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).