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  • 1. Chap 5
    Specialized care
  • 2. Specialized functions
    Eye
    sense of sight
    receives images and sends to brain
  • 3. Discuss common disorders of the sensory organs
    Objective
  • 4. Common Disorders Of The Sensory Organs
    Cataract - lens of eye loses its transparency
    Glaucoma - increased pressure in the eye due to an excess of aqueous humor
    Conjunctivitis - inflammation of the eyelid lining
    Sty - tiny abscess at the base of an eyelash
  • 5. Discuss changes in the sensory organs due to aging.
    Objective
  • 6. Changes In Sensory Organs Due to Aging
    Lens in eye becomes thick and cloudy
    Sclera becomes more yellow
    Less light reaches inner eye
    Hearing structures of ear become less moveable
    Soft wax production decreases
  • 7. Vision Impairment
    Resident with vision and hearing problems are at high risk for injury, communication difficulties, and a potential for social isolation and low-esteem.
    Common vision problems: chronic conditions such as glaucoma is a excessive pressure builds inside the eye that can cause blindness if left untreated.
    Vision impairment
  • 8. Disorders of the Eye
    Cataract: Vision becomes cloudy
    Glaucoma: Aqueous humor accumulates. The pressure destroys the nerves and the blood vessels in the retina
    Blindness
    Has different causes and forms
    A person affected by blindness may learn how to read using Braille
  • 9. cataracts
    A clouding of the lens, prevent clear vision.
    Macular degeneration causes the loss of central vision while leaving side-to-side, or peripheral, vision intact.
    Diabetic retinopathy, a complication of diabetes, causes hardening of the arteries that carry blood and oxygen to the eye as well as damaging the retina.
  • 10. Observations Of The Sensory Organs
    Sclera (white of eye) suddenly reddened or yellow
    Lens of eye becomes cloudy
    Complaint of pain in or around ear or eye
    Red, swollen eye lid
    Drainage from eyes
    Complaint of difficulty seeing objects
    observations
  • 11. Safety and Security
    It is important to assist residents with impaired vision.
    Knock before entering the resident’s room, identify yourself and announce your entry
    Informed of the placement of room furniture and belongings.
    Arrange personal and other equipment and supplies within easy reach and encourage to use.
  • 12. Safety and security
    Keep resident room clean, uncluttered, and safe.
    Maintain adequate light.
    Bed in lower position
    Explain everything you are about to and alert the resident when you completed each task
    Explain any extraordinary sounds in the environment.
  • 13. vision impairment
    Safety/security/comfort
    When assistant to walk stand beside and slightly behind the resident who is wearing the gait belt snugly around the waist, hold the gait belt with your hands to increase your control and help to increase the resident’s sense of security.
    Always announce when leaving the resident’s room place call light readily available.
    Keep eyeglasses, magnifying glass, or other reading devices clean in good repair and readily available for the resident; report any damage or loss to the nurse immediately.
    If assisting the resident to care for an artificial eye ( also called a prosthesis), follow the facility’s procedure for removing, cleaning, and reinserting it.
    To reduce glare, keep light sources behind the resident instead of behind you.
    Stay within the resident’s field of vision to unable the resident to focus on your face and voice.
    Speak in a pleasant tone of voice
    Use a gentle touch to communicate
    When eating, open cartons or assist with feeding but encourage as much independence with eating as possible.
    Use hands of the clock to teach the resident the location of the foods in a plate
    Ensure the resident can locate and touch the light before leaving the room. ( read exam alert in the book)
  • 14. Sensory Organs
    Ear
    sense of hearing
    transmits sounds to brain
  • 15. Common Disorders Of The Sensory Organs(continued)
    Otitis media - infection of the middle ear
    Deafness - partial or complete hearing loss
  • 16. Hearing impairments
    Changes In Sensory Organs Due to Aging
    Progressive hearing loss of high-pitched sounds occurs
    Hearing impairment
  • 17. Observations Of The Sensory Organs(continued
    Drainage from ear canal
    Complaint of feeling of fluid or noise in ear
  • 18. Hearing impairments
    Have trouble understanding speech especially fast speech
    Confused by noises, echoes, and hollow sounds.
    Trouble understanding accented speech by persons for whom English is a second language
    Hearing loss does not affect the activities of daily living of hearing-impaired residents.
    Loss of interest in socializing, which affects their quality of life.
  • 19. Communicate principles with hearing loss residents
    Place yourself directly in front of the resident prior to beginning a conversation.
    Decrease background noise
    Taking in a low tone and in an unhurried manner.
    Speaking clearly and distinctly
    Keeping objects out of your mouth when you speaking and not covering your mouth when talking.
    Making short statements but long enough to help give the resident a frame of reference.
  • 20. Using sign language, finger spelling, teaching posters, note pads, white board, or other visual aids to improve communication.
    Restricting conversation to one topic at a time, changing topics carefully, and giving the resident enough time to follow the change.
    For resident who wears a hearing device, using the same communication techniques as with other hearing-impaired residents
  • 21. Hearing impairments
    High-pitched sounds are especially hard to understand for those with hearing impairments
    Taking special care of hearing aids or other devices and following the facility’s procedure for cleaning and storage to prevent damage or accidental losses.
    Asking the resident to confirm his or her understanding of important information by repeating instructions.
  • 22. Speech Impairment
    Discuss common disorders or conditions of the nervous system that might affect speech.
    Residents who might be dysphasic ( have difficulty speaking )
    This condition can be due to a nervous system disorder such as stroke (also called a cerebral vascular accident ( CVA ).
    Parkinson’s disease, Alzheimer’s disease, or an
  • 23. 23
    Common Disorders Or Conditions Of The Nervous System
    CVA – Stroke or cerebrovascular accident - damage to part of brain due to blood clot or hemorrhage cutting off blood supply
    Head or spinal cord injuries
  • 24. Speech Impairment
    Or an injury that affects the speech center of the brain.
    Other causes of dysphasia might be a result of surgery to remove cancer from the mouth, oral cavity, tongue, or larynx ( voice box ) affecting speech.
    Remember that they understand what you are saying because their speech problem has no effect on their intelligence.
  • 25. Speech Impairment
    Always address each resident experiencing vision, hearing, or speech problems with respect. Avoid offensive or demeaning descriptions such as blind, deaf, mute or disabled. Instead, use terms such as vision impaired, hearing-impaired, or disability.
  • 26. 26
    The
    Respiratory
    System
  • 27. 27
    Objective
    Identify the function and structure of the respiratory system.
