NURS-6512N Week 1: An 85-year-old white woman living alone with declining health

A teenage white male without health insurance seeking medical help for a sexually transmitted infection (STI).
A Hispanic/Latino teenage boy residing in a middle-class suburb.
A 4-year-old African American boy living in a rural area.

Your task is to take on the role of a clinician and build a health history for one of these patients assigned by your instructor.

To get ready:

Considering the information from Chapter 1 of Ball et al., think about:
– Your communication and interview techniques for each patient.
– How to tailor your questions based on the patient’s social determinants of health.
– Which risk assessment tools or questions would be suitable for each patient.
– Any potential health risks considering factors like age, gender, ethnicity, or environment.
– Choose a risk assessment tool from the textbook or another familiar one for your selected patient.
– Create at least five specific questions to evaluate the patient’s health risks and start building their health history.

By the third day of the week:

Share a summary of the interview and describe the communication techniques you’d use with your assigned patient, explaining your choices. Also, justify your selection of the risk assessment instrument and provide the five targeted questions you would ask the patient.

In the provided case study, I’m assigned to analyze the health history of an 85-year-old white woman living alone and experiencing declining health. Here’s an expansion of the case study in SOAP note format:

Subjective (S): JD, an 85-year-old white woman, arrives at the emergency department worried about declining health due to multiple falls and left hip pain. Falls started a year ago, worsening in the past three months, with the latest fall today while using the bathroom. She reports intense pain in the left hip when bearing weight and is unable to do so. She has a history of osteoporosis, hypertension, dyslipidemia, anxiety, and depression, with current medications including metoprolol, atorvastatin, sertraline, multivitamin, and vitamin D3.

Objective (O): JD appears frail, malnourished, and anxious, with vital signs indicating hypertension. Significant bruising is observed on her left lower extremity, and X-rays reveal a left femoral neck fracture.

Assessment (A): Diagnoses include traumatic left femoral neck fracture, falls, malnourishment, hypertension, osteoporosis, dyslipidemia, anxiety, and depression.

Plan (P): Immediate hospital admission for surgery, referral to orthopedics, education on nutrition and weight management, discussion on home safety, and follow-up appointments with specialists upon discharge.

Communication and Interview Techniques:

With elderly patients like JD, who may not seek emergency care unless severe, the focus should be on open communication and building trust. Positioning near the patient, maintaining eye contact, and using appropriate non-verbal cues are crucial. As the interview happens in the emergency setting, it needs to be timely and focused, starting with open-ended questions to understand the chief concern.

Risk Assessment Instrument:

For JD, a fall risk assessment tool like the Johns Hopkins Fall Risk Assessment Tool is suitable. Additionally, assessing her nutritional status using tools like the Mini Nutritional Assessment Short-Form would be beneficial, given her malnourishment and its link to falls.

Expanding on this, malnourishment, common among elderly, is a risk factor for falls, emphasizing the importance of nutritional interventions to prevent future incidents. The Mini Nutritional Assessment Short-Form, designed for older adults, can provide valuable insights into JD’s nutritional needs and help plan interventions to reduce fall risks.

Rachel Adler Alcohol Use Disorder shadow health Objective Data Collection

NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY

Case B 85 year old white female living alone with no family in declining health
Case C Adolescent white male without health insurance seeking medical care for STI
Case E Adolescent Hispanic/Latino boy living in a middle-class suburb
Case G 4 year old African American male living in a rural community

For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient (above) assigned by your Instructor.

To prepare:

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
How would your communication and interview techniques for building a health history differ with each patient? NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY
How might you target your questions for building a health history based on the patient’s social determinants of health?
What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

BY DAY 3 OF WEEK 1

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Introduction

The case study analysis assigned to me involves an 85-year-old white female living alone with no family who is in declining health. In expanding upon the case study, I utilized the SOAP note format, which is presented below:

Subjective (S): JD is an 85-year-old white woman who presents to the emergency department with concerns about declining health due to multiple falls and pain in the left hip. The falls began about a year ago and have increased in frequency and severity in the past three months. The most recent fall was today when the patient fell while getting up to use the bathroom, and she fell to the floor and landed on her left side. She immediately called 911. She states that pain in the left hip increases with weight-bearing activities, and she has been unable to put weight on the left side. She has not taken anything for the pain. She states that pain is 10/10 with any weight-bearing or ROM activities. She does not use any assistive devices for mobility. She eats one meal daily and tries to have a Boost supplemental shake daily. Patient has intermittent urine incontinence. She does not have relatives or friends available to assist her. She still drives, though she avoids driving at night.

