KOZIER & ERB’S

Fundamentals of NURSING
NINTH EDITION Concepts, Process, and Practice

CHAPTER 32
Safety

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Directory

• Classroom Response System Questions

• Lecture Note Presentation

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Classroom Response
System Questions

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 1
An 87-year-old man is admitted to the hospital for
cellulitis of the left arm. He ambulates with a walker
and take a diuretic medication to control symptoms
of fluid retention. Which intervention is most
important to protect him from injury?
A.Leave the bathroom light on.
B.Withhold the client’s diuretic medication.
C.Provide a bedside commode.
D.Keep the side rails up.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 1 Answer
An 87-year-old man is admitted to the hospital for
cellulitis of the left arm. He ambulates with a walker
and take a diuretic medication to control symptoms
of fluid retention. Which intervention is most
important to protect him from injury?
A.Leave the bathroom light on.
B.Withhold the client’s diuretic medication.
C.Provide a bedside commode.
D.Keep the side rails up.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 1 Rationales
A. Leaving the light on would assist the client in
locating the bathroom, but would not reduce the
risk of falling when rushing to the bathroom.
B. The nurse cannot withhold a client’s medication
without consultation with the physician.
C. Correct. A bedside commode decreases the
number of steps required to reach the goal.
D. Rails up would increase the risks of falls as well
as falling from a greater distance.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 2
A mother and her 3-year-old live in a home built in
1932. Which NANDA nursing diagnosis is most
applicable for this child?
A.Risk for Suffocation
B.Risk for Injury
C.Risk for Poisoning
D.Risk for Disuse Syndrome

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 2 Answer
A mother and her 3-year-old live in a home built in
1932. Which NANDA nursing diagnosis is most
applicable for this child?
A.Risk for Suffocation
B.Risk for Injury
C.Risk for Poisoning
D.Risk for Disuse Syndrome

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 2 Rationales
A. The risk for suffocation could happen but is
more likely with a newborn or infant, which is
the reason parents are taught not to prop the
bottle, to cut food in small pieces, and to use
toys with no small detachable pieces.
B. Option 2 is too vague to address risks
associated with a specific group of clients.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Question 2 Rationales (continued)
C. Correct. Remember that toddlers are active,
like to explore, and are unable to use discretion
about what they place in their mouths and as a
result are at risk for poisoning (e.g., lead
poisoning, toxic substances under the sink or in
a drawer).
D. Option 4 is more applicable to the elder who is
on total bed rest.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 3
A 75-year-old client, hospitalized with a cerebral
vascular accident (stroke), becomes disoriented at
times and tries to get out of bed, but is unable to
ambulate without help. What is the most
appropriate safety measure?
A.Restrain the client in bed.
B.Ask a family member to stay with the client.
C.Check the client every 15 minutes.
D.Use a bed exit safety monitoring device.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 3 Answer
A 75-year-old client, hospitalized with a cerebral
vascular accident (stroke), becomes disoriented at
times and tries to get out of bed, but is unable to
ambulate without help. What is the most
appropriate safety measure?
A.Restrain the client in bed.
B.Ask a family member to stay with the client.
C.Check the client every 15 minutes.
D.Use a bed exit safety monitoring device.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 3 Rationales
A. Option 1 can increase agitation and confusion and
removes the client’s independence.
B. Option 2 would help but transfers the responsibility to
the family member.
C. Option 3: Client could fall during the unobserved
interval and is also not a realistic answer for a nurse.
D. Correct. Answer 4 is an intervention that can allow the
client to feel independent and also alert the nurse and
nursing staff when the client needs assistance. It is the
most realistic answer that promotes client safety.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 4
Which nursing intervention is the highest in priority
for a client at risk for falls in a hospital setting?
A.Keep all of the side rails up.
B.Review prescribed medications.
C.Complete the “get up and go” test.
D.Place the bed in the lowest position.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 4 Answer
Which nursing intervention is the highest in priority
for a client at risk for falls in a hospital setting?
A.Keep all of the side rails up.
B.Review prescribed medications.
C.Complete the “get up and go” test.
D.Place the bed in the lowest position.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 4 Rationales
A. Option 1 can cause a fall with injury because
the client may fall from a higher distance when
trying to get over the rail.
B. Option 2 is important to do as certain meds can
increase a risk of a fall (e.g., tranquilizers,
analgesics).

