Week 5: Impaired Mobility: Falls Flashcards
List some intrinsic factors (individual) that contribute to falls?
- impaired vision
- cardiovascular conditions such as postural hypotension or syncope (decreased blood flow to the brain)
- conditions affecting mobility such as arthritis, muscle weakness, and foot problems
- conditions affecting the balance
- alterations in bladder function such as frequency or incontinence
- cognitive impairment
- adverse medication reactions (i.e benzodiazepines and other hypnotics can impair an older person’s CNS and affect gait)
- history of falls
- fear of falling
List some extrinsic factors (environmental) that contribute to falls in older adults?
- unfamiliar environment
- clutter (wheelchair, walker)
- poor lighting
- surfaces (slippery, rugs, cords, footstools)
- stairs
- impaired footwear
- restraints
Define mobility:
The ability to move easily and independently.
Optimal mobility = musculoskeletal and nervous systems of the body intact and functioning.
List pathological conditions that affect mobility:
Good to know
- Postural abnormalities: assessed through body alignment and ROM exercises. Referred to PT/OT to enhance nursing interventions.
- Impaired muscle development: muscle dystrophies may be due to injury or disease. Results in progressive, symmetrical weakness, and wasting of skeletal muscle groups, with increasing disability and deformity.
- Damage to CNS: caused by trauma to the head, ischemia from a stroke, or cerebrovascular accident, hemorrhage, tumor, or bacterial infection such as meningitis can damage the cerebellum or the motor strip in the cerebral cortex. Damage to the cerebral cortex = problems with balance, and motor impairment and results in hemiplegia (muscle paralysis) or hemiparesis (muscle weakness). Injury to the spinal cord = spinal motor fibers damaged which results in quadriplegia (four-limb paralysis) or paraplegia (two-limb paralysis).
- Direct trauma to musculoskeletal system: bruises, contusions, sprains, and fractures.
What are the consequences of falling?
- fractures (most common: vertebrae, hip, forearm, leg, ankle, pelvis, upper arms, and hand)
- pre-fall mobility not always restored
- lacerations, bruising
- impaired mobility ->falls -> impaired mobility
- hospitalization
- admission to LTC
What are the systemic effects of immobility in terms of metabolic changes?
good to know
- alter endocrine metabolism (carbs, fats, proteins; causing fluid, electrolyte, and calcium imbalances), calcium resorption (loss of calcium from bones but kidneys unable to excrete from body = hypercalcemia), and functioning of the GI system (slowed peristalsis = constipation; fecal impaction).
- negative nitrogen balance (since the body is constantly synthesizing proteins but intake of proteins is very low due to immobility) = weight loss, decreased muscle mass, and weakness as a result of tissue catabolism (tissue breakdown)
Define disease atrophy:
good to know
the tendency of cells and tissue to reduce in size and function in response to prolonged inactivity resulting from bd rest, trauma, casting of a body part, or local nerve damage.
The function of the endocrine system:
good to know
The endocrine system (hormone-secreting glands) maintains and regulates vital functions such as 1) response to stress and injury; 2) growth and development; 3) reproduction; 4) maintenance of the internal environment; and 5) energy production, use, and storage.
Maintains homeostasis!!
What are the systemic effects of immobility in terms of respiratory changes?
good to know
- atelectasis (collapse of alveoli); hypostatic pneumonia (inflammation of lung from stasis or pooling of secretions) —> decrease oxygenation, prolong recovery and add to pt’s discomfort
What are the systemic effects of immobility in terms of cardiovascular changes?
good to know
- orthostatic hypotension (drop in BP when pt goes from lying to sitting or standing) - cardiac workload increases and efficiency decreases with immobilizatio
- thrombus (accumulation of platelets, fibrin, clotting factors, and cellular elements of the blood attached to the interior of a vein or artery)
- embolus (dislodged venous thrombus) can travel to lungs = impairs circulation/oxygenations (life-threatening)
What are the systemic effects of immobility in terms of musculoskeletal changes?
good to know
- lean muscle mass loss = increased fatigue, decreased endurance, muscle mass and strength, and joint instability, putting the pt at higher risk for falls.
- impaired calcium metabolism (risk of osteoporosis = increased risk of fractures = risk of falls)
- joint abnormalities (caused by disuse, atrophy, and shortening of muscle fibers). = loss of ROM
- footdrop (permanently fixed in plantar flexion, maybe be due to nerve damage, peripheral neuropathy, or CVAs (stroke)) = impaired balance, gait, etc = increased risk of falls
- sarcopenia (loss of skeletal muscle mass)
- have to rely more on proprioception (sense, independent of vision, of movements, and position of the body in space)
What are the systemic effects of immobility in terms of urinary elimination changes?
good to know
- urinary stasis (renal pelvis filling with urine before it enters ureters due to loss of gravity ) = increased UTIs and renal calculi (stones)
- risk of hypercalcemia
- decreased fluid intake = dehydration = UTi’s or renal calculi
What are the systemic effects of immobility in terms of integumentary changes?
good to know
- pressure injury (local damage to skin/underlying tissue) as a result of prolonged ischemia (decreased blood supply to tissues) - intact skin or pressure ulcer.
What are the systemic effects of immobility in terms of psychological changes?
good to know
- decreased social interaction, social isolation, sensory deprivation, loss of independence, and role changes.
- Depression
How can falls be prevented?
- exercise
- medication review
- vision and hearing assessment
- safe environment
What are 3 important things to assess when doing a fall assessment for a pt?
- risk for falls assessment
- environmental assessment
- assessment after fall has occurred (post-fall assessments are essential to the prevention of future falls and the implementation of risk-reduction programs)
