CNA Basic Restorative Services 2

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Which of the following statements is true about range of motion (ROM) exercises?

Correct! Wrong!

A way to ensure that range of motion (ROM) exercises are done is to incorporate them into ADL tasks. ROM provides a way to maintain joint flexibility. In passive ROM, someone moves the joints with no assistance from the client. In active ROM, the client does the exercises alone or with the help of devices, such as a strap. ROM is important to prevent contractures. A contracture is a shortening of muscles, tissues, tendons, and skin at the joints, due to lack of movement and exercise. When joints remain bent over time, they can no longer be straightened.

A cane should be used on the ________.

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When using a cane, it "goes on the strong side, but moves with the weak side." This automatically shifts the person's weight to the strong side. To walk properly, place the cane the distance of an average step, and move the weak (affected) leg with it. Do not reach or stretch to increase the distance. The strong arm and weak leg share the load. Steady the walk through leaning on the strong side while moving one step on the weak side, making sure the weak foot is placed securely before taking another step with the strong side. When climbing stairs, remember "up with the good" and "down with the bad" to maintain balance.

What is the branch of medicine that deals with physical medicine and rehabilitation called?

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Physiatry is the branch of medicine that is involved with physical medicine and rehabilitation. It treats conditions that include the brain, spinal cord, nerves, bones, joints, ligaments, and tendons. If a nurse aide chooses to work in physiatry, they will have patients with cognitive problems, mobility issues, gait disorders, feeding and swallowing issues, and muscle conditions. Many of these patients will require care in assisted living and long-term care facilities.

Restorative nursing care is the process of

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Restorative care provides specialized services to help a client regain the highest possible health and function and to prevent decline. The goal is to assist the client to return to a home setting and live independently. Rehabilitation methods are used to teach clients activities of daily living, speech, and safety.

What is the term for a device used to take the place of a missing body part?

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A prosthesis is a device that replaces a part of the body that is missing from surgery, accidents, or at birth. It helps restore function for the client. It can also improve a client's appearance. A prosthesis can be made for eyes, teeth, arms, legs, joints, or breasts.

When walking a resident, a gait or transfer belt is often _________.

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A gait belt provides support and stability for the resident during walking or transfer. When putting on a gait belt, it should fit snugly, with just enough room to insert two fingers. It goes over the client's clothing, with the buckle in front. Walk behind and slightly to the side of the client, grasping the belt from the underside. Always remove it when you finish walking.

Mr. Lopez is learning to use a walker. What should the nurse aide do?

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Using a gait belt with Mr. Lopez will keep him safe as he learns to walk. It can also prevent both him and you if he loses his balance and starts to fall. A gait belt provides support and stability for the resident during walking or transfer. When putting on a gait belt, it should fit snugly, with just enough room to insert two fingers. It goes over the client's clothing, with the buckle in front. Walk behind and slightly to the side of the client, grasping the best from the underside. Always remove it when you finish walking.

When helping a client who is recovering from a stroke to walk, the nurse aide should assist

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When helping a client walk who is recovering from a stroke, the nurse aide should stay on the client's weak side. Walk next to, and slightly behind, the client in order to be ready to suddenly support the weak side. If the client is using a walker or cane, allow space for the device. While walking, be alert to avoid possible fall hazards. The client should wear slippers or shoes with rubber soles for traction.

Raising the bed to a comfortable position will help prevent

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Nursing care has the highest risk for back injuries. One study showed that during a shift, a hospital nursing staff member will lift 20 patients and transfer 5-10 patients from bed to a chair. Another study showed that lifting patients accounts for about half of all patient care-related injuries. Patients typically weigh more than 100 pounds—more than the maximum load for industrial workers! Working at a comfortable height is essential to prevent back strain and injury.

An elderly resident who is inactive is at risk for constipation. In addition to increased activity and exercise, which of the following actions helps to prevent constipation?

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Getting enough fluids is important in preventing constipation. Elderly people may not have an adequate fluid intake for several reasons. 1. Older people may not recognize when they are thirsty. They may need to be reminded to drink or the nurse aide can offer a drink every two hours. 2. They may restrict their own fluids to avoid incontinence or frequent toileting. Scheduled toileting can reduce the chance of incontinence. 3. They may have a medical condition, such as congestive heart failure or kidney disease, that have restricted fluid intakes. If any resident is constipated on a regular basis, tell the nurse.

Residents who have had a stroke are at risk for a fall because of

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Following a stroke, the risk for falling increases for several reasons. Muscles may be paralyzed or weakened, so the resident cannot rely on their former ability to balance and walk. Coordination can be impaired, so standing still becomes difficult. Changes in their cognitive function can cause them to make poor decisions, such as to refuse a cane or walker. New medications may have side effects that affect movement or thinking.

Exercises that can help maintain the movement of joints are called

Correct! Wrong!

Range of motion (ROM) exercises provide a way to maintain joint flexibility. In passive ROM, someone moves the joints with no assistance from the client. In active ROM, the client does the exercises alone or with the help of devices, such as a strap. ROM is important to prevent contractures. A contracture is a shortening of muscles, tissues, tendons, and skin at the joints, due to lack of movement and exercise. When joints remain bent over time, they can no longer be straightened.

Which statement about gait belts is NOT true?

Correct! Wrong!

