Define the following terms:

1
Define the following terms

• Rehabilitation
• care given by a specialist to restore or improve
  function after an illness or injury.

2
1. Discuss rehabilitation and restorative care

• Rehabilitation seeks to move the resident from
• Illness to health
• Disability to ability
• Dependence to independence

3
1. Discuss rehabilitation and restorative care

• The goals of rehabilitation are as follows
• Help resident regain abilities or recover from
  illness.
• Develop and promote a residents independence.
• Allow resident to feel in control of his or her
  life.
• Help resident accept or adapt to limitations of a
  disability.

4
1. Discuss rehabilitation and restorative care

• Observe and report the following
• Increase or decrease in abilities
• Change in attitude or motivation
• Change in general health
• Signs of depression or mood changes

5
Transparency 9-1 Assisting with Rehabilitation
and Restorative Care

• Be patient.
• Be positive and supportive
• Focus on small tasks and small accomplishments.
• Recognize that setbacks occur.
• Be sensitive to the residents needs.
• Encourage independence.

6
2. Describe the importance of promoting
independence and list ways exercise improves
health

• REMEMBER
• It is very important for NAs to encourage
  residents independence while assisting with or
  performing all tasks.

7
2. Describe the importance of promoting
independence and list ways exercise improves
health

• These are some problems that may result from a
  lack of mobility
• Loss of self-esteem
• Depression
• Illnesses such as pneumonia or UTI
• Constipation
• Blood clots
• Dulling of senses
• Muscle atrophy and contractures
• Increased risk of pressure sores

8
Transparency 9-2 Regular Ambulation and Exercise

• Regular ambulation and exercise help improve
• Health of skin
• Circulation
• Strength
• Sleep and relaxation
• Mood
• Self-esteem
• Appetite
• Elimination
• Blood flow
• Oxygen level

9
Define the following terms

• Ambulation
• walking.
• Adaptive/assistive devices
• special equipment that helps a person who is ill
  or disabled to perform ADLs.

10
3. Discuss ambulation and describe assistive
devices and equipment

• REMEMBER
• Check the care plan before helping a resident to
  ambulate.
• Keep the residents limitations in mind.

11
3. Discuss ambulation and describe assistive
devices and equipment

• Remember the following guidelines for cane or
  walker use
• Make sure cane or walker is in good condition.
• Make sure resident is wearing securely fastened
  non-skid footwear.
• Resident should place cane on stronger side.
• Resident should place both hands on the walker
  and walker should be placed no more than 12
  inches in front of resident.
• Stay near resident on weaker side.
• Do not hang purses or clothing on walker.
• Report to nurse if cane or walker seems to be the
  wrong height.

12
Assisting a resident to ambulate

• Equipment gait belt, non-skid shoes for the
  resident
• Wash hands. Provides for infection control.
• Identify yourself by name. Identify the resident
  by name. Resident has right to know identity of
  his or her caregiver. Addressing resident by name
  shows respect and establishes correct
  identification.

13
Assisting a resident to ambulate (contd.)

• Explain procedure to resident. Speak clearly,
  slowly, and directly. Maintain face-to-face
  contact whenever possible. Promotes understanding
  and independence.
• Provide for residents privacy with curtain,
  screen, or door. Maintains residents right to
  privacy and dignity.
• Before ambulating properly fasten non-skid
  footwear on resident. Promotes residents safety.
  Prevents falls.

14
Assisting a resident to ambulate (contd.)

• Adjust bed to a low position. Lock bed wheels.
  Assist resident to sitting position with feet
  flat on the floor. Prevents injury and promotes
  stability.
• Stand in front of and face resident.
• Brace residents lower extremities. Bend your
  knees. Place one foot between the residents
  knees. If resident has a weak knee, brace it
  against your knee. Promotes proper body
  mechanics. Reduces risk of back injury.

15
Assisting a resident to ambulate (contd.)

• With gait (transfer) belt Place belt around
  residents waist over clothing (not on bare
  skin). Bend your knees and lean forward. Grasp
  the belt on both sides. Hold him close to your
  center of gravity. Tell the resident to lean
  forward, push down on the bed with her hands, and
  stand, on the count of three. When you start to
  count, begin to rock. At three, rock your weight
  onto your back foot. Assist resident to a
  standing position.
• Without gait belt Place arms around residents
  torso under armpits, while assisting resident to
  stand.

