DFS Approved Curriculum-Unit 131 Unit 13 Basic Restorative Services Nurse Aide I Course

DFS Approved Curriculum-Unit 132 Basic Restorative Services Introduction This unit explores various aspects of restorative care and the role of the nurse aide in this process. Disease, injuries and surgery are often responsible for the loss of a body part or the loss of bodily function.

DFS Approved Curriculum-Unit 133 Basic Restorative Services (continued) Introduction Working with the elderly and disabled requires a great deal of patience, caring and understanding from health care workers. Working together to assist the resident to attain the highest possible level of functioning can be a very challenging and rewarding experience.

DFS Approved Curriculum-Unit 134

5 13.0Demonstrate skills which incorporate principles of restorative care under the direction of the supervisor.

DFS Approved Curriculum-Unit 136 Rehabilitation/Restoration Definition - process of restoring disabled individual to highest level of physical, psychological, social and economic functioning possible

DFS Approved Curriculum-Unit 137 Rehabilitation/Restoration (continued) Emphasis on existing abilities Encourages independence Promotes productive lifestyle

DFS Approved Curriculum-Unit 138 Rehabilitation/Restoration (continued) Goals include: –Prevention of complications –Retraining in lost skills –Learning new skills

DFS Approved Curriculum-Unit Identify the nurse aide’s role in rehabilitation/restoration.

DFS Approved Curriculum-Unit 1310 Rehabilitation/Restoration (continued) Nurse Aide’s Role –Encourage resident –Praise accomplishments –Review skills taught –Report progress or need for additional teaching

DFS Approved Curriculum-Unit 1311 Rehabilitation/Restoration (continued) Nurse Aides Role (continued) –Promote independence praise all attempts at independence overlook failures show confidence in resident’s ability

DFS Approved Curriculum-Unit 1312 Rehabilitation/Restoration (continued) Nurse Aides Role (continued) –Promote independence (continued) be patient and allow time for residents to do things for themselves –Be sensitive and understanding

DFS Approved Curriculum-Unit 1313

DFS Approved Curriculum-Unit Provide training in and the opportunity for self-care according to the resident’s capabilities.

DFS Approved Curriculum-Unit 1315 Self-Care According To Resident’s Capabilities Training in self-care requires that three questions be answered prior to starting: 1.What is the goal to be achieved? 2.What approaches are used to help the resident achieve the goal? 3.How will progress or lack of progress be measured?

DFS Approved Curriculum-Unit 1316 Self-Care According To Resident’s Capabilities (continued) Resident included in goal-setting process, whenever possible.

DFS Approved Curriculum-Unit 1317 Self-Care According To Resident’s Capabilities (continued) Functional losses cause: –Resentment –Anger –Frustration –Withdrawal –Depression –Grief

DFS Approved Curriculum-Unit 1318 Guidelines To Assist With Restorative Care And Training Assist resident to do as much as possible for himself/herself Be realistic Never offer false hope Explain what is going to be done Begin tasks at resident’s level of functioning

DFS Approved Curriculum-Unit 1319 Guidelines To Assist With Restorative Care And Training (continued) Provide encouragement and reinforcement Praise successes Emphasize abilities Treat resident with respect Explain what resident needs to accomplish, and how you will help.

DFS Approved Curriculum-Unit 1320 Guidelines To Assist With Restorative Care And Training (continued) Accept residents and encourage them to express their feelings Help to put new skills into use immediately Assist the resident to recognize his or her progress

DFS Approved Curriculum-Unit 1321 Self-Care According To Resident’s Capabilities Treatment initiated by: –Physical therapist –Occupational therapist –Speech therapist –Licensed nurse

DFS Approved Curriculum-Unit 1322 Self-Care According To Resident’s Capabilities (continued) ADL considerations for resident: –Resident to control how and when activities carried out, when possible –Use tact in making resident aware of hygiene needs

DFS Approved Curriculum-Unit 1323 Self-Care According To Resident’s Capabilities (continued) ADL considerations for resident (continued): –Encourage use and selection of clothing –Be patient and allow time for slower paced activities

DFS Approved Curriculum-Unit 1324 Self-Care According To Resident’s Capabilities (continued) ADL considerations for resident (continued): –Provide for rest periods –Assist to exercise –Promote independence by having do as much of activity, as possible –Encourage use of adaptive devices

DFS Approved Curriculum-Unit 1325

DFS Approved Curriculum-Unit Discuss methods for assisting with bowel and bladder retraining.