She has a history of osteoporosis, hypertension, dyslipidemia, anxiety, and depression. Her medications include: metoprolol tartrate 50 mg twice daily, atorvastatin 20 mg daily, sertraline 50 mg daily, multivitamin daily, and vitamin D3 25 mcg daily NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY.

Objective (O): JD is an older white woman who appears frail, malnourished, and anxious. Alert and oriented x 3. VS: 143/94, P 101, RR 20, 97% on room air at rest, and T 97.8F. Weight 91 pounds and height 5’1”. BMI is 17.2. Significant bruising was noted in the LLE from the lateral aspect of the hip that extends medially towards the groin and distally above the knee. X-rays demonstrate a left femoral neck fracture.

Assessment (A): 1.) Traumatic fracture of the left femoral neck 2.) falls 3.) malnourishment 4.) hypertension 5.) osteoporosis 6.) dyslipidemia 7.) anxiety 8.) depression.

Plan (P): Patient is being admitted to the hospital for immediate surgery for a traumatic left femoral neck fracture. Referral and transfer to orthopedics are planned. Patient was provided education on proper nutritional requirements and how to maintain a healthy weight via teach-back and literature. The provider had a conversation with the patient regarding the safety of living within her home, and the patient plans to return home accordingly. Patient is to follow up with the orthopedic surgeon, primary care provider, and cardiologist upon discharge. A discussion for plans to discharge from the hospital to a skilled nursing facility was had, and the patient agreed with this plan. Medication additions include: hydrocodone-acetaminophen 5-325 every 4-6 hours as needed. No medications were discontinued NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY.

Communication and Interview Techniques

Providers must efficiently use several communication and interview techniques with various populations. In this case study, the patient is an elderly 85-year-old woman. One study provides evidence that the elderly population does not tend to seek out emergency department care unless severe or life-threatening injuries occur (Lutz et al., 2018). She has no hearing or visual concerns; therefore, the provider does not need to make adjustments. The provider should position themselves near the patient with as few obstacles in between as possible (Ball et al., 2019). Maintaining eye contact, having an open posture, using appropriate non-verbal cues, and utilizing appropriate follow-up questions are necessary to gain the patient’s trust (Ball et al., 2019). Since the interview is occurring in the emergency department, the interview must be focused and timely. The provider should begin with open-ended questions to ascertain the patient’s chief concern and follow up with appropriate questions to gain the patient’s trust (Ball et al., 2019). Once rapport is developed and the patient is more at ease, the provider can ask more personal questions, such as about lifestyle and socioeconomic status (Ball et al., 2019). Questions should occur one at a time and in a manner that allows for the patient to respond fully before proceeding. Though the patient’s care will be transferred to the orthopedic surgeon, education should be provided to the patient. Since the patient is in a heightened emotional state, it is necessary to provide educational materials in the form of literature for the patient to reference later (Hoek et al., 2020). Keeping the patient informed at every step of care is imperative to ease the patient’s anxiety and ensure safe outcomes.

Risk Assessment Instrument

Several risk assessment instruments would be beneficial in this case study. A fall risk assessment tool is the most common and pertinent tool for the patient in this case study. A widely used tool is the Johns Hopkins Fall Risk Assessment Tool, which consists of 7 questions about age, fall history, elimination, bowel and urine, medications, patient care equipment, mobility, and cognition (Johns Hopkins Medicine, n.d.). Scores between 6-13 are a moderate fall risk, and greater than 13 points are a high fall risk (Johns Hopkins Medicine, n.d.). Patient in this case study is a high-fall risk as demonstrated by her age (85), fall in the past six months, incontinence, medications (antihypertensive, opiate), and impaired mobility NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY.

