1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 39 Rehabilitation and Restorative Care

2. Slide 2 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Body function can be affected by: Disease, injury, and surgery Disease, injury, and surgery Birth injuries and birth defects Birth injuries and birth defects  Often, more than one function is lost.  Losses are temporary or permanent.  A disability is any lost, absent, or impaired physical or mental function.  An acute problem has a short course.  A chronic problem has a long course.

3. Slide 3 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Disabilities are short-term or long-term.  The degree of disability affects how much function is possible.  Goals of health care: To prevent and reduce the degree of disability To prevent and reduce the degree of disability Helping the person adjust Helping the person adjust  The focus of rehabilitation is on improving abilities. When improved function is not possible, the goal is to prevent further loss of function. When improved function is not possible, the goal is to prevent further loss of function.

4. Slide 4 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  RESTORATIVE NURSING  Restorative nursing programs: Help maintain the highest level of function Help maintain the highest level of function Prevent unnecessary decline in function Prevent unnecessary decline in function  Many persons need restorative nursing and rehabilitation. Both focus on the whole person. Both focus on the whole person.  A restorative aide is a nursing assistant with special training in restorative nursing and rehabilitation skills. Required training varies among states. Required training varies among states.

5. Slide 5 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  REHABILITATION AND THE WHOLE PERSON  The person needs to adjust physically, psychologically, socially, and economically. Abilities are stressed. Abilities are stressed. Complications are prevented. Complications are prevented.  Rehabilitation takes longer in older persons than in other age-groups.

6. Slide 6 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Physical aspects Rehabilitation starts when the person first seeks health care. Rehabilitation starts when the person first seeks health care. Complications are prevented. Complications are prevented. The following measures are needed: The following measures are needed:  Good alignment  Turning and repositioning  Range-of-motion exercises  Good skin care

7. Slide 7 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Some persons need bladder training. Some persons need bladder training. Some need bowel training. Some need bowel training. Self-care is a major goal. Self-care is a major goal. Persons may need assistance with: Persons may need assistance with:  Nutrition  Communication  Mobility  Mechanical ventilation

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Psychological and social aspects The person may: The person may:  Feel unwhole, useless, unattractive, unclean, or undesirable  Deny the disability  Expect therapy to correct the problem  Be depressed, angry, and hostile Successful rehabilitation depends on the person’s attitude. Successful rehabilitation depends on the person’s attitude.  The focus is on abilities and strengths.  Spiritual support helps some persons.  Economic aspects are addressed.

9. Slide 9 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  THE REHABILITATION TEAM  Rehabilitation is a team effort. The person is the key team member. The person is the key team member. The family, doctor, nursing team, and other health team members help the person set goals and plan care. The family, doctor, nursing team, and other health team members help the person set goals and plan care.  Your role Every part of your job focuses on promoting the person’s independence. Every part of your job focuses on promoting the person’s independence. Preventing decline in function also is a goal. Preventing decline in function also is a goal.

10. Slide 10 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  REHABILITATION PROGRAMS AND SERVICES  Common rehabilitation programs include: Cardiac rehabilitation Cardiac rehabilitation Brain injury rehabilitation Brain injury rehabilitation Spinal cord rehabilitation Spinal cord rehabilitation Stroke rehabilitation Stroke rehabilitation Respiratory rehabilitation Respiratory rehabilitation Musculoskeletal rehabilitation Musculoskeletal rehabilitation Rehabilitation for complex medical and surgical conditions including wound care, diabetes, burns, and so on. Rehabilitation for complex medical and surgical conditions including wound care, diabetes, burns, and so on.

11. Slide 11 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  The rehabilitation process may continue after the person leaves the hospital. OBRA requires that nursing centers provide rehabilitation services needed by the person. OBRA requires that nursing centers provide rehabilitation services needed by the person. The center must provide services required by a person’s comprehensive care plan. The center must provide services required by a person’s comprehensive care plan.

17. Slide 17 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  QUALITY OF LIFE  Successful rehabilitation and restorative care improve the person’s quality of life. Promoting quality of life helps the person’s attitude. Promoting quality of life helps the person’s attitude. The more the person can do alone, the better his or her quality of life. The more the person can do alone, the better his or her quality of life.