Enter Title

INJURY PREVENTION

100

3 inappropriate uses for restraints

What is

• Convenience of the staff
• Punishment for the client
• Clients who are extremely physically or mentally unstable
• Clients who cannot tolerate the decreased stimulation of a seclusion room

200

5 Risk Factors that increase client injuries

What is

• Age and developmental status
• Mobility and balance
• Knowledge about safety hazards
• Sensory and cognitive awareness
• Communication skills
• Home and work environment
• Community in which the client lives
• Lifestyle choices

300

5 ways to prevent falls

What is

• Complete a fall-risk assessment for each client at admission and at regular intervals. 
• Be sure the client knows how to use the call light
• Respond to call lights in a timely manner.
• Use fall-risk alerts (color-coded wristbands).
• Provide regular toileting and orientation of clients who have cognitive impairment.
• Provide adequate lighting.
• Orient clients to the setting
• Place clients at risk for falls near the nurses’ station.
• Provide hourly rounding.
• Make sure’ bedside tables, overbed tables, and frequent-use items (telephone, water, facial tissues) are within reach.
• Keep the bed in the low position and lock the brakes.
• For clients who are sedated, unconscious, or otherwise compromised, keep the side rails up.
• Avoid the use of full side rails 
• Provide nonskid footwear and nonskid bath mats, or bath chairs for use in tubs and showers.
• Use gait belts and additional safety equipment when moving clients.
• Keep the floor clean, dry, and free from clutter with a clear path to the bathroom (no scatter rugs, cords, or furniture).
• Keep assistive devices nearby after validation of safe use (eyeglasses, walkers, transfer devices).
• Educate the client and family about safety risks and the plan of care.
• Lock the wheels on beds, wheelchairs, and carts
• Use electronic safety monitoring devices

400

5 actions required when a client has a seizure

What is

• Stay with the client, and call for help.
• Maintain airway patency and suction PRN.
• Administer medications PRN.
• Note the duration of the seizure and the sequence and type of movements.
• After a seizure, determine mental status and measure oxygenation saturation and vital signs. Explain what happened, and provide comfort, understanding, and a quiet environment for recovery.
• Document the seizure with any precipitating behavior and a description of the event (movements, injuries, duration of seizures, aura, postictal state), and report it to the provider.

500

10 Nursing responsibilities for a client in restraints

What is

• Explain the need for the restraints to the client and family, emphasizing that the restraints keep the client safe and are temporary.
• Ask the client or guardian to sign a consent form.
• Review the manufacturer’s instructions for correct application.
  • Assess skin integrity, and provide skin care according to the facility’s protocol, for example every 2 hr.
  • Offer food and fluid.
  • Provide a means for hygiene and elimination.
  • Monitor vital signs.
  • Offer range-of-motion exercises of extremities.
• Pad bony prominences to prevent skin breakdown.
• Secure/tie restraints to a part of the bed frame that can raise and lower when the bed controls are used.  Do not secure/tie restraints to the side rails of the bed. If restraints with a buckle strap are not available, use a quick-release knot to tie the strap.
• Make sure the restraints are loose enough for range of motion and that there is enough room to fit two fingers between the restraints and the client.
• Remove or replace restraints frequently to ensure good circulation to the area and allow for full range of motion to the limbs.
• Conduct an ongoing evaluation of the client.
• Regularly determine the need to continue using the restraints. 
• Never leave the client alone without the restraints.
• Check facility policy regarding types of restraints. 

The Cooties

100

First line of defense

What is

INTACT SKIN

200

Infections that a client acquires upon indirect contact, while receiving care in a health care setting. Formerly called nosocomial infections, caused by E. coli, Staphylococcus aureus, and enterococci.

