1. Chapter 9 Care of the Rehabilitation Patient

2. Goals for Rehabilitation
Patient’s physical, emotional, and social functions will be restored and maintained.

3. Specialized Rehabilitation Centers
There are specialized rehabilitation centers for:
Brain and spinal cord injuries
Stroke rehabilitation
Burn injuries
Acute mental illness
Drug or alcohol addiction

4. Members of the Rehabilitation Team
Rehabilitation physician (physiatrist)
Rehabilitation nurse
Occupational therapist
Physical therapist
Speech therapist
Rehabilitation aide
Orthotist
Prosthetist
Neuropsychologist

5. FACTORS AFFECTING REHAB EFFORT
ATTITUDE AND COPING SKILLS
REQUIRES EFFORT
IS OFTEN PAINFUL
SUCCESS DEPENDENT OF COPING SKILLS
RESPONSE OF FAMILY AND CAREGIVER TO DISABILITY
ALLOWING THE PERSON TO DO THEIR OWN CARE

6. FACTORS AFFECTING REHAB EFFORT
OVERALL HEALTH STATUS
MAY BE CHRONIC HEALTH PROBLEMS PRESENT
EX. DIABETES, OSTEOPOROSIS, ARTHRITIS
DELAY THE REHAB EFFORT AND MAKE COMPLETE RESTORATION IMPOSSIBLE
AGE
AGE RELATED CHANGES MAKE IT MORE DIFFICULT FOR THE ELDERLY

7. Spinal Cord Injury

8. SPINAL CORD INJURIES DISABLITY DEPENDS ON THE SEVERITY OF INJURY
LOCATION OF THE INJURY
CERVICAL (C5, C6, C7)= QUADRIPLEGIA
THORACIC (T12, L1)=PARAPLEGIA
LUMBAR =PARAPLEGIA
SACRAL
RARELY RESULTS IN PARALYSIS

9. Traumatic Brain Injury
A concussion is a temporary change in mental status caused by head trauma.
A skull fracture occurs when the bones of the skull break.
A cerebral contusion is a bruise on the brain that occurs when the brain tissue hits the skull.
A hematoma is a pool of blood.
An epidural hematoma occurs when blood collects between the skull and the dura mater.

10. Rancho Los Amigos Scale

11. Question
Bleeding and swelling of the brain tissue after trauma results in an increase in which of the following?
TBI
Intracranial pressure
Concussion
Osteoporosis

12. Answer B. Intracranial pressure
The ICP is the pressure in the space between the skull and the brain. (Intra means “within” and cranial means “the skull.”) An increase in the ICP can crush the brain tissue, reduce blood flow to the brain tissue, or cause structures in the brain to shift position. If the ICP remains too high for too long, severe disability or death can result.

13. Observations to Report to the Nurse Immediately
The person complains of headache or increased head pain
The person complains of dizziness
The person is restless or agitated
There are changes in the person’s respirations
The person’s pupils are unequal in size
The person complains of sudden weakness or loss of feeling in any body part
The person’s speech is slurred
There is drainage from the person’s ears or nose

14. STROKE (CVA) TWO TYPES ISCHEMIC
BLOCKAGE OF AN ARTERY PREVENTING BLOOD FLOW TO THE BRAIN
LACK OF OXYGEN CAUSES TISSUE TO DIE
HEMORRHAGIC
ARTERY IN THE BRAIN BURSTS
BLEEDING INTO SURROUNDING TISSUE CAUSING DAMAGE

15. ACUTE AND SUBACUTE PHASES
MONITOR LOC
RESPIRATORY SUPPORT
MONITOR VITALS
OBSERVATION FOR INTERNAL BLEEDING
AIRWAY SUCTIONING

16. CHRONIC PHASE OF REHAB SELF CARE SKILLS COGNITIVE SKILLS SPEECH SKILLS
SWALLOWING

17. Observations to Report to the Nurse Immediately (cont)
There is a change in the person’s LOC
There is a change in the person’s vital signs, especially the blood pressure or pulse
The person shows signs or symptoms of a stroke that were not present before (for example, drooling; drooping of the eyelid; slurred speech; paralysis, tingling, or numbness of an arm, leg, or one side of the face)
The person complains of the sudden onset of a severe headache

