MS. LEE PRESENTS TO YOUR CLINIC FOR A NEW PATIENT EVALUATION. SHE IS A 75 YEAR-OLD WOMAN WITH AN HISTORY OF ATRIAL FIBRILLIATION, DIABETES, CAD AND GLAUCOMA. HER DAUGHTER COMES WITH HER TO THE FIRST APPOINTMENT AND TELLS YOU SHE WAS RECENTLY IN THE EMERGENCY DEPARTMENT AFTER STUMBLING AND FALLING ONTO HER LEFT SIDE. HER X-RAY DID NOT SHOW ANY FRACTURES AND SHE WAS DISCHARGED HOME. ON FURTHER QUESTIONING MS. LEE REPORTS THAT SHE FELL EARLY IN THE MORNING WHEN SHE WAS GETTING UP TO GO TO THE BATHROOM. SHE THINKS SHE TRIPPED ON THE EDGE OF THE RUG. SHE WAS ABLE TO GET UP ON HER OWN, BUT HAS HAD PAIN IN HER LEFT KNEE SINCE. SHE HAD BEEN FEELING LIKE HER USUAL SELF BEFORE THE FALL AND DENIES ANY RECENT FEVER, CHILLS, COUGH DYSPNEA,URINARY OR GI COMPLAINTS. SHE DID NOT HIT HER HEAD OR LOSE CONSCIOUSNESS. SHE DID NOT HAVE ANY CHEST PAIN, PALPITATATIONS OR DIZZINESS PRIOR TO THE FALL. SHE LIVES ALONE.HER DAUGHTER LIVES NEAR AND HELPS HER WITH HER MEDICATIONS. SHE TESTS HER BLOOD SUGER EACH MORNING AND IT HAS BEEN 120-200MG/DL. SHE OCCASIONALLY FEELS LIGHTHEADEDFIRST THING IN THE MORNING WHEN SHE GETS OOB, BUT SHE HAS NOT HAD ANY OF THOSE SYMPTOMS THROUGHOUT THE DAY. SHE DENIES ALCOLHOL USE.

PHYSICAL EXAM

BP 134/78 LYING, 126/72 STANDING

HR 78 IRREGULAR

TRACE EDEMA IN BOTH LOWER EXTREMITIES

BILATERAL KNEE CREPITUS, BUT FULL ROM

3/10 PAIN LEFT KNEE

DIFFICULTY GETTING OUT OF CHAIR 9NEEDS TO ROCK SEVERAL TIMES)

IT TAKES HER 15 SECONDS TO WALK 10 FEET AND SIT BACK DOWN

SHE SWAYS AND CANNOT HOLD HER POSTURE WITH ONE FOOT IN FRONT OF THE OTHER.

SHE TELLS YOU SHE WANTS TO EXERCISE BUT DOES NOT KNOW THE BEST WAY TO DO SO.

MEDCATIONS

ASPIRIN 81MG DAILY

GLUCOPHAGE 100MG TWICE DAILY

METOPROLOL 50 MG TWICE DAILY

ATORVASTIN 20MG DAILY

SITAGLIPTIN 50MG DAILY

DIPHENHTDRAMINE 25MG AS NEED AT NIGHT FOR SLEEP

QUESTIONS

1. LIST MS. LEE’S RISK FACTORS FOR FALLING
2. HOW DO YOU TEST GAIT?
3. WHAT IS A GOOD BALANCE TEST? DESCRIBE HOW IT IS PERFORMED.
4. DESCRIBE THE PROCEDURE FOR CHECKING ORTHOSTATIC BP.
5. WHY IS IT IMPORTANT TO CHECK ORTHOSTATIC BP IN THIS PATIENT.
6. HOW CAN YOU ASSESS WHETHER SHE IS READY TO HEAR YOUR ADVISE ABOUT FALL PREVENTION.
7. LIST 3 PRIORITY NURSING DX FOR MS. LEE

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