Chapter 14: Safety

Question 1

Macroenvironment

Answer 1

Consists of the elements in the larger world that affect groups of people or even entire populations (e.g., the weather, pollution, traffic, and natural resources).

Question 2

Microenvironment

Answer 2

Our immediate surroundings with which we closely interact (e.g., furnishings, wall coverings, lighting, room temperature, animals/insects, & room sounds).

Question 3

Statistics about falls

Answer 3

40% of elderly (65+) experience a fall.

Question 4

Age related fall risks

Answer 4

Presbyopia
Presbycusis
Slowed response & reaction time
Decreased sensory receptors
Decreased strength
Impaired gait
Urinary frequency

Question 5

Fall risks

Answer 5

Inadequate lighting
Change in body temperature (deviating from 97-99)
Overstimulating decorative patterns/colors
Noise
Pain
Trip hazards
Certain medications: Anticholinergics, antidepressants, barbiturates, antihypertensives, sedatives, antipsychotics, & diuretics.

Question 6

Fall prevention

Answer 6

Arranging furniture in full view, providing good lighting, eliminating clutter on stairways, using contrasting colors on stairs, & providing signals to indicate when a change in level is being approached. Loose rugs, slippery floors, clutter, poorly fitting slippers & shoes should be eliminated.

Question 7

When a client falls

Answer 7

Perform an assessment - we want them moving as little as possible.
Document any witnesses, the story, physical observations/assessment findings, time, causative factors etc…

Question 8

Safety promotion

Answer 8

• Educating on proper use of assistive equipment/devices
• Ways to prevent falls by cleaning, taking medications properly, staying hydrated, keeping walkways well lit, incorporating strength exercise in daily routine…
• Self assessment education

Question 9

Describe the issue with polypharmacy

Answer 9

Due to a lack of communication between the many providers an older patient may have, they end up getting double, even triple dosed on the same medications. This increases risk for toxicity.

Question 10

Which aspect of the microenvironment is a 79 year old widow most likely to focus on first?

A) The decor of the house is several decades out of date.
B) The home was recently burglarized and the television stolen.
C) The front steps of the house are decaying and pose a safety risk.
D) The home is unbearably hot in the summer and has cockroaches.

Answer 10

D) The home is unbearably hot in the summer and has cockroaches.

Question 11

An older individual is touring an assisted living facility with his family in order to find a place to live after the death of his spouse and issues with mobility. Which characteristic of the facility is most in need of modification?
A) The temperature of common areas is kept between 75°F and
77°F
B) Aromatherapy is used in the facility to provide a pleasant scent environment
C) Area rugs are placed in front of each sink in residents’ washrooms to ensure warmth
D) There is more tile than carpet throughout the facility and carpets are glued to the floor

Answer 11

C) Area rugs are placed in front of each sink in residents’ washrooms to ensure warmth

Question 12

Integrative Care Plan: Which self-care activity should the nurse instruct an older patient with a history of congestive heart failure, type 2 diabetes, and hypertension?
A) Monitoring of radial heart rate and lung sounds
B) Starting a course of antibiotics with temperature increases
C) Accurate measurement of total daily fluid intake and output
D) Adjustment of blood pressure medication dosage based on home blood pressure readings

Answer 12

A) Monitoring of radial heart rate and lung sounds

Question 13

The home care nurse is concerned that an older patient is at risk for a kitchen fire. What actions can the nurse recommend to reduce the risk of this occurring? (Select all that apply.)
A) Avoid placing electrical items near a water source
B) Instruct the patient to stay in the kitchen while cooking
C) Encourage the use of meal delivery services to reduce cooking
D) Recommend the use of a timer to check the food on the stove
E) Suggest a microwave be used to heat liquids and not the stove

Answer 13

B) Instruct the patient to stay in the kitchen while cooking
D) Recommend the use of a timer to check the food on the stove
E) Suggest a microwave be used to heat liquids and not the stove

Question 14

The nurse is visiting the home of an older patient with changes in peripheral vision and depth perception.
What should the nurse instruct the family to ensure safety for the patient? (Select all that apply.)
A) Use contrasting colors on the stairs
B) Avoid the use of bright colors on walls
C) Arrange furniture so that it is in full view
D) Ensure good lighting throughout the home
E) Approach the patient directly and not from the side

Answer 14

A) Use contrasting colors on the stairs
C) Arrange furniture so that it is in full view
D) Ensure good lighting throughout the home
E) Approach the patient directly and not from the side

Question 15

The nurse identifies the diagnosis of risk for injury as being appropriate for an older patient.
What health problems would increase this patient’s risk for injury? (Select all that apply)
A) Hard of hearing
B) Weak gag reflex
C) Chronic renal failure
D) Fatigue and weakness
E) Macular degeneration

Answer 15

A) Hard of hearing
C) Chronic renal failure
D) Fatigue and weakness
E) Macular degeneration

Question 16

Explain how Maslow’s theory of low-level needs having to be fulfilled before one can concentrate on the fulfillment of high-level needs relates to satisfaction from one’s environment.

Answer 16

A person who does not feel safe, or does not have food or shelter, cannot be more concerned with how their friendships or spiritual well-being is doing.
Example:
An older woman has to consider how much she displays anything that may be portrayed of value in her low income, high crime neighborhood- as it would make her a target. Even though she loves decorating for the holidays, and hasn’t been involved in the past 3 parties between her girlfriends, who she meets to do crafts, because she hasn’t participated in the group decorating contest due to concerns for her safety.

Question 17

During a morning assessment the nurse notes that the oral temperature of an older patient is 96°F (35.6°C).
What guide will the nurse use to make decisions about this assessment finding?
A) Older adults are at increased risk for hyperthermia
B) Low temperature constitutes a risk to cardiac health
C) Older adults often lose body heat in response to infection
D) The normal body temperature of older adults is often lower than that of younger people

Answer 17

D) The normal body temperature of older adults is often lower than that of younger people

Question 18

A nurse recommends to an older patient’s family to place a seat alongside the bathtub to enable the older adult bather to rest while drying off. What is the best explanation for the nurse’s recommendation?
A) A drop in blood pressure may follow bathing.
B) Nonslip surfaces are essential for tubs and shower floors.
C) The elderly use the bathroom often and can benefit from the rest.
D) Most elderly have an age-related problem discriminating hazards.

Answer 18

A) A drop in blood pressure may follow bathing.

Question 19

Consideration with Furosemide for hypotension

Answer 19

Furosemide is used in the tx for hyperkalemia; we should be monitoring electrolytes including potassium as they may drop too low. Encourage the intake of foods high in potassium and limit salt intake.

Question 20

What should the nurse include in the incident report if the client didn’t receive their medication?

Answer 20

Date, time & vitals at time of the “incident”