Chapter 4 Flashcards
Homeostasis
The name for the condition in which all of the body systems are working at their best
Metabolism
Physical and chemical processes that must be working at a steady level to maintain homeostasis
10 systems of the human body
- Integumentary
- Muscoskeletal
- Nervous
- Circulatory
- Respiratory
- Urinary
- Gastrointestinal
- Endocrine
- Reproductive
- Immune and lymphatic
Normal changes of aging to the integumentary system
Skin is thinner, dryer and more fragile. It is more easily damaged
Skin is less elastic
Protective fatty tissue is lost, so the person may feel colder
Hair thins and may turn gray
Wrinkles and brown spots, or “liver spots” appear
Nails are harder and more brittle
Try, itchy skin may result from a lack of oil from the sebaceous glands
How the CNA can help
Give complete baths only twice a week, with Sponge baths everyday
Apply lotions as ordered to relieve dry skin
Be gentle. Elderly skin is fragile and can tear easily
Hair becomes drier needs to be shampooed less often
Gently brushing dry hair stimulates and distributes natural oils
Layer clothing for additional warmth
Bed linens should be kept wrinkle free
To not cut residence toenails
Encourage fluid intake
Observing and reporting: integumentary system
Pale, white, reddened or purple areas
Blisters or bruises
Complaints of tingling, warmth or burning
Dry or flaking skin
Itching or scratching
Rash or any skin discoloration
Swelling
Cuts, boils, sores, wounds or abrasions
Fluid or blood draining from the skin
Broken skin
Changes in an injury or wound (size, depth, drainage, color, odor)
Redness or broken skin between toes or a round toenails
Scalp or hair changes
In darker complexions, changes in skin tone
Changes in skin temperature and the feel of the tissue as compared to the skin nearby
Results of inactivity and immobility
Loss of self-esteem
Depression
Pneumonia
Urinary tract infections
Constipation
Blood clots
Dulling of the senses
Muscle atrophy or contractures
Atrophy
When the muscle waste away, decreases in size and becomes weak due to inactivity
Range of motion exercises can help prevent atrophy
Contractures
The muscle or tendon shortens, becomes inflexible and freezes in position. This causes permanent disability of the limb.
Range of motion exercises can help prevent contractures
Normal changes of aging in the muscoskeletal system
Muscles weaken and lose tone
Body movement slows
Bones lose density becoming more brittle and susceptible to breaks
Joints May stiffen and become painful
Height is gradually lost
How the CNA can help
Prevent calls by answering call light to mediately
Keep pathways clear, clean up spills and do not move furniture.
Walkers and canes need to be placed where residents can easily reach
Residents should wear non-skid shoes that are securely fastened
Encourage regular movement and self-care
Encourage residents to perform as many ADLs as possible
Assist with range of motion exercises as needed
Observing and reporting: signs and symptoms of the musculoskeletal system
Changes in ability to perform routine movements and activities
Any changes in a residence ability to perform range of motion exercises
Pain during movement
Any new or increased swelling of joints
Wait, shiny, red or warm areas over a joint
Bruising
Aches and pains
Arthritis
A general term referring to inflammation, or swelling of the joints.
It causes stiffness, pain and decreased mobility.
Arthritis may be the result of aging, injury or an autoimmune illness
Autoimmune illness
When the body’s immune system attacks normal tissues in the body
Rheumatoid arthritis
Joints become red, swollen and very painful. Deformities can result and may be severe and disabling. Movement is eventually restricted.
Fever, fatigue and weight loss are also symptoms.
Rheumatoid arthritis is considered an autoimmune disease
Arthritis treatments
Anti-inflammatory medication
Aspirin, ibuprofen as well as other medications
Local applications of heat to reduce swelling and pain
Range of motion exercises
Regular exercise and/or activity routine
Diet to reduce weight or maintain strength
Observing and reporting guidelines for arthritis
Watch for stomach irritation or heartburn caused by aspirin, ibuprofen or other medications. Report immediately
Encourage activity
Adapt ADLs to allow for Independence. Encourage self-care
Osteoporosis
The condition in which Bones lose density causing them to become porous and brittle.
Maybe caused by a lack of calcium in the diet, Loss of estrogen, lack of exercise, reduced mobility or age
It is more common in women after menopause
Menopause
The end of menstruation; occurs when a woman has not had a menstrual period for 12 months
Signs and symptoms of osteoporosis
Low back pain
Stooped posture
becoming shorter over time
fractures
How to slow osteoporosis
Encourage residents to walk and the other light exercise
Move residence very carefully
Medications and supplements
Fractures
Broken bones
Signs and symptoms of fractures
Pain
swelling
bruising
changes in skin color at the site
limited movement
Guidelines to assisting clients after hip replacements
Keep often used items within easy reach.
