Transcript Environmental Hazards (cont`d

Chapter 19
Safety: Measures that prevent
accidents or unintentional
injuries
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Discuss the purpose of the National Patient Safety goals and methods
for implementing them.
Give an example of one common injury that predominates during each
developmental stage (infancy through older adulthood).
Name six injuries that result from environmental hazards.
Identify at least two methods for reducing latex sensitization.
List four areas of responsibility incorporated into most fire plans.
Describe the indications for using each class of fire extinguishers.
Discuss five measures for preventing burns.
Name three common causes of asphyxiation.
Discuss two methods for preventing drowning.
Explain why humans are susceptible to electrical shock.
Discuss three methods for preventing electrical shock.
Name at least six common substances associated with poisonings.
Discuss four methods for preventing poisonings.
Discuss the benefits and risks of using physical restraints.
Explain the basis for enacting restraint legislation and the Joint
Commission’s accreditation standards.
Differentiate between a restraint and a restraint alternative.
Give at least four criteria for applying a physical restraint.
Describe two areas of concern during an accident.
Explain why older adults are prone to falling.
NATIONAL PATIENT SAFETY GOALS


Description: established in 2003 by Joint
Commission on Accreditation of Healthcare
Organizations (JCAHO)
Purpose: Safe and effective care of the
highest quality by reducing the risk of
adverse client outcomes.
NATIONAL PATIENT SAFETY GOALS
 Goals
are revised annually to reduce the
incidences of deaths & injuries among
those being cared for in health agencies.
 Most
hospital deaths & injuries are
attributed to medication errors &
adverse medication effects,
infections, surgical errors.
Text p. 399
SAFETY


Major nursing responsibility
Death from hospital errors: ranked
between 5th – 8th leading cause of death
by National Center for Health Statistics
NATIONAL PATIENT SAFETY GOALS
 Potential
methods for implementation (Text
p.400) Table 19-1 Summary of Nat’l Patient
Safety Goals 2009-2010
Prevent infection
Follow hand-washing
& hand antisepsis
guidelines (recommended
by CDC or WHO)
Use evidence based
practices to prevent
and treat infections.
NATIONAL PATIENT SAFETY GOALS
 Prevent
Infection
 Identify
patients
Correctly
 Improve
staff
Communication
Promote Flu &
Pneumococcal vaccines
in older adults
2 methods of ID
before medications/
blood/treatment
administration
Use only approved
abbreviations and
symbols (list on page
16 w/medical terms)
NATIONAL PATIENT SAFETY GOALS
 Improve
staff
Communication
Contact appropriate
healthcare providers
promptly when a
client’s health status
changes. Repeat or
read back verbal &
phone MD orders
NATIONAL PATIENT SAFETY GOALS
 Use
medications
safely
Label all meds.
Confirm that any
new meds are
appropriate to take
with current meds.
Provide a list of
client’s meds to MD,
client, family & next
healthcare provider
prior to discharge.
NATIONAL PATIENT SAFETY GOALS



Identify clients with
risks
Prevent pressure
ulcers
Involve clients in
their care
Falls Risk, suicide, safety
fires from O2
administration &
institute
precautionary
measures
Determine which
clients are at risk
for pressure
ulcers, develop a plan of
care, reassess periodically
Inform clients how to
report safety issues
NATIONAL PATIENT SAFETY GOALS
 Prevent
surgical Mark the body
errors
part, do “time
out” checks
making sure right
client and
documentation
immediately before
surgery. Commonly
called OR Checklists
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
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
ENVIRONMENTAL HAZARDS
 Latex
sensitization
 Thermal
burns
 Asphyxiation
 Electrical
 Poisoning
 Falls
shock
QUESTION

Is the following statement true or false?
Poisoning is a common hazard found only in
homes.
ANSWER
False.
Poisoning is a common hazard found in the
home and health care environment.
ENVIRONMENTAL HAZARDS (CONT’D)
 Latex
sensitization: allergic response to the
latex proteins

