Safety Flashcards by Kent Niño Perdez

A fundamental concern of nurses, which extends from the bedside to the home to the community,

is preventing injuries and assisting the injured.

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Major causes of injury and death

Motor vehicle crashes
Falls
Drowning
Fire and burns
Poisoning
Inhalation and ingestion of foreign objects
Firearm use

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_ are often caused by human conduct and can be prevented.

Injuries

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Factors Affecting Safety

The ability of people to protect themselves from injury is affected by such factors as:

Age and Development
Lifestyle
Mobility and Health Status
Sensory-Perceptual Alterations
Cognitive Awareness
Emotional State
Ability to Communicate
Safety Awareness
Environmental Factors

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Lifestyle factors that place people at risk for injury include:

Unsafe work environments,
Residence in neighborhoods with high crime rates,
Access to firearms,
Insufficient income to purchase safety equipment or make necessary repairs,
Access to illicit drugs, which may also be contaminated by harmful additives.

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_ are contributing factors in some accidents.

Risk-taking behaviors

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Mobility and Health Status

Alterations in mobility related to _, _, _, and _ place clients at risk for injury.

paralysis, muscle weakness, diminished balance, and lack of coordination

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Mobility and Health Status

_ impair the client’s ability to perceive discomfort, increasing the risk for injury or skin breakdown.

Spinal cord injuries or paralysis

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Mobility and Health Status

Clients who have _ such as hemiplegia or leg casts are prone to falls related to poor balance.

impaired mobility

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Mobility and Health Status

Clients weakened by _ or _ may suffer from impaired levels of alertness, placing them at risk for falls or injury.

illness or surgery

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Sensory - Perceptual Alterations:

People with impaired touch perception, hearing, taste, smell, and vision are highly susceptible to injury. A person with impaired vision may trip over a toy or not see an electric cord. A person with impaired olfactory sense may not smell burning food or the sulfur aroma of escaping gas.

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_ is the ability to perceive environmental stimuli and body reactions and to respond appropriately through thought and action.

Awareness

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Cognitive Awareness

Clients with impaired awareness include:

people lacking sleep; people who are unconscious or semiconscious; disoriented people who may not understand where they are or what to do to help themselves; people who perceive stimuli that do not exist; and people whose judgment is altered by disease or medications, such as narcotics, tranquilizers, hypnotics, and sedatives.

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Cognitive Awareness

_ clients may momentarily forget where they are, wander from their rooms, misplace personal belongings, and so forth.

Mildly confused

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Emotional State

People with _ may think and react to environmental stimuli more slowly than usual.

depression

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Ability to Communicate:

Individuals with diminished ability to receive and convey information are at risk for injury. They include clients with aphasia, language barriers, or the ability to read. For example, the person unable to interpret the sign “No smoking-oxygen in use” could cause a fire.

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Safety Awareness:

Information is crucial to safety. Clients in unfamiliar environments frequently need specific safety information. Lack of knowledge about unfamiliar equipment, such as oxygen tanks, intravenous tubing, and hot packs, is a potential hazard. Healthy clients need information about water safety, car safety, fire prevention, ways to prevent the ingestion of harmful substances, and many preventive measures related to specific age-related hazards.

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Environmental Factors:

Client safety is affected by the health care setting. Depending on the client situation, the nurse may need to assess the environment of the home, workplace, or community. Bioterrorism and natural disasters are national safety concerns.

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HEALTH CARE SETTING

In 1999, the Institute of Medicine (IOM) released its first publication on client safety and medical errors:

To Err Is Human: Building a Safer Health System

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HEALTH CARE SETTING

This landmark report attracted a great deal of attention when it reported that 98,000 people died in hospitals each year as a result of medical errors, and many more were seriously harmed (Regenstein, 2013).

To Err Is Human: Building a Safer Health System
1999
IOM

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HEALTH CARE SETTING

Since this report (To Err Is Human: Building a Safer Health System, 1999 by IOM), organizations such as _ and the _ developed and/or continued to accelerate work around patient safety.

The Joint Commission and the Agency for Healthcare Research and Quality (AHRQ)

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_ project developed guidelines that would enable future nurses to have the knowledge, skills, and attitudes necessary to improve the quality and safety of the health care systems within which they work (Sammer & James, 2011).

Quality and Safety Education for Nurses (QSEN)

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HEALTH CARE SETTING

The clear message of the IOM report was that _. IOM recommended that health care organizations create safety systems.

errors were not usually the result of one individual but of a complex system-related problem.

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HEALTH CARE SETTING

The Joint Commission created the _ program to help organizations target areas most in need of improvement (Shaw & Miller, 2013, p. 19).

