| Question |
Answer |
| Emphasis of rehabilitation |
Abilities |
| Impairment |
Loss of function |
| Rehabilitation efforts begin |
During initial contact w Pt |
| Goal of rehabilitation |
Restore Pt's independence as quickly as possible, Promote acceptable quality of life |
| Severe disability |
Cannot perfrom one/more activities, Cannot use assistive device for mobility, Needs help from another person |
| Goal of assistive/adaptive devices |
Maximize independence and promote access |
| Disability caused by |
Acute incident, Progression of chronic condition |
| Acute incidents |
Stroke, Trauma |
| Chronic conditions |
Arthritis, Multiple sclerosis |
| Concerns of older adults r/t disability |
Loss of independence, Increased potential for abuse, Decreased access to health care, Added burden on caregiver |
| Common nursing interventions r/t disability |
Coping, Self-care, Mobility limitations, Skin care, Bowel/bladder management |
| Basis of rehab program |
Assessment of functional capacity |
| Functional Independence Measure (FIM) |
Tool to assess Pt's independence level |
| Focusing on gross functional movements vs. Fine motor skills |
Gross functional movements are priority, Then fine motor skills |
| Expected Pt. outcomes r/t Self-care deficits |
Performs at maximal level of independence, Uses adaptive devices effectively, Reports satisfaction w/independence level |
| During position changes/transfer/ambulation activities, nurse observes for |
Orthostatic hypotension |
| Crutch walking vs. Walker |
C requires high energy expenditure and balance, W is more stable |
| Prevention r/t Deformities and contractures |
Proper positioning |
| Prevention r/t External rotation of hip |
Trochanter roll |
| Causes of footdrop |
Prolonged bed rest, Lack of exercise, Incorrect positioning, Weight of bedding |
| Muscles r/t Footdrop contracture |
Gastrocnemius and Soleus |
| Exercises r/t Footdrop prevention |
Dorsiflexion/plantar flexion of feet, Flexion/extension of toes, Eversion/inversion of ankles |
| Active vs. Assisted vs. Passive ROM |
Active- performed by Pt, Assisted- nurse helps if necessary, Passive- performed by nurse |
| Proper amount of ROM per joint |
Complete ROM 3x, at least twice/day |
| IADL's are activities that are necessary for |
Independent living |
| PULSES profile assesses |
Physical condition |
| Barthel Index measures |
Pt's level of independence r/t ADL's |
| Opposition |
Touching thumb to each fingertip |
| Internal vs. External rotation |
I: turning inward toward center, E: turning outward away from center |
| Joints r/t ROM exercises |
Moved to point of resistance, Stopped at point of pain |
| ROM exercise functions |
Build muscle strength, Maintain joint function, Prevent deformity, Circulation, Endurance, Relaxation |
| Indicators of Orthostatic hypotension |
Drop in BP, Pallor, Diaphoresis, Nausea, Tachycardia, Dizziness |
| When trying to ambulate, what to do w/presence of orthostatic hypotension |
Stop activity, Assist Pt to supine position |
| Raising bed r/t spinal cord injuries |
Slowly raise head of bed to 90 degrees |
| Signs r/t intolerance of upright position |
Orthostatic hypotension, Cerebral insufficiency |
| Passive vs. Active-assistive exercises |
P:performed by RN, A:performed by Pt w/RN assistance |
| Passive vs. Active-assistive exercises r/t Purpose |
P:joint ROM, Circulation, A:normal muscle function |
| Active vs. Resistive exercises |
A:performed by Pt, R:performed by Pt against resistance |
| Active vs. Resistive exercises r/t Purpose |
A:muscle strength, R:increase muscle power |
| Isometric exercises |
Performed by Pt, Body part in fixed position |
| Isometric exercises r/t Purpose |
Strength even w/joint immobilized |
