Chapter Seven

1. Chapter Seven Safety

2. Falls • Cause disability and may impair overall health • Most prevalent cause of death related to unintentional injury.

3. How many older adults experience falls? • ¾ • ½ • ⅓ • ¼

4. Answer C. ⅓

5. Contributing Factors • Changes in the body systems place older adults at a higher risk for falls. • Changes in the musculoskeletal, neurological, cardiovascular, genitourinary, and digestive systems that occur with natural aging may increase the risk. • In addition, the cognition, nutritional and hydration status, and the sensory impairments that may be present may increase risks.

6. Decreasing Risks for Falls • Clothing should fit properly. • Sensory assistive devices should be applied appropriately. • Medications that cause dizziness and drowsiness should be administered at night and those that cause urination or defecation should be given early in the day. • Maintaining safe blood glucose levels decreases dizziness. • Appropriate hydration decreases risk for orthostatic hypotension. • Durable medical equipment should be fitted for the patient.

7. Decreasing Risks for Falls: Environmental Concerns • Adequate lighting • Throw rugs should be avoided. • Hallways and rooms should be free from clutter and debris. • Restrooms should have appropriate safety equipment such as raised seats, nonslip rugs, and safety rails. • Outdoor safety includes stairs, walkways, and lighting.

8. When should medications that increase urination be administered? • Early in the morning • With the noon meal • With the evening meal • Before bed

9. Answer A. Early in the morning

10. Injury Prevention Related to Skin Integrity • Clothing should be loose, comfortable and lightweight; rough edges should be avoided. • Remove adhesives cautiously and gently. • Use pillows and pads for positioning. • Reposition at least every 2 hours. • Apply emollients to maintain moisture in the skin which will help to maintain skin integrity. Can be applied after bath. Ensure that staff follows policy about nail length.

11. How often should patients be repositioned? • When they request it • At least once a shift • At least every 4 hours • At least every 2 hours • At least hourly

12. Answer D. At least every 2 hours

13. Heat-Related Issues • Decreased responses and decreased adipose tissue may make patients may feel colder. • Decreased thirst and decreased sweat may cause internal temperature to rise. • Ensure that there are fans or air conditioners, but not blowing directly on patient. • Lower the temperature of a patient safely using tepid baths and cool cloth. • Assess for possible hyperthermia-Box 7.2

14. Cold-Related Issues • Decrease in adipose tissue and sedentary lifestyle may cause decrease in temperature. • Encourage blankets and multiple clothing layers. • Increased risk of heart attack in cold weather when performing strenuous activity • Assess for hypothermia-Box 7.2 Signs of Hypothermia

15. Dementia and Delirium • May be chronic or result from acute disease • Assess increasing isolation from friends, family, or activities • Increased risk of wandering and falls • Alarm system may be beneficial. • “Sun downing”-wandering or confusion that occurs in the evening hours • Identification bracelet-to help patient in case they become lost • Kitchen hazards must be addressed.

16. When do patients with dementia often display an increase in behaviors such as wandering? • Early in the morning • Late in the morning • Early in the afternoon • During the evening

17. Answer D. During the evening

18. Mental Health Disorders • Depression may manifest as increase in isolation, increased sleeping, and suicidal thoughts. • Anxiety may be exhibited by insomnia and verbalization. • Post-traumatic stress may include flashbacks, and may put the patient and others at risk for injury. • Substance abuse increases the risk of overdose and suicide (self-harm).

19. Social Isolation • May be cyclical and cause a decline in mental health

20. Sexual Safety • A topic that is often avoided in older adult care • A thorough assessment is important in providing holistic patient care. In order to be able to assist the patient receive a more holistic approach to the care they receive

21. Sexuality • More than 20% have not disclosed sexuality to doctor. • If admit to being other than heterosexual they believe that their care may be substandard • Sexual orientation discrimination in housing • Legal rights of significant others • Remember to include all people that might be involved with patient, this includes not the typical forms of relationships that we are accustomed to • Bullying and alienation from family and caregivers

22. Sexual Activity • Sexually transmitted diseases are increasing in older adults. • Only 12% of men and 32% of women in this population report using safety precautions.

23. To improve safety in intimate relationships, the nurse should encourage which of the following? • To avoid them • To use barrier devices • To alert health-care providers • To discuss feelings related to intimacy

24. Answer B. To use barrier devices

25. Elder Abuse • 10% have been reported victims; however, it is estimated that only 20% are reported. • Categories • Physical: damage or injury to physical body • Psychological/emotional: damage to the perception of well-being; at times children may use intimidating methods when caring for their parents • Financial/material abuse: misuse of funds, taking money or property • Sexual abuse: forced participation in a sexual act • Neglect and abandonment: not providing basic needs or leaving alone for extended periods when unable to perform self-care

26. Nursing Care for Suspected Abuse • Communicate • LISTEN to the patient • Mandatory reporting

27. What is the appropriate action when the nurse suspects abuse? • Ignore it. • Ask the patient directly. • Confront the suspected abuser. • Notify the appropriate agency.

28. Answer D. Notify the appropriate agency.

29. Emergency Situations • Increased risk compared to general population • Prevention!! • Fire • Flooding • Carbon monoxide poisoning • Food poisoning • REMEMBER SAFETY OF THE CLIENT IS ALWAYS FIRST. ENSURE THEY ARE SAFE BY REMOVING THEM FROM HARMS WAY

30. Natural and Manmade Disasters • 59% of those 50 to 74 years old and 85% over 75 years old reported inability to evacuate in an emergency. • Safety bags-should include money, cell phone and charger, medications for at least 10 days, food and water for at least 3 days • Phone access-ensure cell phone is charged • Life alert systems

31. Safety in the Home: Communication • LISTEN • Fall risks • Risks for impaired tissue integrity • Temperature extremes • Mental health • Sexual safety • Elder abuse • Emergency situations

32. Safety in the Home: Inspection • Allowed to make lifestyle choices • Visually assess for issues within and around the home. • Determine if you can see any issues that were not verbalized.

33. Contacting Resources • To address safety concerns • Based on communicated needs • May include support groups, food delivery, home repair organizations, assistance with housework, legal assistance, and registries in case of disasters