Ch 32: Rehab and Restorative Care Flashcards
goal of rehab and restorative care
Prevalence of chronic conditions, frailty, and disability is increased
Goal is saving lives and preserving quality of life
examples of rehabilitative care
Therapies focused on returning an individual to their previous level of function
–Occurs after a problem that affects function
–Skilled rehabilitative care centers with PT/OT/SLP
examples of restorative care
Care that assists people in maintaining or improving current level of function, avoiding decline and complications, and achieving the highest quality of life
–For those who have reached their maximum functional ability with no rehab potential
–Enables people to cope, be maximally independent, have a sense of well-being, and enjoy life
Inability to perform an activity in a normal manner
disability
frailty means they have three of more of the following symptoms:
progressive weight loss, slow walking speed,
low grip strength, fatigue,
low activity levels
frailty can be due to:
sarcopenia (age-related changes to skeletal muscle mass from inactivity,
malnutrition, malignancies,
reduction in nerve cells & anabolic hormones)
frailty causes risk for
falls
disability
hospitalization
death
Psychological, physiologic, or anatomic loss or abnormality causing restriction
impairment
Limitation in ability to fulfill role or functions
Consequence of disability or impairment
handicap
living with a disability
Can disrupt roles, relationships, responsibilities; diminished body image and self-concept
Introduces vulnerability
Physical and emotional pain; frustration
Previous attitudes, personality, lifestyle, experiences, and family have strong influence on reactions to a disability
Can come with many losses function, role, income, status, independence, and/or anatomic structure
–May exhibit stages of grief; fluctuates
principles of rehabilitative care
Increase self-care capacity
Eliminate or minimize self-care limitations
Act for/do for when the person is unable
guidelines for rehabilitative nursing
Know the unique capacities and limitations of the individual
Emphasize function rather than dysfunction
Provide time and flexibility
Recognize and praise accomplishments
Do not equate physical disability with mental disability
Prevent complications
Demonstrate hope, optimism, and a sense of humor
Rehab is individualized; requires multidisciplinary team
functional status fo older adults
Directs rehabilitative care
Can change from time to time and vary
Can be totally independent, partially independent, or dependent
Examples
functional assessment
- Determines the individual’s level of independence in
performing ADLs and IADLs - Determines rehabilitative needs
- Assessments
- Katz Index of Independence in ADLs
- Deficits with ADLs and IADLs require intervention
Interventions to Facilitate and Improve Functioning
Facilitate proper positioning
–Correct body alignment
Assist with range of motion
Assisting with mobility aids and assistive technology
Teaching about Bowel and bladder training
Maintaining and promoting mental function
assistance with range of motion
Active _ independently by patients
Active assistive _ with assistance to the patient
Passive _ with no active involvement of the patient
Most significant concern is degree of ROM to complete ADLs
Put all joints through full ROM daily
Stop if: resting HR >100, exercise HR >35% above resting HR, increase/decrease in SBP by 20 mm Hg, angina, dyspnea, pallor, cyanosis, dizziness, poor circulation, diaphoresis, acute confusion, restlessness
Steps
Offer support above and below joint
Move joint slowly and smoothly x3
Do not force past resistance
Document
Assisting with mobility aids and assistive technology
Enable patients to independently fulfill needs and enhance function
Evaluate for true need
Individually fitted
Cane
Provide wider base of support; not for weight bearing; used on unaffected side and advanced when affected limb advances
Walkers
Offer broad base and used for weight bearing and stability
Advance the walker then step forward
Wheelchairs
Promote mobility for persons unable to ambulate, disabilities, paralysis, or cardiac disease
Assistive technology
Promote independent function
Splints, utensil grips, Velcro attachments, computers, voice synthesizers, Braille reading, remote control devices, robotic arms
Teaching about Bowel and Bladder Training
Complications of incontinence and poor bladder and bowel control
Nurse should evaluate the physical and mental capacity for training program
Be consistent!
Interventions for bowel incontinence (from Digestion and Bowel Elimination chapter)
Assessment
Position for optimal evacuation of bowel (lean forward or prop feet up)
Bear down to defecate
Good exercise, fiber, and 1500 mL of fluid intake
interventions for bladder incontinence
Assessment
Bathroom is easily accessible
1500 mL of fluid
Lean forward and press on lower abdomen for complete bladder emptying
Kegel exercises
Containment devices
Avoid indwelling catheters
Improve environment for urination
Explore feelings
Maintaining and Promoting Mental Function
Mental function can deteriorate if not exercised
Mental stimulation is individualized based on intellect, interests, and educational level
Reminiscence
AKA life review
Improves memory, reduces depression, resolves past conflicts, validates existence, and enhances the quality of life
For people with dementia improves communications, mood, cognition, and quality of life
Most important skill for nurses listening
Encourage greater exploration
Reality orientation
Keeps the client oriented with clocks, calendars, holiday themed decorations, reality boards WITH interactions
Clarify and state the facts
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