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A. Specific hazards to safety I. fire a. three elements necessary to start a fire: i. sufficient heat to start the fire ii. a combustible material iii. sufficient oxygen to support the fire II. scalds and burns a. scalds i. result from hot liquid or vapor, such as steam b. burns i. result from excessive exposure to thermal, chemical, electrical, or radioactive agents III. falls IV. poisoning V. electric shock a. types of electric shock i. macroshock a. electric current passing through a relatively large area of a person ii. microshock a. electric current passing through a relatively small area of a person, usually part of the heart b. equipment needs to be properly grounded i. transmits an electric current from an object or surface to the ground c. grounded electrical plugs have three prongs: i. the two short prongs transmit power to the equipment ii. the third, longer, prong carries short circuits or stray electric currents to the ground VI. excessive noise a. danger of excessive noise depends on three factors: i. the overall level of noise ii. the frequency range of the noise iii. the duration of exposure and individual susceptibility to the noise b. decibel levels (units of loudness) i. noises above 120 decibels are painful ii. exposure to noises of 85 to 95 decibels for several hours a day can lead to progressive or permanent hearing loss VII. radiation VIII. suffocation or choking IX. equipment-related accidents X. procedure-related accidents B. Factors affecting safety I. age a. developing fetus i. exposure to maternal smoking, alcohol consumption, addictive drugs, radiographs (first trimester), certain pesticides b. newborns and infants i. falling, suffocation in crib, choking from aspirated milk or ingested objects, burns from both water or spilled hot liquids, automobile accidents, crib or
playpen injuries, electric shock, poisoning
c. toddlers i. physical trauma from falling, banging into objects, getting cut by objects, automobile accidents, burns, poisoning, drowning, electric shock d. preschoolers i. injury from traffic, playground equipment, and other objects; choking, suffocation, and obstruction of airway and ear canal by foreign objects;
poisoning; drowning; fire and burns; harm from other people or animals
e. adolescents i. vehicle (automobile, bicycle) accidents, recreational accidents, firearms, substance abuse f. other adults i. falling, burns, pedestrian and automobile accidents II. life-style a. work environments can be a potential safety hazard by the presence of the following: i. heavy machinery, industrial belts and pulleys, chemicals, pollutants, radioactive substances b. living environments can be a potential safety hazard by the presence of the following: i. high crime rate, chemicals, pollutants, radioactive substances, guns and ammunition c. insufficient income can be a potential safety hazard by lack of monetary funds to do the following: i. buy necessary safety equipment or make necessary safety repairs d. risk-taking behavior can be a potential safety hazard by failure to do the following: i. operate machinery safely, e.g.: a. driving automobiles at high speed ii. wear safety devices when operating machinery, e.g.: a. seat belts while driving/riding in automobiles, headgear while driving/riding on motorcycles, flotation jackets while on boats III. mobility a. impaired mobility can be a potential safety hazard by decreasing the ability to move safely and avoid dangerous situations in the environment b. examples of conditions resulting in impaired mobility are the following: i. paralysis, which may result from the following: a. spinal-cord injury, cerebral vascular accident (CVA) ii. muscle weakness, which may result from the following: a. recent surgery or prolonged illness iii. poor balance or coordination, which may result from the following:
a. casts, braces, crutches IV. sensory/perceptual alterations a. sensory/perceptual alterations can be a safety hazard by decreasing sensitivity to and ability to correctly interpret dangerous situations in the environment b. examples of conditions resulting in sensory/perceptual alterations are the following: i. blindness, which may resulting in the following: a. falls from tripping over objects in the environment ii. deafness, which may result in the following: a. unawareness of signals about dangerous situations in the environment b. misunderstanding about instructions regarding medications and health care iii. anosmia (loss of smell), which may result in the following: a. failure to smell smoke or gas in the environment iv. tactile anesthesia (loss of touch), which may result in the following: a. extremes of temperature being unnoticed v. gustatory anesthesia (loss of taste), which may result in the following: a. contaminated food being undetected V. level of awareness a. altered level of awareness can be a safety hazard by interfering with sensitivity to and ability to correctly interpret dangerous situations in the environment b. examples of conditions resulting in an altered level of awareness are the following: i. sleep deprivation ii. altered consciousness, e.g.: a. unconsciousness or semiconsciousness iii. altered perception of reality, e.g.: a. disorientation iv. perception of stimuli that do not exist, e.g.: