CRRN Rehabilitation Nursing Decision Guide Study Guide

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A patient can wash the upper body but cannot reach the feet safely. The nurse provides adaptive equipment, assists with inaccessible areas, and evaluates whether practice reduces the amount of help required.

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A patient declines repeated dressing practice but wants to attend a grandchild's ceremony. The nurse connects dressing skills with preparing for that event and negotiates a manageable daily practice goal with the patient.

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After three teaching sessions, a patient still cannot sequence catheter supplies. The nurse observes the task, identifies difficulty reading small labels, introduces a visual arrangement, and reevaluates performance using the revised setup.

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A mobility study enrolled participants who could follow multistep instructions. Before applying its protocol to a patient with substantial cognitive impairment, the nurse evaluates whether instruction methods, supervision, and outcome expectations require modification.

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An adolescent wants to manage a new bowel routine privately. The nurse teaches the adolescent directly, offers accessible written steps, and negotiates a family support role that preserves privacy while ensuring needed assistance.

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Two patients have similar hand weakness. One lives with an available caregiver; the other lives alone and must prepare meals. The nurse assesses their actual routines before recommending assistance, equipment, and self-management priorities.

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A patient says, 'I could never organize my medicines.' The nurse begins with sorting one scheduled dose, gives feedback on the successful steps, and gradually adds complexity as the patient demonstrates consistent performance.

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A previously independent parent becomes tearful about needing help with dressing. The nurse explores what dependence means to the patient, acknowledges the loss, and identifies one family role the patient wants to resume.

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A patient who previously enjoyed family visits now declines them, reports hopelessness, and has lost interest in therapy and hobbies. The nurse assesses depressive symptoms and safety while coordinating further evaluation and support.

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A patient says, 'I have saved enough tablets to end this tonight.' The nurse stays with the patient, summons immediate assistance, and communicates the stated plan and access to medication to the responding team.

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A spouse agrees to help but reports shoulder pain and nightly exhaustion. The nurse assesses the actual lifting demands, observes available skills, and works with the team to arrange equipment and additional support.

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A patient asks whether needing bladder care means intimacy is no longer possible. The nurse explores the specific concern privately and coordinates individualized education about the care routine, comfort, and the patient's relationship goals.

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A patient walks independently in the hallway but repeatedly misses medication times and cannot arrange transport. The nurse identifies instrumental activity limitations and incorporates cognitive supports and community resources into the independence assessment.

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A patient's supine blood pressure after five minutes is 132/76 mmHg. At one minute standing, it is 110/70 mmHg and the patient reports dizziness. The 22 mmHg systolic decrease meets the criterion. Assist the patient to a safe seated or lying position immediately; completing the three-minute measurement does not justify continued standing. Review medication effects, hydration status, and recent inactivity before further supervised mobility.

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A patient performs accurately early in the morning but makes repeated errors after consecutive sessions. The nurse records the pattern and collaborates on shorter work periods, planned rests, and placement of demanding learning earlier.

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During a noisy group session, a patient repeatedly loses the sequence for grooming. In a quiet room, the nurse presents one step at a time and checks whether fewer distractions improve accurate task completion.

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A patient with reduced foot sensation reports that a new brace feels comfortable. The nurse inspects contact areas and discovers localized warmth and discoloration, prompting removal of pressure and reassessment of the fit.

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A patient reports less pain after treatment but becomes too drowsy to practise transfers. The nurse documents both effects and collaborates on a plan that better supports comfort, alertness, and the agreed mobility goal.

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After a medication change, a patient becomes sleepy during morning teaching and dizzy on standing. The nurse records timing, vital signs, and functional effects, then requests review while maintaining supervised mobility and safe teaching conditions.

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A patient with T4 injury usually has systolic pressure near 90 mmHg. A new reading of 126 mmHg with headache and sweating is treated as a concerning relative rise, prompting immediate dysreflexia assessment.

