A nurse is admitting a client who has a history of frequent, uncontrolled generalized tonic-clonic seizures. Which of the following interventions should the nurse implement to promote accident and injury prevention? (Select all that apply.)
- Verify that functioning suction equipment and supplemental oxygen are available at the bedside.Answer
- BDelegate the initial assessment of the client's environmental safety to the unlicensed assistive personnel (UAP).
- Apply padding to the bed's side rails to protect the client from impact.Answer
- DKeep a padded tongue blade at the bedside to insert into the client's mouth during a seizure.
- Keep the client's bed in the lowest position with the wheels locked.Answer
- FRestrain the client's extremities during active seizure activity to prevent musculoskeletal injury.
Answer
The correct interventions for seizure precautions are verifying the presence of functioning oxygen and suction equipment, applying padding to the side rails, and keeping the bed in the lowest locked position.
Safe and effective seizure precautions involve altering the environment to prevent injury during involuntary movements. Maintaining the bed in the lowest position with locked wheels reduces fall-related injuries. Padding the side rails protects the client from blunt force trauma. Having supplemental oxygen and functioning suction readily available at the bedside is critical to manage the airway and clear secretions immediately following the seizure.
Step-by-Step Solution
Key Concept
Standard seizure precautions focus on preventing traumatic injury and ensuring airway safety without restricting the client's movements or introducing objects into the oral cavity.
Estimated Time:1m 0s