Download Chapter 9 Rehab

Chapter 9
Care of the Rehabilitation Patient
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Goals for Rehabilitation
• Patient’s physical, emotional, and social functions will be
restored and maintained.
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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
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Members of the Rehabilitation Team
• Rehabilitation physician (physiatrist)
• Rehabilitation nurse
• Occupational therapist
• Physical therapist
• Speech therapist
• Rehabilitation aide
• Orthotist
• Prosthetist
• Neuropsychologist
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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
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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
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Spinal Cord Injury
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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
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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 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.
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Rancho Los Amigos Scale
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Question
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
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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.
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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
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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
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ACUTE AND SUBACUTE PHASES
• MONITOR LOC
• RESPIRATORY SUPPORT
• MONITOR VITALS
• OBSERVATION FOR INTERNAL BLEEDING
• AIRWAY SUCTIONING
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CHRONIC PHASE OF REHAB
• SELF CARE SKILLS
• COGNITIVE SKILLS
• SPEECH SKILLS
• SWALLOWING
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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
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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
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ACUTE AND SUBACUTE PHASES
• MEDICATIONS TO STOP OR CONTROL CARDIAC
SYMPTOMS
• MONITOR OXYGEN LEVELS
• BED REST
• CONTINUOUS ECG
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CHRONIC PHASE
• REGAIN STRENGTH
• ADOPT HABITS TO HELP CARDIO SYSTEM BECOME
HEALTHIER
• EXERCISE
• PROPER DIET
• SMOKING CESSATION
• MEDICATIONS
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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
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MUSCULOSKELETAL DISORDERS
• HIP FRACTURE
– SOME RESULT IN DEATH IN ELDERLY
– CAN CAUSE IMMOBLITY
• COMPLICATIONS OF IMMOBILITY
• PNEUMONIA
• BLOOD CLOTS
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MUSCULOSKELETAL DISORDERS
• ACUTE AND SUB-ACUTE PHASES
– STABILIZE THE PATIENT
– PAIN MANAGEMENT
– PREVENT MOVEMENT THAT CAUSES MORE DAMAGE
TO HIP
– PREPARE FOR SURGERY
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Surgical Repair of Hip Fracture
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CHRONIC PHASE
• BUILD MUSCLE
• INCREASE STRENGTH
• BALANCE EXCERCISES
• GAIT TRAINING
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AMPUTATION
• NECESSARY AS A RESULT OF TRAUMA OR DISEASE
– BONE CANCER
– DIABETES
– ACCIDENT
– CIRCULATORY DISORDER
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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
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CHRONIC PHASE
• ENSURE PROPER HEALING OF THE STUMP
• ADJUSTMENTS TO LOSS OF LIMB
• PREVENTION OF ANOTHER LOSS
• JOB TRAINING
• PROSTHETIC FITTINGS
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Prosthetic Device
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BURNS
• SEVERITY IS DETERMINED BY
– DEPTH
– SURFACE AREA INVOLVED
– AGE
– LOCATION
– OTHER INJURIES OR CONDITIONS
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Burn Depth
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Burn Surface Area
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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
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CHRONIC PHASE
• MAY BE OVER THE COURSE OF MANY YEARS
• SPLINTS AND OTHER SUPPORTIVE DEVICES MAY BE
USED
• SURGICAL PROCEDURES
– SKIN GRAFTS
– DEBRIDEMENT
o PSYCHOLOGICAL CARE
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Question
Tell whether the following statement is true or false.
Geriatric patients receive no benefit from rehabilitation.
A. True
B. False
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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.
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins