Chapter 9 Care of the Rehabilitation Patient

1. Chapter 9Care of the Rehabilitation Patient

2. Goals for Rehabilitation • Patient’s physical, emotional, and social functions will be restored and maintained.

3. Specialized Rehabilitation Centers There are specialized rehabilitation centers for: • Brain and spinal cord injuries • Stroke rehabilitation • Burn injuries • Acute mental illness • Drug or alcohol addiction

4. Members of the Rehabilitation Team • Rehabilitation physician (physiatrist) • Rehabilitation nurse • Occupational therapist • Physical therapist • Speech therapist • Rehabilitation aide • Orthotist • Prosthetist • Neuropsychologist

5. FACTORS AFFECTING REHAB EFFORT • 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

6. FACTORS 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

7. Spinal Cord Injury

8. SPINAL 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

9. Traumatic 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 bruiseon 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.

10. Rancho Los Amigos Scale

11. Question Bleeding and swelling of the brain tissue after trauma results in an increase in which of the following? • TBI • Intracranial pressure • Concussion • Osteoporosis

12. Answer 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.

13. Observations 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

14. 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

15. ACUTE AND SUBACUTE PHASES • MONITOR LOC • RESPIRATORY SUPPORT • MONITOR VITALS • OBSERVATION FOR INTERNAL BLEEDING • AIRWAY SUCTIONING

16. CHRONIC PHASE OF REHAB • SELF CARE SKILLS • COGNITIVE SKILLS • SPEECH SKILLS • SWALLOWING

17. 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

18. CARDIOVASCULAR 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

19. ACUTE AND SUBACUTE PHASES • MEDICATIONS TO STOP OR CONTROL CARDIAC SYMPTOMS • MONITOR OXYGEN LEVELS • BED REST • CONTINUOUS ECG

20. CHRONIC PHASE • REGAIN STRENGTH • ADOPT HABITS TO HELP CARDIO SYSTEM BECOME HEALTHIER • EXERCISE • PROPER DIET • SMOKING CESSATION • MEDICATIONS

21. 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

22. MUSCULOSKELETAL DISORDERS • HIP FRACTURE • SOME RESULT IN DEATH IN ELDERLY • CAN CAUSE IMMOBLITY • COMPLICATIONS OF IMMOBILITY • PNEUMONIA • BLOOD CLOTS

23. MUSCULOSKELETAL DISORDERS • ACUTE AND SUB-ACUTE PHASES • STABILIZE THE PATIENT • PAIN MANAGEMENT • PREVENT MOVEMENT THAT CAUSES MORE DAMAGE TO HIP • PREPARE FOR SURGERY

24. Surgical Repair of Hip Fracture

25. CHRONIC PHASE • BUILD MUSCLE • INCREASE STRENGTH • BALANCE EXCERCISES • GAIT TRAINING

26. AMPUTATION • NECESSARY AS A RESULT OF TRAUMA OR DISEASE • BONE CANCER • DIABETES • ACCIDENT • CIRCULATORY DISORDER

27. ACUTE 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

28. CHRONIC PHASE • ENSURE PROPER HEALING OF THE STUMP • ADJUSTMENTS TO LOSS OF LIMB • PREVENTION OF ANOTHER LOSS • JOB TRAINING • PROSTHETIC FITTINGS

29. Prosthetic Device

30. BURNS • SEVERITY IS DETERMINED BY • DEPTH • SURFACE AREA INVOLVED • AGE • LOCATION • OTHER INJURIES OR CONDITIONS

31. Burn Depth

32. Burn Surface Area

33. ACUTE 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

34. CHRONIC PHASE • MAY BE OVER THE COURSE OF MANY YEARS • SPLINTS AND OTHER SUPPORTIVE DEVICES MAY BE USED • SURGICAL PROCEDURES • SKIN GRAFTS • DEBRIDEMENT • PSYCHOLOGICAL CARE

35. Question Tell whether the following statement is true or false. Geriatric patients receive no benefit from rehabilitation. • True • False

36. Answer 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.