Chapter 11 Principles and Practices of Rehabilitation

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Rehabilitation
Dynamic, health-oriented process that helps ill people or people with disabilities achieve greatest level of physical, mental, spiritual, social, economic functioning Disabilities may be physical, mental, emotional Helps person achieve acceptable quality of life with dignity, self-respect, independence Integral part of nursing Every major illness or injury carries for disability or impairment.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question
Tell whether the following statement is true or false: Rehabilitation is a dynamic, health-oriented process that helps people with acute or chronic disorders or people with physical, mental, or emotional disabilities to achieve the greatest possible level of physical, mental, spiritual, social, and economic functioning.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
True. Rationale: Rehabilitation is a dynamic, health-oriented process that helps people with acute or chronic disorders or people with physical, mental, or emotional disabilities to achieve the greatest possible level of physical, mental, spiritual, social, and economic functioning.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Rehabilitation Team

Collaborative approach Patient is member of team Family

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The Rehabilitation Team (contd)

Other members: Physicians Occupational therapists Physical therapists Social workers Others

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Question
Who is the key member of the rehabilitation team? A.Nurse B.Occupational therapist C.Patient D.Physician

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
C. Patient Rationale: The patient is the focus of the teams effort and the one who determines the final outcomes of the process. The nurse develops the plan of care designed to facilitate rehabilitation. Other team members, such as the physician and occupational therapist, make a unique contribution to the team effort.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Patient Emotional Reactions to Disability

Patient, family experience emotional reactions Losses precipitate grief responses, go through stages of grief process

Reactions may include disorganization and confusion, denial, depression, anger, regret, acceptance
Reactions may subside, recur Coping abilities, methods vary greatly

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Functional Capacity Assessment

Activities of Daily Living: self-care activities including bathing, grooming, dressing, eating, toileting, bowel and bladder care Instrumental Activities of Daily Living: complex aspects of independence including meal preparation, grocery shopping, household management, finances, transportation

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Assessment of Functional Ability

Functional Independence Measure (FIM) PULSES profile Barthel Index Patient Evaluation Conference System (PECS)

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Nursing Diagnosis
Self-care deficit: bathing/hygiene, dressing/grooming, feeding, toileting

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Goals
Individualize goals to patient Self-care Self-care with assistance Appropriate use of adaptive devices Patient satisfaction with level of independence

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Interventions
Fostering self-care abilities Recommending assistive, adaptive devices Helping patients accept limitations

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Outcomes
Demonstrates independence in self-care in bathing/hygiene or with assistance, using adaptive devices as appropriate Demonstrates independence in self-care in dressing/grooming or with assistance, using adaptive devices as appropriate Demonstrates independence in self-care in feeding or with assistance, using adaptive and assistive devices as appropriate Demonstrates independence in self-care in toileting or with assistance, using adaptive and assistive devices as appropriate
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Strategies for Teaching ADLs

Demonstrate use of adaptive equipment for activities of daily living Identify community resources for peer, family support

Demonstrate how to access transportation

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Nursing Strategies Promoting Mobility and Ambulation

Positioning to prevent musculoskeletal complications Prevent external rotation of hip Prevent foot drop Maintaining muscle strength, joint mobility Range of motion Therapeutic exercises Ambulating with assistive device: crutches, walker, cane Assisting patients with orthosis or prosthesis
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Areas Susceptible to Pressure Ulcers

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Risk Factors for Development of Pressure Ulcers

Immobility Impaired sensory perception or cognition Decreased tissue perfusion Decreased nutritional status Friction, shear Increased moisture

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Shear and Friction

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Assessment for the Prevention of Pressure Ulcers

Assessment of skin Evaluate mobility Evaluate circulatory status Evaluate neurologic status Evaluate nutrition, hydration Braden scale

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Interventions to Prevent Pressure Ulcer Formation

Relieving pressure Positioning patient Using pressure-relieving devices Improving Mobility Sensory perception Tissue perfusion Nutritional status
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Interventions to Prevent Pressure Ulcer Formation (contd)

Reducing friction, shear Minimizing irritating moisture

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Care and Treatment of Pressure Ulcers

Deep tissue injury Immediate pressure relief to affected area Stage I: Remove pressure Prevent moisture, shear, friction Promote proper nutrition, hydration

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Care and Treatment of Pressure Ulcers (contd)

Stage II: Clean with sterile saline Semipermeable occlusive dressings, hydrocolloid dressings, or wet saline dressings provide moist healing environment

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Care and Treatment of Pressure Ulcers (contd)

Stage III and Stage IV: Debridement to remove infected, necrotic tissues Wet-to-damp dressing Enzyme preparations

Surgical debridement
Topical treatment to promote granulation of tissue Surgical interventions may be required

Bone resection
Skin grafting
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Question
Which nutrient is responsible for collagen synthesis? A. Vitamin A B. Vitamin C C. Water D. Zinc

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
C. Vitamin C Rationale: Vitamin C promotes collagen synthesis. Vitamin A stimulates epithelial cells and immune response. Water maintains homeostasis. Zinc sulfate is a cofactor for collagen formation and protein synthesis.

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Interventions to Promote Urinary Continence

Dependent upon type of urinary incontinence Do not restrict fluids; ensure 2 to 3 L daily Bladder training Habit training Biofeedback Kegel exercises Intermittent catherization AVOID indwelling catheters
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Interventions to Promote Bowel Continence

Consistency in implementing plan is essential Toilet patients at same time daily Natural time for defecation is 30 minutes after meal, especially in morning Positioning Nutrition: high fiber, 2 to 3 L fluid daily

Encourage physical exercise/activity

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Promoting Home- and Community-Based Care

Impact of disability on physiologic functioning Changes in lifestyle necessary to maintain health Medications Obtain medical supplies Use of adaptive equipment

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Promoting Home- and Community-Based Care (contd)

Demonstrate mobility status Demonstrate skin care, bladder and bowel care Community resources Access transportation

Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins