UNIT 1

Question 1

surroundings, conditions, or influences which affect an individual

Answer 1

Environment

Question 2

referring to anything which may cause injury or damage

Answer 2

hazard

Question 3

degree of moisture in the air

Answer 3

humidity

Question 4

a harmful chemical or waste material discharged into water or the atmosphere

Answer 4

pollutant

Question 5

a device used to immobilize a client or extremity

Answer 5

physical restraint

Question 6

a lack of sensory stimulation

Answer 6

sensory deprivation

Question 7

Occupational Safety and Health Administration - an official body in each state that randomly inspects facilities with eleven or more workers for violations which may endanger safety of workers

Answer 7

OSHA

Question 8

Center for Disease Control - Act as advisory organization, largely concerned with preventing spread of infection.

Answer 8

CDC

Question 9

Having the ability to burn, corrode, or dissolve by chemical reaction

Answer 9

Caustic

Question 10

Drawing in or out as by suction. Foreign bodies may be aspirated into nose, throat, or lungs inspiration.

Answer 10

Aspiration

Question 11

A radioactive substance used for diagnosis and treatment

Answer 11

Isotope

Question 12

Any agent that can cause blistering, or necrosis, the sloughing of tissue

Answer 12

Vesicant

Question 13

Overview of Safety

Answer 13

a safe environment is essential to the health of a patient. About 98,000 people die due to medical error each year.

Question 14

QSEN

Answer 14

Quality and Safety Education for Nurses. Started in 2005 in NC (Johnson Foundation). KSA (Knowledge, Skills, Attitudes) were developed by QSEN for nurses to teach them to provide a safe environment.

Question 15

Physical and Psychosocial Factors

Answer 15

That reflect a safe environment and will meet patient needs and reduce hazards. Such as Maslow’s Hierarchy of Needs.

Question 16

Maslow’s Hierarchy of Needs

Answer 16

He believed that all humans have certain basic needs and that these needs must be met. Needs Include: (1) Physiological needs - oxygen, shelter, nutrition, and sex (2) Safety and Security Needs - keep us physically and psychologically safe. (3) Love and Belonging needs - the need to feel accepted and is fulfilled by family and friends. (4) Self-esteem needs - how we look at ourselves (5) self actualization - that you approve of who you are.

Question 17

Environmental Factors

Answer 17

Include: (1) Ventilation (2) Lighting (3) Décor and Design (4) Noise (5) Odors (6) cleanliness (7) Privacy

Question 18

Environmental Factors: Ventilation

Answer 18

This is the movement of air. Make sure to avoid chilling the patient. Most people are comfortable with a room temperature of 65-75 degrees Fahrenheit. Be aware of things that can impair this: No Fan or air conditioner, amount of people in the room, odors.

Question 19

Environmental Factors: Lighting

Answer 19

All people need natural light - it is stimulating and you should ask the client how much they prefer. People also need good artificial light - it should be diffuse, soft, cause no glares, and no lights should be too dim. A darkened room is best for sleep and rest. You should provide a night light so that the client is oriented when they wake up, so they can move safely, and so nurses can observe the patient while they are asleep.

Question 20

Environmental Factors: Décor and Design

Answer 20

People respond to colors (especially pastels) for healing purposes. Bright colors are more stimulating (play rooms, cafeteria). Want to try and create a home like environment. Some patterns, such as wavy lines, can make the patient dizzy. General safety concerns and designs.

Question 21

Environmental Factors: Noise

Answer 21

Facilities are designed with acoustic ceiling tiles, resilient floor materials to reduce noise. Try to keep talking to a minimum, wear quiet shoes, monitor volume of the TV/radio, and Monitor visiting hours and visitors.

Question 22

Environmental Factor: Odors

Answer 22

Any odor can be unpleasant to a sick person. Always want to minimize odors by cleaning up such as emptying trash can and cleaning bed pan and urinal after each use. Change soiled linens promptly, remove food tray promptly when patient is finished, monitor floral arrangements, and watch pet odors, cigarettes, and hygiene. Make sure the room is adequately ventilated. can use room deodorizers if they are approved.

