Rehabilitative / Restorative CareRehabilitative / Restorative Care

TerminologyTerminology– Active range of motionActive range of motion– AdaptiveAdaptive– Restorative careRestorative care– Bed cradleBed cradle– Foot boardFoot board– Fleece padFleece pad– Egg-crate mattressEgg-crate mattress

Terminology #2Terminology #2

– Flotation padFlotation pad– Trochanter rollsTrochanter rolls– Heel protector / elbow Heel protector / elbow

protectorprotector– Assistive devicesAssistive devices– Passive range of motionPassive range of motion– Active-assistive range of Active-assistive range of

motionmotion

Terminology #3Terminology #3

– DisabilityDisability– AtrophyAtrophy– Alternating pressure Alternating pressure

mattressmattress– Activities of daily livingActivities of daily living– Pressure soresPressure sores– IndependenceIndependence– AmbulationAmbulation– JointJoint– Water bedWater bed

Terminology #4Terminology #4

– Stasis pneumoniaStasis pneumonia– ThrombophlebitisThrombophlebitis– TCDBTCDB– PhlebitisPhlebitis– EmbolismEmbolism– HemiplegiaHemiplegia

Terminology #5Terminology #5

– QuadriplegiaQuadriplegia– ParalysisParalysis– ParaplegiaParaplegia– Clinitron bedClinitron bed– ContracturesContractures– DecubitiDecubiti

Discuss rehabilitationDiscuss rehabilitation

Disability: a physical and/or Disability: a physical and/or mental condition which mental condition which interferes with meeting interferes with meeting basic human needsbasic human needs

Effects of disability:Effects of disability:Feeling of lossFeeling of lossDamage to self-imageDamage to self-imageLoss of self-esteemLoss of self-esteem

Discuss rehabilitation #2Discuss rehabilitation #2

Restorative care: helps Restorative care: helps disabled individuals return disabled individuals return to their highest possible to their highest possible level of physical and level of physical and psychological functioningpsychological functioningHelps person adjust to the Helps person adjust to the disabilitydisabilityEmphasizes abilitiesEmphasizes abilitiesPrevents complications Prevents complications

State goals of restorative careState goals of restorative carePhysical goalsPhysical goals

1.1. Maintain present level of functionMaintain present level of function2.2. Improve physical functionImprove physical function3.3. Encourage independenceEncourage independence

Psychosocial goalsPsychosocial goals1.1. Adjust to psychosocial effects of Adjust to psychosocial effects of

disabilitydisability2.2. Stabilize economic resources Stabilize economic resources

Rehabilitation team / Role of the Rehabilitation team / Role of the nurse assistantnurse assistant

Purpose:Purpose:

Discuss and evaluate resident level Discuss and evaluate resident level of functioningof functioning

Establish resident’ care plan and Establish resident’ care plan and goals for rehabilitationgoals for rehabilitation

Evaluate progressEvaluate progress

Restore the resident to his/her Restore the resident to his/her optimal level of functioningoptimal level of functioning

Members of the teamMembers of the team

Resident Resident

Family membersFamily members

Nurse assistantNurse assistant

Licensed nursing staffLicensed nursing staff

Physical therapistPhysical therapist

Occupational therapist Occupational therapist

Members of the team #2Members of the team #2

PhysicianPhysician

Activity leaderActivity leader

Social workerSocial worker

ClergyClergy

DietitianDietitian

Nurse Assistant Nurse Assistant Responsibilities/Rehabilitation Responsibilities/Rehabilitation

Participate in resident care plan Participate in resident care plan conferenceconference

Observe and report responses to Observe and report responses to carecare

Follow the resident’s care planFollow the resident’s care plan

Encourage to follow the planEncourage to follow the plan

Observe and report early signs and Observe and report early signs and symptoms of complicationssymptoms of complications

Nurse assistant Nurse assistant Responsibilities/Resident CareResponsibilities/Resident Care

Protect resident rightsProtect resident rights

Ensure safetyEnsure safety

Communicate therapeuticallyCommunicate therapeutically

Adhere to legal and ethical principalsAdhere to legal and ethical principals

Follow instructions of immediate Follow instructions of immediate supervisorsupervisor

Report changes in resident Report changes in resident conditionsconditions

Nurse assistant responsibilities #2Nurse assistant responsibilities #2

Practice appropriate and effective Practice appropriate and effective nursing carenursing care

ROM training plan for resident self ROM training plan for resident self carecare

Encourage resident independenceEncourage resident independence

Concentrate on resident’s abilities Concentrate on resident’s abilities

Protect resident from abuseProtect resident from abuse

Activities of Daily LivingActivities of Daily Living

Activities of Daily Living (ADL’S)Activities of Daily Living (ADL’S)

