Principles and practices of rehabilitation

1. Principles and practices of rehabilitation

2. Rehabilitation How would you define rehabilitation? What is a disability? Give examples. What dimensions should the definition of rehabilitation encompass? Who is entitled to rehabilitation services? When should rehabilitation begin? Why is rehabilitation an integral part of nursing?

3. Terms to Understand Assistive Technology Assistive devices Adaptive devices Activities of Daily Living Instrumental Activities of Daily Living Why must nurses understand these terms?

4. Reactions to disability Disability can occur suddenly or occur over time. Persons experiencing disability experience many losses. Give examples of losses the person may experience. What reactions would you anticipate the patient would experience? What plays a major role in how a patient adjusts to the disability? What are major nursing responsibilities?

5. Rehabilitation- a team approach Successful rehabilitation depends upon the coordinated efforts of health care professionals, interdisciplinary rehabilitation team, and involvement of the client, family, and other support systems? Who is involved in rehabilitative care? Who is the most important team member? Why? What are the goals of the rehabilitation team? As a team member, what are the nurse�s responsibilities?

6. Assessment of functional ability Why is it important to assess functional ability? Why must the nurse directly observe patient performance of activities? What should be documented in relation to observation of performance? What other physiological factors affect functional ability and must be assessed?

7. Functional assessment tools Functional Independence Measure (FIM) PULSES profile Barthel Index Patient Evaluation Conference System (PECS)

8. Additional assessment areas Physical Mental Emotional Spiritual Social Economic status Potential for altered skin integrity Altered elimination (bowel and bladder control) Sexual dysfunction

9. Self-care deficits Inability to fully function in relation to bathing/hygiene, dressing/grooming, feeding, toileting What are the nursing goals for a patient with a self-care deficit? Identify outcomes for a patient with a self-care deficit. What nursing interventions would help the patient achieve those goals.

10. Teaching about activities of daily living Define goal of activity Identify multiple approaches Select approach most likely to succeed Incorporate into plan of care and documentation Identify motions involved (detailed) Initially focus on gross motor movements; progress to fine motor movements Encourage performance to maximal capacity Monitor tolerance Minimize frustration and fatigue Assisted practice in real-life situations

11. Therapeutic Exercises Define the following therapeutic exercises Passive Active-resistive Active Resistive Isometric or muscle setting Give an example of situations in which these exercises would be encouraged.

12. Crutch walking Points to remember: Learn standing balance before attempting crutch walking Support weight on hand pieces Supporting weight on the axilla can cause damage First assume Tripod position How does height affect the base of support? Selection of crutch gait Chart 11-8: Crutch Gaits p. 206 What factors are considered in the selection of a crutch gait?

13. Nursing Responsibilities for crutch walking What is the nurse�s responsibility with a patient who is just learning crutch walking? What should alert the nurse that crutch walking practice should be stopped?

14. Other assistive devices What other assistive devices can you identify? What are related nursing responsibilities?

15. Urinary Incontinence

16. Assessment of Continence and interventions Assessment Health history Voiding diary Functional ability Medications Normal bowel patterns Interventions Do not restrict fluids Bladder training Habit training Biofeedback Kegal exercises Intermittent catheterizations Avoid indwelling catheters

17. Interventions for bowel continence Consistently implement plan Toilet at same time daily Positioning Nutrition Encourage physical exercise/activity