Margaret Smith

Question 1

what is margaret’s related topic?

Answer 1

Falls risk/Ageing and Senses

Question 2

how old is she?

Answer 2

75

Question 3

what department is she in?

Answer 3

medical receiving

Question 4

does margaret live alone or with others?

Answer 4

alone

Question 5

does she have a concerned family member

Answer 5

yes, her daughter

Question 6

what is Margaret’s PMH?

Answer 6

• fall(ing) over past few days as a result of occassional lightheadedness
• PT usually fully independent

Question 7

how does margaret sappear on arrival?

Answer 7

fully alert and orientated

Question 8

what is margaret’s complaint?

Answer 8

frequent urination over a period of days

Question 9

name for frequent urination?

Answer 9

polyuria

Question 10

what impact can frequent urination have on physical health?

Answer 10

• dehydration/electrolyte imbalance/thirstiness
• hypotension
• tiredness (constantly going to toilet; elderly pt)
• disturbed sleep patterns
• irritation of genitalia due to consistent passage of urine and wipining (?break down of skin)

Question 11

what impact can polyuria have on mental health?

Answer 11

• social anxiety; fear of incontinence
• depression/anxiety
• disturbed sleep/tiredness

Question 12

what other micturition condition could polyuria cause?

Answer 12

nocturia; having to wake up in the night to urinate

Question 13

another word for urination?

Answer 13

micturition

Question 14

what is post-fall syndrome?

Answer 14

• common in older people
• characterised by a fear of falling
• lack of confidence & voluntary restriction on activity due to fear
• can result in mental health problems, such as depression
• can reasuly in physical health issues; UTI from not going to toilet enough, dehydtration from not making drinks

Question 15

basic checks for reducing falls?

Answer 15

*glasses on
*hearing aids in
*non-slippery footwear/grippy socks on

Question 16

what is polypharmacy?

Answer 16

the use of multiple medications, particularly 6≥

Question 17

what are culprit medications and what do they do?

Answer 17

medicines which contribute to falls in a variety of ways;

*distrubed balance
*hypotension
*dizziness
*confusion
*blurred vision

Question 18

what is postural hypotension?

Answer 18

a drop in someone’s BP upon sitting or standing up

Question 19

symptoms of postural hypotension

Answer 19

*changes in vision
*weakness
*dizziness
*losing consciousness with/without warning

Question 20

enviromental risks for falls?

Answer 20

*incorrect height of bed/chair

*un-worn aids; hearing aids/glassess/mobility aids

*no access to call bell

*innapropriate footwear

Question 21

how soon must a falls risk assessment be carried out?

Answer 21

within 24 hours of admission/transfer to another ward/depaetment

Weekly or sooner if the patient falls or their condition changes

Question 22

what is the somatosensory system and in relation to older people?

Answer 22

• the somatosensory system is within the parietal lobe of the brain
• has a network of neurones which help us recognise objects, discriminate touches and sensations
• in older people and those with neurological conditions, their system’s structure and function may have declined
• this can make foot positioning difficult; affecting mobility/increasing risk of falls

Question 23

what do you think the main problem is with Margaret?

Answer 23

postural hypotension caused by dehydtration

Question 24

why do you think this is the problem with Margaret?

Answer 24

• ?diabetes
• ?renal impairment
• ?medication; overuse of diuretics

Question 25

what would I reccomend we do to find out what the problem is?

Answer 25

• urinalysis
• urine cultures (red top bottle)

Question 26

how does diabetes cause polyuria?

Answer 26

• diabetes means excess glucose (sugar) in the blood (hyperglycaemia)
• instead of all glucose being absorbed into ECF after filtration in the kidneys, due to hyperglycaemia, the glucose amount exceeds the kidney’s capacity, resulting in glucose excreted in the urine
• glucose is a solute that draws water into the urine via omosis, resulting in excesss micturition
• as a result, dehydtration will occur, and the symptom of thirst also

Question 27

another word for postural hypotension?

Answer 27

orthostatic hypotension

Question 28

how could culprit medication be causing margaret’s lightheadedness/falls?

Answer 28

• some medications have symptoms of light-headedness, blurred vision, distorted balance etc. which could be causing Margaret’s falls

Question 29

how could over-use of diuretics be causing margaret’s polyuria?