Rehabilitation Nursing Practice
Rehabilitation Nursing Practice is the largest content area on the CRRN exam. It tests whether you can assess function, plan restorative care, and prevent secondary complications in patients with stroke, spinal cord injury, brain injury, amputation, arthritis, and other disabling conditions. Questions often ask for the next nursing action or the priority assessment, so link each intervention to a functional goal.
Functional assessment
Use standardized tools rather than impressions. The Functional Independence Measure (FIM) has 18 items scored 1–7; 1 means total assistance and 7 means complete independence. The Barthel Index covers 10 self-care and mobility items. Distinguish ADL (bathing, dressing, grooming, toileting, eating, transfers, ambulation) from IADL (shopping, cooking, medication management, finances). The ICF model separates body function, activity, and participation, which helps you write goals that are measurable and patient-centered.
Bowel and bladder programs
Match the program to the lesion. Upper motor neuron (UMN) bowel produces reflex emptying, so a scheduled suppository program every 2–3 days is typical. Lower motor neuron (LMN) bowel requires manual emptying because the reflex is absent. For bladder, UMN lesions often use intermittent catheterization every 4–6 hours with volumes kept below 500 mL; LMN lesions may need Credé or Valsalva only if prescribed, because of reflux risk. Document output, accidents, and triggers.
Mobility, skin, and safety
Reposition at least every 2 hours in bed and shift weight every 15–30 minutes in a chair. Stage pressure injuries by depth and tissue type; do not massage reddened areas. During early mobilization, check orthostatic blood pressure: a drop of 20 mmHg systolic or 10 mmHg diastolic on standing is significant. Teach cane use on the stronger side and walker use with an upright posture.
Complications to recognize early
Autonomic dysreflexia occurs with lesions at T6 or above: pounding headache, hypertension, diaphoresis, and bradycardia. Sit the patient up, loosen clothing, and check for a full bladder, impacted bowel, or other noxious stimulus.
Worked example. A patient with T6 SCI reports a pounding headache. BP is 180/100 mmHg, pulse 52. The nurse should first sit the patient upright and check the bladder scanner. Reasoning: the trigger is most often bladder distention; removing it lowers BP. Antihypertensives are used only if BP remains high after the stimulus is removed.
Traps. Do not equate a low FIM motor score with cognitive dependence; FIM scores each item separately. Do not assume every SCI patient is at risk for dysreflexia-only T6 and above. Do not massage pressure areas or use donut cushions. Do not start a bowel program without checking whether the lesion is UMN or LMN.