Regents College Nursing

Study Guide Expanded Notes

Commonalities in Nursing Care: Area A

Study Guide

IV. Environmental Safety

(A safe environment is one in which physical hazards are reduced. The skin is considered the body's first line of defense against environmental hazards. Maintenance of the integument through hygienic care promotes health.)

A. Theoretical framework: basis for care

1. Principles related to environmental safety and maintenance of the integument (e.g., safe administration of medications, basic physical principles, anatomy and physiology of the integument [this includes the skin and mucous membranes, oral cavity, nails, hair, and sweat glands])

2. Common safety hazards in the environment

a. Physical/mechanical (e.g., wet floors, loose cords, scatter rugs, height of bed, friction, pressure)

b. Thermal (e.g., fire, electrical hazards, exposure to heat and cold)

c. Chemical (e.g., alkaline soaps, commercial mouthwashes, medications, poisons, pesticides)

d. Radiation (e.g., sunburn, heat lamps, X rays)

e. Ecological (e.g., air, noise, water pollution)

3. Common disturbances related to the integument (e.g., changes in skin turgor; changes in secretions; alterations in circulation; disruptions in skin integrity; psoriasis, pustules, papules, etc.)

4. Factors affecting environmental safety and maintenance of the integument

a. Developmental level: infancy through senescence

b. Individual preferences and patterns (e.g., previous accidents, lifestyle, safety knowledge, hygiene practices, use of medications)

c. Physical condition (e.g., level of awareness, sensory perception, hydration, activity patterns, nutritional status)

d. Ethnic and cultural considerations (e.g., familial hygienic practices, genetic differences in skin and hair)

e. Socioeconomic factors (e.g., crowded housing, unemployment, income level)

f. Environmental factors (e.g., proximity to nuclear plants, climate, occupation hazards)

g. Psychological factors (e.g., anxiety, cognition, stress)

5. Theoretical basis for interventions related to environmental safety and maintenance of the integument

a. Environmental modifications (e.g., lighting, furniture arrangement, heat and cold)

b. Safety instructions (e.g., need for appropriate footwear, regulatory guidelines)

c. Medications/topical agents (e.g., syrup of ipecac , powders, lotions, sunscreens)

d. Safety devices (e.g., restraints, siderails)

B. Nursing care related to theoretical framework

1. Assessment: gather and synthesize data about the patient's environmental safety needs in relation to the patient's functional health patterns

a. Determine the presence of environmental hazards (e.g., fire radiation, pollution, safety hazards)

b. Identify patient at risk for physical injury (e.g., confused mental state, sensory deficit, weakened physical state)

c. Determine the condition of the patient's integument (e.g., turgor , elasticity, colour, temperature)

d. Assess factors affecting environmental safety and maintenance of the integument (see IVA4)

2. Analysis: identify the nursing diagnosis (patient problem) and determine the expected outcomes (goals) of patient care

a. Identify nursing diagnoses (e.g., high risk for impaired skin integrity related to knowledge deficit, impaired skin integrity related to urinary or fecal incontinence , self-care deficit [bathing and hygiene] related to inability to use the hands, high risk for injury related to cluttered environment, high risk for injury related to sensory deficit)

b. Set priorities and establish expected outcomes (patient-centered goals) for care (e.g., patient will verbalize factors that increase potential for skin injury; patient's skin will be clean, dry, and intact; patient will not sustain injury; patient will use safety measures when ambulating)

3. Planning: formulate specific strategies to achieve the expected outcomes

a. Plan nursing measures to help the patient achieve the expected outcomes (e.g., teach the patient about risk factors such as overexposure to the sum, check the patient for incontinence q2h, provide total hygiene care for the patient daily, identify potential hazards in the patient's environment, encourage the patient to use a hearing aid)

b. Incorporate factors affecting environmental safety in planning the patient's care (e.g., establish a safe environment for a toddler, provide safety bars in the shower for an older adult, plan to apply moisturizer to the skin of a patient who lives in a dry climate, consider cultural factors when planning hygiene care) (see IVA4)

4. Implementation: carry out nursing plans designed to move the patient toward the expected outcomes

a. Use nursing measures to structure an environment conducive to safety (e.g., place furniture in an uncluttered arrangement, remove safety hazards)

b. use nursing measures to promote the integrity of the patient's integument (e.g., provide oral hygiene; provide care of the skin, hair, eyes, nails, and perineum; use an air mattress to prevent pressure ulcer formation; use appropriate topical agents)

c. Use nursing measures appropriate to particular safety needs (e.g., use heat and cold appropriately, shield appropriately from radiation , provide a large-print thermometer to measure bathwater temperature for an older adult)

d. Use safety devices properly (e.g., use mobilizing devices correctly, siderails)

e. Use measures to safely administer medications (e.g., use the "five rights" in drug administration, use established protocol, perform calculations accurately)

f. Provide information and instruction regarding environmental safety and maintenance of the integument (e.g., orient patient to the environment, explain use of mobilizing devices, provide instructions regarding skin care and the use of sunscreens)

5. Evaluation: appraise the effectiveness of the nursing interventions relative to the nursing diagnosis and the expected outcomes

a. Record and report the patient's response to nursing actions (e.g., administration of medications, condition of the integument, correct use of safety devices)

b. Reassess and revise the patient's plan of care as necessary (e.g., discontinue the use of soap fro hygienic care)