Head Trauma Case Study In Nursing
Nursing Considerations for Mr. J.’s Visit to the E.R.
Mr. J. is an 84 year old man who was admitted to the hospital for assessment after a fall. His physical assessment indicated multiple contusions to the face and shoulder, an unkept appearance and possible malnourished state. While a CAT scan and x-ray showed no fractures or bleeding, the fact that the patient had head trauma was most alarming. Traumatic injury to the head could lead to a hemorrhagic stroke or cerebrovascular accident, could be life threatening, and would require immediate intervention from the healthcare team. In particular, a thrombus could occur up to several days after head trauma (National Institute of Neurological Disorders and Stroke [NINDS], 2013). Head trauma …show more content…
is a major issue for people over the age of 75, with falls being the major cause (NINDS, 2013).
In addition to concern about potential stroke, the cause of Mr. J.’s current fall and his potential for a history of falls is also of concern. If Mr. J. is prone to falls, the nurse must make further assessments to determine the contributing factors. A history of falls could indicate that Mr. J. might be suffering from a functional limitation which in turn might affect his ability to be self-sufficient.
The nurse’s observation that the patient’s clothes were dirty and unwashed, and that the patient was underweight also implies possible functional limitation. Mr. J. may require assistance performing his activities of daily living (ADLs). Another possibility is that his financial status may prevent him from addressing his hygiene and nutritional needs due to inaccessibility to resources.
The patient’s daughter expressed concern for his well being and these concerns need to be addressed. In this case, it would be appropriate for the nurse to refer the patient to a social worker. In addition, the fact that Mr. J.’s daughter lives in another state and that Mr. J. lives alone gives rise to potential social isolation, which could also be a factor contributing to his malnourished state (Lee & Berthelot, 2010).
In order to provide appropriate and thorough care to Mr. J., additional data needs to be collected. To assess the reason for Mr. J.’s fall, lab values to check for malnutrition, and fluid and electrolyte imbalance should be obtained. Either issue could contribute to a fall by causing weakness and instability. For example, if the patient were hypokalemic, he might experience difficulty maintaining balance since low potassium levels cause muscle weakness (“Hypokalemia,” n.d.). Information from vital signs might indicate cardiovascular problems like hypotension, or might signal an infection. Hypotension could cause decreased blood flow to the brain, causing dizziness (Mayo Clinic, 2011); and infection could cause confusion in an elderly person (Mouton, Bazaldua, Pierce, & Espino, 2001). In addition, the fall itself might be an indication of infection (Mouton et al., 2001).
Data as to what medications Mr. J. is currently taking might also provide information as to what factors contributed to his fall. If, for example, Mr. J. were on antihypertensive medication, his fall might have been caused by incorrect dosing for his situation or incorrect self-administration. Certain drugs, (benzodiazepines, antipsychotics and antidepressants, for example) increase the risk of falls (Huang et al., 2012). Therefore, ascertaining what drugs Mr. J. might be on and confirming dosage, proper usage and necessity of the medication is important both, in general, and for determination of causality of his fall.
In addition to information regarding the cause of his current fall, a complete assessment that would include a fall history assessment should be taken. A complete assessment would allow the nurse to determine if there are other factors contributing to the patient’s fall aside from those mentioned above. Factors such as comorbidities and cognitive, sensory or physical impairment could all potentially have contributed to Mr. J.’s fall. A complete patient assessment would also uncover any deficits in ADLs and instrumental activities of daily living (IADLs), as well as provide insight into his financial and social situations, all of which could be contributing to his malnourished and unkept appearance. Determining deficits in ADLs or IADLs would also assist the social worker in determining the best placement for Mr. J. after discharge.
Mr.
J. is 84 and is possibly unable to live on his own. He deserves the quality of care required by the American Nurses Association (ANA) Code of Ethics. Provision 1.3 of the ANA Code of Ethics (2001) states that “the worth of the person is not affected by disease, disability, functional status, or proximity to death.” In order to meet her ethical obligations, a nurse must maintain the patient’s right to dignity, his lifestyle choices, and his value system. Mr. J.’s neurovascular checks were normal and there was no suggestion that he is mentally incapable of making decisions regarding his care. The nurse should discuss with Mr. J., his opinion of his ability to live on his own while keeping in mind her role to advocate for his protection and prevention from harm (ANA, 2001). Mr. J. has “the moral and legal right to determine what will be done with their own person” (ANA, 2001, Provision …show more content…
1.4).