Another risk assessment tool that should be utilized in this case study should involve nutritional status. Significant evidence suggests that malnourishment is a risk factor for falls and should be addressed at every point of care (Adly et al., 2019). Since the patient in this case study is below the recommended BMI and only eats one meal/daily with the occasional supplemental beverage, it is necessary to provide extensive education to inform the patient of the importance of maintaining a healthy diet to prevent future falls and fractures. One of the most commonly used nutritional risk screening tools for the elderly is the Mini Nutritional Assessment Short-Form (MNA). The MNA includes various components such as loss of appetite, altered sense of taste and smell, loss of thirst, frailty, and depression, all of which are relevant in the older population (Reber et al., 2019). Information gathered from this tool allows for timely nutritional intervention. Maintaining an optimal nutritional status could lead to fewer falls.

Health Risk Interview Summary

What is your past medical history?
What is your living situation?
- Do you live alone? Have any relatives or friends that would be able to assist you?
- What obstacles within your home make it difficult for you to complete daily activities? Do you use an assistive device for mobility?
Take me through a typical day.
- How many meals are you eating? What do the meals consist of?
- What are your bowel and urinary habits? Do you wake up at night to use the bathroom?
- Are you able to shower/bathe yourself? Do you use any assistive devices? Do you feel safe and steady when doing these activities?
- How do you manage your medications? Do you always take them as they are prescribed? How do you pick up your medications?
How often do you fall in a week, month, or year?
- Is there a specific time of day when you fall? Is there a specific activity that you are doing when you fall?
  NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY

References

Adly, N. N., Abd-El-Gawad, W. M., & Abou-Hashem, R. M. (2019). Relationship between malnutrition and different fall risk assessment tools in a geriatric in-patient unit. Aging Clinical and Experimental Research, 32(7), 1279–1287. https://doi.org/10.1007/s40520-019-01309-0

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Hoek, A. E., Anker, S. C., van Beeck, E. F., Burdorf, A., Rood, P. P., & Haagsma, J. A. (2020). Patient discharge instructions in the emergency department and their effects on comprehension and recall of discharge instructions: A systematic review and meta-analysis. Annals of emergency medicine, 75(3), 435-444. https://doi.org/10.1016/j.annemergmed.2019.06.008Links to an external site.

Johns Hopkins Medicine. (n.d.). Fall risk assessment tool. Retrieved from https://www.hopkinsmedicine.org/institute_nursing/_docs/JHFRAT/JHFRAT%20Tools/JHFRAT_acute%20care%20original_6_22_17.pdfLinks to an external site.

Lutz, B. J., Hall, A. G., Vanhille, S. B., Jones, A. L., Schumacher, J. R., Hendry, P., … & Carden, D. L. (2018). A framework illustrating care-seeking among older adults in a hospital emergency department. The Gerontologist, 58(5), 942-952. https://doi.org/10.1093/geront/gnx102Links to an external site.

Reber, E., Gomes, F., Vasiloglou, M. F., Schuetz, P., & Stanga, Z. (2019). Nutritional risk screening and assessment. Journal of clinical medicine, 8(7), 1065. https://doi.org/10.3390/jcm8071065Links to an external site.

BY DAY 6 OF WEEK 1 – NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY

Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:

Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
Suggest additional health-related risks that might be considered.
Validate an idea with your own experience and additional research

Additional Risk Factors

As you mentioned, this patient has many things that can make them more likely to get hurt. Another thing that could make them more likely to get hurt is the chance of getting a pressure injury (PI) (Elsorady & Nouh, 2023). We can check how likely they are to get this injury by using tools like the Waterlow or Braden Scales. These tools are good at finding out if someone might get a pressure injury (Elsorady & Nouh, 2023). Elsorady & Nouh (2023) said that if someone has a body mass index (BMI) lower than 18.5, they are more likely to get a pressure injury. Your patient has a BMI of 17, so they are at risk of getting hurt. Other things that could make them more likely to get hurt include checking how frail they are, including their thinking ability and how well they can do things (Elsorady & Nouh, 2023). McCance & Huether (2019) say that frailty is when someone is weaker after something stressful happens, like falling down, and they are more likely to have problems getting back to normal. Being frail makes it more likely that they will have more problems, like falling again, getting confused, needing care for a long time because they can’t do things, or even dying (McCance & Huether, 2019). Since the patient is stuck in bed with a broken hip, it will be hard for them to move around and do things, which can make it easier for them to get hurt. Elsorady & Nouh (2023) said it’s important to start preventing pressure injuries as soon as the patient comes in.

