BAY AREA COLLEGE OF NURSING

Module 14: Rehabilitative/Restorative Care

I. Terminology Active Range of Motion Heel Protector/Elbow Protector Active-assistive Range of Motion Hemiplegia Activities of Daily Living (Self-care Activities) Independence Adaptive Joint Airbed (Kinair, Clinotron, Hill Rom) Paralysis Alternating Pressure Mattress Paraplegia Ambulation Passive Range of Motion Atrophy Phlebitis Bed Cradle Pneumonia Contractures Pressure Sores Decubiti Quadriplegia Disability Restorative Care Egg-crate Mattress Statis Pneumonia Embolism TCDB Fleece Pad Thrombophlebitis Flotation Pads Trochanter Rolls Foot Board Water Bed II. Rehabilitation (restorative care) and how it promotes independence and resident potential. A. Disability: a physical and/or mental condition which interferes with meeting basic human needs. B. Effects of disability related to Maslows hierarchy: 1. Feelings of loss. 2. Damage to self-image. 3. Loss of self-esteem. C. Restorative/rehab care: helps disabled individuals return to their highest possible level of physical and psychological functioning promotes independence. 1. Helps person adjust to the disability. 2. Emphasizes abilities learn new skills, retain old skills 3. Prevents complications rehab begins when person first enters facility. III. Goals of restorative care that promote independence and resident potential. A. Physical goals of rehabilitation/restorative care ADLs: 1. Maintain present level of function.

2. Improve/restore physical function. 3. Encourage independence and performance of self-care activities.

B. Psychosocial goals of rehabilitation/restorative care: 1. Adjust to psychosocial effects of disability recognizes small and simple accomplishments. a. b. IV. Social service referrals. Job skill development. Rehabilitation team and the role of the CNA A. Rehabilitation team 1. Purpose: a. b. Discuss and evaluate residents level of functioning. Establish residents care plan and goals for rehabilitation. c. Evaluate progress and adjust plan of care to achieve residents goals with a greater degree of resident independence. d. Restore the resident to his/her optimal level of functioning. a. b. c. d. e. f. g. h. i. j. k. 2. Members of the team: Resident Family members CNA Licensed nursing staff (RNs) Physical Therapist Occupational Therapist Physician Activity Leader Social Worker Clergy Dietitian B. CNA responsibilities as a member of the rehabilitation team. 1. Participate in resident care planning conferences. 2. Observe and report residents responses to care. 3. Follow the residents care plan. 4. Encourage the resident to follow the rehabilitation plan. 5. Observe and report early signs and symptoms of complications. V. Responsibilities of the CNA in promoting resident self care. 1. Protect residents rights. 2. Ensure safety and privacy. 3. Communicate therapeutically ask residents opinion and let them control. 4. Adhere to legal and ethical principles. 5. Follow instructions of immediate supervisor or plan of care. 6. Report significant changes in resident condition.

7. Practice appropriate and effective nursing care. 8. Implement rehabilitative measures as ordered, i.e., ROM, training plan for resident self-care. 9. Encourage resident independence praise even small accomplishments. 10.Provide emotional support and reassurance. 11.Concentrate on residents abilities. 12.Use equipment and devices knowledgeably. 13.Protect resident from abuse. VI. Activities of Daily Living 1. Daily hygiene, grooming, eating and self-care necessary for normal functioning in society. 2. Examples: a. Grooming b. Dressing c. Feeding d. Hygiene e. Elimination bowel and bladder f. Mobility/ambulation g. Self-turning and positioning VII. Common comfort and adaptive devices and their purposes A. Comfort devices and their purposes: 1. Bed board provides support/alignment. 2. Footboard prevents plantar flexion and pressure sores. 3. Trochanter roll prevents external rotation and pressure sores. 4. Handroll prevents contractures. 5. Bed cradle prevents foot drop decubiti. 6. Trapeze strengthens muscles and facilitates movement. 7. Sheepskin avoids friction, skin breakdown. 8. Heel/elbow protectors protect against friction, skin breakdown. 9. Flotation pads, egg crate mattress, water bed, alternating pressure mattress; Clinitron bed protects pressure points, prevents skin breakdown. 10.Pillows provide support, positioning and prevent contractures. B. Adaptive/self-help devices their purpose and use: 1. Cuffed or swivel-handled utensils, plate guards or holders; eating utensils. 2. Long-handled combs/brushes, button hooks, sock puller, specially designed clothing; hygiene and grooming aides. 3. Reachers, telephone holders, communication boards: promote independence. 4. Artificial limbs, application, care and removal. 5. Casts and splints; immobilization, alignment and support, cast care. Refer to manual skills on care of casts (p. 14.16) activities

VIII. Preventing complications from inactivity A. Complications: 1. Types:

a.