  • 28. 28
    The Respiratory System
    Respiration means to breathe in oxygen and breathe out carbon dioxide
    Exchange of oxygen and carbon dioxide necessary for life
  • 29. 29
    The Respiratory System(continued)
    Process
    External respiration - oxygen and carbon dioxide exchanged between lungs and blood
    Internal respiration - oxygen and carbon dioxide exchanged between blood stream and cells
  • 30. 30
    The Respiratory SystemStructure
    Oral cavity – mouth
    Pharynx – throat
    Larynx - voice box
    Trachea – windpipe
    Bronchi - right and left
    Bronchioles - smallest branches of bronchi
    Alveoli - air sacs covered with capillaries
  • 31. 31
    The Respiratory SystemStructure(continued)
    Nose - lined with mucous membrane
    air filtered by cilia
    mucous membrane warms and moistens air
  • 32. 32
    The Respiratory SystemStructure(continued)
    Lungs
    right - 3 lobes
    left - 2 lobes
  • 33. 33
    The Respiratory SystemStructure(continued)
    Pleura – membrane that encloses lungs
    Diaphragm - muscle that separates the chest and abdomen
    contraction - draws air into lungs
    relaxation - forces air out of lungs
  • 34. 34
    Objective
    Review common disorders of the respiratory system.
  • 35. 35
    Common Disorders of Respiratory System
    URI – Upper Respiratory Infection - infection of nose, throat, larynx, trachea
    Pneumonia - inflammation or infection of the lungs
  • 36. 36
    Common Disorders of Respiratory System(continued)
    Emphysema (Chronic Obstructive Pulmonary Disease – COPD) – alveoli become stretched and stiff preventing adequate exchange of oxygen and carbon dioxide
    Asthma – spasms of bronchial tube walls causing narrowing of air passages usually due to allergies
  • 37. 37
    Common Disorders of Respiratory System(continued)
    Allergy – reaction to substances that leads to slight or severe response by body.
    Influenza – highly contagious URI
    Pleurisy – inflammation of the pleura surrounding the lungs
  • 38. 38
    Common Disorders of Respiratory System(continued)
    Bronchitis - inflammation of the bronchi
    Lung cancer - malignant tumors in the lungs that destroy tissue
  • 39. 39
    Objective
    Discuss changes in the respiratory system due to aging.
  • 40. 40
    Changes in Respiratory System Due To Aging
    Lung tissue becomes less elastic
    Respiratory muscles weaken
    Number of alveoli decrease
    Respirations increase
    Voice pitched higher and weaker due to changes in larynx
    Chest wall and structures become more rigid
  • 41. 41
    Objective
    List observations relating to the respiratory system.
  • 42. 42
    Observations Of Respiratory System
    Rate and rhythm of respirations
    Respiratory secretions – character
    Character of cough
    Changes in skin color - pale or bluish gray
    Temperature changes
    Difficulty breathing
  • 43. 43
    Observations Of Respiratory System(continued)
    Color of sputum
    Complaint of pain in chest, back, sides
    Shortness of breath
    Noisy respirations
    Sneezing
    Gasping for breath
    Anxiety
  • 44. Respiratory Problems
    If a resident have shortness of breath elevate the head of the bed. ( DO NOT GIVE OXYGEN THIS IS NOT ON YOUR JOB DESCRIPTION)
    Respiratory complications can lead to hypoxia, or lack of adequate supply of oxygen to the body tissues that damage the brain and kidneys before other organs.
  • 45. Respiratory problems
    Residents in respiratory distress will struggle to breathe and show signs of shock, which causes their skin to turn bluish in color ( cyanosis ),
    What happens with cyanosis
    Their blood pressure to fall ( hypotension ), and their pulse to rise ( tachycardia ).
    Their also become confused or combative as they lose oxygen to their brain.
  • 46. Respiratory problems
    respiratory
    If this condition is not corrected, they will stop breathing, a condition called respiratory arrest.
    Respiratory arrest can occur very quickly if residents develop a life threatening allergic reaction to food, drugs, or insect sting.
    respiratory
    Time is of the essence when resuscitating (saving ) the resident. This might involve performing the Heimlich maneuver immediately if a parcel of food o other foreign body blocks the airway and the resident begins to chocking, cannot speak, and clutches the throat.
  • 47. Respiratory problems
    If the Heimlich maneuver is unsuccessful and the resident stops breathing call for help and begin rescue breathing by delivering two long breaths by mouth to mouth or mask to mouth technique. Continue breathing for the resident at the rate of at least 12 breaths per minute until the resident resumes breathing or until your are relieved. For severe allergic reactions, the nurse will administer emergency drugs.
  • 48. Respiratory problems
    Oxygen is a drug and, and such, much be administer by licensed nurse.
    Maintain a safe environment for residents who receive oxygen. Remember to post ‘oxygen in use’ warn visitor not to smoke (oxygen supports combustion), and report any change in the resident’s condition.
    Position the patient to make breathing as effortless as possible.
  • 49. Respiratory problems
    If confined to bed, change to resident’s position every two hours.
    Provide mouth care to keep the resident’s mouth clean and moist.
    Encourage frequent rest periods and arrange activities and care to promote rest.
    Follow standard precautions for disposing of sputum.
  • 50. Respiratory problems
    Observe special precautions for active respiratory infections, include TB.
    Observe and record any changes in sputum (changes could indicate infection or bleeding from the lungs)
    Observe all safety precautions for the resident receiving oxygen.
    Encourage fluids to help thin secretions; clear liquids are best for this purpose.
  • 51. Respiratory problems
    Provide careful skin care, especially the nose ( nares ) in residents receiving oxygen by nasal prongs, and the cheeks and ears for residents wearing a facemask.
    Keep facemask clean and placed snugly in place to assure oxygen delivery.
    Maintain water in wall oxygen reservoir to keep delivered air moist. Change water according to facility protocol.
  • 52. Respiratory problems
    If receiving oxygen via portable tank, do not drop or damage the tank and report any leakage to the nurse, replace the tank to maintain constant oxygen supply.
    Provide emotional care to ease the resident’s fears of not being able to breathe normally
    Keep the call light within easy reach of the resident
  • 53. Respiratory problems
    Observe and report any changes in the resident’s breathing pattern.
    NERVER ADJUST OR DISCONTINUE THE OXYGEN
    RESIDENT WITH DIFFICULTY BREATHING ELEVATE THE HEAD OF THE BED.
  • 54. Respiratory problems
    Chronic or long-term respiratory problems such as emphysema and bronchitis might lead to apnea, or respiratory arrest, which means that resident stops breathing.
    The resident will require assistance to breathe artificially with help of a mechanical ventilator.
    The ventilator enables oxygen and carbon dioxide to be exchanged.
  • 55. Respiratory problems
    The ventilator tubing connects to a tracheostomy, or permanent surgical opening into the trachea, the air passage from the throat to the lungs.
    Ventilator-dependent residents must rely on others for their care.
