STEADI's screen, assess and intervene steps, applied to two reconstructed falls in a composite retired coach, tie NU584's Unit 4 analysis to tamsulosin, an orthostatic drop and a hidden step. Searches like "nu 584 unit 4 assignment example", "nu584 unit 4 sample" and "nu584 unit 4 example" land here.
Two Falls, One Transition, Three Culprits: A Falls Risk Analysis Rebuilt Minute by Minute for an 80-Year-Old Former Wrestling Coach
[Student Name]
Purdue University Global
NU584: AGNP II - Primary Care of the Frail Elderly
Unit 4 Falls Risk Analysis
[Instructor Name]
[Date]
The patient is a composite; measurements, doses and dates are bracketed.
Reconstruction
Fall 1, [date]. Time: 6:10 a.m. Activity: walking from the bedroom, still sleepy, stepping down one step into the sunken living room. Footwear: socks on hardwood. Lighting: dim; lamp off. Symptoms before: lightheaded as he stood from bed, he says, "a little woozy." He missed the step and fell forward onto his hands. Got up alone after a few minutes. Lay on the floor: [three] minutes.
Fall 2, [date]. Time: 2:40 a.m. Activity: rising from the toilet after urinating. Footwear: barefoot. Lighting: nightlight only. Symptoms before: "The room went gray." He sat back down, then stood again and fell sideways against the tub. Got up alone with difficulty, using the tub edge. Lay on the floor: [ten] minutes.
Both falls happened at a transition from lying or sitting to standing, at night or at dawn, and in both he felt lightheaded first.
STEADI Assessment
The CDC's STEADI initiative sequences screening, assessment and intervention (Stevens & Phelan, 2013). Screening: positive on all three key questions: he has fallen in the past year, feels unsteady when walking, and worries about falling. Assessment:
1. Gait, strength and balance. Timed Up and Go: [15] seconds, above the 12-second threshold for increased fall risk. 30-Second Chair Stand: [7] rises, below the norm for his age. Four-Stage Balance Test: cannot hold tandem stance for 10 seconds.
2. Orthostatic blood pressure. Lying [142/80]; standing at one minute [114/72]; at three minutes [118/74]. A systolic drop of 28 mm Hg: orthostatic hypotension.
3. Medications. [Tamsulosin] started [six] weeks before the first fall for urinary symptoms; [lisinopril] increased from [10] to [20] mg [two] months ago. No sedatives.
4. Vision. Progressive lenses, which blur the lower field when looking down at a step.
5. Feet and footwear. Socks on hardwood at home; no foot pain or neuropathy.
6. Home hazards. The sunken living room step is unmarked, the same color as the floor; the hallway is dark at night; no grab bar by the toilet.
Synthesis: Ranking the Contributors
1. Orthostatic hypotension, first. It explains the night fall directly, a drop in pressure on standing with graying vision, and plausibly the dawn fall, when he felt woozy rising from bed. Its causes are on his list: tamsulosin, an alpha-1 blocker that relaxes blood vessels as well as the prostate, started six weeks before the first fall, and a recent increase in lisinopril. Nocturia adds to it by bringing him to his feet at night.
2. Weakness and poor balance. A slow Timed Up and Go, few chair rises and failed tandem stance mean that once he is lightheaded, he cannot recover.
3. The unseen step and environment. An unmarked step, progressive lenses and socks on hardwood turned a stumble into a fall at dawn.
The Time on the Floor
The reconstruction records how long he lay on the floor because that time is a risk of its own. After the second fall he lay for ten minutes before he could get up, using the edge of the tub. A longer lie, after a worse fall, can bring dehydration, pressure injury and pneumonia, and fear of lying helpless is a common reason older adults stop moving, which weakens them further. He had not told his daughter about either fall. A former wrestling coach, he said he "knew how to fall," and he did land well both times, but he could not get up easily. The plan therefore adds two things the causes alone do not suggest: practice getting up from the floor, taught by the physical therapist, and a way to call for help from wherever he falls, a wearable alert or a phone he keeps on him at night. He agreed to tell his daughter about the falls himself, and she now calls each morning.
Why a Prostate Drug Can Cause a Fall
Tamsulosin is chosen for urinary symptoms partly because it favors the alpha-1 receptors of the prostate over those of blood vessels, which lowers its effect on blood pressure compared with older alpha blockers. The selectivity is partial, not complete. In an older man, especially one whose blood pressure medicine was just increased and who gets up at night, the small drop in standing pressure it causes can be enough. The timing, six weeks before the first fall, and the orthostatic reading make it a strong suspect, which is why the plan reviews it first.