16
Assisting a resident to ambulate (contd.)

• With gait belt Walk slightly behind and to one
  side of resident for the full distance, while
  holding onto the gait belt.
• Without gait belt Walk slightly behind and to
  one side of resident for the full distance.
  Support residents back with your arm.
• If the resident has a weaker side, stand on that
  side. Use the hand that is not holding the belt
  or the arm not on the back to offer support on
  the weak side.
• After ambulation, remove gait belt if used. Help
  resident to the bed or chair and make resident
  comfortable.

17
Assisting a resident to ambulate (contd.)

• Return bed to lowest position. Remove privacy
  measures. Lowering the bed provides for safety.
• Place call light within residents reach. Allows
  resident to communicate with staff as necessary.
• Wash your hands. Provides for infection control.
• Report any changes in resident to nurse. Provides
  nurse with information to assess resident.
• Document procedure using facility guidelines.
  What you write is a legal record of what you did.
  If you donít document it, legally it didnít
  happen.

18
Assisting with ambulation for a resident using a
cane, walker, or crutches

• Equipment gait belt, non-skid shoes for
  resident, cane, walker, or crutches
• 1. Wash your hands. Provides for infection
  control.
• 2. Identify yourself by name. Identify the
  resident by name. Resident has right to know
  identity of his or her caregiver. Addressing
  resident by name shows respect and establishes
  correct identification.
• 3. Explain procedure to resident. Speak clearly,
  slowly, and directly. Maintain face-to-face
  contact whenever possible. Promotes understanding
  and independence.

19
Assisting with ambulation for a resident using a
cane, walker, or crutches (contd.)

1. Provide for residents privacy with curtain,
   screen, or door. Maintains residents right to
   privacy and dignity.
2. Before ambulating, properly fasten non-skid
   footwear on resident. Promotes residents safety.
   Prevents falls.
3. Adjust bed to a low position. Lock bed wheels.
   Assist resident to sitting position with feet
   flat on the floor. Prevents injury and promotes
   stability.

20
Assisting with ambulation for a resident using a
cane, walker, or crutches (contd.)

1. Stand in front of and face resident.
2. Brace residents lower extremities. Bend your
   knees. Place one foot between the residents
   knees. If resident has a weak knee, brace it
   against your knee. Promotes proper body
   mechanics. Reduces risk of back injury.
3. Place gait belt around residents waist over
   clothing (not on bare skin). Grasp the belt on
   both sides, while helping resident to stand as
   previously described. Promotes residents safety.

21
Assisting with ambulation for a resident using a
cane, walker, or crutches (contd.)

• Help as needed with ambulation.
• a. Cane. Resident places cane about 12 inches in
  front of his stronger leg. He brings weaker leg
  even with cane. He then brings stronger leg
  forward slightly ahead of cane. Repeat.
• b. Walker. Resident picks up or rolls the
  walker. He places it about 12 inches in front of
  him. All four feet or wheels of the walker should
  be on the ground before resident steps forward to
  the walker. The walker should not be moved again
  until the resident has moved both feet forward
  and is steady. The resident should never put his
  feet ahead of the walker. Promotes stability and
  prevents falls.

22
Assisting with ambulation for a resident using a
cane, walker, or crutches (contd.)

• (contd.)
• Crutches. Resident should be fitted for crutches
  and taught to use them correctly by a physical
  therapist or nurse. The resident may use the
  crutches several different ways. It depends on
  what his weakness is. No matter how they are
  used, weight should be on the residents hands
  and arms. Weight should not be on the underarm
  area.
• Walk slightly behind and to one side of resident.
  Stay on the weaker side if resident has one. Hold
  the gait belt if one is used. Provides security.

23
Assisting with ambulation for a resident using a
cane, walker, or crutches (contd.)

• Watch for obstacles in the residents path. Ask
  the resident to look ahead, not down at his feet.
  Promotes residents safety. Prevents injury.
• Encourage resident to rest if he is tired. When a
  resident is tired, it increases the chance of a
  fall. Let resident set the pace. Discuss how far
  he plans to go based on the care plan. Prevents
  falls.
• After ambulation, remove gait belt. Help resident
  to a position of comfort and safety.

