Nursing Assistant

1. Nursing Assistant Rehabilitation & Restorative Care

2. Disability • A physical and/or mental condition which interferes with meeting basic human needs • Effects related to Maslow’s hierarchy • Feelings of loss • Damage to self-esteem • Loss of self-esteem

3. Restorative/Rehab Care • Helps disabled individuals return to their highest possible level of physical & psychological functioning – promotes independence • Helps resident adjust to the disability • Emphasizes abilities – learn new skills, retain old skills • Prevents complications – rehab begins when resident FIRST enters the facility

4. Physical goals of Restorative Care – promoting independence • Maintain present level of function • Improve or restore physical function • Encourage independence & performance of self-care activities

5. Psychosocial goals of restorative care – promoting independence • Adjust to psychosocial effects of disability • Recognize small & simple accomplishments • May need social service referrals • Needs job skill development

6. Rehabilitation team • Purpose – • Discuss & evaluate level of functioning • Establish resident’s care plan & goals for rehab • Evaluate progress & adjust plan of care to achieve resident’s goals with a greater degree of resident independence • Restore resident to his/her optimal level of functioning

7. Members of Rehab Team • Resident & family members • Nursing staff – licensed & CNA • Physical, Occupational, & Speech Therapists • Physician • Activity leader • Social worker • Clergy • Dietician

8. CNA responsibilities • Participate in resident care planning conferences • Observe & report resident’s responses to care • Follow the resident’s care plan • Encourage resident to follow the rehab plan • Observe & report early signs & symptoms of complications

9. Responsibilities in promoting resident self care • Protect resident rights • Ensure safety & privacy • Communicate therapeutically – ask opinions & let them be in control • Adhere to legal & ethical principles • Follow instructions of supervisor & plan of care • Report significant changes in resident condition

10. Responsibilities (Cont) • Practice appropriate & effective nursing care • Implement rehab measures as ordered – ROM, training plan for self-care • Encourage independence – praise even small accomplishments • Provide emotional support & reassurance • Concentrate on resident’s abilities • Use equipment & devices knowledgeably • Protect resident from abuse

11. Activities of Daily Living • Daily hygiene, grooming, eating, & self-care activities necessary for normal functioning in society • Grooming & dressing • Feeding & hygiene • Elimination – bowel & bladder • Mobility & ambulation • Self-turning & positioning

12. Comfort devices • Footboard – prevents plantar flexion • Trochanter rolls – prevents external rotation & pressure sores • Hard splint – prevents contractures • Bed cradle – prevents foot drop decubiti • Trapeze – strengthens muscles & facilitates movement • Sheepskin – avoids friction, skin breakdown

13. Comfort devices (cont) • Heel or elbow protectors – protect against friction & skin breakdown • Flotation pads, egg crate mattresses, water bed, alternating pressure mattress, Clinitron bed – protects pressure points, prevents skin breakdown • Pillows & boosters provide support, positioning, & prevent contractures

14. Adaptive/self help devices • Cuffed or swivel-handled utensils, plate guards, or holders – eating utensils • Long-handled combs/brushes, button hooks, sock puller, specially designed clothing – hygiene & grooming aids • Reachers, telephone holder, communication boards – promote independence • Artificial limbs – application, care, removal • Casts & splints – immobilization, alignment, & support, cast care

31. Complications of inactivity • Respiratory (stasis pneumonia) or atelectasis • Circulatory – thrombophlebitis, pulmonary embolism • Musculo-skeletal – • contractures (permanent), • osteoporosis (demineralization due to lack of weight bearing), • muscle atrophy

32. Complications (cont) • Integumentary – pressure sores • Gastro-intestinal – constipation & decreased appetite • Genito-urinary – kidney stones, UTI, problems • Psychosocial – loneliness, depression

33. Causes of complications • Bed rest • Prolonged illness • Inactivity due to injury • Surgery

34. To prevent complications • Turning & repositioning • TCDB – turn, cough, deep breathe • Body alignment • Range of motion • Supportive devices • Skin care • Encouraging resident independence • Toileting • Bowel & bladder training

35. To prevent complications • Elastic stockings – TEDS • Ambulation is best! • Maintains muscles, bones, & moves joints • Reduces pressure on the skin • Increases circulation • Increases respiratory & heart function • Improves bowel function & promotes bladder emptying • Promotes independence & self-esteem • If resident cannot walk, at least stand them or transfer them to a chair

36. Range of Motion • The movement of joints through their normal range of movement to the point of resistance or discomfort • Purpose • Maintain muscle strength • Stimulate circulation • Maintain body alignment & make positioning easier • Prevent thrombophlebitis • Prevent contractures

37. Range of Motion • ROM frequency • At least THREE times each day with at least three (preferable 5 & for your competency exam 5) repetitions of each movement of the joint • As indicated in the care plan

38. Range of Motion • Active ROM • Resident moves own joints through their normal ROM • Is the best • Maintains muscle • Passive ROM • CNA moves the resident’s joints through their normal ROM to the point of resistance or discomfort • Still gets muscle atrophy

39. Range of Motion • Active assistive ROM • CNA HELPS the resident move the joints through their normal ROM to the point of resistance or discomfort or the resident uses a resistive device

40. General rules • Exercise joint correctly • Avoid unnecessary exposure of resident • Use good body mechanics • Fully support each extremity • Move joint slowly, smoothly, & gently • Do not force joint to move past the point of resistance or discomfort • Do not case resident to have pain • Report c/o pain to the licensed nurse

41. Passive ROM Upper Body • Shoulder • Hold wrist & elbow • Flexion & Extension • Abduction & Adduction • Horizontal abduction & Adduction • Rotation (stop sign)

42. Passive ROM – upper body • Elbow • Hold wrist & elbow • Flexion & extension • Rotation (turn toward face & feet) • Wrist • Hold wrist & fingers • Flexion, extension, hyperextension • Adduction & abduction • Ulnar & radial deviation (toes to nose)

43. Passive ROM – upper body • Fingers & thumb • Hold hand • Fist to flex fingers, extend by straightening • Abduction & adduction of each finger & thumb • Thumb to palm & side of fingers (abduction & adduction) • Thumb opposition

44. Passive ROM – lower body • Hip & Knee • Hold knee & ankle • Flex knee & hip, straighten knee to extend & lower leg to bed • Abduction & adduction • Rotation inward & outward

45. Passive ROM – lower body • Ankle • Hold ankle & foot • Flexion & extension • Abduction & adduction – turn foot inward & outward • Toes • Hand under foot & on top of toes • Flexion & extension • Abduction & adduction

46. Promoting mobility & ambulation • Check this to determine ability to be independent • Physical strength & ability • Available special training • Assistive devices • Financial resources • Cognitive ability • Motivation

47. Procedures to promote mobility • Transfer techniques • Gait training • Training in self-transfer techniques • Use of gait belt for ambulation • Check to see if the resident can sit unassisted & steadily or can stand a few seconds alone

48. Assistive devices • Cane • Walker • Wheelchair • Transfer board • Braces, splints, & prosthesis • Seeing eye dog • Braille • Modifications to accommodate wheelchair access • Disabled parking

49. Relationship between self esteem & family involvement in care • Basic needs met if resident & family are involved in participating in the plan • Love/belonging/affiliation needs • Self esteem need • Self-actualization

50. Therapeutic communication part of plan of care • Promote interaction between resident, family, & rehab team • Treat resident & family with respect & dignity • Be supportive of resident & family & use praise as appropriate to reinforce progress • Encourage independence • Use a positive approach to the restorative plan