Question

Ebony is an independent 86-year-old female who has been admitted to the hospital for dizziness and syncopal episodes that have resulted in falls at home. She has not sustained any injury from her falls. She is being evaluated for a cardiac cause to her syncopal episode. She has a history of diabetes mellitus that is diet controlled. She has no other significant medical or surgical history. She started using a cane to walk due to dizziness and syncope. Ebony is alert and oriented with a normal gait. Intravenous fluids are infusing. Nursing staff oriented her to the use of the call bell and educated her to ring when she wanted to get out of bed. Non-skid slipper socks were put in her bedside stand to use when she got out of bed. Ebony rang the bell during the night to ask for assistance to use the toilet. She waited for ten minutes but there was no response so she decided she would go to the bathroom on her own. When the staff responded, Ebony was found on the floor, bleeding from her head.

1. The nurse's perspective on the fall,
2. an interview with the patient about what caused the fall,
3. factors that could have contributed to the fall, and
4. the nurse's self-reflection on what could have been done differently to prevent the fall.

Answer 1

The Nurse Perspective for the lady fall is due to - sudden change in the position from lying down to the Standing Position that caused drop in blood pressure, that decreases the blood flow to the brain. As when one stands up the gravity causes blood to settle in the lower part of your body, below your diaphragm. When that happens, the heart and autonomic nervous system (ANS) work to keep your blood pressure stable but fails intially and that leads to falls. As Diabetes is the Factor Causing Autonomic Dysfunction.

Also as the patient age is 86 years which is Furthur Contributary to this Condition as there is Osteoporosis in the old age that leading to weakning and decreasing the Bone mineral Density that can also be reason to add-up for her fall.

Factors that Contributted for Fall are-

• Dehydration
• Intense emotional stress
• Anxiety
• Autonomic nervous System Dysfunction (Diabetes)
• Fear
• Pain
• Hunger
• turning the neck
• Urinating (miturition syncope)

Factors that could be done to prevent such Falls are-

• Eat regular meals, and avoid skipping meals. If you feel hungry between meals, eat a healthy snack.
• Make sure you drink enough water every day.
• If you feel lightheaded, nauseous, or sweaty, lie down right away and raise your legs.
• If you need to stand in one place for a long time, be sure to move your legs and don’t lock your knees. Pace if you can, or shake your legs out.
• If you want to change your position from lying down to Standing don't stand Immediately first make your position from lying down to sitting for 2 minutes and then Stand.
• If you’re prone to fainting, avoid exerting yourself in hot weather as much as possible.
• If you’re prone to anxiety, find the coping strategy that works for you. You can try regular exercise, meditation, talk therapy, or many other options.
• Take any medications as prescribed, especially for diabetes or cardiovascular issues. If you feel dizzy or lightheaded from taking a medication, let your doctor know. They may be able to find a different medication for you that doesn’t cause this side effect.