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The nurse is performing an assessment on an older adult. from which data does the nurse deduce that the client is at high risk for falls in the home? select all that apply.

Answer :

  • Admits to drinking wine through the evening
  • Has history of diabetic neuropathy
  • Takes furosemide daily

The nurse is helped by the acronym DAME (Drug/alcohol use, Age-related physiologic state, Medical issues, Environmental) in determining the fall risk at home. With frequent and sometimes urgent trips to the bathroom, the diuretic furosemide might make the customer trip and possibly collapse. Volume loss and standing vertigo are some side effects of furosemide. Due to a loss of normal feeling in the lower limbs and feet brought on by diabetic neuropathy, falls are more likely. A loss of balance, volume loss, and urine urgency are all effects of alcohol use. Positive fall prevention behaviors include having a single floor of living space and exercising frequently.

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