An older male adult who has chronic obstructive lung disease has muscle wasting and poor skin integrity due to a long-term therapeutic regimen. Which patient teaching should the nurse use to help reduce his risk of falls?

Question

a. Take calcium carbonate (Caltrate 600) with meals.
b. Take omeprazole (Prilosec) before breakfast.
c. Participate in a progressive regular exercise program.
d. Avoid crowds and people with contagious illnesses.
e. Consume a well-balanced diet that is high in calories.
f. Perform gentle skin cleansing with an emollient lotion.

Answer 1

C, E

a. Incorrect. Although this man is at risk for below-normal bone density, the nurse instructs the patient to take up to 500 mg of calcium because the system cannot absorb more than 500 mg at a time.
b. Incorrect. Administering a proton-pump inhibitor is a reasonable nursing intervention for a patient with a history of taking steroids to protect the gastrointestinal tract; however, that is not directly related to preventing the risk of falls.
c. Correct. Participating in a regular exercise program is an important nursing intervention to help prevent the risk of falls for this older adult because he has clinical indicators of com-plications from steroid therapy. Steroids are a common therapeutic regimen used during exacerbations of chronic obstructive pulmonary disease (COPD); and, if needed long-term, steroids can ravage the skin and musculoskeletal system of the patient, causing muscle wasting and osteoporosis. Thus this man is likely to have below-normal bone density, and so the nurse instructs him to participate in regular, progressive exercises and pulmonary rehabilitation to build cardiopulmonary reserve, muscle bulk, and bone density to help prevent the risk of falls.
d. Incorrect. Avoiding sick people is a reasonable nursing intervention to prevent the risk of infection for an individual with COPD.
e. Correct. The nurse instructs the patient to eat a high-calorie, well-balanced diet to provide the body with substrate for tissue building and repair. A higher amount of calories than usual are required because patients with COPD work very hard to breathe and this work requires more calories to prevent tissue atrophy. This helps to prevent the risk of falls by supplying the body with sufficient fuel to sustain activity and by increasing bone and mus-cle density to maintain balance and coordinated movement.
f. Incorrect. The nurse instructs this older adult to cleanse the skin gently and apply an emol-lient lotion to maintain skin integrity.