Rehabilitation Programs for Brain and Spinal Cord Injuries

Stroke Recovery Programs and Traumatic Brain Injury Rehabilitation

• Emphasize cognitive remediation to help patients compensate for memory, perceptual, judgment, and safety deficits.
• Teach self-care and mobility skills to patients.
• Goals include helping patients swallow food safely and communicate effectively.

Spinal Cord Injury Rehabilitation Programs

• Understand the effects and complications of spinal cord injury.
• Manage neurogenic bowel and bladder issues.
• Focus on sexuality and fertility enhancement, self-care, and prevention of skin breakdown.
• Include bed mobility and transfers, as well as driving with adaptive equipment.
• Emphasize vocational assessment, training, and reentry into employment and the community.

Orthopedic Rehabilitation Programs

• Manage pain and conserve energy.
• Protect joints and promote independence with prostheses or new joints.
• Focus on patients undergoing joint replacements and those with arthritis.

Cardiac Rehabilitation

• Emphasize monitored, progressive exercise and nutritional counseling.
• Manage stress and promote risk reduction.
• Focus on patients who have had myocardial infarction.

Pulmonary Rehabilitation Programs

• Help patients achieve more effective breathing patterns.
• Teach energy conservation techniques, self-medication, and home ventilatory management.
• Focus on respiratory therapists and patients with respiratory issues.

Comprehensive Pain Management Programs

• Focus on alternative pain treatment modalities, exercise, and supportive counseling.
• Emphasize vocational evaluation and management of chronic pain, especially low back pain.

Diagnosis and Preoperative Nursing Diagnoses

• Deficient knowledge about planned surgical treatments.
• Anxiety related to cancer diagnosis and treatment options.
• Fear related to specific treatments and body image changes.
• Risk for ineffective coping and decisional conflict related to diagnosis and treatment options.

Postoperative Nursing Diagnoses

• Pain and discomfort related to surgical procedure.
• Disturbed sensory perception related to nerve irritation.
• Disturbed body image related to loss or alteration of the breast.
• Risk for impaired adjustment and sexual dysfunction.
• Self-care deficit related to partial immobility of upper extremity.
• Deficient knowledge regarding drain management, arm exercises, and hand and arm care.

Collaborative Problems/Potential Complications

• Lymphedema, hematoma/seroma formation, and infection.

Planning and Goals

• Increase knowledge about the disease and its treatment.
• Reduce preoperative and postoperative fear, anxiety, and emotional stress.
• Improve decision-making ability and coping abilities.
• Manage pain and improve sexual function.
• Avoid complications.

Surgical Management

• Perform surgical procedures to prevent the herniated portion of the stomach from moving upward through the hiatus.
• Fundoplication is the most common surgical procedure.

Abdominal Hernia

• A hernia is an abnormal protrusion of an organ or structure through the wall of the cavity normally containing it.
• The hernia sac is formed by the peritoneum protruding through the weakened muscle wall.
• Causes of abdominal hernias include:
  • Weakness in the abdominal wall along with increased intra-abdominal pressure.
  • Obesity.
  • Pregnancy.
  • Poor wound healing.
• Types of abdominal hernias:
  • Inguinal hernias (located in the groin).
  • Umbilical hernias (seen in obese women and children).
  • Ventral (incisional) hernias (result from weakness in the abdominal wall following abdominal surgery).

Signs and Symptoms

• Abnormal bulging in the affected area of the abdomen.
• Patient may experience discomfort or pain.
• Patient may experience incarceration or strangulation.

Preoperative Care

• Instruct patient in routine preoperative deep breathing and coughing techniques.
• Hold abdomen with a splint to support weakened abdominal muscles during coughing and moving.

Postoperative Care

• Monitor for difficulty with voiding.
• Monitor bowel sounds and report discomfort or distension.
• Teach patient to change dressing and report signs and symptoms of infection.
• Instruct patient to avoid lifting for 2 to 6 weeks.

Ulcerative Colitis

• Multiple ulcerations and diffuse inflammation occur in the superficial mucosa and submucosa of the colon.
• Lesions spread throughout the large intestine and usually involve the rectum.
• Causes of peptic ulcers include:
  • Helicobacter pylori (responsible for 80% of gastric ulcers and more than 90% of duodenal ulcers).
  • Contaminated water.
  • Smoking (increases harmful effects of H. pylori, alters protective mechanisms, and decreases gastric blood flow).
• Signs and symptoms:
  • Dull, gnawing pain or burning sensation in the mid-epigastrium or back.
  • Anorexia and nausea and vomiting.
  • Bleeding may occur with massive hemorrhaging or slow oozing.
  • Patients may have low hematocrit and hemoglobin levels, and gastric or fecal occult blood may be found.
• Diagnosis:
  • Physical examination may reveal pain, epigastric tenderness, or abdominal distension.
  • H. pylori can be diagnosed with several tests, including the urea breath test.