1. Chapter 19
Safety

2. Safety Major nursing responsibility
Hospital errors: ranked as sixth leading cause of death by Centers for Disease Control and Prevention

3. Age-Related Safety Factors
Infants
Falling off changing tables
Unrestrained in automobiles
Toddlers
Climbing; accidental poisoning; falling downstairs or from high chairs; burns; electrocution; drowning

4. Age Related Safety Factors (cont’d)
School-aged children and adolescents
School-aged children: play-related injuries
Adolescents: sports-related injuries
Adults: ignoring safety issues, fatigue, sensory changes, effects of disease

5. Environmental Hazards
Latex sensitization
Thermal burns
Asphyxiation
Electrical shock
Poisoning
Falls

6. Question Is the following statement true or false?
Poisoning is a common hazard found only in homes.

7. Answer
False.
Poisoning is a common hazard found in the home and health care environment.

8. Environmental Hazards (cont’d)
Latex sensitization is an allergic response to the proteins in latex
Latex is natural rubber sap
Component of many household items
Predisposition to latex sensitivity

9. Environmental Hazards (cont’d)
Types of latex reactions
Contact dermatitis
Immediate hypersensitivity
Possible cross-reaction to fruits or vegetables

10. Environmental Hazards (cont’d)
Preparing a latex-free room
Stock room with latex-free equipment, including gloves, client care equipment, and resuscitation equipment
Wipe room clean of glove powder
Communicate with other departments the need to use only latex-free equipment

11. Question Is the following statement true or false?
People with latex allergy may develop a cross-reaction to certain foods.

12. Answer
True.
People with latex allergy may develop a cross-reaction to certain fruits and vegetables.

13. Environmental Hazards (cont’d)
Safeguarding clients and personnel
Prevent latex sensitization
If using latex gloves, avoid oil-based hand creams
Wash hands thoroughly after removing gloves

14. Question Is the following statement true or false?
When using latex gloves, a nurse should use oil-based hand creams.

15. Answer
False.
When using latex gloves a nurse should avoid the use of oil-based creams.

16. Environmental Hazards (cont’d)
Burns
Thermal burns or chemical burns
Burn prevention: exits identified, lighted, unlocked; ensure functioning sprinkler system
Fire plans

17. Environmental Hazards (cont’d)
Burns (cont’d)
Fire management: RACE
Rescue
Alarm
Contain
Extinguish

18. Environmental Hazards (cont’d)
Burns (cont’d)
Roles and responsibilities at and away from fire’s origin
Use of fire alarm system
Agency fire plan concepts

19. Environmental Hazards (cont’d)
Burns (cont’d)
Rescue and evacuation; proper use of equipment
Building compartmentalization for containing smoke and fire
Fire extinguishers

20. Environmental Hazards (cont’d)
Burns (cont’d)
Fire extinguishers
Class A: wood, paper
Class B: liquids, grease
Class C: electrical
Class ABC: combination

21. Evacuation of Clients

22. Environmental Hazards (cont’d)
Asphyxiation
Airway obstruction
Carbon monoxide (CO)
CO binds with hemoglobin
CO poisoning: symptoms similar to flu, except for cherry-red skin color

23. Environmental Hazards (cont’d)
Drowning
Fluid occupies airway, interferes with ventilation
Accidental drownings
Resuscitation
Immediate CPR
CPR certification in nurses

24. Environmental Hazards (cont’d)
Electrical shock
Body prone to electric shock
Macroshock; microshock
Grounded equipment reduces electrical shock potential
Measures to prevent electrical shock

25. Environmental Hazards (cont’d)
Poisoning
Caused by ingestion, inhalation, or absorption of toxic substance
More common in homes than in health care institutions
Accidental poisonings; medication errors

26. Environmental Hazards (cont’d)
Poisoning prevention
Educate children; teach parents
Cognitive-impaired adults: use prefilled medication containers
American Association of Poison Control Centers

27. Environmental Hazards (cont’d)
Falls
Most common accident with the most serious consequences in older adults
Contributing factors: visual impairments; disorders affecting gait, balance, and coordination; medications to lower blood pressure

28. Environmental Hazards (cont’d)
Falls (cont’d)
Contributing factors (cont’d)
Urinary urgency
Social, environmental factors
Accumulation of clutter
Hospitalization
Confusion, impaired judgment

29. Environmental Hazards (cont’d)
Assessment
Determine risk factors
Fall prevention measures
Keep emergency numbers near phone
Daily phone tree
Personal response services

30. Restraints
Restraints: methods of restricting a person’s freedom of movement, physical activity, or normal access to his or her body
Fall-prevention measures
Use of restraints is closely regulated
Restraints may be used for disciplinary reasons
Last intervention used after all others exhausted

31. Restraints (cont’d) Risks of use: Increase client confusion
Cause chronic constipation, incontinence, infections (pneumonia)
May cause pressure ulcers
Experience progressive decline in ability to perform ADLs independently

32. Restraints (cont’d) Legislation
Law incorporated; compliance mandatory since 1990
Accreditation standards
Restraint protocol; medical orders; monitoring and documentation

33. Restraints (cont’d)
Restraint alternatives: protective or adaptive devices that promote client safety and postural support which the client can release independently

34. Nursing Implications Recognize safety hazards
Identify clients at greatest risk for injury
Identify several nursing diagnoses
Client safety; allegations of malpractice

35. General Gerontologic Considerations
Number of falls and severity of injury
Falls robs independence
Well-fitting enclosed shoes, nonskid soles
Most falls occur in clients 65 years or older, at home

36. General Gerontologic Considerations (cont’d)
Factors contributing to falls in older adults: health conditions; situations such as environmental hazards, inadequate lighting, general clutter, assistive devices
Osteoporosis
Fear of falling; history of falling
Cognitive impairment