Chapter 6 Flashcards
What are normal signs of aging
Changes or loss of brain cells
Slower nerve conduction and reflexes
Changes in vision, hearing, taste, and smell
Confusion
Memory changes
What is dementia
The loss of cognitive function and memory loss caused by changes in brain
A cluster of symptoms include loss of thinking, remembering, reasoning ,poor judgment, personality changes
Causes of Dementia
Hereditary
Environment
Drugs
Alcohol
CVA-stroke
depression
multiple sclerosis
parkinson’s disease
brain tumors
infection
trauma
How much is alzheimers disease is dementia
70%
What is delirium
A temporary change in cognitive function which occur over a short period of time
Reversible
Usually a direct physiological consequence from a medical condition
Diagnosis of dementia
Neurological/mental exam
CT scan-Computerised tomography
Neuropsychological testing
Spinal tap
PET-positron emission tomography
EEG-Electroencephalograph
What is PET
PET-positive emission tomography
What is a CT
Ct- computerised tomography
What does CSF stand for?
CSF- spinal tap
A procedure in which a thin, hollow needle is inserted into the lower part of the spine to collect a sample ofcerebrospinal fluid(CSF).
Cerebrospinal fluid(CSF, shown in blue) is made by tissue that lines the ventricles (hollow spaces) in the brain. It flows in and around the brain and spinal cord to help cushion them from injury and provide nutrients.
Neurons
We have about 100 billion neurons
New research shows that new neurons are developed throughout life
Cell body
Dendrites
Axon have two distinctive parts- tube like structure and axon branches at the end
(axon terminals) that connect to dendrites of other cells
Myelin Sheath
covers axon. Increases the speed of neural signals down the axon
Axon terminals
have small storage sacs called synaptic vesicles. This contains neurotransmitter molecules.
Neurotransmitters
binds to receptors that it fits
What are Plaques formed from?
beta amyloid protein
This protein accumulate around the neuron and cause the cells to die.
What are tangles caused by?
twisted strands of protein called tau that form within the cells. Neurons become deformed and clump together.
5.3 million people in US are suffering from AD today
Prevalence of AD in 65 years or older-10%
25-30% - 75 or older
47% - 85 or older
Alzheimers disease
What are risk factors of Alzheimer’s disease
Increase in age
Family history
Diabetes
Hypertension
Estrogen deficiency
Smoking/Alcohol intake
How early do changes in the brain happen for alzheimers start before diagnosis?
20ys
Violent or hostile. Raising one’s voice, yelling, hitting, shoving, kicking, throwing things, biting, spitting, insulting others, and resisting care
Combative
How can a NA promote safety with a combative resident
Observe for early signs of possible combativeness, such as pacing, tensing the body, a flushed face, and angry look
Giving a bath to patient and person doesn’t want to and screaming and yelling
it is ok. Leave them alone. Lower bed and give call light.
what happens in the first stage of Alzheimers disease?
Gradual stage-General- Anxiety
Memory- Look at clocks, calendar frequently, takes long time to do routine tasks
Orientation- Time disorientation
Judgment-Impaired
2-4 years
Memory- forgets name words, difficulty focusing attention, initiating actions, difficulty with decisions, spending irresponsibly, cannot make decisions at job. Difficulty concentrating, frequent errors with check books.
stage 1 of AD
Stage 2 of AD
Increase loss of intellect
More obvious memory loss
Time, place disorientation
Restlessness, uneasy
Dulled senses
Lose impulse control (swear/inappropriate behaviors)
memory loss like important papers, forgets simple directions, forgets medicine
Easily lost, day/ night confusion, forgets meals, judgment is poor, cannot follow
Problem recognizing family and friends
Sun downing
Suspicious, irritable, teary, repetitive movements like tapping
2-10 years
stage 3 of AD
Terminal stage
May lose total communication-grunts, cries, groans
Doesn’t recognize themselves or family
Totally dependent for ADL’s
Swallowing problems
May become totally bed bound
Coma-Death
1-3 years
Need tube feeding to survive, cannot swallow.
