Which intervention should the nurse prioritize to prevent future falls in a patient with mild osteoarthritis and a sedentary lifestyle?

A) Encourage regular, moderate exercise such as walking or tai chi

B) Increase the dosage of acetaminophen to manage pain

C) Advise complete bed rest to avoid strain on the knee

D) Recommend a high-protein diet to support muscle growth

Based on the initial assessment findings, which of the following interventions would be most appropriate to recommend to the patient to enhance joint stability and prevent future falls?

A) Encourage participation in tai chi exercises

B) Advise complete bed rest until the knee heals

C) Suggest over-the-counter calcium supplements

D) Recommend a high-protein diet to build muscle

What is the primary reason for the patient's improvement in knee pain and range of motion?

B) Adherence to the exercise regimen

What is the primary reason for encouraging a patient to continue an established exercise routine following successful pain management and improved joint function?

B) To maintain and further improve joint mobility and strength.

A) To ensure the patient remains busy and distracted.

B) To maintain and further improve joint mobility and strength.

C) To prevent weight gain due to decreased activity levels.

D) To increase the patient's heart rate for cardiovascular benefits.

Which intervention is most appropriate for a patient experiencing mild orthostatic hypotension?

C) Suggest the patient rise slowly from sitting or lying positions

A) Encourage rapid changes in position to adapt to dizziness

B) Advise the patient to decrease water intake to avoid fluid overload

C) Suggest the patient rise slowly from sitting or lying positions

D) Recommend the patient avoid all physical activities to prevent dizziness

What recommendation should the nurse prioritize to help the patient manage his mild orthostatic hypotension?

B) Encourage the patient to rise slowly from sitting or lying positions.

A) Increase daily fluid intake beyond eight glasses of water.

B) Encourage the patient to rise slowly from sitting or lying positions.

C) Advise the patient to avoid any physical activity that might trigger dizziness.

D) Suggest the patient consume a high-salt diet to elevate blood pressure.

What is the most appropriate nursing intervention to prevent orthostatic hypotension in this patient?

B) Advise the patient to rise slowly from sitting or lying positions.

A) Encourage the patient to increase salt intake significantly.

B) Advise the patient to rise slowly from sitting or lying positions.

C) Suggest the patient avoid all physical activities to prevent dizziness.

D) Recommend the patient to reduce fluid intake to decrease blood pressure fluctuations.

During a follow-up visit, a nurse assesses a patient who reports improvement in dizziness symptoms and continues to practice recommended balance exercises. Which statement by the patient indicates a correct understanding of managing orthostatic hypotension?

C) 'I will continue to practice my balance exercises and rise slowly from sitting to standing.'

A) 'I should drink less water to avoid feeling dizzy.'

B) 'I need to rise quickly from sitting to standing to improve my circulation.'

C) 'I will continue to practice my balance exercises and rise slowly from sitting to standing.'

D) 'I can stop my exercises since my dizziness has improved.'

Falls - Nursing Case Study

Pathophysiology

• Primary mechanism: Balance disturbances - As people age or due to certain conditions, the body's balance system, involving the inner ear, vision, and proprioception, becomes less effective, increasing the risk of falls.

• Secondary mechanism: Muscle weakness - Weak muscles, often due to inactivity or neurological conditions, reduce stability and the ability to recover from a loss of balance, leading to falls.

• Key complication: Minor injuries - Even minor falls can lead to bruises, sprains, or small fractures, which can significantly impact mobility and confidence, potentially leading to a cycle of reduced activity and increased fall risk.

Patient Profile

Demographics:

65-year-old male, retired teacher

History:

• Key past medical history: Mild osteoarthritis

• Current medications: Acetaminophen PRN

• Allergies: None

Current Presentation:

• Chief complaint: Recent fall while walking at home

• Key symptoms: Mild knee discomfort, no loss of consciousness

• Vital signs: Blood pressure 128/76 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F, SpO2 98% on room air

Section 1

Initial Assessment Findings:

During the initial assessment, the nurse conducts a focused physical examination and finds that the patient has mild swelling and tenderness around the right knee, with a slight limitation in range of motion. The patient reports mild pain rated at 3 out of 10, which is exacerbated by bending or putting weight on the knee. There are no signs of bruising or visible deformities, and the patient is able to bear weight with some discomfort, indicating the absence of a fracture. The nurse performs a balance test and observes slight unsteadiness when the patient stands on one leg, suggesting a minor balance impairment likely contributing to the fall.

The nurse reviews the patient's medication and lifestyle, finding that the patient takes acetaminophen on an as-needed basis and has a sedentary lifestyle, having retired from teaching without incorporating regular physical activity into his daily routine. Given the patient's mild osteoarthritis and recent fall, the nurse identifies the need for interventions aimed at improving balance and strengthening muscles. The nurse educates the patient on the importance of regular, moderate exercise to enhance joint stability and balance, suggesting simple activities such as walking or tai chi. Additionally, the nurse advises using assistive devices, like a cane, for added support when needed, to prevent future falls. The assessment findings and recommendations are documented, and a follow-up appointment is scheduled to monitor progress and adjust the care plan as necessary.

Section 2

Response to Interventions:

Two weeks after the initial assessment, the patient returns for a follow-up appointment. The nurse notes that the patient has been consistently following the recommended exercise regimen, incorporating daily 20-minute walks and practicing tai chi exercises three times a week. The patient reports feeling more stable and confident when moving around. Upon examination, the nurse observes that the swelling around the right knee has decreased significantly, and the range of motion has improved, with the patient able to bend the knee more comfortably. The pain level has reduced to 1 out of 10 during rest and 2 out of 10 when bearing weight, indicating effective pain management and improved joint function.

