Falls, Immoblity, and ADLS Flashcards
Best predictor of falling = _____
Previous fall
_____ → 70% of accidental deaths in patients > 75 yo
Falls
GOALS with a Fall evaluation
- Treat acute injuries, seek emergent care if needed
- Obtain a thorough H&P in order to determine likely etiologies
- Create evaluation & management plan
What are common acute injuries that
result from geriatric falls?
- Wrist fractures
- Ankle fractures
- Hip fractures
- Lacerations/contusions
- Head injuries
T/F An Isolated fall is not
always a sign of a
major problem
T
Recurrent falls =
> 2 falls in a 6-month period
Asked about falls or
mobility problems at least
_____
once per year
“72-hour rule”
Medicare’s 3-day
payment window for
outpatient services
that hospitals and
hospital wholly owned
or wholly operated
Part B entities furnish
to Medicare
beneficiaries
Open-ended questions when gathering a fall history
● Ingestions?
○ Medications, herbal supplements, substances, ETOH
● Witness to the fall?
○ Pt, witnesses &/or caregivers
■ Inquire about details about this & previous falls
● Who is available to assist the patient?
● Was the pt able to get backup without help after falling?
Recommendations for exercise in elderly patients
- ↓ falls by 58% compared to
stretching or multimodal exercise - ↑ walking speed & physical
function - ↑ balance confidence
Decubitus Ulcers
● An area of unrelieved pressure over
a defined area bony prominence ↓ Ischemia, cell death, tissue necrosis
Etiology of pressure ulcers
- Impaired mobility
- Inability to perceive pain
- Skin atrophy
- Incontinence
- Malnutrition
Pathophysiology of pressure ulcers
- Constant pressure sufficient
to impair local blood flow to
soft tissue for an extended
period - Maceration predisposes
to injury - Compression of the tissues
against an external object
Review the staging of pressure ulcers
Slides 36-37
Diagnostics for a pressure ulcer
Labs
● CBC c diff
● ESR
● Imaging
○ Plain films, bone scans, MRI
Tissue biopsy
● Non-healing wounds despite
adequate care
● Bacterial infection is suspected
● Bone biopsy
○ Gold standard = Dx osteomyelitis
Dx osteomyelitis
Bone biopsy
○ Gold standard = Dx osteomyelitis
● + Elevated ESR & WBC
● + Stage 4 ulcer with
exposed bone
What CBC findings would raise suspiscion for osteomyelitis?
An ESR > 120 mm/hr +
WBC > 15,000/μL
=
Suspicious for osteomyelitis
Management of pressure ulcers
● Superficial (70-90%)
■ Heal by secondary intention
● Stage I & II pressure ulcers
■ Wound care is usually conservative
● For stage III & IV pressure ulcers
■ Referral for surgical intervention (Wound Clinic)
Conservative Wound Care
○ Support devices/cushions
○ If able, pts should shift their
weight Q 10 minutes
○ Repositioning Q 2 hrs, even in
the presence of a specialty
surface or bed
● Debridement of necrotic tissue
Dressings for Pressure Ulcers
Skin Sealant Film - Stage 1 ulcers
Hydrocolloid - Stage 2 ulcers
Hydrogel
Moist Saline Gauze - Stage 2-4
Iodine-Solution Wet Gauz
Alginate - Stage 3-4
Foam - Exudating stage 2, stage 3-4
T/F ACP recommends using alternating-air mattresses or alternating-
air (also called dynamic) overlays in patients who are at an increased risk of
developing pressure ulcers
F
_____ heat dressings ↑ wound
healing
Radiant
Use _____ supplementation to
↓ wound size
protein
Use _____
dressings to ↓wound size
hydrocolloid or foam
Skin Sealant Film dressing
● Stage 1 ulcers
● Acts as a protective coating on the skin
● Apply 1-4x/day
● E.g. Tegaderm
Hydrocolloid dressing
● Stage 2 ulcers
● Maintains a moist environment
○ Naturally promotes autolytic debridement
● Change q 3-7 days
● E.g. Duoderm
Hydrogel dressing
● Ulcers with little to no exudate
● Maintains a moist environment
○ Naturally promotes autolytic debridement
● Apply 1-4x/day
● E.g. Tegagel
Moist Saline Gauze dressing
● Stage 2-4 Ulcers
● Maintains a moist environment
○ Antibacterial activity
● Apply 3x/day
● E.g. Kerlix
Iodine-Solution Wet Gauze
● Broad-spectrum antimicrobial activity
● Apply 1-4x/day
Alginate dressing
● Exudating Stage 2 ulcers
● Stage 3-4 ulcers, deep
● Serves as an absorbent by
maintaining a moist environment
● Apply 3x/day
● E.g. Carbou Calcium Alginate Wound
Dressing
Foam dressing
● Exudating Stage 2 ulcers
● Stage 3-4 ulcers, deep or moderately
draining
● Serves as water repellent for water,
bacteria, contaminants, maintaining a
moist environment, insulates, & reduces
odor
● Apply 1x/day
● E.g. CuraFoam
