A 76-year-old client recovering from surgical repair of a fractured femur suddenly exhibits severe psychomotor agitation and repeatedly attempts to remove their surgical dressing. The on-call provider enters an electronic prescription for "Bilateral soft wrist restraints PRN for agitation." The client's family is at the bedside and demands immediate application of the restraints to protect the surgical site. Which action should the practical nurse (PN) implement first?
- Inform the family that as-needed restraint prescriptions are clinically invalid, and implement less restrictive measures such as concealing the surgical dressing.Answer
- BApply the soft wrist restraints to protect the surgical wound, then immediately contact the provider to convert the prescription to a continuous order.
- CDelegate an unlicensed assistive personnel (UAP) to physically hold the client's hands away from the incision site until the agitation resolves.
- DAdminister the client's prescribed as-needed sedative to control the sudden agitation without resorting to physical restraints.
Answer
Inform the family that as-needed restraint prescriptions are clinically invalid, and implement less restrictive measures such as concealing the surgical dressing.
The correct answer demonstrates mastery of safety regulations and the practical nurse scope of practice. As-needed (PRN) prescriptions for physical restraints are universally prohibited by healthcare regulatory agencies. The practical nurse must recognize the invalid order, refuse to apply the restraints, provide appropriate education to the demanding family, and prioritize least restrictive alternatives such as concealing the surgical dressing to ensure the client's safety without violating legal boundaries.
Step-by-Step Solution
Key Concept
Regulatory Constraints on Restraint Orders and Least Restrictive Interventions