The 80-year-old patient has fallen. The fall impacted the right ...

[future617RT]

The 80-year-old patient has fallen. The fall impacted the right arm and hip. The patient describes the fall as painful, the skin is intact, and neither edema nor redness is noted. What is the emergency department care team's best course of action?
 
  A) Discharge the patient home with instructions to follow up with the family doctor if further pain is noted.
  B) Assess the patient for fractures in spite of the absence of obvious signs or symptoms.
  C) Refer the patent to physiotherapy for rehabilitation.
  D) Design an exercise program to increase the patient's stamina to prevent future falls.

Question 2

In which of the following situations would the use of physical restraints most likely be justified?
 
  A) Mr. Y is agitated and aggressive while he is experiencing severe withdrawal from alcohol and is not responding to chemical sedation.
  B) Mrs. U, who has a diagnosis of dementia, was found wandering outside the hospital and nurses have been unable to redirect her to stay on the unit.
  C) Mr. I is delirious during the acute stage of his urinary tract infection and is ringing the call bell nearly continuously.
  D) Mrs. T is frequently entering other patients' rooms and attempting to crawl into others' beds.

[Bsand8]

Answer to Question 1

B
Feedback:
The absence of common signs and symptoms of fracture does not rule out the possibility of a fracture in older adults; a diagnostic workup would be indicated. Discharge would be premature, as would physiotherapy and an exercise program.

Answer to Question 2

A
Feedback:
Answer A best characterizes a situation where the client poses a risk and where restraints are a necessary last resort. In each of the other situations, alternative strategies should be implemented to address the problem in question.