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39 Cards in this Set

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What is rehabilitation?
Rehab is the process of leanring how to deal with chronic and disabling conditions, often those resulting from trauma
What is the goal of rehab?
to return the client to the best possible condition (physically, mentally, socially, vocationally, and economically.)

Goal of the rehab team is to restore and maintain function
Rehab is used for chronic ilnesses and disabling conditions ( at least ___ months)

rehab will be on the rise with more babyboomers gettin to be old now
examples:
Rehabilitation is often used for chronic illnesses (one that has existed for at least 3 months) and disabling conditions.

hypertension, diabetes, strokes, asthma, mental disorders, neurological disordes, trauma
Impairment, disability, and handicap. What are they in relation to each other.
impairment is the alteration at the organ level.
Disability is a disturbance at the personal level as the result of an impairment (in terms of clients altered funcitoinal ability)
Handicap- the disadvantage that a person feels as a result of their disability
Goal of the rehab team is to restore and maintain function
Physiatrist is a MD who specializes in rehabilitative medicine
Rehab RN: coordinates efforts of team and may be called the case manager. Social workers may also help as case managers.
Physical Therapists: Help patient achieve mobility and ADLs that require mobility
OT: develop patient’s fine motor skills needed for ADLs (eating, hygiene, dressing, driving) work with coordination, adaptive equipment, etc.
Speech-language pathologists: evaluate and assist clients with speech, language, and swallowing problems. (speech is the ability to say words. Language is the ability to understand them)
RT or AT: help clients to continue hobbies and interests work closely with the Ots
There are also PT assistants (PTA’s) and Certified OT assistants (COTA’s)
rt is a respiratory therapist
at is a
After gaining confidence with inpatient care, a patient might decide to move home or into a group home for more assistance with rehabilitation. There have to be people there to do what?
assist with ADLs & IADLs. (these are more complex activities of daily living like shopping and driving)
The physical assesment should focus on what abilities of the client?

The main areas of focus are
functional abilities

cardiovascualar (Chest pain, fatigue, fear)
respiratory (SOB/DOE, fear)
GI (I/O)
Rehab (cardiovascular component)
chest pain
fatigue
fear
Changes in cardiac output can result in activity intolerance: look for chest pain and fatigue and fear. When does it occur and what makes it better? Meds might be given prior to activity to help avoid these symptoms. With fatigue: decide how to use limited energy, frequent rest periods may be needed. activity should be done in the _______People who have had cardiac problems are often afraid to engage in activity because they do not want a recurrence of the health issue that hospitalized them. Getting them involved in structured cardiac programs can help them overcome their fear—these rehab programs help patients learn their activity limitations. They gain confidence as they can do more without assistancemorning.
Rehab (respiratory component)
SOB/DOE (Dyspnea on Exertion)
Fear
SOB during or after activity? How much activity can occur before this is experienced? Again, fear can keep them from attempting activity
Rehab (GI component)
I/O
wt loss or gain, intake, anorexia, N/V, dysphagia (difficulty swallowing) Look at Ht, Wt, Hct, Hgb and blood glucose, eating habits. Elimination patterns: many patients and nurses are hesitant about asking or sharing this information; however, it is a necessary part of the assessment.
Ask about the elimination patterns prior to the injury or illness. Has there been a change. Could it be due to a change in diet, activity level, or medications? All three can cause increased and decreased GI motility.. Evaluate bowel habits based on what is normal for that particular person.. Does the patient require assistance with bowel elimination or a bowel regimen. Sometimes this is determined by trial & error.

Inspect
Auscultate
Percuss
Palpate
Assess for nausea, vomiting, change in appetite, taste alterations, inability to swallow, weight changes, diet, bowel patterns, and flatus.
Musculoskeletal:
Assess limb movement (ROM), strength, and equality.
Assess for pain (joint or muscle), cramps, spasm, and stiffness.
Assess ability to walk, sit, stand and turn.
Assess posture and gait.
Assess for Arthritis
Determine if ambulatory or assistive aids are needed.
Assess meds (Remember you are assessing paired muscles and joints. Symmetry is VERY IMPORTANT! Look for hypertrophy (increased muscle size), Atrophy (small muscle size- thin and flabby), Hypertonicity (increased muscle tone) and Hypotonicity (flabby muscle with poor tone).
Arthritis: joint pain, palpate crepitus in the joints, loss of joint mobility.)
Neurologic: Paresis (weakness), paralysis: absence of movement.
Physical Appearance and Behavior
Level of Consciousness
Cognitive Abilities/ Mentation
Sensory Assessment
Cranial Nerves Assessment
Motor/ Cerebellar Assessment
Reflexes
skin
Analyze risk factors for skin breakdown in clients who are in rehabilitation settings

