Unit 13-Basic Restorative Services

Unit 13
Basic Restorative Services

Nurse Aide I Course
DHSR Approved Curriculum-Unit 13 1

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.

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

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

(continued)
• Emphasis on existing
abilities
• Encourages
independence
• Promotes productive
lifestyle

(continued)
• Goals include:
– Prevention of
complications
– Retraining in lost
skills
– Learning new skills

13.1 Identify the nurse aide’s role in
rehabilitation/restoration.

(continued)
• Nurse Aide’s Role
– Encourage resident
– Praise accomplishments
– Review skills taught
– Report progress or need
for additional teaching

(continued)
• Nurse Aides Role (continued)
– Promote independence
• praise all attempts at
independence
• overlook failures
• show confidence in
resident’s ability
(continued)
• Nurse Aides Role (continued)
– Promote independence (continued)
• be patient and allow time for
residents to do things for
themselves
– Be sensitive and understanding

13.2 Provide training in and the
opportunity for self-care
according to the resident’s
capabilities.

Self-Care According To
Resident’s Capabilities
• Training in self-care requires that
three questions be answered prior to
starting:
1. What is the goal to be achieved?
2. What approaches are used to help
the resident achieve the goal?
3. How will progress or lack of
progress be measured?
(continued)
• Resident included in goal-setting

process, whenever possible.

(continued)
• Functional losses cause:
– Resentment
– Anger
– Frustration
– Withdrawal
– Depression
– Grief
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 resident’s level of
functioning
(continued)
• Provide encouragement and
reinforcement
• Praise successes
• Emphasize abilities
• Treat resident with respect
• Explain what resident needs to
accomplish, and how you will
help.
(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
• Treatment initiated by:

– Physical therapist
– Occupational
therapist
– Speech therapist
– Licensed nurse

(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
(continued)
• ADL considerations for
resident (continued):
– Encourage use and
selection of clothing
– Be patient and allow
time for slower paced
activities
(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
13.3 Discuss methods for assisting
with bowel and bladder retraining.

Bowel And Bladder Retraining
• Incontinence: Inability to control

urination or defecation
– Embarrassing for resident
– Uncomfortable

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

Bowel Retraining
(continued)
• Participants in plan
– resident
– family
– all staff members

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

(continued)
• High bulk foods given, if not
restricted
– fruits – bread
– vegetables – bran cereals

(continued)
• Bowel aids ordered by physician and
administered by licensed nurse only:
– laxatives
– suppositories
– stool softeners
• Regular exercise encouraged

(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
(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
Bladder Retraining
• Plan developed to assist

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

Bladder Retraining
• Individualized plan includes:

– schedule that specifies
time and amount of fluids
to be given
– schedule for attempting to
void

Guidelines for Bladder Retraining
• Get resident’s 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
(continued)
• Provide for comfortable
voiding position
• Be supportive and
sensitive
• Provide encouragement
• Offer fluids according to
schedule
(continued)
• Provide stimuli as needed:
– run water in sink
– pour water over
perineum
– offer fluids to drink
– place hands in warm
water
(continued)
• Provide good skin care to prevent
skin breakdown
• Retraining may take 6-10 weeks
– be patient
– be supportive
– ignore accidents
– respect resident’s feelings
(continued)
• Follow facility
procedure for use of:
– incontinent pads
– adult protective
pants
– incontinent briefs

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

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

(continued)
• Supportive devices to
assist with walking –
canes, crutches, walkers
• Wheelchairs and
motorized chairs to
provide movement from
place to place
(continued)
• Prosthesis to replace missing body
parts
• Successful use of adaptive devices
depends on the resident’s:
– attitude
– acceptance of limitations
– motivation
– support from others
13.5 Discuss the various ambulation
devices and transfer aids.

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
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
Transfer Aids
(continued)
• Canes
– Types:
• single-tipped
• tripod - 3 legs
• quad - four point

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

Transfer Aids
(continued)
– Should be fitted properly:
• cane handle level with
femur (greater
trochanter)
• elbow flexed at 15 to 30
degree angle
• shoulders level
Transfer Aids
(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)
Transfer Aids
(continued)
• Crutches
– Provide support and
stability through use of
hands and arms.
– Used when one or both
legs are weak.

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
Transfer Aids
(continued)
– Gaits
• four-point gait
• three-point gait
• two-point gait
• swing-to gait
• swing-thru gait
Transfer Aids
(continued)
– Weight supported on
hand bar, not axilla

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
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
Transfer Aids
(continued)
– Seat should not sag
toward center of chair
– Seat should not reach
back of resident’s bent
knees
– Brakes locked when
chair not moving
Transfer Aids
(continued)
– Wheelchair guided backwards
when going downhill
– Wheelchair pulled backwards
over indented or raised areas
(i.e., entrance to elevators)

Transfer Aids
(continued)
– Feet placed on footrests
for transport

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

Transfer Aids
(continued)
– Always used with
assistance when
transferring resident
on or off
– Pushed feet first
during transport
Transfer Aids
(continued)
– Guided backwards when
going downhill
– Cleaned with mild
detergent and water,
rinsed with water and
dried
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

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

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
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.

