Immobility and Falls Flashcards
What are different causes of fall?
- MSK
- Arthritis of weight bearing joints
- Deformities of feet
- Drugs
- Anti-hypertensives, sedatives, alcohol, beta blockers, anticholinergics, opioids
- Cause falls because they
- Decrease – BP, HR, awareness
- Increase – urine output, sedation, hallucinations, dizziness
- Neurological
- Stroke, PD, dementia, delirium, ataxia
- Sensory
- Visual or hearing impairment
- CVS
- Postural hypotension, arrhythmia, heart failure, aortic stenosis
- Incontinence
- Rushing to toilet
What drugs increase risk of fall?
- Anti-hypertensives, sedatives, alcohol, beta blockers, anticholinergics, opioids
- Cause falls because they
- Decrease – BP, HR, awareness
- Increase – urine output, sedation, hallucinations, dizziness
What are important aspects of the history for falls?
- Detail of fall – what they were doing, who with, what happened, what happened next, how did get up from floor
- Collapse with no memory – syncope or cognition
- Clear history of trip – sensory
- Palpitations preceding fall – CVS
- On turning – postural instability
- Near misses – unsteady on standing
- Syncope on exertion – aortic stenosis
- Systematic enquiry
- Memory
- Urinary symptoms
- Changes in walking
What are important aspects of the examination for falls?
- Cranial nerves
- Pulse, HR, heart sounds
- Kyphosis
- Abdominal examination
- Look at 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 are different kinds of abnormal gait?
- Ataxic
- Arthralgic
- Hemiplegic
- Small steps
- High stepping
Describe the assessment of a fall presenting in A and E?
- ABCDE
- History
- Details of fall
- Important aspects – other falls, cognitive impairment, incontinence, syncope, seizure, drunk
- Talk to relative
- Examination and investigations
- Neurological, chest, heart, abdomen examination
- Look at legs and assess gait if they can
- Full set of obs
- ECG for all
- Bloods for all – check B12, folate, CK, TFTs
- Delirium using 4AT
- CT of head if fall with head injury
Describe the process of assessing an in hospital fall?
Assess both causes of fall and consequences of fall:
- Assess for serious injury – head injuries, seizure, C spine injury, flail chest, abdominal injuries, flail chest, pelvic injuries, limb fracture
- Consider cause of fall
What investigations should be done for a fall?
- CT of 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
- Indication – pain on moving joint
Describe the nurse actions post fall?
- Repeat risk assessment
- Datix
- Call family
- Try and 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
