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    Rehabilitation Concepts For Chronic and Disabling Health Problems

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    Bammary88909
    This document discusses rehabilitation concepts for chronic and disabling health problems. It notes that complications are a leading cause of death and more people are living longer with congenital disorders. Rehabilitation is a continuous process to help patients manage their conditions and return to their best physical, mental, social, and economic functioning. It involves a team that assesses patients' conditions and develops plans to improve mobility, skin integrity, continence, and self-care abilities through techniques like transfers, gait training, and bowel/bladder retraining. The overall goal is for patients to gain independence and successfully manage their conditions.

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    Rehabilitation Concepts For Chronic and Disabling Health Problems

    Uploaded by

    Bammary88909
    87 views59 pages
    This document discusses rehabilitation concepts for chronic and disabling health problems. It notes that complications are a leading cause of death and more people are living longer with congenital disorders. Rehabilitation is a continuous process to help patients manage their conditions and return to their best physical, mental, social, and economic functioning. It involves a team that assesses patients' conditions and develops plans to improve mobility, skin integrity, continence, and self-care abilities through techniques like transfers, gait training, and bowel/bladder retraining. The overall goal is for patients to gain independence and successfully manage their conditions.

    Original Description:

    rehab chapter NUR

    Original Title

    Chapter 6 Iggy

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    This document discusses rehabilitation concepts for chronic and disabling health problems. It notes that complications are a leading cause of death and more people are living longer with congenital disorders. Rehabilitation is a continuous process to help patients manage their conditions and return to their best physical, mental, social, and economic functioning. It involves a team that assesses patients' conditions and develops plans to improve mobility, skin integrity, continence, and self-care abilities through techniques like transfers, gait training, and bowel/bladder retraining. The overall goal is for patients to gain independence and successfully manage their conditions.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    87 views59 pages

    Rehabilitation Concepts For Chronic and Disabling Health Problems

    Uploaded by

    Bammary88909
    This document discusses rehabilitation concepts for chronic and disabling health problems. It notes that complications are a leading cause of death and more people are living longer with congenital disorders. Rehabilitation is a continuous process to help patients manage their conditions and return to their best physical, mental, social, and economic functioning. It involves a team that assesses patients' conditions and develops plans to improve mobility, skin integrity, continence, and self-care abilities through techniques like transfers, gait training, and bowel/bladder retraining. The overall goal is for patients to gain independence and successfully manage their conditions.

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    You are on page 1of 59

    Rehabilitation Concepts for Chronic

    and Disabling Health Problems


    Chronic & Disabling Health Problems
    Complications account for majority of deaths
    Younger adults living longer with potentially
    disabling congenital/genetic disorders
    Accidents are leading cause of death among young
    and middle-aged adults
    Rehabilitation Definition & Goals
    Continuous process of learning to live with/manage
    chronic and disabling conditions
    Helps patients return to best possible physical,
    mental, social, vocational, economic state
    Returns function in post-traumatic situation
    Education/therapy for chronic illnesses
    characterized by change in body system, function,
    or body structure
    Rehabilitation
    Needed for chronic and disabling health problems
    Continuous process to improve:
    Physical state
    Mental state
    Social state
    Vocational state
    Economic state
    Rehabilitation Team
    Physicians
    Nurses and nursing assistants
    Physical therapists and assistants
    Occupational/vocational therapists and assistants
    Speech-language pathologists and assistants
    Rehabilitation Team (contd)
    Rehabilitation assistants/restorative aides
    Recreational or activity therapists
    Social workers
    Spiritual counselors
    Cognitive therapists or neuropsychologists
    Clinical psychologists
    History
    Information on patients present condition, current
    drug therapy/treatments
    General background data
    Usual daily schedule
    Dietary patterns
    Sleep habits
    Assessment
    History
    Cardiovascular and respiratory
    Gastrointestinal and nutritional
    Renal and urinary
    Neurologic and musculoskeletal
    Skin
    Cardiovascular & Respiratory
    Assessment
    Assess for decrease in cardiac output
    Shortness of breath
    Chest pain
    Severe weakness and fatigue
    Plan care to maximize limited energy resources
    Frequent rest periods
    Energy levels often higher in the morning
    GI & Nutritional Assessment
    Assess:
    Height and weight
    Oral intake
    Pattern of eating
    Anorexia, dysphagia, nausea/vomiting, or discomfort
    Hemoglobin/hematocrit
    Serum prealbumin
    Blood glucose levels
    Constipation most common problem
    Renal & Urinary Assessment
    Assess:
    Baseline urinary patterns
    Frequent concerns:
    Nocturia
    Urinary incontinence or retention
    Monitor for UTI:
    Urinalysis
    Culture and sensitivity
    Neurological & Musculoskeletal
    Assessment
    Assess:
    Motor function
    Paresis (weakness) or paralysis (absence of movement)
    Sensation
    Response to touch, temperature and position change
    Cognition
    Gait patterns
    Sensory changes
    Visual acuity
    ROM and endurance level
    Mobility Assistive Devices
    Standard Walker Walking with cane
    Tripod
    Position
    Tool for
    Assessing
    Mobility
    Proper Use of Gait Belt
    Must be used when
    ambulating patient who
    is assessed as contact
    guard assist (CGA) or
    stand by assist (SBA).

