Physical restraints

Purposes of applying restraints

• To restrict the movement of one or more extremities

• To restrict patient’s use of fingers on one/both hands

• To restrict their body movement

Types of physical restraints

• Limb restrainer

• Mitten restrainer

• Body vest

• Belt restrainer

Hospital policy & guidelines

• Least restrictive restraint must be used

• Assessment must be completed prior to treatment

• Dr order MUST state reason, duration & restrainer type

• Restrainers ❌ used for staff convenience

• Restraints are used as a LAST resort

Nursing care of patient with physical restraints

• Assess needs for restraints

• Communicate with family abt needs/risk/benefits of restrainers

• Comply with policies & guidelines for restraint

• Secure in a proper manner to maintain the client’s safety/comfort

• Observe patient & pay attention to dignity, privacy & mental/physical condtions

• Review restraints regularly

• Document use of restraints

Examples of medical complication

Behaviour:

• ⬆ agitation/frustration

Cardiovascular system alterations:

• Change in BP, volume & basal metabolic rate

• Cardiac stress

• Venous stasis

Examples of deadly complications

• Asphyxia

• Aspiration

• Strangulation

Examples of complications due to decreased functional state

• Deconditioning

• ⬆ dependency

Examples of complications due to changes in hydration & nutritional status

• Dehydration from lack of access to fluids

• Loss of appetite

Examples of complications due to infection

Nasocomial infections resulting from immobility

Examples of complications due to injury

Falls → injury

Examples of complications due to musculoskeletal alterations

• ⬇ muscle mass, tone, strength & stiffness

• Contractures - joints ❌ bend as they are stiff

Examples of complications due to perceptions of self

• Loss of autonomy/dignity

• Change in self image

Complications due to changes in skin intergrity

• Abrasions at restraint site

• Bruising

• Pressure ucler

Examples of psychological complications

• Anger

• Anxiety

• Depression

• Fear - of walking/eating

• Sensory deprivation

• ⬆ confusion

• Disordered sleep