– Daily hygieneDaily hygiene– GroomingGrooming– EatingEating– Self-care activities necessary for normal Self-care activities necessary for normal

functioning in societyfunctioning in society

Activities of Daily Living #2Activities of Daily Living #2Examples:Examples:– GroomingGrooming– DressingDressing– FeedingFeeding– HygieneHygiene– Elimination – bowel and Elimination – bowel and

bladderbladder– Mobility/ambulationMobility/ambulation– Self-turning and positioningSelf-turning and positioning

Comfort devices and their purposesComfort devices and their purposes

Bed boardBed board

FootboardFootboard

Trochanter rollTrochanter roll

HandrollHandroll

Bed cradleBed cradle

TrapezeTrapeze

SheepskinSheepskin

Comfort devices and their purposes Comfort devices and their purposes #2#2

Heel/elbow protectorsHeel/elbow protectors

Flotation padsFlotation pads

Egg crate mattressEgg crate mattress

Water bedWater bed

Alternating pressure Alternating pressure mattressmattress

PillowsPillows

Adaptive/self-help devices Adaptive/self-help devices

Eating utensilsEating utensils

Hygiene and grooming Hygiene and grooming aidesaides

Promote independencePromote independence

Artificial limbs and eyesArtificial limbs and eyes

Casts and splintsCasts and splints

Complications from inactivityComplications from inactivity

TypesTypes– RespiratoryRespiratory– CirculatoryCirculatory– Musculo-skeletalMusculo-skeletal– IntegumentaryIntegumentary– Gastro-intestinalGastro-intestinal– Genito-urinaryGenito-urinary– psychosocialpsychosocial

Complications from inactivity #2Complications from inactivity #2

CausesCauses

– Bed restBed rest– Prolonged illnessProlonged illness– Recovery from injuryRecovery from injury– SurgerySurgery

Complications from inactivity #3Complications from inactivity #3

Preventive methodsPreventive methods– Turning/repositioningTurning/repositioning– TCDBTCDB– Body alignmentBody alignment– Rang of motionRang of motion– Supportive devicesSupportive devices– Skin careSkin care

Complications from inactivity #4Complications from inactivity #4– Encouraging independenceEncouraging independence– ToiletingToileting– Bowel and bladder trainingBowel and bladder training– Elastic stockingsElastic stockings

Range of Motion ExercisesRange of Motion Exercises

PurposePurpose– Maintain muscle strengthMaintain muscle strength– Stimulate circulationStimulate circulation– Maintain body alignment Maintain body alignment

and make positioning easierand make positioning easier– Prevent thrombophlebitisPrevent thrombophlebitis– Prevent contracturesPrevent contractures

Range of Motion Exercises #2Range of Motion Exercises #2

FrequencyFrequency

– At least three times each dayAt least three times each day

– As indicated in the care planAs indicated in the care plan

Range of Motion Exercises #3Range of Motion Exercises #3

TechniquesTechniques

– Active ROMActive ROM

– Passive ROMPassive ROM

– Active assistive ROMActive assistive ROM

Range of Motion Exercises #4Range of Motion Exercises #4

General rules to avoid injuryGeneral rules to avoid injury

– Exercise correct jointExercise correct joint– Avoid unnecessary exposureAvoid unnecessary exposure– Use good body mechanicsUse good body mechanics– Fully support each extremityFully support each extremity– Move join slowly, smoothly, Move join slowly, smoothly,

gentlygently

Range of Motion Exercises #5Range of Motion Exercises #5

– Do not force the joint to Do not force the joint to move past the pint of move past the pint of discomfortdiscomfort

– Do not cause painDo not cause pain

– Report complaint of pain to Report complaint of pain to the licensed nursethe licensed nurse

Promoting MobilityPromoting MobilityProceduresProcedures

– Transfer techniquesTransfer techniques

– Gait trainingGait training

– Training in self-transfer Training in self-transfer techniquestechniques

– Use of gait belt for ambulationUse of gait belt for ambulation

Promoting Mobility #2Promoting Mobility #2Assistive devicesAssistive devices

– CaneCane

– WalkerWalker

– WheelchairWheelchair

– Transfer boardTransfer board

Promoting Mobility #3Promoting Mobility #3

– Braces, splints and Braces, splints and prosthesesprostheses

– Seeing eye dogSeeing eye dog– BrailleBraille– Modifications to Modifications to

accommodate wheelchair accommodate wheelchair accessaccess

– Disabled parkingDisabled parking

Self-esteem and Family Self-esteem and Family involvementinvolvement

Basic needs as defined by Basic needs as defined by MaslowMaslow

– Love/belonging/affiliation Love/belonging/affiliation needsneeds

– The need for self-esteemThe need for self-esteem

– The need for self-actualizationThe need for self-actualization

Self-esteem and Family Self-esteem and Family involvement #2involvement #2

MethodsMethods

– Promote interactionPromote interaction– Treat resident/family with Treat resident/family with

respect and dignityrespect and dignity– Be supportiveBe supportive– Encourage independenceEncourage independence– Use a positive approach to Use a positive approach to

restorative planrestorative plan