1. 21 Rehabilitation and Restorative Care 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.

2. 21 Rehabilitation and Restorative Care 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

3. 21 Rehabilitation and Restorative Care 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

4. 21 Rehabilitation and Restorative Care Transparency 21-1: 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 resident’s needs. Encourage independence. Involve residents in their care.

5. 21 Rehabilitation and Restorative Care 1. Discuss rehabilitation and restorative care NAs should observe and report the following signs and symptoms: Increase or decrease in abilities Change in attitude or motivation Change in general health Signs of depression or mood changes

6. 21 Rehabilitation and Restorative Care 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

7. 21 Rehabilitation and Restorative Care Transparency 21-2: 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

8. 21 Rehabilitation and Restorative Care 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.

9. 21 Rehabilitation and Restorative Care 3. Describe assistive devices and equipment REMEMBER: Page 379 of the textbook shows different items available to assist residents adapting to new limitations.

10. 21 Rehabilitation and Restorative Care 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.

11. 21 Rehabilitation and Restorative Care 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.

12. 21 Rehabilitation and Restorative Care 4. Explain guidelines for maintaining proper body alignment REMEMBER: Chapter 10 includes specific instructions for positioning residents.

13. 21 Rehabilitation and Restorative Care 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

14. 21 Rehabilitation and Restorative Care 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.

15. 21 Rehabilitation and Restorative Care 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.

16. 21 Rehabilitation and Restorative Care 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.

17. 21 Rehabilitation and Restorative Care Transparency 21-4: Body Movements

18. 21 Rehabilitation and Restorative Care 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.

19. 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. 5.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.

20. 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).

21. 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).

22. 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).

23. 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).

24. 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).

25. 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).

26. 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).

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

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

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

30. 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).

31. 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).

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

33. 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).

34. 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).

35. 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).

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

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

38. Assisting with passive range of motion exercises 17.Return resident to comfortable position. Return bed to lowest position. Remove privacy measures. 18.Place call light within resident’s reach. 19.Wash your hands. 20.Report any changes in resident to nurse. 21.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.

39. 21 Rehabilitation and Restorative Care 7. Describe the benefits of deep breathing exercises Deep breathing exercises offer these benefits: Help expand the lungs Clear lungs of mucus Prevent infection

40. 21 Rehabilitation and Restorative Care 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.

41. 21 Rehabilitation and Restorative Care Exam Multiple Choice. Choose the correct answer. 1.Which of the following about restorative care should be observed and reported to the nurse? (A)Whether family is visiting (B)How much television the resident watches (C)Whether the resident uses the call light more than twice a day (D)Signs of depression 2.Goals of rehabilitation include (A) Curing a resident’s disease or illness (B) Focusing only on the resident’s physical needs (C) Making all care decisions for the resident (D) Helping a resident adapt to a disability

42. 21 Rehabilitation and Restorative Care Exam 3.Which of the following statements is true of a nursing assistant’s role in restorative care? (A)If a resident takes too long in doing a task by himself, the NA should do it for him. (B)The NA should combine short steps into a long list to keep the resident motivated. (C)The NA should recognize that setbacks occur and reassure the resident. (D)The NA should let the resident know when he is not making progress as quickly as the NA wants. 4.Regular activity and exercise help improve (A)Interaction between the resident and his roommate (B)The resident’s spiritual fulfillment (C)The resident’s family’s opinion of the facility (D)The quality and health of the skin

43. 21 Rehabilitation and Restorative Care Exam 5.Why should an NA stay especially close to a resident who is using a new ambulatory aid? (A)Because the resident is likely to be off-balance (B)To catch the resident if he falls (C)To adjust the aid as necessary (D)To replace the aid with a different one if the NA thinks it would improve ambulation 6.A ____ is the permanent and painful shortening of a muscle. (A)Range of motion (B)Contracture (C)Pressure ulcer (D)Footboard

44. 21 Rehabilitation and Restorative Care Exam 7.Passive range of motion (PROM) exercises are done (A)When a resident cannot move on her own (B)By the resident herself, without help (C)By the resident with some help and support from the NA (D)By a doctor or physical therapist only 8.How should an NA perform range of motion (ROM) exercises? (A) Begin at the abdomen and work upward (B) Begin at the feet and work upward (C) Begin at the head and work downward (D) Begin at the thighs and work downward

45. 21 Rehabilitation and Restorative Care Exam 9.Abduction is (A)Bending a body part backward (B)Straightening a body part (C)Turning a joint (D)Moving a body part away from the midline of the body 10.Bending a body part is called (A)Extension (B)Rotation (C)Flexion (D)Supination

46. 21 Rehabilitation and Restorative Care Exam 11.Which of the following body parts is included in passive range of motion (PROM) exercises? (A) Finger (B) Neck (C) Back (D) Buttock 12.How many times should each range of motion exercise be performed for each body part? (A) At least one time (B) At least two times (C) At least three times (D) At least four times

47. 21 Rehabilitation and Restorative Care Exam 13.Which of the following terms refers to the type of ROM exercises that a resident does on his own, without any help from the NA? (A) Active range of motion (AROM) exercises (B) Active assisted range of motion exercises (AAROM) (C) Passive range of motion (PROM) exercises (D) Planned range of motion (PLROM) exercises 14.Immobile residents should be repositioned every ____ hours. (A) Two (B) Three (C) Four (D) Five

48. 21 Rehabilitation and Restorative Care Exam 15.Which of the following is an example of a prosthesis? (A)An artificial eye to replace an eye that has been lost (B)Handrolls to keep residents’ fingers from curling too tightly (C)Special shoes to help residents with flat feet (D)An adaptive device to assist residents with dressing 16.Deep breathing exercises help (A) Clear the lungs of mucus (B) Clear the stomach of gas (C) Clear the bladder of urine (D) Clear the kidneys of toxins