    Conscious residents might be very frightened by the ventilator and their inability to talk; some might be comatose, or unaware of their surroundings.
  • 56. Respiratory problems
    Remember that you are caring for a human being, not a machine.
    To protect the resident’s airway, work with a anther caregiver to move the resident.
    Measure, record, and report vital signs, noting any change in respiratory effort.
    Provide personal care and ADLs that protect the resident’s airway.
    Provide frequent oral care.
  • 57. Respiratory problems
    Keep the ventilator connected to the electrical outlet, and tubes connected and free of kinks.
    Turn residents every 2 hours
    Keep call light within easy reach of the resident and answer it promptly to help allay resident fears
    Speak to the unconscious, comatose resident on a ventilator as through the resident can hear you.
  • 58. Cardiovascular problems
  • 59. Cardiovascular problems
    Heart disease kills more elders worldwide than any other disease.
    Diseased blood vessels can prevent adequate blood circulation, which can result in pain, disability, and death.
    The arteries supplying the heart muscle
    ( coronary arteries) Coronary artery disease: Occurs when the coronary arteries narrow as a result of atherosclerosis
  • 60. CARDIOVASCULAR PROBLEMS
    The narrow or blocked artery cannot deliver oxygen to the heart muscle, causing chest pain ( angina ), which can worsen with any type of strenuous activity.
    Arteriosclerosis is responsible for temporary condition in which the resident experiences dizziness, light-headedness, or confusion due to an inadequate supply of oxygen to the brain, known as a transient ischemic attack (TIA).
  • 61. Cardiovascular problems
    The resident is at high risk for falling during TIA.
    A blood clot can develop in a sclerotic coronary artery, stopping the oxygen supply to the heart muscle, which leads to heart attack, or acute myocardial infarction (AMI). This is a life-threatening emergency requiring emergency care and transportation to the hospital emergency room.
  • 62. Following heart attack, the heart is often weakened and loses its ability to pump adequately, which can lead to congestive heart failure (CHF).
    CHF causes a buildup of fluid in the lungs, resulting in dyspnea and a wet cough or swelling of the extremities (edema).
    A sudden, severe episode of dyspnea, edema, and urine retention can result in death.
  • 63. Heart Disorders
    Coronary artery disease: Occurs when the coronary arteries narrow as a result of atherosclerosis
    Angina pectoris, myocardial infarction
    Heart failure: Occurs when the heart is unable to pump enough blood to meet the body’s needs
    Heart block: Occurs when the pathway that the heart uses to send the electrical impulses that cause contraction is blocked
  • 64. 64
    The
    Circulatory
    System
  • 65. 65
    Objective
    Identify functions of the circulatory system.
  • 66. 66
    Circulatory System
    Circulation is continuous movement of blood throughout body
  • 67. 67
    Circulatory System(continued)
    Functions of circulatory system
    Arteries carry blood with oxygen and nutrients away from heart and to cells
    Veins carry waste products away from cells and to heart
  • 68. 68
    Blood
    Adult has 5 to 6 quarts (liters)
    Consists of
    water - 90% (plasma)
    blood cells
    carbon dioxide and oxygen
    nutrients, hormones and enzymes
    waste products
  • 69. 69
    Blood(continued)
    Types of blood cells 
    Red blood cells - erythrocytes 
    carry oxygen from blood to cells 
    White blood cells - leukocytes 
    fight infection 
    Platelets - thrombocytes 
    required for clotting to stop bleeding 
  • 70. 70
    Blood Vessels
    Arteries - carry blood away from heart
    Veins – carry blood to heart
  • 71. 71
    Objective
    Discuss how the blood vessels relate to the pulse and blood pressure.
  • 72. 72
    Heart
    • Tissue (three layers)
    • 73. endocardium - smooth, inner layer
    • 74. myocardium – thick, muscular middle layer
    • 75. pericardium – double-walled membrane that covers outside of heart
  • 73
    Heart Chambers
    Heart divided into right and left side
    Atria – upper chambers – receive blood
    • Ventricles – lower chambers – pump blood to lungs and body
  • 74
    1
    2
    Heart Chambers
    Four chambers
    right atrium (1) - receives blood from two large veins:
    superior vena cava
    inferior vena cava
    right ventricle (2) - receives blood from right atrium and pumps it to lungs through pulmonary artery
  • 76. 75
    3
    4
    Heart Chambers(continued)
    Four chambers
    left atrium (3) - receives oxygenated blood from left and right pulmonary veins
    left ventricle (4) - pumps blood to aorta, which delivers blood to all body parts (except lungs)
  • 77. 76
    Valves
    Heart Valves
    Located at entrance and exit of each ventricle
    Four heart valves
  • 78. 77
    Heartbeat
    • Systole - contraction of heart muscle
    • 79. Diastole - relaxation of heart muscle
    • 80. Blood pressure – highest and lowest pressure against walls of blood vessels as heart contracts and relaxes
    • 81. Pulse - expansion and contraction of artery
  • 78
    Objective
    Discuss common disorders of the circulatory system.
  • 82. 79
    Common Disorders of the Circulatory System
    Arteriosclerosis - walls of arteries become thick and harden
    Hypertension - high blood pressure 
    Peripheral vascular disease - decrease in flow of blood to extremities and brain 
    Angina pectoris - chest pain 
  • 83. 80
    Common Disorders of the Circulatory System(continued)
    Varicose veins - enlarged, twisted veins usually in legs 
    Congestive heart failure - circulatory congestion caused by weak pumping of heart muscle
    Myocardial infarction (MI) - heart attack due to blockage in coronary arteries
  • 84. 81
    Common Disorders of the Circulatory System(continued)
    Anemia – low red blood cell counts
    Thrombus – blood clot
    Phlebitis – inflammation of vein
    Atherosclerosis - fatty deposits on walls of arteries that reduce blood flow 
  • 85. 82
    Objective
    Discuss changes that occur in the circulatory system with aging.
  • 86. 83
    Changes of the Circulatory System Due To Aging
    Heart muscle less efficient
    Blood pumped with less force
    Arteries lose elasticity and become narrow
    Blood pressure increases
    Blood chemistry less efficient
    Capillaries become more fragile
  • 87. 84
    Objective
    List observations relating to the circulatory system.
  • 88. 85
    Observations of the Circulatory System
    Changes in pulse rate and blood pressure
    Changes in skin color
    Changes in skin temperature – coldness
  • 89. 86
    Observations of the Circulatory System(continued)
    Complaint of dizziness and headaches
    Complaint of pain in chest and/or indigestion
    Edema in feet and legs
    Shortness of breath
  • 90. 87
    Observations of the Circulatory System(continued)
    Sweating
    Blue color to lips and/or nail beds
    Complaint of tingling sensations
    Memory lapses
    Lack of energy
    Irregular respirations
    Anxiety
    Staring and lack of responsiveness
  • 91. Circulatory conditions
    Arteries or veins in the circulation of the lower extremities can also be blocked by a clot (thrombus), which can cause swelling, pain, and disability.
