This topic contains a solution. Click here to go to the answer
« previous next »

Author Question: The nurse is caring for a patient in restraints. Which essential information will the nurse document ... (Read 29 times)

ap345

  • Hero Member
  • *****
  • Posts: 537
on: Jul 22, 2018
The nurse is caring for a patient in restraints. Which essential information will the nurse document in the patient's medical record to provide safe care? (Select all that apply.)
 
  a. One family member has gone to lunch.
  b. Patient is placed in bilateral wrist restraints at 0815.
  c. Bilateral radial pulses present, 2+, hands warm to touch
  d. Straps with quick-release buckle attached to bed side rails
  e. Attempts to distract the patient with television are unsuccessful.
  f. Released from restraints, active range-of-motion exercises completed

Question 2

The nurse is assessing a patient who reports a previous fall and is using the SPLATT acronym. Which questions will the nurse ask the patient? (Select all that apply.)
 
  a. Where did you fall?
  b. What time did the fall occur?
  c. What were you doing when you fell?
  d. What types of injuries occurred after the fall?
  e. Did you obtain an electronic safety alert device after the fall?
  f. What are your medical problems that may have caused the fall?


Related Topics

Need homework help now?

Ask unlimited questions for free

Ask a Question
Marked as best answer by a Subject Expert

carojassy25

  • Sr. Member
  • ****
  • Posts: 299
Reply #1 on: Jul 22, 2018
Answer to Question 1

ANS: B, C, E, F
Proper documentation, including the behaviors that necessitated the application of restraints, the procedure used in restraining, the condition of the body part restrained (e.g., circulation to hand), and the evaluation of the patient response, is essential. Record nursing interventions, including restraint alternatives tried, in nurses' notes. Record purpose for restraint, type and location of restraint used, time applied and discontinued, times restraint was released, and routine observations (e.g., skin color, pulses, sensation, vital signs, and behavior) in nurses' notes and flow sheets. Straps are not attached to side rails. Comments about the activities of one family member are not necessarily required in nursing documentation of restraints.

Answer to Question 2

ANS: A, B, C, D
Assess previous falls; using the acronym SPLATT:
Symptoms at time of fall
Previous fall
Location of fall
Activity at time of fall
Time of fall
Trauma after fall
Medical diagnoses and an alert device are not components of SPLATT.


ap345

  • Member
  • Posts: 537
Reply 2 on: Jul 22, 2018
Wow, this really help

frankwu0507

  • Member
  • Posts: 322
Reply 3 on: Yesterday
Great answer, keep it coming :)

« previous next »
 

Did you know?

The senior population grows every year. Seniors older than 65 years of age now comprise more than 13% of the total population. However, women outlive men. In the 85-and-over age group, there are only 45 men to every 100 women.

Did you know?

The Centers for Disease Control and Prevention (CDC) was originally known as the Communicable Disease Center, which was formed to fight malaria. It was originally headquartered in Atlanta, Georgia, since the Southern states faced the worst threat from malaria.

Did you know?

When blood is deoxygenated and flowing back to the heart through the veins, it is dark reddish-blue in color. Blood in the arteries that is oxygenated and flowing out to the body is bright red. Whereas arterial blood comes out in spurts, venous blood flows.

Did you know?

The U.S. Pharmacopeia Medication Errors Reporting Program states that approximately 50% of all medication errors involve insulin.

Did you know?

Bacteria have flourished on the earth for over three billion years. They were the first life forms on the planet.

A computerized patient registration form used by offices with electronic health records. A computerized patient registration form used by offices with electronic health records.
The offspring of the microchip—from computers to cell phones—offer access to vast information ... The offspring of the microchip—from computers to cell phones—offer access to vast information ...
Anatomy of the heart. Remember: It is labeled right and left based on the patient’s perspective. Anatomy of the heart. Remember: It is labeled right and left based on the patient’s perspective.
Flow data for a healthy donor (top panel) and a HIV positive patient. CD3 is a T-cell marker, CD4 is ... Flow data for a healthy donor (top panel) and a HIV positive patient. CD3 is a T-cell marker, CD4 is ...
The material safety data sheet (MSDS) for sulfuric acid showing the detailed technical information ... The material safety data sheet (MSDS) for sulfuric acid showing the detailed technical information ...
Nurse measuring the recumbent height of a toddler Nurse measuring the recumbent height of a toddler
Video: ACTH/Cortisol (glycogenolysis, protein catabolism, lipolysis and gluconeogenesis)

For a complete list of videos, visit our video library