Fall Risk and Cognition Assessments Case Study

Mrs. L is an 89-year-old widow who lives independently in her home. She drives, and she is an avid quilter. Her daughter lives within 2 miles and checks in daily with Mrs. L. by phone or in person.

Mrs. L has been admitted to your hospital with the diagnosis of R/O pneumonia.

Her past medical problems include the following:

· Bilateral hip replacements

· Detached retina × 2 (right eye)

· Osteoarthritis

· Depression

· Orthostatic hypotension

· Falls at home × 1

· Urinary frequency

· Insomnia (sleeps about 3 hours per night)

Mrs. L takes no medication, “not even an aspirin.”

Mrs. L uses her call button frequently to request assistance to the bathroom. Upon rounding, her nurse found Mrs. L on the floor, having crawled out of her bed with the side rails up. She was assessed and was found to have no injuries. Her gown was wet with urine. When asked to describe what happened, Mrs. L stated the following: “I called for help to the bathroom and no one came. So rather than wetting the bed, I managed to crawl over the side rails. I slipped on the floor trying to get to the bathroom.”

1. What are Mrs. L’s known risk factors (in the hospital) for falling?

· Environmental

· Medical conditions

· Unsafe behaviors

2. Using the Hendrich II Fall Risk Model (https://consultgeri.org/try-this/general-assessment/issue-8.pdf), determine Mrs. L’s fall risk score.

3. Mrs. L states she is “plagued by insomnia.” Using the Pittsburgh Sleep Quality Index (https://www.opapc.com/uploads/documents/PSQI.pdf), measure Mrs. L’s quality and patterns of sleep. Could Mrs. L’s sleeping pattern contribute to her risk for falls? What actions will you take based on your analysis?

4. Mrs. L is asked to complete the “Clock Drawing” portion of the Mini-Cog (http://mini-cog.com/wp-content/uploads/2015/12/Universal-Mini-Cog-Form-011916.pdf). She draws the clock showing 3 PM. Her drawing is missing the numbers 3, 4, and 5. One clock hand is pointing at 9 and the other is pointing at 12. For the “Three Word Recall” portion, Mrs. L remembers two words. What is her Mini-Cog score?

5. Having assessed Mrs. L’s fall risk and her cognitive state, develop one safety goal for each of the following:

· Environmental and equipment

· Gait and mobility

· New medications

· Anxiety, depression, and unsafe behavior

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You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.