Fall and Injury Prevention

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Brad Bass
ASN,RN
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Study Tools For Fall and Injury Prevention

Prevention of Falls (Picmonic)
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Outline

Overview

  1. Fall & Injury Prevention
    1. Fall risks
    2. Fall prevention
    3. Assistive devices
    4. Body mechanics
    5. Make life easier

Nursing Points

General

  1. Fall risk
    1. Age
    2. Education
    3. Cognition
    4. Tripping Hazards
      1. SCD
      2. Other equipment
  2. Fall prevention
    1. Call light
    2. Declutter room
    3. Non skid socks
    4. Bed alarm
    5. Lighting
    6. Frequent toileting
  3. Using assistive devices
    1. Walker
    2. Cane
    3. Wheelchair
    4. Crutches
  4. Body mechanics
    1. Lift with legs
    2. Never bend and twist
    3. Step up
  5. Make life easier
    1. Move bed up
    2. Use PT/OT
    3. Grab other HCP for moving patients

Nursing Concepts

  1. Safety

Patient Education

  1. Make sure patients understand the use of call light and place it within reach

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Transcript

Hey guys, my name is Brad, and welcome to nursing.com. And in today’s video, what we’re going to be doing is we’re going to be discussing fall and injury prevention. How to prevent falls in patients, and how to prevent injury and healthcare workers. Let’s dive in. 

Now, whenever it comes to falling injury prevention, it’s important to note that prevention is paramount. What did they say? An ounce of prevention is worth a pound of cure, right? Prevention is of the utmost importance whenever it comes to keeping patients safe, preventing falls, preventing injury. And it’s important to know that it all starts with you. 

So it’s important to know what are some of the risk factors associated with increased falls? What patient populations, or what things cause people to be at a higher susceptibility for falling, right? Well we’re talking about age. Okay. Certainly geriatric patients, elderly patients are at an increased risk of falling, just inherently. People who have cognitive disabilities, right? People experiencing things such as delirium or also dementia. People with some sort of cognitive impairment are always at an increased risk of falling. Now there are, of course, medications that can increase a person’s risk of falling as well, right? Things such as pain, medications, sedation medications, maybe muscle relaxers, nerve medications, such as gabapentin. All of these lead to an increased probability of a patient ending up falling.  Now, lines, tubes, drains. This is a kind of a no-brainer, right? Patients who have JP drains, patients who have things over here such as chest tubes, right? Things that are actually connected to patients that would act as a tether or would act as an anchor, holding that patient down in the bed. Should they try to get up, they’re going to trip up. They’re going to fall.  Lines, tubes drains, IV poles, patients being hooked up to an IV pole, right. This right here is another thing that is going to lead to the possibility that a patient falls. And of course, a lot of the equipment that we have patients hooked up to as well. You know, whenever I speak to patients in the ICU, I feel bad for them, of course. You know, it’s like, I’ve never been hospitalized. And I can’t imagine what it’s like being kind of tied down to this bed with all of the drains, tubes, lines, and equipment that you’re hooked up to. I always have empathy for them because they’re so tied down. And all of these things that are hooked up to a patient such as EKG leads, such as SCDs, right? Sequential compression devices, those little leg massagers that we put on patients to squeeze their legs and prevent blood clots from forming. All of these things are tethers, are anchors, are things that can end up causing a patient to fall. 

So what are some things or interventions that we can do as nurses to try and help prevent falls in our patients? Right? Again, prevention is paramount.  Well, of course there are visual identifiers that we can put on our patients to help remind us, as well as any other member of the healthcare team who should interact with this patient, that, Hey, this person is a fall risk. And these things include things such as a fall bracelet on the patient’s risk or these bright yellow, neon yellow socks that have little grippers on the bottom to prevent patients from falling. You also have something such as the call bell, right? I found this cute little image, a call bell. I always make sure that I emphasize to my patients because patients falling is such a big deal. A lot of our patients in the hospital are on blood thinners. Sometimes subcutaneous heparin, sometimes intravenous heparin to try and prevent blood clots when they’re in the hospital. Patients on blood thinners, if they fall, they hit their head, intracranial bleed. It’s incredibly important. I couldn’t stress it more so.  So I always emphasize to my patients, look, this is your call bell. Here is your call bell. I put it in their lap. This big red button is all that you have to push. Push the red button, right? If you need anything, I don’t care how small it is. It’s so important to emphasize that.  Make sure that the patient’s bed is actually low and in the locked position. Also sometimes it’s important to put on bed alarms should a patient be, you know, trying to climb out of bed. It happens. Okay. Another kind of no-brainer is to declutter the room, right? Those SCDs, those foot pumps, tubes, wires, all sorts of things strown about on the floor that could end up leading to a patient falling. You want to make sure that the patient has any assisted devices, walkers, canes, anything that they need in order to increase their mobility and prevent falling. And again, although this is down here on kind of near the bottom of the list, I couldn’t agree with this right here more – proper lighting is so crucial. The first thing I do whenever I go into a patient’s room and it’s time to do any kind of mobility or activity, we’re turning the lights on so that we have proper visualization so that you, as the patient, can see everything in the room, everything in the floor, and hopefully again, prevent these falls. 

