At risk of injury as a result of the interaction of environmental
conditions interacting with the individual's adaptive and defensive
resources
NOTE: This nursing diagnosis overlaps with other diagnoses such as Risk for Falls, Risk for Trauma, Risk for Poisoning, Risk for Suffocation, Risk for Aspiration and, if the client is at risk of bleeding, Ineffective Protection. See care plans for these diagnoses if appropriate.
Related Factors: See Risk Factors.
Risk Factors:
External
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
Nursing Interventions and Rationales
1. Thoroughly orient client to environment. Place call light within reach and show how to call for assistance; answer call light promptly.
2. Avoid use of restraints. Obtain a physician's order if restraints are necessary.
Restrained elderly clients often experience an increased number of falls, possibly as a result of muscle deconditioning or loss of coordination (Tinetti, Liu, Ginter, 1992; Wilson, 1998). If the elderly are restrained and fall, they can sustain severe injuries, including strangulation, asphyxiation, or head injury from leading with their heads to get out of the bed (DiMaio, Dana, Bix, 1986; Evans, Strumpf, 1990). Restraint-free extended care facilities were shown to have fewer residents with activities of daily living (ADLs) deficiencies and fewer residents with bowel or bladder incontinence than facilities that use restraints (Castle, Fogel, 1998).
3. In place of restraints, use the following:
4. If client is extremely agitated, consider using a special safety bed that surrounds client. If client has a traumatic brain injury, use the Emory cubicle bed.
Special beds can be an effective alternative to restraints and can help keep the client safe during periods of agitation (Williams, Morton, Patrick, 1990).
5. If client has a new onset of confusion (delirium), provide reality orientation when interacting with him or her. Have family bring in familiar items, clocks, and watches from home to maintain orientation. If client has chronic confusion with dementia, use validation therapy that reinforces feelings but does not confront reality.
Reality orientation can help prevent or decrease the confusion that increases risk of injury when the patient becomes agitated. Validation therapy is more effective for clients with dementia (Fine, Rouse-Bane, 1995). (See Interventions for Chronic Confusion.)
6. Ask family to stay with client to prevent client from accidentally falling or pulling out tubes.
7. Remove all possible hazards in environment such as razors, medications, and matches.
8. Place an injury-prone client in a room that is near the nurses' station.
Such placement allows more frequent observation of the client.
9. Help clients sit in a stable chair with armrests. Avoid use of wheelchairs and geri-chairs except for transportation as needed.
Clients are likely to fall when left in a wheelchair or geri-chair because they may stand up without locking the wheels or removing the footrests. Wheelchairs do not increase mobility; people just sit in them the majority of the time (Lipson, Braun, 1993; Simmons et al, 1995).
10. To ensure propulsion with legs or arms and ability to reach the floor, ensure that the chair or wheelchair fits the build, abilities, and needs of the client, eliminating footrests and minimizing problems with shearing.
The seating system should fit the needs of the client so that the client can move the wheels, stand up from the chair without falling, and not be harmed by the chair or wheelchair. Footrests can cause skin tears and bruising, as well as postural alignment and sitting posture problems (Lipson, Braun, 1993).
11. Avoid use of wheelchairs as much as possible because they can serve as a restraint device. Most people in wheelchairs do not move.
Wheelchairs can be effective restraints. In one study, only 4% of residents in wheelchairs were observed to propel them independently and only 45% could propel them, even with cues and prompts. This study found that no residents could unlock the wheelchairs without help, wheelchairs were not fitted to residents, and residents were not trained in propulsion (Simmons et al, 1995).
12. Refer to physical therapy for strengthening exercises and gait training to increase mobility. Refer to occupational therapy for assistance with helping clients perform ADLs.
Gait training in physical therapy has been shown to effectively prevent falls (Galinda-Ciocon, Ciocon, Galinda, 1995; Wilson, 1998).
Pediatric
1. Teach parents the need for close supervision of all young children playing near water. If child has epilepsy, recommend showers instead of tub baths, and no unsupervised swimming ever.
Most drowning accidents involving children are preventable if basic safety measures are taken (Bolte, 2000).
