Rehabilitation & Restorative Care Nursing Assistant Rehabilitation & Restorative Care

Disability A physical and/or mental condition which interferes with meeting basic human needs Effects related to Maslow’s hierarchy Feelings of loss Damage to self-esteem Loss of self-esteem

Restorative/Rehab Care Helps disabled individuals return to their highest possible level of physical & psychological functioning – promotes independence Helps resident adjust to the disability Emphasizes abilities – learn new skills, retain old skills Prevents complications – rehab begins when resident FIRST enters the facility

Physical goals of Restorative Care – promoting independence Maintain present level of function Improve or restore physical function Encourage independence & performance of self-care activities

Psychosocial goals of restorative care – promoting independence Adjust to psychosocial effects of disability Recognize small & simple accomplishments May need social service referrals Needs job skill development

Rehabilitation team Purpose – Discuss & evaluate level of functioning Establish resident’s care plan & goals for rehab Evaluate progress & adjust plan of care to achieve resident’s goals with a greater degree of resident independence Restore resident to his/her optimal level of functioning

Members of Rehab Team Resident & family members Nursing staff – licensed & CNA Physical, Occupational, & Speech Therapists Physician Activity leader Social worker Clergy Dietician

CNA responsibilities Participate in resident care planning conferences Observe & report resident’s responses to care Follow the resident’s care plan Encourage resident to follow the rehab plan Observe & report early signs & symptoms of complications

Responsibilities in promoting resident self care Protect resident rights Ensure safety & privacy Communicate therapeutically – ask opinions & let them be in control Adhere to legal & ethical principles Follow instructions of supervisor & plan of care Report significant changes in resident condition

Responsibilities (Cont) Practice appropriate & effective nursing care Implement rehab measures as ordered – ROM, training plan for self-care Encourage independence – praise even small accomplishments Provide emotional support & reassurance Concentrate on resident’s abilities Use equipment & devices knowledgeably Protect resident from abuse

Activities of Daily Living Daily hygiene, grooming, eating, & self-care activities necessary for normal functioning in society Grooming & dressing Feeding & hygiene Elimination – bowel & bladder Mobility & ambulation Self-turning & positioning

Comfort devices Footboard – prevents plantar flexion Trochanter rolls – prevents external rotation & pressure sores Hard splint – prevents contractures Bed cradle – prevents foot drop decubiti Trapeze – strengthens muscles & facilitates movement Sheepskin – avoids friction, skin breakdown

Comfort devices (cont) Heel or elbow protectors – protect against friction & skin breakdown Flotation pads, egg crate mattresses, water bed, alternating pressure mattress, Clinitron bed – protects pressure points, prevents skin breakdown Pillows & boosters provide support, positioning, & prevent contractures

Adaptive/self help devices Cuffed or swivel-handled utensils, plate guards, or holders – eating utensils Long-handled combs/brushes, button hooks, sock puller, specially designed clothing – hygiene & grooming aids Reachers, telephone holder, communication boards – promote independence Artificial limbs – application, care, removal Casts & splints – immobilization, alignment, & support, cast care

Complications of inactivity Respiratory (stasis pneumonia) or atelectasis Circulatory – thrombophlebitis, pulmonary embolism Musculo-skeletal – contractures (permanent), osteoporosis (demineralization due to lack of weight bearing), muscle atrophy

Complications (cont) Integumentary – pressure sores Gastro-intestinal – constipation & decreased appetite Genito-urinary – kidney stones, UTI, problems Psychosocial – loneliness, depression

Causes of complications Bed rest Prolonged illness Inactivity due to injury Surgery

To prevent complications Turning & repositioning TCDB – turn, cough, deep breathe Body alignment Range of motion Supportive devices Skin care Encouraging resident independence Toileting Bowel & bladder training

To prevent complications Elastic stockings – TEDS Ambulation is best! Maintains muscles, bones, & moves joints Reduces pressure on the skin Increases circulation Increases respiratory & heart function Improves bowel function & promotes bladder emptying Promotes independence & self-esteem If resident cannot walk, at least stand them or transfer them to a chair

Range of Motion The movement of joints through their normal range of movement to the point of resistance or discomfort Purpose Maintain muscle strength Stimulate circulation Maintain body alignment & make positioning easier Prevent thrombophlebitis Prevent contractures

Range of Motion ROM frequency At least THREE times each day with at least three (preferable 5 & for your competency exam 5) repetitions of each movement of the joint As indicated in the care plan

Range of Motion Active ROM Passive ROM Resident moves own joints through their normal ROM Is the best Maintains muscle Passive ROM CNA moves the resident’s joints through their normal ROM to the point of resistance or discomfort Still gets muscle atrophy

Range of Motion Active assistive ROM CNA HELPS the resident move the joints through their normal ROM to the point of resistance or discomfort or the resident uses a resistive device

General rules Exercise joint correctly Avoid unnecessary exposure of resident Use good body mechanics Fully support each extremity Move joint slowly, smoothly, & gently Do not force joint to move past the point of resistance or discomfort Do not case resident to have pain Report c/o pain to the licensed nurse

Passive ROM Upper Body Shoulder Hold wrist & elbow Flexion & Extension Abduction & Adduction Horizontal abduction & Adduction Rotation (stop sign)

Passive ROM – upper body Elbow Hold wrist & elbow Flexion & extension Rotation (turn toward face & feet) Wrist Hold wrist & fingers Flexion, extension, hyperextension Adduction & abduction Ulnar & radial deviation (toes to nose)

Passive ROM – upper body Fingers & thumb Hold hand Fist to flex fingers, extend by straightening Abduction & adduction of each finger & thumb Thumb to palm & side of fingers (abduction & adduction) Thumb opposition

Passive ROM – lower body Hip & Knee Hold knee & ankle Flex knee & hip, straighten knee to extend & lower leg to bed Abduction & adduction Rotation inward & outward

Passive ROM – lower body Ankle Hold ankle & foot Flexion & extension Abduction & adduction – turn foot inward & outward Toes Hand under foot & on top of toes Abduction & adduction

Promoting mobility & ambulation Check this to determine ability to be independent Physical strength & ability Available special training Assistive devices Financial resources Cognitive ability Motivation

Procedures to promote mobility Transfer techniques Gait training Training in self-transfer techniques Use of gait belt for ambulation Check to see if the resident can sit unassisted & steadily or can stand a few seconds alone

Assistive devices Cane Walker Wheelchair Transfer board Braces, splints, & prosthesis Seeing eye dog Braille Modifications to accommodate wheelchair access Disabled parking

Relationship between self esteem & family involvement in care Basic needs met if resident & family are involved in participating in the plan Love/belonging/affiliation needs Self esteem need Self-actualization

Therapeutic communication part of plan of care Promote interaction between resident, family, & rehab team Treat resident & family with respect & dignity Be supportive of resident & family & use praise as appropriate to reinforce progress Encourage independence Use a positive approach to the restorative plan