Chapter 21 Rehabilitation and Restorative Care 1 Discuss

Chapter 21 Rehabilitation and Restorative Care 1. Discuss rehabilitation and restorative care Define rehabilitation and restorative services in terms of moving the resident from: • Illness to health • Disability to ability • Dependence to independence

Chapter 21 Rehabilitation and Restorative Care 1. Discuss rehabilitation and restorative care The goals of rehabilitation are: • Help resident regain function or recover from illness • Develop and promote a resident’s independence • Allow resident to feel in control of his or her life • Help resident accept or adapt to limitations of a disability

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.

Chapter 21 Rehabilitation and Restorative Care 1. Discuss rehabilitation and restorative care The following are signs and symptoms to observe and report: • Increase or decrease in abilities • Change in attitude or motivation • Change in general health • Signs of depression or mood changes

Chapter 21 Rehabilitation and Restorative Care 2. Describe the importance of promoting independence and list ways exercise improves health Define the term • Ambulation

Chapter 21 Rehabilitation and Restorative Care 2. Describe the importance of promoting independence and list ways exercise improves health The losses that may result from a lack of mobility are: • Independence • Self-esteem • Ability to move without help • Muscle strength • Less circulation of blood

21 Rehabilitation and Restorative Care Transparency 21 -2 Regular Ambulation and Exercise Regularambulation and exercise help improve: • Health of skin • Circulation • Strength • Sleep and relaxation • Appetite • Elimination • Blood flow • Oxygen level

Chapter 21 Rehabilitation and Restorative Care 3. Describe assistive devices and equipment Define the following terms: • Straight cane • Quad cane • Walker • Crutches

Chapter 21 Rehabilitation and Restorative Care 3. Describe assistive devices and equipment Guidelines for cane or walker use are: • Walker or cane must be in good condition. • Check wheels on walker for safety. • Resident must be wearing non-skid shoes. • Have resident use cane on his strong side. • Have resident use both hands on the walker. • Stay near the person on the weaker side. • Do not hang purses or clothing on the walker. • Notify nurse if height of cane or walker does not fit resident.

Assisting a resident to ambulate Equipment: transfer belt, non -skid shoes for the resident 1. Wash your hands. 2. Identify yourself by name. Identify the resident by name. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for resident’s privacy with curtain, screen, or door.

Assisting a resident to ambulate 5. Before ambulating, put on and properly fasten non-skid footwear for resident. 6. Adjust bed to a safe level, usually waist high. Lock bed wheels. 7. Stand in front of and face the resident. 8. Brace the resident’s lower extremities. Bend your knees. Place one foot between the resident’s knees. If the resident has a weak knee, brace it against your knee.

Assisting a resident to ambulate 9. With transfer (gait) belt: Place belt around resident’s waist. Grasp the belt while helping the resident to stand. Without transfer belt: Place arms around resident’s torso under resident’s armpits. Help resident to stand.

Assisting a resident to ambulate 10. With transfer belt: Walk slightly behind and to one side of resident for the full distance, while holding on to the transfer belt (Fig. 21 -5). Without transfer belt: Walk slightly behind and to one side of resident for the full distance. Support resident’s back with your arm. Fig. 21 -5.

Assisting a resident to ambulate 1. After ambulation, remove transfer belt if used. Help resident to a position of comfort and safety. 2. Return bed to appropriate position. Remove privacy measures. 13. Before leaving, place call light within resident’s reach. 14. Wash your hands.

Assisting a resident to ambulate 1. Report any changes in the resident to the nurse. 2. Document procedure using facility guidelines.

Assisting with ambulation for a resident using a cane, walker, or crutches Equipment: transfer belt, non -skid shoes for resident, cane, walker, or crutches 1. Wash your hands. 2. Identify yourself by name. Identify the resident by name. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

Assisting with ambulation for a resident using a cane, walker, or crutches 1. Provide for resident’s privacy with curtain, screen, or door. 2. Before ambulating, put on and properly fasten non-skid footwear on the resident. 3. Adjust bed to a level, usually waist high. Lock bed wheels. 4. Stand in front of and face the resident.