Geriatric
1. Encourage client to wear glasses and hearing aids and to use walking aids when ambulating.
2. If client experiences dizziness because of orthostatic hypotension when getting up, teach methods to decrease dizziness, such as rising slowly, remaining seated several minutes before standing, flexing feet upward several times while sitting, sitting down immediately if feeling dizzy, and trying to have someone present when standing.
The elderly develop decreased baroreceptor sensitivity and decreased ability of compensatory mechanisms to maintain blood pressure when standing up, resulting in postural hypotension (Aaronson, Carlon-Wolfe, Schoener, 1991; Matteson, McConnell, Linton, 1997).
Multicultural
1. Acknowledge racial/ethnic differences at the onset of care.
Acknowledgement of race/ethnicity issues will enhance communication, establish rapport, and promote treatment outcomes (D'Avanzo et al, 2001).
2. Assess for the influence of cultural beliefs, norms, and values on the client's perceptions of risk for injury.
What the client considers risky behavior may be based on cultural perceptions (Leininger, 1996).
3. Assess whether exposure to community violence is contributing to risk for injury.
Exposure to community violence has been associated with increases in aggressive behavior and depression (Gorman-Smith, Tolan, 1998). Minority students, especially African-American and Latino students in lower grades, may participate in and may more often be victims of school violence (Hill, Drolet, 1999).
4. Use culturally relevant injury prevention programs whenever possible.
The Make It Safe program is a bilingual, culturally sensitive educational presentation for Hispanic families that focuses on living and working safely in a rural environment (Nawrot, Wright, 1998).
5. Validate the client's feelings and concerns related to environmental risks.
Validation lets the client know that the nurse has heard and understands what was said, and it promotes the nurse-client relationship (Stuart, Laraia, 2001; Giger, Davidhizer, 1995).
Home Care Interventions
1. Assess home environment for threats to safety: clutter, inappropriate storage of chemicals, slippery floors, scatter rugs, unsafe stairs and stairwells, blocked entries, dim lighting, extension cords across pathways, unsafe electrical or gas connections, unsafe heating devices, unsafe oxygen placement, high beds without rails, excessively hot water, pets, and pet excrement.
Clients suffering from impaired mobility, impaired visual acuity, and neurological dysfunction, including dementia and other cognitive functional deficits, are at risk for injury from common hazards.
2. Instruct client and family or caregivers in correcting identified hazards. Refer to occupational therapy services for assistance if needed. Notify landlord or code enforcement office of any structural building hazards.
3. Refer to physical therapy services for client and family education in safe transfers and ambulation and for strengthening exercises for ambulation and transfers.
4. Avoid extreme hot and cold around clients at risk for injury (e.g., heating pads, hot water for baths/showers).
Clients with decreased cognition or sensory deficits cannot discriminate extremes in temperature.
5. Provide a signaling device for clients who wander or are at risk for falls. If client lives alone, provide a Lifeline or similar call device.
Orienting a vulnerable client to a safety net relieves anxiety of the client and caregiver and allows for rapid response to a crisis situation.
6. Provide medical identification bracelet for clients at risk for injury from dementia, seizures, or other medical disorders.
Client/Family Teaching
1. Teach how to safely ambulate at home, including using safety measures such as handrails in bathroom.
2. If client has visual impairment, teach client and caregiver to label with bright colors such as yellow or red significant places in environment that must be easily located (e.g., stair edges, stove controls, light switches).
3. Teach clients winter safety information:
NOTE: This nursing diagnosis overlaps with other diagnoses such as Risk for Falls, Risk for Trauma, Risk for Poisoning, Risk for Suffocation, Risk for Aspiration and, if the client is at risk of bleeding, Ineffective Protection. See care plans for these diagnoses if appropriate.
Related Factors: See Risk Factors.