    Signs thrombosis (a blood clot in the vein) include a reddened, warm area in the lower leg, swelling, and pain, which increases with movement.
  • 92. Circulatory conditions
    If a thrombus becomes dislodged from a vein in the lower extremity, it becomes a traveling clot meaning it moves to the heart, lungs or brain, causing a heart attack, respiratory distress, or a stroke. Report all resident complaints of sudden pain or dyspnea immediately because these are considered emergencies.
  • 93. If the resident complains of pain in the lower leg or dyspnea, do not massage the affected leg, ambulate the resident, or bend the toes of the affected leg upward because these movements helps to dislodge a clot.
    Clots in the arteries of the lower extremity can slow or stop circulation.
    The resident will complain of pain, coolness, and a pale color in the affected leg
  • 94. Circulation conditions
    Which requiring immediate surgery to restore adequate circulation.
  • 95. 92
    Measuring
    Blood
    Pressure
  • 96. 93
    Measuring Blood Pressure
    Blood pressure is the force of blood pushing against walls of arteries
    Systolic pressure: greatest force exerted when heart contracting
    Diastolic pressure: least force exerted as heart relaxes
  • 97. 94
    Objective
    List factors that influence blood pressure.
  • 98. 95
    Factors Influencing Blood Pressure
    Weight
    Sleep
    Age
    Emotions
    Sex
    Heredity
    Viscosity of blood
    Illness/Disease
  • 99. 96
    Blood Pressure: Equipment
    Sphygmomanometer (manual)
    cuff - different sizes
    pressure control bulb
    pressure gauge – marked with numbers
    aneroid
    mercury
  • 100. 97
    Blood Pressure: Equipment(continued)
    Stethoscope
    magnifies sound
    has diaphragm
  • 101. 98
    Measuring Blood Pressure
    Normal blood pressure range
    Systolic: 90-140 millimeters of mercury
    Diastolic: 60-90 millimeters of mercury
  • 102. 99
    Guidelines for Blood Pressure Measurements
    Measure on upper arm
    Have correct size cuff
    Identify brachial artery for correct placement of stethoscope
  • 103. 100
    Guidelines for Blood Pressure Measurements(continued)
    First sound heard – systolic pressure
    Last sound heard or change - diastolic pressure
  • 104. 101
    118
    76
    Guidelines for Blood Pressure Measurements(continued)
    Record - systolic/diastolic
    Resident in relaxed position, sitting or lying down
    Blood pressure usually taken in left arm
  • 105. 102
    Guidelines for Blood Pressure Measurements(continued)
    Do not measure blood pressure in arm with IV, A-V shunt (dialysis), cast, wound, or sore
  • 106. 103
    Guidelines for Blood Pressure Measurements(continued)
    Apply cuff to bare upper arm, not over clothing
    Room quiet so blood pressure can be heard
    Sphygmomanometer must be clearly visible
  • 107. 104
    Blood Pressure: Reading Gauge
    Large lines are at increments of 10 mmHg
    Shorter lines at 2 mm intervals
    Take reading at closest line
  • 108. 105
    300
    290
    280
    270
    260
    250
    240
    230
    220
    210
    200
    190
    180
    170
    160
    150
    140
    130
    120
    110
    100
    90
    80
    70
    60
    50
    40
    30
    20
    10
    Blood Pressure: Reading Gauge(continued)
    Gauge should be at eye level
    Mercury column gauge must not be tilted
    Reading taken from top of column of mercury
  • 109. hypertension
    High blood pressure usually exceeding 140/90 after two consecutive readings in the same arm. Average blood pressure (adults) 120/80
    Prone to develop heart disease or other medical conditions.
    Cause of hypertension is unknown, diet, obesity, the effects of diabetes, and other lifestyle factors affects blood pressure.
  • 110. hypertension
    Can affect all body systems, damage organs, and become lethal because it can lead to stroke.
    Follow the plan of care carefully to promote healing and prevent further complications.
    Provide foods and fluids, and monitor I&O (input and output) as prescribed to provide energy and prevent edema
  • 111. Hypertension
    Assist in monitoring the resident’s prescribed dietary restrictions regarding salt, fat, sugar and fluid.
    Monitor vital signs and report any changes immediately to the nurse
  • 112. Paralysis
    Unable to move a body part, which called paralysis.
    Paralysis is classified according to how much of the body is affected.
    For example, paraplegia affects the lower half of the body; quadriplegia involves both arms and legs; hemiplegia means that half of the body, either right or left side, is paralyzed.
  • 113. paralysis
    A stroke or other neurological disease results in decreased blood flow and oxygen to the brain cells causing them to die, which leads to paralysis.
    Signs and symptoms of a stroke depend on the location of the brain injury and the amount of the damage
  • 114. paralysis
    A stroke on one side of the brain affects the opposite side of the body.
    Effects of a stroke include aphasia (being unable to speak), a partial paralysis or weakness of the face (causing drooping of the mouth, eyelid, and so on), or complete paralysis of the arm or leg on the affected side (leaving the arm or leg limp, or flaccid).
  • 115. paralysis
    An injury to the spinal cord can cause paralysis of the body below the injury site, leading to quadriplegia.
    Paralysis in any part of the body can pose problems with mobility and activity of daily living (ADLs)
    Special care is required to help the affected muscles and tendons functioning as much as possible.
  • 116. paralysis
    mobility-impaired residents run the risk of contractures, or shortening of the muscles due to lack of exercise or movement, pressure ulcers, and other hazards of immobility; respiratory difficulties, especially pneumonia; and muscle spasms, incontinence (bowel and bladder) and swallowing difficulties (dysphagia).
  • 117. paralysis
    Maintain a calm, reassuring environment
    Show patience and empathy
    Feed the resident on the unaffected side of the mouth
    If one side of the body is weak or paralyzed, support affected arm/side while undressing and dress
    Remove gown from affected arm last
  • 118. Paralysis
    Weak arm= remove gown from affected arm last
    Unaffected arm= remove gown first from unaffected arm first
    Dress and undress the resident’s affected side first
    If assisting the stroke patient with hemiplegia to walk with a cane, use the cane on the affected side.
  • 119. Paralysis
    When transferring the paraplegic from bed to wheel chair, lock the wheels on the bed as well as the wheel chair.
    Keep the bed of the paralyzed resident in its lowest position with wheels clocked.