24
Assisting with ambulation for a resident using a
cane, walker, or crutches (contd.)

• Walk slightly behind and to one side of resident.
  Hold the transfer belt if one is used. Provides
  security.
• Watch for obstacles in the residents path. Ask
  the resident to look ahead, not down down at his
  feet. Promotes residents safety. Prevents
  injury.
• Encourage resident to rest if he is tired. When a
  resident is tired, it increases the chance of a
  fall. Let resident set the pace. Discuss how far
  he plans to go based on the care plan. Prevents
  falls.

25
Assisting with ambulation for a resident using a
cane, walker, or crutches (contd.)

• Leave bed in lowest position. Remove privacy
  measures.
• Place call light within residents reach. Allows
  resident to communicate with staff as necessary.
• Wash your hands. Provides for infection control.

26
Assisting with ambulation for a resident using a
cane, walker, or crutches (contd.)

• Report any changes in resident to nurse. Provides
  nurse with information to assess resident.
• Document procedure using facility guidelines.
  What you write is a legal record of what you did.
  If you dont document it, legally it didnt
  happen.

27
Transparency 9-3 Proper Body Alignment

• Observe principles of alignment.
• Keep body parts in natural positions.
• Prevent external rotation of hips.
• Change positions frequently, at least every two
  hours.
• Have plenty of pillows available to provide
  support in the various positions.
• Use positioning devices.
• Give back rubs as ordered.

28
4. Explain guidelines for maintaining proper body
alignment

• REMEMBER
• Proper body alignment aids recovery and prevents
  injury to muscles and joints.

29
5. Describe care and use of prosthetic devices

• Remember these guidelines for caring for a
  prosthesis
• Be supportive.
• Help with ADLs.
• Handle prostheses carefully and follow care plan.
• Follow nurses or therapists instructions for
  application and removal. Follow manufacturers
  care directions.
• Keep prosthesis and the skin under it clean and
  dry.
• Apply stump sock if ordered.
• Observe skin on stump and watch for signs of
  breakdown.
• Understand that phantom sensation is real pain.

30
5. Describe care and use of prosthetic devices

• Guidelines for caring for a prosthesis (contd.)
• Never try to repair a prosthesis. Report
  problems.
• Never display negative feelings about prosthesis
  or stump during care.
• If caring for an artificial eye, never clean or
  soak the eye in alcohol - it will crack and
  destroy it.
• Store artificial eye in water or saline. Mark
  container with residents name and room number.
• Make sure resident with hearing aid wears it and
  that it is working properly.

31
Define the following terms

• Range of motion (ROM) exercises
• exercises that put a joint through its full arc
  of motion.
• Abduction
• moving a body part away from the body.
• Adduction
• moving a body part toward the body.
• Dorsiflexion
• bending backward.
• Rotation
• turning a joint.

32
Define the following terms

• Extension
• straightening a body part.
• Flexion
• bending a body part.
• Pronation
• turning downward.
• Supination
• turning upward.

33
Transparency 9-4 Body Movements
34
6. Describe how to assist with range of motion
exercises

• The NA has a different role in each type of ROM
  exercise
• PROM NA does all the work and resident does
  none.
• AROM NA encourages, but resident does all the
  work.
• AAROM NA assists and supports the resident in
  doing the work.

35
Assisting with passive range of motion exercises

1. Wash hands. Provides for infection control.
2. Identify yourself by name. Identify the resident
   by name. Resident has right to know identity of
   his or her caregiver. Addressing resident by name
   shows respect and establishes correct
   identification.
3. Explain procedure to resident. Speak clearly,
   slowly, and directly. Maintain face-to-face
   contact whenever possible. Promotes understanding
   and independence.

36
Assisting with passive range of motion exercises
(contd.)

• Provide for residents privacy with curtain,
  screen, or door. Maintains residents right to
  privacy and dignity.
• Adjust bed to a safe working level, usually waist
  high. Lock bed wheels. Prevents injury to you and
  to resident.

