Unit 13 Basic Restorative Services

1
Unit 13Basic Restorative Services

• Nurse Aide I Course

2
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.

3
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.

4
Rehabilitation/ Restoration
5

• 13.0 Demonstrate skills which incorporate
  principles of restorative care under the
  direction of the supervisor.

6
Rehabilitation/Restoration

• Definition - process of restoring disabled
  individual to highest level of physical,
  psychological, social and economic functioning
  possible

7
Rehabilitation/Restoration(continued)

• Emphasis on existing abilities
• Encourages independence
• Promotes productive lifestyle

8
Rehabilitation/Restoration(continued)

• Goals include
• Prevention of complications
• Retraining in lost skills
• Learning new skills

9

• 13.1 Identify the nurse aides role in
  rehabilitation/restoration.

10
Rehabilitation/Restoration(continued)

• Nurse Aides Role
• Encourage resident
• Praise accomplishments
• Review skills taught
• Report progress or need for additional teaching

11
Rehabilitation/Restoration(continued)

• Nurse Aides Role (continued)
• Promote independence
• praise all attempts at independence
• overlook failures
• show confidence in residents ability

12
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

13
Self-Care According To Resident's Capabilities
14

• 13.2 Provide training in and the opportunity for
  self-care according to the residents
  capabilities.

15
Self-Care According To Residents Capabilities

• Training in self-care requires that three
  questions be answered prior to starting
• What is the goal to be achieved?
• What approaches are used to help the resident
  achieve the goal?
• How will progress or lack of progress be measured?

16
Self-Care According To Residents
Capabilities(continued)

• Resident included in goal-setting process,
  whenever possible.

17
Self-Care According To Residents
Capabilities(continued)

• Functional losses cause
• Resentment
• Anger
• Frustration
• Withdrawal
• Depression
• Grief

18
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 residents level of functioning

19
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.

20
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

21
Self-Care According To Residents Capabilities

• Treatment initiated by
• Physical therapist
• Occupational therapist
• Speech therapist
• Licensed nurse

22
Self-Care According To Residents
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

23
Self-Care According To Residents
Capabilities(continued)

• ADL considerations for resident (continued)
• Encourage use and selection of clothing
• Be patient and allow time for slower paced
  activities

24
Self-Care According To Residents
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

25
Bowel And Bladder Retraining
26

• 13.3 Discuss methods for assisting with bowel and
  bladder retraining.

27
Bowel And Bladder Retraining

• Incontinence Inability to control urination or
  defecation
• Embarrassing for resident
• Uncomfortable

28
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

29
Bowel Retraining(continued)

• Participants in plan
• resident
• family
• all staff members

30
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

31
Guidelines For Bowel Retraining(continued)

• High bulk foods given, if not restricted
• fruits
• vegetables

• bread
• bran cereals

32
Guidelines For Bowel Retraining(continued)

• Bowel aids ordered by physician and administered
  by licensed nurse only
• laxatives
• suppositories
• stool softeners

• Regular exercise encouraged

33
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

34
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

35
Bladder Retraining

• Plan developed to assist to return to normal
  voiding pattern and recorded on care plan
• Staff must be consistent and follow plan

36
Bladder Retraining

• Individualized plan includes
• schedule that specifies time and amount of fluids
  to be given
• schedule for attempting to void

37
Guidelines for Bladder Retraining

• Get residents 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

38
Guidelines for Bladder Retraining(continued)

• Provide for comfortable voiding position
• Be supportive and sensitive
• Provide encouragement
• Offer fluids according to schedule

39
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

40
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 residents feelings

41
Guidelines for Bladder Retraining(continued)

• Follow facility procedure for use of
• incontinent pads
• adult protective pants
• incontinent briefs

42
Adaptive Devices For Assisting With Activities
of Daily Living (ADL)
43

• 13.4 Identify ways to assist the resident in
  activities of daily living and encourage
  self-help activities.

44
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

45
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

46
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
  residents
• attitude
• acceptance of limitations
• motivation
• support from others

47
Ambulation Devices And Transfer Aids
48

• 13.5 Discuss the various ambulation devices and
  transfer aids.

