Safety Flashcards
Home Safety Education for The Older Adult
To promote home safety for the older adult, the nurse should verify the following:
✓ Remove scatter rugs and frayed carpet
✓ Ensure that hallways and steps are well lit
✓ Do not run wires under carpeting
✓ Smoke detectors are present and are tested every six months
✓ The recommendation is one smoke detector per room and one per floor
✓ Ensure fire extinguishers are readily available
✓ Add additional lighting to the bathroom
✓ Medications are clearly labeled and are reviewed periodically by a family member or healthcare provider
✓ Household chemicals are clearly labeled
✓ Rubber (nonskid) mats in the bathtub
✓ Grab bars in the bathroom
✓ Raised toilet seats
✓ Handheld shower head
medications that increase risk for falls
Medications that may hasten the risk for falls and included benzodiazepines such as alprazolam. This medication causes drowsiness and may impair judgment. Bumetanide is a loop diuretic; this medication may cause a client to experience orthostatic hypotension and the urgency to use the bathroom. Both of which pose a fall hazard. Verapamil is a calcium channel blocker and is utilized in the management of migraines and hypertension. This medication causes vasodilation; therefore, it will allow the client to become orthostatic if they do not shift positions slowly.
PCA Pump
Regardless of the prescribed PCA setting, the nurse should verify the settings with a second nurse as the pump is being initiated. This helps reduce errors with morphine which is a high-risk medication. These settings should also be verified during the handoff report and any time prescribed changes are made.
It would be appropriate for the nurse to apply EMLA (topical lidocaine) via a disk or thick cream to the skin prior to starting an IV can decrease the discomfort associated with the procedure. This cream is applied 30 to 60 minutes prior to starting the IV.
It would not be appropriate for the nurse to administer oxygen via nasal cannula as this client has an optimal oxygen saturation. It is detrimental to administer supplemental oxygen to a client with SCA who is appropriately oxygenating. Oxygen does not reverse sickled RBCs, and if used in a nonhypoxic patient, it decreases erythropoiesis.
It is not necessary to keep the client NPO. It would be beneficial to encourage the client to increase their intake of fluids and fluid rich foods such as fruit. Finally, warm compresses effectively provide pain relief because of the vasodilation effect. It does not reverse sickled RBCs, and if used in a nonhypoxic patient, it decreases erythropoiesis.
RN Scope of Practice
- initial assessment
- assessment and care of unstable patients
-administer IV push, blood products, TPN, and medications requiring titration/continuous monitoring - access implanted devices
- interpret and analyze data requrijng complex critical thinking
- care plan development and initiation of referrals
- initial and discharge teaching
LPN Scope of Practice
- monitor RN findings (obtain HR, BP, etc)
- gather data (focused and subsequent on stable patients)
basic client care (changing bandages, inserting catheters)
report clients status and concerns to RN
Care for stable clients with predictable outcomes
Reinforce RN education
UAP Scope of Practice
- assist with client ambulation, ROM, hygiene activities, and ADLs
- feeding and oral care for stable patients
- ins and outs
- vitals
positioning
linen change
transferring patients
reporting concerns to RN/LPN
intramuscular injection considerations
✓ For adults, potential intramuscular sites include the ventrogluteal, vastus lateralis, and deltoid.
✓ The dorsogluteal site is not recommended because of potential damage to nearby nerves and blood vessels.
✓ A normal, well-developed adult patient tolerates 3 mL of medication into a larger muscle without severe muscle discomfort.
✓ Larger volumes of medication (4–5 mL) are unlikely to be absorbed properly.
✓ Children, older adults, and clients who are thin tolerate only 2 mL of an IM injection.
✓ Do not give more than 1 mL to small children and older infants, and do not give more than 0.5 mL to smaller infants
The new graduate nurse knows that malignant hyperthermia is a serious adverse reaction that can occur after the administration of which of the following medications?
halothane
vancomycin
succinylcholine
omeprazole
penicillin
hydrocodone
Malignant hyperthermia is a severe adverse medication reaction. The nurse should know to monitor for this adverse reaction when administering induction agents such as halothane and succinylcholine. These medications can cause excess calcium to build up in the cells, resulting in the client experiencing sustained skeletal muscle contractions. These contractions cause a hypermetabolic state and fever and can lead to death.
✓ Malignant hyperthermia (MH) is an autosomal dominant disorder
✓ Succinylcholine is a neuromuscular blocker indicated in a client being intubated or electroconvulsive therapy (ECT) and has been implicated in causing MH
✓ MH may be life-threatening
✓ The manifestations of MH include muscular rigidity, high fever, mixed metabolic and respiratory acidosis, and hyperkalemia
The home health nurse is assessing a client with suspected carbon monoxide poisoning. The nurse should take which priority action?
Carbon monoxide poisoning is a serious emergency that is often fatal if not promptly treated. This medical emergency requires the client to be immediately relocated away from the carbon monoxide. Moving the client outside is effective because of the fresh air. Once this has been completed, the nurse should notify the PHCP or call emergency medical services (EMS) for further treatment. Another priority treatment is providing the client with 100% high-flow oxygen regardless of their pulse oximetry, lung sounds, or arterial blood gas results.
In preparation for pericardiocentesis, what should the nurse prepare to have at the bedside? Additionally, it is essential to monitor what during the procedure?
defibrillator
Cardiac Rhythym
To ensure adequate safety at home of the older adult, the nurse must consider:
✓ Remove scatter rugs and frayed carpet
✓ Ensure that hallways and steps are well lit
✓ Do not run wires under carpeting
✓ Smoke detectors are present and are tested every six months
✓ The recommendation is one smoke detector per room and one per floor
✓ Ensure fire extinguishers are readily available
✓ Add additional lighting to the bathroom
✓ Medications are clearly labeled and are reviewed periodically by a family member or healthcare provider
✓ Household chemicals are clearly labeled
✓ Rubber (nonskid) mats in the bathtub
sequence for donning PPE
The sequence for donning (applying PPE) is gown, mask (respirator), goggles, and gloves.
When should the patient be verified with two patient identifiers?
Anytime the nurse or unlicensed assistive personnel (UAP) engages directly with the client, two identifiers (name and date of birth) should be asked. This prevents misidentification and mitigates errors related to care delivery. Providing a meal tray will require the identifiers because diets vary by client and are prescribed by the primary healthcare provider (PHCP). Obtaining vital signs requires the two identifiers so the nurse (or UAP) may accurately record these vital signs. Finally, providing range of motion requires two identifiers as it is a task directly involving the client.
