Chapter 9 - Rehabilitation and Restorative Care

A complete set of vocabulary flashcards based on CNA Chapter 9 notes regarding Rehabilitation and Restorative Care.

Rehabilitation

Care managed by professionals that helps restore a person to the highest possible level of functioning.

Main goal of rehabilitation

To restore a person to the highest possible level of functioning.

Disability areas addressed by rehabilitation

Physiological needs and psychosocial needs, including independence and self-esteem.

Four goals of rehabilitation

Regain function or recover from illness; develop independence; help the resident feel in control of life; and help the resident accept or adapt to limitations of a disability.

Benefit recipients of rehabilitation

Residents recovering from conditions such as stroke, accident, joint replacement, or trauma.

Restorative care

Care that usually follows rehabilitation and works to maintain a resident's functioning, improve quality of life, and increase independence.

Goal of restorative care

To keep the resident at the level achieved by rehabilitative services.

Rehabilitation and restorative care approach

A person-centered, team approach.

Importance of nursing assistants in rehabilitation

They spend many hours with residents and help them recover abilities and regain independence.

Restorative care progress speed

Progress may be slow, requiring patience from the NA.

Restorative task organization

Break tasks into small steps and focus on small accomplishments.

Setbacks in restorative care

Setbacks occur and the NA should reassure the resident that they are normal.

Sensitivity in resident encouragement

Residents have different needs and some may be embarrassed by obvious encouragement.

Encouraging independence

Improves self-image and attitude and can help speed recovery.

Importance of privacy in restorative care

It promotes dignity and maintains the resident's legal rights.

Resident involvement in care

Feeling involved and valued may motivate residents to work harder in rehabilitation.

Changes to report in restorative care

Increases or decreases in abilities; changes in attitude or motivation; changes in general health; and signs of depression or mood changes.

Call light policy

An NA must never unplug a call light; it must remain within reach and be answered promptly.

Importance of maintaining independence

An active, independent person is less likely to develop physical and mental problems associated with inactivity and immobility.

Nine problems of inactivity and immobility

Loss of self-esteem, depression, anxiety, boredom, pneumonia, urinary tract infection, skin breakdown/pressure injuries, constipation, and blood clots.

Additional effects of inactivity

Dulling of the senses, muscle atrophy, contractures, and problems with independence and self-esteem.

Benefits of regular ambulation and exercise

Skin health, circulation, strength, sleep and relaxation, mood, self-esteem, appetite, elimination, blood flow, and oxygen level.

Importance of social interaction

Promotes independence and thinking abilities and allows the NA to observe the resident's abilities.

Ambulation

Moving or walking, with or without an assistive device.

Ambulatory resident

A resident who can get out of bed and move or walk.

NA checks before ambulation

The care plan, including the resident's abilities, limitations, and disabilities.

Ambulation equipment

Transfer belts, canes, walkers, crutches, and nonskid footwear.

Transfer belt placement

Around the resident's waist over clothing, not on bare skin.

Bracing a weak knee

The NA places a knee against the resident's knee while helping them stand as directed.

NA position during ambulation

Slightly behind and to one side, staying on the resident's weaker side if there is one.

Resident gaze during ambulation

Look forward, not down at the floor.

Walking with a visual impairment

Walk beside and slightly ahead at a normal pace, warning about turns, corners, steps, or stepping up/down.

Post-ambulation tasks

Return resident to seat, remove belt, check alignment/comfort, leave bed low, place call light, wash hands, report, and document.

Cane

A device used to help with balance.

Cane placement for a weak leg

Held on the stronger side.

C cane

A straight cane with a curved handle and rubber-tipped bottom used to improve balance.

Functional grip cane

A cane with a straight grip handle that improves grip control and provides more support than a C cane.

Quad cane

A cane with four rubber-tipped feet and a rectangular base that can bear more weight than other canes.

Walker

A device providing stability when a resident can bear some weight on both legs but is unsteady or lacks balance.

Walker placement distance

No more than about $6\,\text{inches}$, or a comfortable distance, in front of the resident.

Cane/walker safety check

Confirm good condition, secure rubber tips, and that any walker wheels move properly.

Footwear for ambulation

Securely fastened, nonskid footwear.

Hanging items on a walker

Purses or clothing should not be hung on a walker.

Incorrect cane or walker height

If the height appears wrong, the NA should tell the nurse.

Crutches recipients

Residents who can bear no weight or limited weight on one leg.

Weight placement for crutches

Weight should be on the hands and arms, not the underarm area.

