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Safety

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Safety Foundations of Nursing Christensen Kockrow Mosby Sharon L. Kinley Schwing BSN 2006 Leslie Lehmkuhl RN 2009 Safety The need for a safe environment is always ... – PowerPoint PPT presentation

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Title: Safety


1
Safety
  • Foundations of Nursing
  • Christensen Kockrow
  • Mosby

Sharon L. Kinley Schwing BSN 2006 Leslie
Lehmkuhl RN 2009
2
Safety
  • The need for a safe environment is always
    present.
  • A safe environment implies freedom from injury
    with focus on helping to prevent falls,
    electrical injuries, fires, burns, and poisoning.
  • Both protection and education are primary nursing
    responsibilities, with nurses directly and
    actively involved in ensuring a safe health care
    environment.

3
SAFETY continued
  • The first priority in providing client care.
  • Constant attention to safety factors enables the
    nurse to maintain a safe environment for the
    client.
  • Safety is associated with health promotion and
    illness prevention.

4
FACTORS AFFECTING SAFETY
  • Age
  • Lifestyle/occupation
  • Sensory/perceptual changes
  • Mobility
  • Emotional state

5
Safe Environment
  • The need for a safe environment is always needed
    for every body.
  • Focus is placed on the
  • Immediate environment
  • Local concerns
  • National concern
  • This includes many issues within the environment.

6
Safety Is for Every Age
7
ACCIDENTS IN THE HEALTH CARE SETTING
  • Client behavior accidentsclients behavior or
    actions.
  • Therapeutic procedure accidentsdelivery of
    medical or nursing interventions.
  • Equipment accidentsmalfunction, improper use of
    medical equipment.

8
Precautions to Promote Safety
  • Orient patient to environment.
  • Place bedside table, and needed items within
    reach.
  • Assist patients who have had surgery, receiving
    narcotics, or are sedated.
  • Assist all patients during ambulation, or the
    first time out of bed.
  • Use bed alarms for the restless, confused
    patient.
  • Where non-slip shoes.

9
IDENTIFY CLIENT
  • Checking the clients ID band ensures that the
    correct person receives care.
  • Client identification is essential before
    rendering any care.

10
Precautions to Promote Safety continued
  • Wipe, mop up spills to prevent injury.
  • Adequate lighting.
  • Emergency light, call bells in reach.
  • Answer bells in a timely manner.
  • Follow all fall precaution policies, adopted
    by your institution.

11
Nurses Responsibilities
  • Overall safety of the patient.
  • Safe hospital environment.
  • Recognition and identification of potential
    hazards, and threats within the work setting.
  • Freedom from injury for patients, visitors and
    staff.
  • Providing and maintaining a safe environment
    within the work place.
  • See JACHO recommended patient safety goals.

12
Left Handed
  • Unique challenges.
  • Hospital rooms are typically set up for right
    handed patients, and nurses !
  • 12-30 of the population is a south paw.
  • Being left handed increases the risk of injury
    for a patient.

13
Safety for the Left Handed Patient
  • Place all bathing articles at the patients left.
  • Left hand may be stronger by nature than the
    right.
  • Arrange meal trays, so that silverware, and
    drinks are at the left.
  • Ambulate the pt. by walking on the left side.
  • Adjust the patient room to accommodate the left
    handed patient.

14
Falls
  • Common problem.
  • All patients are at risk for a fall.
  • Majority of patients fall during a transfer of
    some type.
  • Fall are the major , 1 concern for all
    patients in all institutions.
  • Very young, older adults, ill, and injured are
    all at risk for a fall.
  • Use of Anesthesia, sedatives, and or narcotics
    increase the risk of falls.

15
Safety Reminder Devices
  • SRD/ defined as any number of devices used to
    immobilize a patient, or any part of the
    patients body part.
  • When would a SRD be used ?
  • What is the downside of SRDs ?
  • Doctors orders must be obtained. Patients must
    be closely watched.
  • Documentation includes Why, How, How long,
    pts response.