Collaboration is going to be an important aspect in Mr. J.’s case because Mr. J’s home situation is beyond the nurse’s scope of practice. Therefore, she should make the appropriate referrals (ANA, 2001). Mr. J. needs a referral to a social worker and case manager to provide resources, information, and options for a safe home environment. A case manager will help navigate the intricacies of the healthcare system (National Chronic Care Consortium [NCCC], 2000). The case manager would work with Mr. J. and his daughter to incorporate their preferences and help with the continuity and coordination of his care (NCCC, 2000).
The nurse must also protect Mr. J’s right to privacy and his right to determine who he wants to have involved in his healthcare and living decisions. The disclosure of health information must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) guidelines for healthcare privacy, both when talking to the patient’s family and when consulting with other health care team members involved in Mr. J.’s treatment. Only information necessary to address Mr. J.’s medical needs should be disclosed to his health care team and any outside parties, except when that information is used to provide treatment (U. S. Department of Health and Human Services [HHS], n.d.c).
Mr. J. must also give consent to have his personal health information disclosed to his daughter. Once the nurse has informed Mr. J. that she is going to discuss his health status with his daughter and he does not object, she may share his medical information with his daughter (HHS, n.d.a).
The nurse must also comply with the laws of the California Nurse Practice Act, which mandates the California Board of Registered Nursing (BRN) to determine the scope of practice and responsibilities for registered nurses for the protection of the public (BRN, n.d.a). The registered nurse must follow the Standardized Procedure Guidelines, which are guidelines for the “policies and protocols formulated by organized health care systems for the performance of standardized procedure functions” (BRN, 2011, section 1471). These guidelines ensure that the nurse has had the proper training and experience, and meets the education requirements of an organized health care system (BRN, 2011). The guidelines require that standardized procedures be written, signed, and dated; establish evaluation methods for ongoing measurement of registered nurses’ competency in following standardized procedures; and also cover patient record keeping requirements (BRN, 2011). Under Article 4, section 1443.5 of the Nursing Practice Act, the nurse is legally required to follow the Standards of Competent Performance (BRN, n.d.b). Competent care would include forming a care plan with Mr. J., evaluating the effectiveness of the care plan, explaining treatment measures, and assessing his physical condition and behavior (BRN, n.d.b). The registered nurse must also act as an advocate for Mr. J. by acting in his best interest and in line with his wishes (BRN, n.d.b).
As a manager of care, the nurse’s responsibilities to Mr. J are to establish, implement and evaluate the plan of care focusing on his safety due to his recent fall. The nurse needs to perform a full functional status assessment, which includes assessments of ADLs, IADLs, and executive function, to determine his everyday capabilities and any comorbidities that might have contributed to his fall. According to the article, “Patient Choice in the Discharge Planning Process,” the “ADL assessment will be used to determine the patient’s therapy and rehabilitation needs” (Birmingham, 2009, p. 301). The article indicates that IADLs are to be used to “triage what level of care a patient may be safely discharged” and help determine whether or not a patient can go home (Birmingham, 2009, p. 301). Executive function is one’s decision-making ability. This function plays a major role in safe decision-making and risk taking, and deficits in such decision-making ability can also impact a patient’s return home (Birmingham, 2009). The nurse is also responsible for correlating all information, including data from the assessments, information from family members, and observation of the patient’s current appearance, to individualize a plan of care that will meet the patient’s needs.
As part of Mr. J.’s assessment, a fall scale like the Morse Fall Scale can be used. This scale assesses the patient’s fall history, any secondary diagnoses, the patient’s use of ambulatory aids, his present gait and ability to transfer, his mental status, and whether he has an IV (U. S. Department of Veteran Affairs, 2012). Using data from Mr. J.’s full patient assessment, the nurse will establish and implement a plan of care. Included in the plan of care will be fall precautions, neurological checks, monitoring of vital signs, and monitoring for dehydration and signs of thrombosis.
The nurse is also responsible for ensuring that Mr. J. is involved in the decision making as to where he will go upon being discharged, and any assistance he may need. Mr. J.’s daughter should also be involved if the patient has given consent. A nurse’s responsibility is to collaborate with all other fields in healthcare to provide whole care for the patient. Depending on the results of the patient assessment, it is likely that the patient will need to be referred to a social worker or case manager. A social worker or case manager can give the patient the resources and information that will help meet his needs, and will help him with his home situation. Some resources, such as the American Association of Retired Persons, the Administration for Community Living (ACL), Adult Protective Services, Social Security, and Medicare or Medicaid, are aimed at assisting the older population. The ACL is a newly formed organization that aids both the elderly and the disabled access community resources (HHS, n.d.b). Also, depending on his social and financial situation, Mr. J. might need assistance at home or might need placement in an assisted living facility.