DFS Approved Curriculum-Unit 1327 Bowel And Bladder Retraining Incontinence: Inability to control urination or defecation –Embarrassing for resident –Uncomfortable

DFS Approved Curriculum-Unit 1328 Bowel Retraining Plan developed to assist to return to normal elimination pattern and recorded on care plan Information collected: –bowel pattern before incontinence –present bowel pattern –dietary practices

DFS Approved Curriculum-Unit 1329 Bowel Retraining (continued) Participants in plan –resident –family –all staff members

DFS Approved Curriculum-Unit 1330 Guidelines For Bowel Retraining Enemas may be ordered by physician and given by nurse aide, as directed by supervisor Regular, specific times to evacuate bowels established Fluids encouraged on regular basis

DFS Approved Curriculum-Unit 1331 Guidelines For Bowel Retraining (continued) High bulk foods given, if not restricted – fruits – vegetables – bread – bran cereals

DFS Approved Curriculum-Unit 1332 Guidelines For Bowel Retraining (continued) Bowel aids ordered by physician and administered by licensed nurse only: –laxatives –suppositories –stool softeners Regular exercise encouraged

DFS Approved Curriculum-Unit 1333 Guidelines For Bowel Retraining (continued) Ways nurse aide can assist with defecation process: –offer bedpan on set schedule –assist to bathroom when request is made –provide privacy –display unhurried attitude

DFS Approved Curriculum-Unit 1334 Guidelines For Bowel Retraining (continued) Ways nurse aide can assist with defecation process (continued): –offer warm drink –be patient –encourage with positive remarks –do not scold when accidents happen (abuse) –check on resident frequently

DFS Approved Curriculum-Unit 1335 Bladder Retraining Plan developed to assist to return to normal voiding pattern and recorded on care plan Staff must be consistent and follow plan

DFS Approved Curriculum-Unit 1336 Bladder Retraining Individualized plan includes: –schedule that specifies time and amount of fluids to be given –schedule for attempting to void

DFS Approved Curriculum-Unit 1337 Guidelines for Bladder Retraining Get resident’s cooperation Record incontinent times Provide with opportunities to void: –when resident awakens –one hour before meals –every two hours between meals –before going to bed –during night, as needed

DFS Approved Curriculum-Unit 1338 Guidelines for Bladder Retraining (continued) Provide for comfortable voiding position Be supportive and sensitive Provide encouragement Offer fluids according to schedule

DFS Approved Curriculum-Unit 1339 Guidelines for Bladder Retraining (continued) Provide stimuli as needed: –run water in sink –pour water over perineum –offer fluids to drink –place hands in warm water

DFS Approved Curriculum-Unit 1340 Guidelines for Bladder Retraining (continued) Provide good skin care to prevent skin breakdown Retraining may take 6-10 weeks –be patient –be supportive –ignore accidents –respect resident’s feelings

DFS Approved Curriculum-Unit 1341 Guidelines for Bladder Retraining (continued) Follow facility procedure for use of: –incontinent pads –adult protective pants –incontinent briefs

DFS Approved Curriculum-Unit 1342

DFS Approved Curriculum-Unit Identify ways to assist the resident in activities of daily living and encourage self-help activities.

DFS Approved Curriculum-Unit 1344 Adaptive Devices For Assisting With Activities of Daily Living (ADL) Special utensils available to help with eating Electric toothbrushes for brushing teeth Long-handled brushes and combs for hair care

DFS Approved Curriculum-Unit 1345 Adaptive Devices For Assisting With Activities of Daily Living (ADL) (continued) Supportive devices to assist with walking – canes, crutches, walkers Wheelchairs and motorized chairs to provide movement from place to place

DFS Approved Curriculum-Unit 1346 Adaptive Devices For Assisting With Activities of Daily Living (ADL) (continued) Prosthesis to replace missing body parts Successful use of adaptive devices depends on the resident’s: –attitude –acceptance of limitations –motivation –support from others

DFS Approved Curriculum-Unit 1347

DFS Approved Curriculum-Unit Discuss the various ambulation devices and transfer aids.

