Need info about OT & ST Nurse's role

[kwagner_51]

Hi, I am an RN working in HH with one stroke victim. She can't talk, her right side is weak, and she gets PT 2 x a week. We can't get her OT and ST due to the home health company being unable to find anyone.

I want to help this young lady [57 y/o] as much as I can. I do ROM and PROM now but I really need pics of the hand and leg exercises to make sure I'm not hurting her. I watched PT yesterday and saw some of the exercises but would like pics to hang up and share with the other nurses on the case. I saw her sit on the side of the bed yesterday for 10 min!!! I cried. Right now we have to use a hoyer to get her up. I want to work with her, help her get stronger so she can have as much mobility as possible.

Also, is there any communications device that are used for someone who can't speak but might be able to write?

Are there books I can buy. or download to help me help this lady? She is my only patient and I see her 40 hrs a week.

Thanks!!

In His Grace,

Karen RN

Failure is NOT an option!!

Also posted in Rehab nursing forum

[kwagner_51]

please!

[Altra, BSN, RN]

Karen, off topic but just curious ... did you leave your Head Start position?

[kwagner_51]

Karen, off topic but just curious ... did you leave your Head Start position?

Nope, I'm off for the summer. I go back August 13 However, I am planning on working Q Sunday for this family. I may also pick up some holidays cause I'm off for 2 weeks in December.

The reason I'm asking about OT and ST is that the company cannot supply these specialties. we need to find someone on our own.

She can't even get a BSC. It's been ordered, then dropped, then ordered, then ...you get the idea. She lives in a rural area..

Thanks for all your help!!!

In His Grace,

Karen RN

Failure is NOT an option!!

[jer_sd]

What is you exact plan of care? Do you want to improve communication, reduce contractures or other? OT helps with ADLs, ST feeding and communication.

Do you want to improve communication skills how impared is expression? You can make a pointing board that she can point to basic things such as pain, ect... As long as you do ROM and dont force the range it is very low risk to harm her. For ROM spend time with the PT and activly participate rather than just observe.

As a nurse you can develop and impliment a care plan to assist teh patient, I am not a rehab nurse but depending on your goals you can probably help quite a bit.

[TazziRN, RN]

If she can write then a pad of paper and pencils/pens will be invaluable. Otherwise contact a medical supply store and see if they have any communication tools for speech-impaired pts.

[P_RN, ADN, RN]

Has she applied for SS Disability? Sometimes Medicare will pay for outside contractors.

[Speechie]

Hi. i'm a speech path in long-term care and most of my practice is with people who have had strokes. You're really off on the right foot, thinking about alternative communication strategies. Tazzi's right; if your lady can write, that's the most natural strategy. If she can't, you may need to go to a communication board. Spelling (using a board with the alphabet) is the method that allows the "speaker" the most flexibility, but it can be impossible for the person who has aphasia (loss of the language code system). In that case, you may want to move on to a picture board. There is a hierarchy of abstraction in pictures that can be important with aphasic patients. Line drawings are the most abstract, thus can be the most difficult to comprehend. Most commercial communication boards use line drawings. If the person can't understand that, you can try color drawings or even photographs. The more closely the picture resembles the actual item, the more likely a lower-functioning individual will be able to use it functionally. The other thing to think about is how many items will be on a page. Some people can look at a paper with thirty pictures on it and pick out the one they want to "say"... others are limited to 4 or even 3 choices.

Please let us know how you are doing :)

speechie