Chapter 13 Flashcards
Restraints
What are the rules and laws to follow for restraint use? (6)
- Restraints must protect the person
- A doctor’s order is required
- The least restrictive method is used
- Restraints are only used after other measures fail to protect the person
- Unnecessary restraints is false imprisonment
- Informed consent is required
Who provides needed information and obtains the consent for restraints?
Doctor or nurse
If a patient is confused & agitated while in restraints, what can you do as a CNA
Provide repeated explanations and reassurance. Spending time with them has a calming effect
What are the key points to remember in safety guidelines when it comes to restraints? (6)
- Observe for increased confusion & agitation
- Protect person’s quality of life
- Follow manufacturers instructions to safely apply & secure restraints
- Apply restraints with enough help to protect person and staff from injury
- Observe person every 15 minutes
- Remove or release restraint, re-position every 2 hours
How often should you re-position and meet basic needs of a patient in restraints?
At least every 2 hours
Which persons may need constant observation when in restraints?
- Who are aggressive, combative, or agitated
- At risk for aspiration
- At risk for suicide
T/F: A restrained person requires less staff time for care & observations
FALSE: they require more staff time for care & observations
Do not use a restraint to position a person on?
- on a toilet
- On furniture that does not allow for correct application
How is the V restraint applied?
The V neck is the front
How is a jacket restraint applied?
The opening is in the back
How is the belt restraint applied when in a chair?
Apply the restraint at a 45-degree angle over the thighs
When applying restraints, is it okay to criss-cross straps in the back?
No, the straps may loosen when person is moving and can cause serious injury
How much slack room should you leave in straps?
1 to 2 inches
To keep out of patients reach, where should you secure restraint straps when a person is in bed?
Secure the restraint to the movable part of the bed frame
Where should you never secure restraints?
bed rails, head-boards, foot-boards
How can you check for snugness when a restraint is applied to the chest or waist?
A flat hand should slide between the restraint and the person’s body
How can you check for snugness for limb holders and mitt restraints?
You should be able to slide 1 finger under the device
A person can become trapped or suspended between?
- The bars of bed rails
- The space between half-length (split) bed rails
- The bed rail and mattress
- The head-board or foot-board and mattress
You should keep bed rails up when a patient is in what kind of restraints?
Vest, jacket, or belt
To prevent a person in a vest, jacket, or belt restraint from falling off the bed and strangling on the restraint, what extra measures should you take to prevent it?
Use bed rail covers or gap protectors
What should not be used when a person is restrained to a chair?
Back cushion
T/F: It’s okay to cover a restrained person with sheets, blankets, bedspread or other coverings
False: Restraint must be within plain view at all times
Monitor a person in _______ position constantly
Supine
The restrained is removed or released for at least ____ minutes
10
After applying the restraints, what safety measures should you follow?
- Check circulation every 15 minutes
- Remove, release restraint, or re-position the person every 2 hours
What problems should you report to the nurse at once when making observatons of a person in limb holders or mitt restraints?
- You cannot feel pulse
- Fingers or toes are cold, pale, blue
- Person complains of pain, numbness, tingling
- Skin is red or damaged
What basic needs should be met when the restraint is removed/released?
- Measure vital signs
- Elimination needs
- Offer food & fluids
- Meet hygiene needs
- Give skin care
- ROM
- Physical & emotional comfort
A device may be a restraint for 1 person but not for another, give two examples
- Wheelchair with lap-top tray is used for meals
- Person uses half (1/2) bed rails to move in bed and get of out bed
What is an enabler?
A device that limits freedom of movement but is used to promote independence, comfort, or safety
What device limits freedom of movement, the person chooses to use it to help with function?
Enablers
What is the most serious risk of restraint use?
Death from strangulation
CMS requires the reporting of any death that occurs:
- While a person is in restraints
- Within 24 hours after a restraint is removed
- Within 1 week after a restraint was removed
If you find a person is strangling from a restraint, what should you do?
- Release restraint, cut it
- Shout for help and nurse as you are releasing the restraint
- Stay with person, CPR if needed
Which needs to be corrected?
a. A bed chair is placed really close to the wall
b. Pillows and positioning devices are used
c. Exercise programs are provided
d. Extra time is spent with restless person
a. a bed chair is placed really close to the wall
Fabric clothing is fastened and restricts the patients movement, is this a restraint?