DFS Approved Curriculum-Unit 1349 Ambulation Devices And Transfer Aids Walker - four-point aid with rubber tips –Resident stands erect when moving walker forward –Walker adjusted to height of hip joint –Elbows at degree angle –Walker picked up and put down, not slid

DFS Approved Curriculum-Unit 1350 Ambulation Devices And Transfer Aids (continued) Walker - four-point aid with rubber tips (continued) –Back legs of walker even with toes so resident walks into walker –Resident steps toward center of walker –Leads with weaker leg

DFS Approved Curriculum-Unit 1351 Ambulation Devices And Transfer Aids (continued) Canes –Types: single-tipped tripod - 3 legs quad - four point

DFS Approved Curriculum-Unit 1352 Ambulation Devices And Transfer Aids (continued) Canes (continued) –Used when weakness on one side of body and resident has use of at least one arm –Provides balance and support

DFS Approved Curriculum-Unit 1353 Ambulation Devices And Transfer Aids (continued) Canes (continued) –Should be fitted properly: cane handle level with femur (greater trochanter) elbow flexed at 15 to 30 degree angle shoulders level

DFS Approved Curriculum-Unit 1354 Ambulation Devices And Transfer Aids (continued) Canes (continued) –Gaits ordered by physician or physical therapist: move cane and affected leg together move cane, then affected leg –Used on side of body where leg is strongest (side opposite the injury)

DFS Approved Curriculum-Unit 1355 Ambulation Devices And Transfer Aids (continued) Crutches –Provide support and stability through use of hands and arms. –Used when one or both legs are weak.

DFS Approved Curriculum-Unit 1356 Ambulation Devices And Transfer Aids (continued) Crutches (continued) –Measured to fit properly by physical therapist. height correct if two fingers fit between armrest and axilla hand grip adjusted to allow degrees flexion of elbows

DFS Approved Curriculum-Unit 1357 Ambulation Devices And Transfer Aids (continued) Crutches (continued) –Gaits four-point gait three-point gait two-point gait swing-to gait swing-thru gait

DFS Approved Curriculum-Unit 1358 Ambulation Devices And Transfer Aids (continued) Crutches (continued) –Weight supported on hand bar, not axilla

DFS Approved Curriculum-Unit 1359 Ambulation Devices And Transfer Aids (continued) Wheelchairs –Available in different sizes and models to allow for proper fit and usage –Cleaned with mild detergent and water, rinsed with water and dried

DFS Approved Curriculum-Unit 1360 Ambulation Devices And Transfer Aids (continued) Wheelchairs (continued) –Periodic maintenance needed with 3 in 1 oil –Arm rests adjusted to appropriate height –Feet rest flat on floor when chair is not moving

DFS Approved Curriculum-Unit 1361 Ambulation Devices And Transfer Aids (continued) Wheelchairs (continued) –Seat should not sag toward center of chair –Seat should not reach back of resident’s bent knees –Brakes locked when chair not moving

DFS Approved Curriculum-Unit 1362 Ambulation Devices And Transfer Aids (continued) Wheelchairs (continued) –Wheelchair guided backwards when going downhill –Wheelchair pulled backwards over indented or raised areas (i.e., entrance to elevators)

DFS Approved Curriculum-Unit 1363 Ambulation Devices And Transfer Aids (continued) Wheelchairs (continued) –Feet placed on footrests for transport

DFS Approved Curriculum-Unit 1364 Ambulation Devices And Transfer Aids (continued) Gurneys/Stretchers/Litters –Wheels locked when transferring residents on or off –Safety belts secured prior to transfer –Both side rails raised prior to transfer

DFS Approved Curriculum-Unit 1365 Ambulation Devices And Transfer Aids (continued) Gurneys/Stretchers/Litters (continued) –Residents never left alone on stretcher –Backed head first into elevators

DFS Approved Curriculum-Unit 1366 Ambulation Devices And Transfer Aids (continued) –Always used with assistance when transferring resident on or off –Pushed feet first during transport Gurneys/Stretchers/Litters (continued)

DFS Approved Curriculum-Unit 1367 Ambulation Devices And Transfer Aids (continued) –Guided backwards when going downhill –Cleaned with mild detergent and water, rinsed with water and dried Gurneys/Stretchers/Litters (continued)

DFS Approved Curriculum-Unit 1368 Ambulation Devices And Transfer Aids (continued) Gait belt (safety belt, transfer belt) –Used for residents unsteady on feet –Protects resident who loses balance or faints –Held at back

DFS Approved Curriculum-Unit 1369 Ambulation Devices And Transfer Aids (continued) –Must be tight enough to provide support but loose enough to be comfortable –Used to safely transfer resident Gait belt (safety belt, transfer belt) (continued)

DFS Approved Curriculum-Unit Identify safety precautions to be considered by the nurse aide when using ambulatory devices.

