Chapter 5: Rehabilitation, Restorative care and Nutrition

Restoration

Care given by a specialist to restore or improve function after an illness or injury.

Restoration is a resident’s right,it should be based on the resident’s specific needs, following person-centered principles Promote optimal physical and psychosocial wellness.

   

Rehabilitation seeks to move the resident from:

Illness to health

Disability to ability

Dependence to independence

   

The goals of Rehabilitation are as follows:

Help resident regain abilities or recover from illness.

Develop and promote a resident’s independence.

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.

Focus on small tasks & small accomplishments.

Remember

It is very important for NA’s to encourage residents independence while assisting with or performing all tasks.

These are some problems that may result from a lack of mobility and must be reported to the nurse:

Loss of self-esteem

Depression

Illness such as pneumonia or UTI

Constipation

Muscle atrophy and contractures

Increased risk of pressure sores

Ambulation

Ambulation is the medical term for walking

   

Remember:

Check the care plan before helping a resident to ambulate. Keep the resident’s limitations in mind.

Note: When helping a visually impaired resident the NA should be beside and slightly in from of the resident.

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. The 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.

Guidelines for caring for a prostheses:

Help with ADL’s

Prostheses are expensive.

Handle prostheses carefully and follow care plan.

Follow nurse’s or therapist’s instructions for application and removal.

Follow manufacturer’s care directions.

Keep prostheses 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 sensations is real pain.

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.

Range of motion (ROM) exercises

Exercise that puts a joint through its full arc of motion

Each range of motion exercise should be done at least 3 times.

If resident reports pain during ROM stop exercise and report pain to nurse.

Nutrition

How the body uses food to maintain health.

Nutrient

a substance found in food that provides energy, promotes growth and health, and helps regulate metabolism.

Water

We need about eight glasses, or 64oz, per day.

Water is the most essential nutrient for life.

Water aids in digestion, absorption of food, elimination of wastes, and maintaining normal body temperature.

Elderly residents and MyPyramid:

Elderly residents may need a modified MyPyramid that emphasizes nutrient-dense foods, fiber, and water.

Calories may be reduced, but need for vitamins and minerals does not

decrease.

Dietary supplements may be appropriate.

Remember these points about food preferences:

Know and follow residents’ food preferences. Religion may play a role in

food preference.

Ask questions and Pay attention when residents express preferences,

verbally or non-verbally.

Therapeutic diet

a diet for people who have certain illnesses; also called special or modified diet.

Diet cards

cards that list the resident’s name and information about special diets, allergies, likes and dislikes, and other instructions.

For residents who have had CVA (Stroke) , place food in unaffected or stronger side of mouth. Make sure food is swallowed.

Types of food and liquid consistencies

Regular

Food as it normally comes

Mechanical soft

food that is cut up into small particles (like ground beef)

Puree

to chop, blend, or grind food into a thick paste of baby food consistency.

Used for patients who have trouble chewing or swallowing.

Thickened liquids:

Thickening improves the ability to control fluid in the mouth and throat.

A doctor orders the necessary thickness after evaluation by a speech therapist.

NA’s cannot offer residents who must have thickened liquids regular liquids, including water.

There are three different thickening consistencies for liquids:

Nectar thick

Honey thick

Pudding thick

Dehydration

a condition that results from inadequate fluid in the body.

Force fluids

a medical order for a person to drink more fluids.

Restrict fluids

a medical order for a person to limit fluids.

Watch for these signs and symptoms of dehydration:

Drinking little or no fluids at meals

Needing help drinking from cup

Having frequent vomiting, diarrhea, or fever

Report to nurse if Resident has any of the following:

Dry mouth

Cracked lips

Sunken eyes

Dark urine

Strong-smelling urine

Complains of abdominal pain

   

Remember these guidelines for preventing dehydration:

Report warning signs immediately.

Encourage residents to drink every time you see them.

Offer fresh water and fluids often.

Record fluid I&O.

Offer other forms of liquids if permitted (e.g. ice chips, frozen flavored ice sticks, gelatin).

Offer sips of liquids between bites of food.

Make sure pitcher and cup are close by and are light enough for resident to lift.

Offer assistance.

REMEMBER:

Approach residents positively with, “Would you like water or juice?” rather than, “Do you want anything to drink?”

Make an effort to find out what residents’ favorite beverages are and offer at least three times a day, in addition to meals.

Prevention of dehydration is ongoing – you must constantly help residents to stay hydrated.

Low Sodium (salt) diet

is a diet that includes no more than 1,500 to 2000 mg of sodium per day.

Eating to much salt causes the body to keep or retain too much water.

Following a low sodium diet helps keep high blood pressure and edema under control. It can also make breathing easier for residents that have heart failure.

Fluid overload

a condition that occurs when the body is unable to handle the amount of fluid consumed.

Edema

Swelling caused by excess fluid in body tissues.

Watch for these signs and symptoms of fluid overload:

Swelling of extremities

Weight gain

Decreased urine

Tight, smooth, or shiny skin

NPO

nothing by mouth

Guidelines for preventing unintended weight loss:

Encourage residents to eat; talk positively about food.

Help residents who have trouble feeding themselves.

Tell nurse if resident cannot use utensils.

Position residents sitting upright at 90 degrees for feeding.

Ask about loss of appetite or sadness if you observe them.

REMEMBER:

Residents often view mealtime as the highlight of their days.

Meals are not only a time for getting nourishment but a time for socialization as well.

NA’s play an important role in assisting residents to get proper nutrition.

Seat residents next to friends.

Serve food at correct temperature.

Provide proper eating tools, including adaptive utensils if needed.

Give additional food when requested.

Review the guidelines for assisting a resident with eating:

Do not treat the resident like a child. Be supportive and encouraging.

Do not rush resident

Sit at resident’s eye level.

Allow time for prayer if resident wishes.

Verify that it is the right resident.

Do not touch food to test its temperature. Use a hand over the dish instead.

Identify foods and fluids that are in front of resident. Call pureed food by the correct name.

Ask resident what he wants to eat first. Allow resident to make the choice.

Do not mix foods unless resident prefers it.

Alternate food and drink and cold and hot or bland and sweets.

REMEMBER:

It is important to know how much food a resident is eating.

Tracking methods vary from facility to facility.

Watch for these signs and symptoms of dysphagia:

“Dysphagia” means difficulty in swallowing.

It might be caused by stroke, head/neck cancer, multiple sclerosis, Parkinson’s or Alzheimer’s disease.

Coughing during or after meals

Choking during meals

Dribbling saliva, food, or fluid from the mouth

Spitting out pieces of food

Frequent throat clearing during and after meals

Watering eyes when eating or drinking

Food or fluid coming up into the nose

Total parenteral nutrition (hyperalimentation)

the intravenous infusion of nutrients administered directly into the bloodstream, bypassing the digestive tract.

Nasogastric tube

a feeding tube that is inserted into the nose and goes into the stomach.

Percutaneous endoscopic gastrostomy (PEG) tube

a tube placed through the skin directly into the stomach to assist with eating.

REMEMBER:

Your role in tube feedings is to observe for problems and changes in the resident.

NA’s do not insert or remove tubes, do the feeding, or clean the tubes.