Chapter 8 Rehabilitation Concepts And Disabling Health Problems Flashcards
Define “disabling health problems”
Any physical or mental health problem that can cause disability.
Define”rehabilitation”
The process of learning to live with chronic and disabling conditions by returning the patient to the fullest possible physical, mental, social, vocational, and economic capacity
Defined “physiatrist”
Physician who specializes in rehabilitated medicine
Define “rehabilitation nurses”
Nurse who coordinates the efforts of healthcare team members for patients undergoing rehabilitation in the inpatient setting; may be defined as the patient’s case manager
Define “rehabilitation case managers”
Nurse or other healthcare professional who coordinates health for patients undergoing rehabilitation in home or acute care settings
Define “physical therapists”
A member of the rehabilitation healthcare team who helps the patient achieve ability and who teaches techniques for performing certain activities of daily living
Define “occupational therapists”
A member of the rehabilitation healthcare team who works to develop the patient’s fine motor skills used for activities of daily living in the skills related to poor coordination and cognitive restraining
Define “speech-language pathologists (SLPs)”
A member of the rehabilitation healthcare team who evaluates and retrains patients with speech, language, or swallowing problems
Define “restorative aids”
A member of the healthcare team, often with the nursing department, who assists that therapists, especially in the long term care setting
Define “recreational/activity therapists”
A member of the healthcare team who works to help patients continue or develop hobbies or interests; also called “activity therapists”
Define “cognitive therapists”
A member of the rehabilitative healthcare team, usually a neuropsychologist, who works primarily with patients who have experienced head injuries and have cognitive impairments
Define “registered dietitians (RDs)”
Registered dietitians may be needed to ensure that patients meet your nutritional needs. For example, for patients who need weight reduction, a restricted calorie diet can be planned. For patients who need additional calories or other nutrients, including vitamins, nutritionist can plan a patient-specific diet.
Define “nursing assistant/technicians”
A member of the rehabilitative healthcare team who assists a registered nurse in the care of patients
Define “social workers”
Member of the healthcare team who helps patients identify support services and resources and who coordinates transfers to or discharges from the rehabilitation setting
Define “clinical psychologists”
Clinical psychologists council patients and families on their psychological problems and on strategies to cope with disability. They may also perform a battery of cognitive assessments.
Define “spiritual counselors”
Counselor who specializes in special assessment and care, usually a member of the clergy
Define “vocational counselors”
A member of the rehabilitative healthcare team who assist the patient with job placement, training, or further education
Define “chronic health problems”
A condition that has existed for at least three months.
What are considerations for older adults?
Older adults who need rehabilitation often have other chronic diseases that need to be managed, including diabetes mellitus, coronary artery disease, osteoporosis, and arthritis. These health problems added to the normal physiologic changes associated with aging predispose the older adult to falls, pressure ulcers, and pneumonia. When discharged from the hospital setting, some older patients are under nourished, which causes weakness and fatigue. The longer the hospital stay, the more debilitated the older adult can become. Health ketene may be challenging because some older patients may have beginning cognitive changes, including short-term memory loss. Sensory losses, like vision and hearing, also affect their ability to give an accurate history or grasp new information.
What is the assessment of patients in rehabilitation settings?
Cardiovascular system: chest pain, fatigue, fear of heart failure
Respiratory system: shortness of breath or dyspnea, activity tolerance, fear of inability to breathe
Gastrointestinal system and nutrition: oral intake, eating pattern; anorexia, nausea, and vomiting; dysphagia; laboratory data ( e.g., serum prealbumin level); weight loss or gain; bowel elimination pattern or habits; change in stool (constipation or diarrhea); ability to get to toilet
Renal-urinary system: urinary pattern; fluid intake; urinary incontinence and retention; urine culture and urinalysis
Neurologic system: motor functions; sensation; perceptual ability; augmentative abilities
Musculoskeletal system: functional ability; range of motion; endurance; muscle strength
Integumentary system: risk for skin breakdown of; presence of skin lesions
Define “paresis”
Weakness
Define “paralysis”
Absence of movement
! Nursing safety priority
Action alert
Be sure to remind unlicensed assistive personnel to report changes in the patient’s skin promptly, including any new onset or redness. Assess the patient frequently to determine the risk for skin breakdown before it occurs! Older adults are at a very high risk for heel and sacral pressure ulcers.