Dress the affected (weaker) side first
Never rush the resident. Use praise and encouragement often. Do this for even small tasks
Ask the nurse to give pain medication prior to moving if needed
Have the residents set to do tasks in order to save energy
Follow the care plan exactly, even if the resident wants to do more
Never perform rage of motion exercises on the operative (affected) leg unless directed by the nurse
Tossing the resident not to sit with their legs crossed or turn their toes in where they’re outward
Do not bend or flex the hip more than 90°. It also cannot be turned inward or outward
An abduction pillow may be used for 6 to 12 weeks. The legs are secured to the sides of the pillow using straps in order to immobilize and position the hips and lower extremities
Use a pillow between the thighs to keep the legs separated when transferring from the bed. Raise the head of the bed. This allows the resident to move their legs over the side with the thighs still separated. Stand on the unaffected side. Strong side should lead in standing, pivoting and sitting
With chair or toilet transfers, the operative leg should be straightened.
The stronger leg should stand first then the foot of the affected leg can be brought back into the walking position
Partial weight bearing (PWB)
Means the resident is able to support somebody weight on one or both legs
Non-weight-bearing (NWB)
Means the resident is unable to touch the floor or support any weight on one or both legs
Full weight bearing (FWB)
Means that both legs can bear 100% of the body weight on a step
Observing and reporting changes after total hip replacement (THR)
Redness, drainage, bleeding or warmth in incision area
An increase in pain
Numbness or tingling
Tenderness or swelling in the calf of the affected leg
Shortening and/or external rotation of the affected leg
Abnormal vital signs, especially a change in temperature
Resident cannot use equipment properly or safely
Resident is not following doctor’s orders for activity and exercise
Any problems with appetite
Any improvements, such as increased strength and improved ability to walk
Total knee replacement (TKR)
Surgical replacement of the knee with a prosthetic knee
Is performed to relieve pain
Helps to stabilize
Knee replacement guidelines
To prevent blood clots, apply special stockings as ordered
Promote ankle pumps as ordered. These are simple exercises that promote circulation to the legs. They are done by raising the toes and feet toward the ceiling and lowering them again
Encourage fluids, especially cranberry and orange juices which contain vitamin C to prevent urinary tract infections
Assist with deep breathing exercises as ordered
Ask the nurse to give pain medication prior to moving and positioning if needed
Report redness, swelling, heat or deep tenderness and water both calves
Nervous system
Is the control and message center of the body
Controls and coordinates all bodily functions
Senses and interprets information from outside the body
Central nervous system
(CNS)
Composed of the brain and spinal cord
Peripheral nervous system (PNS)
Deals with the periphery, or outer part of the body via the nerves
Normal changes of aging within the nervous system
Responses and reflexes slow
Sensitivity of nerve endings and skin decreases
People may show some memory loss, more often with short-term memory.
How CNAs can help residence with nervous system conditions
Suggest residents make lists or write notes about things they want to remember
Place a calendar nearby
If the resident likes to reminisce take an interest in their past but asking to see photos or hear stories
Allow time for decision making
Avoid sudden changes in schedule
Allow plenty of time for movement
Encourage reading, thinking and other mental activities
Observing and reporting signs and symptoms of the central nervous system
Fatigue or any pain with movement or exercise
Shaking or trembling
Inability to move one side of the body
Difficulty speaking or slurring of speech
Numbness or tingling
Disturbance or changes in vision or hearing
Dizziness or loss of balance
Changes in eating patterns and/or fluid intake
Difficulty swallowing
Bowel and bladder changes
Depression or mood changes
Memory loss or confusion
Violent behavior
Any unusual or unexplained change in behavior
Decrease stability to perform ADLs
Cerebral vascular accident (CVA)/stroke
Cuz when blood supply to a part of the brain is blocks or a blood vessel leaks or ruptures within the brain
Ischemic stroke
Most common type.
The blood supply is blocked. Without blood, part of the brain does not receive oxygen. Brain cells begin to die.
After a stroke, a resident may experience the following:
Hemiplegia: paralysis on one side of the body
Hemiparesis: weakness on one side of the body
Tendency to ignore one side of the body, called one-sided neglect
Loss of the ability to tell where affected body parts are
Expressive aphasia: trouble communicating thoughts through writing
Receptive aphasia: difficulty understanding spoken or written words
Emotional liability: inappropriate or unprovoked emotional responses, including laughing, crying and anger
Loss of sensations such as temperature or touch
Loss of bowel or bladder control
Cognitive problems, such as poor judgment, memory loss, loss of problem solving abilities and confusion
Dysphagia: difficulty swallowing
Stroke guidelines
Apply range of motion exercises to strengthen muscles and keep joints mobile. Perform leg exercises to aid circulation.
