21 Rehabilitation and Restorative Care Define the following term: Rehabilitation care given in facilities or homes by a specialist to restore or improve function after an illness or injury.

21 Rehabilitation and Restorative Care 1. Discuss rehabilitation and restorative care Rehabilitation helps to move the resident from Illness to health Disability to ability Dependence to independence

21 Rehabilitation and Restorative Care 1. Discuss rehabilitation and restorative care The goals of rehabilitation include the following: Help resident regain function or recover from illness Develop and promote a resident’s independence Allow resident to feel in control of his or her life Help resident accept or adapt to the limitations of a disability

21 Rehabilitation and Restorative Care Transparency 21-1: Assisting with Rehabilitation and Restorative Care Be patient. Be positive and supportive. Focus on small tasks and small accomplishments. Recognize that setbacks occur. Be sensitive to the resident’s needs. Encourage independence. Involve residents in their care.

21 Rehabilitation and Restorative Care 1. Discuss rehabilitation and restorative care Observe and report these signs and symptoms: Increase or decrease in abilities Change in attitude or motivation Change in general health Signs of depression or mood changes

21 Rehabilitation and Restorative Care 2. Describe the importance of promoting independence and list ways exercise improves health REMEMBER: Always do what you can to encourage residents’ independence while assisting with or performing all tasks.

21 Rehabilitation and Restorative Care 2. Describe the importance of promoting independence and list ways exercise improves health The following problems may result from a lack of mobility: Loss of self-esteem Depression Illnesses such as pneumonia or UTI Constipation Blood clots Dulling of senses Muscle atrophy and contractures Increased risk of pressure sores

21 Rehabilitation and Restorative Care Transparency 21-2: Regular Ambulation and Exercise Regular ambulation and exercise help improve: Health of skin Circulation Strength Sleep and relaxation Mood Self-esteem Appetite Elimination Blood flow Oxygen level

21 Rehabilitation and Restorative Care 3. Describe assistive devices and equipment REMEMBER: There are many items available to assist residents relearning old skills or adapting to new limitations (see Fig. 21-2, p. 378 in textbook).

21 Rehabilitation and Restorative Care 3. Describe assistive devices and equipment REMEMBER: Residents using new ambulatory aids will likely be off-balance. Stay close by and observe residents for signs of dizziness.

21 Rehabilitation and Restorative Care 4. Explain guidelines for maintaining proper body alignment REMEMBER: Residents who are confined to bed need to maintain proper body alignment.

21 Rehabilitation and Restorative Care Transparency 21-3: Proper Body Alignment Observe principles of alignment. Keep body parts in natural positions. Prevent external rotation of hips. Change positions frequently.

21 Rehabilitation and Restorative Care 5. Explain care guidelines for prosthetic devices Remember these guidelines for caring for a resident with an amputation or prosthesis: Be supportive. Handle prostheses carefully and follow the care plan. Follow the nurse’s or therapist’s instructions in applying and removing the prosthesis. Follow manufacturer’s care directions. Keep prosthesis and skin under it dry and clean. Apply stump sock, if ordered.

21 Rehabilitation and Restorative Care 5. Explain care guidelines for prosthetic devices Guidelines for caring for a resident with an amputation or prosthesis (cont’d.): Observe skin on stump and watch for signs of breakdown. Never try to fix a prosthesis. Do not show negative feelings about the stump during care. Make sure resident with hearing aid wears it and that it is working properly. If resident has eyeglasses make sure they are clean and that resident wears them.

21 Rehabilitation and Restorative Care 5. Explain care guidelines for prosthetic devices Follow these instructions when caring for an artificial eye: Wash hands. Provide privacy. Artificial eyes are held in by suction. They will come out quickly when pressure is applied below the lower eyelid. Wash eye with solution and rinse in warm water. Never clean or soak the eye in alcohol – it will crack and destroy it.

21 Rehabilitation and Restorative Care 5. Explain care guidelines for prosthetic devices Instructions for caring for an artificial eye (cont’d.): Moisten the artificial eye and place it far under upper eyelid. Pull down on lower eyelid and the eye should slide into place. Store artificial eye in water or saline in an eye cup or basin lined with soft cloth or a piece of gauze. Mark container with resident’s name and room number. When the artificial eye is removed, wash eye socket with warm water or saline.

21 Rehabilitation and Restorative Care Define the following terms: Range of motion (ROM) exercises exercises that put a joint through its full arc of motion. Passive range of motion (PROM) exercises range of motion exercises performed by another person, without the affected person’s help. Active range of motion (AROM) exercises range of motion exercises performed by a person by himself. Active assisted range of motion (AAROM) exercises range of motion exercises performed by a person with some assistance and support.

