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Chapter 39 Rehabilitation Nursing


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Mikayla Delenia


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Chronic illness
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A chronic illness generally refers to a condition or state that lasts for 3 months or longer

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Chapter 39 Rehabilitation Nursing - Marcador

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Chapter 39 Rehabilitation Nursing - Detalles

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Chronic illness
A chronic illness generally refers to a condition or state that lasts for 3 months or longer
Commission on Accreditation of Rehabilitation Facilities
A nonprofit, privat, international standard-setting and accreditation body whose mission is to promote and advocate the delivery of quality rehabilitation
Comprehensive rehabilitation plan
Plan of care within 24 hours of the patient's hospital admission and have it ready for review and revision by the rehabilitation team within 3 days of the admission
Disability
The loss of ability to participate in on or more major life activities as a result of mental, emotional, or physical impairments
Exacerbation
An increase in the seriousness of a disease or disorder; marked by greater intensity in the signs or symptoms of the patient being treated
Family centered care
A philosophy that recognizes the pivotal role of the family in the lives of children with disabilities or other chronic conditions
Functional limitation
Any loss of ability to perform tasks or activities of daily living
Gerontological rehabilitation nursing
A specialty practice that focuses on the unique requirements of older adult rehabilitation patients
Impairment
Any loss or abnormality of psychological, physical, or anatomic structure or function
Interdisciplinary rehabilitation team
Collaborates to identify individual's goals and features a combination of expanded problem solving beyond the boundaries of the individual disciplines, together with discipline-specific work toward goal attainment
Multidisciplinary rehabilitation team
Characteristics of this model are discipline-specific goals, clear boundaries between disciplines, and outcomes that are the sum of each discipline's efforts
Pediatric rehabilitation nursing
A specialty practice area that also continues to expand within the field of rehabilitation
Physiatrist
Physicians specializing in physical medicine or rehab
Posttraumatic stress disorder (PTSD)
Defined as a mental health condition related to the experiencing of or witnessing of a traumatic event outside the normal range of human experience
Spinal cord injury (SCI)
Any injury in which the spinal cord undergoes compression by fracture or displacement of vertebrae, by bleeding, or edema
Transdisciplinary rehabilitation team
The blurring of boundaries between disciplines, as well as cross training and flexibility to minimize any duplication of effort toward individual goal attainment
Traumatic brain injury (TBI)
Ranging from mild concussion to the more devastating kind that renders injured people comatose for the remainder of their lives
Explain the goal of rehabilitation nursing
Restoring the patient to the fullest physical, mental, social, vocational, and economic capacity of which he or she is capable
What is the underlying philosophy of rehabilitation?
To focus on abilities rather than disabilities to continually make the most of the abilities that remain intact
Rehabilitation is a bridge for the patient spanning the gap between what?
Uselessness/usefulness Hopelessness/hopefulness Despair/happiness
What criteria is placed into all rehabilitation goals?
Maximize quality of life Address the patient's specific needs Assist the patient with adjusting to an altered lifestyle Directed toward promoting wellness and minimizing complications Assist the patient in attaining the highest degree of function and self-sufficiency possible Assist the patient with home and community reentry
Focus on the individual
All efforts of rehabilitation are centered on the patient's goals and objectives
Community reentry
Rehab is considered successful if the patient is able to reenter the community through participation in social, vocational, and recreational activities
Independence
Focus on promoting and maintaining the patient's physical and emotional independence
Functional ability
Progress in rehab is measured in terms of functional outcomes
Ream approach
Goals are achieved through the work of the rehab team members, including the patient and family
Quality of life
Goals focus on improving the quality of live rather than increasing quantity
Prevention and wellness
Rehab goals focus on preventing complications and maximizing function
Change process
Directing the change in as positive a manner as possible
Adaptation
Learning to adapt to the circumstances created by the limits of their abilities is a positive method of coping
Patient and family education
Patients have the potential to obtain a degree of independence through patient education which enables them to direct their own care
The goals must be what?
Measurable, described in functional or behavioral terms, and must have associated time frames for achievement, and the responsible team member or members must be listed
Patient's role and actions
Role-key member Actions-Participates in goal setting, takes control of own life
Physiatrist's role and actions
Role-Rehab physician Actions-Provides support, educates patient and family concerning rehabilitation process, promotes independence
Rehab LVN role and actions
Role-Care provider, patient's advocate Actions-Provides support, reinforces education to the patient and family concerning the rehabilitation process, assists in treatment plan and implementation
Physical therapist's role and actions
Role-Designing exercise program Actions-Assesses patient's needs, provides trainings
Occupational therapist's role and actions
Role-Assessing independent living needs Actions-Recommends equipment modifications, adapts equipment
Speech-language pathologist's role and actions
Role-Performing assessment of communication and swallowing abilities, designing rehab communication program Actions-Helps patient regain communication skills, teaches patient
