Transcript Nursing Assistant

Nursing Assistant
Rehabilitation &
Restorative Care
Disability
A physical and/or mental condition
which interferes with meeting basic
human needs
 Effects related to Maslow’s hierarchy
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– Feelings of loss
– Damage to self-esteem
– Loss of self-esteem
Restorative/Rehab Care
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Helps disabled individuals return to their
highest possible level of physical &
psychological functioning – promotes
independence
– Helps resident adjust to the disability
– Emphasizes abilities – learn new skills,
retain old skills
– Prevents complications – rehab begins
when resident FIRST enters the facility
Physical goals of Restorative
Care – promoting independence
Maintain present level of function
 Improve or restore physical function
 Encourage independence &
performance of self-care activities
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Psychosocial goals of restorative
care – promoting independence
Adjust to psychosocial effects of
disability
 Recognize small & simple
accomplishments
 May need social service referrals
 Needs job skill development
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Rehabilitation team
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Purpose –
– Discuss & evaluate level of functioning
– Establish resident’s care plan & goals for
rehab
– Evaluate progress & adjust plan of care to
achieve resident’s goals with a greater
degree of resident independence
– Restore resident to his/her optimal level of
functioning
Members of Rehab Team
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Resident & family members
Nursing staff – licensed & CNA
Physical, Occupational, & Speech Therapists
Physician
Activity leader
Social worker
Clergy
Dietician
CNA responsibilities
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Participate in resident care planning
conferences
Observe & report resident’s responses to
care
Follow the resident’s care plan
Encourage resident to follow the rehab plan
Observe & report early signs & symptoms of
complications
Responsibilities in promoting
resident self care
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Protect resident rights
Ensure safety & privacy
Communicate therapeutically – ask opinions
& let them be in control
Adhere to legal & ethical principles
Follow instructions of supervisor & plan of
care
Report significant changes in resident
condition
Responsibilities (Cont)
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Practice appropriate & effective nursing care
Implement rehab measures as ordered –
ROM, training plan for self-care
Encourage independence – praise even small
accomplishments
Provide emotional support & reassurance
Concentrate on resident’s abilities
Use equipment & devices knowledgeably
Protect resident from abuse
Activities of Daily Living
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Daily hygiene, grooming, eating, & selfcare activities necessary for normal
functioning in society
– Grooming & dressing
– Feeding & hygiene
– Elimination – bowel & bladder
– Mobility & ambulation
– Self-turning & positioning
Comfort devices
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Footboard – prevents plantar flexion
Trochanter rolls – prevents external rotation &
pressure sores
Hard splint – prevents contractures
Bed cradle – prevents foot drop decubiti
Trapeze – strengthens muscles & facilitates
movement
Sheepskin – avoids friction, skin breakdown
Comfort devices (cont)
Heel or elbow protectors – protect against
friction & skin breakdown
 Flotation pads, egg crate mattresses, water
bed, alternating pressure mattress, Clinitron
bed – protects pressure points, prevents skin
breakdown
 Pillows & boosters provide support,
positioning, & prevent contractures
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Adaptive/self help devices
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Cuffed or swivel-handled utensils, plate
guards, or holders – eating utensils
Long-handled combs/brushes, button hooks,
sock puller, specially designed clothing –
hygiene & grooming aids
Reachers, telephone holder, communication
boards – promote independence
Artificial limbs – application, care, removal
Casts & splints – immobilization, alignment, &
support, cast care
Complications of inactivity
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Respiratory (stasis pneumonia) or atelectasis
 Circulatory – thrombophlebitis, pulmonary
embolism
 Musculo-skeletal –
– contractures (permanent),
– osteoporosis (demineralization due to lack of
weight bearing),
– muscle atrophy
Complications (cont)
Integumentary – pressure sores
 Gastro-intestinal – constipation &
decreased appetite
 Genito-urinary – kidney stones, UTI,
problems
 Psychosocial – loneliness, depression
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Causes of complications
Bed rest
 Prolonged illness
 Inactivity due to injury
 Surgery
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To prevent complications
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Turning & repositioning
TCDB – turn, cough, deep breathe
Body alignment
Range of motion
Supportive devices
Skin care
Encouraging resident independence
Toileting
Bowel & bladder training
To prevent complications
Elastic stockings – TEDS
 Ambulation is best!
