a MCPHS- Provider I- Ch 11- Principles and Practices of Rehabilitation
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| Emphasis of rehabilitation | Abilities
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| Impairment | Loss of function
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| Rehabilitation efforts begin | During initial contact w Pt
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| Goal of rehabilitation | Restore Pt's independence as quickly as possible, Promote acceptable quality of life
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| Severe disability | Cannot perfrom one/more activities, Cannot use assistive device for mobility, Needs help from another person
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| Goal of assistive/adaptive devices | Maximize independence and promote access
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| Disability caused by | Acute incident, Progression of chronic condition
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| Acute incidents | Stroke, Trauma
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| Chronic conditions | Arthritis, Multiple sclerosis
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| Concerns of older adults r/t disability | Loss of independence, Increased potential for abuse, Decreased access to health care, Added burden on caregiver
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| Common nursing interventions r/t disability | Coping, Self-care, Mobility limitations, Skin care, Bowel/bladder management
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| Basis of rehab program | Assessment of functional capacity
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| Functional Independence Measure (FIM) | Tool to assess Pt's independence level
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| Focusing on gross functional movements vs. Fine motor skills | Gross functional movements are priority, Then fine motor skills
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| Expected Pt. outcomes r/t Self-care deficits | Performs at maximal level of independence, Uses adaptive devices effectively, Reports satisfaction w/independence level
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| During position changes/transfer/ambulation activities, nurse observes for | Orthostatic hypotension
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| Crutch walking vs. Walker | C requires high energy expenditure and balance, W is more stable
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| Prevention r/t Deformities and contractures | Proper positioning
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| Prevention r/t External rotation of hip | Trochanter roll
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| Causes of footdrop | Prolonged bed rest, Lack of exercise, Incorrect positioning, Weight of bedding
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| Muscles r/t Footdrop contracture | Gastrocnemius and Soleus
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| Exercises r/t Footdrop prevention | Dorsiflexion/plantar flexion of feet, Flexion/extension of toes, Eversion/inversion of ankles
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| Active vs. Assisted vs. Passive ROM | Active- performed by Pt, Assisted- nurse helps if necessary, Passive- performed by nurse
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| Proper amount of ROM per joint | Complete ROM 3x, at least twice/day
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| IADL's are activities that are necessary for | Independent living
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| PULSES profile assesses | Physical condition
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| Barthel Index measures | Pt's level of independence r/t ADL's
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| Opposition | Touching thumb to each fingertip
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| Internal vs. External rotation | I: turning inward toward center, E: turning outward away from center
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| Joints r/t ROM exercises | Moved to point of resistance, Stopped at point of pain
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| ROM exercise functions | Build muscle strength, Maintain joint function, Prevent deformity, Circulation, Endurance, Relaxation
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| Indicators of Orthostatic hypotension | Drop in BP, Pallor, Diaphoresis, Nausea, Tachycardia, Dizziness
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| When trying to ambulate, what to do w/presence of orthostatic hypotension | Stop activity, Assist Pt to supine position
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| Raising bed r/t spinal cord injuries | Slowly raise head of bed to 90 degrees
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| Signs r/t intolerance of upright position | Orthostatic hypotension, Cerebral insufficiency
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| Passive vs. Active-assistive exercises | P:performed by RN, A:performed by Pt w/RN assistance
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| Passive vs. Active-assistive exercises r/t Purpose | P:joint ROM, Circulation, A:normal muscle function
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| Active vs. Resistive exercises | A:performed by Pt, R:performed by Pt against resistance
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| Active vs. Resistive exercises r/t Purpose | A:muscle strength, R:increase muscle power
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| Isometric exercises | Performed by Pt, Body part in fixed position
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| Isometric exercises r/t Purpose | Strength even w/joint immobilized
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| Transfer activities begin | As soon as Pt permitted
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| During transfer, RN | Assists and coaches
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| Precautions r/t Transfer board/Sliding board | Shearing, Pt's fingers do not curl around board during transfer
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| Relieving fatigue r/t crutch gait | Pt should be taught two gaits to switch
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| Necessary factors for crutches | Balance, Cardiovascular reserve, Strong upper extremeties, Erect posture
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| First foot forward r/t crutchches- Sitting down, Down stairs, Up stairs | S:weak foot, D:weak foot, U:strong foot
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| Pick-up walker vs. Rolling walker | P:no natural walking pattern, Pts w/poor balance and cardiovascular reserve, R:automatic walking pattern
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| Only non-weight bearing crutch gait | 3-point gait
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| Partial weight bearing crutch gaits | 4-point & 2-point gaits
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| Proper cane height | Level w/trochanter
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| Proper hand for cane | Hand opposite of affected extremity
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| First foot going up and down stairs r/t Canes | "Up w/the good, Down w/the bad"
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| Functions r/t Orthosis | Support, Prevents/corrects deformities, Improves function
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| Static vs. Dynamic orthoses | S:stabilize joints and prevent contractures, D:improve function by assisting weak muscles
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| Moving parts r/t Static & Dynamic orthoses | S:no moving parts, D:flexible
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| Internal vs. External prosthesis | I:artificial hip, E:artificial leg
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| Proper fitment r/t orthosis | Clean/inspect skin daily, Snug brace fitment, Even pressure distribution, Cotton b/w skin and orthosis
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| Pressure ulcers occurance r/t capillary pressure | Occur when pressure on skin > capillary closure pressure
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| Initial sign of pressure | Erythema
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| Factors leading to pressure ulcers | Immobility, Impaired sensory reception, Decreased tissue perfusion, Decreased nutritional status, Friction/Shear, Increased moisture, Age-related skin changes
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| Factors causing Decreased tissue perfusion | DM, Edema, Obesity
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| Factors causing Decreased nutritional status | Anemia, Low protein levels, Negative nitrogen balance
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| Serum albumin level r/t Increasing risk of pressure ulcers | Serum < 3 g/mL
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| Friction vs. Shear | F:2 surfaces moving across each other, S:gravity pushing body down causing friction
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| Most succeptible areas r/t shear | Sacrum & heels
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| Stage I Pressure ulcer | Area of nonblanchable erythema
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| Stage II Pressure ulcer | Break in skin thru epidermis/dermis
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| Stage III Pressure ulcer | Ulcer extends into SubQ tissues
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| Stage IV Pressure ulcer | Ulcer extends into muscle or bone
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| Turning interval r/t pressure ulcer prevention | every 1-2 hours
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| Positioning cycle | Lateral, prone, then dorsal in sequence
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| Important nutrients r/t Healing | Protein, Iron, Vitamin C, Zinc sulfate, Vitamin A
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| Position avoided w/Pts at risk for pressure ulcers | Semireclined
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| Urge vs. Reflex incontinence | U:d/t strong need to void, R:spinal cord lesion interrupts control w/no sensory awareness
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| Stress vs. Functional incontinence | S:weakened perineal muscles (sneezing), F:cannot reach and use toilet before voiding
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| Total incontinence | physiologic or psychological impairment
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| Restricting fluid intake to decrease urinary frequency | NEVER
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| Bladder training helps | Urge incontinence
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| Habit training helps | Functional, Urge, Stress incontinence
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| Biofeedback allows Pt to contract | Urinary sphincters
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| Biofeedback helps | Stress & urge incontinence
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| Kegel exercises help | Stress incontinence
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| Suprapubic tapping is stroking of | Inner thigh
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| Suprapubic tapping helps | Reflex incontinence
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| Best time to plan bowel elimination | After breakfast
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| Massage movement to promote feces movement | Massage abdomen from right to left
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