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Question 4 Rationales (continued)
C. Option 3 would help the nurse assess if a client
is at risk for a fall.
D. Correct. Placing the bed in the lowest position
results in a client falling the shortest distance.
The client is least likely to fall when getting up if
the bed is at an appropriate height. The nurse
would discuss this with the primary care
provider. While it may be a priority, placing the
bed in the lowest position would be a higher
priority in the hospital setting.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 5
When planning to teach health care topics to a
group of male adolescents, which topic should the
nurse consider a priority?
A.Sports contribute to an adolescent’s self-esteem.
B.Sunbathing and tanning beds can be dangerous.
C.Guns are the most frequently used weapon for
adolescent suicide.
D.A driver’s education course is mandatory for
safety.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 5 Answer
When planning to teach health care topics to a
group of male adolescents, which topic should the
nurse consider a priority?
A.Sports contribute to an adolescent’s self-esteem.
B.Sunbathing and tanning beds can be dangerous.
C.Guns are the most frequently used weapon
for adolescent suicide.
D.A driver’s education course is mandatory for
safety.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Question 5 Rationales
A. Option 1 is true; however, it is not be as high a priority
as preventing suicide.
B. Option 2 is true; however, it is not be as high a priority
as preventing suicide.
C. Correct. Suicide and homicide are two leading causes
of death among teenagers, and adolescent males
commit suicide at a higher rate than adolescent
females.
D. Option 4 is not true. A driver’s education course is
certainly encouraged; however, completing a course
does not ensure safe practice.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Lecture Note Presentation

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Learning Outcomes

1. Discuss factors that affect people’s ability

to protect themselves from injury.
2. Describe methods to assess clients at risk
for injury.
3. Discuss the National Patient Safety
Goals.
4. Identify common potential hazards
throughout the lifespan.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Learning Outcomes (cont'd)

5. Give examples of nursing diagnoses,

outcomes, and interventions for clients at
risk for accidental injury.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Learning Outcomes (cont'd)

6. Plan strategies to maintain safety in the

health care setting, home, and
community, including prevention
strategies across the life span for thermal
injury, fires, falls, seizures, poisoning,
suffocation or choking, excessive noise,
electric hazards, firearms, radiation, and
bioterrorism.
7. Explain interventions to prevent falls.
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Learning Outcomes (cont'd)

8. Discuss implementation of seizure

precautions.
9. Discuss the use and legal implications of
restraints.
10.Describe alternatives to restraints.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Learning Outcomes (cont'd)

11.List desired outcomes to use in evaluating

the selected strategies for injury
prevention.
12.Verbalize the steps for:
a) Using a bed or chair exit safety monitoring
device.
b) Implementing seizure precautions.
c) Applying restraints.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Learning Outcomes (cont'd)

13.Recognize when it is appropriate to

delegate using a bed or chair exit safety
monitoring device, implementing seizure
precautions, and applying restraints of
clients to unlicensed assistive personnel.
14.Demonstrate appropriate documentation
and reporting of using a bed or chair exit
safety monitoring device, seizure
precautions, and applying restraints.
Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Factors Affecting Ability to
Protect Self from Injury
• Age and development
• Lifestyle
• Mobility and health status
• Sensory-perceptual alterations
• Cognitive awareness
• Emotional state
• Ability to communicate

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Factors Affecting Ability to
Protect Self from Injury (cont'd)
• Safety awareness
• Environmental factors

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Audrey Berman • Shirlee Snyder All rights reserved.
 Assessing

• Nursing history and physical examination

• Risk assessment tools
• Assessment of client’s home environment

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Audrey Berman • Shirlee Snyder All rights reserved.
 Diagnosing

• Risk for Injury

– Risk for Poisoning
– Risk for Suffocation
– Risk for Trauma
– Latex Allergy Response
– Risk for latex allergy response
– Contamination

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Diagnosing (cont'd)

• Risk for Injury

– Risk for contamination
– Risk for Aspiration
– Risk for Disuse Syndrome
• Deficient Knowledge (Accident Prevention)

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Desired Outcomes Associated with
Preventing Injury
• Prevent accidents and injury
• Often need to change health behavior
• Modify their environment
• Desired outcomes depend on individual
client

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Audrey Berman • Shirlee Snyder All rights reserved.
 Nursing Interventions

• Helping the client and family accomplish

the following:
– Identify environmental hazards in 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

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Nursing Interventions (cont'd)

• Helping the client and family accomplish

the following:
– Demonstrate safe childrearing practices or
lifestyle practices

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 Promoting Safety Across the
Lifespan
• Observation or prediction of potentially
harmful situations so that harm can be
avoided
• Client education that empowers clients to
protect themselves and their families from
injury

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Audrey Berman • Shirlee Snyder All rights reserved.
 Newborns and Infants

• Accidents are leading cause of death

• Parents need to learn the amount of
observation necessary to maintain safety
• Identify and remove common hazards
• First aid include CPR and interventions for
airway obstruction

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Newborns and Infants (cont'd)

• Common accidents
– Burns
– Suffocation or choking
– Automobile crashes
– Falls
– Poisoning