Latex is natural rubber sap

Component of many household items

Predisposition to latex sensitivity (hx. Asthma &
allergies to other substances, multiple surgeries,
& recurrent medical problems)
ENVIRONMENTAL HAZARDS
Latex: a natural rubber sap whose origin is a
species of tree indigenous to Brazil.
Common Items Containing Latex (Text: 401)
Medical gloves
IV ports
Band-aids
Bulb syringes
Urinary catheters
Wound drains (JP)
Tourniquets
Endoscopes
Mattress covers
BP cuffs & tubing
Stethoscope tubing Jobst stockings
ENVIRONMENTAL HAZARDS (CONT’D)
 Types
of latex reactions
Contact dermatitis: delayed localized
skin reaction; occurs within 6-48 hours &
last for several days.
Symptoms include: dry, itchy, irritated
areas on the skin, usually the hands
ENVIRONMENTAL HAZARDS (CONT’D)
Immediate hypersensitivity: instant/quick
reaction manifested by swelling, itching,
resp distress, hypotension, death in severe
cases
Sensitized people can develop a crossreaction to fruits or vegetables: due to the
molecular structure of latex and other plant
substances are similar
ENVIRONMENTAL HAZARDS (CONT’D)
 Preparing
a latex-free room (helps in preventing
latex sensitization and allergic reactions)
 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
ENVIRONMENTAL HAZARDS (CONT’D)
How would nurses communicate with
other departments regarding a client’s
latex allergy?
Flagging the chart, room door,
attaching an allergy-alert I.D.
bracelet
QUESTION

Is the following statement true or false?
People with latex allergy may develop a
cross-reaction to certain foods.
ANSWER
True.
People with latex allergy may develop a crossreaction to certain fruits and vegetables.
ENVIRONMENTAL HAZARDS (CONT’D)
Examples of fruits a person with a history
of a latex allergy could become crosscontaminated with:
Avocados
Bananas
Kiwis
Almonds
Tomatoes
Peaches
Because of similar molecular structure of
latex and other plants substances
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
QUESTION

Is the following statement true or false?
When using latex gloves, a nurse should use
oil-based hand creams.
ANSWER
False.
When using latex gloves a nurse should avoid the
use of oil-based creams.
Why should the nurse avoid oil-based
hand creams or lotions?
Oil-based hand creams can cause glove
deterioration.
ENVIRONMENTAL HAZARDS (CONT’D)
 Burns

Thermal burns: caused by fire, hot liquids,
steam and is the most common form for burns

Chemical burns: result from lye, electric
wires, lightning
ENVIRONMENTAL HAZARDS (CONT’D)

Burn prevention: exits identified, lighted,
unlocked. Most fire codes require public
buildings to have a functioning sprinkler
system, flame-resistant fabric, never smoke
around O2, do not overload outlets or circuits..

Fire plans: procedures in place for
possible/actual fire. Compliance is a major
component of JCAHO.
ENVIRONMENTAL HAZARDS (CONT’D)
One goal JCAHO has when visiting a
facility is to ask random employees what
that particular facility’s fire code is.
Most employees can’t remember, which is
why we have training at least annually.
How often is up to the facility.
This is when the employee gets taught the
acronym R-A-C-E. (Text: 402)
ENVIRONMENTAL HAZARDS (CONT’D)
 Burns
(cont’d)
 Fire management: RACE
o Rescue
o Alarm
o Contain
o Extinguish
ENVIRONMENTAL HAZARDS (CONT’D)
 Burns

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(cont’d)
Roles and responsibilities at and away
from fire’s origin
Use of fire alarm system
Agency fire plan concepts
ENVIRONMENTAL HAZARDS (CONT’D)
 Burns
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
(cont’d)
Rescue and evacuation; proper use of
equipment
Building compartmentalization for
containing smoke and fire
Fire extinguishers
ENVIRONMENTAL HAZARDS (CONT’D)
 Burns

