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QUESTION IMAGE

a nurse is contributing to the plan of care for a client who is confuse…

Question

a nurse is contributing to the plan of care for a client who is confused and requires a prescription for wrist restraints. which of the following interventions should the nurse include in the plan of care? renew the prescription for the use of restraints within 24 hr. secure the restraint with the buckle side next to the clients skin. ensure 4 fingers can be inserted under the secured restraint. remove the restraint every 3 hr.

Explanation:

Brief Explanations
  • For wrist - restraints, prescriptions should be renewed regularly. Usually, renewal within 24 hours is appropriate. Securing the buckle side next to the skin can cause injury. Only 1 - 2 fingers should be able to fit under the restraint to ensure it's not too loose or too tight. Restraints should be removed at least every 2 hours for skin care, range - of - motion exercises, etc.

Answer:

Renew the prescription for the use of restraints within 24 hr.