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Chapter 19

Safety

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Major nursing responsibility

Hospital errors: ranked as sixth leading cause of death by Centers for Disease Control and Prevention

Safety

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1. Infants Falling off changing tablesUnrestrained in automobiles

2. Toddlers Climbing; accidental poisoning; falling downstairs or

from high chairs; burns; electrical shock; drowning

Age-Related Safety Factors

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3. School-aged children and adolescentsSchool-aged children: play-related injuriesAdolescents: sports-related injuries

4. Adults: Ignoring safety issues, fatigue, sensory changes, effects of

disease

Age-Related Safety Factors(cont’d)

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Latex sensitization

Thermal burns

Asphyxiation

Electrical shock

Poisoning

Falls

Environmental Hazards

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Latex sensitization is an allergic response to the proteins in latex

Latex is natural rubber

Component of many household items

Predisposition to latex sensitivity

Types of latex reactions

Contact dermatitis

Immediate hypersensitivity

Environmental Hazards (cont’d)

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Safeguarding clients and personnel

Prevent latex sensitization

If using latex gloves, avoid oil-based hand creams

Wash hands thoroughly after removing gloves

Environmental Hazards (cont’d)

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Burns

Thermal burns or chemical burns

Burn prevention: exits identified, lighted, unlocked; ensure safety measures

Fire plansFire management: RACE

o Rescueo Alarmo Contain (احتواء)o Extinguish

Environmental Hazards (cont’d)

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Burns (cont’d)Roles and responsibilities at and away from fire’s originUse of fire alarm systemAgency fire plan conceptsRescue and evacuation; proper use of equipmentBuilding compartmentalization for containing

smoke and fireFire extinguishers

Environmental Hazards (cont’d)

Evacuation of Clients

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Asphyxiation

Airway obstruction

Carbon monoxide (CO)

o CO binds with hemoglobin

o CO poisoning: symptoms similar to flu, except for cherry-red skin color

Environmental Hazards (cont’d)

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DrowningFluid occupies airway, interferes with

ventilationAccidental drownings ResuscitationImmediate CPR CPR certification in nurses

Environmental Hazards (cont’d)

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Electrical shock

Body prone to electric shock

Macro shock; micro shock

Grounded equipment reduces electrical shock potential

Measures to prevent electrical shock

Environmental Hazards (cont’d)

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Poisoning

Caused by ingestion, inhalation, or absorption of toxic substance

More common in homes than in health care institutions

Accidental poisonings; medication errors

Environmental Hazards (cont’d)

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Poisoning prevention

Educate children; teach parents

Cognitive-impaired adults: use prefilled medication containers

Environmental Hazards (cont’d)

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FallsMost 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

Contributing factors (cont’d)

o Urinary urgency

o Environmental factors

o Hospitalization

o Confusion, impaired judgment

Environmental Hazards (cont’d)

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AssessmentDetermine risk factors

Fall prevention measures

Environmental Hazards (cont’d)

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Restraints: methods of restricting a person’s freedom of movement, physical activity, or normal access to his or her body

Use of restraints is closely regulated

Last intervention used after all others exhausted

Restraints

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Risks of use:Increase client confusionCause chronic constipation, incontinence, infections

(pneumonia)May cause pressure ulcersExperience decline in ability to perform ADLs

independently

Restraints(cont’d)

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Recognize safety hazards

Identify clients at greatest risk for injury

Identify several nursing diagnoses

Client safety; allegations of malpractice

Best wishes

Nursing Implications