REHABILITATION NURSING

Dr. ROHIT, MBBS, DNB

PHYSICAL MEDICINE AND
REHABILITATION
• The quality of medical care that can be provided
for a patient in a designated rehabilitation service
may be dependent to a degree on the quality of
nursing care that is available constantly during
the restoration process.
• The factors that may deserve consideration are
1. The functions and responsibilities that are peculiar
to nursing and no other discipline
2. Relationship of nurses to allied professional groups
3. Contributions of nursing towards total rehabilitation
care
• In rehabilitation nursing the nurse is once a nursing
practitioner, a nursing educator, and, at times, a
nursing coordinator.
• Examples
1. An aphasic hemiplegic patient who is undergoing speech
therapy may be aided markedly by rehab nursing person.
In ward situation every opportunity can be utilized to
promote communication for the patient and thus
provide continuity of speech practice not otherwise
possible.
2. Ambulation training a part of physical therapy can be
carried over into the ward by a coordinating nurse.
 Nursing practice in rehabilitation
• Techniques related to maximum mental and
physical health.
1. Basic procedures of all nursing care
2. Provide good hygiene and sanitary environment
3. Wholesome and happy climate
4. Proper rest and sleep
5. Adequate nutrition
6. Diversional occupation
 Technics to prevent deformities
1. Contractures once developed impede progress of rehab
program
2. Institute effective posture technics
3. Apply principles of body alignment and correct positioning
of the patient
4. Use of mechanical aids e.g. footboards, bed boards,
sandbags, pillows etc. to position patient properly and
thus prevent foot drop, wrist drop, claw hand etc.
5. May initiate simple preventive exercises to maintain
muscle tone and strengthen muscles
6. May initiate early program of self care activities such as
teaching patient to wash his face, comb his hair, brush
teethetc.
 Technics that apply to self care
problems
• Bed and wheelchair activities
• Dressing and undressing
• Feeding
• Bathing
• Toileting
• Rehab nurse must possess knowledge and
adeptness in use of mechanical devices such as
wheelchairs, braces, prosthesis, crutches, canes
and self help aids.
 Technics that apply to elimination of
body wastes
• Bladder management objectives
1. To determine whether patient can void after the
catheter is removed
2. How well the patient empties his bladder
3. Residual urine
4. Obtain better urinary control
5. Obtain maximum cleanliness
6. Alleviate emotional stress associated with
incontinence
7. Obtain max comfort
8. aid in prevention of decubitus ulcers
Clean intermittent self catheterization
• Clean Intermittent Self-Catheterization (CISC)
is a way to empty the bladder by using a clean
catheter. It involves putting the catheter in
and taking it out several times a day.
• CISC helps people who cannot empty their
bladders the usual way. By emptying bladder
regularly, you can help prevent bladder
infections.
 Preparing for CISC
• Equipment
• Straight catheter .
• A new catheter is needed about once a month or when the
one you use is brittle.
• Soap and water
• Clean washcloth
• Water-soluble lubricant
• Do not use a petroleum-based lubri - cant such as Vaseline.
• Plastic bag for used catheters
• Plastic bag for clean catheters
• Urinal (if measuring urine)
 Instructions to the patient
1.Gather equipment and place it on a clean towel.
2. Urinate if you can.
3. Prepare your clothing. Make sure your clothes are
away from your body and that you have enough light to
see well.
4. Wash your hands well with soap and water. This
reduces bacteria and prevents infection.
5. Lubricate the catheter's end to ease insertion.
6.Wash the end of the penis thoroughly with soap and
water. This reduces bacteria and prevents infection.
• 7. Grasp the penis, hold it erect, and insert the catheter
slowly about 6 inches. Once urine starts to flow,
advance the catheter about 1 inch. If you feel
resistance, just stop for a second, take a deep breath,
and gently resume insertion.
• 8. Place the other end of the catheter into a urinal or
container.
• 9. Allow all urine to drain. Measure drainage if an
output record is needed (see sample record).
• 10. After urine flow stops, remove the catheter slowly.
Continue to hold the penis and catheter upright.
• 11. First, rinse the catheter with cold water to
remove any mucous deposits.
• 12. Then, wash the catheter with liquid soap
and hot water, and allow it to dry completely
in the air. Store the catheter in a clean, dry,
safe location.
 Bowel management
• Goals
1. To establish periodic pattern of bowel evacuation on
a regular time schedule
2. To prevent constipation and bowel impaction

Start bowel training as soon as feasible after admission

Select most suitable time for bowel evacuation
Prepare patient for training and elicit his cooperation
Instruct the patient concerning his diet and fluid intake
Encourage mobility
Teach digital stimulation and digital evacuation
 Digital stimulation
• Digital stimulation is a way to empty the reflex bowel
after a spinal cord injury. It may also be called a "dil." It
involves moving the finger or dil stick around in a
circular motion inside the rectum. By doing this, the
the bowel reflex is stimulated and the rectal muscles
open and allow the stool to leave the body.
• This procedure is best done on people who
do not have painful sensation in the rectal
area. Pressure may be felt in the rectal area, but it
should not be painful. The dil should be done at the
same time every day or every other day to stay on a
schedule and avoid bowel accidents. The time and how
often a dil is done depends on the individual.
 Procedure
• Put gloves on both hands or place place dil stick in the hand.
• Lubricate pointing finger or dil stick (whichever will be entering the
rectum).
• Gently put finger or dil stick into the rectum past the muscle.
• Gently move the finger or dil stick around in a circular motion.
• When the stool begins to empty from the rectum, move the finger
or dil stick to one side or remove so the stool can pass.
• Do this for at least 20 minutes if no stool is coming. If stool is
produced, do the dil as long as the stool is coming dil and for
five additional minutes afterward without getting any more stool.
• You may need to gently remove stool from rectum with your finger
if it does not come out on it's own.(Digital Evacuation)
 Decubitus ulcers
• Most often as a result of prolonged pressure
on bony prominences
• Tissue ischemia
• Early warning signs include reddened skin
areas, blister formation
• Positioning the patient from side to side and
from supine to prone every 2 hours
Pressure ulcer prone areas
 Patient education
• Examine skin surfaces thoroughly every day for reddened areas
• Bath daily with warm water and soap
• Particular attention to lower back, buttocks, hips, feet and heels
• Use foam rubber pillow or pad
• Change positions frequently
• Report signs of broken skin areas
• Keep skin dry all times
• Examine genital area for redness or ulceration
• Watch the braces
• Do frequent pushups in the wheelchair
• High protein diet
 Tilt table
• To enable paralysed patient assume erect
position
• To prevent contractures and deformities
• To prevent deconditioning effects of
prolonged bed rest such as loss of muscle
tone, urinary calculi and UTI, decubitus ulcers
 Community implications of rehab
nursing
• Educating the patient
1. Fundamental health principles
2. Necessity for cleanliness
3. Moral factor in wearing attractive clothing
4. Need for good grooming
5. Basic elements of mental and physical hygiene
6. Good nutrition
7. Bladder and bowel training
8. Motivate patient to persevere in performing the activities of
daily living without assistance from over protective family
members
9. Proper care of braces and wheelchair
10. Interpreting patient needs to his family