National Patient Safety Goals (NPSGs)

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HEALTH CARE SETTING It is important for health organizations to create an environment in which safety is a top priority; this is also known as providing a _.

“culture of safety"

HEALTH CARE SETTING The foundation for a culture of safety is _, _, and _. An example is a willingness to share information and learn from errors

a blame-free work environment, transparency, and a process designed to prevent errors.

HEALTH CARE SETTING AHRQ (n.d.) defines a _ or _ as “an event or situation that did not produce client injury, but only because of chance (para. 2).”

near miss or a close call

HEALTH CARE SETTING Another IOM report, _, established a link between nurses’ work environment and client safety. This report found that the usual work environment of nurses is characterized by many serious threats to client safety.

Keeping Patients Safe—Transforming the Work Environment of Nurses (2004)

HEALTH CARE SETTING _ states that health care has one of the highest incidents of occupational injury and illness of any industry in the country and that nurses have among the highest rates of low back disorders (p. 333).

Gerwig (2013)

WORKPLACE:

In the workplace, machinery, industrial belts and pulleys, and chemicals may create danger. Worker fatigue, noise and air pollution, or working at great heights or in subterranean areas may also create occupational hazards. The work environment of the nurse may also be unsafe.

WORKPLACE _ reports that nursing has many hazards. Some of the hazards identified were exposure to infectious agents; activities in client care that require lifting, bending, and walking; exposure to hazardous compounds; and needlesticks. Nurses must adhere to standardized guidelines to prevent injury or disease.

The U.S. Bureau of Labor Statistics (2012)

HOME:

A safe home requires well-maintained flooring and carpets, a nonskid bathtub or shower surface, handrails, functioning smoke alarms that are strategically placed, and knowledge of fire escape routes. Outdoor areas, where steps or stairs increase the risk for falls, may need ramps instead. Swimming pools need to be safely secured and maintained. Adequate lighting, both inside and out, will minimize the potential for accidents.

COMMUNITY

Adequate street lighting, safe water and sewage treatment, and regulation of sanitation in food buying and handling all contribute to a healthy, hazard-free community. A safe and secure community strives to be free of excess noise, crime, traffic congestion, dilapidated housing, or unprotected creeks and landfills.

“deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants (para. 1).”

bioterrorism attack Defined by: Centers for Disease Control and Prevention (CDC)

BIOTERRORISM CATEGORY • Can be easily spread or transmitted from person to person. • Result in high death rates and have the potential for major public health impact. • Might cause public panic and social disruption. • Require special action for public health preparedness.

Category A agents have the highest risk

BIOTERRORISM CATEGORY • Are moderately easy to spread. • Result in moderate illness rates and low death rates. • Require specific enhancements of CDC’s laboratory capacity and enhanced disease monitoring.

Category B agents are the second highest priority

BIOTERRORISM CATEGORY • Are easily available. • Are easily produced and spread. • Have the potential for high morbidity and mortality rates and major health impact.

Category C agents include emerging pathogens that could be engineered for mass spread in the future

DISASTER PLANNING U.S. Department of Health and Human Services requested IOM to develop guidelines that offer a systems approach to providing disaster response. These guidelines are called _.

Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response

Disaster Planning _ (2012) states that these _ “help organizations and health care professionals deliver the best possible care in circumstances in which resources are severely limited and health care standards are compromised” (p. 61)

Murray crisis standards of care (CSC)

Disaster Planning -The role that nurses play in disaster planning is _. - Nurses must also _.

to know and understand the chain of command care for themselves in the event of a disaster

Disaster Planning - An important message from the American Nurses Association is that nurses should “_” (Stokowski, 2012, para. 6).

"never deploy outside of an organized response system"

Disaster Planning Stokowski (2012) lists the following disaster response organizations with which nurses may register: _, the _, the _, _, and the _.

National Disaster Medical System (NDMS) American Red Cross Medical Reserve Corps (MRC) RN Response Network (RNRN) Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP).

NURSING MANAGEMENT Assessing Assessing clients at risk for injury involves (a) _, (b) _, and (c) _.

(a) noting pertinent indicators in the nursing history and physical examination, (b) using specifically developed risk assessment tools, and (c) evaluating the client’s home environment.

NURSING MANAGEMENT Nursing History and Physical Examination - A _ also needs to include the client’s awareness of hazards, knowledge of safety precautions both at home and at work, and any perceived threats to safety

safety history

NURSING MANAGEMENT - _ are available to determine clients at risk both for specific types of injury, such as falls, or for the general safety of the home and health care setting.

Risk assessment tools

NURSING MANAGEMENT - The tools summarize specific data contained in the client’s nursing history and physical examination.

