CRRN cheat sheet
CRRN · Keep the key ideas within reach.
Rehabilitation Nursing Practice
Rehabilitation nursing centers on function, not cure: the goal is maximizing independence in ADLs, mobility, communication, and community participation despite residual impairment.
Scope of practice spans bowel/bladder retraining, skin and pressure injury prevention, spasticity and contracture management, dysphagia precautions, pain management, cognitive retraining, and caregiver education.
Functional assessment tools to recognize: Functional Independence Measure (FIM, 18 items, scored 1-7, total 18-126), Barthel Index (0-100), and the Morse Fall Scale for fall risk.
Interdisciplinary team roles: physiatrist leads the medical plan; PT addresses gross motor mobility and gait; OT addresses ADLs, upper extremity function, and adaptive equipment; SLP addresses swallowing and communication; rehab RN coordinates care, manages medications, and reinforces carryover of therapy.
Transfers and mobility: use a gait belt for all assisted transfers; lock wheelchair brakes and remove/raise footrests before transfer; pivot toward the patient's stronger side; stand-by assistance level is documented as the amount of help required, not the patient's willingness.
Autonomic dysreflexia is a medical emergency in spinal cord injury at or above T6: sudden severe hypertension, pounding headache, bradycardia, flushing, and diaphoresis above the lesion; sit the patient upright, loosen clothing, check for bladder distention and fecal impaction, and treat per protocol.
Pressure injury prevention: reposition at least every 2 hours in bed and every 15-30 minutes in a wheelchair for at-risk patients; keep heels off the surface; use a validated risk scale such as Braden; stage injuries by depth of tissue involvement, with Stage 1 as non-blanchable erythema.
Neurogenic bladder and bowel: intermittent catheterization is preferred when feasible; a bladder retraining schedule uses timed voiding; bowel programs are typically scheduled after a meal to use the gastrocolic reflex.
Deep vein thrombosis and pulmonary embolism are leading preventable complications during rehabilitation; early mobilization, sequential compression devices, and prescribed anticoagulation are core prophylactic measures.