A general guideline for the assessment of a patient who has been restrained is:

Question

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Following application,evaluate patient's condition for signs of injury every 15 minutes.
Frequent assessments prevent injury to patient and removal of restraint at earliest possible time.
Observation and frequent assessments prevent complications such as suffocation,skin breakdown,and impaired circulation.However,the Joint Commission recommends that the patient's condition be evaluated every 15 minutes.
If the nurse restrains patient in an emergency situation because of violent or aggressive behavior that presents an immediate danger,a face-to-face physician assessment within 1 hour is needed to determine the patient's continued need for restraints.
Restraints should be removed at least every 2 hours.If the patient is violent or noncompliant,remove one restraint at a time and/or have staff assistance while removing restraints.Removal provides opportunity to change patient's position,offer nutrients,perform full range of joint motion (ROJM),and toilet and exercise patient.

A General Guideline for the Assessment of a Patient Who