Loss of movement we usually require occupational therapy
Never refer to the weaker side as the “bad side.” Use terms like weaker or involved to refer to the side with paralysis.
Help those with speech loss or communication problems recognize written or spoken words. Evaluated resonance swallowing ability. Thickened liquids may be necessary
Keep a routine of care. Memory loss is upsetting. People often cry for no apparent reason. Be patient and understanding.
Encourage Independence and self-esteem. Let the resident do things for themselves whenever possible. Praise efforts and even the smallest successes
Always check your residence body alignment. Sometimes an arm or a leg can be caught in the resident is unaware
Pay special attention to skin care and observe for changes in the skin of a resident is unable to move
If there is a loss of touch or sensation check for potentially harmful situations (for example heat and sharp objects.) If unable to move, check and change positioning often to prevent pressure injuries
Adapt procedures when caring for residents with one-sided paralysis or weakness
Always use a gait belt during transfers or walking. Stand on the weaker side. Lead with the stronger side
Dress the affected/weaker side first. Place the weaker arm or leg into clothing first.
Undress the stronger side first then remove the affected/weeker arm
Is assistive equipment to help the resident dress themselves. Encourage self-care
Assisting the stroke victim with communication
Keep questions and directions simple
Phrase questions so they can be answered with a “yes” or “no”
Agree on signals, such as shaking or nodding the head or raising a hand or finger for “yes” or “no”
Give residence time to respond. Listen attentively
Use a pencil and paper if the resident can write. A thick handle or tape around the pencil may help the resident hold it more easily
Keep the call signal within reach.
You smiles, touches and gestures to let the resident know you have confidence in their abilities. Gestures and pointing can also help give information or allow the resident to communicate
He’s communication boards are special cards to aid communication
Parkinson’s disease
A disease that causes a section of the brain to degenerate. It affects the muscles, causing them to be stiff. It causes stooped posture and a shuffling gait. Tremors make it hard to perform ADLs.
It is progressive and incurable
Parkinson’s disease guidelines
Visual and spatial impairments may occur. Protect residents from unsafe areas and conditions. Help with ambulation as needed
Assist with ADLs as needed
Assist with range of motion exercises to prevent contractures and to strengthen muscles
Observe for any swallowing problems and report them to the nurse
Encourage self-care. Be patient with self-care and communication
Multiple sclerosis (MS)
A progressive disease that affects the central nervous system. A breakdown of the myelin sheath that covers the nerves, spinal cord and white matter of the brain results in nerves not being able to send messages to and from the brain in a normal way
Symptoms of multiple sclerosis
Weakness
numbness
tingling
incontinence
behavior changes
Blindness
contractures
loss of function in the arms and legs
Multiple sclerosis guidelines
Assist with ADLs as needed. Allow enough time for tasks. Offer rest periods as necessary
Give the resident plenty of time to communicate. Be patient. Do not rush
Prevent falls which may be due to vision loss, fatigue or lack of coordination
Stress can worsen the effects of ms. Be calm. Listen to the residents when they want to talk
Symptoms can sometimes change daily; offer support and encouragement and adapt care to the symptoms reported
Encourage a healthy diet with plenty of fluids
Sis with range of motion exercises to prevent contractures and to strengthen muscles
Paresis
Paralysis, or loss of muscle function that affects only one part of the body. Often paresis describes a weakness or loss of ability on one side of the body
Paraplegia
Loss of function of the lower body and legs
Quadriplegia
Loss of function in the legs, trunk and arms
Head and spinal injuries
The higher the injury on the spinal cord, the greater the loss of function
Head and spinal cord injury guidelines
Be careful residents do not burn themselves. People who are paralyzed have no sensation
Encourage exercise, fluids and a high fiber diet
Male residents may have involuntary erections. Provide for privacy.
Assist with bowel and bladder training is if needed
Normal changes of aging on the nervous system: sense organs
Vision and hearing decrease. Senses of taste, smell and touch decrease as well
Sense of balance may be affected
How the CNA can help
Keep residence eyeglasses clean
Bright colors and proper lighting help vision
Make sure hearing aids are kept clean and that they are worn
Face the resident and speak slowly and clearly. Avoid shouting
Help as needed with regular bathing
Be careful with hot drinks and hot bath water
Observe and report: eyes and ears
Changes in vision or hearing
Signs of infection
Dizziness
Complaints of pain and eyes or ears
Signs and symptoms of glaucoma
Glaucoma can occur suddenly causing severe pain, nausea and vomiting.