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

13.7 Discuss the use of mechanical
lifts.

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

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

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

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

Range of Motion Exercises
• Types of range of motion:

– Active - resident
exercises joints without
help
– Passive - another person
moves body part for
resident
Range of Motion Exercises
(continued)
• Purpose of range of motion:

– Maintains muscle tone
– Prevents deformities
– Increases circulation
– Encourages mobility

Guidelines When Performing
Range Of Motion
• Expose only part of
body being exercised
• Be gentle and stop if
resident complains of
pain
• Use good body
mechanics
Range 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 resident’s
condition
Range 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

Range Of Motion
(continued)
• Exercise joint slowly, smoothly and

gently
• Do not exercise swollen, reddened
joints; report condition to supervisor

Range Of Motion Exercises
Types of Joint Movement
• Abduction
• Adduction
• Extension
• Hyperextension
• Flexion
• Plantar flexion
• Dorsiflexion
• Rotation
Range Of Motion Exercises
Types of Joint Movement
(continued)
• Pronation
• Supination
• Eversion
• Inversion
• Radial deviation Encourage
• Ulnar deviation residents capable
of doing active
ROM exercises
performing range of motion
exercises.

13.11 Assist in care and use of
prosthetic devices.

Prosthetic Devices
• Artificial Eye (glass eye)

– encourage resident to
remove, clean and
replace eye
prosthesis if able

Prosthetic Devices
(continued)
• Eyeglasses
– Lens made of glass or
plastic
– Stored in protective
case to prevent
damage when not in
use
– Held by frames
Prosthetic Devices
(continued)
• Eyeglasses (continued)
– Washed under running
water using mild
detergent.
• rinsed with clear water
• dried with tissue or soft
cloth
Prosthetic Devices
(continued)
• Eyeglasses (continued)
– Tops of ears and
nose observed for
redness or irritation
from glasses
• Wash hands before
and after cleansing
resident’s glasses
Prosthetic Devices
(continued)
• Contact Lenses (hard or

soft)
– Resident encouraged
to care for lenses

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

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 resident’s
satisfaction

Prosthetic Devices
(continued)
• Braces
– Uses
• support a weak part of the body
• prevent movement of joint
• correct deformities
• prevent deformities

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
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
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

Prosthetic Devices
(continued)
(continued)
– Examples of prosthetic devices:
• artificial leg
• artificial foot
• artificial arm
• artificial hand
Prosthetic Devices
(continued)
(continued)
– Prosthesis fitted and made for
each individual.
– Devices must be handled with
care and stored in appropriate
place when not in use.

Devices For Use With Amputation
Assisting with artificial limbs:

– have right device
– check all parts for damage
– evaluate resident’s limb for irritation
and swelling
– pad area of prosthesis touching
resident
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

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

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

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

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

Dangling
(continued)
• Most common signs/symptoms if

feeling faint:
– pale face
– complaints of dizziness or
weakness

Dangling
(continued)
• Return resident to supine position if

they have difficulty dangling
• If dangling is well tolerated, progress
to standing position

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

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

Ambulating
• Effects on body
– stimulates circulation
– strengthens muscles
– relieves pressure on body
parts
– increases joint mobility
– improves function of
digestive and urinary
systems
Ambulating
(continued)
• Effects on body (continued)
– increased independence
leads to more positive
self-image
– provides sense of
accomplishment
– prevents lung congestion

Ambulating
(continued)
• Encourage to ambulate as much
as possible
• Suggest use of handrails for
support

Ambulating
(continued)
• If resident starts to fall, ease to
the floor by:
– grasping under arms
– resting buttocks against nurse
aide’s leg
– sliding down aide’s leg to floor

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
assisting the resident to dangle,
stand and walk.

13.15 Provide cast care for the
resident.

Cast Care
• Cast used to immobilize

body part, providing time
for part to heal

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
Cast Care
(continued)
• Care of Casts
– Allow to air dry
– Keep cast uncovered
– Use pillows to support
cast
– Support cast with palms
of hands
Cast Care
(continued)
• Care of Casts
– Never put pressure on
cast
– Turn and position
frequently to allow air to
circulate around cast

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

(continued)
• Vomiting
• Elevated temperature
• Skin irritation around
edge of cast

(continued)
• Resident reports of:
– Pain – Itching
– Numbness – Tightness
– Tingling – Inability to
sensations move fingers
– Chills or toes
– Hot or cold skin – Nausea
13.16 Demonstrate the proper
technique for transferring a
resident from a bed to a chair.

resident from a bed to
wheelchair.

resident from a bed to a
stretcher.


Unit 13-Basic Restorative Services

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Unit 13-Basic Restorative Services

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Unit 13

Basic Restorative Services

DHSR Approved Curriculum-Unit 13 1

DHSR Approved Curriculum-Unit 13 2

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DHSR Approved Curriculum-Unit 13 6

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• Resident included in goal-setting

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• Treatment initiated by:

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• Incontinence: Inability to control

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• Enemas may be ordered by

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• Plan developed to assist

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• Individualized plan includes:

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• Special utensils available to

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• Shoes must fit and be in

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• Straps, sling and clasps checked

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• Types of range of motion:

• Purpose of range of motion:

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• Each movement is repeated three

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• Exercise joint slowly, smoothly and

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• Artificial Eye (glass eye)

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