unit 13-basic restorative services

8/14/2019 Unit 13-Basic Restorative Services

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DHSR Approved Curriculum-Unit 13 1

Unit 13

Basic Restorative ServicesNurse Aide I Course


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Basic Restorative Services

IntroductionThis unit explores various aspects

of restorative care and the role of the

nurse aide in this process.Disease, injuries and surgery are

often responsible for the loss of a body

part or the loss of bodily function.


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Basic Restorative Services(continued)

IntroductionWorking with the elderly and

disabled requires a great deal of

patience, caring and understandingfrom health care workers.

Working together to assist the

resident to attain the highest possiblelevel of functioning can be a verychallenging and rewarding experience.


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13.0 Demonstrate skills whichincorporate principles ofrestorative care under thedirection of the supervisor.


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Rehabilitation/Restoration

Definition - process of

restoring disabled

individual to highest levelof physical, psychological,

social and economic

functioning possible


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Rehabilitation/Restoration(continued)

Emphasis on existing

abilities

Encouragesindependence

Promotes productive

lifestyle


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Goals include:

Prevention of

complicationsRetraining in lost

skills

Learning new skills


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13.1 Identify the nurse aides role inrehabilitation/restoration.


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Nurse Aides Role

Encourage resident

Praise accomplishmentsReview skills taught

Report progress or needfor additional teaching


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Nurse Aides Role (continued)

Promote independence

praise all attempts atindependence

overlook failures

show confidence inresidents ability


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Nurse Aides Role (continued)

Promote independence (continued)

be patient and allow time forresidents to do things for

themselves

Be sensitive and understanding


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13.2 Provide training in and theopportunity for self-careaccording to the residentscapabilities.


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Self-Care According To

Residents Capabilities

Training in self-care requires thatthree questions be answered prior tostarting:

1. What is the goal to be achieved?

2. What approaches are used to help

the resident achieve the goal?3. How will progress or lack of

progress be measured?


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(continued)

Resident included in goal-setting

process, whenever possible.


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(continued) Functional losses cause:

Resentment

Anger

Frustration

Withdrawal Depression

Grief


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Guidelines To Assist With

Restorative Care And Training

Assist resident to do as much as

possible for himself/herself

Be realistic Never offer false hope

Explain what is going to be done

Begin tasks at residents level of

functioning


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(continued) Provide encouragement and

reinforcement

Praise successes Emphasize abilities Treat resident with respect

Explain what resident needs toaccomplish, and how you willhelp.


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(continued) Accept residents and

encourage them to express

their feelings Help to put new skills into

use immediately

Assist the resident to

recognize his or her progress


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Treatment initiated by:

Physical therapist

Occupationaltherapist

Speech therapist

Licensed nurse


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(continued) ADL considerations for

resident:

Resident to control howand when activitiescarried out, when possible

Use tact in makingresident aware of hygieneneeds


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(continued)

ADL considerations forresident (continued):

Encourage use andselection of clothing

Be patient and allowtime for slower pacedactivities


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(continued) ADL considerations for resident

(continued):

Provide for rest periodsAssist to exercise

Promote independence by havingdo as much of activity, as possible

Encourage use of adaptive devices


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13.3 Discuss methods for assistingwith bowel and bladder retraining.


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Bowel And Bladder Retraining

Incontinence: Inability to control

urination or defecation

Embarrassing for resident

Uncomfortable


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Bowel Retraining

Plan developed to assist to return tonormal elimination pattern andrecorded on care plan

Information collected:bowel pattern before incontinence

present bowel pattern

dietary practices


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Bowel Retraining(continued)

Participants in plan

resident

familyall staff members


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Guidelines For Bowel Retraining

Enemas may be ordered byphysician and given by nurse aide,

as directed by supervisor

Regular, specific times to evacuate

bowels established

Fluids encouraged on regular basis


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Guidelines For Bowel Retraining(continued)

High bulk foods given, if notrestricted

fruits

vegetables

bread

bran cereals


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Bowel aids ordered by physician andadministered by licensed nurse only:

laxatives suppositories

stool softeners

Regular exercise encouraged


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Ways nurse aide can assist withdefecation process:

offer bedpan on setschedule

assist to bathroom whenrequest is made

provide privacy

display unhurried attitude


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Ways nurse aide can assist withdefecation process (continued):

offer warm drink

be patient encourage with positive remarks

do not scold when accidentshappen (abuse)

check on resident frequently


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Bladder Retraining

Plan developed to assist

to return to normal

voiding pattern and

recorded on care plan

Staff must be consistent

and follow plan


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Bladder Retraining

Individualized plan includes:

schedule that specifies

time and amount of fluidsto be given

schedule for attempting to

void


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Guidelines for Bladder Retraining

