Module 4, Prevention and Management of Catastrophes and Unusual Occurrences. Section 1, Define Key Terminology. Review the terms listed in the terminology section.
Spell the listed terms accurately. Pronounce the terms correctly. And use the terms in their proper context.
Section 2, The Role of the Nurse Assistant in Emergency, Disaster, and Fire Situations. A, Be Prepared. No emergency codes, facility rules, no fire and disaster plans, and no location of fire exits, extinguishers, and alarms. B. Remain calm.
C. Use emergency call system. Telephone numbers used within each facility. The licensed nurse activates the EMS, Emergency Medical System, by dialing 911. D. Remain calm and...
do not shout fire or cardiac arrest, etc. E. Stat means to respond at once or there is an immediate need. F. Send family or visitors to the facility designated area.
G. Use race and pass per policy. C. Section 8. H. Do not act beyond your level of knowledge.
I. Move patient or resident if in immediate danger. J. Remain with patient or resident. K.
Keep patient or resident comfortable and calm. L. Evacuate patient or resident to safety according to facility fire and disaster plans. Section 3. Ways the nurse assistant can help patients or residents, families, and visitors remain calm in an emergency situation.
Stay calm. and use a calm voice. Project confidence.
Know and use facility emergency codes and plans. Stay with the patient or resident and keep them comfortable and quiet. Move or direct families and visitors to the designated area in the facility or a safe environment and close all fire doors.
Section 4. Common emergency codes used in facilities. Each facility may have different codes. Patient or resident safety issue.
Examples may be manpower or a special alarm code. Disaster code. Example may be disaster level 3. May be different for internal or external disasters.
Emergency colors and meanings. Code red. Fire.
Code blue. Adult medical emergency, such as cardiac or pulmonary. Code yellow.
Bomb threat. Code gray. Combative person.
Code silver. Person with weapon or hostage. Code orange. Hazardous waste spill or release. Section 5. General rules for providing a safe environment for the nurse assistant.
A. Use body mechanic principles. B.
Use ergonomics. C. Know the policy and procedures regarding OSHA safety laws on the use of equipment and handling hazardous materials. MSDS.
D. Wipe up spills immediately and identify wet floors with the appropriate signs. E. Walk, never run in halls and watch carefully at intersections.
F. Use contents of containers only if they have proper labels and dates and you know how to use them correctly. G. Tag and report broken equipment. H.
Report unsafe situations. I. Use three-pronged plugs on electrical equipment.
J. Refuse to do any task that you do not know how to do. K.
No proper operation of equipment. L. Watch linen and garbage cans for safety hazards. M. Report if sharps container is over half full.
N. No procedure to follow in case of personal injury. Report the injury immediately to the supervisor.
Fill out an incident report or unusual circumstance form as per facility policy and procedure. Seek medical help as necessary. O. Patient or resident and staff safety is an important quality assurance issue.
Section 6, General Rules for Providing a Safe Environment for the Patient or Resident. A. Know the National Patient Safety Goals. B. Check wristbands or name tags before performing any task on a patient or resident. C. Use side rails when performing any task.
appropriate and no facility policy and procedure on side rails. D. Have the patient or resident use handrails or appropriate assistive device when unstable. E.
Have patient or resident wear non-skid footwear when ambulatory. F. Place the call signal light within reach of the patient or resident and instruct them on correct use.
G. Lock wheels on the bed, gurney, or wheelchair when transferring the patient or resident. H. Answer call lights promptly.
I. Use night lights to help ensure good lighting and reduce obstacle hazards. J.
Keep the bed in the lowest position, except when tending to the patient or resident. K. Check better chair alarms, ensuring working condition. And L. Keep environment clutter-free. Section 7. Two of the top safety issues for patients or residents, and interventions to prevent them.
A. Falls are 70% of all patient or resident related accidents. Most falls occur during 4 p.m. and 8 p.m.
and during shift changes. B. Ways to prevent falls.
Watch for arms or legs and tubing. Make sure the rails are locked in the up position. 4. Brakes should be on when transferring patient or resident to or from a wheelchair, bed, or gurney. 5. Comfort items, such as water, call bell, urinal, etc., should be easy for patient or resident to reach.
Answer call lights promptly. 7. Areas should have good lighting and be free of clutter. 8. Check to ensure foot latches on beds and foot supports on the wheelchair are out of the way to prevent tripping or hitting staff or patient or resident's legs.
Wipe up spills promptly. 10. Meet the comfort needs of the patient or resident promptly, such as water and elimination. 11. Fall precautions. Identify at-risk patients who are taking medications that cause patients to be weak, dizzy, or sleepy. 12. Check patients or residents for weakness, dizziness, and ambulation or transfer hazards.
