Potential Injuries Resulting From Falls In Older Adults.

During my final year placement in the cardiac ward, I was allocated three patients during my early shift out of which one of my patients had a falls experience. The patient, Mr. Turner, was admitted to the ward three days ago due to an acute anterior myocardial infarction. Mr. Turner had received femoral angiogram; angioplasty and a stent was also inserted to his left anterior descending artery on the first day of his admission itself. The patient also has a history of atrial fibrillation, type II diabetes mellitus, osteoarthritis and cerebrovascular accident or stroke; these past medical conditions are suspected to have played a role in the anterior myocardial infarction for which Mr. Turner was initially admitted to the hospital. The nursing concerns for the patient is firstly the fall that Mr. Turner experienced while returning from the toilet. The second actual concern is the slight abrasion on the right side of his forehead and the changes in his vital signs after the fall (Sapra et al., 2019). In addition, the shortness of breath, chest pain and the swollen right arm are also the actual concerns that will require nursing attention. The potential nursing concerns that arise due to the fall are the possible injuries to the patient. Falls incidence in older people is an increasing phenomenon that is recognised as the most common reason for injuries in older individuals. Moreover, the treatment costs for injuries caused due to falls have also been reported to increase constantly. As the patient had a history of multiple chronic conditions, it makes him fragile and prone to serious falls. Therefore, a potential concern that can be identified through the case scenario is intercranial injury and fracture in the patient. The patient also complained of pain in his right arm which was not previously swollen implying that there is a possibility of an arm fracture (Berkova & Berka, 2018). Moreover, the pain in Mr. Turner’s chest after the fall and the increase in his respiratory rate and heart rate are also potential areas of concern as they indicate that he may experience angina or related heart condition due to the fall (Mol et al., 2019).  Nursing Concerns For A Patient Who Experienced A Fall Essay Paper

The vital signs in older patients are essential assessment criteria to predict, monitor chronic conditions in them. These serve as the basic assessment criteria for nurses. Several pathological and physiological changes have been observed to occur with an individual’s age that are reflected in the vital signs of the patient (Sapra et al., 2019). Changes like these in the vital signs such as heart rate, respiratory rate, oxygen saturation, temperature and blood pressure have the potential to reduce the ability of the different organ systems to adapt to the physiological stressors that contributes to the frailty in older individuals. In the present case scenario, Mr. Turner during the initial assessment was observed to have normal vital signs such as heart rate being 75, which was within the normal range for older individuals, the respiratory rate was recorded to be 16 which also within the normal range of respiratory rate, the blood pressure was recorded to be 110/75 which is within the normal range for older individuals with type II diabetes mellitus as it is recommended that such individuals have blood pressure lower than 140/90 mmHg to be in a good state (Solini & Grossman, 2016). The incident of fall that Mr. Turner experienced was a concern as it has been related to several severe consequences such as fractures in hip, arms, legs depending on the manner which they fell, serious head injuries that can lead to potential mental disorders due to accidental injury to the head.  Moreover, it has been reported that older individuals that experience a fall that could be potentially dangerous have a higher chance of developing symptoms of post-traumatic stress disorder as they will associate the incident with a trauma that left them with severe consequences (Jayasinghe et al., 2014). Moreover, the incident of falling was reported to be a concern as it affects the quality of life of Mr. Turner through lowering his self-confidence and affecting his independence (CDC, 2021). Secondly, the slight abrasion on his forehead indicates that Mr. Turner might have hit his head while falling. Even though the external injury is minor, the internal effect of the fall cannot be ascertained without monitoring the patient after the incident. Moreover, the changes in vital signs of the patient after the fall are another area of concern as it makes Mr. Turner prone to serious complications due to his medical history of cerebrovascular accident, osteoarthritis, type II diabetes mellitus and atrial fibrillation that causes heart rhythm problems in older individuals. The increased heart rate, respiratory rate are manifestations of the sudden fall that the patient experienced but they are concerning as Mr. Turner complained of chest pain and his blood pressure was observed to drop that indicate he may experience life-threatening shock. The lowered blood pressure indicates that his vital organs are not receiving enough oxygen and due to which the heart is pumping blood faster to fulfil this requirement which resulted in an elevated heart rate (NHLBI, 2022; Sagawa et al., 2018). The increased respiratory rate implies that the pulmonary system is compensating for the lack of oxygen that is present in the organs therefore, higher breathing rate would meet the need for supplying the blood with enough oxygen that reaches the organs and prevents the patient from going into a shock (Khan et al., 2021). The reduced oxygen saturation rate also indicates the hypoxic state that the patient was gradually moving into due to the fall that he experienced while returning from the toilet. The chest pain that is experienced by the patient is a concern as it reduces the quality of life of Mr. Turner as he is possibly in a state of confusion and suffering due to the accident he was involved in (CDC, 2021). Mr. Turner’s deteriorating quality of life was therefore the reason why the chest pain was also listed as a concern. Moreover, the changes in the heart rate along with the chest pain can be related as the cardiovascular and pulmonary systems were working hard to compensate for the lack of oxygen as mentioned above, therefore, the chest pain could possibly have been due to the increase in heart rate that Mr. Turner was experiencing as chest pain due to his frail state (Khan et al., 2021). It is also possible that Mr. Turner was experiencing an incident of stroke as it was an existing condition in his history. Lastly, the pain and swelling in his right arm after the fall are indications that he might have fallen directly on his arm and sustained a fracture during the fall that has resulted in broken bones that resulted in swelling and pain. As described above, the injuries sustained after such incidences of falling result in increased treatment costs for elderly patients that affect them financially, psychologically through instilling a fear of falling due to lack of confidence and threatens their independence as they will now be monitored and assisted for prevention of a similar incident in the future.