they are bed bound
Three considerations of AD
Caution
communication
comfort
Protect the patient from harm , provide a safe environment
Provide for understanding, both verbal and non verbal
Physical, emotional and environmental comfort
AD daily activites
Fearful
*Not understanding
*Forgetting what he needs to do
*Brain- can’t tell the muscles to move
*Bath/ dressing/ eating
*Oral hygiene/ undergarment change
Bath- raining- wet- cold-stepping into shower, take clothes off, get into bathtub
Dressing- tight vest, pulling sweater, forget what he put on, stand up, sit down
Eating- noneatible- chewing on utensils
Oral hygiene- chewing on tooth brush, brushing hair, tooth paste- eating it- person getting too close
Diaper change- doesn’t know that he is wet, don’t want people touching the body
Digestive system—Feeding techniques
May have to go along with ideas or words that are not grounded in reality
*Focuses on steps leading to final outcome
Dementia
What should a NA never do with a person with dementia
Confront them with loss of memory
*Talk about them in front of their face
*Respond to their accusations
*Get in to power struggle with them
*Put them on the spot, argue with them
*Put them through memory test
Communication Strategies for people with AD
State ideas in a positive rather than negative terms
*Avoid questions and state ideas in positive terms. If a question must be asked , limit choice.
*Avoid baby talk; speak to them as an adult
*Do not reason and apply logic
e terms like guide individual to behavior that you would like them to do like “ put your hands in the lap”, negative terms( focus on undesirable behavior and don’t help the individual understand what you would like) “ don’t put your hand in mashed potatoes”.
- Rather than asking “ What would you like for lunch today”, state in positive terms like “ we are having chicken nuggets for lunch today or limit choice by saying “ would you like grilled cheese sandwich or chicken stew”
- Avoid words and tone of voice normally reserved for children and infants
4.Find an alternative response that does not confront the individual. Don’t say” Now you know you are not supposed to wear your shorts over your pants” say like “ let me help you to take those shorts off”
Techniques with ADL’s for AD patients
CONSISTENCY IN APPROACH
*FOCUS ON ABILITY
*TASK BREAKDOWN TECHNIQUE
*CLUEING
*DISTRACTION TECHNIQUE
R SCHEDULE IS IMPORTANT, ROUTINE IS FAMILIAR AND COMFROTING,BE FLEXIBLE WITH THE SCHEDUL,STAY CLAM AND UNHURRIED,RESIDENTS WILL RECAT TO YOU AND YOUR BEHAVIOR( GETTING ANXIOUS AND AGITATED), MAINTAIN A CONSISTENT REALISTIC SCHEDULE BUT BE FLEXIBLE WITHIN THE SCHEDULE.
2..WORK WITH RESIDENTS STRENGTH AND ABILITIES, FOCUS ON WHAT THEY CAN DO AND WHAT THEY CANNOT DO, HELP MAINTAIN ABILITIES FOR AS LONG AS POSSIBLE( KEEP AS INDEPENDENT AS POSSIBLE)
3..BREAKDOWN TASKS INTO STEPS,THE RESIDENT MAY ONLY BE ABLE TO CONCENTRATE ON ONE THING AT ATIME
4..CLUES ARE REMINDRERS THAT STIMULATE THE MEMORY AND HELP A PERSON TO DO THE ATSK( NAMES ON DOOR, PICTURES)
5..YOU CAN CHANGE THE SUBJECT HE WON’T RENMEBERFROM ONE MOMENT TO THE NEXT), COMMENT ON SOMETHING POSITIVE( MARY, YOUR DRESS IS LOVELY), STAY CALM WHEN USING DISTRACTION OR THE RESIDENT WILL PICK UP ON YOUR FEELINGS.
What are some feeding problems for people with AD
Doesn’t like food
*Poor nutrition
*No concept of getting food to mouth
*Keep food in the mouth
*Picks up food
*Dehydration
What are some techniques for feeding for people with AD
Sit across
*Tell what is on the plate
*Alternate food and water—Chew—water
*Remind to swallow
Adaptive therapies
Reality orientation
*Validation
*Reminiscence therapy
*Activities
Wander guard, chair alarm, bed alarm is for someone at risk of
Elopement
TOOMANY PEOPLE,NOISE, ACCIDENTS., OR MESSES), INABLITY TO PERFORM AN ACTIVITY, TOOMANY DISTRACTIONS AT ONCE, BEING ASKED TOO MANY QUESTIONS.
OVERLOAD
: KEEP THE PACE LOW, ONE QUESTIONS AT A TIME, USE CALMING WORDS AND ACTIONS, REGULAR ROUTINES, AVOID DISTRACTING THE PATIENT.
