The nurse in the surgical unit is caring for a 79-year-old male client.
0130:Day 2 after bowel surgery. Confused since midnight: knows own name only. Has pulled out the nasogastric tube twice tonight and is now pulling at the central venous catheter. Reorientation and a sitter at the bedside have not stopped the behavior. Primary health care provider (PHCP) at the bedside.
Complete the following sentences by choosing from the lists of options.
The nurse should fasten the restraint straps with .
While the restraints are on, best practice is a visual check of the client at least every .
If the restraints are removed because the behavior has stopped and the client later pulls at the lines again, the nurse needs to reapply them.