21 Rehabilitation and Restorative Care Define the following terms: Abduction moving a body part away from the midline of the body. Adduction moving a body part toward the midline of the body. Dorsiflexion bending backward. Rotation turning a joint.

21 Rehabilitation and Restorative Care Define the following terms: Extension straightening a body part. Flexion bending a body part. Pronation turning downward. Supination turning upward.

21 Rehabilitation and Restorative Care Transparency 21-4: Body Movements

21 Rehabilitation and Restorative Care 6. Describe how to assist with range of motion exercises REMEMBER: PROM: NA does all the work and resident does none. AROM: NA encourages, but resident does all the work. AAROM: NA assists and supports the resident in doing the work.

Assisting with passive range of motion exercises 1.Wash your hands. 2.Identify yourself by name. Identify the resident by name. 3.Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4.Provide for resident’s privacy with curtain, screen, or door.

Assisting with passive range of motion exercises (cont’d.) 5.Adjust bed to a safe level, usually waist high. Lock bed wheels. 6.Position the resident lying supine—flat on his or her back—on the bed. Use proper alignment. 7.Repeat each exercise at least 3 times. While supporting the limbs, move all joints gently, slowly, and smoothly through the range of motion to the point of resistance. Stop if any pain occurs.

Assisting with passive range of motion exercises (cont’d.) 8. Shoulder. Support the resident’s arm at the elbow and wrist during ROM for the shoulder. Place one hand under the elbow and the other hand under the wrist. Raise the straightened arm from the side position forward to above the head and return arm to side of the body (flexion/extension). Raise the arm to side position above head and return arm to side of the body (abduction/adduction).

Assisting with passive range of motion exercises (cont’d.) 9. Elbow. Hold the resident’s wrist with one hand, the elbow with the other hand. Bend the elbow so that the hand touches the shoulder on that same side (flexion). Straighten the arm (extension). Exercise the forearm by moving it so the palm is facing downward (pronation) and then the palm is facing upward (supination).

Assisting with passive range of motion exercises (cont’d.) 10. Wrist. Hold the wrist with one hand and use the fingers of the other hand to help the joint through the motions. Bend the hand down (flexion); bend the hand backwards (extension). Turn the hand in the direction of the thumb (radial flexion). Then turn it in the direction of the little finger (ulnar flexion).

Assisting with passive range of motion exercises (cont’d.) 11. Thumb. Move the thumb away from the index finger (abduction). Move the thumb back next to the index finger (adduction). Touch each fingertip with the thumb (opposition).

Assisting with passive range of motion exercises (cont’d.) 11.Thumb (cont’d.) Bend thumb into the palm (flexion) and out to the side (extension).

Assisting with passive range of motion exercises (cont’d.) 12. Fingers. Make the hand into a fist (flexion). Gently straighten out the fist (extension). Spread the fingers and the thumb far apart from each other (abduction). Bring the fingers back next to each other (adduction).

Assisting with passive range of motion exercises (cont’d.) 13. Hip. Support the leg by placing one hand under the knee and one under the ankle. Straighten the leg and raise it gently upward. Move the leg away from the other leg (abduction). Move the leg toward the other leg (adduction).

Assisting with passive range of motion exercises (cont’d.) 13. Hip (cont’d.) Gently turn the leg inward (internal rotation), then turn the leg outward (external rotation).

Assisting with passive range of motion exercises (cont’d.) 14. Knees. Support the leg under the knee and under the ankle while performing ROM for the knee. Bend the leg to the point of resistance (flexion). Return leg to resident’s normal position (extension).

Assisting with passive range of motion exercises (cont’d.) 15. Ankles. Push/pull foot up toward the head (dorsiflexion). Push/pull foot down, with the toes pointed down (plantar flexion). Turn the inside of the foot inward toward the body (supination). Bend the sole of the foot so that it faces away from the body (pronation).

Assisting with passive range of motion exercises (cont’d.) 16. Toes. Curl and straighten the toes (flexion and extension). Gently spread the toes apart (abduction).

Assisting with passive range of motion exercises (cont’d.) 17.Return resident to comfortable position. Return bed to lowest position. Remove privacy measures. 18.Place call light within resident’s reach. 19.Wash your hands.

Assisting with passive range of motion exercises (cont’d.) 20.Report any changes in resident to nurse. 21.Document procedure using facility guidelines. Note any decrease in range of motion or any pain experienced by the resident. Notify the nurse or the physical therapist if you find increased stiffness or physical resistance. Resistance may be a sign that a contracture is developing.

21 Rehabilitation and Restorative Care 7. Describe the benefits of deep breathing exercises REMEMBER: Deep breathing exercises expand the lungs, clear them of mucus and prevent infections. Do not assist with deep breathing exercises if you are not trained to do so.