Question: Mrs Phillips Is A Frail And Thin 85 -year-old Woman Whose Husband Recently Died. She Presents To The Emergency Department After A Fall At Home, And Although Xrays Reveal No Bony Injuries, She Has Extensive 4cm Sized Bruising In Various Locations On Her Skin, That Are Not Consistent With The Position Of Her Fall. Mrs Phillips Past Medical History And …

Mrs Phillips is a frail and thin 85 -year-old woman whose husband recently died. She presents to the emergency department after a fall at home, and although xrays reveal no bony injuries, she has extensive 4cm sized bruising in various locations on her skin, that are not consistent with the position of her fall. Mrs Phillips past medical history and medications include: • Hypertension (Thiazide diuretic 12.5mg daily) . “Mini stroke” about 3 years ago (Warfarin 5mg daily). In the emergency department: When asked about the bruising, Mrs Phillips has no idea what could have caused them, but said they seemed to come and go’. She has not had her INR reviewed lately as she finds it is very difficult for her to get out to see a doctor and that she could not remember the last time it was checked. She thinks she is “quite good” at remembering to take her medicine. The medical staff thought it best to admit Mrs Phillips for further assessment and evaluation. Mrs Philips vital signs on admission to the ward were: • Temperature – 36.8 (oral) • Pulse – 86 • Respirations – 17 • Blood Pressure – 130/80 supine (lying down), 105/75 standing Once admitted to the ward: Following her shower, while assisting Mrs Phillips back to bed she asks you for her handbag which is in the bedside locker. When reaching into the bedside locker, you notice a large packet of herbal Gingko Biloba tablets. Mrs Phillips tells you that she has been taking them for years on the advice of her daughters because they help with her memory. 6 pts Explain the reason for her falls risk in association with the diuretic Mrs Phillip’s is taking? Explain the reason for her falls risk in association to the diurectic Not associated with diurectic related falls risk Thiazide is a vasoconstrictor that can affect BP Diuretics directly reduce skeletal muscle strength This medication affects the nervous system, which affects her coordination This medication directly affects the movement centres of her brain affecting her balance. Reduce BP can affect balance when moving from a sitting to standing position rapidly This medication causes increased urine output reducing blood volume