ch 19 - falls and fall risk reduction Flashcards
what poor outcomes is impaired mobility linked with (7)
- early predictor of physical disability
- falling
- loss of independence
- depression
- decreased quality of life
- institutionalization
- death
all falls in nursing homes must be reported to who
centers for medicare and medicaid services (CMS)
what % hip fractures are caused by falls
95%
pts over what age have highest rates of TBI related hospitalization and death
75+ yo
fear of falling
fallophobia
S+S mild TBI in older adults
- trouble concentrating
- fatigue
- change in sleep pattern
- blurred vision
- loss taste/smell
- change in sexual drive
- mood changes
S+S moderate to severe TBI in older adults
- repeated N/V
- seizures
- inability to wake from sleep
- dilation one/both pupils
- weakness/numbness in arms/legs
common risk factors for falls for older adults (intrinsic)
- meds/substance (alcohol, sedatives, psychoactive meds, diuretics, anticholinergics, antidepressants, antihypertensives, anticoagulants)
- polypharmacy
- previous falls and fractures
- females, 80+ yo
- acute recent illness, hospitalization
- cognitive impairment
- chronic pain
- depression, anxiety
- orthostatic hypoTN
- sleep disorders
7 fall classifications
- due to acute events (orthostatic hypoTN, loss of balance)
- due to chronic events (chronic dizziness, lower extremity weakness)
- due to meds
- due to environmental mishaps
- due to equipment malfunction
- due to poor safety awareness
- due to poor pts judgment
common risk factors for falls for older adults (extrinsic)
- urinary incontinence, urgency
- relocation to new environment
- improper use safety/assistive devices
- slippery, uneven, glossy surfaces
- pets
- electrical cords
- throw rugs
- side rails, restraints
postprandial hypoTN occurs after eating what
carbohydrate meal
fall risk assessment tools (3)
- morse fall scale
- hendrich II fall risk model (SNF and rehab)
- minimum data set (LTC for mobility and fall data)
what does a postfall assessment include
- fall focused history
- fall circumstances
- med problems
- med review
- mobility assessment
- vision and hearing assessment
- neurological exam
- cardio exam
program for decreasing falls
NICHE
fall risk reduction interventions
- safe environment
- withdrawal/minimize psychoactive meds and others
- detection and prevention delirium
- management orthostatic hypoTN
- management footwear
- exercise
system level interventions for fall prevention in acute care settings
- use of ANP consult
- teach backs
- comfort care and safety rounds
- safety huddle postfall
- protective bundles
environmental safety checks for preventing falls
- check surfaces for uneven ground, spills…
- keep hallways free from clutter
- proper illumination
- grab rails and nonskid appliances in bathroom
- appropriate shoe wear
- bed rails don’t collapse when transferring
how do you use a cane
- put cane on ground ahead of you
- put all weight on good leg
- move cane and affected leg at same time
how do you use a cane on the stairs
GOING UP:
- step up with good leg first
- use cane to support bad leg stepping up
GOING DOWN:
- use cane to support bad leg going down first
- then good leg down
how to use a walker
- lift/roll walker a step’s length ahead
- lean slightly forward
- step with bad leg
- step with good leg
what adverse effects/events are physical restraints associated with
- higher death rates
- injuries with falls
- nosocomial infections
- incontinence
- contractures
- pressure ulcers
- agitation
- depression
most common mechanism of
restraint-related death
asphyxiation
what is considered restrictive side rail use
two full length side rails
four half length side rails
tips for dealing with medical devices when using restraints/instead of using restraints
- use sleeves/splints to cover IVs on arm
- use mitts and roll belts instead of wrist and vest restraints
- hide lines behind pts eyesight
- cover tubes with abdominal binder/pants/dressing
- tape male catheter to pubis, run around back and down leg
- remove restraints when working with pt
risk factors for TBI for older adults
- comorbid conditions
- antiplatelet/anticoagulant meds
- changes in brain with age
how to admin the “timed up and go” assessment
- pt sits in chair
- goal is ten feet away
- when you say “go” pt stands up, walks to goal, turns around, walks back, and sits down
- stop timing when pt sits back down
what time result from the “timed up and go” test is associated with at risk for falling
> 12 secs
how to admin the “30 second chair stand” assessment
- pt sits in chair
- cross arms and put on shoulders
- stand up and then sit back down
- count each stand up as a rep
- time for 30 secs
Tx for corns/calluses of feet
- padding
- daily lubrication
Tx for bunions of feet
- corticosteroid injections
- surgery
- NSAIDs
Tx for hammer toes
- specially designed shoes
- surgery
Tx for fungal infections of feet
- topical antifungal powders
- keep areas in between toes clean and dry
how should you cut toenails
after bath/shower
straight across
how to assess for orthostatic hypoTN
- lay in bed for 5 mins
- take bp in both arms
- stand
- take bp
- take bp again after standing for 3 mins
what is considered orthostatic hypoTN
drop of 20+ Sbp and 10+ Dbp from lying to standing
red flag risk factors for falls (3)
- osteoporosis
- mobility problems
- anticoagulant therapy
self assessment tool for falls
STEADI
what vitamins should older adults with osteoporosis take to prevent fractures if they fall
- calcium
- vitamin d
