A nurse is admitting and orienting an older adult to the hospital ...

[tingc95]

A nurse is admitting and orienting an older adult to the hospital unit. She discusses fall preven-tion and demonstrates the use of the call bell to the patient. The patient's daughter asks:
 
  Why don't you just put up all the side rails to prevent my mother from getting out of bed by herself and falling. That should work, right? The best response by the nurse is:
  a. Side rails have only proven to be effec-tive in decreasing falls in patients who have already fallen.
  b. There is no evidence that side rail use decreases falls, and in fact there is a greater risk of injury.
  c. Side rails are only effective when used with patients who have dementia.
  d. Side rails do not decrease falls, but they do decrease fall-related injuries.

Question 2

A nurse in a long-term care facility notes that there has been an increase in falls on one unit and that many of the falls are occurring immediately following mealtime.
 
  The nurse recommends that the nursing home conduct a trial of six smaller meals instead of the three traditional meals. The nurse makes this recommendation on the understanding that:
  a. postural changes in blood pressure are common in older adults and frequently occur around mealtimes.
  b. postprandial hypotension occurs after in-gestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide.
  c. residents of long term care facilities are often on many different medications, which are given at mealtimes.
  d. it is common practice to take long term care residents to the bathroom immediate-ly following meals.

[rnehls]

Answer to Question 1

ANS: B
There is no evidence to date that side rail use decreases the risk or rate of fall occurrence. There are numerous reports and studies documenting the negative effects of side rail use, including en-trapment deaths and injuries that occur when the person slips through the side rail bars or be-tween split side rails, the side rail and the mattress, or between the head or footboard, side rail, the mattress, or between the head or footboard, side rail, and mattress.

Answer to Question 2

ANS: B
Postprandial hypotension occurs after ingestion of a carbohydrate meal and may be related to the release of a vasodilatory peptide. Modifications such as increased water intake before eating or substituting six smaller meals daily for three larger meals may be effective. Orthostatic hypoten-sion is a cause of falls in older adults, but does not just occur around meal times. While it is true that residents of long term care facilities are on multiple medications and are usually toileted fol-lowing meals, neither of these options addresses postprandial hypotension.