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Difficulty: MediumSafe Use of Restraints and Safety Devices

During an interdisciplinary case review, the healthcare team evaluates several clients exhibiting challenging behaviors on a medical unit. According to regulatory standards and safety guidelines, for which client is the application of physical restraints clinically justified?

  1. A
    A client with advanced Alzheimer's disease who paces the hallways and frequently wanders into the rooms of other hospitalized individuals
  2. B
    A client whose assigned unlicensed assistive personnel (UAP) independently determines that wrist restraints are necessary to safely complete a bed bath
  3. A client with metabolic encephalopathy who persistently attempts to remove a life-sustaining chest tube despite continuous reorientation and a trial of alternative sensory itemsAnswer
  4. D
    A client with a history of recurrent falls who continuously attempts to climb out of bed unassisted to use the restroom

Answer

A client with metabolic encephalopathy who persistently attempts to remove a life-sustaining chest tube despite continuous reorientation and a trial of alternative sensory items
The correct answer identifies that physical restraints are only legally and clinically appropriate when they are necessary to prevent the disruption of life-sustaining medical therapy, and only after less restrictive measures have been attempted and documented. The client with metabolic encephalopathy pulling at a chest tube meets these strict criteria.

Step-by-Step Solution

1
Evaluate the clinical indication for each client's behavior.
Identify that wandering, resisting a bed bath, and attempting to get out of bed to use the restroom do not threaten immediate medical stability in a way that requires restraints.
Restraints must only be used for the immediate physical safety of the client or others, never for convenience, discipline, or routine fall prevention.
2
Determine if less restrictive alternatives were attempted.
The client pulling the chest tube had continuous reorientation and alternative sensory items trialed first, which failed.
Regulatory standards mandate that physical restraints are an intervention of last resort after alternative measures have been documented as ineffective.
3
Select the client for whom restraints are legally and clinically indicated.
The client attempting to remove the life-sustaining chest tube is the only appropriate candidate.
Removal of a chest tube is a life-threatening event, justifying the temporary use of restraints to protect the medical device.

Key Concept

Physical restraints are an intervention of last resort, justified only to prevent immediate physical harm to the client (such as pulling out life-sustaining equipment) after less restrictive alternatives have failed, and cannot be used for fall prevention or staff convenience.
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Safe Use of Restraints and Safety Devices

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