Morning assessment, dress them with tech, oob to chair, vent patients are bagged, suctioned, trach care, oob to chair, disconnect from wall power, battery hooked up, disconnect wall O2; connect tank, feed them, give meds, power chair to therapy, push vent with one hand, guide power chair with the other one, don’t be late. Everyone first dressed and OOB to chair, feed, give meds to therapy. Therapy is the priority after personal care: diaper change, or erect privacy wall to change diaper while on the mat, dress, brush teeth. 4 hrs of therapy a day, 900am-1200pm, 100pm- 4pm with 2 physical therapy sessions 45 minutes a day, and 2 occupational sessions 45 minutes a day. Charting, giving meds, Rounding, techs make beds, and assist with feeding. RN feed maybe 4 quads at the table carefully, give IV ABX q12 plus routine meds. 1st shift gets them OOB, 2nd shift puts them back into bed, they want to give excuses not to go to therapy to stay in bed be fed and narcotics it is constant encouragement and hustle. Transfers with hoyer lift, respiratory Txs, IV starts, admissions, discharges, checking for DVTs, giving Blood thinners, patient teaching, family teaching, straight cath q4 hrs or q6, family teaching. Bowel care after spinal cord injury, Bladder care after spinal cord injury, Skin care after spinal cord injury, sexual function after spinal cord injury, trach care, suctioning, transfers using sliding board from bed to chair, and chair to bed. Also when dressed abdominal binder and Ted hose to compensate Blood pressure issues. Every other night bowel program using suppositories, manual removal, transfer to chair and to the shower. They have to be prodded to get bowel program, nurses fudge the truth that the patient refused bowel program and shower, floaters and agency nurses. You have the bowel sheet the most important documentation like the narcotics count because we have to keep track of who did and who did not poop, even the head nurse wants to know because of the problems and accidents on the way to and in therapy. They need enemas and Mag citrate to go and it is a magnanimous problem, getting to and finding the truth about the bowel programs. Patients have to be straight cathed every 4 or 6 hrs correctly using gravity with the catheter or the urine does not flow. They can get autonomic dysreflexia and stroke out with a noxious stimulant of having too much urine in the bladder. Sometimes the nurse can’t get the catheter to go in properly so they need a special bird beak catheter, to get the urine out. When the patient is trached initially, with a number eight, then afterwards they are downsized to a number six cuffed trach so the air does not escape around their neck and the vent alarm goes off, and then progress to a speech valve, one way valve. The trachea cuff must be deflated when putting on the speech valve or they will suffocate, as they are being weaned from the vent. They must always have on the pulse Ox with alarm for safety to make sure there are no mistakes. Vents, tubing, rates, pressures must be checked, bagged good every morning, trach care done. Tube feedings must be put on hold when HOB goes down or their lungs will fill up with the milk!
Outpatient rehab doesn't generally require a nurse. It is usually PT, OT & ST typically in a home or clinic type setting.
Inpatient rehab will require a nurse. Medication administration & continually educating and reminding pt to utilize instruction provided by their therapist.
I love acute inpatient rehab nursing! There is nothing better than watching a broken pt move through the healing process and walk out of the hospital.
The nurse's role in inpatient rehab is to assist patient with pain control, encourage movement, decrease infection rates (proper wound care) and teach patient and family about medications, outpatient rehab and managing pain.
The outpatient setting the nurse's role is to continue education on medications, pain control, encouraging movement and activity to help regain functional abilities in order to go home with outpatient or home care rehabilitation.
In any rehab setting the job of the nurse is to carry over into patient care the orders from the therapy department. There is a heavier placement of following orders in patient care plan on the PT OT ST. They basically write the care plan. We always follow the doctors orders, but in rehab therapy dictates a lot more of the care given. We must also communicate closely with how patients are doing when not at rehab but under our care as a lot of patients come back from rehab and want nursing to do all the care for them when they do it in therapy themselves. Always a positive attitude when it comes to reaching their goal. Patients mostly are not thrilled at being in and having to do a lot of work to get their lives back in order in rehab. We need to push them in the direction, if you want your life back as it was you have to work at it.
Everything...total patient care. Hardest nursing I've ever done...had to change. Some love it!
Inpatient rehab it's filing charting and outpatient its computerized charting
To rehabilitate the patients which include training, teaching and providing care they needs as required by nursing plan of care
A nurses role is the same regardless on their setting, to provide exceptional quality patient care. With that said there a priority placed on mobilization and discharge needs and planning in an rehab or outpatient setting.
From the answers already given, it seems as though there is a wide variety of experiences and expectations. I work on a neurological rehabilitation unit that does not take patients who are on a vent. The criteria for admission includes tolerating 3 hours of therapy a day, and criteria for remaining on the unit requires they participate in that three hours. The emphasis is on a discharge home with family/caregivers, so the nurse's role includes teaching the family/caregiver a variety of things including medications, tube feedings, pain management, IV care (in the case they go home on antibiotics), bowel program, straight catheterization, turning, hoyer lift transfers (if applicable, in conjunction with therapists), wound care if applicable (we are fortunate that trach care/suctioning is typically taught by the respiratory therapist), plus diabetic management and stroke prevention. Patients for sure get up 5-6 days a week unless there is a medical reason not to do so, and if they are not able to participate in therapy for more than 24 hours we have to start planning a transfer to an acute unit. Focus is on making the patient do what they can for themselves - yes, they are often tired upon return from therapy but that still doesn't mean they get a completely free ride. You often walk a fine line knowing when to push and when to pull back.
I loved working in patient rehab..
cool job......not stressful
CVA and Ortho patients.....stable and improve each day
They are in therapy all day
You do help with ADL's in the morning getting them ready for therapy
pass meds
day shift the best
At Inpatient rehab where I worked,we would do assessments, patient care, administer medications team conference, admissions discharge. Also start IVs give blood.
#1.The first response should be patient safety,
2. Then learn why they are there and what their needs are,
3. What does the Dr. wants you to do
