1. Chapter 37 Rehabilitative 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, (6 th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).