| Flap 1 | Flap 2 |
| Emphasis of rehabilitation | Abilities |
| Impairment | Loss of function |
| Rehabilitation efforts begin | During initial contact w Pt |
| Goal of rehabilitation | Restore Pt's independence as quickly as possible, Promote acceptable quality of life |
| Severe disability | Cannot perfrom one/more activities, Cannot use assistive device for mobility, Needs help from another person |
| Goal of assistive/adaptive devices | Maximize independence and promote access |
| Disability caused by | Acute incident, Progression of chronic condition |
| Acute incidents | Stroke, Trauma |
| Chronic conditions | Arthritis, Multiple sclerosis |
| Concerns of older adults r/t disability | Loss of independence, Increased potential for abuse, Decreased access to health care, Added burden on caregiver |
| Common nursing interventions r/t disability | Coping, Self-care, Mobility limitations, Skin care, Bowel/bladder management |
| Basis of rehab program | Assessment of functional capacity |
| Functional Independence Measure (FIM) | Tool to assess Pt's independence level |
| Focusing on gross functional movements vs. Fine motor skills | Gross functional movements are priority, Then fine motor skills |
| Expected Pt. outcomes r/t Self-care deficits | Performs at maximal level of independence, Uses adaptive devices effectively, Reports satisfaction w/independence level |
| During position changes/transfer/ambulation activities, nurse observes for | Orthostatic hypotension |
| Crutch walking vs. Walker | C requires high energy expenditure and balance, W is more stable |
| Prevention r/t Deformities and contractures | Proper positioning |
| Prevention r/t External rotation of hip | Trochanter roll |
| Causes of footdrop | Prolonged bed rest, Lack of exercise, Incorrect positioning, Weight of bedding |
| Muscles r/t Footdrop contracture | Gastrocnemius and Soleus |
| Exercises r/t Footdrop prevention | Dorsiflexion/plantar flexion of feet, Flexion/extension of toes, Eversion/inversion of ankles |
| Active vs. Assisted vs. Passive ROM | Active- performed by Pt, Assisted- nurse helps if necessary, Passive- performed by nurse |
| Proper amount of ROM per joint | Complete ROM 3x, at least twice/day |
| IADL's are activities that are necessary for | Independent living |
| PULSES profile assesses | Physical condition |
| Barthel Index measures | Pt's level of independence r/t ADL's |
| Opposition | Touching thumb to each fingertip |
| Internal vs. External rotation | I: turning inward toward center, E: turning outward away from center |
| Joints r/t ROM exercises | Moved to point of resistance, Stopped at point of pain |
| ROM exercise functions | Build muscle strength, Maintain joint function, Prevent deformity, Circulation, Endurance, Relaxation |
| Indicators of Orthostatic hypotension | Drop in BP, Pallor, Diaphoresis, Nausea, Tachycardia, Dizziness |
| When trying to ambulate, what to do w/presence of orthostatic hypotension | Stop activity, Assist Pt to supine position |
| Raising bed r/t spinal cord injuries | Slowly raise head of bed to 90 degrees |
| Signs r/t intolerance of upright position | Orthostatic hypotension, Cerebral insufficiency |
| Passive vs. Active-assistive exercises | P:performed by RN, A:performed by Pt w/RN assistance |
| Passive vs. Active-assistive exercises r/t Purpose | P:joint ROM, Circulation, A:normal muscle function |
| Active vs. Resistive exercises | A:performed by Pt, R:performed by Pt against resistance |
| Active vs. Resistive exercises r/t Purpose | A:muscle strength, R:increase muscle power |
| Isometric exercises | Performed by Pt, Body part in fixed position |
| Isometric exercises r/t Purpose | Strength even w/joint immobilized |
| Transfer activities begin | As soon as Pt permitted |
| During transfer, RN | Assists and coaches |
| Precautions r/t Transfer board/Sliding board | Shearing, Pt's fingers do not curl around board during transfer |
| Relieving fatigue r/t crutch gait | Pt should be taught two gaits to switch |
| Necessary factors for crutches | Balance, Cardiovascular reserve, Strong upper extremeties, Erect posture |
| First foot forward r/t crutchches- Sitting down, Down stairs, Up stairs | S:weak foot, D:weak foot, U:strong foot |
| Pick-up walker vs. Rolling walker | P:no natural walking pattern, Pts w/poor balance and cardiovascular reserve, R:automatic walking pattern |
| Only non-weight bearing crutch gait | 3-point gait |
| Partial weight bearing crutch gaits | 4-point & 2-point gaits |
| Proper cane height | Level w/trochanter |
| Proper hand for cane | Hand opposite of affected extremity |
| First foot going up and down stairs r/t Canes | "Up w/the good, Down w/the bad" |
| Functions r/t Orthosis | Support, Prevents/corrects deformities, Improves function |
| Static vs. Dynamic orthoses | S:stabilize joints and prevent contractures, D:improve function by assisting weak muscles |
| Moving parts r/t Static & Dynamic orthoses | S:no moving parts, D:flexible |
| Internal vs. External prosthesis | I:artificial hip, E:artificial leg |
| Proper fitment r/t orthosis | Clean/inspect skin daily, Snug brace fitment, Even pressure distribution, Cotton b/w skin and orthosis |
| Pressure ulcers occurance r/t capillary pressure | Occur when pressure on skin > capillary closure pressure |
| Initial sign of pressure | Erythema |
| Factors leading to pressure ulcers | Immobility, Impaired sensory reception, Decreased tissue perfusion, Decreased nutritional status, Friction/Shear, Increased moisture, Age-related skin changes |
| Factors causing Decreased tissue perfusion | DM, Edema, Obesity |
| Factors causing Decreased nutritional status | Anemia, Low protein levels, Negative nitrogen balance |
| Serum albumin level r/t Increasing risk of pressure ulcers | Serum < 3 g/mL |
| Friction vs. Shear | F:2 surfaces moving across each other, S:gravity pushing body down causing friction |
| Most succeptible areas r/t shear | Sacrum & heels |
| Stage I Pressure ulcer | Area of nonblanchable erythema |
| Stage II Pressure ulcer | Break in skin thru epidermis/dermis |
| Stage III Pressure ulcer | Ulcer extends into SubQ tissues |
| Stage IV Pressure ulcer | Ulcer extends into muscle or bone |
| Turning interval r/t pressure ulcer prevention | every 1-2 hours |
| Positioning cycle | Lateral, prone, then dorsal in sequence |
| Important nutrients r/t Healing | Protein, Iron, Vitamin C, Zinc sulfate, Vitamin A |
| Position avoided w/Pts at risk for pressure ulcers | Semireclined |
| Urge vs. Reflex incontinence | U:d/t strong need to void, R:spinal cord lesion interrupts control w/no sensory awareness |
| Stress vs. Functional incontinence | S:weakened perineal muscles (sneezing), F:cannot reach and use toilet before voiding |
| Total incontinence | physiologic or psychological impairment |
| Restricting fluid intake to decrease urinary frequency | NEVER |
| Bladder training helps | Urge incontinence |
| Habit training helps | Functional, Urge, Stress incontinence |
| Biofeedback allows Pt to contract | Urinary sphincters |
| Biofeedback helps | Stress & urge incontinence |
| Kegel exercises help | Stress incontinence |
| Suprapubic tapping is stroking of | Inner thigh |
| Suprapubic tapping helps | Reflex incontinence |
| Best time to plan bowel elimination | After breakfast |
| Massage movement to promote feces movement | Massage abdomen from right to left |
