chapter 33 safety. 33-2 copyright 2004 by delmar learning, a division of thomson learning, inc....
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33-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Safety Culture
Safety is a functional concern of nurses from the bedside to the home and community
Excellent nursing care is safe for both the clients receiving the care, and the workers involved in the delivery of health care.
33-3Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Factors Affecting Client Safety
Age:• Fetus: maternal exposure e.g. drugs and smoking• Infants: falling, suffocation, burns. Poisoning, and
electrical shock• Toddlers: falling, sharp object injury, automobile
accident, poisoning, electrical shock• Preschooler: injuries, suffocation, poisoning, burn,
automobile accidents• Adolescent: Vehicle accident, Suicide, sport injuries,
substance abuse• Adults: accidents (occupational or vehicle), fire
burns, suicide• Elderly: falling, burns, automobile accidents
33-4Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Factors Affecting Client Safety
Lifestyle:• Work environment• Residence• Risk Talking behaviors• Income
Sensory and Perceptual Alterations: problem in senses
Mobility and health status: paralysis, patient after surgery
Emotional State: stress, or depressed
Cognitive awareness: unconscious under narcotic Ability to communicate: unable to read
33-5Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Types of Incidents
Client behavior incidents Therapeutic procedure incidents Equipment incidents
33-6Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Safety and the Environment of Care
Each nurse is responsible for following the facility’s established safety guidelines.
It is the nurse’s responsibility to report promptly and to document a mishap.
33-7Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Focus of Safety Assessments
The individual The environment Specific risk factors
• Falls• Fires• Poisoning• Suffocation and choking• Firearm injuries
33-8Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Potential Occupational Hazards
Chemical and biological exposures Physical exposures (lasers, ionizing
radiation, noise) Psychosocial stressors (shift work,
overtime, threat of workplace violence) Ergonomic stressors (lifting and moving
clients)
33-9Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Potential Occupational Hazards
Routes of Exposure• Methods by which chemical and biological
substances are assimilated into the body - Inhalation- Ingestion- Injection- Skin contact- Skin absorption
33-10Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Potential Occupational Hazards
Latex Allergy• Irritant contact dermatitis• Allergic contact dermatitis
33-11Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Potential Occupational Hazards
Hand Hygiene• Any dermatitis should be promptly reported
to Employee Health.• Barrier creams or special soaps are
available.• Strict guidelines on nail care and nail
coverings should be implemented and followed.
33-12Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Factors that Contribute to Falls
Age >65 History of falls Impaired vision or balance Altered gait or posture, impaired mobility Medication regime Postural hypotension Slowed reaction time Confusion or disorientation Unfamiliar environment
33-13Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Diagnosis
Risk for Injury• Risk for Suffocation• Risk for Poisoning• Risk for Trauma• Risk for Aspiration• Risk for Disuse Syndrome• Latex Allergy Response
33-14Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Diagnosis
Risk for Infection Related to (RT)• Inadequate primary defenses• Inadequate secondary defenses• Tissue destruction and increased
environmental exposure• Chronic diseases and malnutrition
33-15Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Diagnosis
Risk for Infection Related to• Invasive procedures• Pharmaceutical agents• Trauma• Rupture of amniotic membranes• Insufficient knowledge to avoid exposure to
pathogens
33-16Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Outcome Identification and Planning
Identification of actual or potential hazards
Reduction of the risk of injury and infection
Client/caregiver education regarding safety measures and modification of an unsafe environment
33-17Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Raise Safety Awareness and Knowledge Bed Safety Prevent Falls
• Apply restraints• Ensure adequate lighting• Remove obstacles
33-18Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Types of physical restraintsA. Jacket
B. Belt
C. Mitten or Hand
D. Elbow
E. Limb or Extremity
F. Mummy
33-19Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Reduce Bathroom Hazards Prevent Fire
• Common causes of fire • Fire prevention• Protection of clients during a fire• Institutional policies and procedures for fire
containment and evacuation
33-20Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Ensure safe operation of electrical equipment.• Three-pronged electrical plug that is
grounded• Warning labels on all equipment• Electrical shock
33-21Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Reduce exposure to radiation.• Both the client and the nurse are at risk for
injury.• Radiation injury can occur from
overexposure or exposure to untargeted tissues.
• General principles of radiation exposure and protection are based on time, distance, and shielding.
33-22Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Prevent poisoning.• A poison is any substance that causes an
alteration in the client’s health when inhaled, injected, ingested, or absorbed by the body.
• Antidotes and treatments are available for some but not all types of poisonings.
• Poison control center • Client education
33-23Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Implementation
Reduce Noise Pollution.• Sensory overload can alter a client’s
recovery by increasing anxiety, paranoia, hallucinations, and depression.
• Safety measures include maintaining a quiet environment, traffic control, and providing earplugs.