Transcript Basic Restorative Services Unit 13 Nurse Aide I Course DHSR Approved Curriculum-Unit 13

Unit 13
Basic Restorative Services
Nurse Aide I Course
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Basic Restorative Services
Introduction
This unit explores various aspects
of restorative care and the role of the
nurse aide in this process.
Disease, injuries and surgery are
often responsible for the loss of a body
part or the loss of bodily function.
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Basic Restorative Services
(continued)
Introduction
Working with the elderly and
disabled requires a great deal of
patience, caring and understanding
from health care workers.
Working together to assist the
resident to attain the highest possible
level of functioning can be a very
challenging and rewarding experience.
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13.0 Demonstrate skills which
incorporate principles of
restorative care under the
direction of the supervisor.
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Rehabilitation/Restoration
• Definition - process of
restoring disabled
individual to highest level
of physical, psychological,
social and economic
functioning possible
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Rehabilitation/Restoration
(continued)
• Emphasis on existing
abilities
• Encourages
independence
• Promotes productive
lifestyle
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Rehabilitation/Restoration
(continued)
• Goals include:
–Prevention of
complications
–Retraining in lost
skills
–Learning new skills
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13.1 Identify the nurse aide’s role in
rehabilitation/restoration.
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Rehabilitation/Restoration
(continued)
• Nurse Aide’s Role
–Encourage resident
–Praise accomplishments
–Review skills taught
–Report progress or need
for additional teaching
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Rehabilitation/Restoration
(continued)
• Nurse Aides Role (continued)
–Promote independence
• praise all attempts at
independence
• overlook failures
• show confidence in
resident’s ability
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Rehabilitation/Restoration
(continued)
• Nurse Aides Role (continued)
–Promote independence (continued)
• be patient and allow time for
residents to do things for
themselves
–Be sensitive and understanding
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13.2 Provide training in and the
opportunity for self-care
according to the resident’s
capabilities.
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Self-Care According To
Resident’s Capabilities
• Training in self-care requires that
three questions be answered prior to
starting:
1. What is the goal to be achieved?
2. What approaches are used to help
the resident achieve the goal?
3. How will progress or lack of
progress be measured?
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Self-Care According To
Resident’s Capabilities
(continued)
• Resident included in goal-setting
process, whenever possible.
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Self-Care According To
Resident’s Capabilities
(continued)
• Functional losses cause:
– Resentment
– Anger
– Frustration
– Withdrawal
– Depression
– Grief
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Guidelines To Assist With
Restorative Care And Training
• Assist resident to do as much as
possible for himself/herself
• Be realistic
• Never offer false hope
• Explain what is going to be done
• Begin tasks at resident’s level of
functioning
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Guidelines To Assist With
Restorative Care And Training
(continued)
• Provide encouragement and
reinforcement
• Praise successes
• Emphasize abilities
• Treat resident with respect
• Explain what resident needs to
accomplish, and how you will
help.
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Guidelines To Assist With
Restorative Care And Training
(continued)
• Accept residents and
encourage them to express
their feelings
• Help to put new skills into
use immediately
• Assist the resident to
recognize his or her progress
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Self-Care According To
Resident’s Capabilities
• Treatment initiated by:
–Physical therapist
–Occupational
therapist
–Speech therapist
–Licensed nurse
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Self-Care According To
Resident’s Capabilities
(continued)
• ADL considerations for
resident:
–Resident to control how
and when activities
carried out, when possible
–Use tact in making
resident aware of hygiene
needs
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Self-Care According To
Resident’s Capabilities
(continued)
• ADL considerations for
resident (continued):
–Encourage use and
selection of clothing
–Be patient and allow
time for slower paced
activities
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Self-Care According To
Resident’s Capabilities
(continued)
• ADL considerations for resident
(continued):
–Provide for rest periods
–Assist to exercise
–Promote independence by having
do as much of activity, as possible
–Encourage use of adaptive devices
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13.3 Discuss methods for assisting
with bowel and bladder retraining.
