Mrs. R.: “The Room Is Spinning” During a Return Transfer
Mrs. R., 84, had a left-hemisphere stroke nine days ago and has right-sided weakness. She takes a diuretic every morning and is on thickened liquids. At 7:40 a.m. you help her to the toilet; she is in the bathroom for twelve minutes. On the way back to bed she says the room is “spinning,” her face looks pale and clammy, and she grips your arm hard. You are alone, six feet from the bed and three feet from the wheelchair. Her right leg is buckling. Her call light is on the bed, out of reach. Breakfast trays arrive in ten minutes and your other three residents are still in their rooms.
1. What do you do in the next 30 to 60 seconds, and why in that order?
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Do not try to cover the last six feet. A buckling leg means she cannot bear weight. If you hold on and keep walking, you will both go down and she will land on the floor edge or on you.
- Guide her down, do not catch her. Bend your knees, keep your back straight, let her slide down your body to the floor, or lower her into the wheelchair if it is already at her side. Trying to “catch” a falling adult is how aides injure their own backs and how residents hit their heads.
- Do not pull on her right arm. The affected shoulder subluxates easily after a stroke, and that injury outlasts the dizziness.
- Protect her head and keep her seated on the floor with her back supported.
- Get help without leaving her. Pull the call light cord if you can reach it, bang on the wall, or call out. Walking away from a pale, clammy, dizzy resident to look for a coworker is the wrong choice.
- Stay with her and keep talking calmly. Dizziness and clamminess that begin shortly after sitting and then standing is the classic pattern of orthostatic hypotension, and your calm voice lowers her panic and her heart rate.
Breakfast and the other three residents wait. Nothing else on your assignment outranks a resident who is going down.
2. She is safely on the floor and a coworker has arrived. What do you assess, and what do you hand off to the nurse?
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Assess only what is in your scope, and keep it systematic:
- Head and skin: ask whether she struck her head, look for bumps, cuts, or new bruising; check the right arm and shoulder for new pain or a change in shape.
- Pain: where, how bad, and whether it changed when she went down. New hip or leg pain after a stroke is not something to “watch.”
- Vitals: blood pressure and pulse lying, then sitting if your facility protocol allows, plus respirations and oxygen saturation if available. Compare with her last recorded set.
- Recent history: when the diuretic was given, how much she ate and drank, when she last voided and how much.
- Mental status: is she alert and oriented as she was at 7:00 a.m., or more confused?
Hand off in a tight, ordered report: who she is, what happened, what you saw, what you did, what the vitals are, and what you are worried about. Say the words “possible orthostatic drop after her morning diuretic” so the nurse knows why you are calling now rather than at lunch.
3. The nurse asks you to write a note. What belongs in it, and what does not?
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Belongs:
- Time-stamped, objective observations: “7:52 a.m. - resident reported room spinning while returning from bathroom; skin pale and clammy; right knee buckled; lowered to floor with assistance; no head strike reported; call light used to summon staff.”
- What you did and who you told, with the time you told them.
- Vitals you actually took, with the position she was in.
- Direct quotes when they matter: “She said, ‘I don’t want to be a bother.’”
Does not belong:
- Guesses about cause (“she had a TIA,” “she didn’t take her water pill”).
- Blame or judgement of the resident or of the previous shift (“resident was noncompliant,” “days left her call light out of reach”).
- The phrase “incident report completed.” The incident report is a separate, factual, non-punitive document; referring to it in the chart makes it discoverable in a way your facility’s policy is designed to prevent.
- Anything you did not personally see or do.
If you are unsure of a word, describe the behavior instead: “gripped my arm and said the room was spinning” is charting; “dizzy” is a diagnosis.