37
Assisting with passive range of motion exercises
(contd.)

1. Position the resident lying supineflat on his or
   her backon the bed. Position body in good
   alignment. Reduces stress to joints.
2. Repeat each exercise at least three times. While
   supporting the limbs, move all joints gently,
   slowly, and smoothly through the range of motion
   to the point of resistance. Stop if any pain
   occurs. Rapid movement may cause injury. Pain is
   a warning sign for injury.

38
Assisting with passive range of motion exercises
(contd.)

• Shoulder. Support residents arm at elbow and
  wrist while performing ROM for shoulder. Place
  one hand under the elbow and the other hand under
  the wrist. Raise the straightened arm from the
  side position forward to above the head and
  return arm to side of the body (flexion/extension)
  . Raise the arm to side position above head and
  return arm to side of the body (abduction/adductio
  n).

39
Assisting with passive range of motion exercises
(contd.)

• 9. Elbow. Hold the wrist with one hand. Hold the
  elbow with the other hand. Bend elbow so that the
  hand touches the shoulder on that same side
  (flexion). Straighten arm (extension).
• Exercise forearm by moving it so palm is facing
  downward (pronation) and then upward
  (supination).

40
Assisting with passive range of motion exercises
(contd.)

• 10.Wrist. Hold the wrist with one hand. Use the
  fingers of the other hand to help the joint
  through the motions. Bend the hand down
  (flexion). Bend the hand backwards (extension).
• Turn the hand in the direction of the thumb
  (radial flexion). Then turn the hand in the
  direction of the little finger (ulnar flexion).

41
Assisting with passive range of motion exercises
(contd.)

• 11. Thumb. Move the thumb away from the index
  finger (abduction). Move the thumb back next to
  the index finger (adduction).
• Touch each fingertip with the thumb
  (opposition).
• Bend thumb into the palm (flexion) and out to
  the side (extension).

42
Assisting with passive range of motion exercises
(contd.)

• 12. Fingers. Make the hand into a fist (flexion).
  Gently straighten out the fist (extension).
• Spread the fingers and the thumb far apart from
  each other (abduction). Bring the fingers back
  next to each other (adduction).

43
Assisting with passive range of motion exercises
(contd.)

• 13. Hip. Support the leg by placing one hand
  under the knee and one under the ankle.
  Straighten the leg. Raise it gently upward. Move
  the leg away from the other leg (abduction). Move
  the leg toward the other leg (adduction).
• Gently turn the leg inward (internal rotation).
  Turn the leg outward (external rotation).

44
Assisting with passive range of motion exercises
(contd.)

• 14.Knees. Support the leg under the knee and
  ankle while performing ROM for knee. Bend the leg
  to the point of resistance (flexion). Return leg
  to residents normal position. (extension).

45
Assisting with passive range of motion exercises
(contd.)

• 15. Ankles. Push/pull foot up toward head
  (dorsiflexion). Push/pull foot down, with the
  toes pointed down (plantar flexion).
• Turn inside of the foot inward toward the body
  (supination). Bend the sole of the foot away from
  the body (pronation).

46
Assisting with passive range of motion exercises
(contd.)

• 16.Toes. Curl and straighten the toes (flexion
  and extension).
• Gently spread the toes apart (abduction).

47
Assisting with passive range of motion exercises
(contd.)

• Return resident to comfortable position. Return
  bed to lowest position. Remove privacy measures.
  Promotes residents safety.
• Place call light within residents reach. Allows
  resident to communicate with staff as necessary.
• Wash your hands. Provides for infection control.
• Report any changes in resident to nurse. Provides
  nurse with information to assess resident.

48
Assisting with passive range of motion exercises
(contd.)

• Document procedure using facility guidelines.
  Note any decrease in range of motion or any pain
  experienced by the resident. Notify the nurse or
  the physical therapist if you find increased
  stiffness or physical resistance. Resistance may
  be a sign that a contracture is developing. What
  you write is a legal record of what you did. If
  you dont document it, legally it didnt happen.