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Bowel And Bladder Retraining
• Incontinence: Inability to control
urination or defecation
–Embarrassing for resident
–Uncomfortable
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Bowel Retraining
• Plan developed to assist to return to
normal elimination pattern and
recorded on care plan
• Information collected:
–bowel pattern before incontinence
–present bowel pattern
–dietary practices
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Bowel Retraining
(continued)
• Participants in plan
–resident
–family
–all staff members
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Guidelines For Bowel Retraining
• Enemas may be ordered by
physician and given by nurse aide,
as directed by supervisor
• Regular, specific times to evacuate
bowels established
• Fluids encouraged on regular basis
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Guidelines For Bowel Retraining
(continued)
• High bulk foods given, if not
restricted
– bread
– fruits
– vegetables – bran cereals
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Guidelines For Bowel Retraining
(continued)
• Bowel aids ordered by physician and
administered by licensed nurse only:
– laxatives
– suppositories
– stool softeners
• Regular exercise encouraged
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Guidelines For Bowel Retraining
(continued)
• Ways nurse aide can assist with
defecation process:
–offer bedpan on set
schedule
–assist to bathroom when
request is made
–provide privacy
–display unhurried attitude
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Guidelines For Bowel Retraining
(continued)
• Ways nurse aide can assist with
defecation process (continued):
– offer warm drink
– be patient
– encourage with positive remarks
– do not scold when accidents
happen (abuse)
– check on resident frequently
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Bladder Retraining
• Plan developed to assist
to return to normal
voiding pattern and
recorded on care plan
• Staff must be consistent
and follow plan
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Bladder Retraining
• Individualized plan includes:
–schedule that specifies
time and amount of fluids
to be given
–schedule for attempting to
void
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Guidelines for Bladder Retraining
• Get resident’s cooperation
• Record incontinent times
• Provide with opportunities to void:
–when resident awakens
–one hour before meals
–every two hours between meals
–before going to bed
–during night, as needed
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Guidelines for Bladder Retraining
(continued)
• Provide for comfortable
voiding position
• Be supportive and
sensitive
• Provide encouragement
• Offer fluids according to
schedule
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Guidelines for Bladder Retraining
(continued)
• Provide stimuli as needed:
–run water in sink
–pour water over
perineum
–offer fluids to drink
–place hands in warm
water
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Guidelines for Bladder Retraining
(continued)
• Provide good skin care to prevent
skin breakdown
• Retraining may take 6-10 weeks
–be patient
–be supportive
–ignore accidents
–respect resident’s feelings
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Guidelines for Bladder Retraining
(continued)
• Follow facility
procedure for use of:
–incontinent pads
–adult protective
pants
–incontinent briefs
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13.4 Identify ways to assist the
resident in activities of daily living
and encourage self-help
activities.
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Adaptive Devices For Assisting With
Activities of Daily Living (ADL)
• Special utensils available to
help with eating
• Electric toothbrushes for
brushing teeth
• Long-handled brushes and
combs for hair care
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Adaptive Devices For Assisting With
Activities of Daily Living (ADL)
(continued)
• Supportive devices to
assist with walking –
canes, crutches, walkers
• Wheelchairs and
motorized chairs to
provide movement from
place to place
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Adaptive Devices For Assisting With
Activities of Daily Living (ADL)
(continued)
• Prosthesis to replace missing body
parts
• Successful use of adaptive devices
depends on the resident’s:
–attitude
–acceptance of limitations
–motivation
–support from others
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13.5 Discuss the various ambulation
devices and transfer aids.
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Ambulation Devices And
Transfer Aids
• Walker - four-point aid with rubber tips
–Resident stands erect when moving
walker forward
–Walker adjusted to height of hip
joint
–Elbows at 15-30 degree angle
–Walker picked up and put down, not
slid
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Ambulation Devices And
Transfer Aids
(continued)
• Walker - four-point aid with rubber tips
(continued)
–Back legs of walker even
with toes so resident walks
into walker
–Resident steps toward
center of walker
–Leads with weaker leg
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Ambulation Devices And
Transfer Aids
(continued)
• Canes
–Types:
• single-tipped
• tripod - 3 legs
• quad - four point
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Ambulation Devices And
Transfer Aids
(continued)
• Canes (continued)
–Used when weakness
on one side of body and
resident has use of at
least one arm
–Provides balance and
support
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Ambulation Devices And
Transfer Aids
(continued)
• Canes (continued)
–Should be fitted properly:
• cane handle level with
femur (greater
trochanter)
• elbow flexed at 15 to 30
degree angle
• shoulders level
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Ambulation Devices And
Transfer Aids
(continued)
• Canes (continued)
–Gaits ordered by physician or
physical therapist:
• move cane and affected leg
together
• move cane, then affected leg
–Used on side of body where leg is
strongest (side opposite the injury)
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Ambulation Devices And
Transfer Aids
(continued)
• Crutches
–Provide support and
stability through use of
hands and arms.
–Used when one or both
legs are weak.
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Ambulation Devices And
Transfer Aids
(continued)
• Crutches (continued)
–Measured to fit properly by
physical therapist.
