1. Rehabilitation and Restorative Care NCOA Chapter 18 (4 th ed) Pati L.H. Cox, RN, BSN, M.Ed. Rolla Technical Center

2. Introduction The goal of nursing care is to assist the O.A. back to health and allow them to return home. OBRA of 1990 regulates care with MDS and “emphasizes restorative care as a major priority of care” Anderson, pg. 304 Concepts The Nurse’s Role Goals Developing Goals Implementation Assessment of Goals Clinical Implications

3. Rehabilitative vs. Restorative RehabilitativeRestorative Goal – To assist people to obtain highest level of independent function (functional) XX Team or holistic approachXX Assists with living environment, resources available X Implemented when rehab goal met or no further improvement noted. X Short term intensive strengthening trainingX Continues with care over long period of timeX Ambulation, personal care, feeding, toiletingX

4. Focus Maximize the abilities and functions of the older adult to ensure the highest level of independence and quality of life

5. The Nurse’s Role Bedside Caregiver Educator Counselor Advocate Case Manager Researcher

6. Goals Rehabilitative & Restorative Provide direction Behavioral outcome Solution to problem Realistic Focus – highest level of independence within limits of injury Must look at –Physical changes –Psychological changes –Functional changes

7. Changes affecting Restorative Care

8. Physical Changes These changes must be considered: –Musculoskeletal –Cardiovascular –Respiratory –Renal and Digestive Tract –Consciousness and mental status –Perceptual

9. Functional Changes Result from impact of social & environmental situations –Inability to negotiate stairs @ home –Functional problems from chronic diseases –Physical changes resulting in limited ROM, strength, endurance –Inability to consume appropriate diet –Inability to perform ADL’s

10. Psychological Changes Well-being = motivation Self Esteem & positive self image = critical factors in developing motivation for restorative program

11. Developing Goals Assessment LPN works with RN to analyze data Prioritize rehabilitative & restorative goals

12. Implementation Maintenance of Joint Function Active Exercise Bladder Continence Appropriate Sexual Expression Psychosocial and Spiritual Well- Being Restorative Goals specific for O.A= –Improvement of Function –Delay of Deterioration –Accommodation of dysfunction –Comfort in the dying process

13. Clinical Implications Rehabilitative & Restorative Care Walking Program –Excellent Foot Care & well fitting shoes –Crutch walking –For those without assistive devices Continence Training –Should not use foley catheter for effective bladder management –Regular schedules imp. Feeding and Self-Feeding Program Self Promoting Behaviors & ADL’s