    To move any resident, use proper body mechanics: keep the spine straight, bend your knees lift with your legs (not your back) seek for assistance to protect you and the resident
  • 120. Digestive and elimination problems
    Diseases or conditions involving the digestive and urinary system can cause malnutrition, elimination difficulties, and complications due to infections, cancer, or organs failure.
    Severe infections of the digestive organs include gall bladder disease (cholecystitis) pancreatitis (inflammation or infection of the pancreas), and hepatitis (liver infection) or nephritis, kidney disease).
  • 121. Digestive and elimination problems
    Common symptoms: severe pain, nausea, vomiting, fever, diarrhea or constipation, dysuria or yellowish color to the skin (jaundice), and life-threatening chemical imbalances.
    Residents recoring from infections might be kept NPO meaning they can have no foods or fluids by mouth.
  • 122. Digestive and elimination problems
    The resident will receive fluids, nutrients, antibiotics, and other medications through an IV (within the vein)
    You can support the resident receiving IV therapy by being careful to not pull on the IV catheter, kink the IV tubing, or interrupt the IV flow,
    The tasks of starting, adjusting, and discontinue IV therapy are reserved for licensed nurse.
    Do not place the solution below the IV site.
  • 123. Digestive and elimination problems
    Change the resident’s gown carefully to maintain the IV connection.
    Report any signs of infection, swelling at the IV site, or activation of IV pump alarms to the nurse immediately.
  • 124. Cancers in the Digestive and Urinary Tract
    resident recovering from surgery to remove a cancerous tumor in the GI tract, bladder, or kidney who cannot swallow or take foods or fluids by mouth (PO) might require tube feedings or total parental nutrition (TPN)
    Residents receiving their total diet through a feeding tube are often NPO, or can have no food or fluids by mouth.
  • 125. Cancers in the Digestive and Urinary Tract
    Provide oral care at least every two hours or more, raise the head of the bed at least 35 degrees, and report any abnormal
  • 126. Cancers in the Digestive and Urinary Tract
    Residents recovering from surgery to remove cancer from gallbladder, small intestine, or colon (large intestine that holds solid wastes) might also have a temporary or permanent ostomy, or surgical diversion to aid in elimination.
    Diversion means that, in the case of bladder cancer, an artificial appliance is attached to a stoma in the abdomen to provide an alternative path to expel urine
  • 127. Chronic diseases
    Chronic liver disease such as cirrhosis (scarring of the liver) causes a buildup of toxic wastes in the body due to failure of the liver to handle the chemicals released by metabolism.
    Chronic kidney disease, often linked to type 1 diabetes, affects all body systems and can result in kidney failure.
    The resident with kidney failure is at increased risk of life-threatening complications.
  • 128. Chronic diseases
    Such as congestive heart failure and severe generalized infection, because the kidneys are not able to filter toxins from the body or control fluid and electrolyte absorption.
  • 129. Chronic diseases
    Special care of residents with chronic diseases or those recovering from surgery includes:
    Observing, recording, and reporting vital signs, and pain tolerance
    Observing, recording and reporting any changes in the surgical site.
    Strictly adhering to the diet order, including fluid restrictions.
    Keeping feeding tubes free of kinks
  • 130. Chronic Diseases
    Prompt reporting of vomiting, diarrhea, constipation, or skin color changes.
    Observing, recording, and reporting of emesis (vomit) or abnormal stools or urine, especially color, consistency, or odor.
    Using standard precautions when handling bodily fluids
    Prompt empting and care of stoma appliances.
  • 131. Chronic Diseases
    Observing, recording, and reporting I&O
    Observing and recording any behavior changes
    Provide careful skin care, especially around stomas.
    Provide frequent oral care
    Provide comfort measures to help to relieve pain and promote rest (position changes)
    Providing emotional support.
  • 132. 129
    Diabetes Mellitus
    Diabetes mellitus – the most common disorder of the endocrine system
    80% of diabetics over 40 years of age
    incidence increases as people age
    5% of people over age 65 require treatment
  • 133. 130
    Diabetes Mellitus(continued)
    Diabetes mellitus – the most common disorder of the endocrine system
    USA has highest morbidity and mortality rates
    disorder of carbohydrate metabolism with decreased insulin production from pancreas
  • 134. 131
    Diabetes Mellitus(continued)
    Uncontrolled diabetes leads to damage to eyes, kidneys, circulation
    Diabetes characterized by consistent, elevated blood glucose levels requiring oral medication to stimulate pancreas or insulin injections
  • 135. 132
    Diabetes Mellitus
    Hypoglycemia
    low blood sugar
    Hyperglycemia
    high blood sugar
  • 136. Diabetes
    Is a disease of the endocrine system, is listed separately because it effects metabolism, impacts every system of the body, and is becoming an epidemic among Americans.
    Diabetes mellitus is a disease of the pancreas in which the body cannot use carbohydrates (sugars and starches) efficiently.
    The pancreas cannot produce enough insulin or does not use insulin properly to change carbohydrates to energy.
  • 137. diabetes
    When this occurs, the body burns fats for energy instead, leading to a dangerous imbalance in ketones, the product of fat breakdown.
    The exact cause of diabetes is unknown but several factors such as age, obesity, and family history can contribute to developing diabetes.
    Residents with type 1 diabetes must take insulin to live; those with type 2 diabetes can control their disease with diet and medication.
  • 138. Diabetes Mellitus
    Type 1 diabetes mellitus: The cells in the pancreas that produce insulin are destroyed
    Insulin administration: The person must have daily injections of insulin
    Blood glucose monitoring:
    Hypoglycemia: Caused by too much insulin
    Hyperglycemia: Caused by too little insulin
    Diet: Should be nutritious and person should eat at the recommended time
  • 139. Diabetes Mellitus (Cont’d)
    Type 2 diabetes mellitus:
    The pancreas produces some insulin
    The cells of the body are unable to respond to the insulin
    Results in higher blood glucose levels
    Treated through diet, exercise, and the use of oral medications
  • 140. Complications of Diabetes
    Damaged blood vessels cause atherosclerosis, high blood pressure, heart disease, kidney disease, and blindness
    Nerve damage results in decreased blood flow in the feet and lower legs, increasing the risk of infection and poor tissue healing in the event of injury
    Early detection of diabetes is essential for preventing complications
  • 141. diabetes
    Both types of diabetes require a careful diet that contains the right amount of proteins, fats, and carbohydrates to maintain adequate nutrition an systems functioning.
    Signs and symptoms of diabetes: excessive thirst, excessive hunger, excessive urination (polyuria), weight loss, night sweats, and irritability.
    Snacks are part of the diet because they are important to maintain a steady supply of glucose to prevent hypoglycemia.