INTERVENTONS for catastrophic reactions
INCREASED RESTLESSNESS AND AGITATION, CONFUSION, SUSPICIOUSNESS, DECREAES ATTENTION SPAN, CONCENTRATION, DEMANDING BEHAVIOR are all aspects of what behavior
Catastrophic reactions
What is clueing
Reminders, pictures of them when they were young
CAUSES of sundowning-
OVERSTIMULATION WHOSE TOLERANCE FOR STRESS IS LOWER AT THE END OF THE DAY.MAY BE CAUSED BY HUNGER, DISCOMFORT, PAIN OR NEED TO URINATE. CAREGIVER’S FATIGUE IS COMMUNICATE DTO RESIDENTS.
INterventions for sundowning
INTERVENTIONS: PLAN DAY SOTHAT FEWER THINGS OCCUR BY THE END OF THE DAY, REDUCE ACTIVITY AROUND PATIENT, GIVE SIMPLE CHORE TO DO ( FOLDING, WIPING, PAINTING),HAVE SOME ONE
TENDENCY TO MOVE ABOUT IN SEEMINGLY AIMLESS MANNER.
wandering
What are the causes of wandering
THERE ARE DIFFERENT KINDS OF WANDERING AND DIFFERENT REASONS WHY A BRAIN IMPAIRED PERSON WILL WANDER. IDENTIFYING THE CAUSES WILL HELP TO PLAN THE WAY TO MANGE IT. IT IS VERY DIFFICULT TO MANGE AT HOEM AND ALSO AT NUSING FACILITY.
What are some dangers of wandering
TRAFFIC, GETTING LOST, PEOPLE DEAL WITH ANXIETY AND RESTLESSNES WANDER, THEY HAVE BEEN REAL ACTIVE IN THEIR LIFE AND COULD NEVER SIT STILL, IT’S THEIR WAY OF HANDLING STRESS.WANDERING MAY BE RESULT OF FEELING LOST.IT INCREASES WHEN APERSON MOVES TO ANEW HOME. THEY MAY WANDER INTERMITTENTLY FOR NO APPRENT REASON. IT CAN GO ON FOR HOURS. IT RELEIVE THEM OF BOREDOM.
GETTING INTO OTHER PEOPLE’S THINGS AND HIDING THEM.
Rummaging
What are some causes of rummaging
DRIVEN TO SEARCH FOR SOMETHING THEY THINK IS MISSING. CAN’T FIGURE OUT WHAT BELONGS TO THEM OR WHAT BELONGS TO OTHER PEOPLE. CAN’T FIGURE OUT WHERE THEY HIDE THINGS OR WHAT THEY HAVE HIDDEN.
How can we manage rummaging
KEEP BUSY RUMMAGING,DISTRACT RESIDENT WHEN YOU FIND IN ANOTHER PATIENT;’S ROOM, LEARN HIDING PLACES, DON’T ACCUSE FOR TAKING THINGS, KEEP THE ENVIONMNET SAFE.
Techniques with ADL’s
consistency in approach
focus on ability
task breakdown technique
clueing
distraction technique
What do you do when You see people wandering and wandering and find a patient sleeping in another patients room
Do not wake them up if they Alzheimer’s patient because they need sleep and rest
A disorder that can occur in men as they age in which the prostate becomes enlarged and causes problems with urination and/or emptying the bladder
benign prostatic hypertrophy
A form of female reproductive cancer that begins in the cervix
cervical cancer
if patient moving food around on the plate what do you do
Move tray back and offer food they want so it doesn’t get cold
a sexually transmitted infection caused by bacteria
generally treated with a single-dose of oralazithromycinor a prescription of oral doxycycline that is taken twice a day for one week.
chlamydia
a form of female reproductive cancer that begins in the uterus
endometrial cancer
If patient says they don’t want this food
offer them something else
what do you do if patient gets up and starts walking around the dining room
Give them bites when they are walking around
What do you do if a patient asks to be fed by someone else or mom
Tell them your mom just called me, she made this food, talk about their mom, she told me to start feeding you, she is on the way
The inability to have or maintain a penile erection
erectile dysfunction
If a patient tells you are doing something wrong or correcting you
do it they way they are telling you or ask them to tell you more
What if patient is throwing food at someone else
Distract them and remove them from the situation
what if a patient is trying to feed you?
remind them I just ate my food. sometimes the CNA eats with patient.
a sexually transmitted incurable infection caused by herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2)
genital herpes
What if someone wet the seat they are sitting on?
never blame patient, just help them get changed
Always take blame off patient
Never make them feel guilty
a sexually transmitted infection caused by human papillomavirus
genital HPV infection
Organs that produce and secrete chemicals called hormones
glands
The male and female sexual reproductive glands
gonads
A sexually transmitted bacterial infection that, if untreated, may cause infertility.