Changes in diet, water intake, O2 saturation, continence, sensation, ability to fight infection, mental status, and mobility can lead to altered skin integrity. We must evaluate for signs of skin break down in these patinets. Many of them have impaired healing. Stopping the breakdown before it occurs is essential to their well being. We are also assessing for risk for pressure ulcers and breakdown caused by
Friction : results in blisters or superficial abraisions but can lead to pressure ulcer development


How can pressure develop a pressure ulcer?

Actual: If an ulcer or a skin change occures, check or assess the area evey 2 hours measure the depth, diameter in cm or inches. Determine if there is cellulitis. Determine clients understanding of cause and treatment and ability to inspect and maintain integrity.. Photos are often taken by wound care nurses.
Pressure: resricts flow and causes ischemia leading to tissue breakdown this leads to pressure ulcers
How does shearing occur commonly and how can it cause a pressure ulcer?
Shearing: skin remains stationary but tissue beneath is shifted… blankets under the patient are pulled rathet than lifted
Result in tearing of subcutaneous cappilarries, ischemia,a dn development of pressure ulcers
A pressure ulcer can develop during surgery and go unnoticed for days because actual skin breakdown in not immediately visible. Most present ____ to____ days after surgery.
What % of surgery patients develop pressure ulcers ?
Surgeries at what length of time will double risk of skin changes?
quadruples
1-3

8% of surgical patients develop pressure ulcers.

Surgeries 2.5 to 4 hours double the risk of skin changes.

8 hours or more
NEVER MASSAGE A REDDENED AREA IT CAN COMPROMISE CIRCULATION IN A POTENIALLY DAMMAGED AREA
Actual: If an ulcer or a skin change occures, check or assess the area evey 2 hours measure the depth, diameter in cm or inches. Determine if there is cellulitis. Determine clients understanding of cause and treatment and ability to inspect and maintain integrity.. Photos are often taken by wound care nurses.
For potential pressure ulcers what scale should be used to assess?
Braden Scale
6 subsection to score with (sensory perception, moisture, activity, mobility, nutrition, and friction and shear.)
scores range from 6 -23 the lower the score the higher the risk.
For actual pressure ulcers, what should be documented?
what is present on admission and what is present on discharge as well as progression in between
What is the FIM used to measure
Functional Independence Measure is used to asses a pt. ADL's and IADL's

specifically it looks at: This scale tries to quantify what the patient does—not what they should be doing.

It is administered by trained personnel

It looks at: self care: sphinctor control (continence), mobility, communication, and cognition.

Clients are evaluated upon admission and discharge

0 fully independent
4 completely dependent
In transfer always assess what prior to transfer?
ambulatory status
Orthostatic hypotesion is charachterized by a drop of more than __mmHg in systolic or __mmHg in diastolic pressures. Tell the MD.
20
10
Orthostatic hypotension is of particular concern in which two types of patients
elderly
and
antihypertensive pts
Weight gain or loss is tracked every ___ week/s.
week
Ambulatory aids
Level surface.
Cane: strong side. Move cane forward, move weak leg forward, move strong leg one step forward balance.
Walker: move about 2’ forward, walk forward, balance, repeat.
Reinforce clear pathways—eliminate throw rugs and other obstacles
clear pathways—eliminate throw rugs and other obstacles
To prevent complications of further immobility the following should be done:
PROM/AROM exercises
Repositioning, turning
Bed/Chair pressure relief surfaces
Good skin care—lotion, moisture barriers, etc
Inspection of skin, feet EVERY shift
Good nutrition/hydration
* Passive range of motion (or PROM) - Therapist or equipment moves the joint through the range of motion with no effort from the patient.
* Active assistive range of motion (or AAROM) - Patient uses the muscles surrounding the joint to perform the exercise but requires some help from the therapist or equipment (such as a strap).
* Active range of motion (or AROM) - Patient performs the exercise to move the joint without any assistance to the muscles surrounding the joint.

