Ch 27 Safety, security, emergency preparedness Flashcards
What kind of concern is safety
Safety is a paramount concern underlying all nursing care
What are factors that affect safety
-Developmental considerations
- lifestyle : use of drugs and alcohol/ occupation
 - social behavior: any drinking or driving?
- environment
- mobility : how is their gait? , any DME
-sensory perception : DM with paresthesia or Cataracts

-knowledge : is patient aware, any security issues
-ability to communicate : what is the mode of communication
-physical and psychosocial health states:
Give appropriate devices and consider patient anxiousness depression to provide appropriate care
What is the primary focus of safety assessment
-what do we want to ask about the patient’s mobility
What are the three focuses of the safety assessment
Patient is the most important!!!
- any balance/visual issues, can patient speak? can they maneuver?
3 focuses:
- Person
- environment: is it unfamiliar, any stairs? 
- specific Risk factors
- electrical
- fire burn issues
- prevent poisoning
- falls
- firearms
- abuse
- safety belt
 what are nursing actions you can do to decrease hospital risk factors
Bed position Side rails Call Bell Room Personal items Alarm
-bed in lowest position
-side rails down
•document of up
-make sure the call bell is within reach and answered
-orient patient’s room
-have all items within reach
-activate the bed alarm: to prevent falls
As far as discharge planning what do we immediately do as soon as patient is within our care
-why do we do this
- give 2 examples
Immediately within our care necessities that the patient will have when they go home
-done to assess if they will be safe
what is the lighting, no rugs
When doing a nursing history on the patient what do you want to assess for in regards to security and safety
Assess for history of falls
assistive devices
drug are alcohol abuse
obtain knowledge of family support systems and home environment
What patient is a Highfall risK
Upon mentioning assistive devices how should a person use a cane (what side) what are gait belts used for
Why do we assess the knowledge of a family support and home environment
If a patient has a history of falling they are a high full risk
Upon assistive devices:
- Canes used on unaffected side
- Gait belt used to hold, ambulate, and assist patient to floor
When assessing family support and home environment we do this to plan for safe return home
What are fall prevention interventions we can do for the patient in the hospital
With your family support and home environment what do we want to look for specifically that may increase fall risks
We can put nonskid socks and clear the pathway
Look for any polypharmacy
-specifically tranquilizers, sedatives, hypnotics due to drowsiness
Age, unfamiliarity
Postural hypertension
Slow reaction time
When we assess using the Morse scale questionnaire how do we know patient is at increased risk of
What are two things you want to assess for
What kind of status do you want to check
What’s the score on the Morse scale questionnaire equivalents to Highfall risk
Using Morse for questionnaire:
-if patient had a last fall within three months there it increased risk for falls
- Assess for any Iv/saline locks or secondary diagnosis is
- Check mental status
A score of over 51 means high fall risk
What is the leading cause of injury among elders
What kind of events are falls leading to injury fatality
Leading cause of injury: falls number one for injuries and fatalities
Falls leading to injury fatalities are sentinel events:
they do not happen often!!!
In assessing for ability to communicate what does using the call light mean if the patient cannot speak and what must you do
What must you ALWAYS assess for in a patient in regards to safety
What is a specific population to target for sensory perception assessments
If a patient is using call light but cannot speak you get up and go assess the patient, but it shows awareness among patient
In regards to safety always assess level of orientation ALWAYSSSS
Assess diabetics to see if neuropathy affects safety
What are examples of potential hazards within a hospital
If a patient brings equipment from home what must be done and what must the equipment have
What is the one equipment from home you want the patient to bring to the hospital
Examples of potential hazards:
- equipment that does not work
- equipment from home 
If the patient bring equipment from home it must be checked by the biomedical department and it must have a safety sticker
Patients with CPAP machines should bring from home to use in hospitals
During the physical examination as you assess for domestic violence or neglect what are signs and symptoms to be aware for
-Violence (5)
-Sexual abuse
emotional abuse
Neglect
Violence: 1. Unexplained injuries 2. bruises in different healing stages 3.Head injuries 4. burn configurations 5biting
Sexual abuse:
- genital pain
- vaginal discharge young
- STI/UTI
- difficulty sitting
- regression
- patient coming in for unrelated assessment says they have been raped
Emotional abuse: -difficulty sleeping stomach/headache -low self-esteem -avoiding activities
 Neglect: disheveled
When you report abuse what are you reporting what do you not have to do
-how is the report of abuse done
When reporting abuse you report the findings you do not have to prove abuse and it was done in good faith
What are factors that contribute to Falls in your elderly
Weakness Poor feetmeds dizziness hazards
Lower body weakness Poor vision/gait/balance issues Problems with feet or shoes - sores, they don’t fit properly Psychoactive medications -stimulants, antidepressant, narcotics postural dizziness Home and community hazards
How do we keep the environment safe for our elderly
- water
- light
- path
- rug
What is our goal in relation to hazards
To ensure a safe environment:
Clean any water on floor
Use good lighting
Avoid clutter (free pathway)
Remove rugs
Nurses goal is to minimize hazards
If a nurse is reasonable and prudent with behavior that is similar to those expected of another nurse under similar circumstance are they liable if a patient falls
A nurse who is reasonable, prudent and behaves in a similar way that another nurse would under the same circumstance is not found liable if a patient falls
-we did our best it is understandable a patient may fall