Interventions, With Owners and Dates
1. Tamsulosin: move the dose to bedtime after dinner only if it stays, or consider stopping it and reassessing urinary symptoms; review with the prescriber by [date]. Owner: prescriber.
2. Lisinopril: consider returning to [10] mg, with home blood pressure monitoring, including standing readings. Owner: prescriber. Date: [date].
3. Orthostatic habits: sit up and dangle his legs for a full minute before rising; stand slowly from the toilet with a hand on a grab bar. Owner: patient, taught today.
4. Exercise: the Otago program through physical therapy, twice weekly for [eight] weeks, then at home. Home-based strength and balance exercise reduced falls in older women in the trial that established the program (Campbell et al., 1997), and the USPSTF gives exercise a grade B for older adults living at home whose fall risk is raised, as his is (US Preventive Services Task Force, 2024). Owner: physical therapist. Start: [date].
5. Home: occupational therapy home visit; contrast tape and a rail at the living room step; motion-sensor lights in the hallway and bathroom; a grab bar by the toilet. Owner: occupational therapist and his daughter. Date: within [two] weeks.
6. Vision: single-vision distance glasses for walking, especially outdoors and on steps. Owner: optometrist. Date: [date].
7. Footwear: supportive shoes or nonslip slippers at home, never socks alone on hardwood. Owner: patient.
8. Nocturia: limit fluids after dinner; review urinary symptoms after any tamsulosin change. Owner: prescriber.
Reassessment
Orthostatic blood pressure at every visit for the next [three] months; repeat mobility tests, the timed walk and the chair rises, after [eight] weeks; any new fall reviewed with the same reconstruction. The measure of success is not only fewer falls but the numbers that predict them: a standing blood pressure that no longer drops by 20 or more, a Timed Up and Go under 12 seconds, and a tandem stance he can hold. If those improve and he still falls, the analysis starts again from the new event.
References
Campbell, A. J., Robertson, M. C., Gardner, M. M., Norton, R. N., Tilyard, M. W., & Buchner, D. M. (1997). Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ, 315(7115), 1065-1069. https://doi.org/10.1136/bmj.315.7115.1065
Stevens, J. A., & Phelan, E. A. (2013). Development of STEADI: A fall prevention resource for health care providers. Health Promotion Practice, 14(5), 706-714. https://doi.org/10.1177/1524839912463576
US Preventive Services Task Force. (2024). Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. JAMA, 332(1), 51-57. https://doi.org/10.1001/jama.2024.8481
How this NU584 Unit 4 example is structured
The analysis argues backward from events to causes and then forward to a plan. Reconstruction comes first because a fall's circumstances usually carry its explanation, and both falls here share a transition from lying or sitting to standing. The STEADI assessment then tests the candidate causes one domain at a time, linking each abnormal finding to one or both falls. A synthesis ranks contributors, putting orthostatic hypotension first because it explains the nighttime fall outright and plausibly the dawn one. The intervention table pairs each contributor with a response, an owner and a date: a review of tamsulosin timing and the lisinopril increase for the prescriber, the Otago program through physical therapy, an occupational therapy home visit, single-vision glasses for walking outdoors, and a rail with contrast tape on the step. Exercise is justified by the USPSTF's 2024 recommendation.
Get an NU584 Unit 4 example written to your instructions
Paste the Unit 4 case with every detail it gives about the falls, the drugs he takes and the home, plus the rubric. The sample reconstructs each fall, runs the STEADI assessment against the data provided, and ties each intervention to a finding, with drugs bracketed. It comes back within 24-48h, at no charge the first time. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
NU584 Unit 4 questions, answered
Does a falls paper have to use STEADI?
Not always, but STEADI is the CDC's framework for primary care, and many sections expect it or something comparable. Its value in a paper is structure: screen, assess, intervene, with validated tests named. If your prompt names another framework, follow it; the logic of linking each finding to a response carries over unchanged.
Which balance and strength tests should be reported?
The three STEADI names are the Timed Up and Go, the 30-Second Chair Stand and the 4-Stage Balance Test. Report each with its result and the cutoff or age norm used. Where the case supplies only one, report that one and note what the others would add. Invented results should never appear in the paper.
How should vitamin D be handled in a falls plan?
Carefully. In 2018 the USPSTF recommended against vitamin D supplementation to prevent falls in community-dwelling adults 65 or older, so adding it by reflex can cost credit. Checking for deficiency where the history suggests it, and treating a documented deficiency, is a different matter. The sample keeps that distinction explicit.