16
Elderly Safety
17
Applying Safety Reminder Devices
  • Safety reminder device (SRD) is any device that
    immobilizes the patient or a part of the patient.
  • Soft restraint (Posey).
  • Used for patient safety and maintain treatment.
  • Prevent the disoriented patient from wondering
    and prevent or reduce risk of patients falling.
  • May be used with aggressive patient to protect
    other patients and staff.

18
Extremity (ankle or wrist) Restraint
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
19
Precautions When Using SRDs
  • Document the following
  • Position of device
  • Circulation
  • Physical and mental status
  • Ongoing need for the device
  • SRDs should be removed at least every 2 hours and
    the skin assessed
  • Know the agency policy and procedures regarding
    SRD use

20
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21
Use of Gait Belts
  • Apply gait belt securely around patients waist.
  • Walk to the side of the patient.
  • Nurse should walk on the patients weaker side.
  • Use of hand rail, support systems as needed.
  • Remove gait belt after ambulation.
  • Document procedure.

22
Infants and Children
  • Infants and children require different type of
    safety within their environment.
  • These small patient require protection within
    their environments.
  • Accidents involving children are largely
    preventable.
  • Growth and development skills need to be taken
    into consideration, during the care of the young
    patient.

23
Older Adult Considerations
  • Adults taken many different medications, and have
    an increase in fall risks.
  • Use of safety devices are encouraged.
  • Accidental poisoning/over doses are common in
    adults.
  • Changes in Vision
  • Perception
  • Hearing
  • Muscle
    strength
  • Joint
    function

  • Cardiovascular
  • Peripheral
    vascular system

24
Safety within theHospital/Health Care
Environment
  • Hospital environment is a source of potential
    hazards.
  • Use of various biologic, chemical, and physical
    hazards have been identified.
  • Use of laser, can cause skin and eye irritation.
    Fire risks are increased.
  • Exposure to blood, body fluids, needle, radiation
    and resp. diseases pose threats to all hospital
    personnel.
  • Needle sticks are still the prime source of blood
    borne pathogens.
  • Do not Recap and needle-less systems are now
    common practice

25
Work Place Safety
  • Employee Right to Know Laws
  • Regulation Relation to Hazardous Materials
  • Material Safety Data Sheets

26
USE PROPER BODY MECHANICS
  • Center of gravitylocated in center of body, in
    pelvic area. All movement should pivot around
    this central point.
  • Base of supportfeet are base of support. The
    feet should be kept wide apart when lifting heavy
    items.

27
Patient Teaching for Infection Control
  • The nurse will need to educate patient about the
    nature of infection and the techniques to use in
    planning or controlling its spread.
  • Infection control for home and hospice settings.
  • Prevention of infection.
  • Hand washing
  • Food preparation
  • IV lines
  • Waste containers
  • Body fluid spills

28
Hospital Environment
  • The hospital environment is a source of potential
    safety hazards to health care workers
  • Biological
  • Chemical
  • Physical hazards
  • Blood and body fluids
  • Radiation
  • Contaminated needles
  • Equipment

29
Electrical Hazards
  • Much of the equipment used in health care are
    electrical.
  • Use of properly grounded plugs.
  • Use of only red plugs for life supportive
    equipment.
  • Do not use any equipment that is in poor
    condition.
  • Avoid use of electrical equipment , in or near
    water.

30
REDUCE EXPOSURE TO RADIATION
  • Minimize time spent in contact with and distance
    from the radiation source.
  • Use appropriate radiation shields.
  • Monitor exposure with a film badge.
  • Label all potentially radioactive material.
  • Never touch dislodged implants or body fluids of
    a client receiving radiation.

31
  • Radiation
  • Radiation and radioactive materials are
  • used to treat and diagnosis
    diseases.
  • Environment related risks are present.
  • Minimize time / Maximize distance
  • Wear monitors / Never touch dislodged implant
  • Mercury Spill
  • Mercury is considered a hazardous
    chemical
  • according to OSHA.
  • Mercury spill cleanup procedures.

32
Safety Promotion
  • Education is the key to safety in and out of the
    hospital !
  • What are some examples of safety education ?

