Editing Infection Control and Safety – RN Flashcards (section)

== Safety, Restraints, and Environment ==

;Name two validated fall risk screening tools and the strongest single predictor of a fall.
:The '''Morse Fall Scale''' and the '''Hendrich II Fall Risk Model'''. The strongest single predictor is a '''history of a previous fall'''.
;Which medication classes most increase fall risk, and which increase fall harm?
:Risk: '''benzodiazepines and sedative-hypnotics, opioids, antipsychotics, antidepressants, anticholinergics, antihypertensives, diuretics, insulin and sulfonylureas''', and polypharmacy generally. Harm: '''anticoagulants and antiplatelets''', which raise the risk of serious bleeding after a fall.
;First action after an unwitnessed fall?
:'''Assess before moving the client''': level of consciousness, vital signs, pain, deformity or leg shortening and external rotation, and head injury. Perform neurologic checks if the head was struck, the fall was unwitnessed, or the client is anticoagulated. Then notify the provider and family, and complete the '''incident report as an internal document that is not referenced in the chart'''.
;When do side rails become a restraint?
:When they prevent the client from leaving the bed voluntarily, classically '''all four rails raised'''. They also create '''entrapment risk''' and increase injury from climbing over.
;State the CMS time limits and face-to-face requirement for violent or self-destructive restraint.
:A '''face-to-face evaluation within 1 hour''' by a physician, other licensed independent practitioner, or trained registered nurse. Order limits: '''4 hours for adults 18 and older, 2 hours for ages 9 through 17, and 1 hour for children under 9''', renewable within these limits up to 24 hours before a new in-person evaluation.
;What is the order requirement for restraint, and what is never allowed?
:An order from a physician or other licensed independent practitioner is required; in an emergency a trained RN may apply and obtain the order as soon as possible, generally within one hour. '''PRN and standing restraint orders are never permitted.''' Nonviolent medical or surgical restraint orders are renewed at least once each calendar day.
;State the safe application and monitoring rules for restraints.
:Least restrictive device, applied over padding, '''two fingers''' fitting underneath, tied to the '''movable bed frame''' with a '''quick-release knot''', never to side rails. Release at least '''every 2 hours''' for range of motion, repositioning, toileting, hydration, and skin care. Monitor every 2 hours for nonviolent and every 15 minutes with continuous observation for violent restraint. Never restrain prone or in any way that impairs breathing.
;What do RACE and PASS stand for?
:'''R'''escue, '''A'''larm, '''C'''onfine, '''E'''xtinguish. '''P'''ull the pin, '''A'''im at the base of the fire, '''S'''queeze the handle, '''S'''weep side to side. An '''ABC''' extinguisher is the multipurpose choice in healthcare.
;State the evacuation priority and route rules.
:Ambulatory clients first, then those needing assistance, then nonambulatory and bedbound. Evacuate '''horizontally past smoke barrier doors first, vertically only if needed, and never by elevator'''.
;List key oxygen safety measures.
:No smoking or open flame, no spark-producing devices such as electric razors, avoid petroleum-based and alcohol-based products near the face, use '''cotton''' rather than wool or synthetic bedding, post signage, and secure cylinders '''upright in a holder or chained''' away from heat.
;What is microshock and who is at risk?
:Injury from a very small leakage current reaching the myocardium through a conductive path such as a '''pacing wire or central catheter'''. Minimize bedside electrical devices, use grounded hospital-grade equipment, and never defeat the ground pin.
;PPE and handling for hazardous antineoplastic drugs.
:'''Double chemotherapy-rated gloves''', a closed-front impermeable gown, eye protection, a closed system transfer device, and preparation in a '''biological safety cabinet'''. Handle excreta with PPE for at least 48 hours after administration per policy and use a spill kit for spills.
;Radiation safety principles for a client with a sealed internal implant.
:'''Time, distance, and shielding.''' Limit time in the room, maximize distance, wear a lead apron and dosimeter, keep '''long-handled forceps and a lead container''' in the room, '''never touch a dislodged implant with bare hands''', and restrict pregnant staff, pregnant visitors, and children.