49
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

50
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

51
Ambulation Devices And Transfer Aids(continued)

• Canes
• Types
• single-tipped
• tripod - 3 legs
• quad - four point

52
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

53
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

54
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)

55
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.

56
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

57
Ambulation Devices And Transfer Aids(continued)

• Crutches (continued)
• Gaits
• four-point gait
• three-point gait
• two-point gait
• swing-to gait
• swing-thru gait

58
Ambulation Devices And Transfer Aids(continued)

• Crutches (continued)
• Weight supported on hand bar, not axilla

59
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

60
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

61
Ambulation Devices And Transfer Aids(continued)

• Wheelchairs (continued)
• Seat should not sag toward center of chair
• Seat should not reach back of residents bent
  knees
• Brakes locked when chair not moving

62
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)

63
Ambulation Devices And Transfer Aids(continued)

• Wheelchairs (continued)
• Feet placed on footrests for transport

64
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

65
Ambulation Devices And Transfer Aids(continued)

• Gurneys/Stretchers/Litters (continued)
• Residents never left alone on stretcher
• Backed head first into elevators

66
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

67
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

68
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

69
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

70

• 13.5.1 Identify safety precautions to be
  considered by the nurse aide when using
  ambulatory devices.

71
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

72
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.

73
Demonstration and Return Demonstration
74

• 13.6 Demonstrate the method used to assist a
  resident to ambulate using a cane or walker.

75
Mechanical Lifts
76

• 13.7 Discuss the use of mechanical lifts.

77
Mechanical Lifts

• Used for transfer of residents
• Lower end of sling positioned behind knees
• Hooks turned away from body

78
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

79
Demonstration and Return Demonstration
80

• 13.8 Demonstrate the procedure for transferring a
  resident using a mechanical lift (Hoyer).

81
Range of Motion Exercises (Movement of all joints
of body)
82

• 13.9 Perform range of motion exercises as
  instructed by the physical therapist or
  supervisor.

83
Range of Motion Exercises

• Types of range of motion
• Active - resident exercises joints without help
• Passive - another person moves body part for
  resident

84
Range of Motion Exercises(continued)

• Purpose of range of motion
• Maintains muscle tone
• Prevents deformities
• Increases circulation
• Encourages mobility

85
Guidelines When PerformingRange Of Motion

• Expose only part of body being exercised
• Be gentle and stop if resident complains of pain
• Use good body mechanics

86
Guidelines When PerformingRange 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
  residents condition

87
Guidelines When PerformingRange 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

88
Guidelines When PerformingRange Of
Motion(continued)

• Exercise joint slowly, smoothly and gently
• Do not exercise swollen, reddened joints report
  condition to supervisor

89
Range Of Motion ExercisesTypes of Joint Movement

• Abduction
• Adduction
• Extension
• Hyperextension
• Flexion
• Plantar flexion
• Dorsiflexion
• Rotation

90
Range Of Motion ExercisesTypes of Joint
Movement(continued)

• Pronation
• Supination
• Eversion
• Inversion
• Radial deviation
• Ulnar deviation

Encourage residents capable of doing active ROM
exercises
91
Demonstration and Return Demonstration
92

• 13.10 Demonstrate the procedure for performing
  range of motion exercises.

93
Prosthetic Devices
94

• 13.11 Assist in care and use of prosthetic
  devices.

95
Prosthetic Devices

• Artificial Eye (glass eye)
• encourage resident to remove, clean and replace
  eye prosthesis if able

96
Prosthetic Devices(continued)

• Eyeglasses 
• Lens made of glass or plastic 
• Stored in protective case to prevent damage when
  not in use 
• Held by frames

97
Prosthetic Devices(continued)

• Eyeglasses (continued) 
• Washed under running water using mild detergent. 
• rinsed with clear water 
• dried with tissue or soft cloth 

98
Prosthetic Devices(continued)

• Eyeglasses (continued)
• Tops of ears and nose observed for redness or
  irritation from glasses
• Wash hands before and after cleansing residents
  glasses

