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Funds I Lab > Fall Prevention, Positioning, Bathing/Bedmaking > Flashcards

Fall Prevention, Positioning, Bathing/Bedmaking Flashcards

1
Q

What is the leading cause of injury in elderly?

A

falls

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2
Q

Standard Fall Precautions

A

2 bed rails
anti-slip socks
call light w/in reach
water/kleenex/bed pan/personal belongings w/in reach
clear path
night light (when available)
bed in low position, wheels locked

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3
Q

What is the program used at BHS to assess fall risk?

A

SAFE

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4
Q

CPM Resource Center Fall Risk Assessment Tool

A

assessment of risk for falling in adults in the acute care inpatient setting

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5
Q

Score Interpretations for CPM (Fall Risk Assessment Tool)

A

score 4 or greater = at risk for falls, initiate Fall Risk guideline

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6
Q

Recommended Frequency of CPM (Fall Risk Assessment Tool)

A

complete on admission
re-evaluate every shift and after significant condition change

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7
Q

4 Point Value for CPM (Fall Risk Assessment Tool) (1)

A

history of fall (within 3 months)

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8
Q

3 Point Value for CPM (Fall Risk Assessment Tool) (3)

A

poly-pharmacy
CNS/Psychotic meds (ex: sedative/hypnotic, anti-depressant, anti-psychotic/neuroleptic, benzodiazapine)
Cardiovascular meds (ex: diuretic, anti-arrythmic, cardiac glycoside) because decreased heart rate = decreased blood pressure

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9
Q

2 Point Value for CPM (Fall Risk Assessment Tool) (7)

A

age greater than 65 years
altered elimination (ex: incontinence, urgency, frequency, nocturia, diarrhea)
cognitive deficit (impaired vision, hearing with affect on mobility)
dizziness/vertigo
depression (history of or current diagnosis)
mobility deficit/weakness (unsteady gait, requires assistance/supervision)

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10
Q

1 Point Value for CPM (Fall Assessment Tool (1)

A

male gender (riskier behaviors, more impulsive, stubborn)

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11
Q

High Risk Interventions for Falls

A

score greater than 4

gait belt
“safe” band on patient
signage on door
turn alarm on bed
alarm for seated patient
3 bed rails up
communication

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12
Q

How much weight can you lift, pull, or push without help?

A

35 lbs

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13
Q

Fowler’s

A

patient in a semi-upright position at an angle between 30 and 90 degress

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14
Q

Semi-Fowler’s

A

patient on back with a bed angle between 30 and 45 degrees

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15
Q

Orthopneic

A

“tripod”, upright, pillow on table, lean on pillow/table (allows lung expansion)

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16
Q

Dorsal Recumbent

A

lies on back with lower extremities moderately flexed and rotated outward

17
Q

Lateral

A

side

18
Q

Sims

A

lying on left side, left hip and lower extremity straight and right hip and knee bend

19
Q

Prone

A

on stomach

20
Q

Trendelenburg

A

head lower than feet, increase blood flow to brain

21
Q

Complete Bed Bath

A

head to toe

22
Q

Assist/Set Up (Self-Help)

A

can bathe, cannot gather supplies

23
Q

Partial Bath

A

face, hands, axillae, perineal area, feet and back

most important areas cleaned

24
Q

Assistive Devices/Safety for Patient Taking Bath

A

don’t leave alone
may slip
shower chair
call light in shower
shower bench

25
Q

Order when Giving a Complete Bed Bath

A

face
arms/axillae
chest
legs/feet
back
perineal

26
Q

What way do we wash?

A

from cleanest to dirtiest

27
Q

Supplies to Perform Oral Hygiene

A

gloves, basin, cup, brush/paste, water

28
Q

Special Consideration when Cleaning Dentures

A

line sink w/ towels because they are breakable

29
Q

What position should an unconscious patient be in, in order for you to be able to brush their teeth?

A

lateral; so everything runs out of the side of the mouth and less of a choking hazard

30
Q

What direction should you shave a patient?

A

direction of hair growth

31
Q

How do you hold the skin while shaving patient?

A

tight

32
Q

Anticoagulant Therapy Considerations

A

use an e razor

33
Q

What are some examples of anticoagulants?

A

blood thinner

Lovenox, Heparin, Coumadin

34
Q

Should you wear gloves while providing nail care?

A

yes

35
Q

Special Considerations for hearing aids

A

keep dry
very expensive
wipe off w/ damp cloth
open battery door when not in use

Funds I Lab (7 decks)

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