• height correct if two fingers fit
between armrest and axilla
• hand grip adjusted to allow
20-30 degrees flexion of
elbows
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Ambulation Devices And
Transfer Aids
(continued)
• Crutches (continued)
–Gaits
• four-point gait
• three-point gait
• two-point gait
• swing-to gait
• swing-thru gait
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Ambulation Devices And
Transfer Aids
(continued)
• Crutches (continued)
–Weight supported on
hand bar, not axilla
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Ambulation Devices And
Transfer Aids
(continued)
• Wheelchairs
–Available in different
sizes and models to allow
for proper fit and usage
–Cleaned with mild
detergent and water,
rinsed with water and
dried
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Ambulation Devices And
Transfer Aids
(continued)
• Wheelchairs (continued)
–Periodic maintenance
needed with 3 in 1 oil
–Arm rests adjusted to
appropriate height
–Feet rest flat on floor
when chair is not moving
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Ambulation Devices And
Transfer Aids
(continued)
• Wheelchairs (continued)
–Seat should not sag
toward center of chair
–Seat should not reach
back of resident’s bent
knees
–Brakes locked when
chair not moving
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Ambulation Devices And
Transfer Aids
(continued)
• Wheelchairs (continued)
–Wheelchair guided backwards
when going downhill
–Wheelchair pulled backwards
over indented or raised areas
(i.e., entrance to elevators)
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Ambulation Devices And
Transfer Aids
(continued)
• Wheelchairs (continued)
–Feet placed on footrests
for transport
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Ambulation Devices And
Transfer Aids
(continued)
• Gurneys/Stretchers/Litters
–Wheels locked when transferring
residents on or off
–Safety belts secured prior to
transfer
–Both side rails raised prior to
transfer
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Ambulation Devices And
Transfer Aids
(continued)
• Gurneys/Stretchers/Litters (continued)
–Residents never left alone on
stretcher
–Backed head first into elevators
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Ambulation Devices And
Transfer Aids
(continued)
• Gurneys/Stretchers/Litters (continued)
–Always used with
assistance when
transferring resident
on or off
–Pushed feet first
during transport
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Ambulation Devices And
Transfer Aids
(continued)
• Gurneys/Stretchers/Litters (continued)
–Guided backwards when
going downhill
–Cleaned with mild
detergent and water,
rinsed with water and
dried
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Ambulation Devices And
Transfer Aids
(continued)
• Gait belt (safety belt, transfer belt)
–Used for residents unsteady on
feet
–Protects resident who loses
balance or faints
–Held at back
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Ambulation Devices And
Transfer Aids
(continued)
• Gait belt (safety belt, transfer belt)
(continued)
–Must be tight enough
to provide support but
loose enough to be
comfortable
–Used to safely transfer
resident
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13.5.1 Identify safety precautions to be
considered by the nurse aide
when using ambulatory
devices.
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Safety Considerations When Using
Ambulatory Devices
• Correct aids must be used
because they are
individually fitted
• Resident observed closely
to be sure aids are being
used as ordered
• Faulty equipment reported
and not used until repaired
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Safety Considerations When Using
Ambulatory Devices
(continued)
• Shoes must fit and be in
good condition
• Skin breakdown reported
• Rubber tips on aids in
good condition.
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13.6 Demonstrate the method used to
assist a resident to ambulate
using a cane or walker.
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13.7 Discuss the use of mechanical
lifts.
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Mechanical Lifts
• Used for transfer of
residents
• Lower end of sling
positioned behind
knees
• Hooks turned away
from body
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Mechanical Lifts
(continued)
• Straps, sling and clasps checked
for defects
• Enough assistance available to
assure safe transfer
• Area checked for safety hazards
prior to transfer
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13.8 Demonstrate the procedure for
transferring a resident using a
mechanical lift (Hoyer).
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13.9 Perform range of motion
exercises as instructed by the
physical therapist or supervisor.
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Range of Motion Exercises
• Types of range of motion:
–Active - resident
exercises joints without
help
–Passive - another person
moves body part for
resident
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Range of Motion Exercises
(continued)
• Purpose of range of motion:
–Maintains muscle tone
–Prevents deformities
–Increases circulation
–Encourages mobility
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Guidelines When Performing
Range Of Motion
• Expose only part of
body being exercised
• Be gentle and stop if
resident complains of
pain
• Use good body
mechanics
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Guidelines When Performing
Range Of Motion
(continued)
• Follow directions from
supervisor on number of
times each joint to be
exercised and how to
perform exercises safely,
based on each resident’s
condition
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Guidelines When Performing
Range Of Motion
(continued)
• Each movement is repeated three
times unless otherwise ordered.