Risk assessment tools

NURSING MANAGEMENT - _ are major causes of falls, fire, poisoning, suffocation, and other accidents, such as those caused by improper use of household equipment, tools, and cooking utensils.

Hazards in the home

NURSING MANAGEMENT National Patient Safety Goals - The newest goal is _.

to reduce the harm associated with clinical alarm systems

NURSING MANAGEMENT National Patient Safety Goals - It is important to remember that the focus of the NPSGs is _.

on system-wide solutions

NURSING MANAGEMENT Bioterrorism Attacks - The biologic agents that have been identified by the CDC as being of highest concern include _, _, _, _, _, and _.

anthrax, botulism, plague, viral hemorrhagic fevers, smallpox, and tularemia.

NURSING MANAGEMENT Diagnosing Under the domain of Safety/Protection, NANDA International offers a broad diagnostic label related to safety issues:

• Risk for Injury: • Deficient Knowledge (Accident Prevention): • Readiness for Enhanced Knowledge (Accident Prevention):

NURSING MANAGEMENT Diagnosing - Diagnoses that describe injury more specifically include:

Risk for Falls; Latex Allergy Response; Risk for Latex Allergy Response; and Risk for: Infection, Suffocation, Poisoning, Trauma, Vascular Trauma, Aspiration, Adverse Reaction to Iodinated Contrast Media, Impaired Skin Integrity, and Risk for Self-Directed Violence

NURSING MANAGEMENT Planning - The major goal for clients with safety risks is _.

to prevent accidents and injury

NURSING MANAGEMENT Planning Nursing interventions to meet desired outcomes are largely directed toward helping the client and family to accomplish the following:

• Identify environmental hazards in the home and community. • Demonstrate safety practices appropriate to the home health care agency, community, and workplace. • Experience a decrease in the frequency or severity of injury. • Demonstrate safe child-rearing practices or lifestyle practices.

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Measures to ensure the safety of people of all ages focus on (a) _ and (b) _.

(a) observation or prediction of potentially harmful situations so that harm can be avoided and (b) client education that empowers clients to protect themselves and their families from injury.

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Newborns and Infants - _ are a leading cause of death during infancy, especially during the first year of life.

Accidents

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Newborns and Infants - Common accidents during infancy include _, _ or _, _, _, and _.

burns, suffocation or choking, automobile crashes, falls, and poisoning

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Toddlers - Parents prevent many accidents by “_” the home or other setting where the child will be.

toddler-proofing

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Toddlers - This practice extends to the use of federally approved car restraints and removing or securing all items that can pose a safety hazard to the child in any setting.

"toddler-proofing"

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Toddlers - _ is a risk for children exposed to lead paint chips, fumes from leaded gasoline, or any “leaded” substances.

Lead poisoning (plumbism)

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Preschoolers - _ for the child must begin now. Education of the preschooler involves learning how to cross streets, what traffic signals mean, and how to ride bicycles and other wheeled toys safely.

Safety education

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Preschoolers - Parents must also keep in mind that their child’s cognitive and motor skills _; hence, safety measures must _ with the acquisition of new skills.

increase quickly keep up

Ckinical Alert! The remodeling and renovation of older homes (e.g., those built before _) accounts for most of the lead poisoning seen today. Nurses need to educate families living in older homes about their children’s risk for lead poisoning and provide lead poisoning prevention advice.

1978

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span School-Age Children - _ sustained as a result of accidents are the leading cause of death in school-age children.

Injuries

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Adolescents - Teenagers may use _ as an outlet for stress, as a way to assert independence, or as a way to impress peers.

driving

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Adolescents - Adolescents are at risk for _ because their coordination skills are not fully developed. - _ and _ are two leading causes of death among teenagers.

sports injuries Suicide and homicide

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Young Adults - _ are by far the leading cause of mortality for this group; other causes of death for young adults include _, _ , _, and _.

Motor vehicle crashes drowning, fires, burns, and firearms

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Young Adults - One safety hazard for many young adults is _.

exposure to natural radiation from sunbathing or outdoor activities

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Young Adults - _ is another leading cause of death in young adults.

Suicide

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Young Adults - The nurse’s role in the prevention of suicide includes identifying behaviors that may indicate potential problems: _; _; and _.

depression; a variety of physical complaints including weight loss, sleep disturbances, and digestive disorders; and decreased interest in social and work roles along with an increase in isolation.

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Middle-Aged Adults - _, as well as _, may contribute to the injury rate of middle-aged people. - _ are the most common cause of accidental death in this age group.

Changing physiological factors concern over personal and work-related responsibilities Motor vehicle crashes

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Older Adults - _ is a major concern for older adults. Because vision is limited, reflexes are slowed, and bones are brittle, activities such as climbing stairs, driving a car, and even walking require caution.