Risk Factors:
External
- Mode of transport or transportation;
- people or provider (e.g., nosocomial agents, staffing patterns, cognitive, affective and psychomotor factors);
- physical (e.g., design, structure, and arrangement of community, building, and/or equipment);
- nutrients (e.g., vitamins, food types);
- biological (e.g., immunization level of community, microorganism);
- chemical (e.g., pollutants, poisons, drugs, pharmaceutical agents, alcohol, caffeine, nicotine, preservatives, cosmetics, and dyes)
- Psychological (affective orientation);
- malnutrition;
- abnormal blood profile (e.g., leukocytosis/leukopenia);
- altered clotting factors;
- thrombocytopenia;
- sickle cell;
- thalassemia;
- decreased hemoglobin;
- immune-autoimmune dysfunction;
- biochemical, regulatory function (e.g., sensory dysfunction, integrative dysfunction, effector dysfunction, tissue hypoxia);
- developmental age (physiological, psychosocial);
- physical (e.g., broken skin, altered mobility)
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
- Risk Control
- Parenting: Social Safety
- Fetal Status: Intrapartum
- Maternal Status: Intrapartum
- Immune Status
- Safety Behavior: Home Physical Environment
- Safety Behavior: Personal: Safety Status: Falls Occurrence
- Safety Status: Physical Injury
- Remains free of injuries
- Explains methods to prevent injury
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
- Health Education
- Behavior Modification
- Patient Contracting
- Self-Modification Assistance
Nursing Interventions and Rationales
1. Thoroughly orient client to environment. Place call light within reach and show how to call for assistance; answer call light promptly.
2. Avoid use of restraints. Obtain a physician's order if restraints are necessary.
Restrained elderly clients often experience an increased number of falls, possibly as a result of muscle deconditioning or loss of coordination (Tinetti, Liu, Ginter, 1992; Wilson, 1998). If the elderly are restrained and fall, they can sustain severe injuries, including strangulation, asphyxiation, or head injury from leading with their heads to get out of the bed (DiMaio, Dana, Bix, 1986; Evans, Strumpf, 1990). Restraint-free extended care facilities were shown to have fewer residents with activities of daily living (ADLs) deficiencies and fewer residents with bowel or bladder incontinence than facilities that use restraints (Castle, Fogel, 1998).
3. In place of restraints, use the following:
- Alarm systems with ankle or wrist bracelets
- Bed or wheelchair alarms
- Increased observation of client
- Locked doors to unit
- Bed with wheels removed to keep bed low (NOTE: may not be acceptable with fire regulations)
4. If client is extremely agitated, consider using a special safety bed that surrounds client. If client has a traumatic brain injury, use the Emory cubicle bed.
Special beds can be an effective alternative to restraints and can help keep the client safe during periods of agitation (Williams, Morton, Patrick, 1990).
5. If client has a new onset of confusion (delirium), provide reality orientation when interacting with him or her. Have family bring in familiar items, clocks, and watches from home to maintain orientation. If client has chronic confusion with dementia, use validation therapy that reinforces feelings but does not confront reality.
Reality orientation can help prevent or decrease the confusion that increases risk of injury when the patient becomes agitated. Validation therapy is more effective for clients with dementia (Fine, Rouse-Bane, 1995). (See Interventions for Chronic Confusion.)
6. Ask family to stay with client to prevent client from accidentally falling or pulling out tubes.
7. Remove all possible hazards in environment such as razors, medications, and matches.
8. Place an injury-prone client in a room that is near the nurses' station.
Such placement allows more frequent observation of the client.
9. Help clients sit in a stable chair with armrests. Avoid use of wheelchairs and geri-chairs except for transportation as needed.
Clients are likely to fall when left in a wheelchair or geri-chair because they may stand up without locking the wheels or removing the footrests. Wheelchairs do not increase mobility; people just sit in them the majority of the time (Lipson, Braun, 1993; Simmons et al, 1995).
10. To ensure propulsion with legs or arms and ability to reach the floor, ensure that the chair or wheelchair fits the build, abilities, and needs of the client, eliminating footrests and minimizing problems with shearing.
The seating system should fit the needs of the client so that the client can move the wheels, stand up from the chair without falling, and not be harmed by the chair or wheelchair. Footrests can cause skin tears and bruising, as well as postural alignment and sitting posture problems (Lipson, Braun, 1993).
11. Avoid use of wheelchairs as much as possible because they can serve as a restraint device. Most people in wheelchairs do not move.
Wheelchairs can be effective restraints. In one study, only 4% of residents in wheelchairs were observed to propel them independently and only 45% could propel them, even with cues and prompts. This study found that no residents could unlock the wheelchairs without help, wheelchairs were not fitted to residents, and residents were not trained in propulsion (Simmons et al, 1995).
