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When caring for a client who uses a protective device (restraint), the nurse aide SHOULD

A.Check the client's body alignment
B.Assess the client once every hour
C.Release the protective device one per shift
D.Ensure the protective device is tight

1 Answer

5 votes

Final answer:

The nurse aide SHOULD check the client’s body alignment, frequently assess the client, release the protective device periodically, and ensure it is not too tight, focusing on client safety and compliance with nursing care standards.

Step-by-step explanation:

When caring for a client who uses a protective device, commonly referred to as a restraint, the role of the nurse aide is critical to ensure the client's safety and well-being. The nurse aide SHOULD check the client's body alignment to ensure the client is in a comfortable and appropriate position and there is no undue pressure on any part of the body. Additionally, it is important to assess the client more frequently than once every hour; typically, the standard of care requires checks at least every 15-30 minutes. These checks include monitoring for any signs of distress or circulation problems related to the restraint. Furthermore, it's important to release the protective device periodically (e.g., every 2 hours), depending on the institutional policies and the client's condition, to permit movement and reduce the risk of complications such as pressure ulcers and blood clots. Lastly, the protective device should never be too tight; it must be secure, yet not so tight as to cause injury or prevent circulation.

The answer aligns with standard nursing practices which highlight thorough, frequent monitoring, and careful application when using restraints, adhering to policies that prioritize the client's safety and respect their dignity.

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User Merelda
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