    (please read e-book page 80 & 81 exam alert
  • 142. Essentials for Nursing Assistants
    Chapter 29
    Caring for People With HIV/AIDS
  • 143. Introduction to HIV/AIDS
  • 144. HIV Infection
    HIV: Bloodborne pathogen that invades the body’s T-cells
    The infected person begins to have severe infections and rare cancers
    An HIV-positive person is infected with HIV; may or may never develop AIDS
    People with AIDS die from infections and cancers that the body is no longer able to fight
  • 145. Risk Factors
    Having unprotected sex
    Sharing needles
    Receiving tissue transplants
    Receiving transfusions of blood or blood products
    Having an HIV-positive mother
  • 146. AIDS
    Occurs when the person’s immune system is no longer able to fight off infections and cancers
    Medications:
    To date, there is no cure for AIDS
    Medications can delay the onset of AIDS in HIV-positive people
    Can cost more than $10,000 per year
  • 147. AIDS (Cont’d)
    Medication side effects:
    Headache, dizziness, nausea, diarrhea, fever, skin rash, severe anemia, and extreme fatigue
  • 148. Attitudes Toward People With HIV/AIDS
  • 149. Attitudes Toward HIV/AIDS
    Factors that contribute toward the negative attitude:
    HIV infection is associated with unsafe sex
    Behaviors such as abusing street drugs or being homosexual are not approved of
    Many people fear becoming infected through casual contact with an infected person, due to lack of information
  • 150. Rights of People With HIV/AIDS
    Protecting the person’s privacy and right to confidentiality is very important
    People with AIDS are protected under the Americans with Disabilities Act (ADA)
    Nursing assistants are responsible for maintaining absolute confidentiality about a person’s HIV status
    You need to know the HIV status of a person to whom you are providing care…however, no one else needs to know!
  • 151. Caring for a Person With HIV/AIDS
  • 152. Caring for a Person With AIDS
    People with HIV/AIDS may receive care from different health care organizations
    They require hospitalization for the treatment of severe infections and other problems, and towards the end of their lives require almost complete assistance with activities of daily living
    Most people with AIDS eventually require hospice care
  • 153. Meeting the Physical Needs
    As HIV infection progresses, the person is likely to develop:
    Anorexia, nausea, vomiting, or diarrhea, weight loss, fatigue, fever, dysphagia
    Swollen lymph nodes in the neck, armpits, and groin
    A cough or recurrent episodes of pneumonia
  • 154. Meeting the Physical Needs (Cont’d)
    Sores or white patches in the mouth
    Bruises or dark bumps on the skin that do not heal
    Forgetfulness and confusion, dementia
  • 155. Meeting the Physical Needs (Cont’d)
    A person can be infected with HIV and not know it
    Your job responsibilities place you at risk for contacting body fluids that are known to transmit HIV and other bloodborne pathogens
    Use standard precautions with every patient or resident, not just those who are known to be infected with HIV
  • 156. Meeting the Emotional Needs
    People with HIV/AIDS have a great deal of emotional stress:
    Family members may abandon the person due to fear, shame, or disapproval
    The person may face financial problems
    The person may suffer from guilt if the infection was due to risky behavior
  • 157. Meeting the Emotional Needs (Cont’d)
    A person may have many fears about pain, his or her declining health, or death
    Clinical depression and suicide are common
  • 158. Psychological Problems
    Meaning conditions affecting thought, mood, and behavior, can be as threatening to the health of residents as physical illness.
  • 159. DHSR Approved Curriculum-Unit 16
    156
    Confusion
  • 160. 157
    Objective
    Discuss disorders that cause confusion for residents.
  • 161. 158
    Confusion
    Symptom or side effect of many disorders
    Disorders causing confusion
    Stroke
    Arteriosclerosis
    Dementia
    Alzheimer’s Disease
    Huntington’s Chorea
  • 162. 159
    Confusion(continued)
    Other Causes
    Drug reactions
    Depression
    Environmental changes
    Vision and/or hearing loss
    Dehydration
    Poor nutrition
    Decreased oxygen levels in blood
    Head injury
  • 163. 160
    Confusion(continued)
    Condition can be permanent or temporary
  • 164. 161
    Reality Orientation Used For Confusion
    Includes:
    Facing resident and speaking clearly and slowly
    Greeting the resident by name with each interaction
    Identifying yourself with each interaction
  • 165. 162
    Reality Orientation Used For Confusion(continued)
    Includes:
    Explaining care in simple terms prior to giving care
    Frequently orienting the resident to the day, month, date, and time
    Giving short, simple instructions
  • 166. 163
    Reality Orientation Used For Confusion(continued)
    Includes:
    Encouraging residents to wear glasses or hearing aides
    Communicating with touch and clear and simple comments and questions
  • 167. 164
    Reality Orientation Used For Confusion(continued)
    Includes:
    Encouraging use of radio, television, newspapers, and magazines
    Maintaining resident’s routine
  • 168. 165
    Reality Orientation Used For Confusion(continued)
    Includes:
    Giving only one direction at a time
    Keeping the environment calm and relaxed
  • 169. 166
    Reality Orientation Used For Confusion(continued)
    Includes:
    Providing clocks, calendars and bulletin boards to remind residents of time and activities
    Discussing current topics
  • 170. 167
    Reality Orientation Used For Confusion(continued)
    Includes:
    Reminiscing
    Showing resident self-image in mirror
    Providing recreational activities which reinforce reality orientation
  • 171. 168
    Reality Orientation Used For Confusion(continued)
    Includes:
    Dressing residents during the day and assisting them to stay on a day-night schedule
  • 172. Aggressive Residents
    Confused residents who become defensive, aggressive, or combative need your calm demeanor and understanding so that you can find out what is causing the resident’s behavior.
    Do not argue with the resident or return his or her aggressive.
    To diffuse the aggressive behavior, leave the situation if you can and return later.
  • 173. 170
    Ways To Assist Combative Residents
    Display a calm manner
    Avoid touching the resident
    Provide privacy for out-of-control residents
    Secure help if necessary
  • 174. 171
    Ways To Assist Combative Residents(continued)
    Do not ignore threats
    Protect yourself from harm
    Listen to verbal aggression without argument
  • 175. 172
    Dementia
  • 176. 173
    Objective
    Identify the symptoms displayed by residents with dementia.