Regarding risk factor assessments
How does one explain patient’s falling even if nurse is prudent and what may be activated
Why are most people killed in fires and what do most fires result from a
What is the first action to do if there is a concern of poisoning
At times despite our efforts a patient may still fall and depending on facility you may have to activate rapid response or a fall alert
Most people killed in fires due to smoke inhalation and most fires result because of cooking
If poison concern #1 intervention is to pcall center for poison control
If there is a fall what are the actions to take
How do you want to fill out the safety occurrence report
1 ASSESS PT!!! Patient is #1
If a fall occurs:
- Tell Doc/tell nursing supervisor
3 fill out safety occurrence report
-fill out safety occurrence report objectively from where you found the patient
Regarding risk factor assessment
 What may Commonly cause suffocation what may commonly cause choking
-How do you prevent adult and child choking
What are the three rules to prevent fire arm injuries
Suffocation caused by drowning choking caused by pillow, plastics , balloons, little toys, grapes
- adult: Heimlich maneuver
- Child: five back five compression pats
Preventing firearm injuries:
- Keep locked
- keep unloaded
- keep safe
Describe the fire extinguisher types AB and C
For fire what is vital for everyone to know
A: paper B: liquid and gas/Oil C: Electrical  If a fire it is vital for everyone to know an evacuation route
Give the precautions to educate patients on fires
Define RACE In hospitals
- if patient on fire: stop drop and roll
- Close windows and doors
- Cover mouth with damp cloth
- stay close to floor
- ask if fire extinguisher
In hospitals: R-rescue immedicate patients!! #1 A-ctivate fire alert and notify C-contain fire by closing windows and doors E-vacuate #1
What do you educate on regarding A carbon monoxide detector
What are rules to follow if there is an oxygen tank at home
Change carbon monoxide detector annually
If oxygen tank at home:
- no flames within 6 feet
- no smoking
- keep toys away
- don’t keep against wall
- tell fire department
What kind of resources do you want to give your patient for safety information
What should a family practice a few times a year
In elderly especially with loss of sensation how do we remain injury free regarding temperature
Regarding safety information give patients written resources
-Family should practice fire evacuation routes a few times a year
Remain injury free regarding temperature:
- checking temperature of water
- Do not put heating pad
What is a safety precaution all states mandate
What is the safest Type of seatbelt
 ALL State mandate car seats
Three part seatbelts are the safest
How do you monitor a childs use of the Internet
As nurses what do we want to promote within parents of children
Monitor child use of the Internet by telling them not to meet with anyone online and putting the computer in a open area
Promote volunteering for safety committees and getting involved in school activities
In the Home what are safety precautions to take
- outlet
- cabinets
- chemicals
At home put covers in all outlets
Lock all cabinets and drugs
Lock away all soaps and chemicals
To prevent falls describe the use of:
- Side rails
1. How many can you have, what are situations that call for these side rails
2. When can you put side rails and what must patient be able to do - brakes
- Socks / alarm
Only two side rails at a time
- if patient is Sedated/unconscious
- transferring patient
You can put side rails if requested but patient must be able to put down
- apply brakes to beds and wheelchairs
- use nonskid socks and bed alarms if you have fall risk patient 
Car seat safety:
What is the best type of car seat to use beginning at birth until when
When can you stop using car seats
When can child sit in passenger front seats
Rear facing seats are recommended
-from birth to two years of age
You can stop using car seats at
-height of 4‘9“(80 to 100 pounds)
At the age of 13 child can sit in passenger front seat
What are safety considerations for neonate
Behaviors
unattended
How do you hold to support
how do you place a infant to sleep
Avoid behaviors that might harm fetus as a pregnant woman
- excessive caffeine
- alcohol drugs smoking
- radiation, pesticides
- viruses
Never leave infant unattended
Use crib rails
Support infants Head place on back to sleep
What are safety considerations for toddlers and preschoolers
Supervise toys bathtub grab everything
- supervise child closely
- Select appropriate toys nothing too small
- never leave alone in bathtub
- childproof home + helps to prevent poisonings
For safety considerations for your school aged children
Dangerous Bike abduction seatbelt bullying
- help avoid activities that are potentially dangerous
- teach bicycle safety like helmets and pads
- Teach about child abduction (stranger danger)
- wear seatbelts
- Report bullying
What are indications of a concussion and what do you wanna ensure in a patient who shows these manifestations
Indications:
H/A, vomiting, balance issues, confusion, fogginess, drowsiness
If you see these findings ensure patient six care to avoid brain disruption
What is the main cause of death in adolescence
What are safety considerations for adolescence Driving Sex, birth control infection (two) Internet
Adolescent mean cause of death = MVC
Safety considerations:
- avoid distracted driving
- teach about safe sex, STI is birth control
- teach about risk of infection with piercings and tattoos
- be safe on the Internet
What are infection risks associated with body piercings and tattoos
What is a teaching to avoid date rape drugs
If infection body piercing and tattoos may cause hep B/C, tetanus, HIV
If you leave a drink at the table get another
What are safety considerations for adults
Defensive driving
Habits
Guve space
- enroll in defensive driving
- council unsafe habits (drugs alcohol reliance)
- give caregivers information on respite care
If patient is living under intimate partner violence with abuser what must the patient have
What is the ultimate goal of someone in an intimate partner violence relationship
If living under intimate partner violence patient must have a what is plan especially with kids
If IPV Ultimate goal is to leave the relationship

