Psychiatric Nursing Restraints Quiz

Physical limitations used to restrict a person's movement, such as belts, vests, or handcuffs, that prevent them from moving their body, limbs, or head. These can be applied to the body or to furniture or equipment.

The involuntary confinement of a patient in a designated room or area, typically locked, to separate them from others and provide a controlled environment.

Physical restraints involve using physical devices, such as belts, vests, or wrist restraints, to limit movement.

Chemical restraints refer to medications used to subdue a patient, such as antipsychotics or sedatives, to control their behavior.

Environmental restraints include any physical barriers or restrictions that limit a patient's movement, such as locked doors, side rails on a bed, or seclusion.

Restraints may be used for safety and to prevent harm to the patient or others.

Seclusion may be indicated to provide a safe and controlled environment for a patient who is at risk of harming themselves or others.

Nurses need to monitor patients under seclusion or restraints closely for changes in their physical and mental status, including signs of injury, pain, or distress.

A patient showing aggression, violence, or self-harming behavior who poses a serious threat to themselves or others.

Maintaining a safe environment for a patient in distress, de-escalating tense situations, facilitating medical procedures or treatments.

Consistent and direct observation of the patient's behavior, vital signs, and overall physical condition.

Using a calm and reassuring voice to communicate with the patient, addressing their concerns, and clearly explaining the rationale for seclusion or restraint.

These are physical indicators that suggest a patient using restraints might be experiencing restricted blood flow, which requires immediate attention.

An inability to move extremities normally, such as hands or feet, could signal nerve damage due to pressure from restraints.

To minimize the risk of harm from restricted blood flow, it's essential to remove the restraint if signs of compromised circulation are observed.

A complete assessment helps to understand the patient's condition and determine the best course of action.

Nurses play an important role in documenting patient behavior changes, interventions made, and any medications administered during restraint or seclusion.

Close monitoring of a patient's well-being is crucial after releasing them from restraints to ensure they are safe and comfortable.

This involves assessing the patient's state regularly, checking vital signs, and observing their behavior to understand their progress.

This gradual approach allows the patient to feel comfortable, less threatened, and more likely to regain their composure and control.

Exercises that move a patient's joints through their full range of motion when they can't move on their own.

Keeping the patient safe from harming themselves, such as by moving potentially dangerous objects out of reach.

Assessing the risk factors that can contribute to a patient getting hurt.

Using calming techniques to help a patient who is agitated or becoming violent.

Checking on a patient's vital signs, such as heart rate and breathing, to make sure they are safe.

Using clear and understanding communication to help a patient feel safe and supported.

Providing a safe and comfortable environment for a patient to prevent bedsores or pressure ulcers.

Regularly checking restraints for any signs of wear or tear to ensure patient safety.

A nursing diagnosis used when a patient's physical movement is limited, often due to restraints. This can lead to complications like contractures and decreased muscle strength.

A nursing diagnosis used for patients exhibiting behaviors that pose a threat to their own safety, such as self-harm or aggression.

A nursing diagnosis used when a patient is at risk of physical injury, often due to restraints or falls. This requires specific measures to improve patient safety.

Regularly assess the patient's range of motion to identify any limitations or changes. This helps prevent complications like contractures.

Encourage the patient to actively participate in exercises like stretching and range of motion exercises within safe limits, to maintain muscle strength and flexibility.

Provide passive range of motion exercises if the patient is unable to move actively. This helps prevent stiffness and contractures.

Ensure that restrained limbs are adequately padded and supported to prevent discomfort, injury, and pressure sores.

Engage in a structured discussion with the patient after seclusion or restraint, addressing their experience, concerns, and exploring alternative strategies for future management.

Using methods to prevent injury from loose or damaged restraints. Includes repositioning the patient frequently and providing regular skin care.

Regularly checking how the patient is doing physically and mentally. This includes their physical needs and their responses to care.

Working with the patient, family, and other healthcare professionals to ensure the patient's well-being and safety.

Keeping detailed records of all actions taken, observations made, and the patient's reactions to care. This is crucial for legal, ethical, and clinical reasons.

Using ethical principles and ensuring patient rights are respected. Restraints and seclusion should only be used as last resorts, for the shortest possible time, and with constant review.

Regularly changing the patient's position to prevent bedsores and maintain healthy skin.

Keeping the patient's skin clean and dry, and looking for any signs of skin damage or irritation.

The most important action is to assess the patient's needs, risks, and responses to care. This includes both physical and psychological evaluations.