Get residents cooperation Record incontinent times Provide with opportunities to void:

when resident awakensone hour before mealsevery two hours between meals

before going to bedduring night, as needed


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Guidelines for Bladder Retraining(continued)

Provide stimuli as needed:

run water in sink

pour water overperineum

offer fluids to drink

place hands in warm

water


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Provide good skin care to prevent

skin breakdown

Retraining may take 6-10 weeksbe patient

be supportive

ignore accidents

respect residents feelings


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Follow facility

procedure for use of:

incontinent padsadult protective

pants

incontinent briefs


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13.4 Identify ways to assist theresident in activities of daily livingand encourage self-helpactivities.


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Adaptive Devices For Assisting With

Activities of Daily Living (ADL)

Special utensils available tohelp with eating

Electric toothbrushes forbrushing teeth

Long-handled brushes and

combs for hair care


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(continued)

Supportive devices toassist with walking canes, crutches, walkers

Wheelchairs andmotorized chairs toprovide movement fromplace to place

Ad ti D i F A i ti With


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(continued) Prosthesis to replace missing body

parts

Successful use of adaptive devicesdepends on the residents:

attitude

acceptance of limitationsmotivation

support from others


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13.5 Discuss the various ambulation

devices and transfer aids.


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Ambulation Devices And

Transfer Aids

Walker - four-point aid with rubber tips

Resident stands erect when movingwalker forward

Walker adjusted to height of hipjoint

Elbows at 15-30 degree angle

Walker picked up and put down, notslid



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Transfer Aids

(continued) Walker - four-point aid with rubber tips(continued)

Back legs of walker evenwith toes so resident walksinto walker

Resident steps towardcenter of walker

Leads with weaker leg



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Transfer Aids

(continued) Canes

Types:

single-tipped tripod - 3 legs

quad - four point



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Transfer Aids

(continued) Canes (continued)

Used when weakness

on one side of body andresident has use of atleast one arm

Provides balance andsupport



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Transfer Aids


Should be fitted properly:

cane handle level withfemur (greatertrochanter)

elbow flexed at 15 to 30degree angle

shoulders level



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Transfer Aids


Gaits ordered by physician or

physical therapist: move cane and affected legtogether

move cane, then affected legUsed on side of body where leg is

strongest (side opposite the injury)



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Transfer Aids(continued)

Crutches

Provide support and

stability through use ofhands and arms.

Used when one or both

legs are weak.



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Crutches (continued)

Measured to fit properly by

physical therapist. height correct if two fingers fitbetween armrest and axilla

hand grip adjusted to allow20-30 degrees flexion ofelbows



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Gaits

four-point gait three-point gait

two-point gait

swing-to gait

swing-thru gait



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Transfer Aids

(continued)


Weight supported onhand bar, not axilla



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Transfer Aids

(continued) Wheelchairs

Available in different

sizes and models to allowfor proper fit and usage

Cleaned with mild

detergent and water,rinsed with water anddried



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Transfer Aids

(continued) Wheelchairs (continued)

Periodic maintenance

needed with 3 in 1 oil

Arm rests adjusted to

appropriate height

Feet rest flat on floor

when chair is not moving



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Wheelchairs (continued)

Seat should not sag

toward center of chairSeat should not reach

back of residents bent

kneesBrakes locked when

chair not moving



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Transfer Aids

(continued) Wheelchairs (continued)

Wheelchair guided backwards

when going downhill

Wheelchair pulled backwards

over indented or raised areas

(i.e., entrance to elevators)



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Transfer Aids

(continued)

Wheelchairs (continued)

Feet placed on footrestsfor transport



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Transfer Aids

(continued) Gurneys/Stretchers/Litters

Wheels locked when transferring

residents on or offSafety belts secured prior to

transfer

Both side rails raised prior totransfer



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Transfer Aids

(continued) Gurneys/Stretchers/Litters (continued)

Residents never left alone on

stretcherBacked head first into elevators



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Transfer Aids

(continued)

Always used with

assistance whentransferring residenton or off

Pushed feet firstduring transport

Gurneys/Stretchers/Litters (continued)



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Guided backwards when

going downhillCleaned with mild

detergent and water,

rinsed with water anddried

Gurneys/Stretchers/Litters (continued)



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Transfer Aids

(continued) Gait belt (safety belt, transfer belt)

Used for residents unsteady on

feetProtects resident who loses

balance or faints

Held at back



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Transfer Aids

(continued)

Must be tight enoughto provide support butloose enough to be

comfortableUsed to safely transfer

resident

Gait belt (safety belt, transfer belt)(continued)


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13.5.1 Identify safety precautions to be

considered by the nurse aidewhen using ambulatorydevices.