Depending on the outcome of his assessment, Mr. J. may also need a referral to a physical therapist or an occupational therapist. If he suffered some temporary or permanent physical damage from his fall or his malnourished status is found to be related to a physical deficit, Mr. J. could benefit from a referral to the appropriate therapist. Also, if Mr. J. were to return home, a visit from a home nurse to assess the home for fall risk would be in order.
Prior to discharge, any medications that Mr. J. is on should be reviewed for necessity and appropriateness, polypharmacy, correct dosing, and correct administration. The nurse should also ensure that the patient has the information that he needs for any necessary follow-up care like a doctor’s appointment to confirm that his contusions are healing properly. Mr. J. should also be taught the signs and symptoms of infection and stroke, and when to call the doctor. Due to his age, care must be taken to ensure that Mr. J. has understood the discharge information and should be given both written and verbal instructions in terms that he can understand. He should also be asked to reiterate instructions to ensure that he has understood.
From the time Mr. J. enters the hospital to the time that he is discharged, the nurse must provide proper care for his health deviation as well as ensure that he has appropriate continuity of care after he leaves the hospital in order to prevent further injury or illness. References
American Nursing Association. (2001). Code of ethics for nurses with interpretive statements. [PDF document]. Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
Birmingham, J. (2009). Patient choice in the discharge planning process. Professional Case Management. 14(6), 296–309. Retrieved from http://www.nursingcenter.com/pdf.asp?AID=943516
California Board of Registered Nursing. (n.d.a). Nursing practice act. [Web page] Retrieved from http://www.rn.ca.gov/regulations/npa.shtml
California Board of Registered Nursing. (n.d.b). Nursing practice act. Retrieved from http://www.rn.ca.gov/regulations/title16.shtml
California Board of Registered Nursing. (2011). Standardized procedure guidelines. [PDF document]. Retrieved from http://www.rn.ca.gov/pdfs/regulations/npr-i-19.pdf
Huang, A. R., Mallet, L., Rochefort, C. M., Eguale, T., Buckeridge, D. L., Tamblyn, R. (2012). Medication-related falls in the elderly: Causative factors and preventive strategies. Drugs & Aging, 29(5), 359-376. Abstract retrieved from the National Center for Biotechnology Information database. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22550966
Lee, M. R., & Berthelot, E. R. (2010). Community covariates of malnutrition based mortality among older adults. Annals of Epidemiology, 20(5), 371-379. Abstract retrieved from the National Center for Biotechnology Information database. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20382338
Mayo Clinic. (2011, May 19). Low blood pressure (hypotension). Retrieved from http://www.mayoclinic.com/health/low-blood-pressure/DS00590
Mouton, C.
P., Bazaldua, O. V., Pierce, B., & Espino, D. V. (2001). Common infections in older adults. American Family Physician, 63(2), 257-269. Retrieved from http://www.aafp.org/afp/2001/0115/p257.html
National Chronic Care Consortium. (2000). Case management: Methods and issues. [PDF document]. Retrieved from http://www.nccconline.org/pdf/CaseManagement.pdf
National Institute of Neurological Disorders and Stroke. (2013). Traumatic brain injury: Hope through research. Bethesda, MD. Retrieved from http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm
U. S. Department of Health and Human Services. (n.d.a). A healthcare provider’s guide to the HIPAA privacy rule: Communicating with a patient’s family, friends, or others Involved in the patient’s care. [PDF document]. Retrieved from http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/provider_ffg.pdf
U. S. Department of Health & Human Services. (n.d.b). Administration for Community Living. Retrieved March 5, 2013 from http://acl.gov/About_ACL/Index.aspx
U. S. Department of Health and Human Services. (n.d.c). Summary of the HIPAA privacy rule. [PDF document]. Retrieved from
http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html
U. S. Department of Veteran Affairs. (2012, December 13). VHA NCPS Fall Prevention and Management. Retrieved March 2, 2012 from http://www.patientsafety.gov/CogAids/FallPrevention/index.html
Wikipedia. (n.d.). Hypokalemia. Retrieved March 3, 2013 from Wikipedia Wiki: http://en.wikipedia.org/wiki/Hypokalemia#Signs_and_symptoms
Mr. J. is an 84 year old man who was admitted to the hospital for assessment after a fall. His physical assessment indicated multiple contusions to the face and shoulder, an unkept appearance and possible malnourished state. While a CAT scan and x-ray showed no fractures or bleeding, the fact that the patient had head trauma was most alarming. Traumatic injury to the head could lead to a hemorrhagic stroke or cerebrovascular accident, could be life threatening, and would require immediate intervention from the healthcare team. In particular, a thrombus could occur up to several days after head trauma (National Institute of Neurological Disorders and Stroke [NINDS], 2013). Head trauma …show more content…
is a major issue for people over the age of 75, with falls being the major cause (NINDS, 2013).
