Patient education should she receive for fall precautions

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Reference no: EM133829718

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Donna is an 82-year-old WF presenting for follow-up after a 2-week intense inpatient rehab following hospitalization for uncontrolled A-fib. While in the hospital, the doctor was unable to get her cardioverted with adenosine push or amiodarone IV. Donna required a pacemaker and underwent an AV ablation 6 days later. Additionally, 4 weeks ago (3 days before the A-fib exacerbation), Donna had a devastating fall at home resulting in multiple injuries. She was pushing a garbage can to the street and fell on the way back to her garage. This is her 3rd fall in the last 2 months; however, the other two were inside the house with no injuries. Prior to this hospitalization, Donna lived alone and handled all of her IADLs and ADLs; however, her daughter is currently staying with her as she requires both assistance and supervision. Her daughter voices concern that her mother will not ask for help (like taking the garbage to the street). Donna is A&O x 3 but does lack insight and judgment regarding her current physical abilities. She currently needs assistance getting up out of a chair. Her gait is steady with the walker, but she is unable to safely ambulate without it. PmHx: Allergies: PCN Chronic Illnesses: HTN (20+ years), Hyperlipidemia (20+ years), CAD with a stent place in her LAD (10 years), CHF (10 years), COPD (20+ years), Diabetes (20+ years), Peripheral Neuropathy (15 years), Osteoarthritis (10+ years), Bladder Incontinence at times, Constipation at times, and Vascular Dementia (mild) 3+ years. Acute Illnesses: Has seasonal allergies and has been taking Zyrtec and Flonase prn. Injuries: Fell in her driveway 4 weeks ago and suffered a broken left middle finger with a Mallet finger injury, mildly displaced fracture of the right orbital floor, and multiple deep tissue injuries on knees, hands, and face. Meds: Rx: Valsartan 40mg qd, Xarelto 20mg, Metoprolol 25mg bid, Furosemide 20mg qd, Klor-Con 10mEq, Rosuvastatin 10mg, Metformin 1000mg bid, Lantus 62u qd, Trulicity 4.5mg qwk, Jardiance 10mg qd, Anora Ellipta 62.5/25 mcg, Gabapentin 300 mg qd, Duloxetine 30mg hs, Doxepin 10mg hs, Ambien 10mg hs OTC: Alpha Lipoic Acid, MVI, Calcium, Vit D3, Zinc, Vit C, Flonase prn, Zyrtec 10mg prn Hospitalizations: 3x in the past year for A-Fib, 2 additional ER visits in the last year, once for a nosebleed and the other for a Fall. Other recent hospitalizations include pneumonia 2 years ago, and UTI 3 years ago. Surgeries: A/V node ablation 2 weeks ago, Pacemaker placed 3 weeks ago, Back fusion for spinal stenosis 8 years ago, Stent in LAD 10 years ago, Cholecystectomy 25 years ago. Family History: Mother and Grandmother with HTN, CAD, and Hyperlipidemia (both deceased), Father died of multiple myeloma. Social: Smoker 2.5 packs a day for 20 years. Quit 30 years ago. No ETOH or illicit drug use. Not sexually active for 30+ years. Retired nurse. Lives alone. Financially stable. Health Maintenance: Up to date on Covid and Flu Vaccines. Has received Shingles and Pneumonia Vaccines. Mammogram 3 years ago. Colonoscopy 9 years ago. Assistive Devices at Home: Walker, rollator, 4-prong cane, shower chair, bedside commode; however, she was only using the walker and shower chair before hospitalization.

Question: Read over Donna's history and list ALL the risk factors she has for falls. What patient education should she receive for fall precautions? According to the Henrich II Fall Risk Model, is she a high risk for falls? What information do you still want to know about her risk? Is she on any medications that need review? What, if any, changes would you make? What referrals will she need now that she is home from the hospital?

Reference no: EM133829718

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