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Importance Of Vital Signs In Assessing Older Patients.

According to the Nursing and Midwifery Board Standards for registered nurse, a nurse is responsible for comprehensively conducting assessments that are important for the development of treatment plan for the patient. They are responsible for using a range of assessment techniques that allow them to systematically collect accurate information that will aid them in working in partnership with the patient (NMBA, 2017). Conducting an assessment of medication history would allow the professionals to determine any allergic reactions that could occur during the treatment. The nursing interventions that will be needed to be instigated for the provision of safe and effective nursing care would be to manage the shortness of breath that is experienced by the patient. The patient will be provided oxygen therapy in Semi Fowler’s position to improve the discomfort that is felt due to the shortness of breath in the patient (Ekstrom et al., 2016; Morrow et al., 2016). In addition, the patient will be provided knowledge on the associated risks of falling and will be encouraged to exercise (Guirguis-Blake et al., 2018). For the increased vital signs such as respiratory rate and heart rate, the patient will be encouraged to practise deep breathing, diaphragmatic breathing and undergo respiratory muscle training to manage the elevated respiratory rate (Bolzani et al., 2017). Moreover, to control the heart rate, the intervention could include medications such as antiarrhythmics which would help in lowering the heart rate and stabilise the vital signs of Mr. Turner to the normal levels. In addition, the hypotensive state of the patient after the fall will be improved through administration of intravenous fluids that would raise the blood pressure to a stable state (Sharma et al., 2022). Lastly, the swelling and pain in the arm could be relieved through application of cold therapy using ice bag or a frozen item. This could be done for a short duration such as ten minutes and removed for fifteen to twenty minutes and then re-applied for relief (Barth et al., 2016). In case there is no relief after the cold therapy, it is possible that the arm has been fractured and requires immediate treatment in the emergency department. The fracture could be stabilised through partial cast or a splint that will provide support to the arm. If the patient experiences excessive pain, they could be administered analgesics that provide relief from the pain (Ingrasciotta et al., 2019). Lastly, the patient will be monitored throughout the remainder of the shift for assessment of the vital signs and the effectiveness of the interventions on Mr. Turner’s condition (Sapra et al., 2019).