| Transfer activities begin |
As soon as Pt permitted |
| During transfer, RN |
Assists and coaches |
| Precautions r/t Transfer board/Sliding board |
Shearing, Pt's fingers do not curl around board during transfer |
| Relieving fatigue r/t crutch gait |
Pt should be taught two gaits to switch |
| Necessary factors for crutches |
Balance, Cardiovascular reserve, Strong upper extremeties, Erect posture |
| First foot forward r/t crutchches- Sitting down, Down stairs, Up stairs |
S:weak foot, D:weak foot, U:strong foot |
| Pick-up walker vs. Rolling walker |
P:no natural walking pattern, Pts w/poor balance and cardiovascular reserve, R:automatic walking pattern |
| Only non-weight bearing crutch gait |
3-point gait |
| Partial weight bearing crutch gaits |
4-point & 2-point gaits |
| Proper cane height |
Level w/trochanter |
| Proper hand for cane |
Hand opposite of affected extremity |
| First foot going up and down stairs r/t Canes |
"Up w/the good, Down w/the bad" |
| Functions r/t Orthosis |
Support, Prevents/corrects deformities, Improves function |
| Static vs. Dynamic orthoses |
S:stabilize joints and prevent contractures, D:improve function by assisting weak muscles |
| Moving parts r/t Static & Dynamic orthoses |
S:no moving parts, D:flexible |
| Internal vs. External prosthesis |
I:artificial hip, E:artificial leg |
| Proper fitment r/t orthosis |
Clean/inspect skin daily, Snug brace fitment, Even pressure distribution, Cotton b/w skin and orthosis |
| Pressure ulcers occurance r/t capillary pressure |
Occur when pressure on skin > capillary closure pressure |
| Initial sign of pressure |
Erythema |
| Factors leading to pressure ulcers |
Immobility, Impaired sensory reception, Decreased tissue perfusion, Decreased nutritional status, Friction/Shear, Increased moisture, Age-related skin changes |
| Factors causing Decreased tissue perfusion |
DM, Edema, Obesity |
| Factors causing Decreased nutritional status |
Anemia, Low protein levels, Negative nitrogen balance |
| Serum albumin level r/t Increasing risk of pressure ulcers |
Serum < 3 g/mL |
| Friction vs. Shear |
F:2 surfaces moving across each other, S:gravity pushing body down causing friction |
| Most succeptible areas r/t shear |
Sacrum & heels |
| Stage I Pressure ulcer |
Area of nonblanchable erythema |
| Stage II Pressure ulcer |
Break in skin thru epidermis/dermis |
| Stage III Pressure ulcer |
Ulcer extends into SubQ tissues |
| Stage IV Pressure ulcer |
Ulcer extends into muscle or bone |
| Turning interval r/t pressure ulcer prevention |
every 1-2 hours |
| Positioning cycle |
Lateral, prone, then dorsal in sequence |
| Important nutrients r/t Healing |
Protein, Iron, Vitamin C, Zinc sulfate, Vitamin A |
| Position avoided w/Pts at risk for pressure ulcers |
Semireclined |
| Urge vs. Reflex incontinence |
U:d/t strong need to void, R:spinal cord lesion interrupts control w/no sensory awareness |
| Stress vs. Functional incontinence |
S:weakened perineal muscles (sneezing), F:cannot reach and use toilet before voiding |
| Total incontinence |
physiologic or psychological impairment |
| Restricting fluid intake to decrease urinary frequency |
NEVER |
| Bladder training helps |
Urge incontinence |
| Habit training helps |
Functional, Urge, Stress incontinence |
| Biofeedback allows Pt to contract |
Urinary sphincters |
| Biofeedback helps |
Stress & urge incontinence |
| Kegel exercises help |
Stress incontinence |
| Suprapubic tapping is stroking of |
Inner thigh |
| Suprapubic tapping helps |
Reflex incontinence |
| Best time to plan bowel elimination |
After breakfast |
| Massage movement to promote feces movement |
Massage abdomen from right to left |
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