(cont’d)
Fire extinguishers
 Class A: wood, paper
 Class B: liquids, grease
 Class C: electrical
 Class ABC: combination
EVACUATION OF CLIENTS
The methods listed below correspond with the
picture on the following slide:
A. Human Crutches: rescuers secure a weak, but
ambulatory client’s arms and waist
B. Seat Carry: rescuers interlock arms and carry
a non-ambulatory client
C. Body drag: rescuer drags an unconscious
victim or a victim who can’t walk on a blanket
or sheet.
EVACUATION OF CLIENTS
ENVIRONMENTAL HAZARDS (CONT’D)
 Asphyxiation
(inability to breathe): can result
from airway obstruction, drowning, inhalation
of gases like carbon monoxide (CO) and smoke.
o
o
CO binds with hemoglobin
CO poisoning: symptoms similar to flu,
except for cherry-red skin color
ENVIRONMENTAL HAZARDS (CONT’D)
Box 19-2 Symptoms of Carbon Monoxide
Poisoning (Text: 405)
- Nausea/vomiting
- Muscle Weakness
- Headache
- Confusion
- Dizziness
- Shortness of breath
- Cherry-red skin color
- Lapse into a coma, followed by death
ENVIRONMENTAL HAZARDS (CONT’D)
What is the treatment of someone suspected
of CO poisoning?
Get the victim out of the immediate
environment. If you can’t get the victim
out, the open windows & door for cross
ventilation.
ENVIRONMENTAL HAZARDS (CONT’D)
Extremely high levels of CO, may be treated
with hyperbaric (high-pressure) O2,
which delivers 100% O2 at 3x the normal
atmospheric pressure within an airtight
chamber
Prevention: Have carbon monoxide
detectors installed.
ENVIRONMENTAL HAZARDS (CONT’D)
 Drowning





Fluid occupies airway, interferes with
ventilation
Accidental drowning (during water
activities)
Resuscitation
Immediate CPR
CPR certification in nurses
ENVIRONMENTAL HAZARDS (CONT’D)
 Drowning
•
•
•
•
•
Prevention
Learn to swim
Never swim alone
Wear an approved flotation device
Do not drink alcohol when participating
in water-related sports
Notify law enforcement officer if boaters
appear unsafe
ENVIRONMENTAL HAZARDS (CONT’D)
 Electrical
shock (discharge of electricity
through the body)

Body prone to electric shock because we are
made up of H2O and electrolytes, both are
good conductors of electricity

Macroshock: harmless distribution of
low-amperage electricity over a large
area of the body. Feels like a slight tingling
ENVIRONMENTAL HAZARDS (CONT’D)
Electrical shock

Microshock: Low-voltage but high-amperage,
intact skin acts as a barrier, usually not felt;
can be fatal, especially if delivered directly to
the heart
Measures to prevent electrical shock

Grounded equipment reduces electrical shock
potential. (3-prong plug)

Do not use extension cords
Other safety measures are in Text p.406
ENVIRONMENTAL HAZARDS (CONT’D)
 Poisoning