Safety Considerations When Using


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Ambulatory Devices

Correct aids must be usedbecause they areindividually fitted

Resident observed closelyto be sure aids are beingused as ordered

Faulty equipment reportedand not used until repaired



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Ambulatory Devices

(continued) Shoes must fit and be in

good condition

Skin breakdown reported Rubber tips on aids in

good condition.


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13.6 Demonstrate the method used to

assist a resident to ambulateusing a cane or walker.


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13.7 Discuss the use of mechanical

lifts.


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Mechanical Lifts

Used for transfer ofresidents

Lower end of sling

positioned behindknees

Hooks turned awayfrom body

Mechanical Lifts


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Mechanical Lifts(continued)

Straps, sling and clasps checkedfor defects

Enough assistance available toassure safe transfer

Area checked for safety hazards

prior to transfer


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13.8 Demonstrate the procedure for

transferring a resident using amechanical lift (Hoyer).


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13.9 Perform range of motion

exercises as instructed by thephysical therapist or supervisor.

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Range of Motion Exercises

Types of range of motion:

Active - resident

exercises joints withouthelp

Passive - another person

moves body part forresident

Range of Motion Exercises


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Range of Motion Exercises(continued)

Purpose of range of motion:

Maintains muscle tone

Prevents deformitiesIncreases circulation

Encourages mobility

Guidelines When Performing


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Range Of Motion

Expose only part of

body being exercised

Be gentle and stop ifresident complains of

pain

Use good bodymechanics



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Range Of Motion

(continued) Follow directions from

supervisor on number of

times each joint to beexercised and how to

perform exercises safely,

based on each residentscondition



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Range Of Motion(continued)

Each movement is repeated three

times unless otherwise ordered.

Support joint as it is exercised

Report complaints of pain or

discomfort to supervisor



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Range Of Motion(continued)

Exercise joint slowly, smoothly and

gently

Do not exercise swollen, reddened

joints; report condition to supervisor

Range Of Motion Exercises


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Types of Joint Movement

Abduction Adduction Extension Hyperextension Flexion Plantar flexion Dorsiflexion Rotation



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Types of Joint Movement(continued)

Pronation

Supination

Eversion Inversion

Radial deviation

Ulnar deviation

Encourage

residents capable

of doing active

ROM exercises


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performing range of motionexercises.


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13.11 Assist in care and use of

prosthetic devices.


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Prosthetic Devices


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(continued)

EyeglassesLens made of glass or

plastic

Stored in protective

case to prevent

damage when not in

use

Held by frames

Prosthetic Devices


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(continued)

Eyeglasses (continued)Washed under running

water using mild

detergent.

rinsed with clear water

dried with tissue or softcloth

Prosthetic Devices


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(continued)

Eyeglasses (continued)Tops of ears and

nose observed for

redness or irritationfrom glasses

Wash hands before

and after cleansing

residents glasses

Prosthetic Devices


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(continued)

Contact Lenses (hard or

soft)

Resident encouragedto care for lenses

Prosthetic Devices


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(continued)

Contact Lenses (hard or soft)(continued)

Unusual observations to bereported:

redness

itching

swelling complaints of pain, blurring, orscratching sensations

Prosthetic Devices


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(continued)

Hearing AidEar piece cleaned daily with

soap and water; this is the

only washable partEar piece and tubing should

be soft

Wax cleaned from tubing with

special equipment

Prosthetic Devices


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(continued)

Hearing Aid (continued)Batteries checked for

power

Skin observed for

redness or irritation in

or around ear

Ear wax build-up

reported to supervisor

Prosthetic Devices


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(continued)

Removing hearing aid:turn volume to lowest level or offgently lift ear piece up and out of

earuse tissues to wipe wax off earpiece

store in safe placeremove battery when not in use

or open battery case

Prosthetic Devices


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(continued)

Inserting hearing aid:turn volume toward maximum

until whistle is heard

replace batteries if whistle cannot

be heard

turn volume to low setting


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Prosthetic Devices


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(continued)