Assisting with ambulation for a resident using a cane, walker, or crutches 1. Brace resident’s lower extremities. Bend your knees. If resident has a weak knee, brace it against your knee. 2. Place transfer belt around resident’s waist. Grasp the belt while helping resident to stand.

Assisting with ambulation for a resident using a cane, walker, or crutches 10. Help as needed with ambulation. a. Cane. Resident places cane about 12 inches in front of his stronger leg. He brings weaker leg even with cane. He then brings stronger leg forward slightly ahead of cane. Repeat (Fig. 21 -6). Weak Side Fig. 21 -6.

Assisting with ambulation for a resident using a cane, walker, or crutches b. Walker. Resident picks up or rolls the walker. He places it about 12 inches in front of him. All four feet or wheels of the walker should be on the ground before resident steps forward to the walker. The walker should not be moved again until the resident has moved both feet forward and is steady (Fig. 21 -7). The resident should never put his feet ahead of the walker. Fig. 21 -7.

Assisting with ambulation for a resident using a cane, walker, or crutches c. Crutches. Resident should be fitted for crutches and taught to use them correctly by a physical therapist or a nurse. The resident may use the crutches in several different ways. It depends on what his weakness is. No matter how they are used, weight should be on the resident’s hands and arms. Weight should not be on the underarm area (Fig. 21 -8). Fig. 21 -8.

Assisting with ambulation for a resident using a cane, walker, or crutches 11. Walk slightly behind and to one side of resident. Hold the transfer belt if one is used. 12. Watch for obstacles in the resident’s path. Ask the resident to look ahead, not down at his feet. 13. Encourage the resident to rest if he is tired. When a resident is tired, it increases the risk of a fall. Let resident set the pace. Discuss how far he plans to go based on the care plan.

Assisting with ambulation for a resident using a cane, walker, or crutches 1. After ambulation, remove transfer belt. Help resident to a position of comfort and safety. 2. Return bed to appropriate position. Remove privacy measures. 3. Before leaving, place call light within resident’s reach. 4. Wash your hands.

Assisting with ambulation for a resident using a cane, walker, or crutches 1. Report any changes in the resident to the nurse. 2. Document procedure using facility guidelines.

Chapter 21 Rehabilitation and Restorative Care 4. Explain guidelines for maintaining proper body alignment Define the following term: • Contracture

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 frequently.

Chapter 21 Rehabilitation and Restorative Care 5. Describe how to assist with range of motion exercises Define the following terms: • Range of motion (ROM) • Passive range of motion (PROM) • Active range of motion (AROM) • Active assisted range of motion (AAROM)

Chapter 21 Rehabilitation and Restorative Care 5. Describe how to assist with range of motion exercises Discuss the differences in these types of ROM: • PROM: NA does all the work and resident does none. • AROM: NA encourages, but resident does all the work. • AAROM: NA assists and supports the resident in doing the work.

Chapter 21 Rehabilitation and Restorative Care 5. Describe how to assist with range of motion exercises Define the following terms: • Abduction • Adduction • Dorsiflexion • Rotation • Extension • Flexion • Pronation • Supination

21 Rehabilitation and Restorative Care Transparency 21 -4 Body Movements

Assisting with passive range of motion exercises 1. Wash your hands. 2. Identify yourself by name. Identify the resident by name. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door.

Assisting with passive range of motion exercises 1. Adjust bed to a safe level, usually waist high. Lock the bed wheels. 2. Position the resident lying supine—flat on his or her back—on the bed. Position body in good alignment.

Assisting with passive range of motion exercises 7. Shoulder. Support the resident’s arm at the elbow and wrist during ROM for the shoulder. Place one hand above the elbow. Place the other hand around the wrist. Move the arm up so that the upper arm is aligned with the side of the head (forward flexion) (Fig. 21 -12). Fig. 21 -12.

Assisting with passive range of motion exercises 7. (con't. ) Move the arm downward to the side (extension) (Fig. 21 -13). Return arm to side. Fig. 21 -13.

Assisting with passive range of motion exercises 7. (con't. ) Bring the arm sideways away from the body to above the head (abduction) and back down to midline (adduction) (Fig. 21 -14). Fig. 21 -14.