    When in doubt, always


    use gait belt for safety,
    both the patients and
    yours.
    Skin Assessment
    Assess skin integrity
    Skin assessment tools
    Braden Scale

    Marks, J. & Miller, J. (2006). Lookingbill and Marks Principles of Dermatology. 4th Ed. St. Louis: Saunders.
    Skin Assessment
    Actual or potential interruptions in skin integrity
    Iatrogenic wound
    Fixator wound
    Ingrown rope
    Ingrown rope
    Macerated heel
    Heel
    Ulcers
    Why we tape catheters
    Urethral Slit Caused by Tension from Foley
    Catheter
    Functional Assessment
    Ability to perform ADLs
    Instrumental activities of daily living (IADLs)
    phone use, shopping, preparing food,
    housekeeping
    Functional independence measure (FIM)
    Levels of Function (FIM Score)
    Independent another person is not required for the
    activity (NO HELPER).
    IND or I 7 Complete Independence
    Mod I 6 Modified Independence
    Dependent Patient requires another person for
    either supervision or physical assistance in order to
    perform the activity, or it is not performed (REQUIRES
    HELPER).
    Levels of Function (FIM Score), cont.
    Modified Dependence the patient expends half
    (50%) or more of the effort.
    Supv. 5 Supervision or Set-up (stand by, cueing,
    coaxing, etc.)
    Min PA 4 Minimal Contact Assistance (75%) or more
    of the effort
    Mod PA 3 Moderate Contact Assistance (between 50
    and 74%) effort
    Levels of Function (FIM Score), cont.
    Complete Dependence the patient expends less than
    half of the effort. Maximal or total assistance is
    required.
    Max PA 2 Maximal assistance expends 24 to 49%
    effort
    Total 1 Total assistance expends less than 25% effort.
    Psychosocial Assessment
    Body image and self-esteem
    Use of defense mechanisms
    Response to loss
    Presence of stress-related physical problems
    Availability of support systems
    Vocational Assessment
    Vocational counselors can help find meaningful
    training education or employment after discharge
    Job analysis
    Job modifications
    Americans with Disabilities Act, 1991 Prevents
    employer discrimination against disabled people
    Workers compensation
    Improving Physical Mobility
    Transfer techniques
    Gait training
    Wheelchair mobility skills
    ROM techniques
    Proper Use of Gait Belt
    Must be used when
    ambulating patient who
    is assessed as contact
    guard assist (CGA) or
    stand by assist (SBA).
    When in doubt, always
    use gait belt for safety,
    both the patients and
    yours.
    Transfers from Bed to Wheelchair
    Safe Patient Handling Practices

