course materials

1. Types of Assessments in Outpatient and Inpatient Settings
Types of Assessments in Outpatient and Inpatient SettingsTypes of Assessments in
Outpatient and Inpatient SettingsResponse 1Fall preventionThe purpose of this discussion
is to describe fall prevention measures in the geriatric population. Risk factors in the
elderly, type of assessments, and health promotion for fall prevention will be explored. The
term fall is an unintentional incident where an individual lands or rests on the floor from an
upright or upper position (The Royal Children’s Hospital Melbourne, 2017). Fall risk is the
susceptibility of an individual to unintentionally land on the floor from an upright position.
Some individuals are more at risk than others. Fall risk is high in the geriatric population as
reports show that one in three older adults fall each year (Slade et al., 2017). Once a fall
occurs, the chances of a repeated fall is doubled (Bainbridge, 2019).ORDER NOW FOR
ORIGINAL, PLAGIARISM-FREE PAPERSSpecific Geriatric Risk Factors That Create an
Increase in Fall RisksAccording to Hamed et al. (2018), evidence show that biological
decline related to age increases the incidence of falls among the geriatric population. Low
extremity, core muscles, and an overall decrease in strength, contribute to falls in the
elderly. Additionally, declines in flexibility, endurance, and vision changes are risk factors
for fall (Bainbridge, 2019). Poor balance from factors of aging, foot pain, and inappropriate
footwear, and certain medications further intensifies the risk. Deficient vitamin D is also a
noted factor (Bainbridge, 2019). Geriatric factors such as chronic or medical illnesses,
altered mental status, impaired mobility, elimination needs, past history of fall, and
immobility are strong predictors of the risk for falls (The Royal Children’s Hospital
Melbourne, 2017).Types of Assessments in Outpatient and Inpatient SettingsPrior to
implementation of any plan, an assessment is necessary to conduct. There are several types
of assessment for fall risk factors in both outpatient and inpatient settings. Assessing fall
risks includes a review of medication, history of falls, physical exam, and evaluation of the
environment. If the patient have a history of falls, number of times in the last year,
symptoms prior to falling, activity at the time of fall, fall location, use of glasses, type of
footwear, getting up after falling, injuries, time of day, and treatment received should be
obtained and documented (Phelan et al., 2015). Medication review can provide insight of
the classes of medications that contributes to fall. Classes of drugs that poses the risk for
falls are psychoactive medication (Phelan et al., 2015) such as Antidepressants,
Barbiturates, Phenothiazines, Sedatives, and Hypnotics. Diuretics and laxatives escalate the
risk of falling as well (The Royal Children’s Hospital Melbourne, 2017). Postural
hypotension is a condition commonly seen with blood pressure medication that have

