Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Geriatrics > Falls and Immobility > Flashcards

Falls and Immobility Flashcards

1
Q

One major risk factor for falls includes _____. The risk for developing a mobility disorder increases with age.

A

problems with mobility

  • Mobility disorders range from subclinical to obvious, and within this range, fall risk is elevated.
  • b/c the risk for mobility disorders and falls is increased in older persons, clinicians should be particularly aware of how to prevent and treat both
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Over 50% of people over the age of what fall?

A

80 y/o

  • 60% have hx of falling will have a subsequent fall
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

50% of falls result in some type of injury, the most serious of which includes ?

A

hip fractures, head trauma, and cervical spine fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Falls in older adults typically are not d/t a single cause, but occur when there is _____

This makes an older person unable to compensate as well as a younger person, and thus more likely to fall.

A

additional stress - acute illness, new meds, or an environmental hazard,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Fall RF varies – Depending on Source:

name some RF for falls - not including strongest risk factors

A

● Past history of a fall
● Lower-extremity weakness
● Age
● Cognitive impairment
● Balance problems
● Psychotropic drug use
● Arthritis
● History of stroke
● Orthostatic hypotension
● Dizziness
● Anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Multiple studies have shown that the strongest risk factors for falling include: 
(4)

A
  1. previous falls;
  2. decreased muscle strength;
  3. gait and balance impairment
  4. specific medication use.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

examples of intrinstic RF for falls

A
  • Advanced age
  • Previous falls
  • Muscle weakness
  • Gait & balance problems
  • Poor vision
  • Postural hypotension
  • Chronic conditions including arthritis, stroke, incontinence, DM, Parkinson’s, dementia
  • Fear of falling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

extrinsic RF for falls

A
  • Lack of stair handrails
  • Poor stair design
  • Lack of bathroom grab bars
  • Dim lighting or glare
  • Obstacles & tripping hazards
  • Slippery or uneven surfaces
  • Psychoactive medications; improper Rx
  • Improper use of assistive
  • device
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mobility disorders refer to ____

A

any deviation from normal walking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what components are necessary to walk normally

A

control of balance and posture both at rest and with movement

  • normal gait requires complex integration of adequate strength, sensation, and coordination.
  • For a normal healthy adult, walking is almost automatic.
  • control of gait and posture is both complex and multifactorial
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

complications of falls

A
  1. injuries
    - soft tissue trauma: hematomas, lacerations, infections
    - fractures
    - closed head injuries (CHI): concussion, SDH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Lacerations and skin tears can lead to severe blood loss especially in those on what meds?

A

antiplatelet therapy or anticoagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

with soft tissue trauma, what must you consider about the patient?

A

if patient will be able to care for wounds at home

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what fractures are MC from falls?

A

Hip, wrist, humerus, and ribs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

1/3 of pts >65 who suffer a hip fracture will die within ?

A

one year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what type of fracture is among the most common and costly of fall-related injuries in older adults.

A

hip fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

> 90% of all hip fractures occur as a result of a fall, often from what type of fall?

A

falling sideways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what type of closed head injury should have low threshold to admit for serial neuro exams

A

concussion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

SDH is a big risk for those on what type of medication

A

antiplatelet/anticoag

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

approach to pt with potential SDH after a fall?

A
  • May have delayed onset of bleeding
  • Hematoma may be chronic
  • Should be admitted with Neuro coverage
  • traumatic subdural hematomas may not return to pre-injury level of function
21
Q

for closed head injuries, never forget to look for other injuries especially ____

A

c-spine

22
Q

The single most important question to ask an elderly patient after they have suffered a fall.

A

Why did you fall?