12. Refer to physical therapy for strengthening exercises and gait training to increase mobility. Refer to occupational therapy for assistance with helping clients perform ADLs.
Gait training in physical therapy has been shown to effectively prevent falls (Galinda-Ciocon, Ciocon, Galinda, 1995; Wilson, 1998).
Pediatric
1. Teach parents the need for close supervision of all young children playing near water. If child has epilepsy, recommend showers instead of tub baths, and no unsupervised swimming ever.
Most drowning accidents involving children are preventable if basic safety measures are taken (Bolte, 2000).
Geriatric
1. Encourage client to wear glasses and hearing aids and to use walking aids when ambulating.
2. If client experiences dizziness because of orthostatic hypotension when getting up, teach methods to decrease dizziness, such as rising slowly, remaining seated several minutes before standing, flexing feet upward several times while sitting, sitting down immediately if feeling dizzy, and trying to have someone present when standing.
The elderly develop decreased baroreceptor sensitivity and decreased ability of compensatory mechanisms to maintain blood pressure when standing up, resulting in postural hypotension (Aaronson, Carlon-Wolfe, Schoener, 1991; Matteson, McConnell, Linton, 1997).
Multicultural
1. Acknowledge racial/ethnic differences at the onset of care.
Acknowledgement of race/ethnicity issues will enhance communication, establish rapport, and promote treatment outcomes (D'Avanzo et al, 2001).
2. Assess for the influence of cultural beliefs, norms, and values on the client's perceptions of risk for injury.
What the client considers risky behavior may be based on cultural perceptions (Leininger, 1996).
3. Assess whether exposure to community violence is contributing to risk for injury.
Exposure to community violence has been associated with increases in aggressive behavior and depression (Gorman-Smith, Tolan, 1998). Minority students, especially African-American and Latino students in lower grades, may participate in and may more often be victims of school violence (Hill, Drolet, 1999).
4. Use culturally relevant injury prevention programs whenever possible.
The Make It Safe program is a bilingual, culturally sensitive educational presentation for Hispanic families that focuses on living and working safely in a rural environment (Nawrot, Wright, 1998).
5. Validate the client's feelings and concerns related to environmental risks.
Validation lets the client know that the nurse has heard and understands what was said, and it promotes the nurse-client relationship (Stuart, Laraia, 2001; Giger, Davidhizer, 1995).
Home Care Interventions
1. Assess home environment for threats to safety: clutter, inappropriate storage of chemicals, slippery floors, scatter rugs, unsafe stairs and stairwells, blocked entries, dim lighting, extension cords across pathways, unsafe electrical or gas connections, unsafe heating devices, unsafe oxygen placement, high beds without rails, excessively hot water, pets, and pet excrement.
Clients suffering from impaired mobility, impaired visual acuity, and neurological dysfunction, including dementia and other cognitive functional deficits, are at risk for injury from common hazards.
2. Instruct client and family or caregivers in correcting identified hazards. Refer to occupational therapy services for assistance if needed. Notify landlord or code enforcement office of any structural building hazards.
3. Refer to physical therapy services for client and family education in safe transfers and ambulation and for strengthening exercises for ambulation and transfers.
4. Avoid extreme hot and cold around clients at risk for injury (e.g., heating pads, hot water for baths/showers).
Clients with decreased cognition or sensory deficits cannot discriminate extremes in temperature.
5. Provide a signaling device for clients who wander or are at risk for falls. If client lives alone, provide a Lifeline or similar call device.
Orienting a vulnerable client to a safety net relieves anxiety of the client and caregiver and allows for rapid response to a crisis situation.
6. Provide medical identification bracelet for clients at risk for injury from dementia, seizures, or other medical disorders.
Client/Family Teaching
1. Teach how to safely ambulate at home, including using safety measures such as handrails in bathroom.
2. If client has visual impairment, teach client and caregiver to label with bright colors such as yellow or red significant places in environment that must be easily located (e.g., stair edges, stove controls, light switches).
