Restraints Flashcards
Does a family member get to decide to use restraints for their hospitalized kin
no, but it should prompt the nurse to assess the client to see if restraints are necessary
What must be documented
the assessments and if the restraint is needed
What are the standards for using restraints
Can be used to ensure clients immediate physical safety
seeclusion is only used to manage violent or self destructive behavior that is an immediate threat to the clients physical safety
can only be used if less restricitve measure didnt work
type and teechnique for restraint or seclusion must be the minimal needed to be effective
they must be administered by hospital policy
must be discontinued at the earliest possible time
Can you have a PRN order for restraints
no
What are the criteria for selecting a type of restraint
it restricts the client as little as possible
its safe for the client
it doesnt interfere with the clients treatment or H prob
it is readily changeable
it is as discreet as possible
What are some alternatives to restraints
assess for pain and treat it appropriately
Ask F member to stay with client
reduce stimulation
assign another nurse to act as buddies so the other can observe the client when the other nurse leaves
provide freq toileting
prepare clients before transfering to limit shock and confusion
monitor the patients meds and if possible try to reduce the dosages of sedatives or psychotropics
ask if they would like a warm beverage or back rub
use soft lights
What are some practice guidelines when using a restraint
apply so that the client can move as much as possible
pad bony prominences
if knot is used, use a knot that doesnt tighten when pulled
Assess and assist with basic needs like nutrition, elimination, and hygeine
when a restraint is temporarily removed dont leave
immediately report any difference in skin under the restraints
At the first sign cyanosis, coldness of skin, numbness, pain loosen restraint and exercise that area
provide emotional support verbally and through touch
