FALLS ASSESSMENT Flashcards
FALLS HISTORY
what do you want to know in presenting complaint?
- when did you fall?
- what were you doing at the time?
- where did you fall?
- what happened before/during and after the fall?
- why do you think you fell?
- how many times have you fallen over the last 6 months?
FALLS HISTORY
what do you want to know about before the fall?
- was there any warning
- any dizziness/chest pain or palpitations
FALLS HISTORY
what do you want to know about during the fall?
- any incontinence or tongue biting
- any loss of consciousness
- were they pale or flushed
- did they injure themselves
- what part of the body hit the floor first
FALLS HISTORY
what do you want to know about after the fall?
- what happened after the fall
- were they able to get themselves up off the floor
- were they able to resume normal activities after the fall
- was there any confusion after the event
- was there any weakness or speech difficulty
FALLS HISTORY
what symptoms do you want to screen for in systemic enquiry?
- fatigue
- weight loss
CVD
- chest pain
- palpitations
RESPIRATORY
- shortness of breath
- cough
NEURO
- loss of consciousness
- seizures
- motor or sensory disturbance
GU
- incontinence
- urgency
- dysuria
GI
- abdominal pain
- diarrhoea
- constipation
MSK
- joint pain
- muscle weakness
FALLS HISTORY
what cardiovascular symptoms should you screen for?
- chest pain
- palpitations
FALLS HISTORY
what are the respiratory symptoms that should be screened for?
- shortness of breath
- cough
FALLS HISTORY
what neurological symptoms should you screen for?
- loss of consciousness
- seizures
- motor or sensory disturbance
FALLS HISTORY
what GU symptoms should you screen for?
- incontinence
- urgency
- dysuria
FALLS HISTORY
what GI symptoms should you screen for?
- abdominal pain
- diarrhoea
- constipation
FALLS HISTORY
what MSK symptoms should you screen for?
- joint pain
- muscle weakness
FALLS HISTORY
what medical conditions should you ask about?
GENERAL
- vision/hearing problems
- diabetes
- anaemia
CARDIO
- heart disease
- arrhythmias
RESPIRATORY
- COPD
NEURO
- parkinsons
- peripheral neuropathy
- stroke
- dementia
GU
- recurrent urinary infection
- incontinence
GI
- diverticulitis
- chronic diarrhoea
- alcoholic liver disease
MSK
- arthritis
- chronic pain
- fractures
FALLS HISTORY
what should you ask about in social history?
- alcohol intake
- support at home
- mobility (require any aids)
FALLS HISTORY
what medications increase the risk of falls?
- beta-blockers (bradycardia)
- diabetic meds (hypoglycaemia)
- benzodiazepines (sedation)
- antibiotics (intercurrent infection)
- diuretics (hypotension)
- antihypertensives (hypotension)
- antidepressants
FALLS EXAM
what are the steps for a falls exam?
- examine c-spine
- examine spine
- examine long bones
- look for head injury
- focus on any symptoms
FALLS EXAM
how would you examine c-spine?
- any pain?
- palpate down spine
- chin to chest
- look up
- ear to shoulder on either side
- turn to look at side to side
FALLS EXAM
how would you examine the rest of the spine?
- palpate the length of the spine
- thoracic rotation
- bend forwards
- bend backwards
- slide hands down sides
FALLS EXAM
how would you examine the long bones?
- palpate the hips
- palpate the femurs
- palpate the lower legs
- palpate the arms
FALLS EXAM
how would you look for head injury?
- look all over the head for signs of bruising or bleeding
FALLS EXAM
what cardiovascular things could you examine?
- pulse
- blood pressure
- listen for carotid bruits
- listen for any heart murmurs
FALLS EXAM
what respiratory things could you check?
- inspection = increased work of breathing
- percussion
- auscultation of lungs
FALLS EXAM
what neurological things could you check?
- cranial nerve examination
- power
- tone
- reflexes
- sensation
- co-ordination
FALLS EXAM
what GI things could you examine?
- palpate abdomen gently and deeply
- palpate for organomegaly
FALLS EXAM
what ENT things could you examine?
- evidence of ear wax
- are the tympanic membranes intact
FALLS
what further investigations are required?
BEDSIDE
- observations (BP, HR, sats, temp, resp rate)
- lying standing blood pressure
- urine dipstick
- ECG
- blood glucose
BLOODS
- FBC, U&Es, LFTs, bone profile
IMAGING
- CT head
- x-ray
- echo
SPECIALIST TESTS
- dix-hallpike
- cardiac monitoring (24-48hr ECG)
FALLS
what are some of the most common causes of falls?
CARDIO
- arrhythmias
- orthostatic hypotension
- bradycardia
- valvular heart disease
NEURO
- stroke
- peripheral neuropathy
GU
- incontinence
- UTI
ENDOCRINE
- hypoglycaemia
MSK
- arthritis
- disuse atrophy
ENT
- BPPV
- ear wax
FALLS
what are the possible interventions for gait problems?
- physiotherapy
FALLS
what are the possible interventions for vision problems?
- eye tests
- wear glasses
FALLS
what are the possible interventions for hearing problems?
- remove earwax
- hearing assessment
FALLS
what are the possible interventions for polypharmacy?
- remove unnecessary meds
FALLS
what are the possible interventions for alcohol intake?
- alcohol cessation advice
- alcohol service referral
FALLS
what are the possible interventions for cognitive impairment?
- referral to psychiatric team
FALLS
what are the possible interventions for postural hypotension?
- review medications
- improve hydration
FALLS
what are the possible interventions for incontinence?
- treat or rule out infections
- continence assessment
FALLS
what are the possible interventions for environmental hazards?
- turn on lights
- take up rugs