Question 23

Environmental Factor: Cleanliness

Answer 23

Patients environment must be free from pathogenic organisms. Patients are susceptible to pathogens. There are 2 types of cleaning: (1) concurrent disinfection - daily cleaning - floors, furniture, bathroom. The Nursing department cleans the bedside, tables, garbage, remove clutter, wipe of surfaces, keep the patient “utensils” clean (bedpan). (2) Terminal Disinfection - cleaning of the room when the patient has left or passed on.

Question 24

Environmental Factor: Privacy

Answer 24

Knock on door before entering the room. Only uncover the body part that you need for that certain procedure. Announce your presence. Shut the door when you leave.

Question 25

Furniture and Supplies likely to be in patients room

Answer 25

(1) FURNITURE: bed, bedside stand, chair or couch, over the bed table, trash can, call light, TV (2) UTENSILS: wash basin, emesis basin, bed pan, urinal, water pitcher and cup, soap dish (3) LINEN: mattress pad, sheets (top and bottom), draw sheet, bed spread, pillow, pillowcase, bath blanket, towels, washcloth, gown or PJs, extra blanket (4) PERSONAL CARE (varies): toothbrush and toothpaste, mouthwash, comb, tissues, lotion, soap and soap dish, deodorant, denture cup, shaving cream, razor.

Question 26

Factors Influencing Safety

Answer 26

Developmental Stages: (1) Infant, Toddler, Preschooler (2) School aged children, (3) Adolescent, (4) Adults, (5) Older Adults.

Question 27

Developmental Stage: Infant, Toddler, Preschooler

Answer 27

injuries are leading cause of death over the age of 1 and cause more death and disabilities that do all other diseases combined. (lead poisoning, choking, curiosity)

Question 28

Developmental Stage: School Aged Children

Answer 28

learning how to perform more complicated motor activities and are often uncoordinated. Teach them how to use protective equipment (helmet) and what to do if approached by strangers.

Question 29

Developmental Stage: Adolescent

Answer 29

Greater independence and sense of identity and their own values. Generally have a stronger influence by peers than family. Increased risk for accidents from cars and experimenting with drugs and alcohol.

Question 30

Developmental Stage: Adults

Answer 30

Greatest threat to adult safety are mostly related to lifestyle habits (excessive alcohol use puts them at greater risk for MVAs) Smokers have the greater risk for cardiovascular or pulmonary disease.

Question 31

Developmental Stage: Older Adults

Answer 31

Physiological changes affect the older adult increasing risk for falls and other accidents. Older adults often have acute or chronic disease processes. Take multiple medications. Have a slower reaction time.

Question 32

Individual Risk Factors

Answer 32

Alterations: (1) sensory, (2) sensory deficits, (3) Sensory Deprivation, (4) Sensory Overload. INTERVENTIONS: (1) meaningful stimuli to avoid deprivation (2) control of stimuli to avoid sensory overload.

Question 33

Alteration: Sensory

Answer 33

the senses include: visual, auditory, tactile(touch), olfactory, gustatory (taste)

Question 34

Alteration: Sensory Deficits

Answer 34

deficit in normal function of sensory reception and perception. Such as deaf people are unable to receive auditory stimuli or a person with blurred vision due to cataracts may cause visual stimuli to be distorted.

Question 35

Alteration: Sensory Deprivation

Answer 35

A lack of quantity or quality of stimulation. 3 types: (1) reduced sensory input such as deficits for hearing or visual loss (2) Elimination of order or exposure to a strange environment. (3) restriction of environment - bed rest, isolation, reduced environmental variance.

Question 36

Alteration: Sensory Overload

Answer 36

excessive sensory stimulation from multiple stimuli which cannot be disregarded or selectively ignored. (EX: client in ICU - constant activity, lights always on, multiple sounds, staff conversation, numerous tubes, equipment, and procedures). EFFECTS of this: behavioral changes, racing thoughts, scattered attention, restlessness, and anxiety.

Question 37

intervention: meaningful stimuli to avoid deprivation

Answer 37

pets, music, television, family photos, calendar, books, clock, flowers, personal treasures, bright colors, furniture, adequate lighting, visitors or a compatible roommate, activities, bed or chair near the window, therapeutic touch.