Now, again, knowing that prevention is paramount. How do we, as healthcare providers prevent injury to ourselves, right? We want to prevent injury to ourselves. It’s super crucial. It’s very important. If you speak with any seasoned nurse, who’s been at the bedside for, you know, they’re, they’re floating around out there in every department, right? Seasoned nurses who have been doing this for a long time, they will testify to this. This is so crucial, right? You want to protect yourself. You cannot pour from an empty cup, right? As a healthcare giver, we’re so used to giving and pouring into others. You cannot pour from an empty cup. So if you end up hurting yourself, it’s important to make sure that you keep yourself safe so that you can then care for others. How do we do that? Well, we want to make sure that we have proper body mechanics. You know, as nurses, nursing is a physically strenuous job, right? We’re all the time helping get patients up out of bed, get them moving around after surgery, boosting patients up, turning patients in bed to clean patients up, a lot of different things that can end up causing us to hurt our backs. So proper body mechanics: lift with the legs, don’t bend over at the waist, don’t twist at the hips as you’re lifting things. A lot of stuff that we got taught a long time ago, but as nurses, whenever you’re at the bedside and everything is so busy, it’s easy to forget. So make sure that you don’t forget. And we also, of course, want to make sure that we’re protecting our back, raising that bed up to a proper working level, whenever we’re turning our patients, or whenever we’re boosting our patients up in bed. Also make sure that you get help with boosts. Okay. Do things to keep yourself safe. And some of the patient education associated with fall and injury prevention, some of the things that we’ve already gone over, but of course, again, emphasizing the call bell, call me for anything. I don’t care how small it is. I don’t care if you drop the straw on the ground and you want help getting that straw. It’s too great of a risk for you to try and get up alone. Again, maybe also emphasizing how crucially important it is that they don’t get up alone. Should they fall, what could occur.  Sometimes presenting that reality to the patients is important. Also, again, letting them know the risk of ambulating alone. And it’s also important that we utilize our friends with physical therapy and occupational therapy to assist us with ambulating the patient, giving the patient proper education related to ambulation, related to using proper body mechanics so that the patient themselves can prevent their own fall. 

And so to summarize some of our key points surrounding fall and injury prevention, it’s important to understand that prevention is paramount. It all starts with you as the nurse. An ounce of prevention is worth a pound of cure, et cetera. Important to understand a lot of those fall risk factors so that whenever you have a patient who is elderly or a patient who is cognitively impaired, or you realize on your MAR that your patient has a medication that can lead to an increased fall risk, you’ll be much more aware of them. Also understanding fall prevention goes hand in hand with a lot of these interventions that you can do to help prevent: keeping that call bell close by, call me for anything, bed low and locked, et cetera. Also, making sure that you keep in mind proper body mechanics and the way that you can prevent injury to yourself and the patient education that we just discussed. 

I hope that this helped bring a little bit of light to fall and injury prevention. I hope that you guys go out there and be your best selves today. And as always, happy nursing.

 

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Study Plan for Study Skills, Test Taking for the NCLEX® Using Med-Surg (Lewis 10th ed.) designed for Westmoreland County Community College

Concepts Covered:

  • Concepts of Population Health
  • Factors Influencing Community Health
  • Community Health Overview
  • Substance Abuse Disorders
  • Upper GI Disorders
  • Renal Disorders
  • Newborn Care
  • Integumentary Disorders
  • Tissues and Glands
  • Central Nervous System Disorders – Brain
  • Digestive System
  • Urinary Disorders
  • Urinary System
  • Musculoskeletal Trauma
  • Concepts of Mental Health
  • Health & Stress
  • Developmental Theories
  • Fundamentals of Emergency Nursing
  • Communication
  • Basics of NCLEX
  • Test Taking Strategies
  • Prioritization
  • Delegation
  • Emotions and Motivation
  • Integumentary Disorders
  • Legal and Ethical Issues
  • Basic
  • Preoperative Nursing
  • Labor and Delivery
  • Fetal Development
  • Newborn Complications
  • Postpartum Complications
  • Postpartum Care
  • Labor Complications
  • Pregnancy Risks
  • Prenatal Concepts
  • Circulatory System
  • Cardiac Disorders
  • Emergency Care of the Cardiac Patient
  • Vascular Disorders
  • Shock
  • Postoperative Nursing
  • Intraoperative Nursing
  • Oncology Disorders
  • Neurological Emergencies
  • Respiratory Disorders
  • Female Reproductive Disorders
  • Acute & Chronic Renal Disorders
  • Liver & Gallbladder Disorders
  • Lower GI Disorders
  • Disorders of Pancreas
  • Disorders of the Thyroid & Parathyroid Glands
  • Disorders of the Adrenal Gland
  • Disorders of the Posterior Pituitary Gland
  • Immunological Disorders
  • Hematologic Disorders
  • EENT Disorders
  • Integumentary Important Points
  • Musculoskeletal Disorders
  • Emergency Care of the Neurological Patient
  • Peripheral Nervous System Disorders
  • Central Nervous System Disorders – Spinal Cord
  • Neurologic and Cognitive Disorders
  • Eating Disorders
  • Noninfectious Respiratory Disorder
  • Respiratory Emergencies
  • Infectious Respiratory Disorder
  • Psychological Emergencies
  • Trauma-Stress Disorders
  • Personality Disorders
  • Cognitive Disorders
  • Bipolar Disorders
  • Depressive Disorders
  • Psychotic Disorders
  • Anxiety Disorders
  • Somatoform Disorders
  • Infectious Disease Disorders
  • Musculoskeletal Disorders
  • Renal and Urinary Disorders
  • Cardiovascular Disorders
  • EENT Disorders
  • Gastrointestinal Disorders
  • Hematologic Disorders
  • Oncologic Disorders
  • Endocrine and Metabolic Disorders
  • Childhood Growth and Development
  • Adulthood Growth and Development
  • Medication Administration
  • Nervous System
  • Dosage Calculations
  • Learning Pharmacology
  • Prefixes
  • Suffixes

