Knowledge Assessment: Fall Prevention

Knowledge Assessment: Fall Prevention

            Most elderly population are victims to fall, and around 30% of patients who fall suffer moderate to severe physical injuries such as cuts, bruising, and breaks. The elderly population is often hospitalized for fall-related injuries five times more compared to other injuries (Kim & Choi-Kwon, 2013). Mrs. L is an older woman, an 88-year-old widow, with past medical problems such as urinary frequency, insomnia, falls at home, detached retina, and bilateral hip replacements.

1. What are Mrs. L’s known risk factors (in the hospital) for falling?

Environmental Factors in Fall Prevention

Her risk falls are mostly attributed to the lack of conducive environment to carter to her needs. Mrs. L reported having called for assistance to the bathroom but using the call button but received no response hence prompting her to try accessing it by herself. The stations are located far from patient rooms, and this reduces speedy reactions to call buttons. Mrs. L’s bed is also too high, and this makes it hard for her to stand on her own feet without help comfortably. Since the nurses did not hear her call button, the hospital environment also seems to have a higher auditory environment than usual.

Medical Conditions

            Insomnia is among the medical conditions faced by Mrs. L. Insomnia is a sleep disorder that is related to conditions like depression, and this often results in her getting fatigues. Mrs. L ‘s bilateral hip replacements, as well as urinary frequency, also prompted her to visit the bathroom frequently, and she fell in the process. Mrs. L also has a detached retina on her right eye, and this can make her make wrong judgments concerning her mobility since it affects their balance.

Unsafe Behaviors

            Unsafe behaviors also contributed to Mrs. L’s risk falls since she was aware of her medical condition, bilateral hip replacement, and still went ahead to take the risk of accessing the bathroom on her own. The decision by Mrs. L is unsafe behavior since she had developed anxiety after falling previously, and merely using handheld rails may not be effective in reducing her risk of falls.

2. Mrs. L’s Fall Risk Score

3. Mrs. L’s Sleeping Patterns and its contributions to her Risk of Fall

After the analysis using the Pittsburgh Sleep Quality Index, insomnia was identified to have the highest fall risk, and it significantly contributed to falls. Mrs. L falls (Mollayeva, Thurairajah, Burton, Mollayeva, Shapiro & Colantonio, 2016). Encouraging her to maintain quality sleep by sleeping more hours can be useful in reducing insomnia, as well as the use of correct medication to cure the condition. For instance, Mrs. L can be encouraged to improve her sleep duration from 4 hours to around 8 hours every day to reduce her fatigue.

4. Mrs. L’s Mini-cog Score

            Under instructions, Mrs. L drew numbers within a circle to resemble a clock, but she made errors by failing to draw numbers 3, 4, and 5. The patient pulls the cock to show 3 PM. One clock hand pointed at nine while the other aimed at 12. From the three questions, she managed to remember two. In the three-item recall memory test, Mrs. L scored two. She scored 1 for the clock test drawing hence being classified as a class 3, illustrating her ability to handle instructions and function properly.

5. Having assessed Mrs. L fall risk and her cognitive state, develop safety goals for the following:

Environmental and equipment

            The healthcare organization should ensure the stations are located near patient rooms to enhance speedy reactions to call buttons. The rooms should also be customized such that the distance from the patient’s room to the bathroom is short, and the patient’s bed should be too high. The rooms should also be customized such that the distance from the patient’s room to the bathroom is short, and the patient’s bed should be too high. The hospital should also avail mobility equipment in the patient’s room, including standers, walkers, and manual wheelchairs, to ease patient mobility and reduce risk falls.

Gait and Mobility

            Physical therapies can be used to treat gait and mobility issues related to Mrs. L’s risk falls. Mrs. L can go through personalized physical therapy programs to help her gain her previous functioning level. According to Cruz-Jimenez (2017), individualized physical therapy can also be useful in improving her strength and endurance, joint range of motion, as well as balance and coordination. The physician can engage Mrs. L in massage, thermal therapy, or therapeutic exercise.

New Medications

            New medications are necessary to improve Mrs. L’s medical condition that significantly contributes to her risk falls. Antidepressants such as trazodone (Desyrel) can be useful in treating insomnia. Effective sleep support supplements such as NoctuRest can also be introduced to the patient’s medication to improve her sleep quality and reduce cases of insomnia.

Anxiety, depression, and unsafe behavior

            Support supplements like Zenapin can be useful in reducing anxiety in Mrs. L, and this can improve her courage in taking bold steps. To add on that, Mrs. L can be encouraged to take small steps gradually as she steps on the floor as well as use the appropriate support equipment to aid in her mobility

References

Cruz-Jimenez, M. (2017). Normal changes in gait and mobility problems in the elderly. Physical Medicine and Rehabilitation Clinics, 28(4), 713-725.

Kim, Y. S., & Choi-Kwon, S. (2013). Fall risk factors and fall risk assessment of inpatients. Korean Journal of Adult Nursing, 25(1), 74-82.

Mollayeva, T., Thurairajah, P., Burton, K., Mollayeva, S., Shapiro, C. M., & Colantonio, A. (2016). The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: A systematic review and meta-analysis. Sleep medicine reviews, 25, 52-73.