Chapter 8 Rehabilitation Concepts And Disabling Health Problems

Question 1

Define “disabling health problems”

Answer 1

Any physical or mental health problem that can cause disability.

Question 2

Define”rehabilitation”

Answer 2

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

Question 3

Defined “physiatrist”

Answer 3

Physician who specializes in rehabilitated medicine

Question 4

Define “rehabilitation nurses”

Answer 4

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

Question 5

Define “rehabilitation case managers”

Answer 5

Nurse or other healthcare professional who coordinates health for patients undergoing rehabilitation in home or acute care settings

Question 6

Define “physical therapists”

Answer 6

A member of the rehabilitation healthcare team who helps the patient achieve ability and who teaches techniques for performing certain activities of daily living

Question 7

Define “occupational therapists”

Answer 7

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

Question 8

Define “speech-language pathologists (SLPs)”

Answer 8

A member of the rehabilitation healthcare team who evaluates and retrains patients with speech, language, or swallowing problems

Question 9

Define “restorative aids”

Answer 9

A member of the healthcare team, often with the nursing department, who assists that therapists, especially in the long term care setting

Question 10

Define “recreational/activity therapists”

Answer 10

A member of the healthcare team who works to help patients continue or develop hobbies or interests; also called “activity therapists”

Question 11

Define “cognitive therapists”

Answer 11

A member of the rehabilitative healthcare team, usually a neuropsychologist, who works primarily with patients who have experienced head injuries and have cognitive impairments

Question 12

Define “registered dietitians (RDs)”

Answer 12

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.

Question 13

Define “nursing assistant/technicians”

Answer 13

A member of the rehabilitative healthcare team who assists a registered nurse in the care of patients

Question 14

Define “social workers”

Answer 14

Member of the healthcare team who helps patients identify support services and resources and who coordinates transfers to or discharges from the rehabilitation setting

Question 15

Define “clinical psychologists”

Answer 15

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.

Question 16

Define “spiritual counselors”

Answer 16

Counselor who specializes in special assessment and care, usually a member of the clergy

Question 17

Define “vocational counselors”

Answer 17

A member of the rehabilitative healthcare team who assist the patient with job placement, training, or further education

Question 18

Define “chronic health problems”

Answer 18

A condition that has existed for at least three months.

Question 19

What are considerations for older adults?

Answer 19

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.

Question 20

What is the assessment of patients in rehabilitation settings?

Answer 20

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

Question 21

Define “paresis”

Answer 21

Weakness

Question 22

Define “paralysis”

Answer 22

Absence of movement

Question 23

! Nursing safety priority

Action alert

Answer 23

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.

Question 24

Define “activities of daily living (ADLs)”

Answer 24

The activities performed in the course of a normal day, such as bathing, dressing, feeding, and ambulating

Question 25

Define “independent living skills”

Answer 25

IADLs

Question 26

Define “instrumental activities of daily living (IADLs)”

Answer 26

Special activities performed in the course of a day such as using the telephone, shopping, preparing food, and housekeeping. Also called independent living skills

Question 27

Define work related musculoskeletal disorders (MSD’s)

Answer 27

Disorders caused by heavy lifting and dependent transfers by staff members

Question 28

What does MSD stand for?

Answer 28

Work-related musculoskeletal disorders

Question 29

Define “ethnopharmacology”

Answer 29

The study of how ethnicity affects how drugs work in the body, including drug absorption, distribution, metabolism, and excretion

Question 30

What does PT or RPT stand for?

Answer 30

Physical therapist

Question 31

What does OT or OTR stand for?

Answer 31

Occupational therapist

Question 32

What does SLP stand for?

Answer 32

Speech-language pathologist

Question 33

What are the best practices for patient safety and quality care
Gate training with selected ambulatory aids
Walker assisted

Answer 33

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

Question 34

What are the best practices for patient safety and quality care
Gate training with selected ambulatory aids
Cane assisted

Answer 34

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

Question 35

Define assistive/adaptive device

Answer 35

Any item that enables the patient to perform all or part of an activity independently

Question 36

Define “spastic bladder”

Answer 36

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.”

Question 37

Define “flaccid or areflexic bladder”

Answer 37

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.”

Question 38

Define “post-void residual (PVR)”

Answer 38

The amount of urine remaining in the bladder within 20 minutes after voiding

Question 39

What does PVR stand for?

Answer 39

Post-void residual

Question 40

Define “Crede maneuver”

Answer 40

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

Question 41

! Nursing safety priority

Action alert

Answer 41

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

Question 42

! Nursing Safety priority

Critical rescue

Answer 42

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