It can also occur gradually
Symptoms include:
Blurred vision
Tunnel vision
Blue green halos around lights
Normal signs of aging related to the circulatory system
The heart pumps less efficiently
Blood flow decreases
Blood vessels narrow
How the CNA can help tonify the circulatory system
Encourage walking, stretching and even lifting weights to maintain strength and promote circulation
Range of motion exercises are important for residents who can’t get out of bed
Player clothing to help keep residents warm
Sucks, slippers or shoes help keep the feet warm
Observing and reporting signs and symptoms of the circulatory system
Changes in pulse rate
Weakness, fatigue
Loss of ability to perform ADLs
Edema or the swelling of ankles, feet, fingers or hands
Pale or bluish hands, feet or lips
Chest pain
Weight gain
Shortness of breath, changes in breathing patterns, inability to catch breath
Severe headache
Inactivity
Hypertension (HTN)
High blood pressure
130/80 mm Hg
It’s major cause is atherosclerosis, or hardening and narrowing of the blood vessels.
It can also result from kidney disease, tumors of the adrenal gland, pregnancy and certain medications
Hypertension guidelines
Hypertension can lead to CVA (stroke) heart attack, kidney disease or blindness
Residents may take medication that lowers blood pressure.
They may take diuretics: medications that reduce fluid in the body
Offer trips to the bathroom regularly
Exercise and special diets such as low fat or low sodium maybe prescribed
Coronary artery disease
(CAD)
Occurs when the blood vessels in the coronary arteries narrow reducing the supply of blood to the heart muscle and depriving it of oxygen and nutrients. Over time as fatty deposits black the artery, the muscle that was supplied by the blood vessel dies. CAD can lead to heart attack or stroke
Angina pectoris
Chest pain resulting from the heart muscle not receiving enough oxygen causing pain, pressure or discomfort
Usually described as pressure or tightness occurring in the left side or the center of the chest, behind the sternum or breast bone. Some people have pain moving down the inside of the left arm or to the neck and left side of the jaw.
A person suffering from angina pectoris May sweat or look pale. They may feel dizzy and have trouble breathing
Angina pectoris guidelines
Encourage rest which reduces the heart’s need for extra oxygen. It helps blood flow return to normal often within 3 to 15 minutes
Nitroglycerin is used to medicate and relax the walls of the coronary arteries. It can be used as symptoms arise. I led the nurse of the resident needs help taking a medication.
Nitroglycine is also available as a patch. Tell the nurse immediately if the patch comes off
Residents should avoid heavy meals, overeating and intense exercise
Help mitigate the effects of cold, hot and humid weather
Myocardial infarction (MI)
AKA heart attack
When blood flow to the heart muscle is blocked, oxygen and nutrients fail to reach the cells in that area. Waste products are not removed. The muscle cells die.
An MI can result in serious heart damage or death
Myocardial infarction guidelines:
A cardiac rehabilitation program consists of the following:
Low cholesterol, low saturated fat and low sodium diet
Regular exercise
Medications to regulate heart rate and blood pressure to lower cholesterol and lower triglycerides
Regular blood testing
Cessation of smoking
Avoiding cold temperatures
Stress Management program
Encourage residents to follow their special diets and exercise programs
Be encouraging if residents have quit or are trying to quit smoking
Reduce stress as much as possible. Report signs and complaints of stress to the nurse
Congestive heart failure
(CHF)
When one or both sides of the heart stopped pumping blood properly, occurring after the heart muscle has been severely damaged.
When the left side of the heart is affected, blood backs up into the lungs
When the right side of the heart has been affected, blood backs up into the legs, feet or abdomen.