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 Toddlers

• “Toddler-proof proofing” home

• Physical trauma from falling, banging into
objects, or getting cut by sharp objects
• Use of federally approved car restraints
• Removing or securing all items

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 Toddlers (cont'd)

• Inspect and remove sources of lead

– Lead paint chips
– Fumes from leaded gasoline
– Any “leaded” substances

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 Preschoolers

• Control of the environment must continue

• Keep matches, medicines, and other
potential hazards out of reach
• Safety education must begin
– Learning how to cross the stress
– What traffic signals mean
– How to ride bicycles and other wheeled toys
• Parents must maintain careful surveillance

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 School-Age Children

• Engage in fantasy and magical thinking

• Intimate actions of parents and
superheroes
• Leading cause of death are accidental
injuries

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 School-Age Children (cont’d)

• Most frequent cause of death

– Motor vehicle crashes
– Drowning
– Fires
– Firearms

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 School-Age Children (cont’d)

• Minor injuries
– Swings, bicycles, skateboards, and swimming
pools

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 Adolescents

• Obtain driver’s license

– Outlet for stress
– Assert independence
– Impress peers
• Sports injuries
– Enhance social and personal development
– Help experience competition, teamwork, and
conflict resolution

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Adolescents (cont'd)

• Suicide and homicide

– Two leading causes of death
– Economic deprivation, family breakup, and
availability of firearms

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Young Adults

• Leading cause of death

– Motor vehicle crashes
– Suicide
• Nurses role in prevention is identifying
behaviors
– Depression
– Physical complaints
– Decrease in social and work roles

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 Middle-Aged Adults

• Accidental death
– Motor vehicle crashes most common cause
▪Decreased reaction time
▪Decreased visual acuity
– Falls
– Burns
– Poisonings
– Drowning

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 Middle-Aged Adults (cont'd)

• Safety hazard
– Occupational injuries

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
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 Older Adults

• Night driving
– Accommodation to light is impaired
– Peripheral vision is diminished
– Driving in fog should be avoided

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 Older Adults (cont'd)

• Fires
– Forgets iron or stove left on
– May not extinguish cigarette completely
– Need to prevent burns when person bathes or
using heating devices
• Risk for wandering
• Analgesic and sedative use
• Suicide increasing

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 Scalds and Burns

• Common home hazards

– Pot handles that protrude over edge of stove
– Electrical appliances used to heat liquids or
oils, especially with dangling cords that are
within reach of crawling infants and young
children
– Excessively hot bath water
• Monitor clients with impaired skin
sensitivity

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 Agency Fires

• Be aware of fire safety regulations and fire

prevention practices of the agency
• RACE
• PASS

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 Home Fires

• Teach fire safety

• Keep emergency numbers near the
telephone, or stored for speed dialing
• Be sure smoke alarms are operable and
appropriately located
• Teach to change batteries in smoke alarms
annually on a special day
• Have a family “fire drill”

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Home Fires (cont'd)

• Keep fire extinguishers available and in

working order

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 Home Fires

• Close windows and doors, if possible

• Cover mouth and nose with damp cloth
• Avoid heavy smoke by assuming bent
position with head close to floor as
possible

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Audrey Berman • Shirlee Snyder All rights reserved.
 Falls

• Infants and older adults are prone to falling

• Leading cause of injury in older adults
• Most frequently reported adverse event
• Most occur in the home
• “Get up and go”

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 Preventing Falls

• Orient clients to surroundings and explain

the call system
• Carefully assess the client’s ability to
ambulate and transfer
• Provide walking aids and assistance as
required
• Closely supervise the clients at risk for
falls, especially at night

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Audrey Berman • Shirlee Snyder All rights reserved.
 Falls

• Encourage the client to use the call bell to

request assistance and ensure that the bell
is within easy reach
• Place bedside tables and overbed tables
near the bed or chair so that clients do not
overreach

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
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 Falls (cont'd)

• Always keep hospital beds in the low

position and wheels locked when not
providing care so that clients can move in
or out of bed easily

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 Preventing Falls

• Encourage clients to use grab bars

mounted in toilet and bathing areas and
railings along corridors
• Make sure nonskid bath mats are available
in tubs and showers
• Encourage the clients to wear nonskid
footwear

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
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 Preventing Falls (cont’d)

• Keep the environment tidy, especially

keeping light cords from underfoot and
furniture out of the way
• Use individualized interventions, e.g.
electronic devices, rather than side rails for
confused client
• Use mechanical or electronic ceiling lifts to
transfer dependent clients

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Safety Features to Reduce Falls

• Regulating toileting and orientation of

confused or impaired clients
• Fall risk alerts
• Railings around corridors
• Call bell at each bedside
• Safety bars in toilet areas
• Lock on beds, wheelchairs, and stretchers

