Common Issues in Rehab Nursing.

[StudentOfHealing]

Hello Nurses!

I'm a 5th semester senior nursing student and I am rotating at a rehab facility. The facility caters to neurological injuries/strokes/neuromuscular disorders.

I know that this is very broad but on the unit you personally work on, what are common issues? (Falls/bed ulcers)?

I would appreciate both personal input or referrals to articles/websites. My Google search has proven to be little help. ):

I just want to be prepared. What should I read over? What medications are commom?

Your help is greatly appreciated.

Thank YOU!

[TheCommuter, BSN, RN]

Common issues at the rehab hospital where I work include falls, skin breakdown (a.k.a. pressure ulcers), urinary tract infections, bladder training, bowel programs, incontinence, and patient satisfaction issues.

Our patient population is a mixed bag of CVAs, debility secondary to pneumonia, MS, Parkinson's, orthopedic cases (knee and hip arthroplasty), spinal cord injury (paraplegia and quadriplegia), COPD, and trauma secondary to motor vehicle accidents.

We deal with lots of meds for pain, diabetes, HTN, Parkinson's, hypothyroidism, elevated cholesterol, respiratory issues, constipation, urinary retention, antivirals, antibiotics, muscle relaxants, antispasmotics, and much more.

[StudentOfHealing]

Thank you so much!

[RNGriffin]

Depends on the unit you are working on...Stroke patients are notorious for being impulsive. So, fall risk, comfort measures, skin break down due to regional or generalized weakness is a major concern. In every CVA patient's room I advise everyone to keep bed alarms on at all times.

Spinal cord injuries are complex cases. I am pretty sure you have discussed Autonomic Dysreflexia being one of the major complications. This is why you must keep these patient's bowel & bladder regulated, we attempt to develop a routine for our paras to begin to defecate on their own, but it's likely one may never regain bladder sensation post spinal cord injury.

Neuro Patients: nutrition, nutrition, nutrition! Watch these patients for impulsive behavior, incontinence leading to PU(s), falls, ICP increases( can be rebound for 1 month depending on the extent of injury)...etc.

List of common complications: Foot drop, UTI(s), pneumonia in our spinal cord patients( watch the respiratory status & for any cervical fractures encourage position changes and IS), Pain management is our biggest obstacle...you may never be able to regulate patients pain, but we attempt to assist the patient to tolerate activity more rapidly.

[rnmelody]

Rehab nursing is very complex. The caseload is now evolving into more complex situations such as strokes with accompanying co morbid issues. We now take care of patients with TBIs, multiple sclerosus, craniotomy and worst, drug dependent hips and knees. I dont mind caring for patients who has multiple needs and total assists with ADLs but for me, my biggest challenge is caring for bipolar, narcissistic and drug seeking patients with uncomplicated orthopedic surgery who takes too much time and emotional effort to keep them satisfied with their care. Esp now that patient satisfaction is driver of medicare reimbursement. I also advocate for bladder and bowel training to promote continence and toileting regularity; Purposeful rounding while taking care of pain, potty, personal possessions and position should promote patient satisfaction and prevent falls. Being proactive in toileting schedule at least every 2 hours especially for impulsive and incontinent patients would help prevent falls. Doing the interdisciplinary team meetings also is beneficial for patient safety because Speech, Occupational and Physical therapists would be able to share insights into patient's tranfers, ADLs and Cognition. Overall, Rehab nursing focuses more on developing patient's independence, safety awareness and get them ready to take care of themselves at home.