Question

a nurse in a mental health facility is evaluating the effectiveness of mechanical restraints for a client who threw a chairin the day room. the nurse should identify which of the following findings as an indication to remove the restraints?

Answer 1

After initial orders are placed, nurses will be tasked to assess and reassess the patient in restraints every two hours on the even hour. Non-violent restraint reassessment must occur every 2 hours. Describe each time what the patient is doing (i.e. pulling at tubes, agitated, combative, etc.) to be removed.

You’ll need to help patients to meet behavior criteria for the discontinuation of restraint.

Remove restraints as soon as the patient meets behavior criteria for discontinuation. Discontinue restraint use when it becomes evident that the patient is no longer a danger to himself/herself or others.
"Your assessment should note whether or not the patient is calmer, not thrashing around, not yelling, etc."