Gait belts are made of sturdy material and have a non-reversible buckle. A gait belt provides support and stability for the resident during walking or transfer. When putting on a gait belt, it should fit snugly, with just enough room to insert two fingers. It goes over the client's clothing, with the buckle in front. Walk behind and slightly to the side of the client, grasping the belt from the underside. Always remove it when you finish walking.

After Mr. Hall's stroke, his right arm is weak, he should be taught to

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Mr. Hall should use his left arm to put his right arm into his shirt first. When dressing a resident with one-sided weakness, teach the resident to use their unaffected (strong) side to dress the affected (weak) side first. When getting undressed, take the unaffected side out of the sleeve first, Clothing should be loose fitting and comfortable.

When helping a resident get out of bed, what should a nurse aide do?

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Each time you assist, move, or transfer a resident, remember to use good body mechanics to avoid hurting yourself. Proper body mechanics uses the legs to do most of the work. Keep your back straight and locked; do not turn or twist. If you bend, do so at the knees and hips, not the waist. Before lifting or moving a resident, assess how much they are able to do. If you have any doubts, always ask for assistance from a co-worker.

Residents who are bedridden face all following risks EXCEPT

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When a resident is unable to get out of bed, there can be many serious complications. Because lungs can't fully expand, pneumonia can develop. Without weight-bearing activity, calcium leaves the bones, causing bones to thin. And with sluggish circulation, blood clots can form, especially in the legs. Muscles can atrophy, and there is a risk of developing contractures.

The doctor has ordered physical therapy (PT) for every day of the week. The patient's religion does not permit any activity on Saturday. What should you do when PT arrives on Saturday?

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Tell the nurse about the patient's religious beliefs, so the nurse can contact the doctor to change the orders. The patient has the right to refuse PT on a Saturday. If a patient's religion or culture does not permit activities or has diet restrictions, always respect those. For many patients, if they are not allowed to observe their religious rules, they may feel they have violated the rules and could be punished. Do not force the patient to have PT.

Mrs. Wilson is in your facility for rehabilitation after her hip replacement. Her husband wants to help give her a bath and she agrees. What should you say?

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If a resident agrees, and the nurse approves, family members can assist with tasks such as bathing. This can be a useful teaching tool for families who will be providing support when the resident returns home. Studies have shown that residents may eat better and less likely to become depressed when the family can provide some physical and emotional support.

Mr. Brown is blind from an industrial accident. How can you help him learn to feed himself?

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Patients who become blind as adults must learn to live without vision. Help them be as independent as possible by establishing a way to eat their meals. Set the table in the standard way. Say to them, "Your chicken is at two o'clock and your potatoes are at six o'clock…" For other items, say, "Salt and pepper are above the fork, and your water is above the knife." If food might present a challenge, ask, "would you like me to cut your steak and put butter on your roll?"

To encourage blood circulation in residents who must remain in bed, you can do all of the following EXCEPT

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Good blood circulation can keep residents healthy and prevent skin breakdown. During baths, dressing, or position changes, inspect the skin for redness, pallor, warmth, or bruising. Do not irritate fragile skin with vigorous rubbing. Reposition at least every two hours, protecting areas that rub together, as well as the bony prominences. Massages to the back and buttocks can promote circulation. Range-of-motion exercises are also helpful. Always report any signs of breakdown to the nurse.

When is an easy time to do Range of motion (ROM) exercises?

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Although range of motion (ROM) can be done at any time, it fits well as part of the resident's bath. As you wash the arms and legs, put each limb through the exercises. If you do ROM with each limb you're washing, you will not skip any areas. You can also do ROM while applying lotion after the bath.

What would be the BEST way for the nurse aide to promote client independence in bathing a patient who has had a stroke?

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Regaining independence after a stroke can be challenging and frustrating. The nurse aide must be patient during the recovery process. Encourage the patient to do as much as possible. Offer assistance as needed, but always provide positive feedback for each gain. It can be tempting to do things for the patient, such as give a bath, but remember that the goal is to be as independent as possible, even if tasks are not done perfectly.

When a patient ambulates for the first time, the nurse aide should

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Ambulation is important for muscle strength, joint flexibility, and better circulation. When a patient has been ill or recovering from surgery, they may be anxious about ambulating for the first time. Assess how much help they will need: can they walk, or will they need a gait belt, crutch, or walker? Take time to let the patient sit up and dangle for a few minutes on the side of the bed. Ask if they are dizzy or light-headed before helping them stand. Do the same thing when they stand. If they seem steady, proceed to help them ambulate.

While helping a resident perform a Range of Motion (ROM) exercise, he complains of pain. The nurse aide should

Correct! Wrong!

Range of motion (ROM) exercises provide a way to maintain joint flexibility. In passive ROM, someone moves the joints with no assistance from the resident. In active ROM, the resident does the exercises alone or with the help of devices, such as a strap. When doing or assisting with ROM, always stop if the resident complains of pain. Watch the resident for signs of discomfort, shortness of breath, or fatigue. If you observe any of these, stop and tell the nurse.

To move a resident up in bed when they are able to move with assistance, the nurse aide should _________.

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Moving a resident up in bed can be done if the resident is alert and able to cooperate. Ask them to bend their knees and place the soles of their feet on the bed. Then ask them to hold on to the trapeze bar or side rails. Slide your arms under the resident's hips. On the count of three, both of you can move towards the head of the bed.

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