1. Chapter 32 Rehabilitative and Restorative Care

2. Introduction Significance and prevalence of chronic conditions
Frailty and disability
Emphasis on saving lives
Must be balanced with an emphasis on preserving quality of life (QOL)

3. The Need for Rehabilitation
Defined broadly in geriatric care
Improvement of functional capacity to promote coping
Maximal independence
Sense of well-being
Enjoyment of a satisfying life

4. The Need for Rehabilitation (cont.)
Symptoms of frailty
Unplanned weight loss
Slow walking speed
Low grip strength
Fatigue, poor endurance
Low levels of activity
Causes of frailty
Sarcopenia

5. The Need for Rehabilitation (cont.)
High risk for
Falls
Disability
Hospitalization
Nursing home admission
Death

6. The Need for Rehabilitation (cont.)
Prevention of frailty:
Positive health practices
Effective management of health conditions
Early recognition and intervention
Nursing assessment

7. Question Is the following statement true or false?
Nursing assessment of older adults should include assessment of frailty or potential for frailty.

8. Answer
True
Rationale: Early recognition and intervention for symptoms of frailty can prevent or delay some of the frailty older adults experience. For this reason, it is especially useful to review symptoms of frailty during nursing assessments of older adults.

9. Living with Disability
Sudden disability or disease progression
Impact of disability:
Losses and limitations
Relationships, roles, and responsibilities disrupted
Disfigurement and dysfunction alter body image and self-concept
Vulnerability and frustration

10. Importance of Attitude and Coping Capacity
Severity of a disability may be less important than the coping capacity of a disabled person
Influence on reactions to disability
Previous attitudes
Personality
Lifestyle
Family response

11. Losses Accompanying Disability
Multiple losses:
Function
Role
Income
Status
Independence
Anatomic structure
May demonstrate stages of dying reactions
Fluctuates

12. Principles of Rehabilitative Nursing
Increase self-care capacity
Eliminate or minimize self-care limitations
Act for or do for when the person is unable to take action for himself or herself
Improving functional capacity can promote well- being and QOL

13. Guidelines for Rehabilitative Nursing
Know the unique capacities and limitations of the individual
Emphasize function rather than dysfunction; capabilities rather than disabilities
Provide time and flexibility
Recognize and praise accomplishments

14. Guidelines for Rehabilitative Nursing (cont.)
Do not equate physical disability with mental disability
Prevent complications
Demonstrate hope, optimism, and humor
Rehabilitation is a highly individualized process
Multidisciplinary team effort

15. Functional Assessment
Functional status, rather than diagnosis, directs rehabilitative care
Functional status varies widely among older adults
Functional status can change within an individual depending on the control of symptoms, progression of the disease, and mood

16. Functional Assessment (cont.)
Determine individuals ability to perform
Activities of daily living (ADLs)
Instrumental activities of daily living (IADLs)
Tools
Underlying causes needs to be identified and treated
Can be totally independent, partially independent, or dependent

17. Question
Which of the following assessment tools is frequently used to assess ADLs?
PULSES Index for Daily Living
Barthel Tool for Dependence
Katz Index of Independence
Geriatric Functional Tool

18. Answer C. Katz Index of Independence
Rationale: The Katz Index of independence in ADLs assesses a person’s ability to meet basic requirements such as eating, bathing, dressing, toileting, and moving.

19. Interventions to Facilitate and Improve Functioning
Facilitating proper positioning
Correct body alignment facilitates
Respiration
Circulation
Comfort
Prevents complications

20. A. Supine position. B. Prone position. C. Lateral position. D
A. Supine position. B. Prone position. C. Lateral position. D. Chair position.

21. Interventions to Facilitate and Improve Functioning (cont.)
Assisting with range of motion (ROM) Exercises
Exercise as essential component of health maintenance and promotion
Benefits
Types
ROM exercises as a nursing intervention
Cautions

22. Range-of-Motion Exercises

23. Range-of-Motion Exercises (cont.)

24. Range-of-Motion Exercises (cont.)

25. Question
Which of the following statements is an incorrect statement related to assistance with ROM exercises?
ROM should be performed at least once a day
The joint should be moved slowly and smoothly
Provide support above and below the joint being exercised
Gently force the joint past the point of resistance

26. Answer D. Gently force the joint past the point of resistance
Rationale: The joint being exercised should not be forced past the point of resistance or to the point where pain occurs.

27. Interventions to Facilitate and Improve Functioning
Assisting with mobility aids and assistive technology
Wheelchairs, canes, and walkers can increase independence and enhance functional capacity
Education necessary to prevent injury
Use mobility aids only when necessary
Selection of an aid to mobility

28. Proper Use of Mobility Aids
CANES
Depending on the disability, various canes may be recommended. Canes should be individually fitted, usually based on the distance from the greater trochanter to a distance 6 inches from the side of the person’s foot.
The cane is used on the unaffected side of the body and is advanced when the affected limb advances. For example, if the right leg is affected, the person holds the cane in his or her left hand and advances it with the advance of the right leg.
WALKERS
A variety of walkers can provide support and stability during ambulation.

29. Proper Use of Mobility Aids (cont.)
WALKERS (cont.)
Walkers are sized by the measurement from the patient’s trochanter to the floor.
The person should place his or her hands on the sides of the walker, with the elbows slightly flexed. During ambulation, the person advances the walker and then steps forward.
Appropriate use should be followed during transfer activities also. When lowering to a seat, the person should back the walker to the seat. When lifting from a seat, the person’s hands should be on the arm of the chair. The person pushes on the arms of the chair to a standing position; the person should not use the walker to pull himself or herself to a standing position.

30. Proper Use of Mobility Aids (cont.)
WHEELCHAIRS
A wheelchair should be individually fitted. The seat should be slightly larger than the person’s width to prevent pressure and friction. The person’s arm should be able to reach the wheels easily, and footrests should be adjusted to support the patient’s foot in a flat position. Removable or fold-down armrests facilitate transfer.
Wheelchairs should be checked routinely for ease of wheeling; function of brakes; and freedom from jagged edges, tears in upholstery, and broken or missing hardware.

31. Interventions to Facilitate and Improve Functioning
Teaching about bowel and bladder training
Impact of incontinence on general health and well-being
Education can improve continence
Physical and mental nursing assessment
Consistency is a crucial factor
Adherence to the schedule

32. Interventions to Facilitate and Improve Functioning (cont.)
Maintaining and promoting mental function
Mental function can decline if not exercised
Mental stimulation is a highly individualized process
Specific therapies:
Reminiscence or life review
Reality orientation

33. Using Community Resources
Disabled and their caregivers
Education, support, and assistance
Guidance in locating appropriate resources
Variety of health care professionals
Sources of information and services
Local libraries
Health departments