Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Chapter 20 Falls Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 1 Learning Objectives • • • • Define falls. Give the incidence of falls. Describe factors that increase the risk of falls. Discuss the relationship between restraint use and falls, types of restraints, and regulations for restraint use. • Describe fall prevention techniques. • Describe nursing interventions to use when a fall occurs. Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 2 Definition • Definitions vary from “unexpected displacement” to “unintentional change in position” to “inadvertent events in which the subject comes to rest unintentionally on the ground” • More useful definition: “a circumstance in which one unintentionally falls to the ground or hits an object such as a chair or stair” Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 3 Incidence and Risk Factors • The risk of injury is highest in people older than age 65; falls are the most frequent cause of accidental injury and death among older adults • Older adults constitute only 12%-13% of the total U.S. population but account for 72% of total deaths from falls • Rate of death increases from 5 in 100,000 for between ages 45 and 64 to 200 in 100,000 for those older than 85 years of age • The U.S. Public Health Service estimates that two thirds of deaths due to falls are preventable Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 4 Incidence and Risk Factors • Intrinsic factors • Factors related to the functioning of the individual, such as the aging process or physical illness • Extrinsic factors • Environmental factors • Enhance possibility of falling; extrinsic factors enhance the opportunity to fall Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 5 Intrinsic Factors • • • • • • • • • Age-related changes: reduced vision and hearing Age-related changes in posture and gait Confusion or depression Lack of exercise leads to weakness and decline in physical vigor Multiple medications related to the increased incidence of chronic illness in older adults Psychotropic medications Acute infections Diseases affecting the central nervous system may affect balance by causing dizziness and gait disorders Overestimation of abilities Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 6 Extrinsic Factors • Home environment • • • • • • • Low-lying and poorly visible tables Trailing electrical wires Pets Steep and unlit stairs Loose carpeting Unsafe walking aids Inconvenient bathroom or kitchen arrangements • Institutional setting • Changes in position; transferring to/from bed or chair • Toileting procedures • Unstable and defective equipment Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 7 Incidence and Risk Factors • Injury-causing falls are more likely to occur in long-term care facilities than in the community • Among community-dwelling older adults, 30% fall every year, compared with 50% of those living in residential care facilities • In about 75% of all reported falls, no injuries occur • Contusions, cuts, or lacerations occur in about 25% to 30% of all reported falls • Deep tissue damage or concussion occurs in about 5% • 1% to 5% of falls result in fractures Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 8 Incidence and Risk Factors • Factors known to increase the risk of falling • • • • • • • • A history of previous falls Osteoporosis Hemiparesis Sensory impairment Diminished muscle strength, balance, reaction time Diabetes with peripheral neuropathies Loss of consciousness or falls on a hard surface Multiple medications Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 9 Restraints Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 10 Physical Restraints • Anything that restricts movement • If patient able to apply or release a safety device, it is not considered a restraint • Geriatric chairs, side rails, vest, waist, wrist, or ankle ties • Common reasons • To protect the patient or others from harm and prevent tampering with medical devices • To prevent falls from the bed or chair • To prevent wandering Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 11 Physical Restraints • May actually cause or worsen problems • Patients often able to untie their restraints and wriggle out of them, resulting in falls from wheelchairs and beds • Accidental strangulation with some restraints, particularly with a restraint vest • Using side rails now in question • Patients have been injured, sometimes fatally, after crawling over side rails or becoming trapped between side rail bars or between side rails and the mattress Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 12 Physical Restraints • May have damaging psychological effects on older patients • Patients may experience anger, discomfort, resistance, and fear of physical restraint • Poor self-image, growing dependency, increased confusion and disorientation, regressive behavior, and withdrawal • Omnibus Reconciliation Act (OBRA) of 1987 • Protects patients from unnecessary restraint in longterm care facilities Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 13 Physical Restraints • Physician’s order for restraint use; must specify duration and circumstances under which restraint may be used Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 14 Physical Restraints • According to OBRA regulations, the only people who are considered restrainable are those who • Have a history of severe falls or are at extremely high risk of taking a fall that is life-threatening • Are neurologically, orthopedically, or muscularly impaired; need postural support for safety or comfort, or both • Experience mental dysfunctions; may cause them to be a serious hazard to themselves, objects, or others • Have life-threatening medical symptoms; a restraint is used temporarily to provide necessary treatment Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 15 Physical Restraints • • • • The least restrictive device is best Check patient frequently, at least every 15 to 30 minutes Agitated or combative patient: monitored continually Make sure that the patient’s condition is good and that the restraint is used properly and is providing adequate protection and without impeding circulation or breathing • Remove and release physical restraints every 2 hours for 10 minutes to provide for range of motion, toileting, nourishment, and restorative activities such as physical therapy, ambulation, and mental stimulation Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 16 Alternatives • Physical therapy • Sitting and talking with patients for short periods • Asking staff to be responsible for wanderers in small blocks of time Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 17 Chemical Restraints • Never use psychotropic drugs for the purposes of discipline or convenience • Use only when danger of self-injury or injury to others • Administration of a psychotropic drug requires a physician’s written order that specifies the duration and circumstance under which the medication is to be used Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 18 Chemical Restraints • Commonly prescribed psychotropic drugs • Antidepressants • Sedatives/hypnotics • Antipsychotic drugs • Adverse effects • Confusion, agitation, increased number of falls • Orthostatic hypotension Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 19 Fall Prevention • Most important intervention for falls: prevention • Best prevention: education of patients and caregivers • Prevention aimed toward minimizing intrinsic and the extrinsic factors causing falls and the potential for injury • The first step: determine who is at greatest risk • Fall prevention strategies are carried out in the home and institutional environments Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 20 Figure 20-1 Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 21 Reducing Fall-Related Injuries • Hip protectors • Aims to decrease the severity of fall-related injuries • Individuals at risk for falling also can be taught to rotate forward or backward to avoid falling sideways; reduces the risk for hip injury • Measures to prevent osteoporosis may reduce the risk of fractures associated with falls Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 22 When a Fall Occurs • Hospital or long-term care facility • Determine circumstances of fall and any injuries • Document the fall according to agency protocol • Note what the patient was doing at the time, the mental and emotional status, and environmental factors that may have contributed to the fall • Remove or correct the cause • Have the patient ambulate as soon as possible and at least several times a day in order to prevent the hazards of bed rest and to restore confidence Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 23 When a Fall Occurs • Home • Requires cooperation of the person who is at risk, the family, and possibly neighbors • Plan of action should include information about getting up and seeking help • Devices worn around the neck that can send signals to a control center are effective and provide feeling of well-being for the individual Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. 24