Congestive heart failure guidelines:
Medications can strengthen the heart muscle and improve its pumping
Medications help remove excess fluids. This means more trips to the bathroom. Answer call lights promptly and help as needed with getting to the toilet or commode
Encourage residents to follow low sodium diet orders or fluid restrictions
A weakened heart may make it hard for residents to walk, carry items or climb stairs. Allow for rest after an activity
Measure intake and output of fluids is ordered
Play residence as instructed. Daily weighing at the same time to watch for weight gain from fluid retention
Play elastic leg stockings is ordered to reduce swelling and feet and ankles
Assist with range of motion exercises as ordered
Keep the head of the bed elevated and/or use extra pillows to assist with breathing
The common side effect of medications for CHF is dizziness. Report this to the nurse if observed
Peripheral vascular disease (PVD)
When the legs, feet, arms or hands do not have enough blood circulation due to fatty deposits in the blood vessels
Signs and symptoms of peripheral vascular disease
Legs, arms and extremities feel cool or cold
Swollen hands and feet
Ulcers of the legs and feet may develop and can become infected
Severe pain with walking
Risk factors include: smoking
Diabetes
High cholesterol
Hypertension
Inactivity
Obesity
Respiration
The body taking in oxygen and removing carbon dioxide through breathing
Respiratory cycle
Consists of:
inspiration (breathing in oxygen)
Expiration (breathing out carbon dioxide)
Normal changes of aging to the respiratory system
Lung strength decreases
Lung capacity decreases
Oxygen in the blood decreases
Voice weekends
Have a CNA can help residents with respiratory conditions
Reduce / eliminate exposure to cigarette smoke or polluted air
Encourage exercise and regular movement giving rest periods as needed
Assist with deep breathing exercises
Residents who have difficulty breathing will usually be more comfortable sitting up rather than lying down
Observing and reporting signs and symptoms of the respiratory system
Change in respiratory rate
Shallow breathing or breathing through pursed lips
Coughing or wheezing
Nasal congestion or discharge
Sore throat, difficulty swallowing or swollen tonsils
I need to sit after mild exertion
Pale, bluish or gray color of the lips, arms and/or legs
Pain in the chest area
Discolored sputum (green, yellow, blood-tinged, or gray)
Chronic obstructive pulmonary disease (COPD)
And incurable disease which causes trouble with breathing, especially in getting air out of the lungs.
The two groups of COPD include chronic bronchitis and emphysema
Symptoms of COPD
Chronic cough or wheeze
Trouble breathing, especially with inhaling and exhaling deeply
Shortness of breath, especially during physical effort
Pale, blue or reddish- purple skin
Confusion
General State of weakness
Trouble completing meals due to shortness of breath
Fear and anxiety
COPD guidelines
Colds or viruses can make COPD worse. Always observe and report signs and symptoms of colds or illness
Help residents sit upright or lean forward. Offer pillows for support
Offer plenty of fluids and small, frequent meals
Keep an oxygen supply available as ordered
Be calm and supportive if a resident is unable to breathe or fearing suffocation
Use infection prevention practices
Encourage purse lip breathing which is inhaling slowly through the nose and exhaling slowly through pursed lips
Encourage residents to rest and save energy for important tasks
Report:
A temperature over 101 Fahrenheit
Changes in breathing patterns, including shortness of breath
Changes in color or consistency of lung secretions
Changes in mental state or
Refusal to take medications is ordered
Excessive weight loss
Increasing dependence upon caregivers and family
Normal changes of aging to the urinary system
The kidneys ability to filter blood decreases
Bladder muscle tone weakens
The bladder holds less urine, which causes more frequent urination
The bladder may not empty completely, causing a greater risk of infection
Have a CNA can help with urinary conditions
Encourage fluids and offer frequent trips to the bathroom
Wipe from front to back after elimination
Do not show frustration or anger at urinary incontinence (inability to control the bladder)
Keep residents clean and dry
Observing and reporting signs and symptoms of the urinary system
Weight loss or gain
Swelling in upper or lower extremities
Pain or burning during urination
Changes in urine, such as cloudiness, odor or color
Changes in frequency and amount of urination
Swelling in the abdominal/bladder area
Complaints that bladder feels full or painful
Urinary incontinence / dribbling
Pain in the kidney or back/flank region
Inadequate fluid intake
Confusion
Guidelines to urinary incontinence
Incontinence is not a normal part of aging
Offer a bedpan, urinal, commode or trip to the bathroom often
Incontinence is a major risk factor for pressure injuries. Document all episodes of incontinence
Keep residents clean, dry and free from urine. Observe the skin carefully when bathing and giving perineal care
Change wet or soiled clothing/bedding/briefs immediately.
