Chapter 37 Rehabilitative Care
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Transcript of Chapter 37 Rehabilitative Care
Chapter 37Rehabilitative Care
Chapter 37Rehabilitative Care
Functional Status Among the ElderlyFunctional Status Among the Elderly
• Active in the community.
• Perform activities of daily living (ADLs) with assistance.
• Requires total care.
Factors Affecting Functional Status Factors Affecting Functional Status
• Control of symptoms
• Progression of the disease
• Mood
Considerations for FrailtyConsiderations for Frailty
• Unplanned weight loss (10+ lbs in the past year)
• Slow walking speed
• Low grip strength
• Fatigue, poor endurance
• Low levels of activity
Risks for Frail EldersRisks for Frail Elders
• Falls
• Disability
• Hospitalization
• Nursing home placement
• Death
Health Challenges for the ElderlyHealth Challenges for the Elderly
• Disability
– Unable to perform activity in normal manner.
• Impairment
– Psychological, physiologic, or anatomic loss or abnormality.
• Handicap
– Limitation in ability to fulfill role.
Factors Influencing Reactions to a DisabilityFactors Influencing Reactions to a Disability
• Previous attitudes
• Personality
• Experiences
• Lifestyle
Principles Guiding Gerontological Nursing Care with RehabilitationPrinciples Guiding Gerontological Nursing Care with Rehabilitation
• Increase self-care capacity.
• Eliminate or minimize self-care limitations.
• Act for or do for when the person is unable to take action for himself or herself.
Points to Consider in Rehabilitative NursingPoints to Consider in Rehabilitative Nursing
• Know individual unique capacities and limitations.
• Emphasize function rather than dysfunction.
• Provide time and flexibility.
• Recognize and praise accomplishments.
• Do not equate physical disability with mental disability.
Points to Consider in Rehabilitative Nursing (cont.)Points to Consider in Rehabilitative Nursing (cont.)
• Prevent complications.
• Demonstrate hope, optimism, and a sense of humor.
• Recognize individuality of rehabilitation process.
Assessment of ADL and IADLAssessment of ADL and IADL
• ADL: Skills the patient possesses to meet basic requirements
– Eating, washing, dressing, toileting, and moving
• IADL: Skills beyond the basics that enable the individual to function independently in the community.
– Preparing meals, shopping, managing finances, etc.
Ability to Perform ADLs and IADLsAbility to Perform ADLs and IADLs
• Persons can be:
– Totally independent
– Partially independent
– Dependent
Benefits of Correct Body AlignmentBenefits of Correct Body Alignment
• Facilitates optimal respiration
• Improves circulation
• Promotes comfort
• Prevents complications
– Contractures and pressure ulcers
Degrees of ExerciseDegrees of Exercise
• Active: independently by patients.
• Active Assistive: with assistance to the patient.
• Passive: with no active involvement of the patient.
Signs Warranting Stopping ExerciseSigns Warranting Stopping Exercise
• A resting heart rate greater than or equal to 100 beats/min
• An exercise heart rate greater than or equal to 35% above the resting heart rate
• Increase or decrease in systolic blood pressure by 20 mm Hg
• Angina
• Dyspnea; pallor; cyanosis
Signs Warranting Stopping Exercise (cont.)Signs Warranting Stopping Exercise (cont.)
• Dizziness; poor coordination
• Diaphoresis
• Acute confusion; restlessness
Selecting a Mobility AidSelecting a Mobility Aid
• Canes
– Used to provide a wider base of support and should not be used for bearing weight.
• Walkers
– Offer a broader base of support than canes and can be used for weight-bearing.
• Wheelchairs
– Provide mobility for persons unable to ambulate because of various disabilities.
Problems That Can Result from IncontinenceProblems That Can Result from Incontinence
• Falls
• Social isolation
• Infections
• Depression
Methods of Mental StimulationMethods of Mental Stimulation
• Reminiscence
• Life review
• Reality orientation
– Used for persons with cognitive impairment
– Consistency is important to promoting orientation.
Community Resources Community Resources
• Professionals
– Social workers
– Physical therapists
– Occupational therapists
– Speech and hearing therapists
– Rehabilitation and vocational counselors
Community Resources (cont.)Community Resources (cont.)
• Sources of information and services
– Local libraries
– Health departments
– Information and referral services
SourceSource
• Eliopoulos, C. (2005). Gerontological Nursing, (6th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).