copyright © 2010 wolters kluwer health | lippincott williams & wilkins chapter 9 care of the...

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 9Care of the Rehabilitation Patient

Chapter 9Care of the Rehabilitation Patient


Goals for RehabilitationGoals for Rehabilitation

• Patient’s physical, emotional, and social functions will be restored and maintained.


Specialized Rehabilitation CentersSpecialized Rehabilitation Centers

There are specialized rehabilitation centers for:

• Brain and spinal cord injuries

• Stroke rehabilitation

• Burn injuries

• Acute mental illness

• Drug or alcohol addiction


• Rehabilitation physician (physiatrist)

• Rehabilitation nurse

• Occupational therapist

• Physical therapist

• Speech therapist

• Rehabilitation aide

• Orthotist

• Prosthetist

• Neuropsychologist

Members of the Rehabilitation TeamMembers of the Rehabilitation Team


• ATTITUDE AND COPING SKILLS

– REQUIRES EFFORT

– IS OFTEN PAINFUL

– SUCCESS DEPENDENT OF COPING SKILLS

• RESPONSE OF FAMILY AND CAREGIVER TO DISABILITY

– ALLOWING THE PERSON TO DO THEIR OWN CARE

FACTORS AFFECTING REHAB EFFORTFACTORS AFFECTING REHAB EFFORT


FACTORS AFFECTING REHAB EFFORTFACTORS AFFECTING REHAB EFFORT

• OVERALL HEALTH STATUS

– MAY BE CHRONIC HEALTH PROBLEMS PRESENT

– EX. DIABETES, OSTEOPOROSIS, ARTHRITIS

– DELAY THE REHAB EFFORT AND MAKE COMPLETE RESTORATION IMPOSSIBLE

• AGE

– AGE RELATED CHANGES MAKE IT MORE DIFFICULT FOR THE ELDERLY


Spinal Cord InjurySpinal Cord Injury


SPINAL CORD INJURIESSPINAL CORD INJURIES

• DISABLITY DEPENDS ON

– THE SEVERITY OF INJURY

– LOCATION OF THE INJURY

• CERVICAL (C5, C6, C7)= QUADRIPLEGIA

• THORACIC (T12, L1)=PARAPLEGIA

• LUMBAR =PARAPLEGIA

• SACRAL

• RARELY RESULTS IN PARALYSIS


Traumatic Brain InjuryTraumatic Brain Injury

• A concussion is a temporary change in mental status caused by head trauma.

• A skull fracture occurs when the bones of the skull break.

• A cerebral contusion is a bruise on the brain that occurs when the brain tissue hits the skull.

• A hematoma is a pool of blood.

• An epidural hematoma occurs when blood collects between the skull and the dura mater.


Rancho Los Amigos Scale Rancho Los Amigos Scale


QuestionQuestion

Bleeding and swelling of the brain tissue after trauma results in an increase in which of the following?

A. TBI

B. Intracranial pressure

C. Concussion

D. Osteoporosis


AnswerAnswer

B. Intracranial pressure

The ICP is the pressure in the space between the skull and the brain. (Intra means “within” and cranial means “the skull.”) An increase in the ICP can crush the brain tissue, reduce blood flow to the brain tissue, or cause structures in the brain to shift position. If the ICP remains too high for too long, severe disability or death can result.


Observations to Report to the Nurse ImmediatelyObservations to Report to the Nurse Immediately

• The person complains of headache or increased head pain

• The person complains of dizziness

• The person is restless or agitated

• There are changes in the person’s respirations

• The person’s pupils are unequal in size

• The person complains of sudden weakness or loss of feeling in any body part

• The person’s speech is slurred

• There is drainage from the person’s ears or nose


STROKE (CVA)STROKE (CVA)

• TWO TYPES

– ISCHEMIC

• BLOCKAGE OF AN ARTERY PREVENTING BLOOD FLOW TO THE BRAIN

• LACK OF OXYGEN CAUSES TISSUE TO DIE

• HEMORRHAGIC

• ARTERY IN THE BRAIN BURSTS

• BLEEDING INTO SURROUNDING TISSUE CAUSING DAMAGE


ACUTE AND SUBACUTE PHASESACUTE AND SUBACUTE PHASES

• MONITOR LOC

• RESPIRATORY SUPPORT

• MONITOR VITALS

• OBSERVATION FOR INTERNAL BLEEDING

• AIRWAY SUCTIONING


CHRONIC PHASE OF REHABCHRONIC PHASE OF REHAB

• SELF CARE SKILLS

• COGNITIVE SKILLS

• SPEECH SKILLS

• SWALLOWING


Observations to Report to the Nurse Immediately (cont)Observations to Report to the Nurse Immediately (cont)

• There is a change in the person’s LOC

• There is a change in the person’s vital signs, especially the blood pressure or pulse

• The person shows signs or symptoms of a stroke that were not present before (for example, drooling; drooping of the eyelid; slurred speech; paralysis, tingling, or numbness of an arm, leg, or one side of the face)