Encourage plenty of fluids
Be reassuring and understanding
Urinary tract infection (UTI)
A bacterial infection of the urethra, bladder, ureter, or kidney resulting in painful burning during urination and causing a frequent feeling of needing to urinate
UTIs are more common in women due to a shorter urethra and its proximity to the anus
Guidelines to preventing UTIs
Encourage residents to wipe from front to back after elimination
Get peroneal care when changing incontinence briefs
Encourage plenty of fluids. Water, cranberry, orange and blueberry juice
Offer trips to the toilet at least every 2 hours
Showers rather than baths help prevent UTIs
Report cloudy, dark or foul smelling urine, or if a resident urinates often in small amounts
Report if the resident has a fever. Report new or worsening confusion
Digestion
The process of preparing food physically and chemically so that it can be absorbed into the cells
Absorption
The transfer of nutrients from the intestines to the cells
Elimination
The process of expelling waste that are not absorbed into the cells
Normal changes of aging to the gastrointestinal system
Decrease saliva production affects the ability to chew and swallow
Dulled sense of taste may result in poor appetite
Absorption of vitamins and minerals decreases
The process of digestion takes longer and is less efficient
Body waste moves slowly through the intestines, causing more frequent constipation
How the CNA can help with gastrointestinal conditions
Encourage fluids
Allow time to eat and make meal time enjoyable
Regular Oral Care should be provided
Dentures must fit properly and be cleansed regularly
Give residents an opportunity to have a bowel movement around the same time each day
Signs and symptoms of the gastrointestinal system
Observe and report:
Difficulty swallowing or chewing, including denture problems, tooth pain or mouth sores
Fecal incontinence (inability to control the bowels)
Weight gain / loss
Loss of appetite
Abdominal pain and cramping
Diarrhea
Nausea and vomiting (especially vomitous that looks like coffee grounds)
Constipation
Flatulence
Hiccups or belching
Bloody, black or hard stools
Heartburn
Constipation
The inability to eliminate stool or the infrequent, difficult and often painful elimination of hard dry stool
This occurs when the feces move too slowly through the intestine and can result from decreased fluid intake, poor diet, inactivity, medications, aging, disease or ignoring the urge to eliminate
Signs and symptoms of constipation
Abdominal swelling
Gas
Irritability
A record of no recent bowel movement
Treatment for constipation
Increasing fiber and fluid intake
Increasing activity
Medications
Enema or rectal suppository
Enema
Water with or without an additive that is introduced into the colon to eliminate stool
Fecal impaction
Hard stool that is stuck in the rectum and cannot be expelled resulting from unrelieved constipation
Symptoms include:
no stool for several days
Oozing of liquid stool
Cramping
Abdominal swelling
Rectal pain
Hemorrhoids
Enlarged veins in the rectum
Signs and symptoms of hemorrhoids
Rectal itching
Burning pain
Leaving during elimination
Treatment of hemorrhoids
Increase fiber and fluid intake
Medications
Compresses
Sitz baths
Diarrhea
The frequent elimination of liquid or semi liquid feces.
Abdominal cramps, urgency, nausea and vomiting can accompany diarrhea depending on the cause
Gastroesophageal reflux disease (GERD)
Chronic condition in which the liquid contents of the stomach back up into the esophagus inflamming and damaging the lining of the esophagus. It can cause bleeding or ulcers. Scars from tissue damage can narrow the esophagus and make swallowing difficult
Heartburn is the most common symptom
Treatment for GERD
Serving the evening meal 3 to 4 hours before bedtime
The resident should not lie down until at least 2 to 3 hours after eating.
Extra pillows should be used to keep the body more upright during sleep
Serve the largest meal of the day at lunch time
Reduce fatty and spicy foods
Cessation of smoking and abstinence from alcohol
Wearing loose fitting clothing
Ostomy
Surgical creation of an opening from an area inside the body to the outside.
A portion of the intestine is brought out of the body through an artificial opening in the abdomen call the stoma.
Steeler feces are eliminated through the ostomy rather than through the anus
Disposable pouching system fits over the stoma to collect the feces and is attached to the skin by adhesive. About may also be used to secure it
Clean or replace the ostomy pouch whenever stool is eliminated
Colostomy
Large intestine is brought out to the stoma
Ileostomy
Small intestine is brought out to the stoma
Ostomy care equipment:
Disposable bed protector
Bath blanket
Clean ostomy pouch
Belt (if needed)
Disposable wipes (made for ostomy care)
Basin of warm water
Washcloth
Two towels
Plastic disposable bag
Gloves
Ostomy care
Identify myself and identify the resident by name
Wash my hands
Explain the procedure to the resident
Provide for the residence privacy
Adjust bed to a safe level / lock the bed Wheels
Put on gloves
Place bed protector under the resident. Cover the resident with a bath blanket. Pull down the top sheets and blankets. Expose only the ostomy site. Offer the resident a towel to keep clothing dry
Undo the ostomy belt if used. Remove the ostomy pouch carefully. Place it in the plastic bag. Not the color, odor, consistency and amount of stool in the pouch
What the area around the stoma with disposable wipes used for ostomy care. Discard the wipes in the plastic bag