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Safety Features to Reduce Falls
(cont'd)
• Well-maintained and appropriately sized
wheelchairs
• One-quarter to one-half length side rails or
pads
• Night lights
• Safety monitoring device

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Bed or Chair Exit Safety Monitoring
Device
• Apply the leg band or sensor pad
– Place the client’s leg in a straight horizontal
position
– Sensor is usually placed under the buttocks
area
– Set the time delay
– Connect the sensor pad to the control unit

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
Bed or Chair Exit Safety Monitoring
Device (cont'd)
• Instruct to client to call nurse when getting
up
• Ensure client safety
• May delegate if UAP is trained in
application and monitoring

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Bed or Chair Exit Safety Monitoring
Device (cont'd)
• Documentation
– The type of alarm used
– Where it was placed
– Its effectiveness
– All additional safety precautions and
interventions discussed and employed

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 Seizure Precautions

• Pad the bed by securing blankets, linens

around the head, foot, and side rails of the
bed
• Put oral suction equipment in place and
test to ensure that it is functional
• Children who have frequent seizures
should wear helmets for protection.

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Seizure Precautions (cont'd)

• UAP should be familiar with establishing

and implementing seizure precautions and
assist during a seizure
• Care during a seizure is the nurses
responsibility due to importance of
assessment and potential need for
intervention

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Seizure Precautions (cont'd)

• If seizure occurs:
– Remain with the client
– Assist client to floor if not in bed
– Turn client to lateral position if possible
– Move items in environment for client safety
– Do not insert anything into mouth
– Time the seizure duration

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Seizure Precautions (cont'd)

• If seizure occurs:
– Observe progression of seizure
– Apply oxygen
– Suction oral airwary
– Administer anticonvulsants as ordered
– Assist client to comfortable position

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
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 Seizure Precautions (cont'd)

• Should wear a medical identification tag

• Safety precautions if seizures are not well-
controlled include restriction or direct
supervision by others for certain activities:
– Tub bathing
– Swimming
– Cooking
– Using electrical equipment or machinery
– Driving

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Seizure Precautions (cont'd)

• Document the event in the client record

using forms or checklists supplemented by
narrative notes when appropriate

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Poisoning

• Teaching parents to “childproof” the

environment
• Providing information and counseling about
insect, snake bites and drugs used for
recreational purposes

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Poisoning (cont'd)

• Safeguarding the environment and

monitoring the underlying problems to
prevent accidental ingestion of toxic
substances
• Telephone number of poison control
centers should be readily available
• Educating the public about what to do in
the event of poisoning

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Suffocation or Choking

• Teach universal distress signal

• Teach Heimlich maneuver
• Any obstruction must be immediately
removed
• Life support measures instituted when an
arrest occurs

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Excessive Noise

• Minimize noise in the hospital setting

• Protect hearing as much as possible
• Physiological effect of noise
– Increased heart and respiratory rate
– Increased muscular activity
– Nausea
– Hearing loss

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Excessive Noise (cont'd)

• Noise can be minimized in several ways:

– Acoustic tile on ceilings, walls, and floors
– Drapes and carpeting absorb
– Background music

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Electrical Hazards

• Electric equipment must be properly

grounded
• Faulty equipment presents a electric shock
or fire danger
• May sustain superficial or deep burns,
muscle contractions, and cardiac and
respiratory arrest
• Use machines in good repair

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Electrical Hazards (cont'd)

• Wearing shoes with rubber shoes

• Standing on a nonconductive floor
• Using nonconductive gloves
• Do not touch victim until electrical current
turned off or victim removed from contact

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Firearms

• Store all guns in sturdy locked cabinets

without glass
• Make sure the keys are inaccessible to
children
• Store the bullets in a different location
• Tell children never to touch a gun or stay in
a friend’s house where a gun is accessible

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Firearms (cont'd)

• Teach children never to point the barrel of

a gun at anyone
• Ensure the firearm in unloaded and the
action open when handing to someone
else
• Don’t handle firearms while affected by
alcohol or drugs of any kind, including
pharmaceuticals

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Firearms (cont'd)

• When cleaning or dry firing a firearm,

remove all ammunition to another room
• Double-check the firearm when entering
the room used to clean the firearm
• Have firearms that are regularly used
inspected by a qualified gunsmith at least
every 2 years

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Radiation

• Limit time near source

• Provide as much distance as possible from
source
• Use shielding devices
• Be familiar with agency protocols

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.
 Restraints

• Protective devices used to limit the

physical activity of the client or part of the
body
• Two reasons for restraining
– Avoid and/or prevent purposeful or accidental
harm to the resident/client
– To do what is required to provide medically
necessary treatment that could not be
provided through any other means

Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Ninth Edition Copyright ©2012 by Pearson Education, Inc.
Audrey Berman • Shirlee Snyder All rights reserved.