Chapter 11 Principles and Practices in Rehabilitation

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Chapter 11

Principles and Practices of Rehabilitation


Rehabilitation• Dynamic, health-oriented process that helps ill people or

people with disabilities achieve greatest level of physical, mental, spiritual, social, economic functioning

• Disabilities may be physical, mental, emotional• Helps person achieve acceptable quality of life with

dignity, self-respect, independence• Integral part of nursing

– Every major illness or injury carries for disability or impairment.


Question• Tell whether the following statement is true or false:• Rehabilitation is a dynamic, health-oriented process that

helps people with acute or chronic disorders or people with physical, mental, or emotional disabilities to achieve the greatest possible level of physical, mental, spiritual, social, and economic functioning.


Answer• True. • Rationale: Rehabilitation is a dynamic, health-oriented

process that helps people with acute or chronic disorders or people with physical, mental, or emotional disabilities to achieve the greatest possible level of physical, mental, spiritual, social, and economic functioning.


The Rehabilitation Team• Collaborative approach• Patient is member of team• Family


The Rehabilitation Team (cont’d)• Other members:

– Physicians– Occupational therapists– Physical therapists– Social workers– Others


Question• Who is the key member of the rehabilitation team?A.NurseB.Occupational therapistC.PatientD.Physician


Answer• C. Patient• Rationale: The patient is the focus of the team’s effort

and the one who determines the final outcomes of the process. The nurse develops the plan of care designed to facilitate rehabilitation. Other team members, such as the physician and occupational therapist, make a unique contribution to the team effort.


Patient Emotional Reactions to Disability• Patient, family experience emotional reactions• Losses precipitate grief responses, go through stages of

grief process• Reactions may include disorganization and confusion,

denial, depression, anger, regret, acceptance• Reactions may subside, recur• Coping abilities, methods vary greatly


Functional Capacity Assessment• Activities of Daily Living: self-care activities including

bathing, grooming, dressing, eating, toileting, bowel and bladder care

• Instrumental Activities of Daily Living: complex aspects of independence including meal preparation, grocery shopping, household management, finances, transportation


Assessment of Functional Ability• Functional Independence Measure (FIM)• PULSES profile• Barthel Index• Patient Evaluation Conference System (PECS)


Nursing Diagnosis• Self-care deficit: bathing/hygiene, dressing/grooming,

feeding, toileting


Goals• Individualize goals to patient• Self-care • Self-care with assistance• Appropriate use of adaptive devices• Patient satisfaction with level of independence


Interventions• Fostering self-care abilities• Recommending assistive, adaptive devices• Helping patients accept limitations


Outcomes • Demonstrates independence in self-care in

bathing/hygiene or with assistance, using adaptive devices as appropriate

• Demonstrates independence in self-care in dressing/grooming or with assistance, using adaptive devices as appropriate

• Demonstrates independence in self-care in feeding or with assistance, using adaptive and assistive devices as appropriate

• Demonstrates independence in self-care in toileting or with assistance, using adaptive and assistive devices as appropriate


Nursing Strategies for Teaching ADLs• Demonstrate use of adaptive equipment for activities of

daily living• Identify community resources for peer, family support• Demonstrate how to access transportation


Nursing Strategies Promoting Mobility and Ambulation• Positioning to prevent musculoskeletal complications

– Prevent external rotation of hip– Prevent foot drop

• Maintaining muscle strength, joint mobility– Range of motion– Therapeutic exercises

• Ambulating with assistive device: crutches, walker, cane• Assisting patients with orthosis or prosthesis


Areas Susceptible to Pressure Ulcers


Risk Factors for Development of Pressure Ulcers• Immobility• Impaired sensory perception or cognition• Decreased tissue perfusion• Decreased nutritional status• Friction, shear• Increased moisture


Shear and Friction


Assessment for the Prevention of Pressure Ulcers• Assessment of skin• Evaluate mobility• Evaluate circulatory status• Evaluate neurologic status• Evaluate nutrition, hydration• Braden scale


Interventions to Prevent Pressure Ulcer Formation• Relieving pressure• Positioning patient• Using pressure-relieving devices• Improving

– Mobility– Sensory perception– Tissue perfusion– Nutritional status


Interventions to Prevent Pressure Ulcer Formation (cont’d)• Reducing friction, shear• Minimizing irritating moisture


Care and Treatment of Pressure Ulcers• Deep tissue injury

– Immediate pressure relief to affected area • Stage I:

– Remove pressure – Prevent moisture, shear, friction– Promote proper nutrition, hydration


Care and Treatment of Pressure Ulcers (cont’d)• Stage II:

– Clean with sterile saline– Semipermeable occlusive dressings, hydrocolloid

dressings, or wet saline dressings provide moist healing environment


Care and Treatment of Pressure Ulcers (cont’d)• Stage III and Stage IV:

– Debridement to remove infected, necrotic tissues• Wet-to-damp dressing• Enzyme preparations • Surgical debridement

– Topical treatment to promote granulation of tissue – Surgical interventions may be required

• Bone resection• Skin grafting


Question• Which nutrient is responsible for collagen synthesis?A. Vitamin AB. Vitamin CC. WaterD. Zinc


Answer• C. Vitamin C• Rationale: Vitamin C promotes collagen synthesis.

Vitamin A stimulates epithelial cells and immune response. Water maintains homeostasis. Zinc sulfate is a cofactor for collagen formation and protein synthesis.


Interventions to Promote Urinary Continence• Dependent upon type of urinary incontinence• Do not restrict fluids; ensure 2 to 3 L daily• Bladder training• Habit training• Biofeedback• Kegel exercises• Intermittent catherization• AVOID indwelling catheters


Interventions to Promote Bowel Continence• Consistency in implementing plan is essential• Toilet patients at same time daily• Natural time for defecation is 30 minutes after meal,

especially in morning• Positioning• Nutrition: high fiber, 2 to 3 L fluid daily• Encourage physical exercise/activity


Promoting Home- and Community-Based Care• Impact of disability on physiologic functioning• Changes in lifestyle necessary to maintain health• Medications• Obtain medical supplies• Use of adaptive equipment


Promoting Home- and Community-Based Care (cont’d)• Demonstrate mobility status• Demonstrate skin care, bladder and bowel care• Community resources• Access transportation

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Chapter 11 Principles and Practices in Rehabilitation