You also pointed out that the patient doesn’t have enough good food. Older people in the hospital can become malnourished because of their sickness and other health problems (Dent et al., 2018). This patient will go without food or water sometimes because they need surgery. Checking how good their nutrition is can help remind the doctors to get a dietician to help (Dent et al., 2018). Dent et al. (2018) found that even when doctors saw that a patient needed help with nutrition, they sometimes didn’t ask a dietician for help.

Another thing we need to check is if the patient is confused. Older people in the hospital are more likely to get confused (McCance & Huether, 2019). Confusion can make them act too much, too little, or both (McCance & Huether, 2019). Hewitt et al. (2019) used a test called the Confusion Assessment Method to see how many people in the hospital with broken bones got confused. They found that about 10% of them did, and it made them stay in the hospital longer (Hewitt et al., 2019). To help with confusion, we need to get them moving, make sure they have enough to drink and eat, manage their pain, help them sleep well, and if needed, give them medicine (McCance & Huether, 2019). But it’s better to stop confusion before it starts, so checking early and doing things like making sure they drink and eat enough can help older patients a lot (McCance & Huether, 2019).

As you stated this patient has multiple risk factors. An additional risk factor for this patient would be risk for pressure injury (PI) (Elsorady & Nouh, 2023). Assessments could be completed using the Waterlow or Braden Scales, which both have high sensitivity for pressure injury risks (Elsorady & Nouh, 2023). Elsorady & Nouh (2023) stated that a body mass index (BMI) under 18.5 places a patient at risk for PI. Your patient with a BMI of 17 would be at risk of injury. Other factors include a frailty assessment including cognition and functional status (Elsorady & Nouh, 2023). McCance & Huether (2019) state that frailty is a state that follows a stressor (such as a fall) in which the patient is at increased risk of poor resolution of homeostasis. Frailty increases the risk of further adverse outcomes such as further falls, delirium, the need for long term care due to disability, and death (McCance & Huether, 2019). The patient is currently bedbound with a broken hip so functional status will be an issue for pressure injury prevention. Elsorady & Nouh (2023) highlighted the need for early intervention for PI prevention at time of admission.

You did highlight on the poor nutritional status of the patient. Malnutrition can occur in older adults hospitalized due to their acute illness and comorbidities (Dent et al., 2018). This patient will have time periods of nothing per oral or NPO due to need for surgery. Completing a nutritional screening can assist in prompting orders for a dietician consult (Dent et al., 2018). Dent at al. (2018) found that when the nutritional assessments were being completed upon admission, even if the result triggered a best practice alert for a nutritional consult, the consult was not being added to the patient.

Another assessment that should be performed for the patient is a delirium assessment (McCance & Huether, 2019). The population at greatest risk for delirium are hospitalized older individuals (McCance & Huether, 2019). Delirium can present as hyperactive, hypoactive, or mixed features (McCance & Huether, 2019). Hewitt et al. (2019) used the Confusion Assessment Method (CAM) scoring. They concluded that around 10% of acutely hospitalized patients with fractures developed delirium, which significantly lengthened their hospital stays (Hewitt et al., 2019). Interventions for delirium include early mobility, hydration, nutrition, pain management, sleep maintenance, and lastly pharmacologic therapy (McCance & Huether, 2019). Prevention is better than treatment though so early screening and nonpharmacologic interventions such as hydration and nutrition can have effective results in elderly patients (McCance & Huether, 2019).