What is 

HAI

Health-Care Associated Infection

300

Individuals who have compromised health or defenses against infection include:

Must name 5

What is

• Those who are immunocompromised
• Those who have had surgery
• Those with indwelling devices
• A break in the skin (the body’s best protection against infection).
• Those with poor oxygenation
• Those with impaired circulation
• Those who have chronic or acute disease (diabetes mellitus, adrenal insufficiency, renal failure, hepatic failure, or chronic lung disease)

400

5 Stages of Illness

What is

Incubation: interval between the pathogen entering the body and the presentation of the first finding

Prodromal stage: interval from onset of general findings to more distinct findings; during this time, the pathogen multiplies

Illness stage: interval when findings specific to the infection occur

Decline stage: interval when manifestations begin to subside as the number of pathogens decrease

Convalescence: interval when acute findings disappear, total recovery taking days to months

500

6 Links of infection, IN ORDER

What is

Causative agent

Reservoir/Host

Portal of exit

Mode of Transmission

Portal of entry

Susceptible host

Name that Precaution

100

This tier of precautions applies to all body fluids (except sweat), non-intact skin, and mucous membranes.  

What is

Standard Precaution

200

A private room or a room with other clients who have the same infection. Gloves and gowns worn by the caregivers and visitors. Disposal of infectious dressing material into a single, nonporous bag without touching the outside of the bag.

What is 

Contact Precaution

300

This precaution requires a private room, N95 masks, and respiratory protection devices for caregivers and visitors. Negative pressure airflow exchange in the room, and those with the infection should wear a mask while outside of the room/home.

What is

Airborne precaution

400

Measles, varicella, SARS-CoV-2, pulmonary or laryngeal tuberculosis

What is

Airborne precaution

500

Travel 3 to 6 ft from the client with streptococcal pharyngitis or pneumonia, Haemophilus influenzae type B, scarlet fever, rubella, pertussis, mumps, mycoplasma pneumonia, meningococcal pneumonia and sepsis, pneumonic plague.

What is 

Droplet precaution

UNHAND ME!!!

100

Sedatives, neuroleptic or psychotropic medications

What is

Chemical Restraint

200

4 hr of restraints for an adult, 2 hr for clients ages 9 to 17, and 1 hr for clients younger than 9, with a max of _________

What is 

24 consecutive hours of restraints. 

300

The Mandatory Nursing Assessment Documented Every 2 Hours When Restrained

What is

Circulation, Mental Status, ROM, Skin

400

2 Requirement for restraints

What is

Doctors order and all other less restrictive means have failed to prevent a client from harming themselves or others

500

What is included in the prescription for restraints

Must name 3

What is

The type of restraints, the location of the restraints, how long to use the restraints, and the type of behavior that warrants using the restraints.

Emergency

100

Nursing MAJOR 2 responsibilities

What is

Providing for safety and preventing injury

200

Status Epilepticus

What is

a prolonged seizure and is a medical emergency.

300

The 3rd step in a Fire response

What is 

Contain/Confine the fire by closing doors and windows and turning off any sources of oxygen and any electrical devices. Ventilate clients who are on life support with a bag-valve mask.

400

Priority nursing step to prevent falls

What is 

Nurses must evaluate all clients in health care facilities for risk factors for falls and implement preventative measures accordingly.

500

Proper Ergonomics in Nursing

Must name at least 7

What is

• Have one or more staff members assist with positioning clients. Moving them up in bed is a significant cause of back pain and injury.
• Plan ahead for activities that require lifting, transfer, and ambulation of a client, and ask others to be available to assist.
• Prepare the environment by removing obstacles prior to the procedure.
• Explain the process to the client and assistants to clarify their roles.
• Be aware that the safest way to lift a client is with assistive equipment.
• Rest between heavy activities to decrease muscle fatigue.
• Maintain good posture and exercise regularly to increase the strength of your arms, legs, back, and abdominal muscles, so these activities will require less energy.
• Keep your head and neck in a straight line with your pelvis to avoid neck flexion and hunched shoulders, which can cause impingement of nerves in your neck.
• Use smooth movements when lifting and moving clients to prevent injury from sudden or jerky muscle movements.
• When standing for long periods of time, flex your hips and knees by using a footrest. When sitting for long periods of time, keep your knees slightly higher than your hips.
• Avoid repetitive movements of the hands, wrists, and shoulders. Take a break every 15 to 20 min to flex and stretch joints and muscles whenever possible.
• Avoid twisting your spine or bending at the waist (flexion) to minimize the risk for injury.