Assistive devices

Devices that help residents recovering from or adapting to a physical condition perform activities of daily living.

Personal care assistive equipment examples

Long-handled brushes/combs, plate guards, reachers, sock aids, long-handled shoehorns, and long-handled sponges.

Supportive devices

Devices like canes, walkers, and crutches used to assist residents with ambulation.

Safety devices

Devices like shower chairs, transfer belts, and grab bars used to help prevent accidents.

Proper body alignment for bedbound residents

Aids recovery and helps prevent injury to muscles and joints.

Basis of proper alignment

Straight lines, with the spine kept in a straight line.

Supine position supports

Pillows or rolled or folded blankets can support the back or raise knees/head.

Natural finger position

Slightly curled.

Bed cradle

A device that keeps bed covers from resting on the feet.

Prevention of external hip rotation

Necessary because legs and hips turning outward during bedrest can lead to hip contractures.

Repositioning frequency

At least every $2\,\text{hours}$, depending on the care plan, condition, and preference.

Observation during repositioning

The NA should check the resident's skin each time they are moved.

Amputation

The surgical removal of some or all of a body part, usually an arm, hand, leg, or foot.

Phantom sensation

The feeling that an amputated body part is still present.

Phantom limb pain

Real pain felt in a limb or extremity that has been amputated.

Response to phantom limb pain

It is real, should not be ignored, and must be reported to the nurse.

Prosthesis

A device that replaces a body part that is missing or deformed due to accident, injury, illness, or birth defect.

Reason for a prosthesis

To improve a person's ability to function and/or improve appearance.

Examples of prostheses

Artificial limbs, artificial breasts, hearing aids, artificial eyes, and dentures.

Handling of prostheses

Handle carefully as they are specially fitted and can be expensive.

Teaching prosthesis application and removal

A therapist or nurse should teach these; NAs follow their and the manufacturer's directions.

Decision to wear a prosthesis

Respect the resident's decision if they do not want to wear a prosthetic limb.

Maintenance of prosthesis and skin

Keep both dry and clean; clean the socket at least daily as directed.

Amputation stump observations

Check for skin breakdown from pressure or abrasion, discoloration, and open areas.

Repairing a broken prosthesis

The NA should not try to repair it; report problems to the nurse.

Artificial eye cleaning restriction

Never use rubbing alcohol, as it can crack and destroy the plastic.

Range of motion (ROM)

Exercises that put a joint through its full arc of motion.

ROM exercise goals

Decrease or prevent contractures or atrophy, improve strength, and increase circulation.

Active range of motion (AROM)

ROM exercises performed by the resident independently, without help.

Active-assisted range of motion (AAROM)

ROM exercises performed by the resident with some help and support from the NA.

Passive range of motion (PROM)

ROM exercises performed by a staff member when the resident cannot move the body part independently.

Orders for ROM exercises

ROM exercises require an order from a doctor, nurse, or physical therapist.

Repetition of ROM exercises

Usually repeated $3$ to $5\,\text{times}$, $1$ or $2\,\text{times}$ a day, as ordered.

Sequence of PROM exercises

Begin at the shoulders and work down; exercise upper extremities before lower extremities.

Limb support during PROM

Support the limb above and below the joint.

Movement technique during PROM

Move joints gently, slowly, and smoothly to the point of resistance.

ROM causing pain

Stop the exercise and report the pain to the nurse immediately.

Abduction

Moving a body part away from the midline of the body.

Adduction

Moving a body part toward the midline of the body.

Extension

Straightening a body part.

Flexion

Bending a body part.

Dorsiflexion

Bending backward; at the ankle, bringing the foot/toes upward toward the head.

Rotation

Turning a joint.

Pronation

Turning downward, such as turning the palm downward.

Supination

Turning upward, such as turning the palm upward.

Opposition

Touching the thumb to any other finger.

Elbow ROM movements

Flexion, extension, and forearm pronation and supination.

Hip ROM movements

Flexion/extension, abduction, adduction, and internal/external rotation.

Knee ROM movements

Flexion and extension.

Ankle ROM movements

Dorsiflexion, plantar flexion, and inward/outward turning.

Toe ROM movements

Flexion, extension, and abduction.

PROM documentation

Record the procedure, any decrease in ROM, pain, increased stiffness, or physical resistance.

Meaning of increased stiffness or resistance

May indicate a contracture is developing; notify the nurse or physical therapist.

Need for bladder/bowel retraining

Injury, illness, or inactivity may cause loss of normal bladder or bowel function.