In addition to concern about potential stroke, the cause of Mr. J.’s current fall and his potential for a history of falls is also of concern. If Mr. J. is prone to falls, the nurse must make further assessments to determine the contributing factors. A history of falls could indicate that Mr. J. might be suffering from a functional limitation which in turn might affect his ability to be self-sufficient.
The nurse’s observation that the patient’s clothes were dirty and unwashed, and that the patient was underweight also implies possible functional limitation. Mr. J. may require assistance performing his activities of daily living (ADLs). Another possibility is that his financial status may prevent him from addressing his hygiene and nutritional needs due to inaccessibility to resources.
The patient’s daughter expressed concern for his well being and these concerns need to be addressed. In this case, it would be appropriate for the nurse to refer the patient to a social worker. In addition, the fact that Mr. J.’s daughter lives in another state and that Mr. J. lives alone gives rise to potential social isolation, which could also be a factor contributing to his malnourished state (Lee & Berthelot, 2010).
In order to provide appropriate and thorough care to Mr. J., additional data needs to be collected. To assess the reason for Mr. J.’s fall, lab values to check for malnutrition, and fluid and electrolyte imbalance should be obtained. Either issue could contribute to a fall by causing weakness and instability. For example, if the patient were hypokalemic, he might experience difficulty maintaining balance since low potassium levels cause muscle weakness (“Hypokalemia,” n.d.). Information from vital signs might indicate cardiovascular problems like hypotension, or might signal an infection. Hypotension could cause decreased blood flow to the brain, causing dizziness (Mayo Clinic, 2011); and infection could cause confusion in an elderly person (Mouton, Bazaldua, Pierce, & Espino, 2001). In addition, the fall itself might be an indication of infection (Mouton et al., 2001).
Data as to what medications Mr. J. is currently taking might also provide information as to what factors contributed to his fall. If, for example, Mr. J. were on antihypertensive medication, his fall might have been caused by incorrect dosing for his situation or incorrect self-administration. Certain drugs, (benzodiazepines, antipsychotics and antidepressants, for example) increase the risk of falls (Huang et al., 2012). Therefore, ascertaining what drugs Mr. J. might be on and confirming dosage, proper usage and necessity of the medication is important both, in general, and for determination of causality of his fall.
In addition to information regarding the cause of his current fall, a complete assessment that would include a fall history assessment should be taken. A complete assessment would allow the nurse to determine if there are other factors contributing to the patient’s fall aside from those mentioned above. Factors such as comorbidities and cognitive, sensory or physical impairment could all potentially have contributed to Mr. J.’s fall. A complete patient assessment would also uncover any deficits in ADLs and instrumental activities of daily living (IADLs), as well as provide insight into his financial and social situations, all of which could be contributing to his malnourished and unkept appearance. Determining deficits in ADLs or IADLs would also assist the social worker in determining the best placement for Mr. J. after discharge.
Mr.
J. is 84 and is possibly unable to live on his own. He deserves the quality of care required by the American Nurses Association (ANA) Code of Ethics. Provision 1.3 of the ANA Code of Ethics (2001) states that “the worth of the person is not affected by disease, disability, functional status, or proximity to death.” In order to meet her ethical obligations, a nurse must maintain the patient’s right to dignity, his lifestyle choices, and his value system. Mr. J.’s neurovascular checks were normal and there was no suggestion that he is mentally incapable of making decisions regarding his care. The nurse should discuss with Mr. J., his opinion of his ability to live on his own while keeping in mind her role to advocate for his protection and prevention from harm (ANA, 2001). Mr. J. has “the moral and legal right to determine what will be done with their own person” (ANA, 2001, Provision …show more content…
1.4).