99
Prosthetic Devices(continued)

• Contact Lenses (hard or soft)
• Resident encouraged to care for lenses

100
Prosthetic Devices(continued)

• Contact Lenses (hard or soft) (continued)
• Unusual observations to be reported
• redness
• itching
• swelling
• complaints of pain, blurring, or scratching
  sensations

101
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

102
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

103
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

104
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

105
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 residents satisfaction

106
Prosthetic Devices(continued)

• Braces
• Uses
• support a weak part of the body
• prevent movement of joint
• correct deformities
• prevent deformities

107
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

108
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

109
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 

110
Prosthetic Devices(continued)

• Devices for use with amputation (continued)
• Examples of prosthetic devices
• artificial leg 
• artificial foot 
• artificial arm 
• artificial hand 

111
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.

112
Devices For Use With Amputation

• Assisting with artificial limbs
• have right device
• check all parts for damage
• evaluate residents limb for irritation and
  swelling
• pad area of prosthesis touching resident

113
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

114
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

115
Body Mechanics For Residents
116

• 13.12 Assist the resident in the proper use of
  body mechanics.

117
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

118
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

119
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

120
Dangling, Standing and Walking
121

• 13.13 Provide assistance for the resident with
  dangling, standing and walking.

122
Dangling

• Dangling - sitting on edge of bed before getting
  up
• Standing up too quickly may cause feeling of
  dizziness and fainting may occur

123
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

124
Dangling(continued)

• Most common signs/symptoms if feeling faint
• pale face
• complaints of dizziness or weakness

125
Dangling(continued)

• Return resident to supine position if they have
  difficulty dangling
• If dangling is well tolerated, progress to
  standing position

126
Standing

• Get assistance if resident is weak or unsteady
• Assist resident to stand by placing your hands
  under the residents arms with hands around the
  shoulder blades, and use good body mechanics to
  assist to standing position

127
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

128
Ambulating

• Effects on body
• stimulates circulation
• strengthens muscles
• relieves pressure on body parts
• increases joint mobility
• improves function of digestive and urinary
  systems

129
Ambulating(continued)

• Effects on body (continued)
• increased independence leads to more positive
  self-image
• provides sense of accomplishment
• prevents lung congestion

130
Ambulating(continued)

• Encourage to ambulate as much as possible
• Suggest use of handrails for support

131
Ambulating(continued)

• If resident starts to fall, ease to the floor
  by
• grasping under arms
• resting buttocks against nurse aides leg
• sliding down aides leg to floor

132
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

133
Demonstration and Return Demonstration
134

• 13.14 Demonstrate the procedure for assisting the
  resident to dangle, stand and walk.

135
Cast Care
136

• 13.15 Provide cast care for the resident.

137
Cast Care

• Cast used to immobilize body part, providing time
  for part to heal

138
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

139
Cast Care(continued)

• Care of Casts
• Allow to air dry
• Keep cast uncovered
• Use pillows to support cast
• Support cast with palms of hands

140
Cast Care(continued)

• Care of Casts
• Never put pressure on cast
• Turn and position frequently to allow air to
  circulate around cast

141
Cast Care(continued)

• Maintain good body alignment
• Keep cast dry
• Observe cast for rough edges and report
• Over-bed trapeze provided if appropriate

142
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

143
Cast Care Observations To Report To Supervisor
Immediately(continued)

• Vomiting
• Elevated temperature
• Skin irritation around edge of cast

144
Cast Care Observations To Report To Supervisor
Immediately (continued)

• Resident reports of
• Pain
• Numbness
• Tingling
• sensations
• Chills
• Hot or cold skin

• Itching
• Tightness
• Inability to move fingers or toes
• Nausea

145
Demonstration and Return Demonstration
146

• 13.16 Demonstrate the proper technique for
  transferring a resident from a bed to a chair.

147

• 13.17 Demonstrate the proper technique for
  transferring a resident from a bed to wheelchair.

148

• 13.18 Demonstrate the proper technique for
  transferring a resident from a bed to a stretcher.

149
The End