Therapeutic recreation therapist's role and actions
Role-Recreation planner Actions-Plans leisure activities, promotes patient's interest in activities
Clinical psychologist's role and actions
Role-Emotional evaluator Actions-Assesses patient's position on the mental health continuum, promotes patient's independence by maximizing active participation, assists patient in developing realistic positive attitudes
Chaplain's role and actions
Role-Spiritual consultant Actions-Provides spiritual support and guidance
Vocational rehabilitation counselor's role and actions
Role-Vocational planner Actions-Helps patient obtain training for new or current employment
Pathophysiology
The disordered physiological processes associated with disease or injury
Roles of the Rehab Nurse
Educator Provider of care Collaborator Patient advocate
5 step approach to guide nursing interventions
1. Assess patient's and family's needs, abilities, and concerns 2. Plan interventions based of needs, abilities, and concerns 3. Implement educational plan 4. Document the educational process 5. Evaluate and revise
Key elements of family-centered care
Incorporating Facilitating family-professional collaboration Exchanging complete and unbiased info Encouraging and facilitating family-to-family support Appreciating unique characteristics of families and children
Cultural competence
Requires the acknowledgment and awareness of one's own cultural norms Involves the awareness and acceptance of those cultural values and behaviors of another
What describes a culturally competent practitioner
Has the capacity for cultural self-assessment Provides health care that is sensitive to the culture and values of the patient and is linguistically appropriate Conscious of the dynamics of difference Disseminates cultural knowledge Adapts to diversity
Cultural proficiency
Hold culture in high regard
Issues in rehabilitation
Quality vs. quantity Care vs. cure High cost of interdisciplinary care vs. long-term care
PT/BRI
Polytrauma-blast related injury as result of explosions
Primary blast related injuries
Air filled cavities in the body (ears, lungs, and gastrointestinal tract) and organs enveloped by fluid (brain and spinal cord) are most susceptible to compression damage from high explosive blasts
PTSD was also known as what?
Shell shock War neurosis
When is the diagnosis of PTSD considered?
If the symptoms do not improve or even worsen after at least 1 month and are dependent on the identification of a traumatic event or re-living traumatic events through dreams or reoccurring vivid memories or flashbacks interfering with normal life functions
What is the Americans with Disabilities Act and when did it become law?
1990 Provides protection against discrimination for people with disabilities
Injury to the spinal cord is______
Irreversible in that the cord is unable to repair itself
Complete injury
No motor or sensory function below the level of injury
Incomplete injury
Some or all motor or sensory function below the level of injury
Quadriplegia
Damage to the cervical spine or the neck that involves weakness or paralysis in all four extremities
Paraplegia
Damage below the cervical area that involves weakness or paralysis in the trunk and lower extremities
Paresis
Slight paralysis, incomplete loss of muscular power, or weakness of a limb
Cervical cord injury
Level of injury is at the cervical spine (C2-C7) Paralysis of all extremities and trunk
Thoracic cord injury
Level of injury is at the thoracic spine (T1-T12) involves paralysis of lower extremities After injury, muscles are flaccid and later become spastic
Lumbar cord injury
Injury of the lumbar spine (L1-L2) Paralysis of lower extremities, bladder, rectum, loss of sexual function
Postural hypotension
Common for many quadriplegic patients to have a bp of 90/60 or lower when sitting as a result of the pooling of the blood in the lower extremities and in the abdominal area
Autonomic dysreflexia
Patients with spinal cord lesions above T5 sometimes experience sudden and extreme elevations in blood pressure cause by a reflex action of the autonomic nervous system Is the result of some stimulation of the body below the level of injury
Heterotopic ossification
The abnormal formation of bone cells in joints
Deep vein thrombosis
Clotting of blood within vessels of the legs cause by slowing of the circulation or an alteration in the blood vessel walls
Shearing
When the brain mass is rotated in the cranial vault
Classifications of brain injuries
Mild Moderate Severe Catastrophic
Mild brain injury
Brief or no loss of consciousness
Moderate brain injury
Period of unconsciousness ranging from 1-24 hours Cognitive skills including planning, sequencing, judgment, reasoning, and computation skills are usually impaired
Severe brain injury
Experience unconsciousness or post-trauma amnesia for longer than 8 days Cognitive, psychosocial, and behavioral disabilities result
Catastrophic brain injury
Coma lasting several months or longer Affected individuals sometimes appear to be awake They generally never regain significant, meaningful communication with their environment
Explain post-concussive syndrome and how long it can last
Can persist for months, years, or indefinitely Signs/symptoms: fatigue, headache, vertigo, lethargy, irritability, personality changes, cognitive deficits, decreased information processing speed, and difficulties with memory, understanding, learning, and perception
With moderate brain injury what type of psychosocial problems can occur?
Self-centeredness, denial, mood swings, agitation, depression, lethargy, sexual dysfunction, emotional lability, low tolerance for frustration , poor judgment, and behavioral outbursts
Explain what pediatric rehab nurses do
Collab with the interdisciplinary team, provide a continuum of care so that affected children can become contributing members of society and function at their maximal potential
Rehabilitation vs. habilitation
Rehab: refers to the relearning of skills or behaviors lost as a result of disease or injury Habilitation: refers to the process of acquiring skills and behaviors by an individual whose development has been affected by disease or other disabling conditions since birth or early childhood
Comprehensive rehabilitation plan
A multifaceted and properly involves a functional assessment, an evaluation conference and a family conference