please i need help answering these questions. Background information Mr Don Trip
ID: 126791 • Letter: P
Question
please i need help answering these questions.
Background information Mr Don Tripp is a retired accountant who has lived in a large residential nursing home. Lately he has developed symptoms and subsequently been diagnosed with Alzheimer's disease. Most of the time Mr. Tripp can ambulate freely by himself, responds in a way which to staff has become his 'norm', that is he gets a little confused, he can 'over react, etc. but most of the time he is oriented and can communicate his feelings It had been a busy day in the home and it was only by accident that someone heard Mr. Tripp shouting from his room. On entering the room, Mr. Tripp is on the floor. He is shouting that no-one is listening and that he is hurt but wants to get off the floor. Discussion: 3 What assessment findings could indicate obvious signs of injury in this patient? D What questions might you ask the patient?Explanation / Answer
A fall is an accidental event whereby a person unintentionally and without control moves to the ground. Injury can result from a fall. It can occur at any age specially whne the group is a vunerable one like younger children, elderly patients, mentally challenged or physically challenged clients. All the organisation place different srategies to prevent fall as it can lead to minor or major injuries. Fall prevention protocols are part of hospital policies. In case of patients with alzheimers disease, it becomes very vital to monitor their activitiesand movements because of their changing state of mind with decrease in memory makes them more prone for accidental fall.
Signs of Injury-
When there is a fall from some height like cot or chair, the patient is found on the floor. In such instances, not to move the patient vigorously unless the patient is assessed for any potential spinal injury.
Signs of injury may include: bruising, lacerations, swelling, redness, abrasions, shortening of limbs, restricted limb movement, external rotation of lower limbs, inability to weight bear, pain on applying pressure, and signs of deformity.
Risk factors indicating potentially significant mild head injury
GCS <15 at 2 hours post injury
Age >65 years
Large scalp haematoma or laceration or active bleeding
Deterioration in GCS
Post traumatic seizure
Multi-system trauma if the injury is severe
Focal neurological deficit
Prolonged loss of consciousness (>5 min)
Clinical suspicion of skull fracture
Vomiting (especially if recurrent)
Persistent abnormal alertness or disorientation / behaviour / cognitive changes particularly if these symptoms persists for 4 hours post time of injury
Questions to be asked with the patient -
At many instances the patient may not be in a state to answer any questions as there will be loss of memory for short span of time or the patients in a confused state. it is easy to ask question the patient ,if the client is conscious and oriented. But still it can give a detailed explannation to the fall circumstances at that moment.
- It is very vital to ask the patient about any problems or discomfort they face post fall and simultaneously assess the vital parameters like pulse, blood pressure, level of consciousness and oxygen saturation.
- Receiving the patient's statement about the event, it can give better understanding about the event which can help in prevention strategies
- Asking the patient about the medication history, as certain medications can give rise to giddiness
- Enquiring about postural hypotension ,which is commonest in many individuals specially elderly groups
Safety Measures to prevent fall :
Safety is an important aspect of delivery of care in any healthcare settings because without safety measures , the patient may not receive quality services and there could be many errors causing adverse events or even death. Certain safety measures can be followed which are given below;
- Adequate lighting in room which can help the patient to move around without getting displaced in dark
- Height of the cot or furnitures shall be kept at lower end ,to minimise injuries
- Side bed rails to be kept always intact
- Remove the clutter from the area and clera pathway for the patient to move around
- Avoid slippery floors, which can aggravate the problem and safe footwears
- Assisting the client whenever necessary and assuring for the same will help the patient to come forward for help
- Keeping the things near to the patient like glass of water, plates or glasses
- For confused and agitated patients, restraints can be applied with appropriate assessment and consent
- Sensing devices include pressure sensing technology (such as a pressure sensing pad) that can be placed on a chair or on the bed with an alarm that goes off when the senior attempts to get up unassisted. This techniques are advanced and not available in many organisations
Communications Issues:
As the patient was presented with mild confusion and over reaction to the health care providers, but seemingly oriented on many occassions before the event. However, during the vent and post fall, the client is seemingly restless and want to get off the floor and he mentioned that nobody is listening to his calls. in such situation, it is very difficult to retrieve information about the event and may not be cooperative for further assessment.
it is also difficult to convince the client because of his restless nature. From this point of view, communication can be with many barriers.
Documentation:
It is very important to notify the event to the nursing managers and physician ,because post fall monitoring and assessment is very essential to prevent complications. Many organisations follow filling up Incident report post fall with complete details within 24 hours of the event or as specified by the organisation's protocol.
The Documentation shall include the folloeing;
- details of the patient like name, age, gender, date of admission, diagnosis, medications and any comorbidities
- event details like date, time of the event noticed or occurred, person who noticed firstly
- condition of the patient before and after fall
- assessment findings to rule out signs of injury and categorising injuries as minor, major or sentinel
- immediate interventiond by the healthcare provider post fall
- any supportive investigations performed and their reports to be attcahed
- analysing causative factors for fall to occur
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