Ms. Pm 's Observation

A patient who is admitted to a facility may be alert, oriented, and independent in ambulation. Add on intravenous (IV) tubing attached to a pole, a telemetry monitor, a foley catheter, and new medications for the patient. This patient now has fall risk factors. The purpose of this paper is to describe and evaluate change in preventing falls in the hospital setting.

At Brigham and Woman Hospital, this fall prevention program has been instituted throughout the facility. The protocol requires all patients to be screened for fall risk factors upon their admission to the hospital. Upon admission, nurses must conduct a throughout medical assessment, and use the Morse Fall Scale to assess patients mobility, muscle strength, gait, vision of patients because those conditions can put patients at increase risk for falls. At the end of each assessment, a number is provided to each patient determining the degree of fall and documented in the patient chart. For example, a patient might be a low risk for fall while another might at high risk for fall. In addition, the nurse must create a plan of care and

Patient 1 has a negative diagnosis, as all the cells are lower than 33%. Their average nuclear to cytoplasmic ratio was 13.32%, which is the lowest overall and is below 33%. This means patient 1 is not required to have any further tests done. They will just need to come for screening tests every 3 years. Patient 1’s cells were all blue, which means only a haematoxylin stain, was used. The blue indicates nuclei.

The multidisciplinary team (MDT) meeting that the author attended was regarding Laura 's case, a 62 year old lady that lives alone and had a fall followed by knee surgery on her right leg which now needed rehabilitation. Laura also has Hypertension, arthritis and was recently diagnosed with Parkinsons Disease, which is managed with medication.

Her procedure was performed by a physician in an outside department rather than the oncology advance practice providers. As a result, the physician performing the procedure did not have personal knowledge of the test required and was dependent on our providers to communicate this information. Had her procedure been performed at the bedside, the team would have likely been performed in the afternoon. This may have prompted further communication of the need of this test during bedside round with the attending or a second advance practice provider who would have likely done the

The Hendrich II Fall Risk assessment was chosen as one of the appropriate functional assessments, because the patient stated that he recently had fallen a few weeks ago. Moreover, while observing the patient during the conversation, I noticed slight tremors on the patient’s lower extremities that may place him at risk for falls.

Upon assessment, I found that both her lower legs had +1 edema, were red, skin was a bit peeling, and warm to touch. She reported a bit of tenderness on palpation. The right leg, however, had black “scabs” towards the outer side; upon palpation, I noticed that they were under the skin and I could not feel any bumps. Other than her lower legs, her skin was dry and intact, color consistent with her ethnicity, no surgical incisions, and mucous membranes were pink, moist, and intact. She had a #22 IV in her left hand, and the IV site was clean. She was oriented x3, calm and cooperative, had clear speech, had no weakness, no flaccid tone, and no numbness. Her strength was normal in upper extremity, and her lower extremities moved against resistance. Her pupils were round, equal in size, and reactive to light. Her blood pressure was 133/76, heart rate 94, oxygen saturation of 98% on room air, respiratory rate of 18, oral temperature of 36.7

1. Client was physically active before injury and diagnoses; she wants to return to active lifestyle.

Pt is a 69 y/o female referred to skilled PT due to decline in ADL’s of transfer and gait, BLE muscle weakness with decreased coordination, increasing confusion and required increasing assistance with functional ADL’s. Pt was noted with 2 fall incidents on 3/3/2018 and 3/19/2018. PMH: Alzheimer’s disease, cellulitis, hypertension, hyperlipidemia, depressive disorder. PLOF: a resident in assistive living facility (ALF), mod I with ADL’s and self care, bed mobility and transfer, SBA with ambulation w/o AD. CLOF: gait with no AD and SBA for 150’, standing dynamic balance at fair-, BLE coordination at fair-. Pt’s goal is return to prior level of function of I. The following article exploring cognitive reserve might help the patient as well as people

I directed Henderson to place her right foot in front of her left and keep her hand by her side while I demonstrate. Henderson was unable to keep balance without swaying. Henderson was then asked to stop before she hurt herelf. I demonstrated five times how to do the test and Henderson still had difficulties following instructions. Henderson also started the test without being promt to do so.

to Sparks and Taylor’s (2011), helping weak and unsteady patients get out of bed and

*insert article *attachedBesides being able to see the inside of a shoulder, doctors use different physical tests to evaluate the shoulder in order to determine what type of injury and how severe an injury may be. One such test was recently developed by Dr. Carl J. Basamania at the Womack Army Medical center in Fort Bragg, N.C. The test was developed to evaluate shoulder instability in a patient. During the test the Dr. or examiner stands next to the patient who is to lay flat on his/her back. The hand of the examined should is held firmly by the examiner. The examiner then pushes against the clavicle to stabilize th scapula, while they also gently hold the pectoral muscle with their thumb in order to be able to assess relaxation. The examiner then rotates the arm form neutral to full external rotation. If the patient has AIGHL incompetence there is a lack of tightening as the arm reaches full external rotation. The test has appeared to be highly accurate and may be of value to Dr.'s and surgeons alike. After doctors have determined what type and what degree of injury a patient has sustained using various tests it is on to the next step, rehabilitation.

Working on evidence-based practice, since traditional way of learning is not sufficient anymore due to the fact that change is inevitable in medical field (Crist, McVay, & Marocco, 2015a), put our profession in more complex yet very challenging task. It will open more intellectual questions and research to countercheck one research done from another. In regards with the discussion for this week, a clinical question for timed up and go (TUG) test had emerged, in regards with the effectiveness of timed up and go in predicting fall risks for elderly patients. Although it is widely used nowadays, it will still be beneficial to see if it can detect and predict if geriatric patient will be at risk if this test will be conducted or if PTs are just using the said test due to “being used by others”. As what Crist et al. (2015b) advised, first, practitioners should be able to have their clinical question, track down multiple research evidence (as noted in the chart), appraise the researches that had been seen, apply it and

Activities of Daily Living/Instrumental ADL –self-care activities due to lack of interest or pleasure, home-making, driving, dressing, and eating Addressing functional use of her right hand will optimize independence with ADLS

Patient also, has history of hypertension, GERD, morbid obesity, anemia, and depression. She reported that the past few months, she has been feeling very weak and overall generalized deconditioning. Her ability to care for herself including her activities of daily living (ADLs), and her basic physical needs (like bathing, grooming, ambulation, meal preparation, transportation, errands, and housekeeping), had decreased, and cannot consistently carry them out.