Geriatrics Chapter 19: Falls and Fall Risk Reduction

A nurse is assessing an older adult's risk for falls. One of the questions that she asks is whether the older adult has fallen in the past year. She asks this because individuals who have fallen: a. have a higher risk of falling again than persons who did not fall in the past year b. are more likely to sustain injuries if they fall again than a person who did not fall in the past year c. have most likely developed a fear of falling d. are more likely to have a balance disorder

Answer: A

An 88-year-old woman is admitted to the hospital with a diagnosis of pneumonia. She has a history of hypertension and congestive heart failure and is on a total of five different medications for these chronic conditions. The nurse caring for the woman develops a care plan that includes the diagnosis "Risk for Falls". A priority nursing intervention for this client is to: a. perform a fall assessment b. keep all of the side rails up on the client's bed at night time c. place the client on bed rest so that she does not fall d. assess the client's dietary intake for calcium adequacy

Answer: A Completing a fall assessment will enable the nurse to identify and correct the risk factors for this patient. -Side rails have not been found to be effective in keeping a client in bed and may actually lead to injury -Maintaining a patient on bed rest can lead to deconditioning and actually contribute to falls -Assessing the client's dietary intake of calcium is a good intervention for this age group, but it is not a priority and it will not prevent falls.

A group of older women in an assisted living facility are talking about one of the residents who fell and fractured her hip. The woman asks a nurse the following: "It seems like so many of us fall and break our hips, and then it is downhill from there. Is this really true?" In formulating a response, the nurce considers which of the following? (Select all that apply) a. hip fractures are a leading cause of hospitalization for older people b. the major cause of hip fractures is falls c. women have significantly higher mortality rates from hip fractures than men d. nearly all older patients who sustain hip fracture will regain prefracture mobility within 1 year e. hip fractures are associated with very high morbidity and mortality

Answer: A, B, E ✓A: hip fractures are the second leading cause of hospitalization for older people ✓B: more than 95% of hip fractures among older adults are caused by falls ✘ C: men have higher mortaliity rates contributed to hip fractures than woman ✘ D: only 50-60% of hip fracture patients will recover their ambulation abilities in the first year ✓E: Older adults with a hip fracture have 5-8 times increased risk of mortality during the first 3 months after a hip fracture

A nurse in a long-term care facility notes that there has been an increase in falls on one unit and that many of the falls are occuring immediately following mealtime. The nurse recommends that the nursing home conduct a trial of six smaller meals instead of three traditional meals on the understanding that: a. postural changes in blood pressure are common in older adults and frequently occur during mealtimes b. postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide c. residents of long term care facilities are often on many different medications, which are given at meal times d. it is common practice to take long term care residents to the bathroom immediately following meals

Answer: B Postprandial hypotension occurs after ingestion of carbohydrate meals and may be related to the release of a vasodilatory peptide. Modifications such as increased water intake before eating or substituting six smaller meals daily may be effective -orthostatic hypotension is a cause of falls in older adults, but does not just occur around meal times -while it is true that residents of long term care facilities are on multiple medications and are usually toileted following meals, neither of these options addresses postprandial hypotension.

Which attempt by the family to prevent an older, frail adult from falling causes the home health nurse concern? a. keeping several low wattage night-lights on in the evening b. installing wooden railings on the stairway to the bathroom c. keeping the side rails up on the client's bed at night d. encouraging the client to use a cane when ambulating

Answer: C Keeping side rails up have proven to be a risk factor for falls rather than a positive intervention. The remaining interventions are generally effective.

Which assessment finding is a contributor to an older adult's risk for falls? (select all that apply) a. client is awaiting cataract surgery on right eye b. client's type 2 diabetes is poorly controlled with diet and exercise alone c. client reports a fall in the last year d. client has a history of contact dermatitis and psoriasis e. client attends Tai Chi classes

Answers: A, B, C These are the correct answers because they affect the client's vision, factors afecting sensations in the legs and feet, and a history of falls. -There is no research to connect the risk of falls with either of the skin conditions mentioned -Tai Chi improves balance, which decreases risk for falls.

A home health nurse is making a home visit to an older patient. A nurse conducts a home safety assessment and screens the environment for potential hazards for falls. Which of the following are hazards in the home? (select all that apply) a. absence of railings on stairway b. night-lights in all rooms c. clutter d. small throw rug outside shower e. grab bars in bathroom besides toilet

Answers: A, C, D The absence of railings on stairway, clutter, and throw rugs can all contribute to falls in the home. -night lights and grab bars are recommended to prevent falls

A homecar nurse visits a client in the home to conduct a fall risk assessment. The nurse assesses the client and the home for extrinsic risk factors for falls. Which of the following are extrinsic risk factors? (Select all that apply) a. unsteady gait b. inappropriate sized cane c. cluttered home d. two different medications that cause orthostatic hypotension e. there are no grab bars in the client's bathroom

Answers: B, C, E ✘A: this is an intrinsic risk factor ✓B: as this is external to the patient and related to the environment, this includes inadequate support devices ✓C: this is an extrinsic risk factor ✘D: this is an intrinsic risk factor ✓E: this is an entrinsic risk factor