According to the National Safety and Quality Health Service Standards nurses have the responsibility of recognising and responding to the chronic deterioration of a patient receiving care through assessing their mental, physical and cognitive condition (NSQHS, 2021). The assessment of these conditions provides the professional with the necessary information on the deterioration that can be detected and effectively addressed, in this case, the nursing intervention of assessing the vital signs throughout the shift to assess the effectiveness of the other interventions allows the nurse to practice this standard in delivering patient-centred care (NSQHS, 2021). Moreover, the intervention for managing the increased respiratory rate and heart rate is suggested as they will provide a quick intervention for the management of the elevated vital signs (Sapra et al., 2019). The deep, diaphragmatic breathing would help the patient in collecting enough air through inhalation to saturate the blood with oxygen that will distribute it to the various organs, thereby decreasing the possibility of a stroke in the patient. Moreover, the oxygen therapy in the Semi Fowler’s position will lower the shortness of breath that was experienced by the patient as the chest expansion in this position requires least amount of effort from the patient but effectively increases the amount of air inhaled by the patient. The oxygen therapy through breathing mask in this position along with the diaphragmatic breathing exercises suggested for the patient will help in saturating the blood with oxygen thereby increasing the SpO2 levels to the desired range and lowering the respiratory rate, which in turn will provide the patient relief from shortness of breath. The enrichment of the blood with oxygen through these interventions fulfills the oxygen demand that was increased after the fall and stabilises the patient’s condition in this manner. The pre-existing condition of type II diabetes mellitus, arterial fibrillation and stroke put the patient at an increased risk of experiencing stroke again after the fall, through the interventions, the situation of a life-threatening stroke was averted (Sun et al., 2019). The intervention of administering antiarrhythmics for managing the elevated heart rate was suggested through acknowledging the suffering of Mr. Turner, as administration of a pharmacologic intervention would provide the relief in a shorter time than non-pharmacologic methods. The suggestion of the interventions demonstrate that evidence-based practice was being implemented in providing care to the patient. In order to implement evidence-based practice, recent research methods such as direct patient care allows the application of the nurses’ knowledge with the available resources that would best improve the patient’s quality of life by improving their condition (Kruschke & Butcher, 2017). Through communicating with the patient on the progress with the suggested interventions, the nurse can apply the principle of coordinated care in their practice and make any improvements that might be required depending on the effectiveness of the interventions. Intervention for elevating the blood pressure through intravenous fluid was suggested as reports have suggested that IV fluids have a faster effect than other interventions for elevating the pressure, in addition, the intervention is safe for patients as Mr. Turner (Kai, 2017). The elevation of the blood pressure to the normal state will allow the blood vessels to effectively distribute the oxygen-rich blood to the various parts of the body, specifically the lungs and heart, thereby relieving the chest pain that was possibly caused due to the elevation in heart rate (Kai, 2017; Berra et al., 2020). Lastly, the non-pharmacologic intervention of using ice pack or a cold item on the swollen arm would allow the blood vessels in the area to cool down and control the amount of blood passing into the surrounding tissue, thereby reducing the pain and swelling experienced by the patient. In addition, the patient was also suggested analgesics and a plaster on the arm to ensure that the suffering of the patient is minimised as early as possible so that an improvement in his quality of life can be achieved sooner. Analgesics do not have significant side effects in older patients and aids them in managing the pain. Most importantly, the intervention for preventing falls in elderly patients focuses on activities such as promoting exercise that improves the leg muscle strength and improves balance in the individual, thereby reducing the possibility of a fall in the future (Guirguis-Blake et al., 2018).

Changes In Vital Signs Post-Fall, And Their Implications.

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Mol, A., Hoang, P. T. S. B., Sharmin, S., Reijnierse, E. M., van Wezel, R. J., Meskers, C. G., & Maier, A. B. (2019). Orthostatic hypotension and falls in older adults: a systematic review and meta-analysis. Journal of the American Medical Directors Association, 20(5), 589-597. Nursing Concerns For A Patient Who Experienced A Fall Essay Paper