Geriatrics Unit 5: Rehabilitation and Restorative Care Study Materials

Rehabilitation

The process of teaching individuals to achieve their highest level of independent function

Starts at the time of injury or disability (on admission), after an extensive assessment of an individual’s physical, emotional, spiritual, and functional strengths and deficits

Care is multidisciplinary

Assessment is important in determining if goals are realistic and achievable for each individual

Individuals and families priorities must be determined (See p. 71, text)

Continues until the individual gains as much physical independence as possible

Theoretically ends when the individual has reached his/her maximum functional ability

SMART =

Specific

Measurable

Attainable

Realistic

Time sensitive

Restorative Care

A specialized type of care that helps patients who have reached their highest level of function through rehabilitation to maintain that level of function over time

Initiated after the individual has reached the rehabilitation goal or has not shown any further improvement

The IDT designs restorative care plans but is not directly involved in implementation

Focuses on helping the individual do things for himself/herself, rather than others “doing for” the individual

Focuses on the individual’s functional potential, not limitations

Strives to improve the individual’s self-image and self-esteem

____________ care is used to maintain the highest level of function goal that the patient reached in therapy

Restorative

IDT =

Interdisciplinary team

Roles of the Nurse

Caregiver: supporting the development of self-care abilities

Educator: providing education to patients and their families, so they can make choices and be involved in rehabilitation &/or restorative process

Advocate: using one’s influence and power to promote an environment that supports the goals of rehabilitation and restorative care

Counselor: helping individuals effectively cope and solve problems

Rehabilitation and Restorative Care Goal

to help the older adult reach his/her highest functional ability; to maximize the older individual's abilities and functions

Rehabilitation and Restorative Care: For a successful outcome, the following goals must be included, and must be individualized

-Independence and self-care

-Mobility

-Involvement in activities

-Fulfillment of life's goals

-Holistic approach to living with a disability

Restorative Nursing Goals Specific to Older Adults

Accommodation to dysfunction (teach them how to live with it)

Strengthening functional abilities (if they can wash their face & arms try to get them to wash their face)

Delay of deterioration (keep them at their highest level of functioning)

Comfort in the dying process

Assessment

Holistic approach

May include:

-Evaluation of mental status (e.g., MMSE)

-Ability to follow directions

-Lower level functioning skills (e.g., brushing teeth) vs higher level functioning skills (e.g., walking)

-Psychosocial (including spiritual, emotional)

Holistic:

Mind, body and soul

Principles of Rehabilitation and Restorative Care

-Begin treatment early

-Activity strengthens; inactivity weakens

-Prevent further disability

-Focus on abilities, not disabilities

-Consider the person holistically

Implementing Principles of Rehabilitation and Restorative Care

-Maintaining a safe environment, providing physical safety, protecting against infections

-Maintaining comfort, rest, activity, mobility

-Maintaining optimum dietary intake

-Maintaining circulatory and respiratory function

-Protecting skin integrity

-Maintaining bowel and bladder function; promoting bladder elimination

-Promoting psychosocial and spiritual well-being

-Encouraging accomplishment of developmental tasks

Urinary Incontinence primary goal:

Find out the cause and if treatment can reverse it

-Treatment depends on the underlying cause

Acute urinary incontinence:

Occurs suddenly, is present for 6 months or less, is caused by treatable factors

Chronic urinary incontinence:

Continues after treatable causes have been ruled out or treated

Acute Urinary Incontinence possible causes (DRIP)

Delirium

Restricted mobility, acute retention

Infection, fecal impaction

Pharmacological, Polyuria, Psychological

Urge incontinence:

Involuntary urination soon after feeling the urge to void, before being able to reach the toilet

Stress incontinence:

Leakage of small amounts of urine due to a sudden increase in intra-abdominal pressure

Overflow incontinence:

Loss of urine associated with impaired bladder emptying; urinary retention with bladder overdistention

Functional incontinence:

Bladder and urethra function normally, but the individual is unable or unwilling to attend to toileting needs; cognitive, physical, psychological, or environmental impairments make it difficult to get to the toilet (Ex: Dementia, amputation pts)

Urinary Incontinence Behavioral interventions include:

-Bladder training

-Timed voiding

-Pelvic muscle exercises

-Medications

-Most toileting schedules start out every 2 hours, and are modified as necessary

-Consider the "costs" of urinary incontinence for the individual

What is the goal, and how would you evaluate the success of a toileting program?

If we take the patient to the bathroom every 2 hours and the patient is dry and does not void you would try to take them every 3 hours and if the patient still is not going you would suspect there is an underlying concern.

