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Question

Difficulty: MediumAccident, Error, and Injury Prevention

A 2-year-old child is hospitalized with severe gastroenteritis and requires continuous intravenous (IV) hydration. The child is irritable, crying, and continuously attempting to grasp and pull at the IV tubing. Which of the following actions should the practical nurse (PN) implement first to prevent the child from accidentally dislodging the device?

  1. Conceal the intravenous insertion site and tubing using a soft, opaque wrap or commercial sleeve.Answer
  2. B
    Request a provider's prescription to apply bilateral elbow immobilizers.
  3. C
    Explain the medical importance of the intravenous therapy to the child in a calm voice.
  4. D
    Reassure the child by promising that the catheter will be removed as soon as they stop crying.

Answer

The priority action is to conceal the intravenous insertion site and tubing using a soft, opaque wrap or commercial sleeve.
The correct action applies the principle of using the least restrictive alternative to maintain patient safety. For a toddler, 'out of sight, out of mind' is an effective developmental concept. By concealing the IV site with an opaque wrap or sleeve, the child is less likely to focus on and pull at the tubing, thereby preventing accidental dislodgement without the need for physical restraints.

Step-by-Step Solution

1
Assess the clinical situation and the client's developmental age.
The client is a 2-year-old toddler who is irritable and at risk of dislodging an essential medical device (IV line).
Understanding the developmental stage is crucial for selecting appropriate interventions. Toddlers operate on sensorimotor and preoperational thought, often exhibiting 'out of sight, out of mind' behavior.
2
Evaluate potential interventions based on the principle of the least restrictive alternative.
Physical restraints (like elbow immobilizers) are highly restrictive. Explanations are developmentally inappropriate. Concealing the IV site is the least restrictive and most developmentally appropriate option.
Safety protocols dictate that nurses must always attempt the least restrictive measures to prevent injury before escalating to physical restraints.

Key Concept

Accident and Injury Prevention: Least Restrictive Alternatives
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Topics

Accident, Error, and Injury Prevention

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