Collaboration is going to be an important aspect in Mr. J.’s case because Mr. J’s home situation is beyond the nurse’s scope of practice. Therefore, she should make the appropriate referrals (ANA, 2001). Mr. J. needs a referral to a social worker and case manager to provide resources, information, and options for a safe home environment. A case manager will help navigate the intricacies of the healthcare system (National Chronic Care Consortium [NCCC], 2000). The case manager would work with Mr. J. and his daughter to incorporate their preferences and help with the continuity and coordination of his care (NCCC, 2000).
The nurse must also protect Mr. J’s right to privacy and his right to determine who he wants to have involved in his healthcare and living decisions. The disclosure of health information must comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) guidelines for healthcare privacy, both when talking to the patient’s family and when consulting with other health care team members involved in Mr. J.’s treatment. Only information necessary to address Mr. J.’s medical needs should be disclosed to his health care team and any outside parties, except when that information is used to provide treatment (U. S. Department of Health and Human Services [HHS], n.d.c).
Mr. J. must also give consent to have his personal health information disclosed to his daughter. Once the nurse has informed Mr. J. that she is going to discuss his health status with his daughter and he does not object, she may share his medical information with his daughter (HHS, n.d.a).
The nurse must also comply with the laws of the California Nurse Practice Act, which mandates the California Board of Registered Nursing (BRN) to determine the scope of practice and responsibilities for registered nurses for the protection of the public (BRN, n.d.a). The registered nurse must follow the Standardized Procedure Guidelines, which are guidelines for the “policies and protocols formulated by organized health care systems for the performance of standardized procedure functions” (BRN, 2011, section 1471). These guidelines ensure that the nurse has had the proper training and experience, and meets the education requirements of an organized health care system (BRN, 2011). The guidelines require that standardized procedures be written, signed, and dated; establish evaluation methods for ongoing measurement of registered nurses’ competency in following standardized procedures; and also cover patient record keeping requirements (BRN, 2011). Under Article 4, section 1443.5 of the Nursing Practice Act, the nurse is legally required to follow the Standards of Competent Performance (BRN, n.d.b). Competent care would include forming a care plan with Mr. J., evaluating the effectiveness of the care plan, explaining treatment measures, and assessing his physical condition and behavior (BRN, n.d.b). The registered nurse must also act as an advocate for Mr. J. by acting in his best interest and in line with his wishes (BRN, n.d.b).
As a manager of care, the nurse’s responsibilities to Mr. J are to establish, implement and evaluate the plan of care focusing on his safety due to his recent fall. The nurse needs to perform a full functional status assessment, which includes assessments of ADLs, IADLs, and executive function, to determine his everyday capabilities and any comorbidities that might have contributed to his fall. According to the article, “Patient Choice in the Discharge Planning Process,” the “ADL assessment will be used to determine the patient’s therapy and rehabilitation needs” (Birmingham, 2009, p. 301). The article indicates that IADLs are to be used to “triage what level of care a patient may be safely discharged” and help determine whether or not a patient can go home (Birmingham, 2009, p. 301). Executive function is one’s decision-making ability. This function plays a major role in safe decision-making and risk taking, and deficits in such decision-making ability can also impact a patient’s return home (Birmingham, 2009). The nurse is also responsible for correlating all information, including data from the assessments, information from family members, and observation of the patient’s current appearance, to individualize a plan of care that will meet the patient’s needs.
As part of Mr. J.’s assessment, a fall scale like the Morse Fall Scale can be used. This scale assesses the patient’s fall history, any secondary diagnoses, the patient’s use of ambulatory aids, his present gait and ability to transfer, his mental status, and whether he has an IV (U. S. Department of Veteran Affairs, 2012). Using data from Mr. J.’s full patient assessment, the nurse will establish and implement a plan of care. Included in the plan of care will be fall precautions, neurological checks, monitoring of vital signs, and monitoring for dehydration and signs of thrombosis.
The nurse is also responsible for ensuring that Mr. J. is involved in the decision making as to where he will go upon being discharged, and any assistance he may need. Mr. J.’s daughter should also be involved if the patient has given consent. A nurse’s responsibility is to collaborate with all other fields in healthcare to provide whole care for the patient. Depending on the results of the patient assessment, it is likely that the patient will need to be referred to a social worker or case manager. A social worker or case manager can give the patient the resources and information that will help meet his needs, and will help him with his home situation. Some resources, such as the American Association of Retired Persons, the Administration for Community Living (ACL), Adult Protective Services, Social Security, and Medicare or Medicaid, are aimed at assisting the older population. The ACL is a newly formed organization that aids both the elderly and the disabled access community resources (HHS, n.d.b). Also, depending on his social and financial situation, Mr. J. might need assistance at home or might need placement in an assisted living facility.