Symptoms include painful urination and abnormal discharge from the penis or vagina. Men may experience testicular pain and women may experience pain in the lower belly. In some cases, has no symptoms.
gonorrhea
By having unprotected vaginal, anal, or oral sex.
By mother to baby by pregnancy, labor, or nursing.
chemical substances produced by the body that control numerous body functions
hormones
What if patient asks where are my children
they are at school. bus is not here yet.
the end of menstruation occurs when a woman has not had a menstrual period for 12 months
menopause
What if patient says they need to go to school or work
It is a snow day today, coloring books, school is closed today
Where is my mom, I want to see my mom today
She is on the way, she is at church, the store, what ever works
The shedding of the lining of the uterus that occurs approximately every 28 days also know as a period
menstruation
What if patient says they want to go home
Your spouse is on the way, stay a little longer for a meal, get them to stay a little longer
a form of female reproductive cancer that begins in the ovaries
ovarian cancer
Look at world from perspective of a person. If you woke up from nap and being undressed by a person you have never met before
female sex cell or egg
ovum
a form of male reproductive cancer that begins in the prostate gland
prostate cancer
infections caused by sexual contact with infected people; signs and symptoms are not always apparent
sexually transmitted infections (STI’s)
male sex cells
sperm
a sexually transmitted infection caused by bacteria
syphilis
a form of male reproductive cancer that begins in the testes
testicular cancer
What should temperature be in a patients room
70-81
a sexually transmitted infection caused by protozoa (single-celled animals)
trichomoniasis
an inflammation of the vagina
vaginitis
What is it called to bring people back to reality
normalization
reminiscence therapy
remembering things of the past. letting people think the past is happening now.
visualize on past memories
reality oreintation
bringing people to reality, what day it is, or back to room. show them a clock or calendar of what is true. for stage 1.
validation/affirmation
validate what they are talking about
normalization
make things they are saying and doing as normal and help them do an activity that they are interested in. Make them feel like they have a normal life. Gardening, or cooking (go over ingredients)
The final stage of HIV infection in which infections, tumors, and central nervous system symptoms appear due to a weakened immune system that is unable to fight infection
AIDS Acquired immunodeficiency syndrome
a disease in which the body is unable to recognize its own tissues and begins to attack these tissues
autoimmune disease
noncancerous
benign
the removal of a sample of tissue for examination and dagnosis
biopsy
a type of severe pain that happens unexpectedly in people who have cancer
breakthrough pain
a general term used to describe a disease in which abnormal cells grow in an uncontrolled way
cancer
a fear of homosexuality
homophobia
a virus that attacks the body’s immune system and gradually disables it; eventually can cause AIDS
human immunodeficiency virus (HIV)
a clear yellowish fluid that carries disease-fighting cells called lymphocytes
lymph
cancerous
malignant
a spread from one part of the body to another
metastasize
an illness caused by microorganisms that do not affect people with healthy immune systems but cause disease in people with weakened immune systems
opportunistic infection
the disappearance of signs and symptoms of cancer or other diseases can b temporary or permanent
remission
a group of abnormally growing cells
tumor
What are the female hormones?
progesterone and estrogen
If you see patient hemorrhaging what should you do?
Call for help
Wear gloves
Place sterile dressing over the wound
Apply pressure to site until bleeding is stopped or you are instructed otherwise by RN
How often should you take vital signs after surgery
Every 15min in first hour, every 30min for 1-2hrs, every hour for 4 hours
What do you do if there is loss of large amount of blood in short period of time?
Call for help
Wear gloves
Place sterile dressing over the wound
Apply pressure to site until bleeding is stopped or you are instructed otherwise by RN
What does BPH stand for?
