Question

Older Adults

1. 73 year old woman presents as a new patient in a primary care setting, registered to NP. She has been taking lorazepam for anxiety/poor sleep since husband’s death 10 years ago. Normally on 1mg hs, but increased poor sleep x 2-3 months, self-increased dose to 2mg. sometimes takes during the day for anxiety with glass of scotch. Other drugs – candesartan and paroxetine (depression).

She reveals a recent ED visit after a motor vehicle accident – crashed car into tree driving home. Fall at home 3 weeks ago which she tripped on scatter mat taking out garbage – sprained wrist, taking ibuprofen, wants Tylenol with codene (T3). NP attempts to open discussion of benzo use and falls/accidents. She is surprised and says “this has never been an issue, no one discussed this before”.

Questions

• Best practices regarding use of benzodiazepines and fall risk in older adults
• Approaches to counselling the older adult client regarding goal, risk/benefit, proper use and potential side effect

2. ABOUT FORENSIC NURSING IN THE COMMUNITY

Answer 1

Answer 1)Drug Benzodiazepine is a tranquilizer used in the treatment of anxiety related conditions including anxiety-related insomnia.Drinking alchahol is contra indicated with Benzodiazepine.

Goal

The NP should discuss the patient about taper and stop the use of drug Benzodiazepine because she is an older adult with recent history of falls.

Risk/Benefits

As a good rule of thumb is to go slow :small dose reduction every 2 weeks. Should avoid sudden withdrawing, which can lead to more incidious rebound effects.

Proper use and potential side effects

In elderly patients ,continous use of Benzodiazepine can exacerbate the underlying dementia and may cause excessive morbidity. Cognitive impairments seems to develop incidiously which is a late complications if started at the younger age.

Side effects

Because of benzos the patient can experience dizziness which can increas the fall risk.

Fatigue and drowsiness can lead to auto accidents.She also met with an accident.

They have a negative effects on the memory and other cognitive functions.

And 2) Forencic nursing provide specialized care for patients experiencing acute and longterm health conciquences associated with violence and or have unmet evidentiary needs relative to having bee victimized or accused of victimization.

Forensic nurses provide consultation for civil and criminal proceedings regarding related to nursing practice, care given and rendered regarding findings.