  • 177. 174
    Dementia (Group Of Symptoms)
    Defined as a progressive loss of mental functioning
  • 178. 175
    Dementia (Group Of Symptoms)(continued)
    Two categories of dementia
    1st Category: Primary
    No known cause
    Irreversible
    May be treated but not completely cured
  • 179. 176
    Dementia (Group Of Symptoms)(continued)
    Two categories of dementia
    1st Category: Primary
    Examples of diseases causing dementia
    Alzheimer’s disease
    Parkinson’s disease
    Huntington’s Chorea (genetic)
  • 180. 177
    Dementia (Group Of Symptoms)(continued)
    • Two categories of dementia
    • 181. 2nd Category: Secondary
    • 182. Usually has known cause
    • 183. Treatable
    • 184. Reversible to some degree
  • 178
    Dementia (Group Of Symptoms)(continued)
    • Two categories of dementia
    • 185. 2nd Category: Secondary
    • 186. Examples of secondary causes of dementia
    • 187. depression
    • 188. minor stroke
    • 189. thyroid dysfunction
    • 190. medication induced
  • 179
    Symptoms Of Dementia
    Confusion
    Inability to reason accurately
    Recent memory loss
    Detailed long-term memory
    Repetitious speech
    Self-centered behavior
    Agitation
    Disorientation
    Confabulation
  • 191. 180
    Alzheimer's
    Disease
  • 192. 181
    Objective
    Review the psychosocial characteristics and care needs of a person with Alzheimer’s disease.
  • 193. 182
    Alzheimer’s Disease
    Defined as a progressive, 3-stage, incurable disease that involves changes in brain tissue
    Responsible for about half of the dementia seen
    Symptoms usually occur in people 50-69 years of age
  • 194. 183
    Alzheimer’s Disease(continued)
    Affects more women than men
    Always ends in death 3-15 years after symptoms begin
  • 195. 184
    Alzheimer’s Disease: Signs And Symptoms
    Irreversible loss of memory
    Speech and writing difficulties
    Disorientation
    Difficulty walking
    loss of balance
    short steps
    spatial disorientation
  • 196. 185
    Alzheimer’s Disease: Signs And Symptoms(continued)
    Deterioration of mental functions
    Unable to make decisions
    Loss of ability to make judgments
    Changes in behavior
    restless
    angry
    depressed
    irritable
  • 197. 186
    Alzheimer’s Disease: Signs And Symptoms(continued)
    Possible seizures
    Coma and death
  • 198. 187
    Alzheimer’s Disease: Considerations For Care
    Assist to be as active as possible
    Encourage in activities of daily living
    Orient to reality
    Protect from injury
  • 199. 188
    Alzheimer’s Disease: Considerations For Care(continued)
    Maintain calm, consistent environment
    Complete ADL at the same time each day
    Use reality orientation
  • 200. 189
    Alzheimer’s Disease: Considerations For Care(continued)
    Same caregivers assigned to resident
    Involve in simple, limited activities
    Follow routines
    Treat with patience and compassion
  • 201. 190
    Alzheimer’s Disease: Considerations For Care(continued)
    Support family
    Communicate with simple phrases
    Don’t pose questions or ask to make choices
  • 202. 191
    Depression
  • 203. 192
    Objective
    Identify symptoms of depression and define the nurse aide’s role in caring for a depressed resident.
  • 204. 193
    Depression
    Reasons for depression
    Loss of independence
    Death of spouse or friend
    Loss of job or home
    Decreased memory
    Terminal illness
  • 205. 194
    Common Signs And Symptoms Of Depression
    Change in sleep pattern
    Loss of appetite and weight loss
    Crying, withdrawal from activities, appearing sad
  • 206. 195
    Nurse Aide’s Role In Caring For The Depressed Resident
    Listen to feelings
    Encourage to reminisce
    Involve in activities
    Encourage friends and family to visit
    Report changes in eating, elimination or sleeping patterns
  • 207. Nurse Aide’s Role In Caring For The Depressed Resident(continued)
    Avoid pitying the resident
    Help to focus on reality
    Monitor eating and drinking
    Promote self-esteem
    Report observations to supervisor
    Report immediately any statement that might signal suicidal ideation or thoughts of committing suicide.
    196
  • 208. 197
    Terminally Ill ResidentCaring For Resident When Death Is Imminent and Following Death
  • 209. 198
    Caring for Resident When Death Is Imminent and Following Death
    Introduction
    Death is defined as the final stage of life.  The nurse aide will need to develop a realistic attitude toward the topic of death to meet the physical and psychological needs of the resident and the family as they experience the dying process.  This unit also includes care of the body following death.
  • 210. 199
    Factors
    Influencing
    Attitudes
  • 211. 200
    Objective
    Explore personal feelings concerning the concept of death.
  • 212. 201
    Caring For Resident When Death Is Imminent and Following Death
    Factors influencing attitudes 
    Personal experiences 
    Culture 
    Some fear death 
    Others look forward to and accept death 
  • 213. 202
    Caring For Resident When Death Is Imminent and Following Death(continued)
    Factors influencing attitudes 
    Religion 
    Belief in life after death 
    Reunion with loved ones 
    Reincarnation 
    Punishment for sins 
    No afterlife 
  • 214. 203
    Caring For Resident When Death Is Imminent and Following Death(continued)
    Factors influencing attitudes 
    Age
    Children view death as temporary
  • 215. 204
    Caring For Resident When Death Is Imminent and Following Death(continued)
    Factors influencing attitudes
    Age 
    Adults may develop fears of:
    pain and suffering
    dying alone
    separation from loved ones
    Elderly generally have fewer fears
  • 216. 205
    Special Needs
    Of Dying Resident
  • 217. 206
    Objective
    Identify the special needs of a dying resident.
  • 218. 207
    Special Needs Of Dying Resident
    Visits with family/significant others
    Features of resident’s room:
    pleasant as possible
    lighting that meets resident’s preferences
    well ventilated
    odor free
  • 219. 208
    Special Needs Of Dying Resident(continued)
    Features of resident’s room:
    Contains personal items which provide comfort and reassurance
    Pictures
    Mementos
    Cards
    Flowers
    Religious objects
  • 220. 209
    Objective
    Identify eight comfort measures that may be used with the dying resident.
  • 221. 210
    Special Needs Of Dying Resident(continued)
    Comfort Measures
    Attention to skin care
    Good personal hygiene
    Oral hygiene - denture care
    Bedding changed as needed
    Back massages
  • 222. 211
    Special Needs Of Dying Resident(continued)
    Comfort Measures
    Frequent position changes
    every two hours
    P.R.N.
    Good body alignment
    supportive devices
    prevention of deformities and pressure ulcers
  • 223. 212
    Special Needs Of Dying Resident(continued)
    Comfort Measures
    Head of bed elevated to facilitate breathing
    Modified diet
  • 224. 213
    Caring For Residents
    When Death Is
    Imminent And
    Following Death:
    Nurse Aide's Role
  • 225. 214
    Objective
    Describe the nurse aide’s role in relationship to the to the needs of the dying.
  • 226. 215
    Caring For Resident When Death Is Imminent and Following DeathNurse Aide’s Role
    Source of strength and comfort
    Open and receptive
    Know own feelings about death and do not project those feelings onto resident.
