Chapter 37 Rehabilitative Care Functional Status Among the

Chapter 37 Rehabilitative Care

Functional Status Among the Elderly • Active in the community. • Perform activities of daily living (ADLs) with assistance. • Requires total care.

Factors Affecting Functional Status • Control of symptoms • Progression of the disease • Mood

Considerations for Frailty • Unplanned weight loss (10+ lbs in the past year) • Slow walking speed • Low grip strength • Fatigue, poor endurance • Low levels of activity

Risks for Frail Elders • Falls • Disability • Hospitalization • Nursing home placement • Death

Health Challenges for the Elderly • Disability – Unable to perform activity in normal manner. • Impairment – Psychological, physiologic, or anatomic loss or abnormality. • Handicap – Limitation in ability to fulfill role.

Factors Influencing Reactions to a Disability • Previous attitudes • Personality • Experiences • Lifestyle

Principles Guiding Gerontological Nursing Care with Rehabilitation • 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.

Points to Consider in Rehabilitative Nursing • Know individual unique capacities and limitations. • Emphasize function rather than dysfunction. • Provide time and flexibility. • Recognize and praise accomplishments. • Do not equate physical disability with mental disability.

Points to Consider in Rehabilitative Nursing (cont. ) • Prevent complications. • Demonstrate hope, optimism, and a sense of humor. • Recognize individuality of rehabilitation process.

Assessment of ADL and IADL • ADL: Skills the patient possesses to meet basic requirements – Eating, washing, dressing, toileting, and moving • IADL: Skills beyond the basics that enable the individual to function independently in the community. – Preparing meals, shopping, managing finances, etc.

Ability to Perform ADLs and IADLs • Persons can be: – Totally independent – Partially independent – Dependent

Benefits of Correct Body Alignment • Facilitates optimal respiration • Improves circulation • Promotes comfort • Prevents complications – Contractures and pressure ulcers

Degrees of Exercise • Active: independently by patients. • Active Assistive: with assistance to the patient. • Passive: with no active involvement of the patient.

Signs Warranting Stopping Exercise • A resting heart rate greater than or equal to 100 beats/min • An exercise heart rate greater than or equal to 35% above the resting heart rate • Increase or decrease in systolic blood pressure by 20 mm Hg • Angina • Dyspnea; pallor; cyanosis

Signs Warranting Stopping Exercise (cont. ) • Dizziness; poor coordination • Diaphoresis • Acute confusion; restlessness

Selecting a Mobility Aid • Canes – Used to provide a wider base of support and should not be used for bearing weight. • Walkers – Offer a broader base of support than canes and can be used for weight-bearing. • Wheelchairs – Provide mobility for persons unable to ambulate because of various disabilities.

Problems That Can Result from Incontinence • Falls • Social isolation • Infections • Depression

Methods of Mental Stimulation • Reminiscence • Life review • Reality orientation – Used for persons with cognitive impairment – Consistency is important to promoting orientation.

Community Resources • Professionals – Social workers – Physical therapists – Occupational therapists – Speech and hearing therapists – Rehabilitation and vocational counselors

Community Resources (cont. ) • Sources of information and services – Local libraries – Health departments – Information and referral services

Source • Eliopoulos, C. (2005). Gerontological Nursing, (6 th ed. ). Philadelphia: Lippincott, Williams & Wilkins (ISBN 0 -7817 -4428 -8).