Restorative Nurse Program (RNP)

Restorative Nurse Program (RNP)

Nursing interventions promoting resident’s ability to adapt/adjust to living independently/safely as possible.

• Focuses on achieving/maintaining optimal physical, mental, psychosocial functioning

Restorative Nursing Assistant (RNA)

Interacts with residents/provides skill practice in activities improving/maintaining function in physical abilities/activities of daily living (ADLs) to prevent further impairment

Rehabilitation

Therapeutic interventions promoting independence of chronically ill, disabled and aged w/ the goal of assisting the resident in becoming a more independent person

ADLs

Activities of daily living (ADLs) → Tasks required to fxn in home/work environment on a day-to-day basis

Adaptive equipment

Assistive devices aiding in independent performance of self-care skills

Adaptive technique

Method of performing tasks using modified process

Grooming

Combing/brushing hair, shaving, applying make-up

Hygiene

Washing face, brushing teeth/dentures, applying deodorant, toilet hygiene

Judgement

Knowing limitations

Precautions

Visual deficits, poor safety awareness, poor judgement, lack of proper safety techniques

Safety Awareness

Understanding own limitations/deficits in relation to ADLs

Visual Deficits

Difficulty with sight/perception (blurred vision, double vision, poor eyesight or blindness)

Affected

Weaker side

Contraindicated

Advised against

Contracture

Within 24 hours, joint begins to stiffen/eventually become inflexible. With longer periods of immobility, tendons/muscles pull tight, result in a fixed position

Joint Crepitus

Noises in the joint

Subluxation

Partial/incomplete dislocation of a joint

Subluxation

Partial/incomplete dislocation of a joint

Flexion

Bending of a joint, angle of joint diminishes

Extension

Return movement from flexion; joint angle is increased

Abduction

Movement away from midline of body

Adduction

Movement toward midline of body. (“Add” back to body)

Internal

Turning inward toward the center

External

Turning outward away from the center

Supination

Rotating forearm so palm of the hand is up

Pronation

Rotating the forearm so palm of the hand is down

Rotation

Turning/movement of a part around its axis

Dorsiflexion

Flexing/bending the foot toward the face

Plantar Flexion

Flexing/bending the foot in direction of the sole

Inversion

Movement turning the sole of the foot inward

Eversion

Movement turning the sole of the foot outward

Arch

Curved/ bowlike shape in palm of hand/bottom of the foot

Bony prominence

Areas having little/no fat between the bone and skin

Contracture

Joint in fixed resistance to movement

Creases

Longitudinal line/straight depression in fold of a joint or palm of hand or bottom of foot

D Ring

Rectangle/D-shaped device in fastening process of a splint on arm or leg

Joint Alignment

Proper positioning that allows proper coordination of flexor/extensor tendons

Prehension

Act of grasping objects w/ the fingers

Range of motion

Movement of a joint through space

Spasticity

Increase of tone of a muscle resulting in difficulty with movement

Splint

Appliance supporting a joint in arm/leg

Stockinette

Thin stretchy cotton used under splits to absorb moisture

Web Space

Space bw knuckle of pointer finger and thumb

Velcro

Fastening material used to keep splint on arm or leg

Aspiration

Entrance of food, liquid, other substance into airway

Dysphagia

Difficulty in swallowing

Aspiration pneumonia

Inflammation/infection of lungs caused by inhaling food, liquid, or other substance

Esophagus

Portion of digestive system. Flexible tube/canal that carries food from throat to stomach

Larynx

Organ of the voice. Sound produced by vibration of vocal folds located in larynx or voice box.

Modified barium swallow

Technique to trace passage of substances during a swallow

Nasogastric tube (NG tube)

Feeding tube inserted into nose/running down throat into stomach. Feed a person unable to take food by mouth

Percutaneous Endoscopic Gastronomy tube (PEG)

Feeding tube inserted directly into abdomen leading into the stomach. Feed a person unable to take food by mouth

Pharynx

A tube referred to as throat, extending from back of the nasal cavity (nose) down to level of the voice box. Pharynx is used in breathing/swallowing

Reflux

Return of food or liquid to throat from stomach

Silent aspiration

Food/liquid entering airway or lungs without producing any symptoms of disturbance such as coughing/struggling behavior

Videofluoroscopy

Moving X-ray studies recorded on videotape

CVAs

Cerebrovascular Accidents

• Muscle weakness/paralysis

• Sensory impairment (loss of feeling)

• Depression / Disoriented

• Emotional lability (Inappropriate crying/laughing unrelated to situation)

• Problems w/ eye-hand coordination/balance

Right CVA , Left Hemiplegia

• Visual impairment/neglect of left side of self in environment/written material

• Poor safety judgement, impulsive

• Short attention span - highly distractible, fixate on inappropriate topics

• Speak clearly but not make any sense as to content

• Limb apraxia (misuse objects)

