be sterile


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Nosocomial Infections

  • Exogenous

  • Endogenous

  • Iatrogenic


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Infection Control

  • Standard precautions

  • Transmission Based precautions

    • Contact

    • Airborne

    • Droplet


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Practices used when caring for ALL patients when coming in contact with body fluids or secretions(except sweat), non-intact skin or mucous membranes

Handwashing

PPE

Sharps

Disposal Practices

Safe injection practices

Respiratory Hygiene/Cough Etiquette(CDC 2007 update)

Standard Precautions


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Transmission Based Precautions

In addition to using Standard Precautions

  • Airborne- used for client with infection spread through the air. (measles, varicella,TB, SARS)

  • Droplet-used for client with infection spread thru large particles/droplets (Influenza, pertussis, Group A strep)

  • Contact used for client with infection spread by direct or indirect contact (VRE, MRSA, C-dificile)


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What PPE is required for:Airborne?Droplet ?Contact ?

What type of room is required for:Airborne?Droplet ?Contact ?


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Isolation Precautions

  • MD orders isolation

  • Based on how pathogen is transmitted

  • Remain in isolation till 3 negative C&S

  • Meet the client’s psychological needs due to isolation

  • Role of Infection Control Nurse


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Isolation-Nursing Responsibilities

  • Explain to client why isolation is needed

  • Post signs outside door

  • Gather supplies

  • Teach family proper donning of PPE


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Critical Thinking

Mrs. Niles is 83 years old and lives alone. She has difficulty walking and relies on a church volunteer group to deliver lunches during the week. Her fixed income limits her ability to buy food. Last week, Mrs. Niles’ sister died. The two sisters had been very close.

As a home care nurse, explain the factors that might increase Mrs. Niles risk for infection


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Critical ThinkingA NOSOCOMIAL STORY

Ms Smiley was admitted to the hospital for foot surgery. Her roommate, Mrs. Sneezy, was in the hospital for an appendectomy. No one ever came to visit Mrs. Sneezy, yet she came down with the flu while in the hospital. None of the hospital personnel had the flu. Three days later, Ms Smiley was recuperating from her foot surgery. The wound on her foot is warm, red, and oozing pus. Nurse Sensitive calls the physician and informs him that the wound looks infected. He tells the nurse that during the surgery his glove tore, and he orders antibiotics for Ms Smiley. The next day, Nurse Sensitive calls in sick to work. She has the flu.


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Critical ThinkingA NOSOCOMIAL STORY

Fill in the blank with either:

Exogenous OR Endogenous OR Iatrogenic

Ms Smiley has a ________________nosocomial infection.

Mrs. Sneezy has a ______________nosocomial infection.

Nurse Sensitive has a ____________nosocomial infection.


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