23
Q

Close to half of all falls can be classified as ____

A

accidental

True trip or slip
Usually precipitated by an environmental hazard

24
Q

Common Environmental Hazards

A
  • Old, unstable, and low-lying furniture
  • Beds and toilets of inappropriate height
  • Unavailability of grab bars
  • Uneven or poorly demarcated stairs and inadequate railing
  • Throw rugs, frayed carpets, cords, wires
  • Slippery floors and bathtubs
  • Inadequate lighting, glare
  • Cracked and uneven sidewalks
  • Pets
    

25
Q

what medications specifically should you be aware of for potential cause of falls

A

antihypertensives
psychotropic agents

26
Q

Qs to ask for Patient’s thoughts on the cause of the fall

A
  • Was patient aware of impending fall?
  • Was it totally unexpected?
  • Can the patient recall the exact events of the fall w/o family help
27
Q

circumstances surrounding the fall

A
  • Location and time of day
  • Activity
  • Situation: alone or not alone at the time of the fall
  • Witnesses
  • Relationship to changes in posture, turning of head, cough, urination, a meal, medication intake
28
Q

associated sx of falls

A
  • Lightheadedness, dizziness, vertigo
  • Cardiac? Palpitations, CP, SOB
  • Sudden focal neurological sx (weakness, sensory disturbance, dysarthria, ataxia, confusion, aphasia)
  • Aura
  • **Incontinence of urine/stool **
29
Q

if the patient lost consciousness after the falls, what Qs should be asked?

A
  • What is remembered immediately after the fall?
  • Could the patient get up, and if so, how long did it take? - “Help I’ve fallen and can’t get up”!
    * Can loss of consciousness be verified by a witness?
30
Q

PE for falls

A
  • VS - orthostasis (lying, sitting, standing) evaluated for any injuries prior to evaluation
  • Skin - Turgor (over the chest; other areas unreliable), Pallor, Trauma
  • Eyes - Visual acuity, Pupils, eye movement
  • CV - Arrhythmias, Carotid bruits, Signs of aortic stenosis
  • Extremities - Degenerative joint disease, ROM, Deformities, Fractures, Podiatric problems (calluses; bunions; ulcerations; poorly fitted, inappropriate, or worn-out shoes)
  • Neurological - Mental status, Focal signs, Muscles (weakness, rigidity, spasticity), Peripheral innervation (especially position sense), Cerebellar (especially heel-to-shin testing), Resting tremor, bradykinesia, other involuntary movements, Observation of gait and balance
  • Eval assistive devices for hazards - missing tips on canes and walkers, impaired locking devices, or broken footrests on wheelchairs
  • feet & footwear
31
Q

what is The Functional Reach test

A
  • requires using a yardstick mounted on a wall at shoulder height.
  • Pt asked to stand close to the wall at a comfortable stance with an outstretched arms-with the shoulders perpendicular to yardstick.
  • Pt instructed to extend arm forward as far as possible without taking a step or losing balance;
  • the functional reach is measured along the yardstick in inches
  • 6-10 inches - moderate fall risk
  • <6 inches - severe fall risk
32
Q

what type of footwear can predispose ppl to trip and fall

A
  • heels, floppy slippers, shoes with slick soles
  • Ill-fitting footwear that is too big, without sufficient grip or too much friction, and/or without proper fixation (untied or loosely tied shoes) will also contribute to increasing someone’s fall risk.
33
Q

what type of shoe is less likely to trips and falls?

A
  • Upper shoe should be soft and flexible with smooth lining.
  • The toe box should be deep enough to allow for toe wiggle room.
  • The sole should be strong and flexible for a good grip.
  • The heel should provide a broad base for stability and be no higher than 4 cm.
  • Finally, the fastening should provide a stable fit with some flexibility to allow for unusually shaped feet or swelling.
34
Q

potentially modifiable risk factors of falls

A
  • muscle strength, gait and balance, and medication
  • visual impairment, depression, pain, and dizziness.
35
Q

General info for Fall Prevention

A
  • Provide PT and education: Gait and balance retraining, Muscle strengthening, Aids to ambulation, Properly fitted shoes, Adaptive behaviors, Rising slowing, using rails, etc
  • Alter the environment: Safe and proper-size furniture, Elimination of obstacles (loose rugs, etc.), Proper lighting, Rails (stairs, bathroom)
  • Tx Fx Pain, but do not ignore the side effects of treatment
36
Q

what are the best ways to prevent falls?