Use the appropriate assistive device as directed by the licensed nurse and ask for help if in doubt. And 14. Be aware of patients or residents location at all times. C.
Assistive devices used to reduce falls and maintain safe mobility of the patient or resident. 1. Assessed for need by the licensed nurse, physical therapist, or rehab aide with input from the nurse assistant. 2. Cane. Types of canes include single tip, tri-tip, and quad cane. Use on the strong side.
Check the rubber tip and height appropriate for the patient or resident. 3. Walker. It provides stability and support.
Types of walkers include pickup, front wheeled, and four wheeled strolling. Some might have seats. Check rubber tips and height appropriate for the patient or resident, and give instruction on the correct use. Number four, gate belt, if the facility permits. Five, wheelchair.
Provide mobility for the non-ambulatory patient or resident. Different types. Remember removable armrests and footrests. Check that the brakes are locked when transferring the patient or resident.
D. Burns are the second most common hazard for patients or residents and often can be prevented. Number one, types and causes of burns.
Steam or water burns. From bath temperature or hot drinks. Flame, smoking. Chemical cleaners like peri-wash. Thermal, such as heating pads or sunburn.
Two, prevention and interventions for burns. Prevention, which is the best approach. Check the water temperature and report if it's too hot. Monitor smoking, monitor hot drinks, and risk for spills. Be familiar with the water temperature and report if it's too hot.
with the use of equipment such as heating pads and hot packs and know the policy and procedure. Protect patient or resident from sunburn with a hat, sunscreen, and brief exposure. Know the policy and procedure on fire response and follow directions on the use of chemical cleansers. B.
Intervention. Initial first aid. For first degree burns, ice and cold water only for discomfort. Never use butter, shortening, etc. it may cause the burn to become worse.
Deeper or larger burns require immediate medical attention. Notify a licensed nurse immediately. Describe the cause of the burn, if possible, such as a flame or chemical. Section 8. Major Causes of Fire and General Fire Prevention Rules A. Major Causes of Fire Smoking is the number one cause of fire. Sparks from faulty electrical equipment.
Heating systems. such as fireplaces, butane or propane heaters, or electrical heaters. Spontaneous ignition, a chemical reaction leading to heat and fire. Improper disposal of rubbish, including disposed of cigarettes, cigars, matches with flammable materials. B.
Three things are needed to start a fire. Fuel, flame, and oxygen. C.
Fire prevention. Electrical. Report frayed electrical cords, smoke or burning smells. Refrain from using too many electrical devices on one wall socket.
And use three-pronged grounded plugs. Smoking fire hazard prevention. Empty waste paper into proper containers.
Supervise patients or residents who smoke if they are confused, lethargic or weak. Be sure materials and ashtrays are completely extinguished before throwing them away. Always use ashtrays when smoking.
Smoking is allowed in designated areas only. D. The role of a nurse assistant during fire emergencies. Number one, the acronym R.A.C.E. Remove the patient or resident from the fire area and close the room door.
Activate the fire alarm system. Contain the fire. And extinguish if possible. Number two, the acronym P.A.S.S. Pull safety pin.
Aim at the base of the fire. Squeeze and sweep low. Be sure patients or residents are not placed near automatic fire doors.
Know and follow the facility's specific policy and procedure related to fires and fire prevention. Section 9, the safety rules to be followed for the patient or resident receiving oxygen therapy. A, oxygen therapy.
Oxygen is abbreviated O2. and measured in liters per minute. It's a colorless, odorless, tasteless gas that's essential for respiration, which is breathing. Some patients or residents need supplemental oxygen to assist them in breathing.
Oxygen is supplied in portable tanks, through wall outlets, or concentrators. Oxygen increases the risk of fire since it supports combustion and is one of the three elements needed for fire. B. When oxygen is in use, specific safety precautions need to be followed.
Place a no smoking oxygen and use sign on the door of the patient or residents room as well as over their bed. Smoking is never allowed near the oxygen by anyone including the patient or resident or visitor. Keep the oxygen tubing open and free of kinks. Check electrical equipment use in the presence of oxygen such as electric razors, fans or radios.
Electrical items must be turned off before unplugging. No flammable liquids such as alcohol, nail polish remover, or petroleum-based products such as chapstick or Vaseline. Watch for static when combing patients or residents'hair, using wool blankets, or nylon materials in clothing.
See types of oxygen equipment. Green metal portable tanks. These are under pressure and must be handled carefully to prevent dropping and possible explosion when in storage. must be secured to wall and must be on a movable stand and strapped in place. Portable tanks, large ones covered with plastic casing, and small ones that the patient or resident can carry or hang on assistive devices when moving.