a. visual, auditory, tactile, olfactory hallucinations v. altered judgment as a result of disease or medications, e.g.: a. opioid analgesics, tranquilizers, hypnotics, sedatives, Alzheimer's disease VI. emotional state a. emotional states can be a safety hazard by interfering with sensitivity to and ability to correctly interpret dangerous situations in the environment b. examples of emotional states are the following: i. anxiety or anger, which results in the following: a. reduced perceptual awareness, level of concentration, awareness of external stimuli; increased errors in judgment ii. depression, which results in the following: a. reduced reaction to environmental stimuli VII. ability to communicate a. altered ability to communicate (read and write) can be a potential safety hazard by decreasing the ability to receive or send messages about dangerous
conditions in the environment
b. examples of conditions that result in altered ability to communicate are the following: i. aphasia, language barriers, illiteracy VIII. knowledge of safety precautions a. lack of knowledge about unfamiliar factors in the environment can be a potential safety hazard by unfamiliarity of the danger they possess b. examples of unfamiliar factors in the environment are the following: i. special equipment (e.g., oxygen tanks, Hoyer lifts, intravenous transfusions), medications, cleaners C. Appraisal of specific hazards to safety I. fires a. home hazard appraisal for fires i. living room a. electrical cords in good condition (e.g., not frayed or worn)? b. electrical cords not threaded under carpets or pinched behind furniture? c. ashtrays readily available if there are smokers in the house? d. wastebaskets free of carelessly discarded cigarettes? e. draperies and furniture more than three feet away from the fireplace? ii. chimney a. fuel for the fireplace (e.g., kindling, newspapers, firewood) stacked at least three feet away from the hearth? b. firescreen over the entire opening of the fireplace? c. flue open when a fire is burning in the fireplace? d. Christmas tree branches or needles properly discarded and not used to start or maintain a fire? e. metal pail available to carry out the ashes from the fireplace? f. ashes cold when carried out in the metal pail? g. chimney cleaned annually? h. fires started properly and not with charcoal starter or gasoline? iii. kitchen a. appliances turned off before going to bed or leaving the house? b. fire extinguisher(s) readily available? c. garments with short or snug sleeves worn when working over the stove? d. baking soda available to snuff out a grease fire? iv. bedroom a. smoking in bed or a comfortable chair forbidden to deter the chance of falling asleep with a burning cigarette? b. two escape routes out of the bedroom been determined in the case of a fire? c. rope or chain ladders installed to escape from a fire quickly if the house has rooms above the ground floor? d. electric space heaters have an automatic shut-off in case they are tipped over? e. operable smoke detectors installed outside sleeping area(s)? f. electric space heaters kept out of damp or wet areas? g. batteries from smoke detectors forbidden to be "borrowed" for other equipment? h. smoke detectors tested regularly? i. smoke detectors always activated and never deactivated for sounding a low battery alarm? v. garage
trash, particularly oily or paint-saturated rags, kept from accumulating in the garage? oily rags, gasoline, or other flammables stored away from sources of heat or open flames? gasoline or paintbrush cleaner used in an open area where fumes can be dissipated and won't drift toward a source of ignition? gasoline forbidden to be used as a cleaner for clothing or furniture? blown fuses replaced with a proper fuse and not a copper penny? hospital hazard appraisal for fires i. are the telephone numbers of emergency services displayed on the phone? ii. does the staff know the location of the fire exits? iii. does the staff know the type and location of fire extinquisher(s)? iv. does the staff participate in routine fire drills or fire evacuation procedures? v. are the hallways free of unnecessary furniture and equipment? vi. are signs posted on the elevator doors regarding the use of stairs in the event of a fire? vii. are locations of the fire exits clearly marked? responding to a hospital fire i. direct ambulatory patients to a safe area ii. move nonambulatory patients to a safe area by carrying them, dragging them on sheets or blankets, or pushing them in wheelchairs, beds, or stretchers iii. activate the fire alarm iv. notify the hospital switchboard of the location of the fire v. spray the fire with the appropriate fire extinguisher a. P = Pull the pin on the fire extinquisher b. A = Aim at the base of the fire c. S = Spray the fire d. S = Sweep side to side vi. close windows and doors in the area of the fire vii. turn off oxygen and electrical appliances in the vicinity of the fire viii. clear the fire exits if blocked ix. place damp cloths or blankets around the outside edges of doors x. provide patients with wet washcloths through which to breath types of fire extinguishers for types of fires i. class "a" fire (paper, wood, upholstery, rags, ordinary rubbish) a. use a water pump, CO 2, or multipurpose fire extinguisher
a. b. c. d. e.
