BellWork Opening Question What does restorative and rehabilitative services mean to a CNA? Which patient populations need this service, name 3 groups of people?

State Standard 22) Understand principles of and successfully perform skills related to basic restorative care. Incorporate guidelines of residents’ rights and utilize rubrics from textbooks, National HOSA guidelines, or other clinical standards of practice for the following: a. Promoting self-care b. Range of Motion (ROM) exercises and maintenance c. Ambulation with and without assistive devices d. Use of assistive devices in transferring, eating, and dressing e. Care and use of prosthetic/orthotic devices f. Role of physical therapy, occupational therapy, and speech therapy in LTC and assisted living facilities

Daily Objective Discuss rehabilitative and restorative care basics List the 9 body movements

1. Discuss rehabilitation and restorative care Define the following term: rehabilitation Care that is given by specialists to help restore or improve function after an illness or injury.

1. Discuss rehabilitation and restorative care The process of rehabilitation is about moving the resident from Illness to health Disability to ability Dependence to independence

1. Discuss rehabilitation and restorative care These are the goals of rehabilitation: Help resident regain function or recover from illness Develop and promote a resident’s independence Allow resident to feel in control of his life Help resident accept or adapt to the limitations of a disability What examples can you and your partner think of for each goal?

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 resident’s needs. Encourage independence. Involve residents in their care.

1. Discuss rehabilitation and restorative care NAs should observe and report the following signs and symptoms: Increase or decrease in abilities Example “Yesterday Mr. Martinez used the BSC without help. Today he asked for the bedpan.” Change in attitude or motivation Change in general health Signs of depression or mood changes

Transparency 21-4: Body Movements

Can you spot the ROM movements? Can you do the movements? Whip/ Nae Nae https://www.vevo.com/watch/silento/watch-me-(whip-nae-nae)-(official)/USUV71501552 Can you spot the ROM movements? Can you do the movements?

Exit Ticket

Name 9 types of ROM movements and difference between each movement. Bellwork Name 9 types of ROM movements and difference between each movement. **Prepare to demonstrate in front of class**

State Standard 22) Understand principles of and successfully perform skills related to basic restorative care. Incorporate guidelines of residents’ rights and utilize rubrics from textbooks, National HOSA guidelines, or other clinical standards of practice for the following: a. Promoting self-care b. Range of Motion (ROM) exercises and maintenance c. Ambulation with and without assistive devices d. Use of assistive devices in transferring, eating, and dressing e. Care and use of prosthetic/orthotic devices f. Role of physical therapy, occupational therapy, and speech therapy in LTC and assisted living facilities

6. Describe how to assist with range of motion exercises Define the following terms: range of motion (ROM) exercises exercises that put a particular joint through its full arc of motion. passive range of motion (PROM) exercises exercises to put a joint through its full arc of motion that are performed by a person alone, without the affected person’s help.

6. Describe how to assist with range of motion exercises Define the following terms: active range of motion (AROM) exercises exercises to put a joint through its full arc of motion that are performed by the affected person alone, without help. active assisted range of motion (AAROM) exercises exercises to put a joint through its full arc of motion that are performed by a person with some help from the affected person.

6. Describe how to assist with range of motion exercises NAs should remember the differences between the types of ROM exercises: PROM - NA does all the work, and resident does none. AROM - NA encourages resident, but resident does all the work. AAROM - NA assists and supports the resident in doing the work.

Bellwork Review for quiz Quiz Lower body ROM skills lab Start section 2 in chapter

Assisting with passive range of motion exercises 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for resident’s privacy with curtain, screen, or door. Adjust bed to a safe level, usually waist high. Lock bed wheels. 6. Position the resident lying supine—flat on her back—on the bed. Use proper alignment. 7. While supporting the limbs, move all joints gently, slowly, and smoothly through the range of motion to the point of resistance. Repeat each exercise at least three times unless the resident complains of pain. Stop performing exercises if resident complains of pain and report to the nurse.

Assisting with passive range of motion exercises 8. Shoulder. Support the resident’s arm at the elbow and wrist while performing ROM for the shoulder. Place one hand under the elbow and the other hand under the wrist. Raise the straightened arm from the side position upward toward head to ear level and return arm down to side of the body (extension/flexion).

Assisting with passive range of motion exercises Move straightened arm away from side of body to shoulder level and return arm to side of body(abduction/adduction).

Assisting with passive range of motion exercises 9. Elbow. Hold the resident’s wrist with one hand and the elbow with the other hand. Bend the elbow so that the hand touches the shoulder on that same side (flexion). Straighten the arm (extension) (Fig. 21-9).

Assisting with passive range of motion exercises Exercise the forearm by moving it so the palm is facing downward (pronation) and then the palm is facing upward (supination).

Assisting with passive range of motion exercises 10. Wrist. Hold the wrist with one hand and use the fingers of the other hand to help move the joint through the motions. Bend the hand down (flexion); bend the hand backward (dorsiflexion).

Assisting with passive range of motion exercises Turn the hand in the direction of the thumb (radial flexion). Then turn the hand in the direction of the little finger (ulnar flexion).