Using a washcloth in warm water, wash the area and One direction away from the stoma. Rinse. Pat dry with another towel
Place the clean ostomy drainage pouch on the resident holding place in seal securely. Make sure the bottom of the purse is clamped
Remove the bed protector and discard. Place soiled linens in the proper container. Discard the plastic bag properly
Remove and discard gloves
Wash my hands
Return the bed to it’s lowest position
Remove privacy measures
Place call light within residence reach
Report any changes in resident to the nurse noting any changes in stoma and surrounding area. A normal stoma is red and moist and looks like the lining up of the mouth. Call the nurse at the stone is very red or blue or swelling or bleeding is present. Report any signs of skin breakdown around the stoma
Document the procedure
Endocrine system
Made up of glands that produce and secrete hormones which control numerous body functions
Endocrine system functions
Maintain homeostasis through hormones secretion
Influence growth and development
Maintain blood sugar levels
Regulate levels of calcium and phosphate in the body
Regulate the body’s ability to reproduce
Determine how fast cells burn food for energy
Normal changes of aging to the endocrine system
Levels of hormones, such as estrogen and progesterone decrease
Insulin production lessons
The body is less able to handle stress
Signs and symptoms of the endocrine system
Report:
Headaches
Weakness
Blurred vision
Dizziness
Irritability
Sweating/excessive perspiration
Change in “normal behavior”
Confusion
Change in mobility
Change in sensation
Numbness or tingling in arms or legs
Weight gain / loss
Loss/increase of appetite
Increased thirst
Frequent urination or any change in urine output
Hunger
Dry skin
Skin breakdown
Sweet or fruity breath
Sluggishness or fatigue
Hyperactivity
Diabetes
Occurs when the pancreas produces too little insulin or does not properly use insulin
Type 1 diabetes is usually diagnosed in children and young adults. The pancreas does not produce any insulin. The condition will continue throughout a person’s life. It is managed with daily injections of insulin or an insulin pump and a special diet. Regularly blood glucose testing must be done
Type 2 diabetes is more common. Either the body does not produce enough insulin or the body fails to properly use insulin. This is known as insulin resistance. Type 2 develops slowly and is a milder form of diabetes. The risk of getting this increases with age. I can usually be controlled with diet
Insulin
A hormone that works to remove glucose, or natural sugar from the blood
Without insulin to process glucose, sugars collect in the blood and cannot get to cells causing problems with circulation and damage to vital organs
Prediabetes
Occurs when a person’s blood glucose levels are above normal but not high enough for a diagnosis of type 2
Gestational diabetes
occurs in Pregnant women who have never had diabetes before but who have high blood sugar levels during pregnancy
Signs and symptoms of diabetes
Excessive thirst / hunger
Frequent urination
Weight loss
High blood sugar levels
Glucose (sugar) in the urine
Sudden vision changes
Tingling or numbness and hands or feet
Feeling very tired much of the time
Very dry skin
Sores that are slow to heal
More infections than usual
Complications of diabetes
Changes in the circulatory system that can cause heart attack and stroke
Reduced circulation
Poor wound healing
Kidney and nerve damage
Vision loss/blindness
Leg and foot ulcers
Gangrene
Insulin reaction and diabetic ketoacidosis
Diabetes guidelines
Follow diet instructions exactly
Meals must be eaten at the same time daily. The resident must eat all that is served. Tell the nurse if the client is not following the diet
Encourage fun physical activity and passive range of motion exercises.
Know when the residents take insulin and when their meals should be served
Perform blood glucose tests as directed
Inspect the feet daily for irritation or sores and give foot Care as directed
Encourage clients to wear comfortable, supportive, well-fitting shoes. Socks should not be too tight
Normal changes of aging to the reproductive system
Sperm production decreases
The prostate gland enlarges, which can interfere with urination
Menstruation ends. Menopause is the end of menstruation and it occurs when a woman has not had a menstrual period for 12 months
A decrease in estrogen may lead to a loss of calcium producing brittle bones and potentially osteoporosis
Vaginal walls become dryer and thinner
How the CNA can provide for the sexual needs of the elderly
Provide privacy when necessary for sexual activity
Any any behavior that seems inappropriate is not a normal sign of aging and could possibly be a sign of illness. Make sure to report it
Signs and symptoms of the reproductive system
Discomfort or difficulty with urination
Discharge from the penis or vagina
Swelling of the genitals
Blood in urine or stool
Breast changes, including size, shape, lumps or discharge from the nipples
Genital sores / rashes
Genital itching
Client reports of erectile dysfunction
Resident reports painful intercourse
Vaginitis
Inflammation of the vagina possibly caused by a bacteria or fungus. It may also be caused by hormonal changes after menopause.
Signs and symptoms of vaginitis
White vaginal discharge accompanied by itching and burning
Benign prostatic hypertrophy (BPH)
A disorder that is common in men over the age of 60. The prostate becomes enlarged and causes pressure on the urethra leading to frequent urination, dribbling of urine and difficulty in starting the flow of urine. It may cause urinary tract infections.
