Nursing Care of the Postmenopausal Woman, 3rd Edition
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ken bones. Head injuries and fractures can rob a woman of her independence. Even if her injuries from a fall are minimal, she may develop a fear of falling, which can lead to fear of movement, resulting in reduced mobility and a greater danger of falls (NIA, 2022). Eight areas must be checked after a fall: ● Signs/symptoms of current illness: Is the woman having any generalized weakness, delirium, or other symptoms of illness? Could she have a urinary tract infection? Be dehydrated? Have anemia? ● Blood pressure : Did her blood pressure drop when she went from a sitting to a standing position? This could be a reaction to a blood pressure medication. ● Labs : Blood tests will ensure her blood cell count, electrolytes, and kidney function are normal. The provider might also check sodium, blood sugar, and other related levels. ● Current medications : Medication reconciliation will be discussed more in this section. ● Gait and balance : The provider should watch the woman walk to see if her gait is abnormal and to ascertain whether she is experiencing pain or discomfort. She might also need to be assessed by physical therapy staff for suitable strength exercises or fitted for an assistive device, such as a walker or cane. ● Vitamin D level : Recent studies have found that a low vitamin D level can contribute to fragile bones and may cause instability and falls. ● Underlying heart conditions or neurological condition s: It is possible that the woman is falling because she
has an underlying heart condition, or she may be developing a new chronic neurological condition, such as Parkinson’s disease. ● Current referrals to vision, podiatry, and home safety staff : It is possible that the woman tripped or slipped on something in the home and removing it would eliminate the safety hazard. A home safety evaluation can assess for such problems (CDC, 2021b). There are many ways a nurse can assist an older woman in fall prevention. For example, the nurse can encourage the woman to exercise. In a 2018 report, the USPSTF recommended exercise to pre- vent falls in community-dwelling adults ages 65 and older who are at increased risk for falls. This is a Grade B recom- mendation (USPSTF, 2018). The exercises should focus on leg strength and balance. Nurses and healthcare providers can of- fer adults ages 65 or older who are at risk of falling multiple ways to prevent falls. These could include getting rid of trip hazards, keeping clutter off the floor, us - ing handrails in the bathroom, and having handrails installed in staircases. The CDC has a fall prevention checklist that is help- ful in working to decrease the risk of falls for older adults. It is available at: https:// www.cdc.gov/steadi/pdf/STEADI-Bro- chure- CheckForSafety-508.pdf (CDC, 2017). Many community agencies provide ex - ercise classes for older adults. The nurse can also encourage the woman to have a pharmacist review her list of medications to look for potential interactions. The nurse should recommend that the woman have her eyes examined by an optome- trist or ophthalmologist on a yearly basis, and they can change the prescription in
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