BracesUses

support a weak part of the body

prevent movement of joint

correct deformities

prevent deformities

Prosthetic Devices


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(continued)

Braces (continued)Materials

metal leather plastic

Bony parts under brace requireprotection in order to prevent skin

irritation

Report any wear noticed and when

brace parts are loose or missing


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Prosthetic Devices


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(continued)

Devices for use with amputationDefinition of amputation -

partial or complete removal of

a body part

usually arm or leg

below knee most commonamputation

Prosthetic Devices


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(continued)

Devices for use with amputation(continued)

Examples of prosthetic devices:

artificial leg

artificial foot

artificial arm artificial hand


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Devices For Use With Amputation


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p

Assisting with artificial limbs (continued):clean according to individual

instructions

report any needed repairs tosupervisor

observe and report any skinchanges to supervisor


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13.12 Assist the resident in the proper

use of body mechanics.

Body Mechanics For Residents


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y

Broad base of supportleads to better balance

and stability

Keep weight the same on

both feet

Stoop using the hips andknees

Body Mechanics For Residents( ti d)


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(continued)

Keep the back straight

Lift and carry objects close

to body for better balance.

Use both hands to lift or

move objects

Use smooth, evenmovements

Body Mechanics For Residents( ti d)


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(continued)

Do not bend or reachif injury possible; ask

for help

Do not twist body to

reach an object

Keep body in goodalignment


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13.13 Provide assistance for the

resident with dangling, standingand walking.

Dangling


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Dangling - sitting on edge of bedbefore getting up

Standing up too quickly may cause

feeling of dizziness and faintingmay occur

Dangling( ti d)


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(continued)

Dangling for several minutes allowsresident to progress to standing and

walking without feeling faint

Taking deep breaths helps to prevent

light-headedness

Dangling(continued)


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(continued)

Most common signs/symptoms iffeeling faint:

pale face

complaints of dizziness or

weakness

Dangling(continued)


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(continued)

Return resident to supine position if

they have difficulty dangling

If dangling is well tolerated, progressto standing position

Standing


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Get assistance if resident is weak orunsteady

Assist resident to stand by placing

your hands under the residents armswith hands around the shoulderblades, and use good bodymechanics to assist to standingposition


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Ambulating


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Effects on body

stimulates circulation

strengthens muscles

relieves pressure on bodyparts

increases joint mobility

improves function ofdigestive and urinarysystems

Ambulating(continued)


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(continued)

Effects on body (continued) increased independence

leads to more positive

self-image provides sense of

accomplishment

prevents lung congestion



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(continued)

Encourage to ambulate as muchas possible

Suggest use of handrails for

support



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(continued)

If resident starts to fall, ease tothe floor by:

grasping under arms

resting buttocks against nurse

aides leg

sliding down aides leg to floor



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(continued)

Be prepared to assist, but allow theresident to do as much as possible

Safety considerations:

use gait belt

get assistance if needed

allow adequate time for walkingso resident does not feel rushed


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assisting the resident to dangle,stand and walk.


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13.15 Provide cast care for the

resident.

Cast Care


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Cast used to immobilizebody part, providing time

for part to heal

Cast Care(continued)


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(continued)

Cast materialsPlaster of Paris

24-48 hours to dry expands and gives offheat while drying

Fiberglass dries rapidly lighter than plaster casts

Plastic



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(continued)

Care of CastsAllow to air dry

Keep cast uncoveredUse pillows to support

cast

Support cast with palmsof hands



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(continued)

Care of CastsNever put pressure on

cast

Turn and position

frequently to allow air to

circulate around cast



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(continued)

Maintain good bodyalignment

Keep cast dry

Observe cast for rough

edges and report

Over-bed trapezeprovided if appropriate

Cast Care: Observations To Report

To Supervisor Immediately


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Drainage

Odors

Swelling of fingers or toes,inability to move parts

Change in color of skin:

paleness, cyanosis




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To Supervisor Immediately(continued)

Vomiting

Elevated temperature

Skin irritation around

edge of cast




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To Supervisor Immediately(continued)

Resident reports of:

Pain

Numbness Tingling

sensations

Chills

Hot or cold skin

Itching

TightnessInability to

move fingers

or toes

Nausea


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13.16 Demonstrate the proper

technique for transferring aresident from a bed to a chair.


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13.17 Demonstrate the proper

technique for transferring aresident from a bed towheelchair.


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unit 13-basic restorative services

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