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Maintains muscles, bones, & moves joints
Reduces pressure on the skin
Increases circulation
Increases respiratory & heart function
Improves bowel function & promotes bladder
emptying
– Promotes independence & self-esteem
– If resident cannot walk, at least stand them or
transfer them to a chair
Range of Motion
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The movement of joints through their normal
range of movement to the point of resistance
or discomfort
 Purpose
– Maintain muscle strength
– Stimulate circulation
– Maintain body alignment & make positioning
easier
– Prevent thrombophlebitis
– Prevent contractures
Range of Motion
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ROM frequency
– At least THREE times each day with at
least three (preferable 5 & for your
competency exam 5) repetitions of each
movement of the joint
– As indicated in the care plan
Range of Motion
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Active ROM
– Resident moves own joints through their normal
ROM
– Is the best
– Maintains muscle
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Passive ROM
– CNA moves the resident’s joints through their
normal ROM to the point of resistance or
discomfort
– Still gets muscle atrophy
Range of Motion
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Active assistive ROM
– CNA HELPS the resident move the joints
through their normal ROM to the point of
resistance or discomfort or the resident
uses a resistive device
General rules
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Exercise joint correctly
Avoid unnecessary exposure of resident
Use good body mechanics
Fully support each extremity
Move joint slowly, smoothly, & gently
Do not force joint to move past the point of
resistance or discomfort
Do not case resident to have pain
Report c/o pain to the licensed nurse
Passive ROM Upper Body
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Shoulder
– Hold wrist & elbow
– Flexion & Extension
– Abduction & Adduction
– Horizontal abduction & Adduction
– Rotation (stop sign)
Passive ROM – upper body
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Elbow
– Hold wrist & elbow
– Flexion & extension
– Rotation (turn toward face & feet)
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Wrist
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Hold wrist & fingers
Flexion, extension, hyperextension
Adduction & abduction
Ulnar & radial deviation (toes to nose)
Passive ROM – upper body
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Fingers & thumb
– Hold hand
– Fist to flex fingers, extend by straightening
– Abduction & adduction of each finger &
thumb
– Thumb to palm & side of fingers (abduction
& adduction)
– Thumb opposition
Passive ROM – lower body
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Hip & Knee
– Hold knee & ankle
– Flex knee & hip, straighten knee to extend
& lower leg to bed
– Abduction & adduction
– Rotation inward & outward
Passive ROM – lower body
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Ankle
– Hold ankle & foot
– Flexion & extension
– Abduction & adduction – turn foot inward &
outward
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Toes
– Hand under foot & on top of toes
– Flexion & extension
– Abduction & adduction
Promoting mobility &
ambulation
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Check this to determine ability to be
independent
– Physical strength & ability
– Available special training
– Assistive devices
– Financial resources
– Cognitive ability
– Motivation
Procedures to promote mobility
Transfer techniques
 Gait training
 Training in self-transfer techniques
 Use of gait belt for ambulation
 Check to see if the resident can sit
unassisted & steadily or can stand a few
seconds alone
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Assistive devices
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Cane
Walker
Wheelchair
Transfer board
Braces, splints, & prosthesis
Seeing eye dog
Braille
Modifications to accommodate wheelchair
access
Disabled parking
Relationship between self esteem
& family involvement in care
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Basic needs met if resident & family are
involved in participating in the plan
– Love/belonging/affiliation needs
– Self esteem need
– Self-actualization
Therapeutic communication part
of plan of care
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Promote interaction between resident, family,
& rehab team
Treat resident & family with respect & dignity
Be supportive of resident & family & use
praise as appropriate to reinforce progress
Encourage independence
Use a positive approach to the restorative
plan