• Support joint as it is exercised
• Report complaints of pain or
discomfort to supervisor
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Guidelines When Performing
Range Of Motion
(continued)
• Exercise joint slowly, smoothly and
gently
• Do not exercise swollen, reddened
joints; report condition to supervisor
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•
•
•
•
•
•
•
•
Range Of Motion Exercises
Types of Joint Movement
Abduction
Adduction
Extension
Hyperextension
Flexion
Plantar flexion
Dorsiflexion
Rotation
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Range Of Motion Exercises
Types of Joint Movement
(continued)
• Pronation
• Supination
• Eversion
• Inversion
• Radial deviation
• Ulnar deviation
Encourage
residents capable
of doing active
ROM exercises
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13.10 Demonstrate the procedure for
performing range of motion
exercises.
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13.11 Assist in care and use of
prosthetic devices.
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Prosthetic Devices
• Artificial Eye (glass eye)
–encourage resident to
remove, clean and
replace eye
prosthesis if able
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Prosthetic Devices
(continued)
• Eyeglasses
–Lens made of glass or
plastic
–Stored in protective
case to prevent
damage when not in
use
–Held by frames
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Prosthetic Devices
(continued)
• Eyeglasses (continued)
–Washed under running
water using mild
detergent.
• rinsed with clear water
• dried with tissue or soft
cloth
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Prosthetic Devices
(continued)
• Eyeglasses (continued)
–Tops of ears and
nose observed for
redness or irritation
from glasses
• Wash hands before
and after cleansing
resident’s glasses
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Prosthetic Devices
(continued)
• Contact Lenses (hard or
soft)
–Resident encouraged
to care for lenses
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Prosthetic Devices
(continued)
• Contact Lenses (hard or soft)
(continued)
–Unusual observations to be
reported:
• redness
• itching
• swelling
• complaints of pain, blurring, or
scratching sensations
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Prosthetic Devices
(continued)
• Hearing Aid
–Ear piece cleaned daily with
soap and water; this is the
only washable part
–Ear piece and tubing should
be soft
–Wax cleaned from tubing with
special equipment
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Prosthetic Devices
(continued)
• Hearing Aid (continued)
–Batteries checked for
power
–Skin observed for
redness or irritation in
or around ear
–Ear wax build-up
reported to supervisor
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Prosthetic Devices
(continued)
• Removing hearing aid:
–turn volume to lowest level or off
–gently lift ear piece up and out of
ear
–use tissues to wipe wax off ear
piece
–store in safe place
–remove battery when not in use
or open battery case
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Prosthetic Devices
(continued)
• Inserting hearing aid:
–turn volume toward maximum
until whistle is heard
–replace batteries if whistle cannot
be heard
–turn volume to low setting
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Prosthetic Devices
(continued)
• Inserting hearing aid (continued):
–gently insert ear piece into ear
canal and adjust for comfort
–loop over ear for over-the-ear
models
–adjust volume to resident’s
satisfaction
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Prosthetic Devices
(continued)
• Braces
–Uses
• support a weak part of the body
• prevent movement of joint
• correct deformities
• prevent deformities
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Prosthetic Devices
(continued)
• Braces (continued)
–Materials
• metal leather plastic
–Bony parts under brace require
protection in order to prevent skin
irritation
–Report any wear noticed and when
brace parts are loose or missing
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Prosthetic Devices
(continued)
• Braces (continued)
–Shoes custom fitted and
checked for:
• broken shoe laces
• heels and soles that are worn
• leather that is worn or torn
• damage from perspiration
– odors
– stains
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Prosthetic Devices
(continued)
• Devices for use with amputation
–Definition of amputation partial or complete removal of
a body part
• usually arm or leg
• below knee most common
amputation
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Prosthetic Devices
(continued)
• Devices for use with amputation
(continued)
–Examples of prosthetic devices:
• artificial leg
• artificial foot
• artificial arm
• artificial hand
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Prosthetic Devices
(continued)
• Devices for use with amputation
(continued)
–Prosthesis fitted and made for
each individual.
–Devices must be handled with
care and stored in appropriate
place when not in use.
