nursingaging week 8

lilyalonso

Chapter_015.ppt

Home >Nursing homework help >nursingaging week 8

Falls and Fall Risk Reduction

Chapter 15

Leading cause of morbidity and mortality for people older than 65 years of age
Falls and subsequent injuries result in physical and psychosocial consequences
A nursing-sensitive quality indicator
Falls in nursing homes are termed sentinel events and must be reported to the Centers for Medicare & Medicaid Services

Falls and Fall Risk Reduction

Hip fracture
More than 95% of hip fractures among older adults are caused by falls
Associated with considerable morbidity and mortality
Traumatic brain injury (TBI)
Falls are the leading cause of TBI for older adults
Fallophobia
Loss of confidence that leads to reduced physical activity, increased dependency, and social withdrawal
An important predictor of general functional decline and a risk factor for future falls

Consequences of Falls

Etiology is multifactorial
May indicate neurologic, sensory, cardiac, cognitive, medication, or musculoskeletal problems or impending illness
Episodes of acute illness, infection, or exacerbations of chronic illness are times of high fall risk
Majority occur from a combination of intrinsic and extrinsic factors that combine at a certain point in time

Fall Risk Factors

Intrinsic factors
Reduced vision and hearing
Unsteady gait
Cognitive impairment
Acute and chronic illnesses
Effects of medication
Extrinsic factors
Lack of support equipment in the bathtub and at the toilet
Height of the bed
Floor conditions
Poor lighting
Inappropriate footwear
Improper or inadequate assistive devices

Factors Contributing to Falls

Institutional settings
Limited staffing
Lack of toileting programs
Use of restraints and side rails
Inadequate staff communication and training
Incomplete patient assessments
Environmental issues
Incomplete care planning
Inadequate organizational culture of safety

Factors Contributing to Falls (Cont.)

Especially observed in those older than
85 years of age
Are indicative of an underlying pathological condition such as arthritis, diabetes, dementia, Parkinson’s disease, stroke, alcoholism, and vitamin D deficiency
Some underlying pathological conditions cause neurologic damage and result in gait problems

Gait Disturbances

Deformities and ill-fitting footwear can cause gait problems
Contributing factors include neglect of corns, bunions, overgrown toenails, loss of fat cushioning, poor arch support, excess weight-bearing activities, obesity, or uneven distribution of weight on the feet
Nurse must assess the feet for clues of functional ability and identify problems

Foot Deformities

Declines in depth perception, proprioception, and normotensive response to postural changes contribute to falls
Postural changes in the pulse rate and blood pressure occur with postural hypotension
Postprandial hypotension occurs after the consumption of a carbohydrate-filled meal and is more common in those with diabetes or Parkinson’s disease

Postural and Postprandial Hypotension

Those with dementia and delirium are at an increased risk for falls and major injuries if falls occur
Screening tools can be used to identify cognitive impairments

Cognitive Impairment

A significant relationship exists between vision and hearing and falls
Risk factors include poor visual acuity, reduced contrast sensitivity, decreased visual field, cataracts, and use of nonmiotic glaucoma medications
Formal vision assessment is an important intervention to identify remediable visual problems

Vision and Hearing

A number of medications are implicated in increasing fall risk
Review all medications, including over-the-counter and herbal medications and limited to those that are essential
Provide patient teaching related to fall risk, appropriate dosing, and drug–drug and drug–alcohol interactions

Medications

Fall risk assessment is an integral part of primary health care for the older person
Adults may be apprehensive about sharing information regarding a fall because of the fear of losing their independence
Screening tools can be used to determine the risk for falling

Implications for Gerontological Nursing and Healthy Aging

Perform an initial fall assessment on admission, after any change in condition, and at regular intervals during a stay
Assessment of the older adult at risk
Nursing assessment of the patient after a fall
Assessment of the environment and other situational circumstances upon admission and during institutional stays
Assessment of the older adult’s knowledge of falls and their prevention

Fall Assessments

Morse Fall Scale
Not for use in long-term care facilities
Performance-Oriented Mobility Assessment
Hendrich II Fall Risk Model
Validated with skilled nursing and rehabilitation centers
Minimum Data Set (MDS) 3.0
Includes information about the history of falls and hip fractures, as well as an assessment of balance during transitions and walking

Fall Risk Assessment Instruments

Determining the reason for a fall occurred provides information about the cause of a fall and ensures that appropriate plans can be instituted to prevent future falls
Includes a fall-focused history, fall circumstances, medical problems, and medication review, as well as mobility, vision and hearing, neurologic, and cardiovascular assessments

Postfall Assessment

One-size-fits-all approach does not work
Interventions depend on the person’s changing condition
Type, timing, and frequency of the interventions are tailored to the person
Education about fall prevention is an important intervention for patients, families, and the community

Interventions for Fall Prevention

May be of benefit when part of a multifactorial program
Home safety assessment and modification interventions are effective in reducing the rates of falls in community-dwelling older adults
In institutional settings, the patient care environment should be assessed routinely for extrinsic factors that may contribute to falls and corrective action taken

Environment Modifications

Many devices are available for specific conditions and limitations
Canes
Walkers
Wheelchairs
Can also improve functional ability and independence
Education is essential because improper use of these devices can lead to an increased fall risk

Assistive Devices

Interventions the nurse may implement to help prevent falls include (Select all that apply.)

keeping the call light within reach.

rounding on the patient every 1 to 2 hours.

reducing fluid intake after the evening meal.

using a bed alarm if the patient is disoriented.

teaching the patient to change positions slowly.

Question

A, B, D, E—Reducing fluid intake after the evening meal does not reduce fall risk. Fluid volume deficit may actually increase the risk because of syncope.

Answer

Physical restraint
Manual method that uses either a physical or a mechanical device and is designed to reduce the ability of the patient to move his or her arms, legs, body, or head freely
Chemical restraint
Drug or medication is used as a restriction to manage the client’s behavior or movement, which is not a standard treatment or dose of a medication

Restraints and Side Rails

Do not protect patients from falling, wandering, or removing tubes and other medical devices
Can cause serious injury and death
Are associated with higher death rates, injurious falls, nosocomial infections, incontinence, contractures, pressure ulcers, agitation, and depression
May cause fear and agitation in those with a history of trauma

Consequences of
Physical Restraints

No evidence suggests that using side rails deceases the risks for or the rates of falls
Side-rail restraint is defined as the two full-length or four half-length raised side rails
If a patient is able to use the half- or quarter-length upper side rail to assist in getting in and out of bed, then he or she is not considered to be physically restrained

Side Rails

Is the standard of practice and an indicator of quality care in all health care settings
Should not be used to manage behavioral symptoms of hospitalized older adults with delirium
What works for one patient may not work for another; assessment is key
Staff education regarding restraint-free care is important

Restraint-Free Care

Gerontological nurses need to be knowledgeable about fall risk factors and fall risk reduction
Health promotion interventions can help maintain fitness and mobility in older adults
Knowledge of the home environment and risk factors for falls is a must

Implications for Gerontological Nursing and Healthy Aging

If a patient is able to use the half- or quarter-length upper side rail to assist in getting in and out of bed, then this patient is considered to be placed in a form of physical restraints.

True

False

Question

B—If the patient uses a half- or quarter-length upper side rail to assist in getting in and out of bed, it is not considered a restraint.

Answer