geriatrics: immobility and falls Flashcards
what are different causes of fall?
MSK: arthritis of weight bearing joints, deformities of feet
neurological: stroke, PD, dementia, delirium, ataxia
CVS: postural hypotension, arrhythmia, heart failure, aortic stenosis
sensory: visual or hearing impairment
incontinence: rushing to toilet
drugs: anti-hypertensives, sedatives, alcohol, beta blockers, anticholinergics, opioids
how do drugs cause falls
decrease – BP, HR, awareness
increase – urine output, sedation, hallucinations, dizziness
what drugs increase risk of fall?
- anti-hypertensives
- anti-cholinergics
- alcohol
- beta blockers
- opioids
- sedatives
What are important aspects of the examination for falls?
- cranial nerves
- pulse, HR, heart sounds
- kyphosis
- abdominal examination
- feet, sensation, vibration sense and proprioception
- co-ordination, assess gait
gait has corresponding pathology that is likely, what pathology corresponds to:
- ataxic
- arthralgia
- hemiplegic
- small steps, shuffling
- high stepping
ataxic - cerebellar damage
arthralgia - arthritis
hemiplegic - stroke
smalls steps - vascular (PD)
high stepping - peripheral neuropathy
what is ataxic gait?
staggered gait with variability in step timing and distance between steps
what is arthralgia gait?
pain in joint
what is hemiplegic gait?
impaired natural swing of the hip and knee with leg circumduction
what investigations should be done for a fall?
CT head immediately if:
- low GCA, <13
- still confused after 2 hours (or not back to baseline cognitive state)
- focal neurology
- signs of skull fracture
- seizure
- vomiting
- anti-coagulation
X-ray if: pain on moving joint
describe the nurse actions post fall?
- repeat risk assessment
- datix
- call family
- prevent further fall
describe the management for a fall?
Fall prevention care plan
- vision and mobility aids can be reached
- bed rails
- regular obs
- tell people
- height of bed
- call bell