References

Dent, E., Wright, O., Hoogendijk, E. O., & Hubbard, R. E. (2018). Nutritional screening and dietitian consultation rates in a

geriatric evaluation and management unit. Nutrition & Dietetics, 75(1), 11–16. https://doi.org/10.1111/1747-0080.12391

Elsorady, K. E., & Nouh, A. H. (2023). Biomarkers and clinical features associated with pressure injury among geriatric

patients. Electronic Journal of General Medicine, 20(1), 1–6. https://doi.org/10.29333/ejgm/12636

Hewitt, J., Owen, S., Carter, B.R., Stechman, M.J., Tay, H.S., Greig, M., McCormack, C., Pearce, L., McCarthy, K., Myint, P.K., &

Moug, S.J. (2019). The Prevalence of Delirium in An Older Acute Surgical Population and Its Effect on Outcome. Geriatrics, 4(4), 57. https://doi.org/10.3390/geriatrics4040057

McCance, K.L. & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children, (8^th ed.). Elsevier.

NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY Sample response 2

Thank you for your very detailed message about your assigned case study. You gave a clear idea of the ways you would talk to the patient, the questions you would ask to learn about their health, and the tools you would use to understand their risks. I agree that it’s important for the patient to feel as comfortable as possible, especially with their injury. Considering things like how the room is set up, how noisy it is, the lighting, and the temperature can all help the patient feel safe and calm. If the advanced practice registered nurse (APRN) can build a good relationship with the patient early on, it will make the interview and physical exam much easier because the patient will already trust the provider. How well the APRN talks to the patient will affect how well the patient understands their injury and what needs to be done to take care of it. Good communication will also affect how involved the patient is in their own care.

You mentioned giving the patient educational materials because of their injury, but it’s also important to think about how the patient likes to learn. In my job as a registered nurse (RN), I have to assess each patient’s preferences for learning every day. This includes asking if they prefer to learn by talking, reading, seeing demonstrations, having things translated, or using virtual methods. Every patient is different, depending on things like age, how much they understand, and any cultural differences, so I always think about this when teaching my patients. In my experience, older people are less likely to come to the hospital right away unless they’re really sick or hurt. It’s interesting to see data about this, but I can see how this thinking can sometimes make people wait too long to get help.

The risk assessment tools you mentioned are ones I know about, especially the John Hopkins Fall Risk Assessment Tool. I use this tool with every patient because it’s a good way to see how likely they are to get hurt from falling. We share this information with other staff like therapists and case managers, and we use it to make sure the patient is safe. Falls can happen at home, but they’re also a big problem in hospitals. Knowing that this patient fell at home means they’re more likely to fall again in the hospital because of things like confusion, side effects from medications, being too active, not sleeping well, and more. According to Tyndall et al. (2020), each fall in the hospital means the patient stays longer and it costs more money. This is a big concern for everyone involved. Knowing this from a reliable study shows why these risk assessment tools are so important for patients, healthcare providers, hospitals, and organizations.

I also appreciate you mentioning doing a nutrition assessment because I think this is often forgotten. A patient’s nutrition can tell us a lot about their physical health, including if they’re more likely to get hurt or if their health is getting worse. Nutrition is really important for staying healthy, being able to move well, dealing with long-term illnesses, sleeping well, healing, thinking clearly, and more. I’ve seen many patients in the intensive care unit who were hurt badly because they weren’t eating or drinking enough. According to Hamrick et al. (2020), not drinking enough can make falls more likely, so it’s important to address these risks to improve patients’ lives as they get older.

The questions you listed, especially the ones about falls, cover a lot of important things. In my experience, many patients think falls are just part of getting older, but often they’re a sign of other problems. Asking about falls is really important for finding out if the patient is living in a safe place, has heart problems, has trouble moving, has injuries or problems with their bones and muscles, doesn’t take their medications properly, or has nutrition problems. Asking about the patient’s medications is also really important because it can help the APRN see if any medications are causing falls or if some need to be changed to prevent more falls.