33
Cultural and Ethnic Considerations
  • Cultural heritage affects all dimensions of
    health, in and out of the hospital.
  • Ones culture may influence a persons every day
    life.
  • The medical personnel need to understand their
    own cultural beliefs, prior to taking care of
    patients.
  • Planning is as important as implementation when
    it comes to cultural and ethic differences, and
    patient care.

34
Ensuring Fire Safety
  • Both homes and health care facilities are at risk
    for fire.
  • Fire in health care facility are most often
    related to smoking in bed.
  • Statistics report that approximately 8100
    hospital and 4300 nursing home fires occur
    yearly.
  • Established fore safety programs are mandatory
    for health care facilities.
  • All employees should know hospital policies,
    escape routes, and location of all fire
    equipment.
  • RACE

35
Ensuring Fire Safety Continued
  • Fires in the health care facility are often
    related to smoking in bed or faulty electrical
    equipment.
  • Established fire safety program is mandatory for
    all facilities.
  • Prevention by
  • Elimination of combustible materials
  • Maintenance of fire protection devices, and
    equipment
  • Special precautions for cooking and laundry
    equipment

36
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37
PREVENT FIRE
  • Make sure fire exits are clearly marked.
  • Identify the locations and demonstrate the
    operation of fire extinguishers.
  • Practice fire evacuation procedures.

38
PREVENT FIRE (continued)
  • Post emergency phone numbers near all telephones.
  • Keep open spaces and hallways clear of obstacles.
  • Check electrical cords for exposed or damaged
    wires.
  • Teach clients about fire hazards.

39
Disaster Planning
  • Disaster planning, or emergency preparedness,
    enables rescuers to respond.
  • A disaster situation is and uncontrollable ,
    unexpected, psychologically shocking.
  • Disaster situations are unique, and directly
    affects health care facilities.
  • What thing are considered disasters?
  • What affects response to disasters?

40
Accidental Poisoning/Interventions
  • When a poisoning occurs.
  • Assess for changes in mental status.
  • Notify the poison control center.
  • Do not induce vomiting unless directed.
  • Wash hands
  • Document
  • Follow-up
  • Reduce risk of accidental overdose.

41
Accidental Poisoning
  • Childhood poisoning is one the major causes of
    death in children under 5 years of age.
  • Specific antidotes and treatments are available
    for all types of poisons.
  • Potential for accidental poisoning
  • Cleaning solutions and disinfectants
  • Drugs
  • Substances in unmarked containers

42
OTHER IMPLEMENTATIONS
  • Prevent poisoning.
  • Prevent choking.
  • Prevent suffocation.
  • Prevent drowning.
  • Reduce noise pollution.

43
Hygiene and Care of the Patients Environment
44
HYGIENE
  • The study of health and ways of preserving
    health.
  • Provides comfort and relaxation, improves
    self-image, and promotes cleanliness and healthy
    skin.
  • Part of safety in that proper hygiene protects
    the client against disease.

45
  • When providing the patients hygiene needs, the
    nurse has a opportunity to observe the patient.
  • All body systems can be assessed during the days
    care.
  • Patients are often place in a dependant role.
  • Nurse will help the patient remain as independent
    as possible, teaching health promotion and
    hygiene.

46
  • Hygiene, the science of health. Includes care of
    the whole body.
  • Conscientious personal hygienic practices are
    essential for the nurse. Nurses are role models
    .
  • Promotion of medical asepsis, clean technique.
  • Hygiene inhibits the growth and spread of
    pathogenic microorganisms.

47
Factors that Influence a Patients
Personal Hygiene
  • Social practice.
  • Body Image.
  • Socioeconomic status.
  • Knowledge.
  • Personal preference.
  • Physical condition
  • Cultural variables.

48
Cultural and Ethnic considerations
Personal Hygiene
  • Touching or lack of touch has cultural
    significance and symbolism.
  • Chinese-Americans, and Vietnamese Americans may
    view tasks associated with closeness and touch
    as being offensive.
  • Nurses must be aware of each patients reaction
    to touch.
  • Individual preferences usually do not affect
    health care, and must be added onto the care
    plan.

