9 Rehabilitation and Restorative Care

Define the following terms: Rehabilitation care given by a specialist to restore or improve function after an illness or injury.

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1. Discuss rehabilitation and restorative care Rehabilitation seeks to move the resident from: Illness to health Disability to ability Dependence to independence

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1. Discuss rehabilitation and restorative care The goals of rehabilitation are as follows: Help resident regain abilities or recover from illness. Develop and promote a residents independence. Allow resident to feel in control of his or her life. Help resident accept or adapt to limitations of a disability.

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1. Discuss rehabilitation and restorative care Observe and report the following: Increase or decrease in abilities Change in attitude or motivation Change in general health Signs of depression or mood changes

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Transparency 9-1: Assisting with Rehabilitation and Restorative Care Be patient. Be positive and supportive Focus on small tasks and small accomplishments. Recognize that setbacks occur. Be sensitive to the residents needs. Encourage independence.

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2. Describe the importance of promoting independence and list REMEMBER: It is very important for NAs to encourage residents independence while assisting with or performing all tasks.

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2. Describe the importance of promoting independence and list These are some problems that may result from a lack of mobility: Loss of self-esteem Depression Illnesses such as pneumonia or UTI Constipation Blood clots Dulling of senses Muscle atrophy and contractures Increased risk of pressure sores

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Transparency 9-2: Regular Ambulation and Exercise Regular ambulation and exercise help improve: Health of skin Circulation Strength Sleep and relaxation Mood Self-esteem Appetite Elimination Blood flow Oxygen level

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Define the following terms: Ambulation walking. Adaptive/assistive devices special equipment that helps a person who is ill or disabled to perform ADLs.

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REMEMBER: Check the care plan before helping a resident to ambulate. Keep the residents limitations in mind.

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Remember the following guidelines for cane or walker use: Make sure cane or walker is in good condition. Make sure resident is wearing securely fastened non-skid footwear. Resident should place cane on stronger side. Resident should place both hands on the walker and walker should be placed no more than 12 inches in front of resident. Stay near resident on weaker side. Do not hang purses or clothing on walker. Report to nurse if cane or walker seems to be the wrong height.

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Transparency 9-3: Proper Body Alignment Observe principles of alignment. Keep body parts in natural positions. Prevent external rotation of hips. Change positions frequently, at least every two hours. Have plenty of pillows available to provide support in the various positions. Use positioning devices. Give back rubs as ordered.

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4. Explain guidelines for maintaining proper body alignment REMEMBER: Proper body alignment aids recovery and prevents injury to muscles and joints.

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5. Describe care and use of prosthetic devices Remember these guidelines for caring for a prosthesis: Be supportive. Help with ADLs. Handle prostheses carefully and follow care plan. Follow nurses or therapists instructions for application and removal. Follow manufacturers care directions. Keep prosthesis and the skin under it clean and dry. Apply stump sock if ordered. Observe skin on stump and watch for signs of breakdown. Understand that phantom sensation is real pain.

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5. Describe care and use of prosthetic devices Guidelines for caring for a prosthesis (contd.): Never try to repair a prosthesis. Report problems. Never display negative feelings about prosthesis or stump during care. If caring for an artificial eye, never clean or soak the eye in alcohol - it will crack and destroy it. Store artificial eye in water or saline. Mark container with residents name and room number. Make sure resident with hearing aid wears it and that it is working properly.

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Define the following terms: Range of motion (ROM) exercises exercises that put a joint through its full arc of motion. Abduction moving a body part away from the body. Adduction moving a body part toward the body. Dorsiflexion bending backward. Rotation turning a joint.

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Define the following terms: Extension straightening a body part. Flexion bending a body part. Pronation turning downward. Supination turning upward.

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Transparency 9-4: Body Movements

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6. Describe how to assist with range of motion exercises The NA has a different role in each type of ROM exercise: PROM: NA does all the work and resident does none. AROM: NA encourages, but resident does all the work. AAROM: NA assists and supports the resident in doing the work.

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7. List guidelines for assisting with bowel and bladder retraining NAs can assist in bowel and bladder retraining in these ways: Follow Standard Precautions. Explain and follow training schedule. Keep record of bowel and bladder habits. This will help you predict when a resident will need to eliminate. Offer a commode or a trip to the bathroom before long procedures. Encourage plenty of fluids. Encourage foods that are high in fiber. Answer call lights promptly. Provide privacy both in the bed and in the bathroom. If resident has trouble urinating, try running water in the sink or suggest she lean forward slightly.

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7. List guidelines for assisting with bowel and bladder retraining Assisting in bowel and bladder retraining (contd.): Never rush resident. Assist with good perineal care. Discard wastes properly. Discard incontinence briefs and clothing protectors properly. If your facility uses washable bed pads or briefs, follow Standard Precautions when handling these items. Keep an accurate record of urination and bowel movements, including episodes of incontinence. Never show frustration or anger.