Assisting with passive range of motion exercises 7. (con't. ) Bend the elbow. Position it at the same level as the shoulder. Move the forearm down toward the midline of the body (internal rotation). Now move the forearm toward the head (external rotation) (Fig. 21 -15). Fig. 21 -15.

Assisting with passive range of motion exercises 8. Elbow. Hold the resident’s wrist with one hand. Hold the elbow with the other hand. Bend the elbow so that the hand touches the shoulder on that same side (flexion). Straighten arm (extension) (Fig. 21 -16). Fig. 21 -16.

Assisting with passive range of motion exercises 8. (con't. ) Exercise the forearm by moving it so the palm is facing downward (pronation) and then upward (supination) (Fig. 21 -17). Fig. 21 -17.

Assisting with passive range of motion exercises 9. Wrist. Hold the wrist with one hand. Use the fingers of the other hand to help the joint through the motions. Bend the hand down (flexion). Bend the hand backwards (extension) (Fig. 21 -18). Fig. 21 -18.

Assisting with passive range of motion exercises 9. (con't. ) Turn the hand in the direction of the thumb (radial flexion). Then turn it in the direction of the little finger (ulnar flexion) (Fig. 21 -19). Fig. 21 -19.

Assisting with passive range of motion exercises 10. Thumb. Move thumb away from the index finger (abduction). Move thumb back next to the index finger (adduction) (Fig. 21 -20). Fig. 21 -20.

Assisting with passive range of motion exercises 10. (con't. ) Touch each fingertip with the thumb (opposition) (Fig. 21 -21). Fig. 21 -21.

Assisting with passive range of motion exercises 10. (con't. ) Bend thumb into the palm (flexion). Bend it out to the side (extension) (Fig. 21 -22). Fig. 21 -22.

Assisting with passive range of motion exercises 11. Fingers. Make the hand into a fist (flexion). Gently straighten out the fist (extension) (Fig. 21 -23). Fig. 21 -23.

Assisting with passive range of motion exercises 11. (con't. ) Spread the fingers and the thumb far apart from each other (abduction). Bring the fingers back next to each other (adduction) (Fig. 21 -24). Fig. 21 -24.

Assisting with passive range of motion exercises 12. Hip. Support the leg by placing one hand under the knee and one under the ankle. Straighten the leg. Raise it gently upward. Move the leg away from the other leg (abduction). Move the leg toward the other leg (adduction) (Fig. 21 -25). Fig. 21 -25.

Assisting with passive range of motion exercises 12. (con't. ) Gently turn the leg inward (internal rotation). Turn the leg outward (external rotation) (Fig. 21 -26). Fig. 21 -26.

Assisting with passive range of motion exercises 13. Knees. Bend the leg at the knee (flexion). Straighten the leg (extension) (Fig. 21 -27). Fig. 21 -27.

Assisting with passive range of motion exercises 14. Ankles. Bend the foot up toward the leg (dorsiflexion). Turn the foot down away from the leg (plantar flexion) (Fig. 21 -28). Fig. 21 -28.

Assisting with passive range of motion exercises 14. (con't. ) Turn inside of the foot inward toward the body (supination). Bend the sole of the foot away from the body (pronation) (Fig. 21 -29). Fig. 21 -29.

Assisting with passive range of motion exercises 15. Toes. Curl and straighten the toes (flexion and extension) (Fig. 21 -30). Fig. 21 -30.

Assisting with passive range of motion exercises (con't. ) Gently spread the toes apart (abduction) (Fig. 21 -31). 1. While supporting the limbs, move all joints gently, slowly, and smoothly through the range of motion to the point of resistance. Stop if any pain occurs. 2. Return bed to appropriate position. Remove privacy measures. Fig. 21 -31.

Assisting with passive range of motion exercises 1. Before leaving, place call light within resident’s reach. 2. Wash your hands. 3. Report any changes in resident to nurse. 4. Document procedure using facility guidelines.

Chapter 21 Rehabilitation and Restorative Care 6. Describe the benefits of deep breathing exercises Define the following term: • Incentive spirometer Deep breathing exercises are especially useful for expanding the lungs, clearing them of mucus, and preventing infections.