Communication is Key in Preventing Falls

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WELCOME

NURSING SCIENCE

Nursing-sensitive indicators for nursing care: A systematic review (1997-2017)

EDUCATION

Critical Thinking Case Study

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PRACTICE

Keeping the Patient at the Center of our Care

PROFESSIONAL DEVELOPMENT

Nursing Leadership Academy (NLA): How to develop a program by going back to basics

FROM OUR TEAMS

PCA Immersion Program

Communication is Key in Preventing Falls

ABOUT DISCOVERN

Case Study 1

A 25-year-old female underwent surgical reconstruction of the right fractured femur. Currently, she is on PCA pump morphine post-op. She is drowsy and the food services notified the RN of her drowsiness and incoherence. CERT team was initiated and the ABG results are as follows:

Normal Ranges

7.26

(7.35-7.45)

PaO₂

(80-100)

PaCO₂

(35-45)

HCO₃

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 52 – High – Culprit of the change
HCO₃ – 25 – Normal

Results

Respiratory Acidosis

Discussion: In this case, respiratory depression is being caused by the side effects of Morphine. As a result, the body is no longer exhaling CO₂ at an acceptable rate, causing the CO₂ level to be high at 52. The CO₂ levels in the body are increasing and thereby altering the pH.

NOTE: If this process were to occur chronically, the body would eventually COMPENSATE by adjusting the HCO₃ levels.

Analysis

Case Study 2

ABG values of A 33-year-old male post-op day 3 are as follows:

Normal Ranges

7.32

(7.35-7.45)

PaCO₂

(35-45)

HCO₃

(22 – 26)

pH – 7.26 – Low – Acidosis

Cause of change in pH

PaCO₂ – 40 – Normal CO₂ tension
HCO₃ – 20 – Low – Culprit of the change

Results

Metabolic Acidosis

Discussion: This patient is in metabolic acidosis. In this case, a clinical picture would be necessary to further determine the cause. From his blood gas analysis, we can recognize that the changes in his pH are due to a metabolic component, rather than respiratory. The surgery can cause a pH imbalance due to dehydration, trauma to certain tissues, or kidney disease.

Analysis

Case Study 3

A 27-year-old male patient is admitted with complaints of shortness of breath, chest tightness, and tingling of fingers and mouth. No past medical history. ABG results are as follows:

Normal Ranges

7.49

(7.35-7.45)

PaO₂

(80-100)

PaCO₂

(35-45)

HCO₃

(22 – 26)

(-2 to +2)

pH – 7.49 – High – Alkalosis

Cause of change in pH

PaCO₂ – 25 – Low – Culprit of the change
HCO₃ – 22 – Normal
BE – +2 – Normal

Results

Respiratory Alkalosis

Discussion: Respiratory alkalosis is most commonly caused by hyperventilation. During hyperventilation, the patient is breathing too fast and releasing too much CO2. As a result, the PaCO2 level is low and the pH is high. Treatment for this patient would include slowing their breathing and treating the underlying reason for the hyperventilation.

Analysis

Case Study 4

A 58-year-old female admitted with complaints of profuse vomiting and abdominal distention in the last 24 hours. CT scan reveals a large mass causing bowel obstruction. ABG results are as shown below:

Normal Ranges

7.51

(7.35-7.45)

PaO₂

(80-100)

PaCO₂

(35-45)

HCO₃

(22 – 26)

(-2 to +2)

Analysis

pH – 7.51 – High – Alkalosis

Cause of change in pH

PaCO₂ – 42 – Normal
HCO₃ – 30 – High – Culprit of the change

Results

Metabolic Alkalosis

Discussion: Metabolic alkalosis in this patient is most likely related to bowel obstruction, which is causing vomiting and excessive fluid loss. The bicarbonate level is high as the blood is more concentrated from free fluid loss and the kidneys are unable to eliminate the excess hydrogen ions. As a result, more bicarbonate is produced.

FROM OUR TEAMS

Communication is Key in Preventing Falls

By Christine Ouko, MSN, RN-BC

As we go back to the basics, it is important to focus on communication. The Unit Administrative Assistant (UAA) is the face of the unit and ensures things run smoothly. To do this, you help close the loop of communication as they relay information between healthcare providers, patients, and family members. This communication can be especially important in deterring falls on the unit.

Why are falls relevant to you as a UAA? Fall prevention decreases the length of hospital stay, hospital cost, mortality rates, unnecessary discharge to long-term care facilities, and long-term cognitive impairment.

The UAA plays a pivotal role in the management and prevention of falls in the unit. They are the first point of contact when a patient calls from the room. They are also key in communicating the message to the appropriate healthcare provider to meet the patient’s needs. These points of communication can be pivotal in ensuring that the patient is able to receive prompt care, thereby preventing falls.

There are many other ways that communicating information about the patient can help keep them safe. The simple task of making sure that the correct Hester-Davis Fall Risk sign is outside the door communicates to all healthcare providers with which patients need to be exceptionally vigilant. Communicating to the oncoming UAA about which patients are high fall risks or are confused ensures that the patient’s needs are met quickly so that they do not attempt to get up and potentially fall.

Effective communication by you, the UAA, can promote efficient delivery of care to the patient to prevent falls. Your role in the unit is pivotal in creating a safer environment. Contact us and let us know other ways where communication can be key in preventing falls!

FROM OUR TEAMS

PCA Immersion Program

PRACTICE

Keeping the Patient at the Center of our Care

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