Assisting with passive range of motion exercises 11. Thumb. Move the thumb away from the index finger (abduction). Move the thumb back next to the index finger (adduction).

Assisting with passive range of motion exercises Touch each fingertip with the thumb (opposition).

Assisting with passive range of motion exercises Bend thumb into the palm (flexion) and out to the side (extension) (Fig. 21-15).

Assisting with passive range of motion exercises 12. Fingers. Make the hand into a fist (flexion). Gently straighten out the fist (extension).

Assisting with passive range of motion exercises Spread the fingers and the thumb far apart from each other (abduction). Bring the fingers back next to each other (adduction).

Assisting with passive range of motion exercises 13. Hip. Support the leg by placing one hand under the knee and one under the ankle. Straighten the leg and raise it gently upward. Move the leg away from the other leg (abduction). Move the leg toward the other leg (adduction).

Assisting with passive range of motion exercises Gently turn the leg inward (internal rotation), then turn the leg outward (external rotation).

Assisting with passive range of motion exercises 14. Knee. Support the leg under the knee and under the ankle while performing ROM for the knee. Bend the knee to the point of resistance (flexion). Return leg to resident’s normal position (extension).

Assisting with passive range of motion exercises 15. Ankle. Support the foot and ankle close to the bed while performing ROM for the ankle. Push/pull foot up toward the head (dorsiflexion). Push/pull foot down, with the toes pointed down (plantar flexion).

Assisting with passive range of motion exercises Turn the inside of the foot inward toward the body (supination). Bend the sole of the foot so that it faces away from the body (pronation).

Assisting with passive range of motion exercises 16. Toes. Curl and straighten the toes (flexion and extension).

Assisting with passive range of motion exercises Gently spread the toes apart (abduction).

2. Describe the importance of promoting independence and list ways that exercise improves health The following problems 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 ulcers

State Standard 22) Understand principles of and successfully perform skills related to basic restorative care. Incorporate guidelines of residents’ rights and utilize rubrics from textbooks, National HOSA guidelines, or other clinical standards of practice for the following: a. Promoting self-care b. Range of Motion (ROM) exercises and maintenance c. Ambulation with and without assistive devices d. Use of assistive devices in transferring, eating, and dressing e. Care and use of prosthetic/orthotic devices f. Role of physical therapy, occupational therapy, and speech therapy in LTC and assisted living facilities

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

2. Describe the importance of promoting independence and list ways that exercise improves health REMEMBER: It is important to get a doctor’s approval before starting a new exercise or activity program. Certain medical conditions might make exercise risky or might require adaptations to ensure safety. Warming up and cooling down are important elements of an exercise program. These processes help prevent injury.

3. Describe assistive devices and equipment REMEMBER: Page 379 of the textbook shows different items available to assist residents adapting to new limitations.

3. Describe assistive devices and equipment REMEMBER: Residents using new ambulatory aids will likely be off-balance. NAs should stay close by and observe residents for signs of dizziness.

Transparency 21-3: Proper Body Alignment Observe principles of alignment. Keep body parts in natural positions. Prevent external rotation of hips. Change positions often, at least every two hours.

4. Explain guidelines for maintaining proper body alignment REMEMBER: Chapter 10 includes specific instructions for positioning residents.

5. Explain care guidelines for prosthetic devices NAs should remember these guidelines for prosthetic devices: Handle them carefully. Follow instructions for application, removal, and care. Keep prosthesis and skin dry and clean. Apply stump sock if ordered. Observe skin for signs of breakdown. Do not try to fix a prosthesis. Do not show negative feelings about prosthesis. Follow these instructions in caring for an artificial eye: Wash hands. Provide privacy. Put on gloves

5. Explain care guidelines for prosthetic devices Guidelines for prosthetic devices (cont’d): Instructions for caring for an artificial eye (cont’d): Wash artificial eye with solution and rinse in warm water. Never clean or soak the artificial eye in rubbing alcohol – it will crack and destroy it. When the artificial eye is removed, wash eye socket with warm water or saline. Store artificial eye in water or saline in an eye cup or basin lined with a soft cloth or a piece of gauze. Mark container with resident’s name and room number. To reinsert eye, moisten it and place it far under upper eyelid. Pull down on lower eyelid and the eye should slide into place.

Assisting with passive range of motion exercises Return resident to comfortable position. Return bed to lowest position. Remove privacy measures. 18. Place call light within resident’s reach. Wash your hands. Report any changes in resident to nurse. Document procedure using facility guidelines. Note any decrease in range of motion or any pain experienced by the resident. Notify the nurse or the physical therapist if you find increased stiffness or physical resistance. Resistance may be a sign that a contracture is developing.

7. Describe the benefits of deep breathing exercises Deep breathing exercises offer these benefits: Help expand the lungs Clear lungs of mucus Prevent infection

7. Describe the benefits of deep breathing exercises REMEMBER: NAs should not assist with deep breathing exercises if they have not been trained to do so; they must ask the nurse for instructions.