Falls
Unintentional change in position coming to rest on the ground or onto the next lower surface.
What is a fall?
painful urination, lower abdominal pain, blood in urine, new or worsening urinary urgency, frequency, incontinence
What are signs of a UTI?
nausea and/or vomiting
diarrhea (3 or more loose stools a day)
constipation
abdominal pain
distended abdomen
What are signs of GI symptoms?
new or worsened cough
new or increased sputum production
new or worsening shortness of breath
chest pain with inspiration or coughing
new or increased findings on lung exam
What are signs and symptoms of a lower respiratory infection?
What is, when to immediately notify the physician?
Temp>100.5
Heart rate >100 or <50
Respirations >28 or < 10
BP <90 or > 200
Oxygen saturation ,90%
What is, when to notify the physician?
abdominal distension
new or worsened incontinence
suprapubic tenderness
gross blood in urine
not eating or drinking
signs of sepsis
What is, when to notify physician immediately?
stool specimen for occult blood and for c diff toxin assay
blood work, amylase,lipase, thyroid function
digoxin level if relevant
hold stool softeners and laxatives
What are, things to consider when calling the physician?
monitor vital signs
oral, iv or subcu fluids
oxygen supplementation
nebulizer treatment
antibiotic treatment
What you can manage in the facility?
increased confusion
decreased level of consciousness
inability to perform usual ADLs
new or worsened physical and/or verbal agitation
unresponsiveness
new or worsened memory loss
What are signs and symptoms of acute mental change?
Take temperature, check BP, pulse, respirations, and oxygen saturation and blood glucose
What is, what you do after a resident falls?
urinalysis, urine culture, change the catheter, blood work, post void residual
What is, what to suggest to the physician to order for further evaluation and management
abdominal tenderness or distention
absent or hypoactive bowel sounds
jaundice
blood in stool or vomit
signs and symptoms of sepsis
What are signs and symptoms to notify the physician immediately?
abnormal lung sounds
edema
change in mental status
possible sepsis
What is, when to notify the physician immediatley?
portable chest xray
ua and culture if indicated
blood work
ekg
what are orders to consider calling the physician for?
Do not move off the floor until examined, look for suspected fracture or new bone deformity, head trauma, altered mental status or decreased LOC, laceration requiring sutures, bleeding risk due to anticoagulants.
What is the initial evaluation for injury/mental status change after a fall?
monitor vital signs, fluid intake/output every 4-8 hours, oral iv or subcutaneous fluids if needed for hydration, check results of ua/culture, consider antibiotic treatment if culture is positive, update care plan if appropriate.
What is, things we can manage in the facility?
monitor vital signs
monitor intake and output
initiate medications for nausea, vomiting, diarrhea, constipation as appropriate
consider iv or subcutaneous fluids
update care plan
What are things you can manage in the facility?
chest xray, blood work, covid test, influenza test
what is, things the physician can order for further evaluation?
vital signs
fluid intake, output
oral, iv, or subcutaneous fluids
non-pharalogical interventions for delirium
pain management
update care plan
What are things we can monitor in facility?
abnormal lung sounds
new irregular pulse
chest pain
acute decline in adls
signs or symptoms of a stroke
What is, when to immediately notify the physician?
A major problem contributing to adverse events, c-diff, and resistant organisms.
What is over treatment of asymptomatic bacteriuria labeled as a UTI
xray/ultrasound
stool analysis
ct scan
What are things that need be done at the hospital?
critical lab values
wbc >14,000
infiltrates or pneumonia on x-ray
what are results to notify the physician of?
wbc>14000
infiltrates or pneumonia on xray
urine results suggest infection and signs and symptoms are present
what are results to notify the physician of?