Injury 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)
Why do more poisonings happen in
the home versus healthcare settings?
ENVIRONMENTAL HAZARDS (CONT’D)
Health care facilities keep their
medications locked up.
ENVIRONMENTAL HAZARDS (CONT’D)
 Clients
in hospitals are not routinely
allowed to keep medications at their
bedside.
 Medications are usually taken upon
admission into health care facilities
ENVIRONMENTAL HAZARDS (CONT’D)
Some Common Substance Associated
with Childhood Poisonings
 Drugs:
ASA, Tylenol, Vitamins with Iron,
Antidepressants, Sedatives
 Cleaning Agents: Bleach, Drain cleaners
 Paint Solvents: Turpentine, gas, kerosene
 Heavy metals: Lead pain chips
ENVIRONMENTAL HAZARDS (CONT’D)
Childhood poisoning agents in the home:
 Chemical products: Glue, shoe polish,
insecticides
 Cosmetics: Hair dye, nail polish remover
 Plants: Mistletoe berries, rhubarb leaves castor
beans
(Text: Box 19-3 p.406)
ENVIRONMENTAL HAZARDS (CONT’D)
Childhood poisoning agents: (Sample)
Iron
 Look like candy
 Parents don’t think Vitamins with Iron
can be harmful.
 Not kept out of reach of small children
ENVIRONMENTAL HAZARDS (CONT’D)
Iron Toxicity: Pediatric Iron Toxicity
 Phase 1: (1st 6 hours post ingestion): Manifests
usually as GI effects such as hemorrhagic
vomiting, diarrhea, abdominal pain
 Phase 2: (latent phase) 4-12 hours post ingestion:
Lab analysis demonstrates progressive metabolic
acidosis, beginning of end-organ dysfunction
ENVIRONMENTAL HAZARDS (CONT’D)
 Latent
phase: Elevated transaminase levels
(ALT & AST) May indicate liver damage
 Phase 3 (12-24 hours post ingestion): Marked
systemic toxicity: GI fluid losses lead to
hypovolemic shock, coagulopathy
More phases can be looked up at later date
Most exposures: children under 6 with many
serious acute occur in children under 3.
ENVIRONMENTAL HAZARDS (CONT’D)
 Poisoning
prevention

Educate children; teach parents

Cognitive-impaired adults: use prefilled
medication containers

American Association of Poison Control
Centers.
Client and Family Teaching 19-2 (p.407)
TREATMENT FOR INGESTED POISONS
 Treatment
depends on the substance, client
condition and if the substance is still in the
stomach.
 Maintain breathing and cardiac function
 Identify substance
 Consult Poison Control Center
Figure: 19-6 Decision tree (p.407)
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
ENVIRONMENTAL HAZARDS (CONT’D)
 Falls

(cont’d)
Contributing factors (cont’d)
o
Urinary urgency
o
Social, environmental factors
o
Accumulation of clutter
o
Hospitalization
o
Confusion, impaired judgment
ENVIRONMENTAL HAZARDS (CONT’D)
 Assessment

Determine risk factors

Fall prevention measures (page 408)

Keep emergency numbers near phone

Daily phone tree

Personal response services
RESTRAINTS
 Physical
restraints-protect a client from
falling out of bed or permit the client to
participate in activities
 Chemical
restraints-manage a client’s
behavior or freedom of movement
 Purpose:
 Use
client or staff safety
of restraints is closely regulated
 Restraints
reasons
 Last
may not be used for disciplinary
intervention used after all others
exhausted
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
RESTRAINTS (CONT’D)
 Legislation
(OBRA: Omnibus Budget
Reconciliation Act

Law incorporated; compliance mandatory since
1990
 Accreditation

standards
Restraint protocol; medical orders; monitoring
and documentation
RESTRAINTS (CONT’D)
 Restraint
alternatives: protective or adaptive
devices that promote client safety and postural
support which the client can release independently:
Seat belts / Harnesses with front releasing Velcro or
buckle closures, support pillows, seat inserts
Figure 19-8 Examples of restraint alternatives
(Text p.410)
RESTRAINTS (CONT’D)
Other Supplementary Measures
 Improve client gait training
 Provide physical exercise
 Reorient clients
 Encourage ambulatory aids (walkers)
 Electronic seat & bed monitors (bed alarm)
 Position wheelchair bound clients correctly
NURSING IMPLICATIONS
 Recognize
safety hazards
 Identify
clients at greatest risk for injury
 Identify
several nursing diagnoses
 Client
safety; allegations of malpractice
GENERAL GERONTOLOGIC CONSIDERATIONS
 Number
 Falls
of falls and severity of injury
rob client of independence
 Well-fitting
 Most
home
enclosed shoes, nonskid soles
falls occur in clients 65 years or older, at
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