Study Plan Lessons

Communicable Diseases
Disasters & Bioterrorism
Cultural Care
Environmental Health
Technology & Informatics
Epidemiology
Health Promotion & Disease Prevention
Head to Toe Nursing Assessment (Physical Exam)
Enteral & Parenteral Nutrition (Diet, TPN)
Specialty Diets (Nutrition)
Blood Glucose Monitoring
Intake and Output (I&O)
Hygiene
Pain and Nonpharmacological Comfort Measures
Bowel Elimination
Urinary Elimination
Complications of Immobility
Patient Positioning
Defense Mechanisms
Overview of Developmental Theories
Abuse
Therapeutic Communication
Overview of the Nursing Process
Triage
Prioritization
Delegation
Maslow’s Hierarchy of Needs in Nursing
Isolation Precaution Types (PPE)
Fall and Injury Prevention
Fire and Electrical Safety
Brief CPR (Cardiopulmonary Resuscitation) Overview
HIPAA
Advance Directives
Legal Considerations
Process of Labor
Fetal Circulation
Fetal Environment
Newborn of HIV+ Mother
Hyperbilirubinemia (Jaundice)
Transient Tachypnea of Newborn
Meconium Aspiration
Babies by Term
Newborn Reflexes
Body System Assessments
Newborn Physical Exam
Postpartum Hemorrhage (PPH)
Mastitis
Initial Care of the Newborn (APGAR)
Breastfeeding
Postpartum Discomforts
Postpartum Physiological Maternal Changes
Dystocia
Precipitous Labor
Preterm Labor
Abruptio Placentae (Placental abruption)
Placenta Previa
Prolapsed Umbilical Cord
Fetal Heart Monitoring (FHM)
Leopold Maneuvers
Mechanisms of Labor
Fetal Development
Infections in Pregnancy
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Gestational HTN (Hypertension)
Hydatidiform Mole (Molar pregnancy)
Ectopic Pregnancy
Disseminated Intravascular Coagulation (DIC)
Gestational Diabetes (GDM)
Nutrition in Pregnancy
Chorioamnionitis
Antepartum Testing
Discomforts of Pregnancy
Physiological Changes
Maternal Risk Factors
Fundal Height Assessment for Nurses
Gravidity and Parity (G&Ps, GTPAL)
Gestation & Nägele’s Rule: Estimating Due Dates
Family Planning & Contraception
Menstrual Cycle
Hemodynamics
Normal Sinus Rhythm
Performing Cardiac (Heart) Monitoring
Preload and Afterload
Sinus Bradycardia
Sinus Tachycardia
Atrial Fibrillation (A Fib)
Premature Ventricular Contraction (PVC)
Ventricular Tachycardia (V-tach)
Ventricular Fibrillation (V Fib)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)
Nursing Care and Pathophysiology for Heart Failure (CHF)
Nursing Care and Pathophysiology of Angina
Pacemakers
Nursing Care and Pathophysiology of Hypertension (HTN)
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology for Thrombophlebitis (clot)
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Cardiogenic Shock
Nursing Care and Pathophysiology for Distributive Shock
Discharge (DC) Teaching After Surgery
Postoperative (Postop) Complications
Post-Anesthesia Recovery
Malignant Hyperthermia
Moderate Sedation
Local Anesthesia
Preoperative (Preop)Assessment
General Anesthesia
Preoperative (Preop) Nursing Priorities
Preoperative (Preop) Education
Informed Consent
Biopsy
Ultrasound
Echocardiogram (Cardiac Echo)
Cardiovascular Angiography
Cerebral Angiography
Magnetic Resonance Imaging (MRI)
X-Ray (Xray)
Computed Tomography (CT)
Nursing Care and Pathophysiology for Menopause
Nursing Care and Pathophysiology for Endometriosis
Nursing Care and Pathophysiology for Pelvic Inflammatory Disease (PID)
Dialysis & Other Renal Points
Nursing Care and Pathophysiology of Chronic Kidney (Renal) Disease (CKD)
Nursing Care and Pathophysiology of Urinary Tract Infection (UTI)
Nursing Care and Pathophysiology of Glomerulonephritis
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology of Acute Kidney (Renal) Injury (AKI)
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care and Pathophysiology for Crohn’s Disease
Nursing Care and Pathophysiology for Ulcerative Colitis(UC)
Nursing Care and Pathophysiology for Inflammatory Bowel Disease (IBD)
Nursing Care and Pathophysiology for Appendicitis
Nursing Care and Pathophysiology for Peptic Ulcer Disease (PUD)
Nursing Care and Pathophysiology for Pancreatitis
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Diabetes Management
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care and Pathophysiology for Diabetes Insipidus (DI)
Addisons Disease
Nursing Care and Pathophysiology for Anaphylaxis
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Oncology Important Points
Lymphoma
Leukemia
Blood Transfusions (Administration)
Nursing Care and Pathophysiology for Disseminated Intravascular Coagulation (DIC)
Glaucoma
Macular Degeneration
Hearing Loss
Fractures
Cataracts
Integumentary (Skin) Important Points
Nursing Care and Pathophysiology of Osteoarthritis (OA)
Nursing Care and Pathophysiology of Osteoporosis
Burn Injuries
Pressure Ulcers/Pressure injuries (Braden scale)
