Mr. O’Brien is an alert and oriented 81 year old man living in a nursing home. H

Question

Mr. O’Brien is an alert and oriented 81 year old man living in a nursing home. His past medical history: Hypertension and heart disease. Gait disturbance with falls. Mr. O’Brien is currently independent with self care and meals. He has weakness and ambulates slowly with a walker. His Vital Signs: BP 140/88, Pulse: 76, Respirations: 24 reg room air is 98%. SPO2 on Medications: • Atenolol 50 mg by mouth daily • Lopressor 50 mg by mouth daily • Tylenol 650 mg by mouth every 6 hours as needed for pain 1. Which patients are at risk for falls in the nursing home environment? 2. What areas are included in a fall risk assessment? Case Study Progresses At 11:00pm: the nurse is on rounds checking her patients when she finds Mr. O’Brien sitting on the floor in the bathroom. He is awake, alert and oriented x 4 and is complaining of pain in his right ankle. He is able to move all his extremities and has no visible bruising on head, trunk, arms or hips/buttocks. The nurse and nurses aide assist Mr. O’Brien to stand and then to the bed and continue the assessment. Mr. O’Brien states he is a little “dizzy feeling.” His VS are 98/60, Pulse of 94, Respirations of 24. SPO2 of 98%. 3. Discuss the initial nursing interventions when the nurse enters the room and finds Mr. O’Brien on the floor in the bathroom. Who should be notified of Mr. O’Brien’s fall? What type of documentation is needed regarding this fall? What are fall precautions? Would a bed alarm be effective? 6. Why would the nurse assess orthostatic blood pressures? Case Study progresses The nurse takes off Mr. O’Briens sock and slipper and observes Right ankle (as above) 7. Describe what the right ankle looks like: When assessing Mr. O’Brien’s ankle, what are the key areas to be evaluated? 8. What will the nurse do for Mr. O’Brien’s ankle to prevent further swelling and injury? 9. List and Discuss what orders the physician will most likely prescribe: 10. Describe and demonstrate the technique for applying an elastic bandage: What is the purpose/rationale? 11. The doctor orders a cold pack to Mr. O’Brien’s ankle. Is the order appropriate? Cold pack to right ankle for 20 minutes on; Repeat every 3 hours as needed How does the nurse explain the effects of cold to Mr. O’Brien? 12. The nurse is assessing how Mr. O’Brien uses his walker. Describe the appropriate steps in using a walker. 6 AttachmentsView allDownload all page1image4720 .png page1image4880 .png page2image1192 .png page3image264 .jpeg page3image432 .png first Question

Explanation / Answer

According to Chegg's policy a minimum of 4 questions should be answered at a stretch, however, I have provided answers to most of the questions (but not all) to enhance understanding and learning.

Which patients are at risk for falls in the nursing home environment?

Patients who are all at risk for falls are:

In this case study, the patient is old aged (81 years) with hypertension, cardiac problems, gait and ambulatory problems. Therefore he is at risk for falls.

What areas are included in a fall risk assessment?

Fall risk assessment includes scoring and grading the patient for risk of falls. Here, patients are graded as high-risk, low-risk and no risk for falls category. This assessment involves:

Discuss the initial nursing interventions when the nurse enters the room and finds Mr. O’Brien on the floor in the bathroom. Who should be notified of Mr. O’Brien’s fall?

The nurse should notify the event of a patient’s fall to her unit in charge and supervisor at first. Moreover, she must also inform the risk manager or patient safety officer (if available) regarding this event. The physician also notified of the fall event and assessments (decreased BP and feeling dizzy) so that appropriate interventions can be initiated. In addition to this, he must communicate the all the staff for being alert for this patient so that the second fall event does not occur.

What type of documentation is needed regarding this fall?

Documentation regarding:

What are fall precautions? Would a bed alarm be effective?

Why would the nurse assess orthostatic blood pressures?

Orthostatic blood pressure determines if there is any blood pressure variation between sitting and standing position. In some cases, especially people with hypertension, patients have a normal BP in the sitting position but while standing their BP suddenly drop due to postural changes and as a result they feel dizzy and fell down. For this reason, always need to check for orthostatic BP changes during mobility of a high-risk patient.

Describe what the right ankle looks like: When assessing Mr. O’Brien’s ankle, what are the key areas to be evaluated?

The nurse must assess

What will the nurse do for Mr. O’Brien’s ankle to prevent further swelling and injury?

The nurse will:

List and Discuss what orders the physician will most likely prescribe:

Physician most likely prescribe

The doctor orders a cold pack to Mr. O’Brien’s ankle. Is the order appropriate? Cold pack to right ankle for 20 minutes on; Repeat every 3 hours as needed How does the nurse explain the effects of cold to Mr. O’Brien?

This is a correct order because it reduces blood flow to the applied area and prevents any internal bleeding/hematoma formation. Moreover, cold application minimizes pain and reduces swelling and inflammation. The nurse communicates the patient about the benefits of cold application to increase his cooperation and participation.

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