LTC Falls

[Kiara Butler]

If you have a patient who falls and you assess them and do vital signs and everything initially checks out so you place them in bed for continuous observation. If the patient expresses they have a head ache during one of your neuro checks is it okay to give Tylenol and follow up with the doctor or is it best not to give medications and only apply something like a cold rag until you get doctor's orders?

[Lynker, LPN]

In this case, I believe it would be okay to give the Tylenol PRN. When did the fall happen, and when are they stating they have the headache? Did the patient hit their head? Are they able to tell you if they did or not? What part of the body was hit from the fall?

I would also contact the doctor. Chances are, they'd just tell you to give the PRN and monitor for any new onsets of pain.

[Rita Clayton]

If a head injury is a possibility post event, you would refrain to give meds that cause cns depression such as benzos or opiates that would make ams less obvious. Tylenol would not do that, so the tylenol would be a good intervention.

[Weaver Craig]

Avoid administering medications that worsen cns depression, like opiates or benzos, as they could mask the symptoms of an apparent head injury. Tylenol would be a positive intervention because it wouldn't do that. https://space-barclicker.com

[karen623]

Kiara Butler said:

If you have a patient who falls and you assess them and do vital signs and everything initially checks out so you place them in bed for continuous observation. If the patient expresses they have a head ache during one of your neuro checks is it okay to give Tylenol and follow up with the doctor or is it best not to give medications and only apply something like a cold rag until you get doctor's orders?

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Do they already have an order for PRN Tylenol? If not then you would have to wait until the doctor gives an order. 

[Tannjo]

In our facility ANY unwitnessed fall or a fall with an oriented patient stating that they hit their head, have a headache, etc. we have standing orders to send out to ED immediately for CT/MRI by our Medical Director (M.D.). The primary reason for this of course is because head trauma can occur without any visible symptoms initially, and when there is a subdural hematoma, the damage is can be insidious initially & severe , especially if there is are no MRI's or scans done-asap.  Of course, we've had the occasional DON who tries to "suggest" other modalities of treatment at our disposal that "can be done here at the facility”… (X-rays, etc). To which the Medical Director called an early learning morning conference with nurse management to squash that idea & of overriding her standing orders.  (Only because corporate was having a hissy fit at the cost). Better to be safe than sorry... I've seen some very sad results from doing "just Tylenol, and the typical in-house NEURO checks”… and not a chance that I as a nurse would ever second guess our medical director's  judgment nor my own over a corporations concerns about their budget for the fiscal year...