Thank you for your very thorough post on your assigned case study. You provided a great picture of the communication strategies you would use, the questions you would ask to compile an adequate health history, and the risk assessment instruments you would utilize. With the patient’s injury, I agree that it would appropriate for the patient’s environment to be as comfortable as possible. Keeping in mind how the room is arranged, including noise level, lighting, and temperature of the environment are all factors that should be considered to ensure the patient feels safe and secure. If the advanced practice registered nurse (APRN) can establish rapport with the patient early on, the interview process and physical assessment will go much smoother knowing the patient already has trust for the provider. The way the APRN communicates with the patient will determine the patient’s understanding and ability to comprehend their injury and overall plan of care. The quality of communication will also determine how well the patient responds and engages with the provider, therefore impacting the care the patient receives.

You had mentioned providing the patient with education in the form of literature due to the nature of the injury, however, it would also be important to consider how the patient prefers to be educated. In my current role as a registered nurse (RN), I am required to document a daily education assessment on each patient. One of the measures of education includes how the patient prefers to be educated whether that be through verbal, written, demonstrative, interpretation, or virtual methods. Every patient is different depending on the circumstances, including age, level of understand, and cultural barriers, so I do take this piece into consideration as I am educating my patients. In my own practice, I can agree that the elderly population is less likely to come to the hospital emergently unless their concern or injury is life-threatening. I find it interesting that there is gathered data on this trend, although I can see where this mentality can lead to a delay in care.

The risk assessment instruments you have provided are something I am familiar with, especially the John Hopkins Fall Risk Assessment Tool. I use this tool on every patient I care for as it truly is a great indicator for patient safety. This data is often communicated with collaborative staff such as our therapy staff (physical therapy, occupational therapy, and speech therapy) and case management, while it is utilized in our world as an indicator to put safety measures in place as soon as possible. You have to think that falls happen at home, but they also happen inpatient as well. Knowing this patient had a fall at home, puts them at further risk of falling in the hospital due to potential delirium, medication side effects, stimulation, inadequate sleep, and so on. Tyndall et al. (2020) adds the “mean additional length of stay per inpatient fall was estimated to be eight days and mean additional financial cost was $6669 per fall in six hospitals in Australia” (para. 7). Beyond the injury comes cost where both factors remain a concern for all parties involved. In knowing this data from a supported study, it shows why risk assessment instruments are so vital for patients, providers, institutions, and organizations to utilize them appropriately.

I also appreciate your mention of a nutritional risk assessment as this is one area that I feel gets overlooked in practice. A patient’s nutritional status is a huge indicator of what is going on with the patient physically, including relatable injuries and declining health trends. Nutrition is such a huge part of anti-aging, mobility, chronic illness, sleep, recovery, hydration, healing, cognitive function, and more. I have cared for a large population of patients in the intensive care setting that fallen victim to horrific falls and injuries due to malnourishment and dehydration. According to Hamrick et al. (2020), there is a strong association between dehydration and falls which is why addressing these risks “has potential for improving quality of life for patients as they age” (para. 4)

NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY.

The target questions you have listed, especially the question in relation to falls, were comprehensive. In my own experience, many of the patients I have cared for write off falls as a normal part of aging although many of these trends often times lead to other undiagnosed conditions or concerns. Gathering fall history data is extremely important in determining if the patient is living in unfit conditions, has cardiac abnormalities, struggles with mobility, has underlying musculoskeletal injuries or deformities, has challenges with medication compliance, or battles with nutritional deficiencies and appetite barriers. Also, asking questions specific to the medications the patient takes is extremely important data that could help clue in the APRN as to what medications could be leading to the falls or what medications need to be titrated to ensure the patient is not put at further risk for falls NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY.

References

Hamrick, I., Norton, D., Birstler, J., Chen, G., Cruz, L., & Hanrahan, L. (2020). Association Between

Dehydration and Falls. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 4(3), 259–265.

https://doi.org/10.1016/j.mayocpiqo.2020.01.003

Tyndall, A., Bailey, R., & Elliott, R. (2020). Pragmatic development of an evidence-based intensive care unit

specific falls risk assessment tool: The Tyndall Bailey Falls Risk Assessment Tool. Australian Critical

Care, 33(1), 65–70. https://doi.org/10.1016/j.aucc.2019.02.003 NURS-6512N Week 1: Discussion BUILDING A HEALTH HISTORY