Unit 13-basic Restorative Services

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. DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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Rehabilitation/Restoration (continued)

• Goals include: – Prevention of complications – Retraining in lost skills – Learning new skills DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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? DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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. DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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Self-Care According To Resident’s Capabilities • Treatment initiated by: – Physical therapist – Occupational therapist – Speech therapist – Licensed nurse DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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Guidelines for Bladder Retraining (continued)

• Follow facility procedure for use of: – incontinent pads – adult protective pants – incontinent briefs DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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) DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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) DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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Prosthetic Devices (continued)

• Braces – Uses • support a weak part of the body • prevent movement of joint • correct deformities • prevent deformities DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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. DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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 DHSR Approved Curriculum-Unit 13

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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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