Define “activities of daily living (ADLs)”
The activities performed in the course of a normal day, such as bathing, dressing, feeding, and ambulating
Define “independent living skills”
IADLs
Define “instrumental activities of daily living (IADLs)”
Special activities performed in the course of a day such as using the telephone, shopping, preparing food, and housekeeping. Also called independent living skills
Define work related musculoskeletal disorders (MSD’s)
Disorders caused by heavy lifting and dependent transfers by staff members
What does MSD stand for?
Work-related musculoskeletal disorders
Define “ethnopharmacology”
The study of how ethnicity affects how drugs work in the body, including drug absorption, distribution, metabolism, and excretion
What does PT or RPT stand for?
Physical therapist
What does OT or OTR stand for?
Occupational therapist
What does SLP stand for?
Speech-language pathologist
What are the best practices for patient safety and quality care
Gate training with selected ambulatory aids
Walker assisted
Apply a transfer belt around the patients waist
Guide the patient to a standing position
Remind the patient in placing both hands on the walker
Ensure that the patient is well balanced
Teach the patient repeatedly to perform this sequence:
Lift the walker
Move the walker about 2 feet forward, and set it down at all legs
While resting on the walker, take small steps
Check balance
Repeat the sequence
What are the best practices for patient safety and quality care
Gate training with selected ambulatory aids
Cane assisted
Apply a transfer belt around the patient’s waist
Guide the patient to a standing position
Be sure the cane is at the height of the patient’s wrist when the arm is placed at his or her side. (Many canes can be adjusted to the required height.)
Remind the patient to place his or her strong hand on the cane
Ensure that the patient is well balanced
Teach the patient to perform this sequence repeatedly:
Move the cane and weaker leg forward at the same time
Move the stronger leg one step forward
Check balance and repeat the sequence
Define assistive/adaptive device
Any item that enables the patient to perform all or part of an activity independently
Define “spastic bladder”
Incontinence characterized by sudden, gushing voids, usually without completely emptying the bladder; caused by neurologic problems affecting the upper motor neuron, such as with spinal cord injuries above the twelfth thoracic vertebrae; also called “spastic bladder.”
Define “flaccid or areflexic bladder”
Urinary retention and overflow (dribbling) caused by injuries to the lower motor neuron at the spinal cord level of S2 to S4 (e.g., multiple sclerosis and spinal cord injury below T12). Bladder emptying may be achieved by performing a Valsalva maneuver or tightening the abdominal muscles. The effectiveness of these maneuvers should be ascertained by catheterizing the patient for residual urine after voiding. Also called “flaccid bladder.”
Define “post-void residual (PVR)”
The amount of urine remaining in the bladder within 20 minutes after voiding
What does PVR stand for?
Post-void residual
Define “Crede maneuver”
Assist the patient in performing the Crede maneuver by placing the patients hand in a cupped position directly over the bladder area and instructing him or her to push inward and downward gently as if massaging the bladder to empty
! Nursing safety priority
Action alert
To prevent UTI, teach patients and their caregivers to wash their hands thoroughly before and after catheterization and clean the genital area well. Remind the patient to drink at least 8 to 10 glasses of fluid (two quarts) every day before dinner and avoid carbonated beverages. If patients have indwelling urinary catheters, remind them to drink 15 glasses of fluid (three quarts) each day before dinner and avoid carbonated beverages
! Nursing Safety priority
Critical rescue
Do not use digital stimulation for patients with cardiac disease because of the risk for inducing a vagal nerve response. This response causes a rapid decrease in heart rate