What is an ambularm what does it till the patient
Ambulance are an alternative to restraints for wandering patients I will tell the staff on the patient stands up
What are safety considerations for your older adults
Hazards
- and + things
What do we want to encourage and report
What can Alzheimer’s lead to
-identifying safety hazards + Modify environment
(-) stairs, poorly lit areas, Rugs
(+) medications clearly labeled advocate for pillbox lower voice if presbycusis
- encourage hearing aids and eyeglasses
-Report any signs of neglect

-Alzheimers
Can lead to forgetfulness, difficulty with activities of daily living
What is the number one form of neglect in your older what is your second form
 What is an alert to Alzheimer’s from the patient
#1 malnutrition #2 financial exploitation
If patient has confusion with time and place it is an alert to Alzheimer’s

Name two items in the safety improvement strategies that prevent falls and investigate them
One. Fall prevention training program
2. Root cause analysis (investigates)
What does the Hendrich II fall risk model measure
What are the four components within the hendrich II Fall risk model
the hendrich II risk model measures if the patient can be independent or any risk factors 
components: 
1. Full scene investigations
2. Hourly patient rounding
3. Root cause analysis
4. Get up and go test
What are you Implementing during your hourly patient rounding’s
What does the root cause analysis investigate for (three simple things)
What are fall risk medication‘s to watch for (2)
During hourly patient roundings implement the 5 P’s
P-otty P-ain P-osition P-ossessions P-eaceful environment
 root cause analysis investigates what, why(Contributing factors), prevention
Full risk medications include Benzos and antiepeptic medication
When do you complete a safety event report ” incident report “ and ehy
What does an incident report entail
Should the incident report be mentioned in documentation
Complete incident report IMMEDIATELY after incident saw a root cause analysis can be made
Incident report:
- describes circumstance of accident
- describe patients response to exam and treatment after incident
Do not mention incident report in documentation it is NOT ! A part of the medical record
What do restraints require to be put on
How often do you monitor your patient on restraints and when do you remove the restraints
What are Used for and what are they not used for
restraints require:
-doctors orders
-justification
- removal criteria
Monitor patient on restraints HOURLY remove as soon as patient comes down
Restraints done for patient safety not for staff convenience

What are hazards as a result of restraints
When placing restraints how do you know they are comfortably placed
Entrapment: small/frail person gets trapped between the bed and the frame
Skin breakdown
delirium
anxiety
aspiration and respiratory difficulties death
You should be able to insert two fingers t between restraint and patient
With restraints what do you want to monitor for in the event they are too tight
What are antipsychotics considered to be if used on a difficult patient
If restraints are too tight monitor for blood flow and circulation

Anticiotics considered to be a restraint if used incorrectly
Describe a Sentinel event
-aka?
Sentinel event a.k.a. never event
A sentinel event is an unexpected occurrence involving death or physical or psychological injury
What are biological threats
What is bioterroris
Define chemical threats
Biological: anthrax, botulism, smallpox
Bioterrorism: deliberate spreading of pathogens into community
Chemical threats:
Biotoxin‘s, blood ages, choking/lung/pulmonary agents
How do you protect yourself as a Healthcare provider from back injuries
Dints and dos
DONTS
Do not twist at the spine
do not bend at the waist
DO
- do use legs
- do push, slide, roll> pull
- get help if heavy
- have a wide base support
