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Chapter 37 Rehabilitative Care

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.

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Chapter 37 Rehabilitative Care

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  1. Chapter 37Rehabilitative Care

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

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

  4. 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

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

  6. 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.

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

  8. 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.

  9. 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.

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

  11. 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.

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

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

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

  15. 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

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

  17. 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.

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

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

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

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

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

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