Found on the Floor, on Warfarin
At 6:15 a.m. you find Mr. Boyd, 76, sitting on the floor beside his bed, one shoe on. He is awake, answers your questions, and says, 'I'm fine, I just slid down. Help me up so I can get to the bathroom.' His chart lists warfarin, a walker, and a fall two weeks ago at home. His care plan says 'assist x1 with walker; call light within reach.' The bed is in the low position with the mat on the floor, and his call light is on the bedrail, not in his hand. No one else is in the hallway.
1. What do you do in the first minute, and what do you specifically not do?
Read the worked answer
Do not lift him. A CNA does not get a fallen resident up, even one who is talking and joking - the resident cannot feel a fracture or a slow bleed, and lifting can turn a stable situation into an emergency.
In the first minute:
- Stay with him. Do not leave to find help; use the call light or call out.
- Get the nurse, per facility policy, before anything else happens.
- Check responsiveness, breathing, and whether he remembers falling - he may not, and 'I slid down' may be his explanation rather than a memory.
- Ask about pain and where, and look without moving him for blood, a bumped head, or an arm or leg sitting at an odd angle.
- Keep him warm and still, cover him, and lower yourself to his level so he isn't looking up at you.
- If he becomes unresponsive or stops breathing normally, call for emergency help per policy rather than continuing the conversation.
2. Why does warfarin make this fall more urgent than it looks, and what would you watch for over the next several hours?
Read the worked answer
Warfarin slows clotting, so the bleeding that matters may be internal and invisible at 6:15 a.m.
- A head strike with no visible cut can bleed slowly inside the skull. Symptoms can appear hours later, so the nurse needs to know a fall happened even if he looks perfect.
- Bruising can take a long time to appear - a clear back or hip at 6:20 a.m. does not rule out injury.
- Report immediately, not at end of shift: any headache, sleepiness, confusion, vomiting, a change in speech or pupil size, dizziness, or a new complaint of pain.
- Also report dark or bloody stool, blood in urine, nosebleeds that won't stop, or new bruising when you provide care later.
- Do not give him anything for pain and do not apply heat to an injury; report and let the nurse assess.
- Expect increased checks - the nurse may add neuro checks and fall precautions, and that is not an overreaction.
3. Two days later Mr. Boyd insists on walking to the bathroom alone. How do you handle it without a standoff?
Read the worked answer
His independence matters, and so does the care plan - the answer is neither 'no' nor 'go ahead.'
- Acknowledge the wish first: 'You want to get there on your own. Let's do it together so you don't end up on the floor again.'
- Offer the walker and walk beside him on his weaker side, at his pace, with a gait belt if the plan calls for one.
- Fix what caused the fall: put the call light in his hand, keep the bed low, clear the path, and ask whether he waited too long because no one answered.
- If he refuses assistance, do not physically block or grab him. Stay close, remind him once, and notify the nurse so the team can address it.
- Report the pattern - repeated unassisted trips mean the toileting schedule or call-light response needs to change, not that he needs to be scolded.
- Never restrain or lock him in; that is not a CNA decision and not a safe one.