CHAPTER 20 ASSISTING WITH EXERCISE CHAPTER 23 ASSISTING WITH REHABILITATION

1. CHAPTER 20 ASSISTING WITH EXERCISE CHAPTER 23 ASSISTING WITH REHABILITATION

2. BEDREST • ORDERED TO: • REDUCE PHYSICAL ACTIVITY • REDUCE PAIN • ENCOURAGE REST • REGAIN STRENGTH • PROMOTE HEALING MAY BE ON: COMPLETE (STRICT) BED REST BEDREST WITH BATHROOM PRIVILEDGES (BRP)

3. COMPLICATIONS OF BEDREST CONTRACTURES CAUSED BY ABNORMAL SHORTENING OF A MUSCLE MUSCLE IS FIXED IN POSITION, IS DEFORMED, AND CAN NOT BE MOVED THE PERSON IS PERMANENTLY DEFORMED ATROPHY DECREASE IN THE SIZE OR THE WASTING AWAY OF MUSCLE TISSUE

4. COMPLICATIONS OF BEDREST ORTHOSTATIC HYPOTENSION ABNORMALLY LOW BLOOD PRESSURE WHEN THE PERSON STANDS UP TO SUDDENLY WHEN YOU STAND TOO QUICKLY, THE BLOOD PRESSURE DROPS. THE PERSON MAY FEEL DIZZY, WEAK, HAVE SPOTS BEFORE THE EYES

5. SUPPORTIVE DEVICES HAND ROLLS PREVENT CONTRACTURES OF THE FINGERS AND WRIST WHAT CAN YOU USE IF YOU DO NOT HAVE A HAND ROLL?

6. SUPPORTIVE DEVICES FOOTBOARD PLACED SO THE SOLES OF THE FEET ARE FLAT AGAINST IT BED CRADLE KEEPS THE WEIGHT OF THE TOP LINEN OFF THE FEET AND TOES THE FOOT IS BENT DOWN PLANTAR FLEXION

7. SUPPORTIVE DEVICES TROCHANTER ROLL PREVENTS THE HIP AND LEG FROM ROTATING OUTWARD HIP ABDUCTION WEDGE KEEPS THE PERSON’S LEGS ABDUCTED SPLINT KEEPS THE ELBOWS,WRISTS,THUMBS, FINGERS, ANKLES, OR KNEES IN NORMAL POSITION

8. RANGE-OF-MOTION EXERCISES • THE MOVEMENT OF A JOINT TO THE EXTENT POSSIBLE WITHOUT CAUSING PAIN • MOVE THE JOINT THROUGH THEIR COMPLETE RANGE OF MOTION • DONE AT LEAST TWICE A DAY • WILL BE ORDERED BY DOCTOR OR NURSE ACTIVE RANGE-OF-MOTION EXERCISES - DONE BY THE PERSON PASSIVE RANGE-OF-MOTION EXERCISES - ANOTHER PERSON MOVES THE JOINT ACTIVE-ASSISTIVE RANGE OF MOTION EXERCISES - THE PERSON DOES SOME OF THE MOVEMENT WITH HELP FROM ANOTHER PERSON

9. TYPES OF JOINTS

10. JOINT MOVEMENTS ABDUCTION - MOVING A BODY PART AWAY FROM THE MIDLINE OF THE BODY ADDUCTION - MOVING A BODY PART TOWARD THE MIDLINE OF THE BODY EXTENSION - STRAIGHTENING A BODY PART FLEXION - BENDING A BODY PART ROTATION - TURNING THE JOINT INTERNAL ROTATION - TURNING THE JOINT INWARD EXTERNAL ROTATION - TURNING THE JOINT OUTWARD PLANTAR FLEXION - BENDING THE FOOT DOWN AT THE ANKLE PRONATION - TURNING THE JOINT DOWNWARD SUPINATION - TURNING THE JOINT UPWARD