49
CULTURAL CONSIDERATIONS cont.
  • Bathing hygiene is different within many
    cultures. Some cultures believe that hot water
    may be added to cold, however cold may never be
    added to hot.
  • Some cultures do not permit women to submerge
    their bodies in water during menstruationfear
    that she may drown.
  • North Americans typically bathe daily and use
    deodorant products.
  • Many Europeans do not bathe daily or use
    deodorant products.

50
Components of Patients Hygiene
  • Care of the skin
  • Oral hygiene
  • Hair care
  • Perineal care
  • Eye, ear, and nose care

51
PROVIDE FOR CLIENTS BATHING NEEDS
  • Cleansing bathsroutine for personal hygiene
  • Shower
  • Tub Bath
  • Self help/Complete bed /Partial bath
  • Therapeutic Bathes

52
PROVIDE FOR CLIENTS BATHING NEEDS (continued)
  • Therapeutic bathsrequire a physicians order
    stating type of bath, body surface to be treated,
    type of medicated solutions to be used
  • Hot, warm, or tepid
  • Soak or sitz
  • Oatmeal, cornstarch, sodium bicarbonate

53
OTHER HYGIENE IMPLEMENTATIONS
  • Provide clean bed linen.
  • Provide perineal care.
  • Offer back rubs.

54
  • Provide foot and toenail care.
  • Provide oral care.
  • Provide hair care.
  • Provide eye, ear, and nose care.

55
Sitz Bath
56
Personal Hygiene for Nurses
  • Daily bath or shower.
  • Strong, odorless and effective deodorant
    everyday.
  • Clean undergarments.
  • Clean uniform daily.
  • Shampoo hair as necessary to maintain
    cleanliness.

57
  • Keep hair off collar.
  • Wear hose or socks.
  • Wear white comfortable shoes.
  • Short , clean fingernails.
  • Minimal to moderate make-up.

58
  • Small earrings.
  • Very light cologne, perfume, aftershave.
  • Standard departmental uniform.
  • Facial hair, clean and short, neatly trimmed.
  • Breath mints.

59
Patients Room Environment
  • Patients with sever illnesses may be restricted
    to prolonged bed rest.
  • Patients with limitations such as traction,
    casts, or monitoring equipment.
  • Rooms should be comfortable and safe, increases
    the sense of well-being.

60
  • The patients illness can not be controlled,
    however something can be controlled.
  • Emptying and rinsing bedpans, and bedside
    commodes keep the room order free, and encourages
    a restful environment.
  • A patients energy must be directed toward
    recovery, keeping environment stimuli to a
    minimal will encourage this.

61
A typical hospital room.
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
62
Room Equipment
  • Bedside stand.
  • Over bed table.
  • Chairs, lounge and straight back.
  • Lights.
  • Call bell.
  • Beds.
  • Water repellent mattresses.
  • Bed controls.

63
Bathing
  • The extent of the patient's bath and methods
    used for bathing depend on t e patient's
    capabilities, and degree of hygiene required.
  • Sitz bath
  • Cool water tub bath
  • Warm water tub bath
  • Hot water tub bath
  • Other baths
  • Back care/Bath rub

64
Bed bath.
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
65
Bed bath.
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
66
Nursing Process for Hygiene
  • Determine if the patient can tolerate hygienic
    procedures
  • Nursing diagnoses
  • Oral mucous membrane, impaired
  • Mobility, impaired physical
  • Skin integrity, impaired
  • Self-care deficit bathing/hygiene,
    dressing/grooming

67
Care of the Skin
  • Normal skin has the following characteristics
  • Intact without abrasions.
  • Warm and Moist.
  • Localized changes in texture across
    surface.
  • Good turgor, generally smooth and soft.
  • Skin color variations from body part to
    body part.
  • Prevention is the ultimate goal, when not
    possible, interventions can result in
  • Healing
  • Decrease discomfort
  • Decrease length on hospitalization.

