Strategies to Reduce Risk of Injury for Mr. Smith

Client: Mr. Joe Smith, 75-year-old male with right visual field deficits, right-sided weakness, using a walker post-CVA. Medications: Metoprolol, Warfarin (newly started).

Goal: Reduce the risk of injury for Mr. Smith in his environment.

Interventions:

1. Environmental Modification: Conduct a comprehensive home safety assessment to identify and address potential hazards. This includes:
   • Removing loose rugs or clutter from walking paths ([Lin et al., 2018]).
   • Ensuring adequate lighting throughout the living space, especially at night ([World Health Organization, 2021]).
   • Installing grab bars in the bathroom near the toilet and shower ([National Institute on Disability, Independent Living, and Rehabilitation Research, 2017]).
   • Placing furniture with rounded edges and avoiding sharp corners to minimize the risk of bumping or collisions.

Rationale: Mr. Smith’s visual field deficits and right-sided weakness increase his risk of falls and injuries. Modifying his environment reduces the presence of hazards and promotes safe mobility.

2. Education and Training: Educate Mr. Smith and his family members on fall prevention strategies. This includes:
   • Proper use of his walker, emphasizing gait training and safe weight distribution ([American Geriatrics Society & British Geriatrics Society, 2010]).
   • Wearing well-fitting shoes with good traction to prevent slips and falls.
   • Importance of rising slowly from sitting or lying positions to avoid orthostatic hypotension (dizziness upon standing) caused by metoprolol ([National Institutes of Health, 2023]).

Rationale: Educating Mr. Smith and his family empowers them to participate in his safety and promotes adherence to fall prevention measures.

3. Medication Management: Monitor Mr. Smith for potential side effects of Warfarin, such as bleeding. Advise him to avoid activities that could increase his risk of bleeding (e.g., shaving with a razor) ([Mayo Foundation for Medical Education and Research, 2023]).

Rationale: Warfarin is a blood thinner that increases the risk of bleeding. Monitoring for side effects and educating Mr. Smith about precautions minimizes the risk of complications.

4. Communication and Collaboration: Collaborate with the occupational therapist to assess Mr. Smith’s needs for assistive devices or adaptive equipment. These could include a raised toilet seat, grab bars in the shower, or a sock aid to assist with dressing ([American Occupational Therapy Association, 2023]).

Rationale: Occupational therapists can provide expert recommendations on assistive devices that can improve Mr. Smith’s independence and safety during daily activities.

5. Vision Rehabilitation: Refer Mr. Smith for vision rehabilitation therapy, if indicated. This therapy can help him develop strategies to compensate for his visual field deficits, such as head scanning techniques to improve his awareness of his surroundings ([American Academy of Ophthalmology, 2023]).

Rationale: Vision rehabilitation can improve Mr. Smith’s spatial awareness and ability to navigate his environment safely.

6. Regular Assessments: Conduct regular assessments of Mr. Smith’s physical abilities, gait, and balance. This allows for early identification of any changes or decline that might necessitate adjustments to his care plan or environment ([Agency for Healthcare Research and Quality, 2023]).

Rationale: Ongoing assessments ensure that Mr. Smith’s safety measures remain appropriate and address any evolving needs he might have due to his condition.

Conclusion

By implementing these strategies and tailoring them to Mr. Smith’s specific needs and environment, the risk of injury can be significantly reduced. Collaboration between the nurse, Mr. Smith, his family, and other healthcare professionals is crucial for ensuring his safety and promoting his well-being.