Difficulty using the bathroom
dysuria
what is difficulty with the blood
hematuria
What prevents blood clots
SCD- sequential compression devices
prevents blood clots by massaging the legs with wave like motion.
What is safety for hot and cold applications
Know how to use the equipment
Know the temperature
Know the precise site of application
Observe every 5 minutes
Do not keep no longer than 15-20 minutes
When to use heat applications
Used for musculoskeletal problems
Sprain, arthritis
Relieves pain and relaxes muscles
Use caution with dementia, elderly, children
Metal implants
What effects happen when heat is applied
Increases blood flow to the area
Blood vessels dilate – More blood flow to the area
What is it called when increases blood flow to the areas
vasodilation
What happens when cold is applied
Blood vessels constrict and decreased flood flow
What are types of cold devices?
Dry Cold- ice bag, ice collar, ice glove
Moist cold- Cold compress
Cooling blankets
What are some complications from cold devices
Pain, pale, grey skin
Burns
Blisters
Frost bite, numbness, shivering
Cyanosis- Bluish discoloration
what are male components of reproductive system
Male- Testes, Scrotum, vas deferens, prostate gland, penis
Hormone- Testosterone
What are female components of reproductive system
Female- Ovaries, fallopian tubes, uterus, vagina, clitoris
Hormone- Estrogen
What are age related changes of female
Decrease in estrogen and progesterone
Loss of calcium and brittle bones-osteoporosis
Decrease in estrogen- high risk of UTI
What are age related changes of male
Sexual response slows
BPH -benign prostate hyperplasia
Erectile dysfunction
What happens BPH benign prostatic hypertrophy
Prostate gland enlarges without tumor development
Causes narrowing of urethra which passes through the prostate
Can produce sufficient enlargement to cause urinary retention
Is non cancerous
Signs of symptoms of BPH
Symptoms- Frequency, nocturia, hesitancy, painful urination, decrease force of urinary stream.
Dribbling, hematuria, infection, obstruction, and kidney damage occurs as a result of above symptoms.
What are complications of bed rest
Pressure sores, weak muscles and stiff joints. Circulation issues. Blood clots.
What should you do when a patient is hemorrhaging in home care?
Apply pressure
Name sex hormones
testosterone-male
estrogen, progestrogen-female
An examination of the body after death by a pathologist to try to determine the cause of death
autopsy
Respirations gradually increase in rate & depth, then become shallow & slow; breathing may stop (apnea)
Cheyne-stokes respirations
Describes the support & care given during the time surround death
end of life care
Care of the body after death done by nursing staff on the unit
post-mortem care
the condition after death in which the muscles in the body become stiff & rigid
rigor mortis
a disease or condition that will eventually cause death
terminal illness
what is POLST
newest advance directive only for persons with serious advanced illnesses. more detailed and specific. it summarizes the persons’ wishes for end of life care
what are the five stages of death
denial, anger, bargaining, depression, acceptance
what are signs and symptom of shock
Pale, cold clammy skin, rapid & weak pulse, rapid, shallow & irregular breathing, low BP, weak anxious, thirsty, sleepy, lethargic
pain indicating damage to nervous system
neuropathic pain
What types of dementia are reversible
Delirium
what does stage one dementia look like
general anxiety
memory-looks at clocks, calendar, takes a long time to do routine tasks, orientation-time disorientation, udgment -impaired, 2-4yrs
what does stage 2 dementia look like
increase loss of intellect, more obvious memory loss, time, place disorientation, restlessness, uneasy, dulled senses, lose impulse control (swearing and inappropriate behaviors), problem recognizing family and friends, sun downing, suspicious, irritable, teary, repetitive movements like tapping, 2-10yrs
what does stage 3 dementia look like
terminal stage, may lose total communication, grunts, cries, groans, doesn’t recognize themselves or family, totally dependent for ADL’s, swallowing problems, may become totally bed bound, coma-death, 1-3yrs
how can you help keep a wandering person safe
use locks, use alarms, wander guard
what are some communication strategies to interact with dementia patients
state ideas in a positive rather than negative terms, avoid questions, limit choices, apply logic
what are techniques to use with ADL’s for dementia patients
consistency in approach, focus on ability, task breakdown techniques, clueing, distraction technique
what are some feeding problems with dementia patients
doesn’t like food, poor nutrition, no concept of getting food to mouth, keep food in the mouth, picks up food, dehydration
what are CAUSE of catastrophic reactions:
SUDDEN SENSORY OVERLOAD( TOOMANY PEOPLE,NOISE, ACCIDENTS., OR MESSES), INABLITY TO PERFORM AN ACTIVITY, TOOMANY DISTRACTIONS AT ONCE, BEING ASKED TOO MANY QUESTIONS.