DFS Approved Curriculum-Unit 1371 Safety Considerations When Using Ambulatory Devices Correct aids must be used because they are individually fitted Resident observed closely to be sure aids are being used as ordered Faulty equipment reported and not used until repaired

DFS Approved Curriculum-Unit 1372 Safety Considerations When Using Ambulatory Devices (continued) Shoes must fit and be in good condition Skin breakdown reported Rubber tips on aids in good condition.

DFS Approved Curriculum-Unit 1373

DFS Approved Curriculum-Unit Demonstrate the method used to assist a resident to ambulate using a cane or walker.

DFS Approved Curriculum-Unit 1375

DFS Approved Curriculum-Unit Discuss the use of mechanical lifts.

DFS Approved Curriculum-Unit 1377 Mechanical Lifts Used for transfer of residents Lower end of sling positioned behind knees Hooks turned away from body

DFS Approved Curriculum-Unit 1378 Mechanical Lifts (continued) Straps, sling and clasps checked for defects Enough assistance available to assure safe transfer Area checked for safety hazards prior to transfer

DFS Approved Curriculum-Unit 1379

DFS Approved Curriculum-Unit Demonstrate the procedure for transferring a resident using a mechanical lift (Hoyer).

DFS Approved Curriculum-Unit 1381

DFS Approved Curriculum-Unit Perform range of motion exercises as instructed by the physical therapist or supervisor.

DFS Approved Curriculum-Unit 1383 Range of Motion Exercises Types of range of motion: –Active - resident exercises joints without help –Passive - another person moves body part for resident

DFS Approved Curriculum-Unit 1384 Range of Motion Exercises (continued) Purpose of range of motion: –Maintains muscle tone –Prevents deformities –Increases circulation –Encourages mobility

DFS Approved Curriculum-Unit 1385 Guidelines When Performing Range Of Motion Expose only part of body being exercised Be gentle and stop if resident complains of pain Use good body mechanics

DFS Approved Curriculum-Unit 1386 Guidelines When Performing Range Of Motion (continued) Follow directions from supervisor on number of times each joint to be exercised and how to perform exercises safely, based on each resident’s condition

DFS Approved Curriculum-Unit 1387 Guidelines When Performing Range Of Motion (continued) Each movement is repeated three times unless otherwise ordered. Support joint as it is exercised Report complaints of pain or discomfort to supervisor

DFS Approved Curriculum-Unit 1388 Guidelines When Performing Range Of Motion (continued) Exercise joint slowly, smoothly and gently Do not exercise swollen, reddened joints; report condition to supervisor

DFS Approved Curriculum-Unit 1389 Range Of Motion Exercises Types of Joint Movement Abduction Adduction Extension Hyperextension Flexion Plantar flexion Dorsiflexion Rotation

DFS Approved Curriculum-Unit 1390 Range Of Motion Exercises Types of Joint Movement (continued) Pronation Supination Eversion Inversion Radial deviation Ulnar deviation Encourage residents capable of doing active ROM exercises

DFS Approved Curriculum-Unit 1391

DFS Approved Curriculum-Unit Demonstrate the procedure for performing range of motion exercises.

DFS Approved Curriculum-Unit 1393

DFS Approved Curriculum-Unit Assist in care and use of prosthetic devices.