The patient shares that he has started using a cane for added support, especially during longer walks, which has contributed to his increased confidence and reduced fear of falling. Vital signs are stable: blood pressure is 128/78 mmHg, heart rate is 72 bpm, respiratory rate is 16 breaths per minute, and temperature is 98.6°F. The nurse performs another balance test, noting marked improvement in the patient's ability to stand on one leg with minimal unsteadiness. This positive response to the interventions suggests that the patient is on the right track toward enhancing balance and muscle strength.

Given the progress, the nurse encourages the patient to continue his current exercise routine and suggests gradually increasing the intensity as tolerated. The nurse also discusses the importance of maintaining a healthy diet to support joint health and overall well-being. A follow-up appointment is scheduled in four weeks to reassess the patient’s condition, ensuring that the current care plan continues to meet his needs and to make any necessary adjustments based on ongoing progress.

Section 3

Four weeks later, the patient returns for another follow-up appointment, and the nurse conducts a comprehensive assessment to evaluate any new changes in the patient’s condition. The patient reports feeling even more confident in his mobility and mentions he has increased the duration of his daily walks to 30 minutes, while still practicing tai chi exercises three times a week. He has also started incorporating some gentle strength-training exercises as advised. Upon examination, the nurse observes that the patient’s gait has become more stable, and he is able to walk longer distances with minimal use of the cane, which he now uses primarily for reassurance.

Vital signs remain stable: blood pressure is 126/76 mmHg, heart rate is 70 bpm, respiratory rate is 15 breaths per minute, and temperature is 98.4°F. The patient’s weight has decreased slightly, which aligns with his increased activity level and adherence to a healthier diet. The knee swelling has resolved, and the patient reports no pain at rest and only a slight discomfort rated at 1 out of 10 during extended periods of walking. A new balance test shows the patient can maintain a single-leg stance for a longer duration without support, indicating a significant improvement in balance and muscle strength.

Despite these positive developments, the patient mentions experiencing occasional mild dizziness when standing up quickly, a new symptom that has emerged over the past two weeks. The nurse considers this new information and discusses with the patient the importance of hydration and gradual position changes to prevent orthostatic hypotension. The nurse decides to monitor this symptom closely and suggests that the patient keep an activity and symptom diary to identify any patterns or triggers. A follow-up appointment is scheduled in another four weeks to reassess the patient’s progress and address the dizziness, ensuring continuous support and adjustment of the care plan as needed.

Section 4

At the follow-up appointment four weeks later, the patient arrives with his activity and symptom diary, which reveals a consistent pattern: the mild dizziness occurs predominantly in the mornings after getting out of bed or after sitting for extended periods. The nurse reviews the diary and notes that the patient has been diligent in staying hydrated, drinking at least eight glasses of water daily, and avoiding rapid position changes. The patient reports that the dizziness episodes are brief, lasting only a few seconds, and do not occur during his daily walks or tai chi sessions.

During the examination, the nurse observes that the patient's gait remains stable, and his confidence in mobility continues to grow. His blood pressure, measured both sitting and standing, shows a slight drop upon standing: 120/74 mmHg when seated and 110/70 mmHg upon standing, confirming mild orthostatic changes. Heart rate remains steady at 72 bpm, respiratory rate at 14 breaths per minute, and temperature at 98.2°F. The nurse discusses the importance of continuing to rise slowly from sitting or lying positions and reassures the patient that these minor orthostatic changes are common and manageable.

To further support the patient, the nurse recommends incorporating additional balance exercises, such as heel-to-toe walking, into his routine. The patient is encouraged to continue monitoring and documenting any dizziness occurrences, while also paying attention to meal times and ensuring regular, balanced nutrition to prevent any potential blood sugar fluctuations. A follow-up visit is planned in another month, with the intention to reassess the patient's progress, further evaluate the dizziness, and continue supporting his overall mobility and safety.

Section 5

At the follow-up visit one month later, the patient presents with a noticeable improvement in his dizziness symptoms. He reports that the dizziness episodes have significantly decreased in frequency and now occur only occasionally, usually when he forgets to rise slowly from a seated or lying position. The patient has diligently incorporated the recommended balance exercises, such as heel-to-toe walking, into his daily routine and expresses increased confidence in his ability to manage the mild orthostatic changes. His activity and symptom diary reflects this positive trend, with fewer entries of dizziness and continued engagement in daily walks and tai chi sessions.

During the examination, the nurse observes further stability in the patient's gait and mobility. His vital signs remain consistent: blood pressure is 118/76 mmHg when seated and 112/72 mmHg upon standing, indicating a slight but stable orthostatic response. Heart rate is steady at 70 bpm, respiratory rate at 14 breaths per minute, and temperature at 98.4°F. The nurse also reviews recent lab results, which show normal electrolyte levels and a stable hemoglobin A1c, ruling out any significant metabolic disturbances that could contribute to dizziness.

The nurse commends the patient for his adherence to hydration and nutrition recommendations, reinforcing the importance of continued monitoring and documentation of any symptoms. The patient is encouraged to maintain his current exercise routine and to remain mindful of positional changes. A follow-up visit is scheduled in two months to evaluate long-term progress and to ensure that the patient continues to experience improvements in his mobility and overall well-being. The nurse reminds the patient to reach out if there are any sudden changes in symptoms or new concerns, ensuring that support is readily available as needed.