Question

Purpose of the Assignment

Identify strategies to reduce the risk for injury to clients in various environments.

Course Competencies

• Select appropriate nursing interventions when providing multidimensional care to clients experiencing alterations in mobility.
• Strategies for safe effective multidimensional nursing practice when providing care for clients experiencing sensory and perception disorders.

Instructions

In a one page Word Document, plan interventions with rationale which will promote an environment of safety for the described client below. Consider the client’s medical history and medications.

Mr. Joe Smith, 75-year old man, recently suffered a left cerebrovascular accident. He has right visual field deficits and residual weakness in this right arm and leg. He uses a walker for mobility. He takes Metoprolol for his blood pressure and the physician started him on Coumadin because he has recently been diagnosed with atrial fibrillation.

Use at least two scholarly sources to support your interventions and rationale. Be sure to cite your sources in-text and on a reference page using APA format.

Answer 1

ANSWER 1. Strategy to reduce the risk of injury in various environment-

1.Modification of the roadway environment-
Motor vehicle accident are the most common cause of injury. So to avoid the accident following measure can be taken.
# Divided highways separate traffic flow in different directions.
# Avoiding lane crossings and reducing the risk of head-on crashes.
# Curves are graded to reduce the risk of cars running off the road.
# Skid-resistant surfaces have been developed to reduce loss of traction while braking.
# Lighted signage has been added to increase visibility and reduce distraction.
# On- and off-ramps help control the integration of slow-speed with high-speed traffic.

2. Modifications to reduce violence in the workplace-
Homicide is the second leading cause of traumatic death in the workplace, following transportation-related deaths.
The majority of workplace homicides are robbery related.
The environmentally based approach called Crime Prevention Through Environmental Design (CPTED) originated in the 1970s to reduce robberies and associated violence. CPTED aims to modify the work environment to reduce vulnerability to crime, allowing businesses direct control of the environment rather than relying on indirect control of criminal behavior. If robberies can be prevented, then the injuries and deaths that occur during robberies will also be prevented.
The CPTED model identifies four elements for environmental modification: natural surveillance, access control, territoriality, and activity support. Natural surveillance includes internal and external lighting—and visibility into the store—and placement of the cash register. Access control includes such factors as number of entrances, door type and placement, and design of the internal environment to control customer movement. Territoriality addresses the location of the store within the community, traffic flow surrounding the store, signs and advertisements for the store, and design issues that empower the employees over the customers (such as bulletproof barriers). Activity support includes efforts to increase the presence of legitimate customers and encourages both increased business and good customer behavior.

3. Home modifications to reduce falls in the elderly-

Falls are a significant health concern for the elderly because of their frequency and the potential for serious consequences.
• Overall decrease in fall risk, especially among those with a history of falling, when modifications such as nonslip bath mats, lighting at night, and stair rails were recommended.
• Home modification in the absence of other intervention approaches may be effective for persons with a history of falling but is likely to be most effective when integrated into a multifaceted intervention program that also focuses on medications, exercise, and nutritional status.

4. Modifications to protect the child pedestrian-
The main reason of accident is that children, especially young children, are not cognitively ready to handle the complex traffic environment. Challenges for children include difficulty seeing and processing traffic patterns, judging speed of vehicles, prioritizing street-crossing activities, and choosing an adequate gap in traffic to cross the road.
Environmental approaches that separate children from the traffic environment and slow traffic in places where children might be in the street would be effective.
For example, using fences to physically separate children from driveways was associated with a threefold decrease in driveway-related child pedestrian injuries.

ANSWER 2.
Appropriate nursing interventions when providing care to the client experiencing mobility alterations-

1.Assist patient for muscle exercises as able or when allowed out of bed; execute abdominal-tightening exercises and knee bends; hop on foot; stand on toes.
2. Present a safe environment: bed rails up, bed in down position, important items close by.
3. Establish measures to prevent skin breakdown and thrombophlebitis from prolonged immobility:
Clean, dry, and moisturize skin as necessary.
Use anti embolic stockings or sequential compression devices if appropriate.
Use pressure-relieving devices as indicated (gel mattress).
4. Execute passive or active assistive ROM exercises to all extremities.
5. Provide foam or flotation mattress, water or air mattress or kinetic therapy bed, as necessary.
6. Promote and facilitate early ambulation when possible. Aid with each initial change: dangling legs, sitting in chair, ambulation.
7. Show the use of mobility devices, such as the following: trapeze, crutches, or walkers.
8. Help out with transfer methods by using a fitting assistance of persons or devices when transferring patients to bed, chair, or stretcher.
9. Give positive reinforcement during activity. Patients may be unwilling to move or initiate new activity because of fear of falling.
10. Encourage resistance-training exercises using light weights when suitable.
11. Keep limbs in functional alignment with one or more of the following: pillows, sandbags, wedges, or prefabricated splints.
12. Encourage coughing and deep-breathing exercises. use suction as necessary. Make use of incentive spirometer.

APPROPRIATE NURSING INTERVENTION FOR PATIENT WITH SRNSORY AND PERCEPTION DISORDER-

1.Provide a consistent physical environment and a daily routine.
2. Provide access to familiar objects, when possible.
3. Provide a low-stimulation environment for patient because
disorientation may be increased by overstimulation.
4. Provide for adequate rest, sleep, and daytime naps.
5. Use a calm and unhurried approach when interacting with patients.
6. Speak to the client in a slow, distinct manner with appropriate
volume.
Engage patient in concrete “here and now” activities (that
is, ADLs) that focus on something outside the self that is concrete
and reality oriented.
7. Facilitate use of hearing aids, as appropriate.
8. Listen attentively.
9. Use simple words and short sentences, as appropriate.
10. Obtain patient’s attention through touch.

Answer 3.

Nursing Interventions for Joe Smith-

Nursing care has a significant impact on the patient’s recovery. In summary, here are some nursing interventions for patients with stroke:

1. Positioning- Position to prevent contractures, relieve pressure, attain good body alignment, and prevent compressive neuropathies.
2. Prevent flexion- Apply splint at night to prevent flexion of the affected extremity.
3. Prevent adduction. Prevent adduction of the affected shoulder with a pillow placed in the axilla.
4. Prevent edema. Elevate affected arm to prevent edema and fibrosis.
5. Full range of motion. Provide full range of motion four or five times a day to maintain joint mobility.
6. Prevent venous stasis. Exercise is helpful in preventing venous stasis, which may predispose the patient to thrombosis and pulmonary embolus.
7. Regain balance. Teach patient to maintain balance in a sitting position, then to balance while standing and begin walking as soon as standing balance is achieved.
8. Personal hygiene. Encourage personal hygiene activities as soon as the patient can sit up.
9. Manage sensory difficulties. Approach patient with a decreased field of vision on the side where visual perception is intact.
10. Visit a speech therapist. Consult with a speech therapist to evaluate gag reflexes and assist in teaching alternate swallowing techniques.
11. Voiding pattern. Analyze voiding pattern and offer urinal or bedpan on patient’s voiding schedule.
12. consistent in patient’s activities. Be consistent in the schedule, routines, and repetitions; a written schedule, checklists, and audiotapes may help with memory and concentration, and a communication board may be used.
13. Assess skin. Frequently assess skin for signs of breakdown, with emphasis on bony areas and dependent body parts.
14. Monitor the level of PT/INR as patient on coumadin for risk of bleeding.

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