Lymphatic system
Removes excess fluids and waste products from the body’s tissues.
It also helps the immune system fight infection
Normal changes of aging to the lymphatic system
The immune system weakens, increasing the risk of all types of infections
It may take longer for a person to recover from an illness
The number and size of lymph nodes decrease resulting in the body being less able to contract a fever to fight infection
Response to vaccine decreases
Factors that weaken the immune system
Not enough sleep
Poor nutrition
Chronic illness
Stress
Infection prevention
Wash hands
Keep resident’s environment clean
Assist with personal hygiene
Monitor temperature (a slight increase May indicate that the resident is fighting an infection)
Signs and symptoms:
Immune and Lymphatic systems
Recurring infections (such as pneumonia, fevers and diarrhea)
Swelling of the lymph nodes
Increased fatigue
HIV
Human immunodeficiency virus
A sexually transmitted disease spread through the blood and from infected needles
The first stage shows symptoms like the flu.
As the infection worsens the immune system overreacts. It attacks not only the virus, but also normal tissue
In the later stages infections, tumors and central nervous system symptoms may appear.
HIV becomes AIDS when the persons CD4+ lymphocyte (a type of white blood cell) count falls to 200 or below
AIDS
Acquired immunodeficiency syndrome
Caused by acquiring the HIV virus through blood or body fluids from an infected person.
It is the final stage of HIV infection in which infections, tumors and symptoms appear due to a weakened immune system that is unable to fight infection.
Damage to the central nervous system may cause memory loss, poor coordination, paralysis and confusion. These symptoms together are known as AIDS dementia complex
Signs and symptoms of HIV infection and AIDS
Flu-like symptoms including fever cough weakness and severe or constant fatigue
Loss of appetite/weight
Night sweats
Swollen lymph nodes in the neck, underarms or groin
Severe diarrhea
Dry cough
Skin rashes
Painful white spots in the mouth or on the tongue
Cold sores / fever blisters
Cauliflower like warts on the skin and in the mouth
Inflamed and bleeding gums
Bruising that does not go away
Low resistance to infection particularly pneumonia
Kaposi sarcoma colon a form of skin cancer that appears as purple, red or brown skin lesions
Pneumocystis jiroveci: a pneumatic lung infection
AIDS dementia complex
HIV and AIDS guidelines
Follow standard precautions. In addition, final transmission based precautions if they are ordered
Be extra meticulous about hand washing and keeping the environment sterile
Encourage the client to relax before a meal and to eat in a pleasant setting. Familiar and favorite food should be served. Report appetite loss or trouble eating to the nurse
Careful mouth care is vital for those with infections. Warm rinses may help painful mouth sores
Encourage fluid intake during and between meals.
For those with nausea or vomiting encourage slowly eating frequent, small meals
Diarrhea rapidly depletes the body of fluids. Replace last rehydrate with water, juice, caffeine-free soda, and broth
Foot issues can occur. Supply the client with soft loose slippers. Employ bed cradles
Give emotional support
Muscle weakness and loss of muscle control make falls a risk. Create a safe environment and supervise closely in their ADLs
Cancer
A general term to describe a disease in which abnormal cells grow in an uncontrolled way
Cancer warning signs
Unexplained weight loss
Fever
fatigue
pain
skin changes, such as a change in skin color
change in bowel or bladder function
sores that do not heal
unusual bleeding or discharge
thickening or lump in the breast, testicle or other part of the body
indigestion or difficulty swallowing
new mole or recent change in appearance of a mole, wart, or spot
nagging cough or hoarseness
Cancer guidelines
Clients may want to talk or may avoid talking. Respect each client’s needs. Never say “everything will be okay”
Clients with cancer frequently have poor appetites. Encourage a variety of food and small portions.
Use plastic utensils for cancer clients receiving chemotherapy. Metal causes a bitter taste
Watch for signs of pain and report to the nurse if the pain seems to be uncontrolled.
Give back rubs for comfort and to increase circulation
Do not apply lotion to areas receiving radiation therapy. Do not remove markings that are used in radiation therapy
Do not use commercial mouthwash. Rinse with baking soda and water, or use a prescribed rinse
Get to know your clients interests and pursue topics other than cancer
Be aware of community resources
Report any of these signs or symptoms to the nurse:
increased weakness or fatigue
Weight loss
Nausea, vomiting or diarrhea
Changes in appetite
Fainting
Signs of depression
Confusion
Blood and stool are urine
Change in mental status
Changes in skin
New lumps, sores or rashes
Increase in pain, or unrelieved pain
Blood in the mouth
