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Questions and Answers
What is a potential consequence of urine not moving out of the body?
What might indicate a problem with calf circulation?
What effect does the heart have when it has to work harder to perform the same task?
What is one method mentioned for assisting patients with movement?
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What is a common issue that may occur as a result of stagnant liquid stool?
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Which of the following factors can lead to an increase in falls among the elderly? (Select all that apply)
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Safety is a basic human need.
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What is a common cause of falls in individuals with Intellectual and Developmental Disabilities (IDD)?
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Which age group is at the greatest risk for home accidents that result in severe injury and death?
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What constitutes a 'Never Event' in a healthcare setting?
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What should a nurse do every 30 minutes when a patient is in restraints?
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Match the following age groups with their associated safety risks:
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What type of restraint utilizes medications to manage behavior?
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Study Notes
Inability to Stand
- Inability to stand can be caused by a build-up of bacteria or a breakdown of tissue.
- Patients who struggle to stand may experience pain, particularly in the calf.
- This inability to stand can also be related to the heart working harder to perform the same tasks.
- Using compression socks may help.
Bowel Issues
- Bowel issues can result in liquid stool exiting from the body around the cast.
- This can lead to an inability to stand or difficulty standing.
Urinary Issues
- If the body struggles to move urine out effectively, pain may be experienced.
- This can also lead to an inability to stand.
Movement Assistance
- Patients with mobility issues require assistance with movement.
- This can be difficult and uncomfortable but is essential for recovery.
Patient Safety
- A basic human need, defined as the freedom from psychological and physical injury.
- IOM Report “To Err is Human: Building a Safer Health System” highlighted the need for patient safety.
- World Health Organization (WHO) defines Patient Safety as the prevention of errors and adverse effects associated with healthcare.
Culture of Safety
- Recognizes the high-risk nature of healthcare activities and emphasizes consistently safe operations.
- Encourages a blame-free environment where staff can report errors or near misses without fear of punishment.
- Promotes collaboration amongst staff and resources to address safety concerns.
Importance of Safety in Healthcare
- Reduces illness and injury incidence.
- Prevents extended hospital stays.
- Improves or maintains patient functional status.
- Enhances patient well-being.
- Contains healthcare costs.
Falls
- Leading cause of unintentional death in people aged 65 and older.
- Increased risk factors for falls in the elderly include:
- Reduced vision.
- Orthostatic hypotension.
- Lower extremity weakness.
- Gait and balance problems.
- Urinary incontinence.
- Improper walking aid use.
- Medication side effects.
- Other fall hazards include:
- Poor lighting.
- Obstacles in walking paths (rugs, cords).
- Spills on floors.
- Lack of home safety devices.
Preventing Falls in People with Intellectual and Developmental Disabilities (IDD)
- Individuals with IDD are at high risk for falls due to factors such as:
- Arthritis: Pain may not be expressed verbally, making ambulation difficult.
- Seizures: Can lead to falls through various presentations.
- Medications: Sedative effects, blood pressure drops, or balance issues can increase fall risk.
- Vision: Poor vision, often unexpressed, can lead to falls.
- Dehydration: Can cause orthostatic hypotension, increasing fall risk.
- Hypoglycemia: Low blood sugar can cause falls, but individuals may struggle to express their sensations.
- Infection: Severe infections (sepsis) can increase fall risk.
- Brain conditions: Brain tumors, Multiple Sclerosis, Parkinson's, strokes.
- Ear-related conditions: Meniere's Disease, vertigo can cause dizziness.
- Unfamiliar environments: Can cause confusion and increase fall risk.
Preventing Falls in People with IDD
- Review medications for potential contributions to falls.
- Assess for reversible health conditions.
- Ensure proper, well-fitting shoes.
- Eliminate hazards like cords, small tables, loose rugs, clutter, and spills.
- Provide adequate lighting.
- Install grab bars and railings.
- Use assistive devices when necessary.
Safety Risks by Developmental Age
- Younger than 5 years: Highest risk for home accidents leading to severe injury and death.
- School-aged children: Risks at school and during transportation, including participation in team and contact sports. Emphasize protective equipment like helmets and seatbelt use.
- Adolescents: Greater independence, identity development, and peer pressure lead to risk-taking behaviors such as substance abuse, driving, sexual activity, and suicide.
- Adults: Lifestyle habits (smoking, drinking, driving under influence), workplace hazards, and stress from work and family responsibilities can pose risks.
