DISC 3

Chapter_011.pptx

Chapter 11

Safety

The leading cause of fatal and noninjuries in older adults

Results in higher rates of morbidity and mortality among those older than 75 because of the higher incidence of frailty and a limited physiologic reserve

Leading cause of hip fractures

Education is the cornerstone of fall prevention and management.

Falls

Older individuals may not perceive a slip that results in a fall to the floor to be an actual “fall”; rather it may be termed a slip, trip, or accident, but not a fall.

Anything that causes a person to unintentionally move from one level plane to another

Definition of Falling

Is a concept that holds negative connotations because it is associated with a decline, drop, or descent to a lower level

Involves several related variables and most likely is determined according to an individual perception of how serious the fall is in terms of daily living

The health care professional may equate a fall with a decline in patient health or function or a worsening of a patient’s condition

Meaning of Falling to Older Adults

Vision—depth perception, problems with glare

Hearing—decrease in directional hearing, hearing loss

Cardiovascular—orthostatic hypotension

Musculoskeletal—osteoarthritis, muscle weakness, reduction in steppage height, which may increase risk for tripping

Neurologic—slowed reaction time

Normal Age-Related Changes That Contribute to Falling

Is not determined solely on the basis of number and kind of diseases, but on how risk factors influence areas of mobility, transferring, and negotiating within the environment

Best determined by observation of mobility

Risk categorized according to intrinsic (illness or disease-related) or extrinsic (environmental) risk

Research has shown that the individual with frailty and physical functional limitations is at greatest risk for falling.

Fall Risk

Combined effect of normal age-related changes and concurrent disease

Relates to gait, balance, stability, and cognition

Intrinsic Fall Risk

Environmental hazards, both indoors and outdoors

Steps

Floor surfaces

Edges and curbs

Lighting

Grab rails

Extrinsic Fall Risk

Hip fractures, head trauma, and internal bleeding affect a small percentage of older individuals who fall.

High mortality rate associated with hip fractures

Physical restraints can increase risk and should never be used.

Injury by attempting to remove the restraints: strangulation and asphyxiation

Elevation of both side rails can cause falls from attempts to climb over side rails.

Risk for Serious Injury

Behavior modification requires older patients to recognize behaviors that are contributing to problem and then to make conscious attempts, whenever a behavior is performed, to change or alter it.

Teaching patients with osteoporosis the ways to incorporate calcium-rich foods in their diet on a daily basis, and about the risk factors for the development of osteoporosis

Identify and treat causes of delirium

Reducing the Risk for Serious Injury

Isolated falling: one-time event that was most likely purely accidental

Cluster falls: observed among individuals with specific diseases who decompensate

Premonitory falls: produced by specific medical illnesses, e.g., new onset seizures

Prodromal falling: onset of frequent falling heralding an acute medical problem

Intentional falls: fall on purpose, possibly with a desire to do harm

Fall Classification

Physical injury ranges from trivial trauma—skin tears and sprains to serious injury-hip fractures, internal bleeding, or subdural hematomas.

Osteoporosis—serious injury

Psychological trauma like post fall trauma is influenced by to personality changes, depression, anxiety, and stress-related syndromes.

Fear of falling interferes with activity and fosters dependence

Fall Consequences

The nurse is caring for an older adult patient who was admitted for pneumonia. The nurse institutes fall precautions based on which of the following assessments? (Select all that apply.)

The patient has rheumatoid arthritis.

The patient fell at home last month.

The patient is hard of hearing.

The patient uses the call light frequently.

The patient is taking antihypertensives twice a day.

Quick Quiz!

ANS: B, C, D

Answer to Quick Quiz

History—the acronym SPLATT can help evaluate:

Symptoms at the time of the fall

Previous fall

Location of the fall

Activity at the time of the fall

Time of the fall

Trauma post fall

Physical exam—focused examination based on the patient’s presenting complaints, also sensory, cardiovascular, musculoskeletal, and neurologic systems

Evaluation After a Fall

Sternal nudge

Tinetti assessment tool for balance

The timed up and go (TUG)

Special Testing for Gait and Balance

Goals: identify the underlying cause, reduce the incidence of recurrent falls, and prevent serious injury

Fall diary

Bed or chair alarms

Video surveillance cameras

Safety belts in wheelchairs and the “lap buddy”

Injury epidemiology

Nursing Management of Falls

Examples of burn Injuries:

Burns, cigarette smoking, fireplace hazards, kitchen hazards, space heaters

Examples of nonburn Injuries:

Carbon monoxide poisoning, chemical injuries, cooling fans, food-borne illnesses

Safety and the Home Environment

Core body temperature of less than 95°F

Risk factors

Clinical manifestations—fatigue, apathy, confusion, lethargy, shivering, numbness, slurred speech, impaired coordination, and possible coma

Management—sponge baths with cool water, fans to circulate cool air, decreasing the room temperature, placing ice packs on the groin and axilla, and cooling blanket

Hypothermia

Core body temperature greater than 105°F

Risk factors

Clinical manifestations—anhidrosis, confusion to coma; hallucinations, combativeness, bizarre behaviors, and syncope

Management—passive external rewarming with blankets for mild; active core rewarming with IV fluids for moderate to severe

Hyperthermia

60% of those who suffered medical problems or died during Hurricane Katrina were frail older adults (AARP, 2013)

We Can Do Better; Lessons Learned for Protecting Older People in Disasters and Recommendations for Best Practices in the Management of Elderly Disaster Victims

Disasters

Storage of medications at home can become a safety and drug-effectiveness issue

Most drugs degrade when left in direct sunlight, with or without excessive heat

Appropriately dispose of all outdated prescriptions when new ones are written

Proper disposal of used wound dressings and needles or syringes

Storage of Medications and Health Care Supplies in the Home

Fear of crime reduces subjective well-being.

Neighborhood strategies to protect older adults living alone

Daily telephone calls to specific persons on a call list

Raising and lowering window shades or curtains at specific times of the day and evening, which will be monitored by a specific person

Mail carrier alerts when mail is not picked up daily from mailboxes of enrolled older persons

Living Alone

Maintaining independence includes the ability to travel to shopping centers and health care providers’ offices, to visit family and friends, and to participate in recreational activities.

A decline in an older adult’s ability to drive safely may result in the loss of driving privileges.

Driving evaluations are essential for older adults with suspected dementia.

Traffic sign identification test

Automobile Safety

Vertigo

Seizure disorders

Stroke sequelae

Macular degeneration or retinal hemorrhage

Unstable cardiac arrhythmias

Disorders That Adversely Affect Driving Ability

A scale to rate the potential for abuse or neglect helps nursing personnel become aware of the incidence and prevalence.

Older persons with physical or mental frailties are more vulnerable to abuse and neglect than are independent older adults.

Need for assistance with basic ADLs may overstress the caregivers.

Stress and strain of caregiving tasks is often the cause for initial abuse or neglect.

Abuse and Neglect

Neglect

Psychological or emotional abuse

Financial abuse or exploitation

Physical abuse

Sexual abuse

Abandonment

In 90% of abuse and neglect cases, a family member is identified as the perpetrator.

Six Areas of Abuse or Neglect

Firearms are associated with high rates of suicide among older men and women.

Age group with the highest rate of successful suicide attempts with firearms is persons age 80 or older.

Dangers of firearms include the potential for accidental injury during weapon cleaning and handling.

Risk of a criminal entering a home and taking the weapon away from an older person with fatal consequences

Firearms