DFS Approved Curriculum-Unit 1395 Prosthetic Devices Artificial Eye (glass eye) –encourage resident to remove, clean and replace eye prosthesis if able

DFS Approved Curriculum-Unit 1396 Prosthetic Devices (continued) Eyeglasses –Lens made of glass or plastic –Stored in protective case to prevent damage when not in use –Held by frames

DFS Approved Curriculum-Unit 1397 Prosthetic Devices (continued) Eyeglasses (continued) –Washed under running water using mild detergent. rinsed with clear water dried with tissue or soft cloth

DFS Approved Curriculum-Unit 1398 Prosthetic Devices (continued) Eyeglasses (continued) –Tops of ears and nose observed for redness or irritation from glasses Wash hands before and after cleansing resident’s glasses

DFS Approved Curriculum-Unit 1399 Prosthetic Devices (continued) Contact Lenses (hard or soft) –Resident encouraged to care for lenses

DFS Approved Curriculum-Unit Prosthetic Devices (continued) Contact Lenses (hard or soft) (continued) –Unusual observations to be reported: redness itching swelling complaints of pain, blurring, or scratching sensations

DFS Approved Curriculum-Unit Prosthetic Devices (continued) Hearing Aid –Ear piece cleaned daily with soap and water; this is the only washable part –Ear piece and tubing should be soft –Wax cleaned from tubing with special equipment

DFS Approved Curriculum-Unit Prosthetic Devices (continued) Hearing Aid (continued) –Batteries checked for power –Skin observed for redness or irritation in or around ear –Ear wax build-up reported to supervisor

DFS Approved Curriculum-Unit Prosthetic Devices (continued) Removing hearing aid: –turn volume to lowest level or off –gently lift ear piece up and out of ear –use tissues to wipe wax off ear piece –store in safe place –remove battery when not in use or open battery case

DFS Approved Curriculum-Unit Prosthetic Devices (continued) Inserting hearing aid: –turn volume toward maximum until whistle is heard –replace batteries if whistle cannot be heard –turn volume to low setting

DFS Approved Curriculum-Unit Prosthetic Devices (continued) Inserting hearing aid (continued) : –gently insert ear piece into ear canal and adjust for comfort –loop over ear for over-the-ear models –adjust volume to resident’s satisfaction

DFS Approved Curriculum-Unit Prosthetic Devices (continued) Braces –Uses support a weak part of the body prevent movement of joint correct deformities prevent deformities

DFS Approved Curriculum-Unit Prosthetic Devices (continued) Braces (continued) –Materials metal  leather  plastic –Bony parts under brace require protection in order to prevent skin irritation –Report any wear noticed and when brace parts are loose or missing

DFS Approved Curriculum-Unit Prosthetic Devices (continued) Braces (continued) –Shoes custom fitted and checked for: broken shoe laces heels and soles that are worn leather that is worn or torn damage from perspiration – odors – stains

DFS Approved Curriculum-Unit Prosthetic Devices (continued) Devices for use with amputation –Definition of amputation - partial or complete removal of a body part usually arm or leg below knee most common amputation

DFS Approved Curriculum-Unit Prosthetic Devices (continued) Devices for use with amputation (continued) –Examples of prosthetic devices: artificial leg artificial foot artificial arm artificial hand

DFS Approved Curriculum-Unit Prosthetic Devices (continued) Devices for use with amputation (continued) –Prosthesis fitted and made for each individual. –Devices must be handled with care and stored in appropriate place when not in use.

DFS Approved Curriculum-Unit Devices For Use With Amputation Assisting with artificial limbs: –have right device –check all parts for damage –evaluate resident’s limb for irritation and swelling –pad area of prosthesis touching resident

DFS Approved Curriculum-Unit Devices For Use With Amputation Assisting with artificial limbs (continued) : –clean according to individual instructions –report any needed repairs to supervisor –observe and report any skin changes to supervisor

DFS Approved Curriculum-Unit Prosthetic Devices Breast Forms – used following removal of breast –Assist female residents with adjustments of forms when dressing –Follow care suggested by manufacturer –Keep form separate and in safe place when handling clothing for laundry

DFS Approved Curriculum-Unit 13115

DFS Approved Curriculum-Unit Assist the resident in the proper use of body mechanics.

DFS Approved Curriculum-Unit Body Mechanics For Residents Broad base of support leads to better balance and stability Keep weight the same on both feet Stoop using the hips and knees

DFS Approved Curriculum-Unit Body Mechanics For Residents (continued) Keep the back straight Lift and carry objects close to body for better balance. Use both hands to lift or move objects Use smooth, even movements

DFS Approved Curriculum-Unit Body Mechanics For Residents (continued) Do not bend or reach if injury possible; ask for help Do not twist body to reach an object Keep body in good alignment

DFS Approved Curriculum-Unit 13120

DFS Approved Curriculum-Unit Provide assistance for the resident with dangling, standing and walking.

