AND 100% CORRECT SOLUTIONS
ALREADY PASSED.
Risk of falling - ANS increases with age, history of falls, most common accident, slower reaction
time and slow less-steady movements, medication side effects, dementia, Alzheimer's,
depression, elimination problems, ill-fitting shoes and foot problems, low blood pressure, joint
pain and stiffness, muscle weakness, dulled senses and decreased temperature sensitivity,
impaired awareness
Most falls occur... - ANS in bedrooms or bathrooms, between 1800 - 2100 hrs, when shift
changes occur
Causes of falls - ANS poor lighting, clutter, wet and slippery areas, rushing to bathroom
How to prevent falls - ANS put bed in lowest position, provide proper lighting, brakes should be
on the bed and wheelchair/commode, non-skid shoes, rails, and mobility aids
Define restraint - ANS any device, garment, barrier, furniture, or medication that limits or
restricts freedom of movement or access to one's body
- last resort
- ordered by a physician
- least restrictive restraint used
- check every 15 mins, reposition at least every 2 hrs
Alternatives to restraints - ANS - calm them
- distract with activity
- non-interrupted sleep
threatening a restraint = assault
using a restraint without orders = battery
unnecessary restraint = false imprisonment
- never use as discipline or for staff convenience
- require informed consent prior
always determine cause of behaviour
Complications of restraints - ANS injuries from client trying to get free or from the wrong
restraint being used or the right restraint but it was applied incorrectly
death from strangulation
affects dignity and self-esteem
depression, anger, agitation, humiliation, mistrust, embarrassment