The internal stability of human body depends on the coordination of sensory organs, central nervous system and skeletal muscle functions. The reasons that disturb this functional system are disease, chronic cumulative strain and senile degeneration.
1. 1 Elderly people with sensory functional factors and imbalance will simplify and weaken their sensory information and increase their reaction time due to the decline of central processing ability; Poor eyesight leads to the inability to correctly judge the environmental structure and obstacles, the cause of sensory center or conduction, and the hearing loss caused by neuroma; The sudden change of the environment made it impossible to make proper actions in time and fell down.
1.2 central nervous system factors Any disease of the central nervous system will affect the stability of human body, such as the decrease of balance ability caused by cerebrovascular accident, tremor paralysis (related to drugs and cerebrovascular dementia), and gait abnormality caused by dementia, Parkinson's disease, hydrocephalus, vitamin b 12 deficiency, spinal diseases, etc. In addition, some acute infectious diseases (such as pneumonia and urinary tract infection) make people's gait abnormal.
1.3 Degenerative arthritis of hip, knee and ankle of lower limbs due to skeletal and muscular factors, leading to gait and muscle disorders; The strain degeneration of lumbar spine reduces the ability of spinal column to readjust and compensate lower limbs. Foot diseases (spur, bursitis, toenail deformity, etc.). ) can provide false proprioception information of lower limbs and induce falls. Osteoporosis caused by aging process is an important risk factor for falls of the elderly.
1.4 psychological factors mental state and cognitive ability are related to the body's ability to control the environment, gait and balance. When the judgment ability is impaired or the surrounding environment is ignored, the risk of falling increases. Hospitalized patients, due to physical illness and huge medical expenses, bring great mental stress to patients, and the application of some drugs often affects the judgment ability of the elderly. For the elderly with mmse score lower than 24 and gds score higher than 10, the risk of falling increases exponentially.
1.5 Transient cerebral hypoxia and transient ischemic attack can affect blood supply to the brain and cause intermittent dizziness. The elderly suddenly stand up from the lying or sitting position, causing dizziness, dizziness, blurred vision and so on. Because the brain is temporarily short of blood supply and unstable, it is easy to fall.
2 external factors
The physical function of the elderly declines, and environmental factors and self-factors increase the risk of falling. When the individual's function declines, environmental factors play a more important role. In addition to uneven roads, insufficient light, dirty environment, unclear roadside boundaries and slippery ground, toilets, bathrooms, corridors and hospital bed guardrails often have no handrails and sit or lie on moving objects (unfixed beds, wheelchairs). In addition, due to
3 Health education
Explaining the adverse consequences of falls to high-risk groups and their families, providing education and strengthening the management of public health environment are effective nursing measures to prevent falls.
3. 1 Do a good job in admission evaluation. When the patient is admitted to the hospital, the nurse in charge should collect the past fall history, whether there are diseases that are easy to cause falls in this illness or in the past medical history, the patient's vision, whether there is a potential fall crisis when taking medicine at or before admission, gait and balance ability, lower limb ability, lower limb musculoskeletal diseases, self-limb mobility, etc., and introduce the ward environment in detail. Dangerous places that are easy to fall, such as toilets, bathrooms, stairs, etc. , should attract the attention of patients. For the elderly who are inconvenient to fall, it is recommended that their families accompany them. For those who cannot be accompanied by family members for various reasons, the condition should be explained in detail and signed as evidence to avoid medical disputes.
3.2 After understanding the medical history, take all necessary safety measures to help patients get familiar with the ward and surrounding environment. When patients get up at night, they can ring the bell to inform the nurse to help them. The beds of the elderly should be properly lowered, and the ground should be kept flat and dry. If they have just wiped the floor, they should be clearly marked to remind the elderly to pay attention to anti-skid. Toilets and corridors should have adequate lighting and handrails. For patients who stay in bed for a long time and patients after eye surgery, it is easy to fall when they suddenly get up. Therefore, it is best for patients to urinate in bed. If they have to get up, family members or nurses should help the patient to urinate, get out of bed and sit in a wheelchair. For patients who are likely to fall, it is best to have a record of preventing falls.
3.3 Psychological and behavioral nursing intervention After the elderly fall once, they will be afraid of falling and limit their activities. Some of them are bedridden for a long time because of their own diseases and are prone to negative psychology. For this kind of old people, besides strengthening muscle strength and balancing exercise, psychological care is more important. Therefore, for the elderly who have this fear of falling, nurses should not only help them understand how to prevent falling, but also help the elderly overcome their fear.
Therefore, a very important task of nursing for the elderly is to effectively evaluate and actively eliminate various risk factors that lead to falls. Only through comprehensive and meticulous nursing evaluation, nursing intervention when necessary, and the joint efforts of nurses, the elderly and their families can we effectively prevent falls and safeguard the health and quality of life of the elderly.