Yes
Why is position alarm a physical restraint?
Person is afraid to move to avoid setting off the alarm
When are restraints used?
Last resort for protection
____ rules protect the person’s right to be free from restraint
CMS
What is a chemical restraint?
Any drug used for discipline or convenience and not required to treat medical symptoms. Control behavior or restrict movement
What factors determine a physical restraint?
- Is attached to or near the person’s body
- Cannot be removed easily by the person
- Restricts freedom of movement or normal access to the body
What is a manual method restraint?
To hold or limit voluntary movement by using body contact
What terms does the CMS follow in regards to restraints?
- Manual method
- Remove easily
- Freedom of movement
- Discipline
- Convenience
- Medical symptom
What does freedom of movement mean when it comes to restraints?
Any part of the body that the person can control. Any item that restricts movement or activity may be a restraint.
_____ _____is an indication or characteristic of a physical or psychological condition
Medical symptom
What does discipline mean when it comes to restraints?
Any action taken by the agency to punish or penalize a patient/resident. Restraints are not used to discipline patient
What care measures should you follow for a dementia patient?
- Identifying causes and triggers
- Understanding the person and following his or her routine
- Providing a calm setting
- Using distraction or an activity that is meaningful to the person
Why should certain drugs not be used for dementia patients?
Drugs used for aggression, agitation, delusions, and hallucinations can cause stroke or death
Where are limb holders applied?
Applied to wrist
What restraint prevents finger use but allows hand, wrist, and arm movement?
Mitt restraints
Where is the belt restraint applied in bed?
Around the waist and secured to the bed or chair. It is applied over garments
What does the belt restraint prevent?
Prevent person from getting out of bed or out of a chair
What is the purpose of limb holders & mitt restraints?
Prevent person from:
* Pulling out tubes for life-saving
* Pulling out devices that monitor vital signs
* Scratches, pulls, picks, peels at the skin, a wound, or a dressing
What restraint limits arm movement?
Limb holders
Where is a vest and jacket restraint applied?
Applied at the chest
T/F: You can apply vest and jacket restraints
FALSE: You are advised to only assist the nurse in applying vest and jacket restraints
Where should the straps of vest & jacket restraints cross?
Cross in the front
What supplies should you grab before applying restraints?
- Correct type and size of restraint
- Padding for skin and bony areas
- Bed rail pads or gap protectors
Before applying restraints, what’s the first step you should do?
Position the person for comfort and good alignment
After you have positioned the person for comfort & good alignment, what should you do after?
- Apply bed rail pads or gap protectors
- Pad bony areas
For mitten holders where should the foam part be facing?
Soft or foam part toward the skin
Before applying mitt restraints, what’s the first thing you should do?
Clean and dry the person’s hands
How should you insert the person’s hand into a mitt restraint?
Insert the person’s hand into the restraint with the palm down
Where should you secure restraints on a bed?
To a movable part of the bed, out of the persons reach
Before applying a belt restraint, what’s the first thing you should do?
Assist person to a sitting position
How do you secure the straps in a wheelchair?
Criss-cross straps, secured to the frame below the seat
For mitt restraints, watch that the person does not?
- Use the teeth to remove or damage the device
- Ingest any mitten material
How can you promote comfort when applying restraints?
- Position person in good alignment
- Make sure needed items are within reach
What are the risks of a belt, vest, and jacket restraint?
- Sliding forward or down in the chair or bed and becoming suspended or entrapped
- Falling off the chair or mattress and becoming suspended or entrapped
T/F: Instructions for 1 restraint applies to all
False: May not apply to another
Are the bed rails raised before or after the restraint is applied?
After restraint is applied
Where should the quick release knot be secured when a patient is in a chair or wheelchair?
Below chair or wheelchair and out of persons reach
Where should the quick release knot be secured on a bed?
Out of persons reach, movable part of bed
What restraints are considered “more restrictive”?
Cuff-style restraints for limbs
When are cuff-style restraints used?
ONLY used in situations of extreme danger
On a wheelchair, straps are secured to which part of the wheelchair?
The frame below the seat
T/F: Jacket and Vest restraint allows person to turn side to side
FALSE: Belt restraint allows person to turn side to side
