Rehabilitation Concepts for Acute and Chronic Problems

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Rehabilitation Concepts for Acute and Chronic
Problems
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Definitions

• Chronic Illness or condition has existed for at
  least 3 months.
• Disabling condition any physical for mental
  health problem that can cause disability.
• Rehabilitation process of learning to live with
  chronic and disabling conditions

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Definitions (continued)

• Impairment an abnormality of a body structure or
  structures or an alteration in a body system
  function resulting from any cause represents a
  disturbance at the organ level
• Disability consequence of an impairment and is
  usually described in terms of clients altered
  functional ability
• Handicap the disadvantage experienced by a
  person as a result of impairments and
  disabilities represents a disturbance at the
  societal level

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Rehabilitation Goal

• To return the client to fullest possible
  physical, mental, social, vocational, and
  economic capacity.

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Rehab A Team Approach

• Successful rehabilitation depends upon the
  coordinated effort of health care professionals,
  interdisciplinary rehabilitation team, and
  involvement of the client, family and other
  support systems.

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Rehabilitation Team Goals

• Prevention of injury
• Restoration of function

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Focused Assessment Of Rehabilitation Clients

• Cardiovascular system
• Respiratory system
• Gastrointestinal system and nutrition
• Renal-urinary system
• Neurologic system
• Musculoskeletal system
• Integumentary system
• (see Table 10-1,
  p. 121)

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Additional Assessment Areas

• Functional Assessment
• Psychosocial Assessment
• Vocational Assessment

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Common Nursing Diagnoses

• Impaired physical mobility r/t neuromuscular
  impairment, sensory-perceptual impairment, pain,
  activity intolerance, fatigue or the effects of
  trauma or surgery.
• Self-care deficit (Total or Partial) r/t effects
  of trauma or chronic illness, muscular weakness,
  pain, immobility, or perceptual-cognitive
  impairment.

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Nursing Diagnoses (Cont.)

• Risk for Impaired Skin Integrity r/t altered
  sensation or mobility.
• Impaired Urinary Elimination r/t sensorimotor
  impairment or immobility.
• Constipation r/t neuromuscular or musculoskeletal
  impairment or immobility.
• Ineffective Coping r/t effects of chronic
  illness, loss of control over body part or a body
  function, or major changes in lifestyle.

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Impaired Physical Mobility

• Expected Outcome
• (1) achieve the maximum physical mobility
  possible with the least restriction of activity
• (2) avoid consequences resulting from immobility

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Impaired Physical Mobility

• Interventions
• Transfer techniques
• Alternative transfer techniques
• Gait training (review Chart 10-2, p. 125)
• Anticipating potential problems with transfers
• Preventing complications of immobility

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Self-Care Deficit

• Expected Outcome
• to become independent in ADLs to the extent
  possible based on his/her disability.

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Self-Care Deficit

• Interventions
• Encouraging client to perform as much of their
  self-care as possible
• Offering emotional support
• Using assistive/adaptive devices
• Energy conservation

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Risk for Impaired Skin Integrity

• Expected Outcome
• to have intact skin

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Impaired Skin Integrity

• Interventions
• Turning and repositioning
• Skin care
• Nutrition
• Mechanical devices

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Impaired Urinary Elimination

• Expected Outcome
• (1) achieve a personally acceptable form or
  urinary elimination
• (2) be free from urinary complications

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Classification of Bladder Dysfunction

• Reflex or spastic (upper motor neuron) bladder
  causes incontinence that is characterized by
  sudden, gushing voids.
• Flaccid (lower motor neuron) bladder results in
  urinary retention and overflow (dribbling)
• Uninhibited bladder result of neurologic
  problem, little sensorimotor control and cannot
  wait until on commode or bedpan before voiding.
  Bladder may not completely empty.

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Impaired Urinary Elimination

• Interventions
• Bladder Training
• Facilitating triggering techniques
• Intermittent catheterization (clean technique)
• Toileting schedule
• Drug Therapy
• Fluid Intake
• Prevention of Complications

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Constipation

• Expected Outcome
• to achieve a personally acceptable form of bowel
  elimination and be free from bowel elimination
  complications

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Constipation

• Interventions
• Bowel Training
• Drug Therapy
• Nutrition
• Prevention of Complications

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Ineffective Coping

• Expected Outcome
• to learn to cope with the chronic illness or
  disability and participate in the rehabilitation
  program.

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Ineffective Coping

• Interventions
• Encourage client to discuss feelings
• Assess clients acceptance of and ability to cope
  with the disability
• Assess for role changes and need for vocational
  training
• Assess for socialization problems and assist with
  re-socialization.
• Assess previous coping strategies, incorporating
  successful strategies and assisting client to
  change unsuccessful ones.

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Remember

• Discharge planning begins at admission!!!
• Health teaching needs must be assessed and
  addressed.