11. JOINT MOVEMENT

12. RANGE - OF - MOTION EXERCISES • WHEN DELEGATED RANGE-OF-MOTION EXERCISES YOU WILL NEED THIS INFORMATION TO SAFELY COMPLETE THE TASK • WILL YOU PERFORM ACTIVE, PASSIVE, OR ACTIVE ASSIST RANGE-OF-MOTION • WHICH JOINT WILL YOU BE EXERCISING • HOW OFTEN WILL YOU BE DOING THE EXERCISE • HOW MANY TIMES WILL YOU REPEAT EACH EXERCISE • RECORD THE FOLLOWING: * THE TIME YOU PERFORMED THE EXERCISES * THE JOINTS THAT WERE EXERCISED * THE NUMBER OF TIMES THE EXERCISES WERE PERFORMED ON EACH JOINT * ANY COMPLAINTS OF PAIN OR STIFFNESS * TO WHAT DEGREE DID THE PATIENT ASSIST

13. PERFORMING RANGE-OF-MOTION EXERCISES • EXERCISE ONLY THE JOINTS THE NURSE TELLS YOU TO EXERCISE • EXPOSE ONLY THE BODY PART BEING EXERCISED • USE GOOD BODY MECHANICS • SUPPORT THE PART BEING EXERCISED • MOVE THE JOINT SLOWLY, SMOOTHLY, AND GENTLY • DO NOT FORCE A JOINT BEYOND ITS PRESENT RANGE OR MOTION OR TO THE POINT OF PAIN • REPEAT EACH EXERCISE 5 TIMES PER JOINT • KNOW THE FACILITY POLICY IN REGARDS TO RANGE OF MOTION EXERCISES FOR THE NECK

14. AMBULATION • AMBULATION IS THE ACT OF WALKING • SOME PEOPLE ARE WEAK AND UNSTEADY • CHECK THE CARE PLAN TO SEE WHAT ASSISTANCE IS NEEDED • ALWAYS USE A GAIT BELT • KNOW THE PERSON’S LIMITATIONS * HOW FAR CAN THEY WALK * ANY PARALYSIS OR WEAKNESS IN LEGS * ANY ASSISTIVE DEVICE (CANE, WALKER, CRUTCHES) • THE PERSON MUST WEAR NON-SKID SHOES • DANGLE THE PERSON FOR A FEW MINUTES BEFORE STANDING THEM UP • WALK TO THE SIDE AND SLIGHTLY BEHIND THE PERSON • STAND ON THE PERSON’S WEAK SIDE • THE PERSON SHOULD LOOK FORWARD, NOT AT THE FLOOR • ENCOURAGE THEM TO WALK NORMALLY

15. THE FALLING PERSON DO NOT TRY TO PREVENT THE FALL YOU COULD HURT YOURSELF OR THE PATIENT BY DOING SO IF A PERSON BEINGS TO FALL, STEP BACK AND EASE HIM TO THE FLOOR THIS ALLOWS YOU TO CONTROL THE FALL DO NOT ALLOW THE PERSON TO GET UP UNTIL CHECKED BY THE NURSE

16. WALKING AIDES CRUTCHES • CRUTCHES ARE USED WHEN THE PERSON CANNOT USE ONE LEG OR WHEN ONE LEG IS WEAK • MUST HAVE RUBBER TIPS ON THE BOTTOM • CHECK ALL BOLTS FOR TIGHTNESS • WEAR NON-SKID SHOES • MUST BE ADJUSTED CORRECTLY FOR PERSON’S HEIGHT

17. CANES CANES ARE USED FOR WEAKNESS ON ONE SIDE OF THE BODY. THEY HELP PROVIDE BALANCE AND SUPPORT • CANES ARE HELD ON THE STRONG SIDE OF THE BODY • DIFFERENT CANES MEET DIFFERENT NEEDS OF THE PERSON WALKING CANE TRIPOD QUAD

18. THREE-POINT GAIT • SUPPORT WEIGHT ON STRONG LEG AND MOVE CANE FORWARD ABOUT 6 - 10 INCHES • THE WEAK LEG IS ROUGHT FORWARD EVEN WITH THE CANE • SHIFT WEIGHT TO THE WEAK LEG AND THE CANE, MOVING THE STRONG LEG FORWARD AHEAD OF THE CANE • REPEAT MOTIONS TO MOVE AHEAD