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Devices For Use With Amputation
Assisting with artificial limbs:
–have right device
–check all parts for damage
–evaluate resident’s limb for irritation
and swelling
–pad area of prosthesis touching
resident
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Devices For Use With Amputation
Assisting with artificial limbs (continued):
–clean according to individual
instructions
–report any needed repairs to
supervisor
–observe and report any skin
changes to supervisor
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Prosthetic Devices
• Breast Forms – used following
removal of breast
–Assist female residents with
adjustments of forms when dressing
–Follow care suggested by
manufacturer
–Keep form separate and in safe
place when handling clothing for
laundry
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13.12 Assist the resident in the proper
use of body mechanics.
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Body Mechanics For Residents
• Broad base of support
leads to better balance
and stability
• Keep weight the same on
both feet
• Stoop using the hips and
knees
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Body Mechanics For Residents
(continued)
• Keep the back straight
• Lift and carry objects close
to body for better balance.
• Use both hands to lift or
move objects
• Use smooth, even
movements
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Body Mechanics For Residents
(continued)
• Do not bend or reach
if injury possible; ask
for help
• Do not twist body to
reach an object
• Keep body in good
alignment
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13.13 Provide assistance for the
resident with dangling, standing
and walking.
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Dangling
• Dangling - sitting on edge of bed
before getting up
–Standing up too quickly may cause
feeling of dizziness and fainting
may occur
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Dangling
(continued)
• Dangling for several minutes allows
resident to progress to standing and
walking without feeling faint
• Taking deep breaths helps to prevent
light-headedness
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Dangling
(continued)
• Most common signs/symptoms if
feeling faint:
–pale face
–complaints of dizziness or
weakness
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Dangling
(continued)
• Return resident to supine position if
they have difficulty dangling
• If dangling is well tolerated, progress
to standing position
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Standing
• Get assistance if resident is weak or
unsteady
• Assist resident to stand by placing
your hands under the resident’s arms
with hands around the shoulder
blades, and use good body
mechanics to assist to standing
position
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Standing
(continued)
• Have resident stand by side of bed
for several minutes prior to
ambulating
• Return to bed or assist to chair if
having difficulty standing
• If standing tolerated, progress to
ambulating
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Ambulating
• Effects on body
– stimulates circulation
– strengthens muscles
– relieves pressure on body
parts
– increases joint mobility
– improves function of
digestive and urinary
systems
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Ambulating
(continued)
• Effects on body (continued)
– increased independence
leads to more positive
self-image
– provides sense of
accomplishment
– prevents lung congestion
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Ambulating
(continued)
• Encourage to ambulate as much
as possible
• Suggest use of handrails for
support
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Ambulating
(continued)
• If resident starts to fall, ease to
the floor by:
–grasping under arms
–resting buttocks against nurse
aide’s leg
–sliding down aide’s leg to floor
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Ambulating
(continued)
• Be prepared to assist, but allow the
resident to do as much as possible
• Safety considerations:
–use gait belt
–get assistance if needed
–allow adequate time for walking
so resident does not feel rushed
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13.14 Demonstrate the procedure for
assisting the resident to dangle,
stand and walk.
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13.15 Provide cast care for the
resident.
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Cast Care
• Cast used to immobilize
body part, providing time
for part to heal
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Cast Care
(continued)
• Cast materials
–Plaster of Paris
• 24-48 hours to dry
• expands and gives off
heat while drying
–Fiberglass
• dries rapidly
• lighter than plaster casts
–Plastic
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Cast Care
(continued)
• Care of Casts
–Allow to air dry
–Keep cast uncovered
–Use pillows to support
cast
–Support cast with palms
of hands
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Cast Care
(continued)
• Care of Casts
–Never put pressure on
cast
–Turn and position
frequently to allow air to
circulate around cast
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Cast Care
(continued)
• Maintain good body
alignment
• Keep cast dry
• Observe cast for rough
edges and report
• Over-bed trapeze
provided if appropriate
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Cast Care: Observations To Report
To Supervisor Immediately
• Drainage
• Odors
• Swelling of fingers or toes,
inability to move parts
• Change in color of skin:
paleness, cyanosis
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Cast Care: Observations To Report
To Supervisor Immediately
(continued)
• Vomiting
• Elevated temperature
• Skin irritation around
edge of cast
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Cast Care: Observations To Report
To Supervisor Immediately
(continued)
• Resident reports of:
–Itching
– Pain
–Tightness
– Numbness
– Tingling
–Inability to
move fingers
sensations
or toes
– Chills
– Hot or cold skin –Nausea
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13.16 Demonstrate the proper
technique for transferring a
resident from a bed to a chair.
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13.17 Demonstrate the proper
technique for transferring a
resident from a bed to
wheelchair.
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13.18 Demonstrate the proper
technique for transferring a
resident from a bed to a
stretcher.
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