Safety and Infection Control Study Guide for the NCLEX-PN Exam
Approximately 10% to 16% of the questions on the NCLEX-PN® test are allotted to the topics of safety and infection control. Anything from emergency response plans to security issues to standard precautions with regard to infection is fair game for these questions. Read on to see exactly what you need to study, and be sure to consult other sources if you still have questions about any of our content.
Preventing errors in nursing care is a key element to a successful career in healthcare as well as a successful outcome for your clients. There are important tools to use when implementing safe practices, such as specific client identifiers and precaution arm bands. It is also vital to think critically when considering the appropriateness of the healthcare provider’s order.
One of the most important ways to prevent errors in nursing care is by always using client identifiers with your clients. Usually, two client-specific identifiers are used to ensure the correct client is being treated. Date of birth and full name are examples of the most common identifiers used. Allergy warning, fall risk, and limb alert bands are used to prevent errors as well. Allergy bands are present to have the nurse verify client allergies to ensure a preventable reaction does not occur. Fall risk bands alert the nurse to unstable clients who are more likely to fall and injure themselves. Limb alert bands make healthcare staff aware that a particular limb cannot be used for things such as an IV, blood draw, or blood pressure reading. If you are present and see a mistake happening, it is your responsibility as a nurse to speak up and prevent any potential or definite harm to any client.
Your knowledge of factors such as mental health disorders and altered mental states protects your clients from harm. When physically protecting a client from themselves or keeping them from harming others, the nurse must assess the level of the threat and determine the appropriate, least restrictive method of protection suitable for that client. When educating a client, assessing and understanding his or her level of education and baseline mental status are important during your pre-assessment of baseline knowledge.
When noting an order for your client, it is important to understand the reasoning behind it. If the order does not make sense or seem appropriate for your client, verify it with the ordering healthcare provider and voice your concerns. For example, a new order for your client comes in and it is a new medication for hypertension. You know your client is currently on one medication for hypertension and has been running slightly hypotensive. Rather than just giving the new med to the client without question, you as the nurse should feel empowered to advocate for your client’s safety and discuss your concerns with the physician before giving the medication.
Preventing client injuries applies to all ages. This can be accomplished by educating the client and/or caregiver, creating a safe environment, giving safety tips for the home, and safe use of equipment. These conversations should include client safety both in and outside of the healthcare facility.
Educating your clients and their caregivers on safety tips and techniques empowers them to be in control of their own healthcare. Prior to any education, it is always important to assess the client’s baseline knowledge of the information needed and build from there. Educate clients on such things as how to call for help from within the healthcare facility and the importance of non-skid footwear for fall risk clients. Encourage behaviors/methods that prevent sexually transmitted diseases. Caregivers and clients should also be instructed on how to use/install a car seat, tips for SIDS prevention, and reducing the risk of choking.
A safe environment is one that is free from fall risks. For example, removing throw rugs and ensuring flooring isn’t slippery both help to prevent falls. A crib that is free from toys, blankets, and bumpers to prevent suffocation is a safe environment for an infant. In the hospital, making sure cords are not in the client’s pathway, ensuring IV lines have slack in order to not accidentally be pulled out, and reporting unsafe situations that you cannot fix yourself are all ways to keep your client safe while in your care.
Home safety can be achieved through education and a home evaluation by a home health nurse. A safe environment, as well as safe practices implemented in clients, can be transitioned to the home. Previously reviewed safety tips about things like removing frayed cords, not leaving a child unattended in the bathtub, and adapting the home to an aging client are ways to help clients achieve home safety.
Using equipment safely applies to the client as well as to any healthcare team member when working with clients. Teaching clients how to use equipment (crutches, walkers, blood glucose monitors, etc.) correctly and safely is an important responsibility for the nurse. It is also important that the nurse observe carefully to be sure safe procedures are practiced by the client after this instruction. Following policies/protocols, ensuring equipment is functioning appropriately, and verifying the selected equipment is appropriate for the particular client task are keys to safety for all.
When using any type of equipment, always ensure that it is functioning properly before using it with clients. You should always check the plugs, restart, etc. prior to reporting faulty or broken equipment. As a nurse, you should also provide the client with equipment for his or her safety, such as oxygen, a walker, etc.
Regardless of who is using the equipment, it is important that the individual is educated on its proper use. Healthcare team members should review protocols for specific equipment and have an experienced team member check them off on correct use. Nurses should educate clients regarding the use of any new equipment and about any peculiarities that are witnessed with current equipment.
Using the Least-Restrictive Option
When using safety equipment such as chemical or physical restraints and seclusion, it is the responsibility of the nurse to assess that the least restrictive option is used first and justify the use of more restrictive devices with clients. When using physical restraints, the nurse should assess skin for breakdown every 2 hours for nonviolent clients and hourly for violent clients. You must have a physician renew the order every 24 hours, thus assessing the need for restraint(s).
Using proper body ergonomics is another principle that applies to clients as well as healthcare team members. Educate your client about, and personally practice, these principles:
- Lift using your legs and not your back.
- Use proper posture when sitting.
- Do not use bending or twisting motions.
- Use suitable safety equipment when needed, such as earplugs when near loud noises.
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