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Do you have any evidence-based practices for monitoring a patient after a fall?

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As a general rule, a physician should examine any indication of injury as soon as possible. A physician should immediately evaluate any head trauma. Other injuries, such as suspected or obvious fractures also require rapid treatment, as do symptoms of cardiac or neurological crisis.

Nurses must be especially alert to possible injuries for several days after a fall. Delayed discovery of a hip or other fracture is a common occurrence. Slow internal bleeding into the brain from trauma to the head may not cause symptoms for days, and the outcome of such slow bleeds can be fatal. Watch for the following indications that anything is different about the patient:

  • Altered gait or limp
  • Unusual hesitation or slowness when moving
  • Verbal complaints of pain
  • Nonverbal indications of pain, such as facial grimaces
  • Loss of appetite
  • Serious bruising of any part of the body
  • Redness or warmth to any part of the body
  • Favoring of an appendage, such as not using an arm or hand
  • Unusual sleepiness or lethargy
  • Changes in behavior or cognition

Nurses should never assume a patient’s complaint of pain or signs of injury are simply the minor effects of taking a tumble and don’t indicate anything serious. Just because a physician evaluates someone and declares him or her uninjured does not rule out an undetected insult to some part of the body with symptoms that may surface later.

A patient’s plan of care following a fall should include additional checks or monitoring of the patient’s status for several days. The frequency of those checks depends on the individual patient and the circumstances, but in many cases, twice a shift for three or four days is sufficient.

—Carole Eldridge, DNP, RN, NEA-BC, dean, campus director, and associate professor at St. John's College of Nursing and Health Sciences at Southwest Baptist University in Springfield, MO

(April 2009)