ii. class "b" fire (flammable liquids and gases) a. use a CO 2, dry chemical, multipurpose, or foam fire extinguisher iii. class "c" fire (electrical) a. use a CO 2, dry chemical, or multipurpose fire extinquisher iv. class "d" fire (designated metals) a. use a dry powder fire extinguisher II. falls a. home hazard appraisal for falls i. exterior a. burnt out or dim exterior lightbulbs? b. lighting along all exterior walking surfaces? c. are exterior walking areas even and in good repair? d. secure hand rails on both sides of exterior steps? e. adequate lighting on exterior steps? f. is the general environment uncluttered and free of debris? ii. bathrooms a. nonslip adhesive strips in front of toilet, sink, and shower area and inside shower area? b. raised toilet seat with support arms? c. grab bars positioned securely next to toilet, tub, and/or shower area? d. scatter rugs eliminated or attached with double-faced, nonslip adhesive strips to undersurface of rug? e. thresholds even with floor? f. burnt out or dim bulbs? g. accessories made with contrasting colors for easy visibility? h. general environment uncluttered and free of debris? iii. kitchen a. secure, sturdy stool with nonslip threads available? b. shelves positioned to allow for easier reach? c. burnt out or dim lightbulbs? d. lighting adequate for working areas? e. hand-held reaching device for inaccessible objects available? f. thresholds even with floor? g. nonslip adhesive strips in front of sink and stove? h. scatter rugs eliminated or attached with double-faced, nonslip adhesive strips to undersurface of rug? i. are kitchen chairs sturdy with armrests? j. kitchen chair height sufficient to allow for easy rising? k. lack of crossbar between front legs of kitchen chairs that interferes with placing feet firmly under chair when rising? iv. bedrooms and other living areas a. chairs sturdy with armrests? b. chair height sufficient to allow for easy rising? c. lack of crossbar between front legs of chairs that interferes with placing feet firmly under chair when rising? d. wobbly accessory tables that may be used for support replaced? e. accessory table surfaces uncluttered? f. colored nonslip adhesive strips on edges of glass tables? g. general environment uncluttered and free of debris? h. burnt out or dim lightbulbs?
i. j. k. l. m. v. stairs a. b. c. d. e. f. g.
lighting adequate for all areas? nightlights where appropriate? thresholds even with floor? raised areas of carpet secured with tape? scatter rugs eliminated or attached with double-faced, nonslip adhesive strips to undersurface of rug?
