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Zorluk: ZorAccident, Error, and Injury Prevention

A registered nurse is coordinating the care of a critically ill client who was just admitted with suspected bacterial meningitis and septic shock. The client is confused, hemodynamically unstable, and receiving a continuous intravenous (IV) infusion of norepinephrine via a central venous catheter. Which of the following actions should the nurse implement to prevent accidents, errors, and injuries? (Select all that apply.)

  1. A
    Assign the unlicensed assistive personnel (UAP) to assess and report any changes in the client's Glasgow Coma Scale (GCS) score.
  2. Verify the physical and chemical compatibility of all intermittent intravenous (IV) medications with the continuous vasoactive infusion prior to administration.Cevap
  3. C
    Place the client in a negative-pressure isolation room and don an N95 particulate respirator prior to entering.
  4. Maintain the head of the bed elevated at 30 degrees to promote cerebral venous drainage and mitigate aspiration risk.Cevap
  5. E
    Apply bilateral soft wrist restraints immediately upon noticing the confused client reaching toward the central venous access device.
  6. Utilize a barcode medication administration (BCMA) system and verify two unique client identifiers before delivering any therapeutic agents.Cevap

Cevap

The appropriate safety actions are verifying IV medication compatibility, maintaining the head of the bed elevated at 30 degrees, and utilizing barcode scanning with two unique identifiers.
Safe and effective care for a critically ill, hemodynamically unstable client requires rigorous error prevention strategies. Verifying IV compatibility prevents dangerous chemical reactions or line occlusions when administering multiple medications. Utilizing a barcode medication administration system alongside two unique identifiers is a non-negotiable standard for preventing wrong-client or wrong-drug errors. Additionally, maintaining the head of the bed at 30 degrees is an essential physical safety measure that prevents aspiration and promotes cerebral venous return, which mitigates dangerous increases in intracranial pressure associated with meningitis.

Adım Adım Çözüm

1
Evaluate the risk of medication errors in a critically ill client receiving continuous vasoactive infusions.
Identified the need to verify IV compatibility and use two unique identifiers via a barcode system.
High-alert medications require strict adherence to administration protocols to prevent fatal adverse events.
2
Determine the appropriate physical positioning for a client with suspected meningitis and confusion.
Identified that elevating the head of the bed to 30 degrees is necessary.
This position facilitates cerebral venous drainage to prevent increased intracranial pressure and reduces the risk of aspiration.
3
Assess the appropriateness of isolation precautions, delegation, and restraint use.
Determined that airborne precautions, delegating GCS assessments, and immediately applying restraints are unsafe actions.
Meningitis requires droplet precautions; UAPs cannot perform clinical assessments on unstable clients; and restraints require prior failure of less restrictive alternatives.

Anahtar Kavram

Prioritization of patient safety through adherence to medication administration protocols, appropriate delegation, and implementation of least restrictive alternatives.
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Konular

Accident, Error, and Injury Prevention

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