M. Jorgenson, RN BSN

viraginityfumblingSoftware and s/w Development

Nov 2, 2013 (3 years and 7 months ago)

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M. Jorgenson, RN BSN

Patient Safety, Comfort, &
Mobility

Patient Safety


FALLS


are the fifth leading causes of death among
Americans aged 75 years and older


the second leading cause of mortality from
related injuries in adults >65 years


Elderly person who sustains a fall are more likely
to die within a year’s time of the fall.





Considine J, Botti M. Who, when and where? Identification of patients at risk of an in
-
hospital adverse event: implications for
nursing practice.
Int J Nurs
Pract.

2004;10(1):21

31.


Fall Prevention:

Everyone’s Responsibility

Physical restraints


considered as a last resort after other care alternatives have
been unsuccessful



The least restrictive restraint should be used and it should be
removed at the earliest possible time



Must be ordered by a MD or other licensed independent
practitioner



Special monitoring/ assessment



Must be reassessed by ordering MD in 24 hours and new order
obtained


Restraints

Ask family to stay with patient

Rule out physical causes for agitation

Reduce stimulation

Use electronic alarm system

Check for environmental hazards

Offer diversion activities

Consider relocation closer to nurse’s
station

Conceal tubes and tubing necessary for
care


Alternatives to Restraints

Extremity restraints

Jacket or vest restraint

Hand Mitt

Elbow restraints

Leather restraints

Mummy restraints

Bed alarms

Types of Restraints

Must be able to insert 2 fingers between restraint and pt’s ankle or
wrist

Restraint must be fastened on moveable part of bed frame, NEVER
side rail

Use a quick
-
release knot to tie

Must be able to insert a fist between vest restraint and patient

When assessing a restraint, must assess CMS


Circulation


Motor


Sensation

Call bell must be within reach

Restraints cont.

Mobility

Cardiovascular system


Increased cardiac workload, orthostatic hypotension and venous
thrombosis


Respiratory system


Decreased ventilatory effort and increased secretions


Gastrointestinal system


Poor digestion and utilization of food


Constipation


Urinary system


UTI and renal calculi



Effects of Immobility


Musculoskeletal system


Atrophy, osteoporosis


Metabolic system


Decrease in metabolism


Integument system


Skin breakdown


Psychological well
-
being


Diminished self
-
esteem, social disturbances

Effects of Immobility cont.

Be organized and plan ahead


Anticipate changes/complications


Prevention versus treatment


Develop good habits


Proper alignment

Preparing for Activity.

Check MD orders, Nursing plan of care, PT notes, and
history for any limitations on mobility


Conduct a pain assessment and provide appropriate
interventions


Talk with the patient


Talk with other members of the team


Gather equipment


Develop a plan



Planning

Know policies and procedures for facility


Ensure adequate assistance for nurse and patient safety


Prepare for smooth, coordinated transfer
-
only one leader


Engage brakes on equipment


Planning cont.

Comfortable working height


Good posture


Feet shoulder width apart (wide base of support)


Use large leg/arm muscles (not back)


Gluteal and abdominal muscles engaged (internal girdle)


Low center of gravity

Body Mechanics

Flex knees (and hips)


Head up


Back straight

no twisting


Smooth, coordinated movements


Position self close to object


Rocking motion (forward
-
push/back
-
pull)

Body Mechanics cont.

Bed position


Arms across chest


Knees flexed and feet flat


Ensure proper body alignment


Trapeze bar


Avoid friction/shearing



Patient Positioning

Change patients positions frequently


Smoothe clothes and linens


Encourage deep breathing and coughing


Apply antiembolism stockings


Pad bony prominences


Bed in lowest position


Special Considerations

Pillows


Mattresses


Side rails


Adjustable beds


Trapeze bar

Hand splints


Trochanter rolls


Heel boot


Foam pads


Hand rolls


Footboard


Positioning

& Protective Equipment

Range of Motion

Promotes circulation, prevents contractures, and
provides joint mobility.


Move each joint until there is resistance but not pain


Incorporate into ADLs


Teach patient and family


Encourage pt to do as much as possible

Anti
-
embolism Stockings

Used to enhance blood flow and venous
return

Patient should be measured for the correct
size.

Assess extremity for pulses, edema,
movement, sensation (CMS)

Remove and check skin q 8 hours