Found on the Floor at 6:10 a.m.
At 6:10 a.m. you find Mrs. P, 82, lying on the floor beside her bed in room 118. She is awake and breathing, and she says, "I climbed over the rail to get to the bathroom. Help me up, I'm fine." Her left leg looks slightly shortened and turned outward, and there is a 3 cm reddened area on her left temple. She takes warfarin daily. The bed is in the low position and the call light is on the floor under her hand. Your coworker is on break down the hall, and the nurse is passing medications in room 106 and cannot see you.
1. List your first actions, in order.
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Sequence matters more than speed.
- Stay with her and do not move her. Kneel or crouch beside her, tell her who you are and that you are getting help.
- Get help without leaving her. Use the call light on the floor (it is within her reach - press it yourself if needed) and call loudly down the hall for the nurse. If no one responds within seconds, that is the one situation where you may need to use the room's emergency call system or shout for a specific person by name, but you do not walk away and leave her alone on the floor.
- Check and monitor: is she breathing normally, is she confused compared with her usual self, does she have pain and where, can she move her arms and legs, is there bleeding. Keep her warm with a blanket or pillow under her head only if the nurse directs.
- Report what you saw, her exact words, the leg position, the temple area, and the warfarin.
- Do not put her back to bed, do not lift under the arms, and do not offer her anything to eat or drink.
2. She is alert and asking you to help her up. Why is refusing the right call, and how do you say it?
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Because a shortened, externally rotated leg is a possible hip fracture, and lifting her could turn a fracture into a worse one - or into a bleed.
- Reasoning: She is awake and oriented, so her request feels reasonable, but an oriented resident can still have a serious injury she cannot feel properly. Her left leg position is the specific finding that makes "help me up" unsafe to honor.
- Being on warfarin raises the stakes on both the head strike and any internal bleeding from manipulation.
- Say it plainly and without arguing: "I'm not going to move you, Mrs. P - I'm worried about your hip and your head. I'm staying right here and the nurse is coming. You're not in trouble."
- Do not debate the side rails or scold her about climbing over them while she is on the floor. Safety first; teaching and care-plan changes come later with the nurse.
- If she tries to get up herself, keep your hands ready to support her head and stay at her level; do not physically wrestle her.
3. What must be reported and watched after the nurse arrives, and what is your role in the incident report?
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Report the facts, watch the head, and stay out of the conclusions.
Report to the nurse:
- Exactly where and how you found her, the time, her words, and that a side rail was in use.
- The reddened temple area, the leg position, and that she takes warfarin daily - the anticoagulant is the detail that turns a bump on the head into a neuro-check order.
- The call light being on the floor.
Monitor and report changes afterward:
- Level of alertness, headache, nausea or vomiting, unequal pupils, weakness, and any change in speech - report immediately, not at the end of the shift.
- Pain, ability to bear weight later, and skin.
Incident report:
- A nurse aide may be asked to give factual information for the facility's incident report, but does not decide whether it is written, does not assign blame, and does not mention the report in the resident's chart or discuss it with the family. Charting describes the resident's condition and care; the incident report is a separate administrative document.