• The person complains of the sudden onset of a severe headache


CARDIOVASCULAR DISORDERSCARDIOVASCULAR DISORDERS

• MOST COMMON

– CORONARY ARTERY DISEASE

• NARROWING OF CORONARY ARTERIES DECREASING BLOOD FLOW TO THE HEART

– MYOCARDIAL INFARCTION

• ONE OR MORE OF THE CORONARY ARTERIES BECOME BLOCKED

• PART OF THE HEART DIE FROM LACK OF OXYGEN


ACUTE AND SUBACUTE PHASESACUTE AND SUBACUTE PHASES

• MEDICATIONS TO STOP OR CONTROL CARDIAC SYMPTOMS

• MONITOR OXYGEN LEVELS

• BED REST

• CONTINUOUS ECG


CHRONIC PHASECHRONIC PHASE

• REGAIN STRENGTH

• ADOPT HABITS TO HELP CARDIO SYSTEM BECOME HEALTHIER

• EXERCISE

• PROPER DIET

• SMOKING CESSATION

• MEDICATIONS


Observations to Report to the Nurse Immediately (cont)Observations to Report to the Nurse Immediately (cont)• complains of chest pain, “crushing,” or “squeezing”

• pain that travels down either arm or up the neck into the jaw

• sweaty, skin is cool and clammy, or face appears pale or gray

• difficulty breathing

• nausea, vomiting, or hiccups

• faints or complains of feeling very weak or tired

• disorientated, confused, or restless

• changes to vital signs (either an increase or a decrease)

• changes in the appearance of the ECG on the monitor


MUSCULOSKELETAL DISORDERSMUSCULOSKELETAL DISORDERS

• HIP FRACTURE

– SOME RESULT IN DEATH IN ELDERLY

– CAN CAUSE IMMOBLITY

• COMPLICATIONS OF IMMOBILITY

• PNEUMONIA

• BLOOD CLOTS


MUSCULOSKELETAL DISORDERSMUSCULOSKELETAL DISORDERS

• ACUTE AND SUB-ACUTE PHASES

– STABILIZE THE PATIENT

– PAIN MANAGEMENT

– PREVENT MOVEMENT THAT CAUSES MORE DAMAGE TO HIP

– PREPARE FOR SURGERY


Surgical Repair of Hip Fracture Surgical Repair of Hip Fracture



• BUILD MUSCLE

• INCREASE STRENGTH

• BALANCE EXCERCISES

• GAIT TRAINING


AMPUTATIONAMPUTATION

• NECESSARY AS A RESULT OF TRAUMA OR DISEASE

– BONE CANCER

– DIABETES

– ACCIDENT

– CIRCULATORY DISORDER


ACUTE AND SUB ACUTE PHASEACUTE AND SUB ACUTE PHASE

• PREVENTION OF HEMMORHAGING

• OBSERVE FOR SIGNS OF INFECTION

• STUMP CARE TO ALLOW FOR PROSTHETIC DEVICE

– OFTEN WRAPPED WITH ELASTIC BANDAGES TO SHAPE OR SHRINK



• ENSURE PROPER HEALING OF THE STUMP

• ADJUSTMENTS TO LOSS OF LIMB

• PREVENTION OF ANOTHER LOSS

• JOB TRAINING

• PROSTHETIC FITTINGS


Prosthetic DeviceProsthetic Device


BURNSBURNS

• SEVERITY IS DETERMINED BY

– DEPTH

– SURFACE AREA INVOLVED

– AGE

– LOCATION

– OTHER INJURIES OR CONDITIONS


Burn DepthBurn Depth


Burn Surface AreaBurn Surface Area


ACUTE AND SUBACUTE PHASEACUTE AND SUBACUTE PHASE

• INTUBATION AND VENTILATOR MAY BE NECESSARY IF THE LUNGS INHALED HOT AIR

• UNRINARY CATHETER CARE

• INFECTION PREVENTION

• ROM TO PREVENT CONTRACTURES

• PAIN MANAGEMENT

• FLUID BALANCE

– MONITOR I AND O



• MAY BE OVER THE COURSE OF MANY YEARS

• SPLINTS AND OTHER SUPPORTIVE DEVICES MAY BE USED

• SURGICAL PROCEDURES

– SKIN GRAFTS

– DEBRIDEMENT

o PSYCHOLOGICAL CARE


QuestionQuestion

Tell whether the following statement is true or false.

Geriatric patients receive no benefit from rehabilitation.

A. True

B. False


AnswerAnswer

B. False

Like all rehabilitation programs, geriatric rehabilitation programs focus on helping the person regain or maintain function and independence. Many elderly people entering rehabilitation programs were independent before rehabilitation and will return to being independent after rehabilitation. Others are entering rehabilitation with a certain degree of disability that is not expected to be resolved by rehabilitation. When this is the case, the rehabilitation effort focuses on helping the person to regain strength and prevent the loss of additional function.

copyright © 2010 wolters kluwer health | lippincott williams & wilkins chapter 9 care of the...

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