Timed voiding:

Continuous use of an unchanged, fixed voiding schedule

(Usually every 2 hours)

Gerontological health-care services may be provided in many settings, including:

Acute care facilities-Hospitals

Long-term care facilities-Nursing homes

Assisted living facilities-ALF

Hospice (may be in-home or facility-based)

Adult day facilities- Adult day care

Physician offices

Dialysis and other clinics

Senior centers

Home

Home Health Care services

Skilled care services can include: skilled nursing, social services, OT, PT, ST, nutritional counseling

Meals On Wheels: Meals delivered daily for lunch (Provided by Elder Services)

Home support services can include: personal care, homemaker services (e.g., meal preparation, shopping), companion services

Home Health Care

Care that takes place in a person's home

Services, medical supplies and equipment can be paid for by Medicare if older adult qualifies

RN usually performs initial assessment and develops plan of care (identifies which services are needed & staff required) to meet the identified goals

LPN works under instructions of the RN case manager

Allows the nurse creativity, opportunity to function as part of a team, variety of older patients, flexibility

Involves documentation, transportation, safety concerns, limited time with individuals

Nursing responsibilities in home health care may include:

Doing assessments

Medication administration

Dressing changes

Wound care

Patient and family teaching

Documenting

Various procedures (e.g., Foley catheter insertion)

Health Promotion

“One does not have to be free of disease to experience the benefits of health and wellness” (text, p. 107)

Many problems related to the aging process can be prevented or managed by basic health-promotion strategies

Quality of life, rather than a longer life, may be a motivating factor in participating in health-promotion activities

Goal always remains the same: to assist older adults to reach a state of optimal health

Health-promotion programs appropriate for older people should focus on:

Maintaining functional abilities

3 multiple choice options

Promoting wellness in older adults should be individualized, with a holistic approach, and directed towards maintaining _________________

functional independence

Health Promotion activities that should be addressed include:

Regular examinations/screenings

Management of chronic conditions

Exercise and activity

Nutrition

Stress management

Lifestyle: including emotional/spiritual consideration

Self-care: working in partnership with HCPs/family

Socialization

Immobility and Functional Decline

Immobility affects all body systems

Functional decline: a loss in the ability to independently perform basic activities of self-care

Deconditioning: the decrease in muscle mass as well as other body system changes that occur as a result of aging or of inactivity

Normal aging changes, acute and chronic diseases, hospital care can contribute to a spiral of functional decline

Interventions that provide physical activity and cognitive stimulation can help alleviate the negative effects of hospitalization in older adults

Functional decline:

a loss in the ability to independently perform basic activities of self-care

Deconditioning:

the decrease in muscle mass as well as other body system changes that occur as a result of aging or of inactivity

How do nurses advocate for their older adult patients to prevent immobility and functional decline?

Constantly support and encourage the patient while being completely honest and transparent.

Incentives for older adults to participate in health promotion behaviors include:

The belief that activities will help keep them independent

3 multiple choice options

Health promotion programs appropriate for older people should focus on:

Maintaining functional ability

3 multiple choice options

Basic components of an exercise routine for older people are:

Strengthening, endurance, and flexibility

3 multiple choice options

Age-related changes that affect nutrition include:

Increase in body fat with decrease in muscle

3 multiple choice options

It is important to include an assessment of alcohol use in the older adult because alcohol in the elderly:

Masks symptoms of other serious health conditions

3 multiple choice options

You recognize that your patient may be an increased fall risk when she states "Ive felt so dizzy today" you know this dizziness could be directly linked to:

Weather

Hydration

Nutrition

Medication

Infection

Drug or alcohol misuse

All of the following may lead to increased anxiety in older adults, except:

Alcohol consumption

3 multiple choice options

Abuse may manifest as all of the following:

Lacerations, bruises on the face, broken bones

Increased tearfulness, withdrawing from others, feelings of worthlessness

Bruising on the genitals, increase in pressure ulcers, weight loss

A 75 year old is being discharged from the hospital after a R sided CVA. He requires at least 6 weeks of further nursing care and physical therapy. The facility most likely to meet these needs is:

A skilled nursing facility

3 multiple choice options

Hospice care provides a multidisciplinary approach to caring for people with:

A terminal illness

3 multiple choice options

The major benefit of living in a continuing-care retirement community is:

Services available for a continuum of health-care needs

3 multiple choice options

A 83 year old with Alzheimers disease has wandered from home on several occasions and the pts family is worried for their safety and desires some respite services. You would recommend:

An adult daycare center

3 multiple choice options

In the home health-care setting, the LPN can expect:

A limited amount of equipment and supplies available

Intermittent contact with clients

To care for clients discharged from the hospital with many physical care needs

The aim of rehabilitation for older adults is to:

Restore an individual to his/her former or best possible function

3 multiple choice options

Which of the following directives most closely coincides with the desired goals of a successful rehabilitation program?

Promote independence and self-care, along with mobility and a holistic approach to living with the disability

3 multiple choice options

Principles of rehabilitation include the most important step in nursing care, which is:

Beginning rehabilitation immediately on the patients admission

3 multiple choice options

Rehabilitation goals specific to older adults include:

Delay of deterioration

Improvement of function

Accommodation to dysfunction

Comfort in the dying process

3 multiple choice options

In continence training for bladder control, the nurse should:

Increase fluids during the daytime hours and toilet the patient every 2 hours

3 multiple choice options