burnt out or dim light bulbs? lighting adequate for all areas? light switch at top and bottom of stairs? steps painted in contrasting colors for improved visibility? nonslip rubber edges to accentuate stair edges? secure handrails on both sides of steps? general environment uncluttered and free of debris? b. hospital hazard appraisal for falls i. are patients oriented on admission to their surroundings and call system? ii. is the ability of patients to ambulate and transfer assessed on admission? iii. are patients at risk for falls closely supervised during the first few days after admission? iv. are patients encouraged to use the call bell to request assistance? v. are patients' bedside and overbed tables, call bell, water, tissue, and urinal within easy reach? vi. are patients' hospital beds kept in low position when not providing care? vii. are patients aware of activity limitations? viii. are patients encouraged to use grab bars mounted in toilet and bathing areas and railings along corridors? ix. are patients provided with nonskid bath mats in tubs and encouraged to wear nonskid footwear? x. are the patients' environments free of debris and uncluttered? xi. are the patients' siderails kept up after they have received analgesics, hypnotics, sedatives, or relaxants and are left unattended? c. restraints i. definition a. any manual method or physical or mechanical device, material, or equipment attached to the person's body that the person cannot remove easily and that restricts freedom of movement or normal access to one's body ii. legal implications of restraints a. know the agency's policy on restraints b. assess the underlying reason for the need for restraints c. never apply restraints for the staff's convenience or to cope with understaffing d. explain the reason for restraints to the patient, family members and significant other(s) e. obtain the consent to restrain from the patient or the patient's appointed guardian or surrogate when possible f. obtain a physician's order prior to applying a restraint when possible g. restrain the patient only to the extent necessary to accomplish the purpose of the restraint h. always use proper fitting restraints i. periodically evaluate the need for restraints j. document correctly iii. guidelines for the use of restraints a. apply the restraint(s) so that it safely allows for the maximum amount of mobility b. pad bony prominences of the restrained extremity(s) c. maintain joints of the restrained extremity(s) in good alignment d. fasten restraint(s) with a knot that does not tighten and is readily removed in an emergency e. remove and change the restraint(s) when it becomes soiled or damp f. fasten the restraint(s) to a moveable part of the bed frame g. remove the restraint(s) a minimum of every two hours for 15 minutes h. provide necessary care on the restrained extremity(s) i. apply restraint as inconspicuously as possible j. remove the restraint(s) if it exacerbates the patient's health problem k. remove the restraint(s) if it interferes with the patient's treatment iv. documenting restraints a. the specific behavior that made it necessary to restrain the client b. the type of restraint used c. the substance of explanations given to the patient, family members and significant other(s) d. the patient's or the patient's appointed guardian or surrogate's consent e. the exact times the restraint was applied and removed f. frequency of nursing assessments made while restraint is in place g. nursing care given when the restraint was applied, while it was in place, and when it was removed h. the patient's response to the restraint poisoning a. home hazard appraisal for poisoning i. are childproof caps on all medications and poisonous products if children are in the home? ii. are medications and poisonous products kept in their original containers and stored out of reach if children are in the home? iii. are medications measured and given in well-lit areas to avoid errors in the amount and type of medication administered? iv. are medication labels read carefully before administration? v. are food items kept separate from medications and poisonous products? vi. are Mr. Yuk stickers placed on poisonous products? vii. are emergency medications to induce vomiting (e.g., Syrup of Ipecac) kept in the home and stored out of reach if children are in the home? viii. is the phone number of the poison control center readily available? ix. are chemical and cleaning products utilized in well-ventilated areas? x. are poisonous household plants kept out of reach if children are in the home? b. responding to poisoning i. identify the type and amount of poison ingested ii. call the poison control center before attempting any intervention iii. if instructed by the poison control center, induce vomiting
if instructed by the poison control center to induce vomiting, give oral fluids to assist in vomiting if instructed to do so, save the victim's vomitus and deliver it to the poison control center if vomiting has been induced, once the vomiting is over, lie the victim down with his/her head turned to the side if instructed by the poison control center to take the victim to an emergency room, call an ambulance when not to induce vomiting i. if the victim has ingested any of the following substances: a. lye b. household cleaners c. grease or petroleum products d. furniture polish ii. if the victim is in the following condition: a. unconscious methods to induce vomiting by age group i. infants (up to 12 months) a. Syrup of Ipecac administered only under direction of a physician ii. children (1 to 12 years) a. 1 tablespoon (15 mLs) of Syrup of Ipecac iii. adults (12 years and older) a. 2 tablespoons (30 mLs) of Syrup of Ipecac end
iv. v. vi. vii.
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