DFS Approved Curriculum-Unit Dangling Dangling - sitting on edge of bed before getting up –Standing up too quickly may cause feeling of dizziness and fainting may occur

DFS Approved Curriculum-Unit Dangling (continued) Dangling for several minutes allows resident to progress to standing and walking without feeling faint Taking deep breaths helps to prevent light-headedness

DFS Approved Curriculum-Unit Dangling (continued) Most common signs/symptoms if feeling faint: –pale face –complaints of dizziness or weakness

DFS Approved Curriculum-Unit Dangling (continued) Return resident to supine position if they have difficulty dangling If dangling is well tolerated, progress to standing position

DFS Approved Curriculum-Unit Standing Get assistance if resident is weak or unsteady Assist resident to stand by placing your hands under the resident’s arms with hands around the shoulder blades, and use good body mechanics to assist to standing position

DFS Approved Curriculum-Unit Standing (continued) Have resident stand by side of bed for several minutes prior to ambulating Return to bed or assist to chair if having difficulty standing If standing tolerated, progress to ambulating

DFS Approved Curriculum-Unit Ambulating Effects on body –stimulates circulation –strengthens muscles –relieves pressure on body parts –increases joint mobility –improves function of digestive and urinary systems

DFS Approved Curriculum-Unit Ambulating (continued) Effects on body (continued) –increased independence leads to more positive self-image –provides sense of accomplishment –prevents lung congestion

DFS Approved Curriculum-Unit Ambulating (continued) Encourage to ambulate as much as possible Suggest use of handrails for support

DFS Approved Curriculum-Unit Ambulating (continued) If resident starts to fall, ease to the floor by: –grasping under arms –resting buttocks against nurse aide’s leg –sliding down aide’s leg to floor

DFS Approved Curriculum-Unit Ambulating (continued) Be prepared to assist, but allow the resident to do as much as possible Safety considerations: –use gait belt –get assistance if needed –allow adequate time for walking so resident does not feel rushed

DFS Approved Curriculum-Unit 13133

DFS Approved Curriculum-Unit Demonstrate the procedure for assisting the resident to dangle, stand and walk.

DFS Approved Curriculum-Unit 13135

DFS Approved Curriculum-Unit Provide cast care for the resident.

DFS Approved Curriculum-Unit Cast Care Cast used to immobilize body part, providing time for part to heal

DFS Approved Curriculum-Unit Cast Care (continued) Cast materials –Plaster of Paris hours to dry expands and gives off heat while drying –Fiberglass dries rapidly lighter than plaster casts –Plastic

DFS Approved Curriculum-Unit Cast Care (continued) Care of Casts –Allow to air dry –Keep cast uncovered –Use pillows to support cast –Support cast with palms of hands

DFS Approved Curriculum-Unit Cast Care (continued) Care of Casts –Never put pressure on cast –Turn and position frequently to allow air to circulate around cast

DFS Approved Curriculum-Unit Cast Care (continued) Maintain good body alignment Keep cast dry Observe cast for rough edges and report Over-bed trapeze provided if appropriate

DFS Approved Curriculum-Unit Cast Care: Observations To Report To Supervisor Immediately Drainage Odors Swelling of fingers or toes, inability to move parts Change in color of skin: paleness, cyanosis

DFS Approved Curriculum-Unit Cast Care: Observations To Report To Supervisor Immediately (continued) Vomiting Elevated temperature Skin irritation around edge of cast

DFS Approved Curriculum-Unit Cast Care: Observations To Report To Supervisor Immediately (continued) Resident reports of: –Pain –Numbness –Tingling sensations –Chills –Hot or cold skin –Itching –Tightness –Inability to move fingers or toes –Nausea

DFS Approved Curriculum-Unit 13145

DFS Approved Curriculum-Unit Demonstrate the proper technique for transferring a resident from a bed to a chair.

DFS Approved Curriculum-Unit Demonstrate the proper technique for transferring a resident from a bed to wheelchair.

DFS Approved Curriculum-Unit Demonstrate the proper technique for transferring a resident from a bed to a stretcher.

DFS Approved Curriculum-Unit 13149