what are some interventions of CNA’s for people having a catastrophic reactions
INTERVENTONS: KEEP THE PACE LOW, ONE QUESTIONS AT A TIME, USE CALMING WORDS AND ACTIONS, REGULAR ROUTINES, AVOID DISTRACTING THE PATIENT.
What is sundowning?
SUNDOWNING:INCREASED RESTLESSNESS AND AGITATION, CONFUSION, SUSPICIOUSNESS, CATASTROPHIC REACTIONS, DECREAES ATTENTION SPAN, CONCENTRATION, DEMANDING BEHAVIOR.
What causes sundowning?
CAUSES- OVERSTIMULATION WHOSE TOLERANCE FOR STRESS IS LOWER AT THE END OF THE DAY.MAY BE CAUSED BY HUNGER, DISCOMFORT, PAIN OR NEED TO URINATE. CAREGIVER’S FATIGUE IS COMMUNICATE DTO RESIDENTS.
What are some interventions for sundowning?
INTERVENTIONS: PLAN DAY SOTHAT FEWER THINGS OCCUR BY THE END OF THE DAY, REDUCE ACTIVITY AROUND PATIENT, GIVE SIMPLE CHORE TO DO ( FOLDING, WIPING, PAINTING),HAVE SOME ONE SPEND TIME WITH PATIENT.
catastrophic reactions
What is wandering
WANDERING- TENDENCY TO MOVE ABOUT IN SEEMINGLY AIMLESS MANNER.
What causes wandering
CAUSES: THERE ARE DIFFERENT KINDS OF WANDERING AND DIFFERENT REASONS WHY A BRAIN IMPAIRED PERSON WILL WANDER. IDENTIFYING THE CAUSES WILL HELP TO PLAN THE WAY TO MANGE IT. IT IS VERY DIFFICULT TO MANGE AT HOEM AND ALSO AT NUSING FACILITY.
What are the dangers of wandering
DANGERS OF WANDERING- TRAFFIC, GETTING LOST, PEOPLE DEAL WITH ANXIETY AND RESTLESSNES WANDER, THEY HAVE BEEN REAL ACTIVE IN THEIR LIFE AND COULD NEVER SIT STILL, IT’S THEIR WAY OF HANDLING STRESS.WANDERING MAY BE RESULT OF FEELING LOST.IT INCREASES WHEN APERSON MOVES TO ANEW HOME. THEY MAY WANDER INTERMITTENTLY FOR NO APPRENT REASON. IT CAN GO ON FOR HOURS. IT RELEIVE THEM OF BOREDOM.
What is rummaging? And what are the causes
RUMMAGING: GETTING INTO OTHER PEOPLE’S THINGS AND HIDING THEM.
CAUSES: DRIVEN TO SEARCH FOR SOMETHING THEY THINK IS MISSING. CAN’T FIGURE OUT WHAT BELONGS TO THEM OR WHAT BELONGS TO OTHER PEOPLE. CAN’T FIGURE OUT WHERE THEY HIDE THINGS OR WHAT THEY HAVE HIDDEN.
how to help manage a person that rummages
MANAGEMNETY: KEEP BUSY RUMMAGING,DISTRACT RESIDENT WHEN YOU FIND IN ANOTHER PATIENT;’S ROOM, LEARN HIDING PLACES, DON’T ACCUSE FOR TAKING THINGS, KEEP THE ENVIONMNET SAFE.
what types of therapeutic baths includes
tepid whirlpool and sitz bath
mr a has mild dementia and doesn’t want his morning care done
freedom from coercion and invasion of privacy
when a person is dying
assume that the person can hear you
signs of approaching death include
decreasing responsiveness
when caring for a dying person you should
continue to talk to them while caring for them
restorative care
maintain a persons functioning
what are some restorative care programs
elimination, range of motion exercises, positioning, mobility and ambulation, transferring, grooming, eating and drinking, splints or braces, communication
