2.6 safety

Question 1

Falls

Answer 1

Leading cause of injury death over age 65
1 of 3 adults age 65 or > fall each year
Most common cause of traumatic brain injury
In 2000, medical costs of falls over $19 Billion-$179 million for fatal falls
“Fallophobia”

Question 2

Factors R/T Falls & Injury in Elderly

Intrinsic

Answer 2

Intrinsic
Limited mobility
Decreased vision
Confusion
Orthostatic hypotension/Syncopy
Decreased Equilibrium-Balance 
Medication effects

Question 3

Factors R/T Falls & Injury in Elderly

Extrinsic

Answer 3

Extrinsic
Unfamiliar environment
Poor lighting
Clutter/Rugs
Loose shoes
No phone/Can’t see to dial
Restraint use
Fire Hazards
Smoking
Stove left on
Lack of Handrails/Supportive aids

Question 4

Hester-Davis Fall Score

Answer 4

Last Known Fall
Mobility
Medications
Mental Status/LOC/Awareness
Toileting Needs
Volume/Electrolyte Status
Communication/Sensory
Behavior

7-10=Low Risk
11-14=Medium Risk
15+=High Risk Fall

Question 5

So what do you do if a patient falls?

Answer 5

Stay with the patient & keep them down
Assess for injury
Know your agency policy
Documentation of falls & incident reports
Post Fall Huddle with Root & Cause Analysis at some agencies-Look at Why patient fell
Reassess fall risk & initiate interventions

Question 6

Fire and burns

Answer 6

Fire hazards in home
Stove left on
Smoking
Oxygen safety
Excessive temperature of hot water

Question 7

Medication Risks

Answer 7

Absorption
Distribution
Biotransformation
Excretion

Question 8

Age-related changes

Answer 8

Chronic disease
Polypharmacy
↓Body water = ↑concentration water-soluble meds
↑Body fat = prolonged effects of fat-soluble drugs
Hepatic blood flow reduced =↓ first-pass effect
↓ albumin=altered binding, ↑“free drug” & toxic level of protein-bound drugs (more is available)
Renal excretion (highly individual)
↓number of receptors & binding, altered cell response
Beers Criteria

Question 9

Adverse Drug Reaction Risk Factors

Answer 9

High-risk meds
Psychotropics
-Antipsychotics
-Anxiolytics
-Sedative-hypnotics

Anti-inflammatory meds-NSAIDS Anticoagulants

Drug-drug interactions
Polypharmacy
Nonadherence-Diet/Dosing
OTC Meds, Vitamins, Supplements

Question 10

Medication Errors

Answer 10

60% of elderly take medications incorrectly
Poly pharmacy
Living Alone-Who sets meds up? 
Inadequate Education
Inadequate Finances
Medication Regime Understanding

Question 11

Extrapyramidal Reactions

Answer 11

Early Onset:

• Acute dystonia (spasm)
• Parkinsonism (rigidity, tremor, ect.)
• Akathisia (Can’t stay still)

Late Onset:

• Tardive dyskinesia-Involuntary asymmetrical movements
• Meds that block dopamine

Question 12

Insulin Reaction in Elderly

Answer 12

What does an insulin reaction look like in an older patient?

Speech Disorder
Slurring
Confusion
Disorientation

Question 13

Hypoglycemia vs. stroke

Answer 13

Hypoglycemia can produce symptoms similar to a stroke
-Facial weakness
-Slurred speech
-Hemiplegia
All suspected strokes should receive hypoglycemia treatment, just in case
Many strokes have been “cured” this way