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NURS105 > Chapter 13 > Flashcards

Chapter 13 Flashcards

Restraint Alternatives & Restraints

1
Q

chemical restraint

A

drug used for discipline / staff convenience
- not required to treat medical symptoms

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2
Q

enabler

A

device that limits freedom of movement but promotes safety / comfort

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3
Q

physical restraint

A

manual / physical device, material, equipment:
- attached to / near person’s body
- cannot be removed easily
- restricts freedom of movement / access to body part

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4
Q

when are restraints used ?

A
  • when less restrictive measures fail
  • LAST RESORT
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5
Q

when are restraints discontinued ?

A

as soon as possible

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5
Q

restraints should not be used for what two reasons ?

A
  • to discipline
  • for staff convenience
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6
Q

manual method

A

hold / limit movement by using body contact

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7
Q

remove easily

A

physical restraint can intentionally be removed by person in same manner restraint was applied
- bed rails, open a buckle, untie knot, etc.

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8
Q

why should restraints concerning when used for persons w/ dementia ?

A

can increase confusion, aggression, agitation,
- induce stroke / death

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9
Q

risks from using restraints ?

A

injuries (trying to get free, applying too tight, etc.)

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10
Q

common injuries from restraints ?

A
  • cuts
  • bruises
  • fractures
  • death from strangulation
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11
Q

how often should you check up on person w/ restraint ?

A

every 15 min

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12
Q

CMS requires the report of any death within what time frames of restraint usage ?

A
  • while person is restrained
  • within 24 hours after restraint was removed
  • within a week after restraint was removed
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13
Q

what to do when person is strangling due to restraint ?

A
  • release / cut straps if possible
  • shout for help and nurse
  • stay w/ person
  • perform CPR according to guidelines
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14
Q

what rules must you follow when using restraints ? (6)

A
  • dr. order is required
  • restraint must protect person
  • least restrictive method is used
  • restraints are only used if all other measures fail
  • unnecessary restraint is false imprisonment
  • informed consent is required
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15
Q

safety guidelines to follow when using restraints ? (5)

A
  • observe person for increased confusion / agitation
  • protect person’s quality of life
  • must follow manufacturer’s instructions
  • observe person at least every 15 min
  • remove restraints / reposition / meet basic needs every 2 hours
16
Q

constant observation may be needed for what kind of people ?

A
  • extremely aggressive, agitated, combative
  • at risk for aspiration
  • at risk for suicide
17
Q

when reposition person w/ restraints, how long are restraints released for ?

A

at least 10 min

18
Q

if applied to chest / waist how much slack should be allowed between restraint and person ?

A

flat hand should be able to slide in-between restraint and person

19
Q

where should straps of restraints be secured if used in a bed ?

A

part of bed frame that moves w/ raising / lowering
- never bed rails, head / foot board

20
Q

where should straps of restraint be secured if used in a wheelchair ?

A

under the seat

21
Q

how to apply vest restraint properly ?

A

“V” neck is in front

22
Q

how to apply jacket restraint properly ?

A

opening is in back

23
Q

how to apply belt restraint properly ?

A

at 45

24
Q

when wearing vest, jacket or belt restraint in bed, should bed rails be up ?

A

yes
- prevents falling off bed and strangulation

25
Q

should back cushions be used when person is restrained in chair ?

A

no
- movement of cushion can reduce / increase slack (risks strangulation and injury)

26
Q

should person in supine position be monitored more often / constantly ?

A

yes
- high risk of aspiration

27
Q

you should not position a person w/ restraints under what conditions ? (2)

A
  • if on a toilet
  • if furniture doesn’t allow proper application
28
Q

how much space should be left between person’s body and limb holder / mitt restraints ?

A

should be able to slide 1 finger in-between restraint and person’s body

29
Q

what material are restraints usually made out of ?

A

cloth / stronger material

30
Q

limb holders would be used for person’s w/ what risks ?

A
  • risk for pulling out treatment tubes (IV, feeding tube, etc.)
  • risk for pulling at vital sign monitors
  • scratches at / picks at skin
31
Q

difference between movement allowed by belt restraints and jacket / vest restraints ?

A

belt restraints allow person to move side-to-side and to sit up; jacket / vest restraints don’t

32
Q

what observations of restrained person’s you must report at once ? (4)

A
  • difficulty breathing
  • pain / numbness / tingling in body part restrained
  • discomfort
  • restraint too tight

NURS105 (43 decks)

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