Fall Risk Assessment and Interventions for Patients with Mobility Limitations

Running head: HEALTH CARE
Health care
Name of the student:
Name of the University:
Author’s note

1HEALTH CARE
Mobility limitation is one of the risk factors of fall risk in an individual and there is
assessment of fall is critical to promote safety of patient. The main purpose of this essay
is to analyse the case study of Jacob Murray and John Ridges and critically analyse the
factors that led to priority problem falls risk due to altered mobility in both the patient. A
essay will give details regarding a comprehensive assessment process to identify the
care needs and goal of care for both patient. The paper will also suggest two evidence
based interventions to address the problem and the instructions to be given to family
members to evaluate effectiveness of the intervention.
Jacob Murray is a 7 year old boy being treated for a fractured left tibia following a
fall from the kitchen table. As Jacob has sustained a fracture in his left tibia, this injury is
a major risk factor for poor mobility which could increase fall risk in the future. Sabatini,
Curtis and Mahan (2014) gives the evidence that history of falling or patient with recent
history of fracture are at increased risk of poor mobility because of muscle weakness
and low grip strength. Hence, these factors increase future risk of fall in Jacob. The
other case study is about John Ridges, a 72 year old man being treated for a fractured
right tibia. He is not able to weight bear and he has a history of osteoporosis. His
presenting injury, history of osteoporosis and ageing are a major risk for fall in patient.
With ageing, muscoskeletal tissues lose cartilage resilience, muscular strength and
ligament elasticity leading to loss of mobility and physical independence (Gheno et al.,
2012). Resnick et al. (2014) argues that osteoporosis is associated with decrease in
bone mass density and bone strength resulting in higher risk of fall related fractures. In
addition, advancing and cognitive decline is also a risk factor fall in elderly (Ambrose,
Paul & Hausdorff, 2013).

2HEALTH CARE
As fall risk is the main priority problem for both Jacob and John, identifying their
care needs and modifiable risk factor will be crucial to promote mobility and prevent
future risk of fall. The assessment will differ based on age of the client. In case of John,
who is 7 year old boy with tibia fracture, there is a need to conduct assessment of
patient using 5P’s of pain, pulse, pallor, parasthesia and paralysis. The significance of
this checklist is that it supports nurse to assess not only mobility impairment following
fall, but also predict severity of pain, changes in peripheral pulses, temperature of the
skin and paresthesia (Maher, 2016). These five factors will accurately help to identify
care needs and modifiable risk factor for Jacob. In addition, Humpty Dumpty Falls Scale
(HDFS), can be used to assess fall risk in pediatric patient. This involves measurement
of age, gender, diagnosis, cognitive impairments, environmental factors, response to
surgery/sedation, and medication usage to assess fall risk (Pauley et al., 2014). In the
context of John, who is an elderly patient with fracture, his care needs will be assessed
based on review of his medications, fall risk assessment and assessment of bone
mineral density. The main rationale for measuring bone mineral density is that he is a
patient with osteoporosis and the bone mineral density value measured through Dual-
energy X-ray absorptiometry (DXA) can predict fracture risk (Edwards et al., 2013). This
assessment will provide guidance regarding medications to be given to John to reduce
fall risk. In addition, geriatric assessment will be necessary to detect impact of ageing
and frailty of mobility and functional capacity and its link with fall risk. It is a patient-
centred assessment process that considers factors like change in living situations,
existing medication condition, presence of psychosocial disorders, frailty and history of
major illness to identify care needs.