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A patient whose usual systolic pressure is 100 mmHg develops headache, sweating, and a pressure of 158 mmHg while catheter drainage stops. Sit the patient upright, loosen restrictions, check the external drainage system, and monitor pressure and pulse every one to two minutes. Obtain ordered antihypertensive treatment consideration before catheter instrumentation. Uncontrolled pressure or an unidentified trigger requires emergency escalation.

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A patient has slurred speech but accurately follows complex information and selects written choices. The nurse uses the reliable written channel to discuss care preferences instead of directing every question to the accompanying relative.

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A patient understands speech but cannot reliably point to small icons. The nurse trials a large display and partner-assisted scanning, confirms consistent selections, and places the agreed communication instructions where all caregivers can use them.

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A patient repeatedly coughs and develops a wet voice after sips during a meal. The nurse stops the trial, assesses immediate status, and reports the observed pattern for swallowing evaluation before further unsupervised intake.

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A patient has recurrent respiratory concerns and reduced intake but does not cough during a brief bedside screen. The nurse communicates the unresolved risk and supports a comprehensive swallowing evaluation rather than documenting aspiration as excluded.

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A patient falls from 75 kg to 69 kg over a documented interval. The nurse calculates an 8% loss, checks intake and swallowing difficulties, and assesses whether shopping, meal preparation, or feeding assistance limits nutrition.

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A patient drops an ordinary spoon but manages food safely once it reaches the mouth. The nurse coordinates a trial of an adapted handle and stable plate, then evaluates intake, fatigue, and independence during meals.

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Over a patient's heel, the nurse finds a warmer, firmer area with a subtle color change compared with the opposite side. The nurse relieves pressure and escalates assessment despite the absence of bright redness.

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A patient develops edema after a brace was fitted. During a scheduled check, the nurse finds a strap-shaped skin change, relieves the pressure safely, and arranges fit reassessment before continued use of the same configuration.

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A wheelchair user can describe pressure relief but cannot perform it effectively with the current seating setup. The nurse observes the maneuver and coordinates an alternative method, equipment review, and reassessment of skin response.

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A patient leaks before reaching a distant bathroom but reports normal awareness of the urge. The nurse evaluates timing, transfer delays, and the voiding pattern before considering environmental changes and a tailored toileting schedule.

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A mobile rehabilitation patient has occasional leakage but no retention or other documented catheter indication. The nurse proposes assessment, accessible toileting, and skin care rather than inserting a catheter to reduce linen changes.

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During a wheelchair transfer, the drainage bag is placed on the patient's lap above bladder level. The nurse restores a secured position below the bladder and checks tubing for obstruction without disconnecting the system. If a disconnection has occurred, merely reconnecting the components is insufficient; both the catheter and collecting system require replacement.

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A patient has an assessed areflexic bowel pattern and repeated incomplete evacuation despite reflex-stimulation techniques. The nurse reviews the prescribed program with the team and teaches the evacuation approach matched to the patient's actual bowel function.

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A patient develops hard stool and prolonged bowel care after a new pain medicine and reduced fluid intake. The nurse documents the change and coordinates review of medication effects, allowed fluids, and the bowel regimen.

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A patient reports poor sleep, but a diary shows repeated awakenings for pain and unscheduled nighttime care. The nurse coordinates symptom management and clustered care while tracking whether sleep continuity and daytime participation improve.

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A patient spends increasing time awake in bed worrying about the next day's therapy despite adequate pain control. The nurse discusses CBT-I referral and helps the patient track sleep patterns and practice the agreed behavioral strategies.

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Therapy and nursing report different transfer performance. At a patient-inclusive conference, they compare surface height, fatigue, cues, and equipment, then agree on one transfer method and a shared outcome to evaluate across settings.

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A patient learns a dressing sequence during therapy. The nurse uses the same agreed cues during morning care and reports that performance deteriorates after poor sleep, helping the team adjust timing and support.

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A patient can transfer using a hospital setup, but the home bathroom cannot accommodate the equipment. The nurse brings the mismatch to the team so access, alternative arrangements, and the discharge plan can be addressed.

