In patient care, restraints are avoided whenever possible. Restraints can be physical, such as wrist restraints which are used the most often and chemical restraints when medications are given to control behaviors.

Chest restraints are avoided due to safety concerns. Leather restraints are used in aggressive behaviors and on all four extremities. When behavior is under control, they will be removed one extremity at a time.

Seclusion is different than suicide watch. Seclusion requires a specially designed room for protection. One-on-one supervision is always needed for both seclusion and suicide watch. When assigned suicide watch, the observer needs to be an arm’s length away and the patient’s hands must always be visible.

General guidelines for restraints includes getting an order although in an emergency, restraints may applied to provide for safety and then followed with an order. Face-to-face assessment in one hour and must include the reason for the restraints. Assessment every 30 minutes, remove every 2 hours, and order renewal every 24 hours or according to facility policy.

Biological and chemical warfare would result in mass casualties. Hazmat precautions will be needed and the safety of the health care worker is the top priority using personal protective equipment.

Agents may be bacterial (anthrax, plague), viral (smallpox, Ebola), or chemical (sarin, mustard gas). Effects of an exposure can include vomiting, skin lesions hemorrhage, multisystem failure, and death.

With hemiparesis, considerations must be taken when ambulating, transferring to a wheelchair, and if a Hoyer lift is needed. To ambulate, they are weak with standing, so the nurse should be on the side of weakness. The strong side should lead with transfer to a wheelchair.

With a Hoyer lift (according to the textbook), only one person is needed for the transfer as long as the patient is in the center of the sling and there is a wide base of support.

There are three types of health promotion.
• Primary is Prevention of illness and disease.
• Secondary is Screening for disease using diagnostics.
• Tertiary it Total rehabilitation.

The elderly are at increased risk for a multitude of complications. If there is a sudden onset of confusion, common causes should be investigated. While UTI is often suspected, elderly are at high risk for respiratory depression, pneumonia, hypoxia, and fluid and electrolyte imbalances.

Renal insufficiency is common with aging. As the glomerular filtration rate falls, the kidneys lose the ability to hold onto sodium so it leaks out of the nephrons and where sodium goes, water follows. Hyponatremia and dehydration will result and can lead to confusion.

The elderly usually have a multiple co-morbidities. To reduce the risk of disease transmission, it is important to remember that anyone with chronic disorder is immunocompromised. Therefore, a patient with diabetes, heart failure, or COPD should not be placed in a room with someone that has an infection.

In planning care in the elderly, the use of medications leading to sedation such as opioids or those that have anticholinergic side effects should be minimized. As a general rule, the dosage of medications are generally decreased.

• Fire safety includes R-A-C-E and then P-A-S-S.
• Restraints, see them in 1 hour, assess every 30, remove every 2, renewal every 24.
• In biological and chemical warfare, priority is safety of the healthcare worker.
• With hemiparesis, remember they are “weak on standing and strong with transfer to a wheelchair.”
• Elderly have a high risk for confusion and are immunocompromised.
• Taper down on medications in the elderly.

In preparing for the NCLEX exam, there is a focus on safety. Safety for the patient and what makes you the safest nurse. Safety is best assured by the professional being directly involved in the patient’s care. In a patient with hemiparesis, ambulation and transferred to a wheelchair should be with an RN or PN. For NCLEX, safety should not be delegated to an UAP.