Question 38

Intervention: Control of stimuli to avoid overload

Answer 38

organize procedures to allow for rest and quiet, control unnecessary noise as much as you can, lower volume of the TV, keep equipment noise to a minimum, control conversation and laughter, close the door to the room or move patient to a more quiet room, limit visitors if needed.

Question 39

Safety Measures

Answer 39

(1) Staff Behavior (2) Working Areas/Corridors (3) Client Rooms (4) Special Considerations

Question 40

Safety Measures: Staff Behavior

Answer 40

(1) use good body mechanics (2) walk briskly, avoid running unless an emergency (3) keep to right in hallways (4) turn corners carefully at a slow rate especially with wheelchair and stretcher (5) open doors slowly. Do not place clients in hallway close to fire doors (6) use stretcher properly, keep patient head closest to you. (7) use breaks on beds and wheelchairs. (8) place elevators on hold so doors do not shut when loading and unloading.

Question 41

Safety Measures: Working Areas/Corridors

Answer 41

(1) lighting should be adequate. May be dimmed in evening but still ensure durability. (2) floor surfaces should be smooth. Cracked tiles, raised linoleum and torn carpet can cause falls. Dropped materials need to be cleaned up immediately. Calling housekeeping can cause a delay. If mopping is in progress post a sign. Hallways need hand rails. (3) Electrical appliances should be in good working condition without frayed or damaged cords and plugs. (4) needles and sharps should be put in sharps container instantly. (5) OSHA mandates hospitals notify workers of hazardous or caustic substances. (EX: neoplastic drugs--chemo, exposure to laser beam or particles, internal radiation therapy, and transmittable viruses) (6) uncluttered hallways. fire codes prohibit equipment in hallways that block emergency personnel or exits

Question 42

Safety Measures: Client Rooms

Answer 42

(1) lighting--enough so ambulatory patients can see as well as staff. A night light helps clients make it to bathroom safe at night (2) floor surfaces need to be smooth. Provide non slip mats for bottom of shower. Have handrails, call cord, and chair/stool within reach. (3) oxygen does not explode but supports rapid combustion. take precautions that sparks and flames never occur. use no smoking signs. electrical appliances should not be used. (4) electrical appliances from home need to be checked by maintenance. (5) furniture and equipment should be in good repair. arrange for easy access. (6) medications and dangerous substances should be removed from bedside. if order to be at bedside, keep out of sight of others. (7) enhance that bathroom, closet, and cabinet doors are fully opened or closed to prevent people running into them. (8) proper temperature of liquids for enemas, baths, compresses, and heating pads.

Question 43

Safety Measures: Special Considerations

Answer 43

(1) unstable temperature control (2) inadequate ventilation (3) improper food prep (4) improper waste exposure (5) radioactive isotopes--specific guidelines include: limit exposure time and maintain safe distances and shielding. (6) improper handling of antineoplastic drugs--use precautions with vesicance (absorb)--gloves, face shield. cover top of needle with sterile gauze when releasing air . clean up all spills. assess IV site often. (7) harmful microorganisms (8) smoking is a potential fire hazard and causes harm to smokers and others.

Question 44

Safety Considerations: High Fall Risk Criteria

Answer 44

(1) clients at high risk for falls are: elderly, children, and the confused. sensory deficits, impaired mobility, fall history, substance abuse, mood altering medications. (2) falls account for up to 90% of all reported incidents in the hospital. Most happen in client room or bathroom.