Depending on the outcome of his assessment, Mr. J. may also need a referral to a physical therapist or an occupational therapist. If he suffered some temporary or permanent physical damage from his fall or his malnourished status is found to be related to a physical deficit, Mr. J. could benefit from a referral to the appropriate therapist. Also, if Mr. J. were to return home, a visit from a home nurse to assess the home for fall risk would be in order.
Prior to discharge, any medications that Mr. J. is on should be reviewed for necessity and appropriateness, polypharmacy, correct dosing, and correct administration. The nurse should also ensure that the patient has the information that he needs for any necessary follow-up care like a doctor’s appointment to confirm that his contusions are healing properly. Mr. J. should also be taught the signs and symptoms of infection and stroke, and when to call the doctor. Due to his age, care must be taken to ensure that Mr. J. has understood the discharge information and should be given both written and verbal instructions in terms that he can understand. He should also be asked to reiterate instructions to ensure that he has understood.
From the time Mr. J. enters the hospital to the time that he is discharged, the nurse must provide proper care for his health deviation as well as ensure that he has appropriate continuity of care after he leaves the hospital in order to prevent further injury or illness. References
American Nursing Association. (2001). Code of ethics for nurses with interpretive statements. [PDF document]. Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
Birmingham, J. (2009). Patient choice in the discharge planning process. Professional Case Management. 14(6), 296–309. Retrieved from http://www.nursingcenter.com/pdf.asp?AID=943516
California Board of Registered Nursing. (n.d.a). Nursing practice act. [Web page] Retrieved from http://www.rn.ca.gov/regulations/npa.shtml
California Board of Registered Nursing. (n.d.b). Nursing practice act. Retrieved from http://www.rn.ca.gov/regulations/title16.shtml
California Board of Registered Nursing. (2011). Standardized procedure guidelines. [PDF document]. Retrieved from http://www.rn.ca.gov/pdfs/regulations/npr-i-19.pdf
Huang, A. R., Mallet, L., Rochefort, C. M., Eguale, T., Buckeridge, D. L., Tamblyn, R. (2012). Medication-related falls in the elderly: Causative factors and preventive strategies. Drugs & Aging, 29(5), 359-376. Abstract retrieved from the National Center for Biotechnology Information database. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22550966
Lee, M. R., & Berthelot, E. R. (2010). Community covariates of malnutrition based mortality among older adults. Annals of Epidemiology, 20(5), 371-379. Abstract retrieved from the National Center for Biotechnology Information database. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20382338
Mayo Clinic. (2011, May 19). Low blood pressure (hypotension). Retrieved from http://www.mayoclinic.com/health/low-blood-pressure/DS00590
Mouton, C.
P., Bazaldua, O. V., Pierce, B., & Espino, D. V. (2001). Common infections in older adults. American Family Physician, 63(2), 257-269. Retrieved from http://www.aafp.org/afp/2001/0115/p257.html
National Chronic Care Consortium. (2000). Case management: Methods and issues. [PDF document]. Retrieved from http://www.nccconline.org/pdf/CaseManagement.pdf
National Institute of Neurological Disorders and Stroke. (2013). Traumatic brain injury: Hope through research. Bethesda, MD. Retrieved from http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm
U. S. Department of Health and Human Services. (n.d.a). A healthcare provider’s guide to the HIPAA privacy rule: Communicating with a patient’s family, friends, or others Involved in the patient’s care. [PDF document]. Retrieved from http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/provider_ffg.pdf
U. S. Department of Health & Human Services. (n.d.b). Administration for Community Living. Retrieved March 5, 2013 from http://acl.gov/About_ACL/Index.aspx
U. S. Department of Health and Human Services. (n.d.c). Summary of the HIPAA privacy rule. [PDF document]. Retrieved from
http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html
U. S. Department of Veteran Affairs. (2012, December 13). VHA NCPS Fall Prevention and Management. Retrieved March 2, 2012 from http://www.patientsafety.gov/CogAids/FallPrevention/index.html
Wikipedia. (n.d.). Hypokalemia. Retrieved March 3, 2013 from Wikipedia Wiki: http://en.wikipedia.org/wiki/Hypokalemia#Signs_and_symptoms