Respiratory (stasis pneumonia) or atelectasis

b. Circulatory (phlebitis/thrombophlebitis, pulmonary embolism) c. Musculo-skeletal 1) contractures are permanent 2) osteoporosis demineralis of bone 3) muscle atrophy d. Integumentary (pressure sores) e. Gastro-intestinal (constipation) and decrease of appetite f. Genito-urinary (kidney stones), UTI, problems g. Psychosocial (loneliness, depression) 2. Causes: a. Bed rest b. Prolonged illness c. Recovery from injury d. Surgery 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. B. Preventive methods: Turning/repositioning TCDB (turn, cough and deep-breathing exercises) Body alignment Range of motion Supportive devices Skin care Encouraging resident independence Toileting Bowel and bladder training Elastic stockings Ambulate is best. a. Maintains muscles, bones and moves joints. b. Reduces pressure on the skin. c. Increases circulation d. Increases respiratory and heart function e. Improves bowel function and empties bladder f. Promotes independence and self-esteem g. If resident can not walk at least stand them or put them in a chair IX. Range-of-Motion Exercises (ROM) A. Range of motion is movement of joints through their normal range of movement or to the point of discomfort. B. Purpose: 1. 2. 3. 4. 5. C. Frequency: Maintain muscle strength. Stimulate circulation. Maintain body alignment and make positioning easier. Prevent thrombophlebitis. Prevent contractures.

1.

At least three times each day with at least three times to each movement of the joint. 2. As indicated in the care plan.

D. Technique: 1. Active ROM a. Resident moves own joints through their normal range of movement. b. Is the best. c. Maintains muscles. 2. Passive ROM a. CNA moves the residents joints through their normal range of movement or to the point of discomfort. b. Still gets muscle atrophy. 3. Active assistive ROM The CNA helps the resident move his/her joints through their normal range of movement or to the point of discomfort. E. General rules to avoid injury: 1. Exercise joint correctly. 2. Avoid unnecessary exposure of resident. 3. Use good body mechanics. 4. Fully support each extremity. 5. Move joint slowly, smoothly and gently. 6. Do not force the joint to move past the point of resident discomfort. 7. Do not cause the resident to have pain. 8. Report resident complaint of pain to the RN. F. Refer to manual (pp.14.12 14.15). X. skills procedure Range-of-Motion Exercises

Procedures and devices to promote mobility and ambulation for residents with physical and/or visual impairment. A. 1. 2. 3. 4. What to check to determine if resident can be more independent: Physical strength and ability Available special training Assistive devices Financial resources

B. Procedures: 1. Transfer techniques review from Module 5 2. Gait training 3. Training in self-transfer techniques 4. Use of gait belt for ambulation 5. Check that resident can sit unassisted and steady, as well as stand a few seconds alone. C. Assistive devices: 1. Cane 2. Walker 3. Wheelchair 4. Transfer board 5. Braces, splints and prostheses 6. Seeing eye dog 7. Braille 8. Modifications to accommodate wheelchair access

9. Disabled parking D. Care and use of adaptive, assistive and orthotic devices. XI. Relationship between residents self-esteem and family involvement in care. A. Basic needs as defined by Maslow which can be met by involving the resident and his/her family in developing and participating in the plan of restorative care: 1. Love/belonging/affiliation needs. 2. The need for self-esteem. 3. The need for self-actualization.

B. Methods of assisting the resident to meet these needs therapeutic communication: 1. Promote interaction between the resident, the family and the restorative team. 2. Treat the resident and family with respect and dignity. 3. Be supportive of the resident and his/her family and use praise as appropriate to reinforce progress. 4. Encourage resident independence. 5. Use a positive approach to restorative plan.