Nursing Care and Pathophysiology for Herpes Zoster – Shingles
Nursing Care and Pathophysiology for Meningitis
Nursing Care and Pathophysiology for Seizure
Seizure Therapeutic Management
Seizure Assessment
Seizure Causes (Epilepsy, Generalized)
Stroke Nursing Care (CVA)
Nursing Care and Pathophysiology for Ischemic Stroke (CVA)
Stroke Therapeutic Management (CVA)
Stroke Assessment (CVA)
Nursing Care and Pathophysiology for Hemorrhagic Stroke (CVA)
Miscellaneous Nerve Disorders
Nursing Care and Pathophysiology for Parkinsons
Nursing Care and Pathophysiology for Multiple Sclerosis (MS)
Cerebral Perfusion Pressure CPP
Intracranial Pressure ICP
Adjunct Neuro Assessments
Levels of Consciousness (LOC)
Routine Neuro Assessments
Hemoglobin A1c (HbA1C)
Glucose Lab Values
Urinalysis (UA)
Creatinine (Cr) Lab Values
Blood Urea Nitrogen (BUN) Lab Values
Ammonia (NH3) Lab Values
Cholesterol (Chol) Lab Values
Albumin Lab Values
Coagulation Studies (PT, PTT, INR)
Platelets (PLT) Lab Values
White Blood Cell (WBC) Lab Values
Hematocrit (Hct) Lab Values
Red Blood Cell (RBC) Lab Values
Hemoglobin (Hbg) Lab Values
Chloride-Cl (Hyperchloremia, Hypochloremia)
Sodium-Na (Hypernatremia, Hyponatremia)
Potassium-K (Hyperkalemia, Hypokalemia)
Hypertonic Solutions (IV solutions)
Hypotonic Solutions (IV solutions)
Isotonic Solutions (IV solutions)
Base Excess & Deficit
Metabolic Alkalosis
Metabolic Acidosis (interpretation and nursing diagnosis)
Respiratory Alkalosis
Respiratory Acidosis (interpretation and nursing interventions)
ABG (Arterial Blood Gas) Interpretation-The Basics
ABGs Nursing Normal Lab Values
Chest Tube Management
Nursing Care and Pathophysiology of Pneumonia
Artificial Airways
Airway Suctioning
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Nursing Care and Pathophysiology for Influenza (Flu)
Nursing Care and Pathophysiology for Tuberculosis (TB)
Lung Sounds
Alveoli & Atelectasis
Gas Exchange
Nursing Care and Pathophysiology for Asthma
Suicidal Behavior
Eating Disorders (Anorexia Nervosa, Bulimia Nervosa)
Alcohol Withdrawal (Addiction)
Grief and Loss
Paranoid Disorders
Personality Disorders
Cognitive Impairment Disorders
Mood Disorders (Bipolar)
Depression
Schizophrenia
Generalized Anxiety Disorder
Post-Traumatic Stress Disorder (PTSD)
Somatoform
Dissociative Disorders
Anxiety
Pertussis – Whooping Cough
Varicella – Chickenpox
Mumps
Rubeola – Measles
Scoliosis
Attention Deficit Hyperactivity Disorder (ADHD)
Autism Spectrum Disorders
Spina Bifida – Neural Tube Defect (NTD)
Meningitis
Enuresis
Nephrotic Syndrome
Cerebral Palsy (CP)
Mixed (Cardiac) Heart Defects
Obstructive Heart (Cardiac) Defects
Defects of Decreased Pulmonary Blood Flow
Defects of Increased Pulmonary Blood Flow
Congenital Heart Defects (CHD)
Cystic Fibrosis (CF)
Asthma
Acute Otitis Media (AOM)
Bronchiolitis and Respiratory Syncytial Virus (RSV)
Tonsillitis
Conjunctivitis
Constipation and Encopresis (Incontinence)
Intussusception
Appendicitis
Celiac Disease
Pediatric Gastrointestinal Dysfunction – Diarrhea
Vomiting
Hemophilia
Nephroblastoma
Fever
Dehydration
Sickle Cell Anemia
Burn Injuries
Pediculosis Capitis
Impetigo
Eczema
Growth & Development – School Age- Adolescent
Growth & Development – Preschoolers
Growth & Development – Toddlers
Growth & Development – Infants
Care of the Pediatric Patient
Vitals (VS) and Assessment
Vasopressin
TCAs
SSRIs
Proton Pump Inhibitors
Vancomycin (Vancocin) Nursing Considerations
Ciprofloxacin (Cipro) Nursing Considerations
Metronidazole (Flagyl) Nursing Considerations
Anti-Infective – Penicillins and Cephalosporins
Parasympatholytics (Anticholinergics) Nursing Considerations
NSAIDs
Nitro Compounds
MAOIs
Hydralazine (Apresoline) Nursing Considerations
Insulin
Magnesium Sulfate
HMG-CoA Reductase Inhibitors (Statins)
Histamine 2 Receptor Blockers
Histamine 1 Receptor Blockers
Epoetin Alfa
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Corticosteroids
Benzodiazepines
Cardiac Glycosides
Calcium Channel Blockers
Parasympathomimetics (Cholinergics) Nursing Considerations
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Autonomic Nervous System (ANS)
Atypical Antipsychotics
Angiotensin Receptor Blockers
ACE (angiotensin-converting enzyme) Inhibitors
Renin Angiotensin Aldosterone System
Complex Calculations (Dosage Calculations/Med Math)
IV Infusions (Solutions)
Injectable Medications
Oral Medications
Basics of Calculations
Dimensional Analysis Nursing (Dosage Calculations/Med Math)
The SOCK Method – K
The SOCK Method – C
The SOCK Method – O
The SOCK Method – S
The SOCK Method – Overview
6 Rights of Medication Administration
Essential NCLEX Meds by Class
12 Points to Answering Pharmacology Questions
Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)
54 Common Medication Prefixes and Suffixes