3. Teach clients winter safety information:
- Burn only untreated wood for heat
- Keep portable space heaters at least 3 feet from anything that can burn
- Install smoke alarms and carbon monoxide alarm near bedrooms
- Check the chimney and flue each year
- Avoid sitting in an idling car in winter when snow can obstruct the exhaust pipe
- Follow safety guidelines for use of snow blowers
11 komentar:
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Herbal medicine is the best Greetings I am here to testify how great man called Dr OMO helped me out with herbs and roots which he prepared for me in use of curing my fibroids and Getting pregnant after 8 years of try to conceive with fibroids I takes his product (cure for my fibroid made with herbal medicine Root) for (14) days before I am to known I was totally pregnant after 2months of using dr omo herbs he also have Herbal medical for all types of diseases, and i promise him that i will tell the world about his Great job he ask me to drink from the herbal medicine before meeting my husband I did and after 2months I was pregnant thank you for your great job he can also help you if you have a low sperm count you want to convince a baby fast PCOS ,infections, stomach ucler ,THYROID, COPD, Endometriosis, breast cancer,HIV?AID,ALS, yeast infection, Gonorrhea, Chronic Sinus, HPV low testosterone, Herpes, blocked fallopian tubes Liver parasites ovarian Arthritis, Cysts, pile, ASTHMA, Crowns and all other type of diseases,WEAK ERECTION, STRETCH MARK REMOVER , breast cancer, Parkinson's, male-enhancement Cream, BARENESS/INFERTILITY, HEPATITIS B pile, Get lost period back, stop period pain, Email : dromo596@gmail.com WhatsApp him on +2349033505260 thank you for all your work..
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Hi, there. I am Tom Neil and I wish to describe how life had been for my younger brother living with schizophrenia and how he had been permanently able to overcome this debilitating disease via a naturopathic, herbal method.
Maicon - my kid brother was twenty years old when he was brought to the emergency room by the campus cops of the academy from which he had been suspended some months ago. A professor had called and reported that he had walked into his classroom, accused him of taking his tuition money, and refused to leave.
Although he had much academic success as a teenager, his behavior had become increasingly odd during the past year. He quit seeing his friends and no longer seemed to care about his appearance or social pursuits. He began wearing the same clothes each day and seldom bathed. He lived with several family members but rarely spoke to any of them. When he did talk to them, he said he had found clues that his college was just a front for an organized crime operation. He had been suspended from college because of missing many classes. My sister said that she had often seen him mumbling quietly to himself and at times he seemed to be talking to people who were not there. He would emerge from my room and ask my family to be quiet even when they were not making any noise.
My father and sister told the staff that Maicon's great-grandmother had had a serious illness and had lived for 30 years in a state hospital, which they believed was a mental hospital. Our mother left the family when Maicon was very young. She has been out of touch with us, and they thought she might have been treated for mental health problems.
Maicon agreed to sign himself into the psychiatric unit for treatment. The whole family except I had agreed to have Maicon transferred to a mental asylum. I knew inwardly there was still some plausible means by which my kid brother could overcome this condition. I knew botanical means of treatment will be more favorable than any other type of treatment, and as such, I had taken a keen interest in the research of naturopathic alternative measures suitable for the treatment of schizophrenia. I had pleaded for some little patience from the family in the delay of the transfer, I was looking forward to proving a point to the entire family, of a positive botanical remedy for this condition.
It was during my ceaseless search on the internet I had been fortunate enough to come across Dr. Utu Herbal Cure: an African herbalist and witch doctor whose professional works had majored on the eradication of certain viral conditions, especially schizophrenia, ( improving the memory capacity positively), via a traditional, naturopathic process and distinguished diet plan. It was by the administration of this herbal specialist that my brother had been able to improve his condition for better.
Before the naturopathic remedy - Maicon's story had reflected a common case, in which a high-functioning young adult goes through a major decline in day-to-day skills. Although family and friends may feel this is a loss of the person they knew, the illness can be treated and a good outcome is possible.
My brother Maicon is just like many other patients out there suffering from this disease. Although he was able to overcome this condition via a naturopathic herbal remedy administered by this African herbal physician and saved completely thus, rekindling the lost joy which had been experienced by the family members.
I wish to use this opportunity to reach across to anyone who may happen to be diagnosed with this disastrous condition to spread the hope of an everlasting herbal remedy that is capable of imposing a permanent end to this disease.
For more information concerning this naturopathic herbal remedy, feel free to contact this African herbal practitioner via email:
drutuherbalcure@gmail.com
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