Keeping Patients Safe

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Keeping Patients Safe : 

Keeping Patients Safe Barbara Dries, RN,MSN, EdD

Protecting patients from adverse event related to cognitive-perceptual problems : 

Protecting patients from adverse event related to cognitive-perceptual problems Altered sensory system problems: Vision Hearing Balance

Visual : 

Visual Infections Injuries Blindness Cataracts Glaucoma Retinal tears /detachments

Creating a Culture of Safety : 

Creating a Culture of Safety Identifying and assessing problems both with patients and the patient’s environment. Develop, implement, and communicate care plan. Evaluate effectiveness of care plan and revised as needed.

Cataract : 

Cataract Opacity of the lens 3rd leading cause of blindness Most common surgical procedure for those > 65 years of age Mostly age related eye disorder Diabetic patients tend to develop cataracts at an earlier age

Slide 11: 

Gradual declines of vision Abnormal color perception Glaring effects Vision worsens at night Mostly age-related Clinical manifestationsof cataract

Cataract Removal : 

Cataract Removal Surgical Goal of treatment to restore vision with lens implant. Outpatient procedure

Post-operative instructions : 

Post-operative instructions Avoid rubbing or pressing on the eye Avoid strenuous activities, bending, stooping, lifting and driving until approved by ophthalmologist Wear eyeglasses or an eye shield, as advised by ophthalmologist Shield eye from UV rays

Additional teaching: : 

Additional teaching: Bleeding Pain S/S of infection Follow-up appointment w/ ophthalmologist, usually next day Do not discharge anyone unable to care for themselves if there is no one at home to assist them!

Glaucoma: a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness. : 

Glaucoma: a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness. Cause: elevated intraocular pressure 2nd leading cause of blindness 1st among African Americans

Interventions : 

Interventions Laser Procedures or Trabeculectomy surgery Removal of part of iris and trabecular meshwork Fluid percolates out through missing iris absorbed into systemic circulation

Retinal Detachment : 

Retinal Detachment Separation of retina with fluid accumulation between the two layers Causes: Retinal break (tears or holes) Can happen due to aging as the vitreous humor shrinks Diabetic retinopathy Ocular trauma

Like a curtain or veil coming down : 

Like a curtain or veil coming down

Scleral buckling procedure : 

Scleral buckling procedure

Auditory problems : 

Auditory problems External Ear Trauma Inflammation and infection Cerumen and foreign bodies in ear canal Middle Ear / Mastoid Acute/Chronic otitis media Otosclerosis

Inner Ear Problems : 

Inner Ear Problems Meniere’s Disease (vertigo/hearing loss) Otosclerosis (abnormal growth of bone) Labyrinthitis (inflammatory/infection) Acoustic Neuroma (growth/tumor)

Hyperplasias : 

Hyperplasias

Seizure / Epilepsy : 

Seizure / Epilepsy Uncontrolled electrical discharge of neurons in the brain interrupting normal functioning.

Seizure Disorders : 

Seizure Disorders Occur suddenly, often without warning, and can reoccur periodically. -Most seizures are considered idiopathic. -Epilepsy defined as recurring seizures w/ unknown cause.

Clinical Manifestations : 

Clinical Manifestations Generalized or partial Determined by the site of electrical disturbance.

Tonic-clonicGrand-mal : 

Tonic-clonicGrand-mal LOC Stiffening of the body Jerking Cyanosis Excessive salivation Tongue or cheek biting Incontinence may occur

Possible Causes of Seizures : 

Possible Causes of Seizures Ages 2 – 20 Birth injury Infection and fever Trauma Genetic Poisoning Ages 20 – 30 Trauma Brain tumors Vascular disease

Ages > 50Cerebrovascular lesionsStrokeBrain tumors : 

Ages > 50Cerebrovascular lesionsStrokeBrain tumors

Causes of Seizure Disorders : 

Causes of Seizure Disorders Head trauma Alcoholism Brain abscess Phenylketonuria (PKU) Infectious diseases like measles, mumps, and diphtheria. Lead poisoning, mercury poisoning, carbon monoxide poisoning, or ingestion of some other poisonous substance. Genetic factors.

Diagnostic tools : 

Diagnostic tools EEG stands for electroencephalogram MRI Positron emission tomography PET Brain scans Blood tests

Nursing management : 

Nursing management Summon assistance, if possible. Stay with your client and use the emergency call system. Maintain a patent airway. Oxygen and suctioning equipment should be brought into the room. Protect from harm; do not force anything into the mouth.

Nursing management : 

Nursing management Emotional support to client, families, and each other. Medication administration. Timeliness of dosages and lab test for therapeutic levels. System for ID of clients w/ seizure disorder

Treatment : 

Treatment Medication Therapeutic range critical Side effects Avoid sudden cessation of drug Possible surgical treatment for epilepsy