    Heavy lifting and dependent transfers by staff


    result in very high incidence of work-related
    musculoskeletal disorders (MSDs)
    Most facilities have policies and procedures
    addressing this problem.
    Maintaining Skin Integrity
    Best intervention frequent position changes with
    adequate skin care, sufficient nutritional intake
    All patients should be turned/repositioned at least
    every 1 to 2 hours
    Monitor patients in wheelchairs
    Lateral Position
    Correct
    Position To
    Relieve
    Pressure
    Shear and Friction
    Areas
    Susceptible to
    Pressure Ulcers
    Wheelchair
    Push-Up
    Maintaining Skin Integrity (contd)
    Pressure-relieving devices
    Specialty beds
    Establishing Urinary Continence
    Spastic or reflex (upper motor neuron) bladder
    incontinence with sudden gushing voids
    Flaccid or areflexic (lower motor neuron)
    bladderurinary retention and overflow
    (dribbling)
    Uninhibited bladdersimilar to reflex; neurologic
    problem affects brains bladder center in the frontal
    lobe
    Bladder Retraining
    Re-training or re-patterning voiding
    Facilitating or triggering techniques (Valsalva, Cred
    maneuvers)
    Intermittent catheterization
    Consistent scheduling of toileting routines
    Drug therapy (cholinergics, antispasmodics, skeletal
    muscle relaxants)
    Fluid intake
    Urinary Assessment

    Post-void residual assessment (PVR)


    Amount of urine remaining in bladder within 20
    minutes of voiding
    Can use Bladder Scanner to determine volume
    Constipation
    Reflex (spastic) bowel
    Upper motor neuron disease/injury
    Defecation occurs suddenly without warning
    Flaccid bowel
    Lower motor neuron disease/injury
    Defecation occurs infrequently and in small amounts
    Uninhibited bowel
    Brain injury
    Frequent defecation
    Urgency
    Hard stool
    Bowel Training
    Combination of suppository use, consistent
    toileting schedule
    Bisacodyl (Dulcolax)
    Fluids
    Fiber
    Bedside commode
    Metamucil
    Community-Based Care
    Home care management
    Teaching for self-management
    Health care resources
    Audience Response System Questions

    54
    Question 1
    Which statement confirms that the patient
    understands the rehabilitation treatment goals?

    A. With rehabilitation Ill be my old self again.


    B. This place will keep me until my nursing home
    room is ready.
    C. I will work hard to learn to use my left hand to do
    everything now.
    D. The plan is to see how well I can function with my
    new disability before I can go home.
    Question 2
    The nurse is conducting an interview with a patient who
    is experiencing a chronic illness. The patient is reluctant
    to discuss his resulting disability. What should the nurse
    do?

    A. Interview the patients family to obtain needed information.


    B. Observe the patient closely for evidence of suicidal thoughts.
    C. Assess the patients self-esteem and body image through his
    description of self-care.
    D. Assume that the patient is experiencing a symptom of
    depression.
    Question 3
    Which nursing intervention is appropriate to assist a
    patient to manage overactive bladder incontinence?

    A. Establish a toileting routine.


    B. Provide a bedside commode.
    C. Encourage use of incontinence pads.
    D. Instruct unlicensed assistive personnel to check on
    the patient every 2 hours.
    Question 4
    The nurse is assessing a patient who has been newly
    admitted to a rehabilitation unit after recovering from a
    stroke. The patient reports, when asked, that he usually has
    a bowel movement every third day. What should the nurse
    do next?

    A. The nurse concludes that the patient is constipated.


    B. The nurse asks if this pattern is normal for him.
    C. The nurse offers him a laxative.
    D. The nurse assesses the patients bowel sounds.
    Question 5
    The nurse is assisting a patient with ambulation. The patient has
    general weakness but is able to walk. Which measure will best
    prevent potential falls due to orthostatic hypotension?

    A. Administer the patients antihypertensive medications 1 hour before


    ambulation.
    B. Hold the patients antihypertensive medication until after the
    ambulation session.
    C. Have the patient move from a lying to standing position slowly.
    D. Teach the patient to first sit on the side of the bed for a few minutes
    before standing slowly.

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