  • 227. 216
    Caring For Resident When Death Is Imminent and Following DeathNurse Aide’s Role(continued)
    Empathetic
    Calm and efficient
    Normal tone of voice
    Good listening skills
    Help them make a wish list
    if they ask
    Non-judgmental
  • 228. 217
    Individual Resident's
    Reaction to Death
  • 229. 218
    Objective
    Review the various reactions residents may have as they face death.
  • 230. 219
    Individual Resident’s Reaction To Death
    Accept or be resigned to death
    Open and receptive
    Communicate about uncertainties
    Fearful or angry
    Despairing and anxious
    Hostile
    Thoughtful and meditative
  • 231. 220
    Five Stages Of
    Grief, Death And
    Dying As Described
    By Dr. Elisabeth Kubler-Ross
  • 232. 221
    Objective
    List and describe the five stages of grief, death and dying.
  • 233. 222
    Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross
    DENIAL
    Defense mechanism
    Buffer against reality
    Emotional escape hatch
    Resident may request another opinion
  • 234. 223
    Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross
    DENIAL (continued)
    Resident may avoid discussion of death
    Feeling of, “This can’t be happening to me.”
  • 235. 224
    Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross
    ANGER
    Bitterness and turmoil
    Sense of unfairness
    Blame of others such as health care workers
    Feeling of, “Why me?”
  • 236. 225
    Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross
    BARGAINING
    Turn to religious and spiritual beliefs
    Promises to God and others
    Comfort and hope when all seems lost
  • 237. 226
    Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross
    BARGAINING (continued)
    Generally know this won’t work
    Frustration and anger dissolve into depression
    “If only...I will”
  • 238. 227
    Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross
    DEPRESSION
    Belief that hope is lost
    Overwhelming despair
    Introverted and withdrawn
    Reminiscing and reviewing life
    Sleeplessness
    “I always wanted to”
  • 239. 228
    Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross
    ACCEPTANCE
    Calm and subdued interest in life
    Strives to complete unfinished business
    Helps loved ones accept death
    Needs others to validate worth of life
    “I’ve had a good life.”
  • 240. 229
    Signs of
    Approaching
    Death
  • 241. 230
    Objective
    Recognize the signs of approaching death.
  • 242. 231
    Signs Of Approaching Death
    Changes in sensory functions and ability to speak
    Vision
    increased secretions in corner of eyes
    blurred vision
    failing vision
    no eye movement/staring
  • 243. 232
    Signs Of Approaching Death
    Changes in sensory functions and ability to speak (continued)
    Speech
    becomes difficult
    hard to understand
    may be unable to speak
    Hearing - last function to be lost
  • 244. 233
    Signs Of Approaching Death
    Changes in circulation and muscle tone
    Circulation
    fails
    heat gradually lost from body
    hands and feet cold to touch and mottled
    face becomes pale or gray and mottled
    perspiration may increase (diaphoresis)
  • 245. 234
    Signs Of Approaching Death
    Changes in circulation and muscle tone (continued)
    Muscle tone
    body limp
    jaw may drop
    mouth may stay partly open
  • 246. 235
    Signs Of Approaching Death
    Changes in Vital Signs
    Respirations
    slower
    shallow
    labored
    may experience dyspnea, apnea, Cheyne-Stokes
    mucous collects in the throat and bronchial tubes (death rattle)
  • 247. 236
    Signs Of Approaching Death
    Changes in Vital Signs (continued)
    Pulse
    rapid
    weak and irregular
    Blood pressure drops
    Temperature
    elevated
    subnormal
  • 248. 237
    Nurse Aide's
    Role In
    Spiritual Preparation
    For Death
  • 249. 238
    Objectives
    Define the role of the nurse aide ithe spiritual preparation for death.
    Contrast the spiritual preparation for death practiced by those of various religions.
  • 250. 239
    Nurse Aide’s Role In Spiritual Preparation For Death
    Priest, rabbi, minister or other clergy may be contacted at request of resident or family
    Privacy to be provided when clergy with resident
  • 251. 240
    Nurse Aide’s Role In Spiritual Preparation For Death(continued)
    Support resident’s religious/spiritual practices even if different from that of nurse aide
    Listen respectfully to religious/spiritual beliefs
    Participate in religious practices if asked and acceptable
  • 252. 241
    Nurse Aide’s Role In Spiritual Preparation For Death(continued)
    Treat religious objects with care and respect:
    medals
    pictures
    statues
    bibles
    Encourage family and friends to be included
  • 253. 242
    Nurse Aide's
    Role In
    Meeting Family
    Needs
  • 254. 243
    Objective
    Identify the needs of the family as they encounter the dying process.
  • 255. 244
    Nurse Aide’s Role In Meeting Family Needs
    Available for support
    Use touch as appropriate
    Courteous and considerate
    Respect right to privacy
    Let family assist with care, if they desire, where appropriate
  • 256. 245
    Nurse Aide’s Role In Meeting Family Needs(continued)
    Use good communication skills
    Listen and provide understanding throughout the grief/loss stages
    Answer questions or refer to supervisor
  • 257. 246
    Hospice Care
  • 258. 247
    Objective
    Discuss the hospice philosophy.
  • 259. 248
    Hospice Care
    Health care service offered:
    in hospitals and extended care facilities
    by special facilities
    usually in the individual’s home
    Continuing care provided by team of health professionals
    Designed for residents with terminal illness
  • 260. 249
    Hospice Care(continued)
    Acceptance of death as imminent (6 months or less)
    Assures that individual dies with dignity and comfort
    Not concerned with cure or life-saving procedures
    Emphasis on pain relief
    Trained volunteers and professionals make regular visits.
  • 261. 250
    Hospice Care(continued)
    Provides counseling for individual and family:
    Emotional
    Psychological
    Spiritual
    Financial
    Bereavement
    Family included in all aspects of care as desired
  • 262. 251
    Postmortem Care:
    Care Of The Body
    After (Post) Death (Mortem)
  • 263. 252
    Objective
    Discuss the meaning of postmortem care.
  • 264. 253
    Postmortem Care
    Care Of Body After (Post) Death (Mortem)
    Begin care when instructed by supervisor
    Treat body to privacy, respect and gentleness
    Give care before rigor mortis sets in
  • 265. 254
    Objective
    List five reasons for doing postmortem care.
  • 266. 255
    Postmortem Care(continued)
    Reasons for Postmortem Care
    Prevent discoloration and skin damage
    Maintain good appearance of body
    Identify body and prepare for transportation
    Position body in normal alignment
    Arrange time family to view the body
  • 267. 256
    Demonstration
    and
    Return Demonstration
  • 268. 257
    Objective
    Demonstrate the procedure for postmortem care.
    (for chapter please read the clinical skills performance checklists page 91-122)
  • 269. 258
    The End