Injury prevention

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Older Adults - _ are a hazard for the older person with a failing memory.

Fires

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Older Adults - Older adults at risk for _ due to organic brain syndromes need to wear identification devices. - Because older adults who take analgesics or sedatives may become lethargic or confused, they should be _.

wandering monitored regularly and closely

Safety Alert! Older adults have trouble seeing the edges of stairs. _ on the edges of the steps will help increase contrast and may prevent falls.

Painting white stripes

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Older Adults - People ages 65 and older comprise about 13% of the U.S. population; however, they account for over _ of all suicides (Caruso, n.d.). As people age, they experience both physical and emotional losses.

18%

NURSING MANAGEMENT Implementing Promoting Safety Across the Life Span Older Adults - Mehra, Gianakos, and Driscoll (2012) report that key risk factors for suicide in older adults include the following:

• Gender. The suicide rate for men 75 years and older is almost twice the rate for men of all ages. • Rural communities. Suicide rates are three times higher in rural areas than in urban ones. • Depression. Common symptoms of depression, such as fatigue, sleep problems, and weight loss or gain, may incorrectly be attributed to the older person’s existing chronic illness(es). Chronic pain can also worsen depression. • Social isolation. The risk of suicide increases when social isolation is due to bereavement or loss of social support.

Safety Alert! Studies show that many older adults who die by suicide visited a primary care provider within a _ before their death. These findings point to the urgency of improving detection and treatment of depression to reduce suicide risk among older adults (National Institute of Mental Health, 2009).

month

NURSING MANAGEMENT Implementing Safety Problems Across the Life Span - _ is increasing at an alarming rate and involving individuals of all ages. It includes child abuse, intimate partner abuse, and older adult abuse and affects the health and safety of families and the community.

Domestic violence

NURSING MANAGEMENT Implementing Safety Problems Across the Life Span - Nurses should be involved in working with all phases of domestic violence: _, _, _, and _.

prevention, screening, referrals for treatment, and follow-up care

NURSING MANAGEMENT Implementing Safety Problems Across the Life Span - _ takes on extra importance because it is known that people who were abused as children often display abusive behavior as an adult.

Domestic violence

NURSING MANAGEMENT Implementing Promoting Safety in the Health Care Setting - One of the primary interventions health care institutions must enact is a _ and _.

climate of change and trust

NURSING MANAGEMENT Implementing Preventing Specific Hazards - Infants and older adults are particularly prone to _ and causing serious injury. _ are the leading cause of injuries among older adults.

falling Falls

NURSING MANAGEMENT Implementing Preventing Specific Hazards Falls - For these individuals the nurse should encourage _, _, and _.

daily or more frequent contact with a friend or family member, installation of a personal emergency response system, and measures to maintain a physical environment that prevents falls

Clinical Alert! _ can break bones and self-confidence, leading to fear of _, which can cause a decreased activity level and decreased muscle strength. All increase the risk of _.

Falls falling

NURSING MANAGEMENT Implementing Preventing Specific Hazards Falls - In 2010, The Joint Commission added two required standards relating to client safety and hospital falls (Jorgensen, 2011): The hospital must (1) _ and (2) _.

(1) assess and manage the client’s risks for falls and (2) implement interventions to reduce falls based on the client’s assessed risk.

NURSING MANAGEMENT Implementing Preventing Specific Hazards Falls - The nurse can complete a 2- to 5-minute assessment tool called the _ in a hospital, long-term care, or home setting. This assessment requires the person to complete a series of tasks that are important for independent mobility: standing, walking, turning, and sitting (Picone, 2013, p. 57).

“Timed Up and Go” (TUG) test

NURSING MANAGEMENT Implementing Preventing Specific Hazards Falls - The AHRQ (2013) strongly encourages health agencies to have “_” as part of their fall prevention programs.

universal fall precautions

NURSING MANAGEMENT Implementing Preventing Specific Hazards Falls - AHRQ (2013) recommends a proactive approach called “_.” This is where the nurse conducts hourly visits between 6 am and 10 pm and visits every 2 hours between 10 pm and 6 am.

scheduled rounding

Clinical Alert! When a client falls, the nurse’s first duty is _. First, _. Then, _.

to the client assess for injuries notify the primary care provider

NURSING MANAGEMENT Implementing Preventing Specific Hazards Falls - Although it may seem that raising the side rails on a bed is an effective method of preventing falls, do not _ for this purpose. - Clients may even become entrapped between the mattress and side rails, leading to _.

routinely raise rails asphyxiation deaths

NURSING MANAGEMENT Implementing Preventing Specific Hazards Falls _ are available to detect when clients are attempting to move or get out of bed.

Electronic safety monitoring devices