68
Stages of Pressure Ulcers
  • I Nonblanchable erythema of the intact skin.
  • II Partial-thickness skin loss involves
    epidermis and or dermis.
  • III Full-thickness skin loss involves damage or
    necrosis of subcutaneous tissue that may extend
    down to but not through underlying fascia.
  • IV Full-thickness skin loss occurs with
    extensive destruction, tissue necrosis, or damage
    to muscle, bone, or supporting structures.

69
Diagram of shearing force exerted against sacral
area.
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
70
Stage I pressure ulcer.
Stage II pressure ulcer.
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
71
Stage III pressure ulcer .
Stage IV pressure ulcer .
72
Stage IV Pressure Ulcer
73
Oral Hygiene
  • Oral hygiene
  • Dentures
  • Oral care must be provided on a regular basis.
  • Beneficial outcomes of oral hygiene may not be
    seen for several days.
  • Repeated cleansing is often needed to remove
    tenacious dried, including the tongue.

74
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75
Conditions that Place Patients at Risk
for Oral Disorders
  • Lack of knowledge about oral hygiene.
  • Inability of perform oral care.
  • Alteration in the integrity of teeth and mucosa
    resulting from disease or treatments.
  • Lack of aggressive care.

76
Patients who are particularly at risk
  • Paralysis

  • Diabetes
  • Being seriously ill

  • NPO Status
  • Upper extremity activity limitations

  • Radiation therapy
  • Unconsciousness

  • Chemotherapy drugs
  • Disorientation

  • Oral surgery

77
Hair Care
  • Proper hair care is important to the patients
    self image.
  • Bed ridden patients hair may soon become
    tangled.
  • Patients are aware of their appearance.
  • Good hair care must be completed daily.
  • Shampoo, and cleansing might have to be
    completed for the bed ridden patients in bed.

78
  • Shaving the patient.
  • Hand, foot and Nail Care.
  • Perineal Care.
  • Perineal care, Indwelling catheter.
  • Eye, Ear, and Nose Care.
  • Contact lens
  • Hearing aids

79
Hearing aid.
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
80
Assisting the Patient with Elimination
  • The nurse should offer the bedpan or urinal
    frequently.
  • This procedure is personal and the patient should
    be afforded as much privacy as his or her
    condition allows.
  • It is not unusual for the patient to
    procrastinate using the bedpan because it is
    uncomfortable and embarrassing.
  • Poor cleaning after elimination leads to skin
    break down.

81
Care of the Incontinent Patient
  • Incontinence characterized by urine of fecal slow
    at unpredictable times.
  • Incontinence is a very common problem,
    especially among older adults.
  • Incontinence is due to pressure in the bladder,
    or sphincter is weak.
  • Incontinence may be a small leak.
  • Products to guard against incontinence must be
    kept discreet for the alert patient.

82
Care of the Comatose Client
  • Eye Care
  • Wipe gentle every four hours.
  • Keep moist / Liquid tears.
  • Shields or tape gently closed.
  • Oral Care
  • Never used fingers or tongue blade
  • Assess gag reflex.
  • Small amount of liquids / have suction on.
  • Prevent aspiration.

83
Patient Teaching Hygiene
  • Initiated at the beginning of hospitalization
    and though out.
  • Independence should be taught and encouraged.
  • Explain steps.
  • Teach elderly how to evaluated water
    temperatures.
  • Teach proper cleaning.
  • Hand washing.
  • Use of sunscreen
  • Prevention or healing of chapped, dry lips.
  • Teach care and cleaning of dentures.

84
Home Health Considerations
Hygienic Care
  • Bathing
  • Skin Care
  • Oral Care
  • Hair care
  • Shaving
  • Nail and Feet
  • Bed making

85
Nursing Process
  • Assessment
  • Nursing Diagnosis
  • Expected Outcome/Planning
  • Implementation
  • Evaluation

86
Nursing Process
  • Using the nursing process, nurses can reduce the
    risk of injury to patients
  • Diagnoses
  • Risk for falls
  • Impaired physical mobility
  • Interventions
  • Health promotions
  • Developmental considerations
  • Environmental protection

87
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