Resistive- actions of client are in opposition to those of the trainer
Must exercise ALL joints!!!! Full ROM of each joint 5 times TID. Not beyond the point of pain or stiffness.
Indications for each type of ROM therapy:
PROM
AAROM
AROM
RROM
1. Patient is weak—Passive
2. Patient is strong—Active
3. Patient is able to do with minimal assistance
4. Full ROM but want to increase strength.
Clients should take action to be doing as much as they can possibly do by themselves with or without assistive devices to complete ADL's. An OT can assist them to do this. In order to encourage that this is succesfful a restorative nursing care model should be used.
There are federal guidelines that require nursing homes and CNF's to work at maintaining resident functional ability.
Fatigue is a big problem for these patients How can we assist patients with poor endurance? We want to reduce energy expenditure: space activities, most activities in the morning, gather equipment before, rest before and after eating and having a toileting routine—are all examples of how .
reduce energy expenditure, space the activities , rest before and after meals, make a regimented time for bowel movements, do activities in morning

MAKE an OT referral for adaptive equipment to assist the client if needed
Stage 1 pressure ulcer:
Skin intact, red but does NOT blanch with pressure; May have difference in temp of the area (warm or cool, may be firm or boggy, pay be painful or itchy. May appear red, blue or purple depending on skin color).
Stage 2 pressure ulcer
Skin is NOT INTACT, partial thickness loss of epidermis or dermis. Superficial wound may look like an abrasion. Can begin as a blister—especially in macerated areas.
Stage 3 pressure ulcer
Full thickness skin loss. Sub Q tissue may be damaged or necrotic. Damage extends down to, but does not go through, underlying fascia. Can be deep
What is ocurring with a spastic/reflexive bladder problem? example?
there is a sudden rush of urine but the bladder does not completely unfill.
this happens in neuro problems ocurring above t12 because the bladder is full and it tells the spine but the brain never gets the message because its a motor response. so the client is unaware
What is flaccid bladder?
retention and overflow or dribbling. This is seen in ms and other neuro injuries below t12 because there is a message sent up to the spine and brain but the message to expel gets garbled and does not cause the client to expel the urine.
what happens in a pt with an uninhibited bladder?
they are not able to "hold it" because the sensorimotor portion of their neruo system is compromised so it just comes out. This happens in patients with frontal lobe injuries and stroke in particular.
What are the differences between stress incontinence, urge incontinence, and mixed incontinence?
stress incontinence= the bladder gets pressure from the lower stomach muscles causing it to expel a little.

urge incontinence= you cant find a toilet fast enough

mixed incontinence = a combination of the two
How can bladder training help?
increase the amount of urine your bladder can hold
increase your ability to control when you go to the bathroom
What techniques are used for bladder training?
kegel exercises- strenthen muscles you use to stop urine flow
scheduling br trips- start by going every hour say (whether you need to go or not) and then try to increase that time interval gradually
delay urination-slowly increase time in between . When urge comes use breathing techniques or kegel exercises to subdue the urge.
losing weight
limit intake of caffeine, alcohol, spicy foods, or foods high in acid.
drinking less before bed time
What kind of drugs can help urinary incontinence?
anticholinergics, antispasmodics, and relaxants,
With a person who has impaired renal ability what stipulations should be made with regard to fluid intake?
Fluid intake: 2000-2500ml/day. Acidic urine minimizes the risks of infections and stones (calcui)
Acidic fluids: tomatoe, cranberry, & prune juices or bullion
Reduce milk and carbonated beverages.
With a person who has impaired renal ability what stipulations should be made with regard to intermittent catheterization?
Intermittent cath: for flaccid bladder Q 2-3 hours use valsalva first. If less than 150 ml of residual urine, then lengthen periods between caths. Up to 3-4 hours never beyond 8 hours unless residual is below 150 and there are adequate fluids being taken in. Home intermittent cath is clean—not sterile procedure