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After reviewing a medication schedule, the nurse asks, 'How will you take these when you get home?' The patient describes an incorrect interval, so the nurse simplifies the schedule and repeats the understanding check.

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A daughter accurately describes transfer steps but cannot position the sling without help. The nurse provides further practice and alerts the team that the current single-caregiver home plan has not yet been demonstrated safely.

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A patient misses outpatient visits because accessible transport is unavailable. The nurse and case manager investigate suitable services, application requirements, and scheduling needs instead of simply repeating the recommendation to attend therapy.

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Before home transfer, the nurse confirms that the receiving service knows the patient's communication method, catheter schedule, required assistance, and pending review. A missing supply delivery is resolved before assuming the home routine can begin.

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A patient declines a recommended support service because of privacy concerns. The nurse explains the service and foreseeable consequences, checks understanding, explores alternatives, and communicates the patient's informed preference to the team.

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During supervised balance training, a therapist intentionally challenges a patient's balance and provides anticipated steadying assistance to maintain standing without injury. This event is excluded from J1800 fall reporting. In contrast, if a fall during that training causes a hip fracture, report the fall in J1800 and count it under major injury in J1900. Outside this training context, an unexpected balance loss during toileting that requires a nurse to catch the patient is an intercepted fall even without injury. Private insurance does not remove the patient's IRF-PAI assessment obligation.

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A patient agrees that a sister may learn the transfer routine but asks that unrelated treatment details remain private. The nurse teaches the relevant care steps while respecting the stated limits on other disclosures.

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A review identifies repeated notes stating only 'tolerated care.' The team examines which clinical observations are missing, teaches staff to document actual interventions and responses, and checks subsequent records for improvement.

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Written notes work for a brief appointment check-in, but a deaf patient cannot follow a complex consent discussion through fragmented messages. The team arranges an effective qualified communication service suited to the patient's needs.

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During routine discharge teaching, a patient requests an adult friend as interpreter and the friend agrees. Assess whether the friend can communicate the material effectively and impartially. A request and agreement do not resolve a demonstrated vocabulary gap or conflict of interest.

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A patient with decision-making capacity requests treatment that differs from an older living will. Facilitate an accessible informed discussion, document the present choice, and arrange appropriate updates to documents and medical orders. If the chart contains only a healthcare-agent designation, do not interpret it as an instruction to withhold CPR. Communicate the applicable preferences and orders during transitions.

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A patient is labeled unlikely to attend follow-up because of missed visits. The nurse identifies inaccessible transportation and advocates for an available transport resource before the team interprets attendance history as lack of commitment.

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A patient needs PT and OT but tolerates shorter sessions. Documented clinical reasons may support the 15-hour schedule across the admission-based seven-day period. Coordinate the rationale and actual performance with the team; verify the other coverage requirements.

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Two transfer devices have different prices, but one cannot fit the home or be operated by the available caregiver. The team compares usable alternatives and total support needs before recommending the least costly suitable option.

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A patient who previously stood with help now cannot bear weight reliably because of new weakness. The nurse stops the planned manual pivot and arranges equipment and trained assistance matched to the current transfer assessment.

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A unit owns lifts, but staff often cannot find charged equipment during busy periods. The team examines storage, charging, access, and maintenance rather than responding only with another reminder about correct lifting technique.

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A patient repeatedly rises to reach a distant toilet. The nurse improves access, establishes timely assistance, and reassesses transfer needs while maintaining supervised walking, rather than relying solely on an alarm or discouraging all movement.

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A fatigued patient becomes increasingly distressed when several staff members give simultaneous instructions. The nurse reduces stimulation, designates one speaker, checks discomfort and basic needs, and evaluates whether the patient can reengage safely.

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A unit tests a new transfer assessment. It tracks completed assessments as a process, falls per patient-days as an outcome, and time spent in appropriate mobility activities as a balancing measure against excessive restriction.

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Falls decrease from six to four, but patient-days fall from 1,200 to 600. The nurse calculates rates of 5 and approximately 6.7 per 1,000 patient-days and recognizes that the lower count does not show improvement.