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Stack #120900

a MCPHS- Provider I- Ch 11- Principles and Practices of Rehabilitation

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
Created by: rpclothier