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maturing family > ch 19 - falls and fall risk reduction > Flashcards

ch 19 - falls and fall risk reduction Flashcards

1
Q

what poor outcomes is impaired mobility linked with (7)

A
  • early predictor of physical disability
  • falling
  • loss of independence
  • depression
  • decreased quality of life
  • institutionalization
  • death
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2
Q

all falls in nursing homes must be reported to who

A

centers for medicare and medicaid services (CMS)

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3
Q

what % hip fractures are caused by falls

A

95%

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4
Q

pts over what age have highest rates of TBI related hospitalization and death

A

75+ yo

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5
Q

fear of falling

A

fallophobia

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6
Q

S+S mild TBI in older adults

A
  • trouble concentrating
  • fatigue
  • change in sleep pattern
  • blurred vision
  • loss taste/smell
  • change in sexual drive
  • mood changes
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7
Q

S+S moderate to severe TBI in older adults

A
  • repeated N/V
  • seizures
  • inability to wake from sleep
  • dilation one/both pupils
  • weakness/numbness in arms/legs
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8
Q

common risk factors for falls for older adults (intrinsic)

A
  • 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
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9
Q

7 fall classifications

A
  • 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
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10
Q

common risk factors for falls for older adults (extrinsic)

A
  • urinary incontinence, urgency
  • relocation to new environment
  • improper use safety/assistive devices
  • slippery, uneven, glossy surfaces
  • pets
  • electrical cords
  • throw rugs
  • side rails, restraints
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11
Q

postprandial hypoTN occurs after eating what

A

carbohydrate meal

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12
Q

fall risk assessment tools (3)

A
  • morse fall scale
  • hendrich II fall risk model (SNF and rehab)
  • minimum data set (LTC for mobility and fall data)
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13
Q

what does a postfall assessment include

A
  • fall focused history
  • fall circumstances
  • med problems
  • med review
  • mobility assessment
  • vision and hearing assessment
  • neurological exam
  • cardio exam
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14
Q

program for decreasing falls

A

NICHE

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15
Q

fall risk reduction interventions

A
  • safe environment
  • withdrawal/minimize psychoactive meds and others
  • detection and prevention delirium
  • management orthostatic hypoTN
  • management footwear
  • exercise
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16
Q

system level interventions for fall prevention in acute care settings

A
  • use of ANP consult
  • teach backs
  • comfort care and safety rounds
  • safety huddle postfall
  • protective bundles
17
Q

environmental safety checks for preventing falls

A
  • 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
18
Q

how do you use a cane

A
  • put cane on ground ahead of you
  • put all weight on good leg
  • move cane and affected leg at same time
19
Q

how do you use a cane on the stairs

A

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
20
Q

how to use a walker

A
  • lift/roll walker a step’s length ahead
  • lean slightly forward
  • step with bad leg
  • step with good leg
21
Q

what adverse effects/events are physical restraints associated with

A
  • higher death rates
  • injuries with falls
  • nosocomial infections
  • incontinence
  • contractures
  • pressure ulcers
  • agitation
  • depression
22
Q

most common mechanism of

restraint-related death

A

asphyxiation

23
Q

what is considered restrictive side rail use

A

two full length side rails

four half length side rails

24
Q

tips for dealing with medical devices when using restraints/instead of using restraints

A
  • 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
25
Q

risk factors for TBI for older adults

A
  • comorbid conditions
  • antiplatelet/anticoagulant meds
  • changes in brain with age
26
Q

how to admin the “timed up and go” assessment

A
  • 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
27
Q

what time result from the “timed up and go” test is associated with at risk for falling

A

> 12 secs

28
Q

how to admin the “30 second chair stand” assessment

A
  • 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
29
Q

Tx for corns/calluses of feet

A
  • padding

- daily lubrication

30
Q

Tx for bunions of feet

A
  • corticosteroid injections
  • surgery
  • NSAIDs
31
Q

Tx for hammer toes

A
  • specially designed shoes

- surgery

32
Q

Tx for fungal infections of feet

A
  • topical antifungal powders

- keep areas in between toes clean and dry

33
Q

how should you cut toenails

A

after bath/shower

straight across

34
Q

how to assess for orthostatic hypoTN

A
  • lay in bed for 5 mins
  • take bp in both arms
  • stand
  • take bp
  • take bp again after standing for 3 mins
35
Q

what is considered orthostatic hypoTN

A

drop of 20+ Sbp and 10+ Dbp from lying to standing

36
Q

red flag risk factors for falls (3)

A
  • osteoporosis
  • mobility problems
  • anticoagulant therapy
37
Q

self assessment tool for falls

A

STEADI

38
Q

what vitamins should older adults with osteoporosis take to prevent fractures if they fall

A
  • calcium

- vitamin d

maturing family (36 decks)

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