Question

You are a nurse working in the Emergency Department (ED) and caring for a 75-year-old woman who arrived via ambulance after falling at home. She tells you she slipped on a rug and hurt her wrist trying to brace herself from the fall. You notice an obvious deformity of her right wrist. Her current weight is 90 pounds; she admits to smoking a half a pack of cigarettes a day for the past 45 years, and drinks 1 alcoholic drink a day. She has a medical history of chronic obstructive pulmonary disease (COPD) and hypertension. X-ray confirms a fractured right distal radius. What other health concerns should be evaluated for this patient? What is the evidence base that supports strategies for educating and planning care for this patient? In particular, what strategies can be implemented in order to educate this patient about fall prevention and maximize her musculoskeletal health? What is the strength of the evidence of the effectiveness of these strategies?

Answer 1

The patient has to be monitored for multiple health issues. 90 Pound can be considered underweight for her age and this may also denote possible malnutrition. There may be imbalance of calcium in the older age which makes the bones fragile and easily susceptible for breakage. And this may be a real reason for the bone fracture. COPD can be a serious concern for her as she seems to be a chronic smoker. Smoking can aggravate the episodes of COPD as makes it more severe. One of the main causes of COPD is smoking so in her case the condition will only increase in severity as the age progresses and that a real threat to her wellbeing. Hypertension is another concern which can have negative impact with her smoking habit. Increased blood pressure and cardiac disorders is one of the complication caused by excessive smoking and even if she takes medication for hypertension due to the excessive smoking and alcoholism the drug may not give the expected outcome.

It I really important to educate the patient on the consequences of her health practice which is going to impact her in a negative way.

Since she is aged the nurse has to be very patient while explaining the consequences of smoking and alcoholism to her.

Visual aids can be very effective in such cases and it helps them to remember more than just oral advice.

To gain her confidence is vital so that the patient may feel to listen to the nurse advice.

Health education.

1. Patient need to be advised on the well balanced diet which plays a crucial role in overall health of the   elder hood.

2. Advice to add more dairy products and egg in the diet daily so that the imbalance of calcium can be sorted out.

3. Small exercises is required to maintain a healthy body and mind and she has to advised to follow small exercises daily

4. Ask her to prevent walking in the dark room to prevent possible walls.

5. Inform the guardian to make well lit rooms so that any obstacles can be easily identified which thereby prevents falls.

6. He patients family also should be involved in the education so that they can support her and prevent the future complications based on her habit.