2. orthostatic hypotension side effects and should be assessed (Phelan et al., 2015). Types of
Assessments in Outpatient and Inpatient SettingsThe environment is assessed in the home
for factors such as stairs, lighting, throw rugs, clutter, and adequate lighting, and other
hazards in the environment outside the home (Phelan et al., 2015). Stopping Elderly
Accidents, Deaths and Injuries (STEADI) is a fall assessment tool that was created by
Centers for Disease Control and Prevention (CDC). This tool is extensively used for elders
who lives in the community, ambulates, and are able to respond to questions (Bainbridge,
2019). The Morse Fall Scale (MFS) screening tool is a valid assessment tool that is used in
the hospital setting to identify patients who has a high risk for falls. In a study that was
done, two other fall risk assessment tools found to be both specific and sensitive are the
Schmid and St. Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY).
These assessment tools are proven to be valid for fall assessment in the hospital setting
(Watson et al., 2016).Health Promotion to Decrease Falls in The ElderlyThe Advanced
Practice Registered Nurse (APRN) can recommend or implement health promotion
measures to decrease falls in the elderly. Once the patient or community have been
assessed, the next step is to plan for ways of preventing falls. Patient who are at risk should
be counseled and encouraged to participate in an exercise program for primary prevention.
According to Pender et al. (2015) strength and agility is improved with physical activity that
is routinely practiced. Increased muscle strength helps to prevent falls among the elderly in
community settings. Additionally, APRNs can place referrals for physical therapy (PT)
services to include a home assessment where necessary changes can be made to facilitate a
safe environment that would prevent fall (Bainbridge, 2019). This can be implemented as a
secondary prevention. Tertiary prevention for fall prevention in which APRNs can
implement is the use of assistive devices such as canes and walkers. Vitamin D is also
recommended for fall prevention (Slade et al., 2017).To conclude, the geriatric population
are susceptible to falls as they continue to increase in age. “Falls are one of the leading
causes of injury-related hospital admissions in this age group and are often followed by
functional dependence, serious or fatal injuries, fractures, and high morbidity” (Hamed et
al., 2018, p. 2). In order to avoid complications, prevention approaches are desirable and
should be promoted by the APRN. There are many fall assessment tools that can be utilized
to facilitate appropriate interventions. Nurse practitioners can help to decrease the chances
of falling in the elderly that could lead to harm, functional decline, or fatality (Phelan et al.,
2015). A multifaceted approach including exercise, strength training, flexibility techniques,
and medication management (Slade et al., 2017) should be applied.Response
2PolypharmacyThe topic surrounding medications and medication compliance is an
important discussion for the advanced practiced registered nurse (APRN) to be apart of.
The concept of Polypharmacy is an additional term that APRN’s should be familiar with.
This definition pertains an individual taking multiple medications to treat a condition or
ailment. Therefore, compliance is important to ensure patients achieve optimal success and
outcomes.Medication ComplianceWhen treating patients with a specific condition, often
times they are placed on a wide variety of different medications to help treat different parts
of their diagnosis or other conditions they may have. Therefore, medication compliance is
extremely important for these patients to ensure all aspect of their conditions are being

3. treated and managed appropriately. A recent study identified that medication compliance
was impacted negatively because adherence changes as the social and environment context
of individuals change, which ultimately leads to fluctuating levels of medication adherence
(Rao, Maurer, Meyer, Zhang, & Shiyanbola, 2020). In addition, the lack of adherence can
further enhance their disease process and lead to undesirable outcomes. When compliance
suffers, it leads to an increased risk of adverse effects and can place the patients life in
danger. Another article identified the lack of medication adherence was more prevalent in
populations who did not earn an income above the poverty level, reported high levels of
stress, and therefore suffered adverse effects and outcomes (Oats, Juarez, Hansen, Kiefe, &
Shikany, 2020). Adverse effects are linked synergistically to medication compliance and it is
important for patients to understand the risks associated with medication non-adherence.In
addition, patients may also experience creatinine clearance level that is less than 50
mL/min. This essentially means that the patients kidneys are not functioning effectively at
filtering out excess waste. Therefore, leading to an accumulation and can significantly alter
an individuals health status. Polypharmacy plays an important role with renal function. A
recent article identified that patients who suffer from kidney disease are at an increased
risk for nephrotoxicity due to some specific medications and build-up or accumulation of a
medication that can be fatal (Azhar, Hussain, & Majid, 2019). This information is important
for the APRN and their ability to prescribe certain medications to patients. In doing so, it is
crucial the APRN be aware of a patients medical history and renal function, along with
providing proper education regarding compliance.APRN in PracticeAs an APRN, it is
important to understand how to effectively manage patients who are not compliant with
their medications. The APRN can address this growing problem by scheduling routine
follow-up appointments, providing detailed education regarding medication adherence, and
explaining the risks and complications that can occur when non-compliance takes place.
Educating is a crucial component to medication compliance and the APRN should be well-
equipped and knowledgable about the risks associated with medications. The type of
surveillance that can be put in place within the APRN own practice are questionnaires, pill
counts, number of prescription refills, and routine laboratory tests or vital signs to ensure
they are within normal limits. Incorporating these surveillance tactics will help improve
medication compliance within the practice of the APRN, and improve the quality of life of
the patients they serve. Within the community of Southern California, the APRN can
advocate for this concern by ensuring all primary care offices have some type of record,
education, or their own surveillance plans in place to improve medication compliance. In
doing so, will help improve awareness to medication compliance and increase the rate of
compliance.