49
7. List guidelines for assisting with bowel and
bladder retraining

• NAs can assist in bowel and bladder retraining in
  these ways
• Follow Standard Precautions.
• Explain and follow training schedule.
• Keep record of bowel and bladder habits. This
  will help you predict when a resident will need
  to eliminate.
• Offer a commode or a trip to the bathroom before
  long procedures.
• Encourage plenty of fluids.
• Encourage foods that are high in fiber.
• Answer call lights promptly.
• Provide privacy both in the bed and in the
  bathroom.
• If resident has trouble urinating, try running
  water in the sink or suggest she lean forward
  slightly.

50
7. List guidelines for assisting with bowel and
bladder retraining

• Assisting in bowel and bladder retraining
  (contd.)
• Never rush resident.
• Assist with good perineal care.
• Discard wastes properly.
• Discard incontinence briefs and clothing
  protectors properly.
• If your facility uses washable bed pads or
  briefs, follow Standard Precautions when handling
  these items.
• Keep an accurate record of urination and bowel
  movements, including episodes of incontinence.
• Never show frustration or anger.

51
7. List guidelines for assisting with bowel and
bladder retraining

• Think about this question
• How would you feel if you were unable to control
  elimination?

52
Chapter Exam

• Multiple Choice.
• 1. Which areas should be observed and reported to
  the nurse about restorative care?
• (A) Whether family is visiting
• (B) How much television the resident watches
• (C) Whether the resident uses the call light more
  than twice a day
• (D) Signs of depression

53
Chapter Exam (cont'd.)

• 2. Which of the following statements is true of a
  nursing assistants role in restorative care?
• (A) If a resident takes too long in doing a task
  by himself, the nursing assistant should do it
  for him.
• (B) The nursing assistant should combine steps
  for a resident into a long list.
• (C) The nursing assistant should recognize that
  setbacks occur and reassure the resident.
• (D) The nursing assistant should tell the family
  progress is happening faster than it really is
  so they can feel better about the situation.

54
Chapter Exam (cont'd.)

• 3. Regular activity and exercise help improve
• (A) Interaction between the resident and his
  roommate
• (B) The residents spiritual fulfillment
• (C) Residents familys opinion of the facility
• (D) Quality and health of the skin
• 4. Where should the NA be when helping a
  visually-impaired resident walk?
• (A) The NA should be beside and slightly in front
  of the resident
• (B) The NA should be beside and slightly behind
  the resident
• (C) The NA should be about three feet away from
  the resident
• (D) It does not matter where the NA stands when
  helping the resident

55
Chapter Exam (cont'd.)

• 5. When a resident can walk, he or she is
• (A) Ambulating
• (B) Accessorizing
• (C) Abducting
• (D) Adducting
• 6. Abduction is
• (A) Bending a body part backward
• (B) Another name for the hip
• (C) Another name for the leg
• (D) Moving a body part away from the body

56
Chapter Exam (cont'd.)

• 7. Bending a body part is called
• (A) Extension
• (B) Rotation
• (C) Flexion
• Supination
• 8. Passive range of motion exercises are done
• (A) When a resident cannot move on her own
• (B) By the resident herself
• (C) By the resident with some help and support
  from the NA
• (D) By a doctor or physical therapist only

57
Chapter Exam (cont'd.)

• 9. Which of the following is an example of a
  prosthesis?
• (A)An artificial eye to replace an eye that has
  been lost
• (B)Handrolls to keep residents fingers from
  curling too tightly
• (C)Special shoes to help residents with flat feet
• (D)An adaptive device to assist residents with
  dressing
• 10.Which of the following is a guideline for
  assisting with bowel retraining?
• (A)NAs should encourage residents to eat
  high-fiber foods, if ordered.
• (B)NAs do not need to wear gloves when handling
  body wastes.
• (C)NAs do not need to provide privacy during
  elimination if residents are in bed.
• (D)NAs should let residents know when they are
  taking too long to have a bowel movement.

58
Chapter Exam (cont'd.)

• 11.Which of the following is true of bladder
  retraining?
• (A)The NA does not need to keep a record of the
  residents bladder habits.
• (B)The NA should encourage the resident to drink
  plenty of fluids even if incontinence is a
  problem.
• (C)The NA does not need to wear gloves when
  handling body wastes.
• (D)The NA should praise the resident in the same
  way she would praise a small child.