- Older adults: Psychological and physiological effects, dementia, decline in vision and hearing, and fear of falling are key risk factors.
Serious Reportable Events (SRES)
- Healthcare providers complete an incident report for any SRES occurrences.
- Incident reports are confidential documents detailing patient accidents within healthcare facilities.
- These reports help identify trends and patterns, guiding improvement efforts.
“Never Events”
- Centers for Medicare & Medicaid Services (CMS) classified specific SRES as "Never Events," which are adverse events that should never happen in a healthcare setting.
- CMS denies higher payments to hospitals for events complicated by "Never Events."
- Many hospital-acquired conditions are Nurse-Sensitive Indicators, indicating a nurse's direct impact on their development, such as falls or pressure ulcers.
Current National Quality Forum (NQF) List of "Never Events"
Surgical Events
- Surgery on the wrong body part or patient.
- Performing the wrong surgical procedure.
- Retention of foreign objects after surgery or a procedure.
- Intraoperative or immediate postoperative death of a healthy patient.
Product or Device Events
- Patient death or serious disability due to contaminated devices or biologics provided by the healthcare facility.
- Patient death or serious disability due to device malfunction or unintended use.
- Patient death or serious disability due to intravascular air embolism while receiving healthcare.
Patient Protection Events
- Discharge or release of a decision-incapable patient to anyone other than an authorized person.
- Patient death or serious disability due to patient elopement (disappearance) for more than four hours.
- Patient suicide or attempted suicide resulting in serious disability while receiving healthcare.
Care Management Events
- Patient death or serious disability due to:
- Medication error.
- Hemolytic reaction due to ABO-incompatible blood transfusion.
- Maternal or neonatal death or serious injury during labor and delivery in low-risk pregnancy.
- Stage 3 or 4 pressure ulcers acquired after hospital admission.
Environmental Events
- Patient death or serious disability due to electric shock while receiving healthcare.
- Patient death or serious disability due to administration of incorrect or contaminated gas.
- Patient death or serious disability due to burns from any source during healthcare.
- Patient death due to falls while receiving healthcare.
- Patient death or serious disability due to restraint or bedrail use while receiving healthcare.
Criminal Events
- Care ordered or provided by someone impersonating a licensed healthcare provider.
- Patient abduction.
- Sexual assault on a patient within or on the grounds of a healthcare facility.
- Death or significant injury of a patient or staff member due to physical assault within or on the grounds of a healthcare facility.
Restraints
Types:
- Physical restraints: Physical or mechanical devices that immobilize a patient.
- Chemical restraints: Medications like anxiolytics and sedatives used to manage patient behavior.
Orders:
- RNs can apply restraints based on patient behavior.
- A provider must assess the patient and order the restraint within one hour of application.
- Restraint orders expire after 24 hours and cannot be PRN (as needed).
Implementation:
- Assess the patient every 30 minutes, checking circulation.
- Release restraints every 2 hours to assess for skin breakdown, perform range of motion (ROM), and assess behavior.
- Use quick-release methods (slip knots, clasps) to secure restraints.
- Never tie restraints to bed rails.
- Discontinue restraints when no longer indicated.
- Restraints are not a solution but a temporary measure to maintain patient safety.
- Use restraints as a last resort when patient behavior poses a risk to themselves or others.
Hazards Associated with Restraints
- Immobilization:
- Suffocation from entrapment or strangulation.
- Changes in mental status.
- Impaired circulation:
- Fractures.
- Diminished muscle and bone mass.
- Altered nutrition and hydration.
- Aspiration and breathing difficulties.
Alternatives to Restraints
- Patient and family orientation.
- Sitters or companions.
- Diversionary activities.
- Positioning patients near the nursing station.
- Calm, simple statements and physical cues.
- De-escalation techniques for aggressive behavior.
- Providing visual and auditory stimuli.
- Promoting relaxation techniques and normal sleep patterns.
- Establishing exercise and ambulation schedules.
- Frequent attention to toileting, food, and liquids.
- Concealing intravenous lines with clothing, stockinette, or Kling dressings.
- Evaluation of medications and adequate pain management.
- Reassessment of physical status and review of lab findings.
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Description
This quiz explores various factors contributing to the inability to stand, including physical, bowel, and urinary issues. It highlights the importance of movement assistance for patients facing mobility challenges and discusses potential remedies like compression socks.