Wall outlets use wall mount flow meter and plastic tubing. Patient or resident equipment used to deliver the flow of oxygen, such as the nasal cannula, face mask, or concentrators. D, nursing care. A physician's order is needed for oxygen because it is considered a Make sure that the patient or resident wears the mask or cannula at all times. If oxygen needs to be turned off, there needs to be an order that the patient or resident may have it off at certain times.
When the oxygen is not in use for a short period of time, then the oxygen needs to be turned off. It is very expensive and poses a fire hazard. The nurse assistant must follow the policy and procedure for their facility in filling the oxygen tanks, turning the tanks on and off, As well as the setup, oxygen is very drying to nasal passages. Check patient's or resident's nose and cleanse.
Maintain the water level in the humidifier to reduce dryness. Check for redness and discomfort over the ears where the tubing rests and on the face when wearing the mask. If redness or discomfort is noted, report it to a licensed nurse.
The nurse assistant may turn the tank on and off. but may not adjust the oxygen flow rate, as that is administration of medication and not in their scope of practice. Section 10. The Safe Application of Postural Supports and the Implications for Their Use.
A. Postural Supports and Soft Protective Devices or Restraints. Description and Purpose. Used to prevent the patient or resident from harming self or others. Used to prevent the patient or resident from Falling out of bed or chair, crawling over side rails or the end of the bed, interfering with therapy by removing tubing or dressings, and hurting themselves or others. Description of terms.
Soft protective device, a device that serves as a reminder to the patient or resident of safety issues, like a waist device or posy, also called safety device reminders, SDR. Postural supports. are devices that help keep the patient or resident in the correct posture position when in a chair, like a jacket or vest. They control behavior and are used only in extreme measures, like limb devices.
Side rails can be considered as a restraint if all four side rails are up. They do infringe on the patient or resident's right to freedom of movement as it holds back or limits a patient or resident's movements and may be considered False imprisonment when inappropriately used. B.
Alternative to the use of devices. Place the patient or resident where they can have constant supervision. Make sure patient or resident's comfort needs are met, like water, toilet, reposition, etc. So there is a reduced risk of them attempting to meet needs unassisted and agitation is reduced. Check for pain or discomfort.
The devices are used as a last resort. and never for nursing convenience or as punishment. C. Types of protective devices and postural supports. Number one, a vest or jacket.
Has an opening in the front. Watch for choking and cutting into the patient or resident. Number two, wrist or ankle device.
This soft limb device restricts limb movement. Number three, hand mitt device. This device helps prevent scratching and removal of tubes and dressings.
Four. Waist device. This can be a soft cloth that may be self-releasing to remind the patient or resident that they need assistance before walking or standing to reduce falls.
Approach the patient or resident in a calm manner to reduce anxiety and agitation during application. Explain to the patient or resident and their family in a non-threatening manner by using terms like safety and soft protective. Use only on patient or residents in a bed or chair that has wheels in case of an emergency.
Place patient or resident in a good body alignment and position. Pad bony prominences. Use quick-release bowtie knot to secure postural support to the bed frame or chair to ensure easy removal in an emergency.
Tie securely but allow some slack for movement. Two-finger check between the support and skin. Check circulation, sensation, and movement, CSM, every two hours.
Tie support to the bed frame that moves the patient or resident, not the side rail. Reposition the patient or resident and do range of movement to the joints every two hours for at least 10 minutes or more frequent per facility policy. Offer fluids, bedpan or url on a frequent regular basis.
Place the call bell in reach. Apply a vest device with the open area of the vest in. in the front to prevent choking or use according to the manufacturer's instructions. Document the type of device, reason for the device, time on and time off, CSMs, effectiveness, and nursing care that is needed. Section 11, the legal and psychological implications of the use of postural supports.
A, legal implications of the use of postural supports. Must have a doctor's order. to use protective devices including stated reason for use, type of device, and for how long. Must have informed consent. Patient or resident's rights require that patient or resident not be restrained unnecessarily or for the convenience of the staff.
Unnecessary restraint of a patient or resident could constitute false imprisonment. Ask the nurse for explanation of needs if in doubt. B. Psychological implication of the use of postural supports. Explain to the patient or resident and the family the reason for using protective devices.
The patient or resident is usually aware of the restricted movement and may struggle against the supports. Reassure and support the patient or resident and the family. Section 12, The Overview of Bioterrorism.
A. Define terrorism. B. Possible terrorist acts.
Biological threats, such as bacteria and threats. Viruses, smallpox Toxins, ricin Chemical threats Explosions Nuclear blast And radiation threat C. Possible types of bioterrorism threats Explosion Chemical or biological attack And nuclear or radiological attack D. National terrorism advisory system NTAS replaces the Homeland Security Advisory System, HSAS, that was color-coded, showing an imminent threat or an elevated threat alert. E.
Sunset Provision expires after a specific time period.