19. WALKER • A WALKER GIVES MORE SUPPORT THAN A CANE • THE WALKER IS PICKED UP AND MOVED ABOUT 6 TO 8 INCHES IN FRONT OF THE PERSON • THE PERSON MOVES THE WEAK LEG FORWARD • THEN MOVES THE STRONG LEG FORWARD DO NOT LET THE PERSON DRAG THE WALKER ON THE FLOOR - IT MUST BE PICKED UP MAY HAVE WHEELS ON THE WALKER TO ASSIST WITH MOVEMENT MAY HAVE BASKETS OR TRAYS ATTACHED TO THE FRONT SO THEY MAY CARRY ITEMS WITH THEM

20. BRACES • BRACES SUPPORT WEAK BODY PARTS • THEY PREVENT OR CORRECT DEFORMITIES OR PREVENT JOINT MOVEMENT • SKIN AND BONY PROMINENCES UNDER THE BRACE ARE KEPT CLEAN AND PROTECTED • REPORT ANY COMPLAINTS OF PAIN OR DISCOMFORT • THE NURSE OR CARE PLAN WILL TELL YOU WHEN TO APPLY THE BRACE

21. REHABILITATION • THE PROCESS OF RESTORING THE PERSON TO HIS OR HER HIGHEST POSSIBLE LEVEL OF FUNCTIONING • MUST LOOK AT THE “WHOLE” PERSON - PHYSICAL, PSYCOLOGICAL, SOCIAL, AND ECONOMIC • GOALS ARE DIFFERENT FOR EACH INDIVIDUAL • STRIVE TO MAKE PERSON AS INDEPENDENT AS POSSIBLE

22. PHYSICAL ASPECTS REHABILITATION BEGINS WHEN PERSON IS FIRST ADMITTED TO HEALTH CARE FACILITY NURSING CARE IS GIVEN TO PREVENT COMPLICATIONS THAT WILL IMPACT REHABILITATION EFFORTS SELF-CARE IS A MAJOR GOAL PERSON WILL PERFORM ACTIVITIES OF DAILY LIVING AS INDEPENDENTLY AS POSSIBLE MAY NEED ASSISTIVE DEVICES

23. PROSTHESIS AN ARTIFICIAL REPLACEMENT FOR A MISSING BODY PART THE PERSON IS MEASURED AND FITTED FOR THE PROSTHESIS THE PERSON LEARNS HOW TO USE THE PROSTHESIS

24. PSYCHOLOGICAL AND SOCIAL ASPECTS SELF-ESTEEM MAY BE AFFECTED BY LOSS OF FUNCTION OR APPEARANCE THE PERSON MAY FEEL WORTHLESS OR UNATTRACTIVE THE PERSON MAY DENY THE DISABILITY THEY MAY BE DEPRESSED, ANGRY, AND HOSTILE THE PERSON MUST BE MOTIVATED TO IMPROVE OR REHABILITATION WILL NOT BE SUCCESSFUL THE PERSON MUST ACCEPT HIS OR HER LIMITATIONS THE FOCUS IS ON WHAT THE PERSON CAN DO - NOT ON WHAT THEY CANNOT DO PROGRESS MAY BE SLOW SO SHOW POSITIVE ENCOURAGEMENT FOR ANY SMALL SUCCESS OR PROGRESS THE PATIENT SHOWS

25. ASSISTING WITH REHABILITATION • MAINTAIN THE PERSON’S DAILY ROUTINE • GIVE GOOD NURSING CARE TO PREVENT COMPLICATIONS • REPORT ANY SIGNS OF COMPLICATIONS • APPLY ASSISTIVE DEVICES AS NEEDED • DO NOT GIVE SYMPATHY OR PITY THE PERSON • ENCOURAGE THE PERSON TO BE INDEPENDENT WHEN PERFORMING ADL’S • DO NOT HURRY THE PERSON. GIVE THEM TIME TO COMPLETE THE TASK • GIVE PRAISE FOR EVERY PROGRESS MADE, EVEN IF THE PROGRESS WAS SMALL • PROVIDE EMOTIONAL SUPPORT • BE UNDERSTANDING • BE FAMILIAR WITH EQUIPMENT AND ASSITIVE DEVICES • FOCUS ON WHAT THE PERSON CAN DO • ALLOW THE PERSON CHOICES WHEN APPROPRIATE