Question 45

Safety Considerations: Protecting the client

Answer 45

(1) Bed should be in lowest position unless during a procedure (2) side rails should always be up if away from patient bed. Patients over 65 can sign a release from liability if does not want side rails. some beds have monitoring device or alarm if patient gets out of bed. (3) position and good alignment. make sure extremities not caught in side rails (4) protect from sharp objects in bed, can cause irritation and eventual skin breakdown. (5) EYES: keeps sharps away. if comatose, monitor for irritation or any foreign bodies. if they cannot blink may need to tape lids closed. assist with contact lenses. (6) AIR PASSAGES: eliminate risk of aspiration . if they cannot swallow saliva position them on side so it will drain. avoid lint from cloth or gauze, cotton balls, or caustic substances around passages. (7) RESTRAINTS: designed to protect client and staff from injury. do not use unless absolutely necessary. TIE TO BED FRAME NOT RAIL. Nurse can apply restraints without order if an emergency but order should be obtained ASAP. Can cause skin irritation, circulatory injury, or neurological injury. PHYSICIAN ORDER REQUIRED--must states type, location, duration, and circumstances for need. order is valid for 4 hours for adult, 2 hours for children aged 9-17, and 1 hour for children under age of 9. orders can be renewed for a max of 24 consecutive hours. an on going assessment by nurse is needed every 1-2 hours and includes behavioral charting

Question 46

Types of restraints:

Answer 46

(1) side rails--half or full (2) safety jacket or vest (3) wrist/arm/leg (4) mittens (5) belts

Question 47

Types of restraints: side rails--half or full

Answer 47

used for confused or sedated clients, to prevent falling out of bed, assist in moving, turning, and getting up. provides feeling of security without being pinned in. never leave the bed with side rails down.

Question 48

Types of restraints: Safety jacket or Vest

Answer 48

for confused or disturbed clients. to prevent falling forward in a chair.

Question 49

Types of restraints: wrist/arm/leg

Answer 49

to remind the client not to move apart during a treatment or when giving an IV. children may need a mummy board. To immobilize a limb to prevent dislodging NG tubes, IV, catheter. and for combative clients.

Question 50

Types of restraints: Mittens

Answer 50

to prevent removing catheters, dressings, or other devices. prevent scratching or picking, allows ambulation

Question 51

Types of restraints: Belts

Answer 51

on chairs and stretchers for the waist and legs.

Question 52

Safety Device Precautions

Answer 52

(1) when side rails are down, go no further than an arms length away without raising rails (2) make client comfortable, good body alignment, before applying restraint. (3) pad restraints on bony prominences, to avoid pressure and chaffing. make sure padding is not out of place. (4) devices should be loosened every 2 hours, change position, ROM, wash If needed, complete restraint form, do not leave patient if released. (5) monitor circulation of limb closely for any impairment (6) check pulse and respirations frequently (7) when lock type of restraint is used, key must be kept in designated place that is readily available (8) fasten to the bed frame using a slip knot and never fasten to the side rail. Explain use of restraint to patient and family and use the type that is least obvious to others to limit embarrassment.

Question 53

Fire Safety: Intervention Guidelines

Answer 53

(1) know agency fire drill and evacuation plan (2) know location of all fire alarms, exits, and extinguishers. (3) use RACE to set priorities. (4) General Measures --keep calm and do not panic, turn on lights and close all doors, do NOT use elevators and be available to help as needed, reassure all clients and visitors, be aware of policy.

Question 54

Fire Safety: R A C E

Answer 54

(R)--RESCUE and remove all clients in immediate danger (A) ALARM - always activate the alarm before attempting to extinguish even a minor fire (C)-- CONTAIN the fire by closing doors and windows; turn off oxygen and electrical equipment (E)--EXTINGUISH the fire using an extinguisher EVACUATE if necessary and ordered.

Question 55

Fire Safety: Fire Extinguisher

Answer 55

TYPES: (1) Class A--ordinary combustibles (paper, wood, cloth, many plastic items) (2) Class B--flammable liquids (gasoline, oil, paint, cooking fats) (3) Class C-- electrical equipment (4) Class D--metals. ****ACRONYM**** A-Ash/B-boil/ C-"current"/ D- "ABC" any combination of 3

Question 56

How to use fire extinguisher

Answer 56

(1) free extinguisher from enclosure (2) remove pin that locks handle (3) aim nozzle near edge, or at the base of fire, not directly at the center (4) move nozzle side to side (5) avoid skin contact with contents of extinguisher (6) return extinguisher to maintenance for replacement or refilling ****ACRONYM**** (P) --pull the pin after breaking the seal (A) --aim the nozzle at base of the fire (S) -- squeeze the handle using a (S) -- sweeping motion to extinguish the fire. (PASS)