• Use yes/no inappropriately

• Difficulty reading clocks

• Confused about time/space, gets lost easily

• Fast learner - no retention

Left CVA, Right Hemiplegia

• Visual impairment/neglect of right side of self in environment/written material

• Slow, cautious behavior

• Difficulty changing topics/tasks

• Aphasic — complete breakdown in any/all communication, writing, speaking, listening

• Anomic — Unable to name objects, though usage is understood

• Verbal apraxia (mix up sounds/words)

• Slow learner — retention

Aids to swallowing

1. Position upright/head tilted slightly forward

2. Tilt head slightly forward (chin down)

3. Hold breath

4. Small bites of food, one bite at a time

5. One bite → Completely chew, swallow before taking another bite

6. Swallow twice after each bite

7. Clear throat frequently (“ahem”)

8. One sip at a time, swallow after each sip

9. Swallow completed = “Adams apple” moves up/returns to normal position

10. Foods high in aroma, flavor, texture most successful in stimulating the swallow reflex

11. Liquids either ice cold or comfortably hot

12. Dry foods moistened w butter/gravy

13. Frequent verbal instructions

14. Give 100% attention to task of swallowing/ should not be engaged in conversation/asked questions

15. Reduce/eliminate environmental distractions

16. Follow any precaution signs

17. Monitor amounts of liquids/foods taken

18. Alternate liquids/solid foods

19. Be aware of foods/liquids remaining in mouth during/after the meal

20. Resident remains in upright position for 20 min after meal

21. Remain calm/reassuring; do not rush feed times

22. Management of impaired swallowing w/ patience/discipline

Total Assist

90% to 100% assist— requires continual physical/verbal cueing and assistance; attention span is short; cognitive skills poor

Maximum assist

75% of effort/instruction or support; skills are sloppy; endurance may be poor

Moderate assist

Physical contact/ verbal instruction make up 50% of effort/instruction or support required to complete task.

• Hands on for 50% and hands off for 50% of task

• Caregiver supplying 50% of effort, instruction or support throughout task

• Combination of both (Equal effort/movement bw caregiver and resident— 50/50)

Minimal Assist

25% of effort, instruction, or support → Combination of physical, gestural and instructional but more general/instructional than physical

Contact Guard

Infrequent hands-on contact using light touch to make sure resident is safe/remind resident of details of task

Verbal Assist

No physical assist, requires instructions to start, pay attention, attend to details/complete the task

Supervision

Frequent checks on resident’s progress, assist with any new problems

Set-up Assist

Caregiver must set up ADL task , resident can then perform task without assist

Independent

Resident performs activity without instruction/assist of caregiver

Basic Rules of Body Mechanics

1. Assess the situation before taking action

2. Get close to object to be moved

3. Bend knees — let legs do the work, not your back

4. Use a wide base of support

5. Push— don’t pull

6. Turn— don’t twist

Keys to Safe Transfers

1. Remember body mechanics

2. Use second person to assist when indicated

3. Use appropriate equipment

4. Allow resident to maintain integrity through independence by providing only as much assistance as necessary

5. Restraints untied and any tubes are protected

6. Adjust equipment to suit needs

7. Transfer shortest distance possible

8. Transfer toward resident’s strong side. Protect weaker side

9. Keep resident informed; short, simple commands

10. Know resident’s limitations

11. Use safest technique

T/F: OSHA recommends manual lifting of residents be minimized in all cases and eliminated when feasible

TRUE!!!

Max Assist or Dependent Transfers

Done w/ rehab resident in a “no-lift” facility. Both knees bracing resident’s weaker knee; knees in front of and to the sides of resident’s knee to block. If possible, transfer to resident’s stronger side

1. Always take your time

2. Plan your move (Position feet, knees, hands)

3. Explain the procedure

4. Get assistance if not sure you can safely perform

5. Use your weight; let legs do the work, not your back

Blocking the knee is a must ! Brace the resident’s weaker knee with your knees

Slide Board Transfers

Technique used w/ some residents rather than non-weight bearing. Ex:

• Non-compliance w/ weight-bearing restrictions

• Amputees above/below knee

• Morbidly obese residents

Residents must demonstrate good upper body strength, follow simple commands, have good trunk balance/intact skin (in buttocks and sacral areas)

1. Brakes locked! Remove wheelchair armrest closest to bed. Tell resident to lean away from side trying to put the slide board

2. Push slide board under resident’s buttocks

3. If resident is able, have him/her grasp the slide board, insert it under buttocks

4. Have resident (if able) reach out and place one hand on board/position other hand on remaining wheelchair arm

Adaptive Walking devices

Canes

• Ortho cane

• Quad cane

• Single-point cane

• Walk cane

Crutches

• Axillary crutch

• Forearm through crutch

• Forearm crutch (Lofstrand)

Walkers

• Pick-up walker

• Front Wheel Walker

• Four-wheeled walker