Patients who have sustained fractures or dislocations.

Patients who have undergone orthopedic surgeries, including, joint replacements, or

reconstructive surgeries.
Patients suffering from degenerative joint or disk disease.
Patients suffering from rheumatoid arthritis.
Patients who have undergrone amputations or require prosthetic training.
Patients who have sustained burns with joint in volvement or have physical impairment with an

associated decrease in function

Patients who have suffered cerebral vascular accidents
Patients who have suffered head injuries or spinal cord injuries
Patients with multiple selerosis
Patients with amyotrophic lateral selerosis
Patients with Parkinsons disease
Patients with a decrease in function as a results of neuropathies and/or myopathies
Patients with cronic obstructive pulmonary disease who require postular drainage and teaching
Patients with cardiac impairment requiring cardiac rehabilitation
Patients with severe immobility as a results of any disease process requiring instruction to the

caregiver in Hoyer lift transfers or any assistive device

Patients with head/neck cancer resulting in partial or total laryngectournies os glossectomies
Patients whose underlying disease process, iliness, or injury has resulted in dysphagia
Patients suffering from a hearing loss

However, before making an interdisciplinary referral, home care nurses must consider the available
reimbursement sources. Payment for rehabilitation services for patients experiencing weakness or
immobility from prolonged hospitalization secondary to medical complications may be denied by
Medicare. Fiscal intermediaries often view this as a weakness or temporary loss of function that will
improve spontaneously and does not warrant the intervention of a skilled therapist. When assessing
patients needs for additional services, it is important that home care nurses not concentrate solely on the
medical diagnosis, because the therapist treats loss of function and not the specific disease or illaess.
Chapter 9 describes clinical indicators for a rehabilitation referral. In all phases o health care, as well
as in the exploding home care arena, there is a severe shortage of qualifie speech, occupational, and
physical therapist. Often the home care nurse will have to fill the needs of the patient in the absence of a
qualified therapist. Community resources may include the home medical supply deaser, representative
from manufacners, and literature from journals, if a therapist is available, aconsultation or an evaluation
with instruction may be all that is necessary to maximally benefit the patient.
HOME CARE APPLICATION

Home care nurses can serve as as important link in the restoration of patients function or in the prevention
of further dysfunction. Their ability to assist patients with transfers, gait training, or range of motion
exercise programs established by the rehabilitation professional hastens the recovery process. Spiritual
and emotional support will also be needed by patients/caregivers in adjusting to and accepting changes in
body image resulting from disease and disability (Box 17-2 and Bos 17-3). Home care nurses may also
help patients to recognize that they gain new skills to replace ones that have been lost. In the mannnes,
many patients who recover with rehabilitative care experience a from of health wthin illness as human
senses and abilities are reshaped and redefined. Nursing and therapist support of patient efforts towards
recovery or independence are critical to this procets.
Of note, when faced with the patients many needs, caregivers may experience role strain and
require respite services. Signs of caregiver role strain are discussed in Chapter 4. The home care aide and
social worker may be of assistance