18. CARDIOVASCULAR DISORDERS
MOST COMMON
CORONARY ARTERY DISEASE
NARROWING OF CORONARY ARTERIES DECREASING BLOOD FLOW TO THE HEART
MYOCARDIAL INFARCTION
ONE OR MORE OF THE CORONARY ARTERIES BECOME BLOCKED
PART OF THE HEART DIE FROM LACK OF OXYGEN

19. ACUTE AND SUBACUTE PHASES
MEDICATIONS TO STOP OR CONTROL CARDIAC SYMPTOMS
MONITOR OXYGEN LEVELS
BED REST
CONTINUOUS ECG

20. CHRONIC PHASE REGAIN STRENGTH
ADOPT HABITS TO HELP CARDIO SYSTEM BECOME HEALTHIER
EXERCISE
PROPER DIET
SMOKING CESSATION
MEDICATIONS

21. Observations to Report to the Nurse Immediately (cont)
complains of chest pain, “crushing,” or “squeezing”
pain that travels down either arm or up the neck into the jaw
sweaty, skin is cool and clammy, or face appears pale or gray
difficulty breathing
nausea, vomiting, or hiccups
faints or complains of feeling very weak or tired
disorientated, confused, or restless
changes to vital signs (either an increase or a decrease)
changes in the appearance of the ECG on the monitor

22. MUSCULOSKELETAL DISORDERS
HIP FRACTURE
SOME RESULT IN DEATH IN ELDERLY
CAN CAUSE IMMOBLITY
COMPLICATIONS OF IMMOBILITY
PNEUMONIA
BLOOD CLOTS

23. MUSCULOSKELETAL DISORDERS
ACUTE AND SUB-ACUTE PHASES
STABILIZE THE PATIENT
PAIN MANAGEMENT
PREVENT MOVEMENT THAT CAUSES MORE DAMAGE TO HIP
PREPARE FOR SURGERY

24. Surgical Repair of Hip Fracture

25. CHRONIC PHASE BUILD MUSCLE INCREASE STRENGTH BALANCE EXCERCISES
GAIT TRAINING

26. AMPUTATION NECESSARY AS A RESULT OF TRAUMA OR DISEASE BONE CANCER
DIABETES
ACCIDENT
CIRCULATORY DISORDER

27. ACUTE AND SUB ACUTE PHASE
PREVENTION OF HEMMORHAGING
OBSERVE FOR SIGNS OF INFECTION
STUMP CARE TO ALLOW FOR PROSTHETIC DEVICE
OFTEN WRAPPED WITH ELASTIC BANDAGES TO SHAPE OR SHRINK

28. CHRONIC PHASE ENSURE PROPER HEALING OF THE STUMP
ADJUSTMENTS TO LOSS OF LIMB
PREVENTION OF ANOTHER LOSS
JOB TRAINING
PROSTHETIC FITTINGS

29. Prosthetic Device

30. BURNS SEVERITY IS DETERMINED BY DEPTH SURFACE AREA INVOLVED AGE
LOCATION
OTHER INJURIES OR CONDITIONS

31. Burn Depth

32. Burn Surface Area

33. ACUTE AND SUBACUTE PHASE
INTUBATION AND VENTILATOR MAY BE NECESSARY IF THE LUNGS INHALED HOT AIR
UNRINARY CATHETER CARE
INFECTION PREVENTION
ROM TO PREVENT CONTRACTURES
PAIN MANAGEMENT
FLUID BALANCE
MONITOR I AND O

34. CHRONIC PHASE MAY BE OVER THE COURSE OF MANY YEARS
SPLINTS AND OTHER SUPPORTIVE DEVICES MAY BE USED
SURGICAL PROCEDURES
SKIN GRAFTS
DEBRIDEMENT
PSYCHOLOGICAL CARE

35. Question Tell whether the following statement is true or false.
Geriatric patients receive no benefit from rehabilitation.
True
False

36. Answer
B. False
Like all rehabilitation programs, geriatric rehabilitation programs focus on helping the person regain or maintain function and independence. Many elderly people entering rehabilitation programs were independent before rehabilitation and will return to being independent after rehabilitation. Others are entering rehabilitation with a certain degree of disability that is not expected to be resolved by rehabilitation. When this is the case, the rehabilitation effort focuses on helping the person to regain strength and prevent the loss of additional function.