A

medication reduction, physical therapy, and home safety modifications

37
Q

how to dx fall and immobility?

A

there is no standard diagnostic evaluation

  • Labs: CBC, BMP, UA, or chest radiograph might be appropriate depending on the clinical scenario, especially if significant cognitive impairment or dementia.
  • hemoglobin, chemistry panel, TSH, vit B12 (deficiency linked to proprioceptive problems)
  • possibly underlying UTI or pneumonia caused the fall
  • imaging: CT/MRI - new or unexplained neurologic findings; r/o stroke, mass, nml pressure hydrocephalus, other structural abnormality.
38
Q

State in which an individual has a limitation in independent, purposeful physical movement of the body or of one or more lower extremities

A

immobility

39
Q

Goal of all members of the health-care team working with older adults?

A

optimizing mobility

40
Q

small improvements in mobility can:

A
  1. decrease the incidence and severity of complications,
  2. improve the patient’s well-being, and
  3. decrease the cost and burden of caregiving
41
Q

Causes of Immobility

A

MSK - Arthritis, Osteoporosis, Fractures (esp hip and femur), Podiatric problems
Neurologic - Stroke, Parkinson disease, Neuropathies, Normal-pressure hydrocephalus, Dementias
CV - CHF, CAD (frequent angina), PVD (frequent claudication)
Pulm - COPD (severe)
Sensory factors - Impairment of vision, Decreased peripheral sensation
Environmental - Forced immobility (in hospitals and nursing homes), Inadequate aids for mobility
Other - Deconditioning (after prolonged bed rest from acute illness), Malnutrition, Severe systemic illness (eg, widespread malignancy), Depression, Drug SE (eg,antipsychotic-induced rigidity), Fear of falling

42
Q
  • Acute inflammatory response limited to epidermis
  • Presents as irregular area of erythema, induration, edema;- may be firm or boggy
  • Pressure areas do not blanch when pressed
  • May be different with different skin pigments
  • Redness with pressure persists after 30 min; in dark skin the color may be red, blue, or a purple hue
  • Often over a bony prominence
  • Skin is unbroken

what stage is this pressure ulcer?

A

Stage I

43
Q
  • Extension of acute inflammatory response through dermis to the junction of subcutaneous fat
  • Appears as a blister, abrasion, or shallow ulcer with more distinct edges
  • Early fibrosis and pigment changes occur
  • May look like an abrasion or a blister

what stage is this pressure ulcer

A

Stage II

44
Q
  • Full-thickness skin ulcer extending through subcutaneous fat. This may extend down to but not through the underlying fascia
  • The skin may have undermining
  • Base of ulcer infected, often with necrotic, foul-smelling tissue
  • This presents like a crater and may have undermining of the adjacent tissue

what stage is this pressure ulcer?

A

stage III

45
Q
  • Extension of ulcer through deep fascia, so that bone is visible at base of ulcer
  • Osteomyelitis and septic arthritis can be present
  • Undermining is even more common and there may be sinus tracts

what stage is this pressure ulcer?

A

stage IV

46
Q

preventing pressure ulcers

A
  • Identify patients at risk
  • Decrease pressure, friction, and skin folding
  • Keep skin clean and dry
  • Avoid excessive bed rest: optimize and encourage function
  • Avoid over-sedation
  • Provide adequate nutrition and hydration
47
Q

tx stage I & II presssure ulcers

A
  • Clean wounds with warm,normal saline or water
  • Avoid pressure and moisture
  • Cover open wounds with dressing
  • Prevent further injury and infection- abx if needed (Stage II)
  • Manage associated pain
48
Q

tx for stage III

A
  • Debride necrotic tissue: autolytic, chemical, mechanical, sharp, or surgical options
  • Cleanse and dress wound
  • Cx wound
  • Abx
  • Manage associated pain
49
Q

tx for Stage IV

A
  • tissue bx for cx
  • Abx (likely IV)
  • Cleanse and dress wound  
  • Have surgical consultation to consider surgical repair
  • Manage associated pain

Geriatrics (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions