CNA Chapter Five
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    CNA Chapter Five CNA Chapter Five Presentation Transcript

    • Chap 5
      Specialized care
    • Specialized functions
      sense of sight
      receives images and sends to brain
    • Discuss common disorders of the sensory organs
    • 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
    • Discuss changes in the sensory organs due to aging.
    • 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
    • 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
    • Disorders of the Eye
      Cataract: Vision becomes cloudy
      Glaucoma: Aqueous humor accumulates. The pressure destroys the nerves and the blood vessels in the retina
      Has different causes and forms
      A person affected by blindness may learn how to read using Braille
    • 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.
    • 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
    • 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.
    • 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.
    • vision impairment
      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)
    • Sensory Organs
      sense of hearing
      transmits sounds to brain
    • Common Disorders Of The Sensory Organs(continued)
      Otitis media - infection of the middle ear
      Deafness - partial or complete hearing loss
    • Hearing impairments
      Changes In Sensory Organs Due to Aging
      Progressive hearing loss of high-pitched sounds occurs
      Hearing impairment
    • Observations Of The Sensory Organs(continued
      Drainage from ear canal
      Complaint of feeling of fluid or noise in ear
    • 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.
    • 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.
    • 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
    • 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.
    • 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
      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
    • 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.
    • 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
    • 27
      Identify the function and structure of the respiratory system.
    • 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
      The Respiratory System(continued)
      External respiration - oxygen and carbon dioxide exchanged between lungs and blood
      Internal respiration - oxygen and carbon dioxide exchanged between blood stream and cells
    • 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
      The Respiratory SystemStructure(continued)
      Nose - lined with mucous membrane
      air filtered by cilia
      mucous membrane warms and moistens air
    • 32
      The Respiratory SystemStructure(continued)
      right - 3 lobes
      left - 2 lobes
    • 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
      Review common disorders of the respiratory system.
    • 35
      Common Disorders of Respiratory System
      URI – Upper Respiratory Infection - infection of nose, throat, larynx, trachea
      Pneumonia - inflammation or infection of the lungs
    • 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
      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
      Common Disorders of Respiratory System(continued)
      Bronchitis - inflammation of the bronchi
      Lung cancer - malignant tumors in the lungs that destroy tissue
    • 39
      Discuss changes in the respiratory system due to aging.
    • 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
      List observations relating to the respiratory system.
    • 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
      Observations Of Respiratory System(continued)
      Color of sputum
      Complaint of pain in chest, back, sides
      Shortness of breath
      Noisy respirations
      Gasping for breath
    • 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.
    • 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.
    • Respiratory problems
      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.
      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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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
    • Respiratory problems
      Observe and report any changes in the resident’s breathing pattern.
    • 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.
    • 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.
    • 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.
    • 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.
    • Cardiovascular problems
    • 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
      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).
    • 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.
    • 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.
    • 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
    • 65
      Identify functions of the circulatory system.
    • 66
      Circulatory System
      Circulation is continuous movement of blood throughout body
    • 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
      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
      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
      Blood Vessels
      Arteries - carry blood away from heart
      Veins – carry blood to heart
    • 71
      Discuss how the blood vessels relate to the pulse and blood pressure.
    • 72
      • Tissue (three layers)
      • endocardium - smooth, inner layer
      • myocardium – thick, muscular middle layer
      • 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
      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
    • 75
      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)
    • 76
      Heart Valves
      Located at entrance and exit of each ventricle
      Four heart valves
    • 77
      • Systole - contraction of heart muscle
      • Diastole - relaxation of heart muscle
      • Blood pressure – highest and lowest pressure against walls of blood vessels as heart contracts and relaxes
      • Pulse - expansion and contraction of artery
    • 78
      Discuss common disorders of the circulatory system.
    • 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 
    • 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
    • 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 
    • 82
      Discuss changes that occur in the circulatory system with aging.
    • 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
    • 84
      List observations relating to the circulatory system.
    • 85
      Observations of the Circulatory System
      Changes in pulse rate and blood pressure
      Changes in skin color
      Changes in skin temperature – coldness
    • 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
    • 87
      Observations of the Circulatory System(continued)
      Blue color to lips and/or nail beds
      Complaint of tingling sensations
      Memory lapses
      Lack of energy
      Irregular respirations
      Staring and lack of responsiveness
    • 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.
    • 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.
    • 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
    • Circulation conditions
      Which requiring immediate surgery to restore adequate circulation.
    • 92
    • 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
    • 94
      List factors that influence blood pressure.
    • 95
      Factors Influencing Blood Pressure
      Viscosity of blood
    • 96
      Blood Pressure: Equipment
      Sphygmomanometer (manual)
      cuff - different sizes
      pressure control bulb
      pressure gauge – marked with numbers
    • 97
      Blood Pressure: Equipment(continued)
      magnifies sound
      has diaphragm
    • 98
      Measuring Blood Pressure
      Normal blood pressure range
      Systolic: 90-140 millimeters of mercury
      Diastolic: 60-90 millimeters of mercury
    • 99
      Guidelines for Blood Pressure Measurements
      Measure on upper arm
      Have correct size cuff
      Identify brachial artery for correct placement of stethoscope
    • 100
      Guidelines for Blood Pressure Measurements(continued)
      First sound heard – systolic pressure
      Last sound heard or change - diastolic pressure
    • 101
      Guidelines for Blood Pressure Measurements(continued)
      Record - systolic/diastolic
      Resident in relaxed position, sitting or lying down
      Blood pressure usually taken in left arm
    • 102
      Guidelines for Blood Pressure Measurements(continued)
      Do not measure blood pressure in arm with IV, A-V shunt (dialysis), cast, wound, or sore
    • 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
    • 104
      Blood Pressure: Reading Gauge
      Large lines are at increments of 10 mmHg
      Shorter lines at 2 mm intervals
      Take reading at closest line
    • 105
      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
    • 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.
    • 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
    • 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
    • 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.
    • 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
    • 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).
    • 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.
    • 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).
    • 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
    • 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.
    • 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
    • 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).
    • 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.
    • 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.
    • 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.
    • 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.
    • 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
    • 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
    • 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.
    • 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.
    • 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
    • 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.
    • 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.
    • 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
    • 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
    • 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
    • 132
      Diabetes Mellitus
      low blood sugar
      high blood sugar
    • 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.
    • 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.
    • 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
    • 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
    • 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
    • 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
    • Essentials for Nursing Assistants
      Chapter 29
      Caring for People With HIV/AIDS
    • Introduction to HIV/AIDS
    • 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
    • Risk Factors
      Having unprotected sex
      Sharing needles
      Receiving tissue transplants
      Receiving transfusions of blood or blood products
      Having an HIV-positive mother
    • AIDS
      Occurs when the person’s immune system is no longer able to fight off infections and cancers
      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
    • AIDS (Cont’d)
      Medication side effects:
      Headache, dizziness, nausea, diarrhea, fever, skin rash, severe anemia, and extreme fatigue
    • Attitudes Toward People With HIV/AIDS
    • 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
    • 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!
    • Caring for a Person With HIV/AIDS
    • 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
    • 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
    • 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
    • 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
    • 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
    • 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
    • Psychological Problems
      Meaning conditions affecting thought, mood, and behavior, can be as threatening to the health of residents as physical illness.
    • DHSR Approved Curriculum-Unit 16
    • 157
      Discuss disorders that cause confusion for residents.
    • 158
      Symptom or side effect of many disorders
      Disorders causing confusion
      Alzheimer’s Disease
      Huntington’s Chorea
    • 159
      Other Causes
      Drug reactions
      Environmental changes
      Vision and/or hearing loss
      Poor nutrition
      Decreased oxygen levels in blood
      Head injury
    • 160
      Condition can be permanent or temporary
    • 161
      Reality Orientation Used For Confusion
      Facing resident and speaking clearly and slowly
      Greeting the resident by name with each interaction
      Identifying yourself with each interaction
    • 162
      Reality Orientation Used For Confusion(continued)
      Explaining care in simple terms prior to giving care
      Frequently orienting the resident to the day, month, date, and time
      Giving short, simple instructions
    • 163
      Reality Orientation Used For Confusion(continued)
      Encouraging residents to wear glasses or hearing aides
      Communicating with touch and clear and simple comments and questions
    • 164
      Reality Orientation Used For Confusion(continued)
      Encouraging use of radio, television, newspapers, and magazines
      Maintaining resident’s routine
    • 165
      Reality Orientation Used For Confusion(continued)
      Giving only one direction at a time
      Keeping the environment calm and relaxed
    • 166
      Reality Orientation Used For Confusion(continued)
      Providing clocks, calendars and bulletin boards to remind residents of time and activities
      Discussing current topics
    • 167
      Reality Orientation Used For Confusion(continued)
      Showing resident self-image in mirror
      Providing recreational activities which reinforce reality orientation
    • 168
      Reality Orientation Used For Confusion(continued)
      Dressing residents during the day and assisting them to stay on a day-night schedule
    • 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.
    • 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
    • 171
      Ways To Assist Combative Residents(continued)
      Do not ignore threats
      Protect yourself from harm
      Listen to verbal aggression without argument
    • 172
    • 173
      Identify the symptoms displayed by residents with dementia.
    • 174
      Dementia (Group Of Symptoms)
      Defined as a progressive loss of mental functioning
    • 175
      Dementia (Group Of Symptoms)(continued)
      Two categories of dementia
      1st Category: Primary
      No known cause
      May be treated but not completely cured
    • 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)
    • 177
      Dementia (Group Of Symptoms)(continued)
      • Two categories of dementia
      • 2nd Category: Secondary
      • Usually has known cause
      • Treatable
      • Reversible to some degree
    • 178
      Dementia (Group Of Symptoms)(continued)
      • Two categories of dementia
      • 2nd Category: Secondary
      • Examples of secondary causes of dementia
      • depression
      • minor stroke
      • thyroid dysfunction
      • medication induced
    • 179
      Symptoms Of Dementia
      Inability to reason accurately
      Recent memory loss
      Detailed long-term memory
      Repetitious speech
      Self-centered behavior
    • 180
    • 181
      Review the psychosocial characteristics and care needs of a person with Alzheimer’s disease.
    • 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
    • 183
      Alzheimer’s Disease(continued)
      Affects more women than men
      Always ends in death 3-15 years after symptoms begin
    • 184
      Alzheimer’s Disease: Signs And Symptoms
      Irreversible loss of memory
      Speech and writing difficulties
      Difficulty walking
      loss of balance
      short steps
      spatial disorientation
    • 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
    • 186
      Alzheimer’s Disease: Signs And Symptoms(continued)
      Possible seizures
      Coma and death
    • 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
    • 188
      Alzheimer’s Disease: Considerations For Care(continued)
      Maintain calm, consistent environment
      Complete ADL at the same time each day
      Use reality orientation
    • 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
    • 190
      Alzheimer’s Disease: Considerations For Care(continued)
      Support family
      Communicate with simple phrases
      Don’t pose questions or ask to make choices
    • 191
    • 192
      Identify symptoms of depression and define the nurse aide’s role in caring for a depressed resident.
    • 193
      Reasons for depression
      Loss of independence
      Death of spouse or friend
      Loss of job or home
      Decreased memory
      Terminal illness
    • 194
      Common Signs And Symptoms Of Depression
      Change in sleep pattern
      Loss of appetite and weight loss
      Crying, withdrawal from activities, appearing sad
    • 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
    • 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.
    • 197
      Terminally Ill ResidentCaring For Resident When Death Is Imminent and Following Death
    • 198
      Caring for Resident When Death Is Imminent and Following Death
      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.
    • 199
    • 200
      Explore personal feelings concerning the concept of death.
    • 201
      Caring For Resident When Death Is Imminent and Following Death
      Factors influencing attitudes 
      Personal experiences 
      Some fear death 
      Others look forward to and accept death 
    • 202
      Caring For Resident When Death Is Imminent and Following Death(continued)
      Factors influencing attitudes 
      Belief in life after death 
      Reunion with loved ones 
      Punishment for sins 
      No afterlife 
    • 203
      Caring For Resident When Death Is Imminent and Following Death(continued)
      Factors influencing attitudes 
      Children view death as temporary
    • 204
      Caring For Resident When Death Is Imminent and Following Death(continued)
      Factors influencing attitudes
      Adults may develop fears of:
      pain and suffering
      dying alone
      separation from loved ones
      Elderly generally have fewer fears
    • 205
      Special Needs
      Of Dying Resident
    • 206
      Identify the special needs of a dying resident.
    • 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
    • 208
      Special Needs Of Dying Resident(continued)
      Features of resident’s room:
      Contains personal items which provide comfort and reassurance
      Religious objects
    • 209
      Identify eight comfort measures that may be used with the dying resident.
    • 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
    • 211
      Special Needs Of Dying Resident(continued)
      Comfort Measures
      Frequent position changes
      every two hours
      Good body alignment
      supportive devices
      prevention of deformities and pressure ulcers
    • 212
      Special Needs Of Dying Resident(continued)
      Comfort Measures
      Head of bed elevated to facilitate breathing
      Modified diet
    • 213
      Caring For Residents
      When Death Is
      Imminent And
      Following Death:
      Nurse Aide's Role
    • 214
      Describe the nurse aide’s role in relationship to the to the needs of the dying.
    • 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.
    • 216
      Caring For Resident When Death Is Imminent and Following DeathNurse Aide’s Role(continued)
      Calm and efficient
      Normal tone of voice
      Good listening skills
      Help them make a wish list
      if they ask
    • 217
      Individual Resident's
      Reaction to Death
    • 218
      Review the various reactions residents may have as they face death.
    • 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
      Thoughtful and meditative
    • 220
      Five Stages Of
      Grief, Death And
      Dying As Described
      By Dr. Elisabeth Kubler-Ross
    • 221
      List and describe the five stages of grief, death and dying.
    • 222
      Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross
      Defense mechanism
      Buffer against reality
      Emotional escape hatch
      Resident may request another opinion
    • 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.”
    • 224
      Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross
      Bitterness and turmoil
      Sense of unfairness
      Blame of others such as health care workers
      Feeling of, “Why me?”
    • 225
      Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross
      Turn to religious and spiritual beliefs
      Promises to God and others
      Comfort and hope when all seems lost
    • 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”
    • 227
      Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross
      Belief that hope is lost
      Overwhelming despair
      Introverted and withdrawn
      Reminiscing and reviewing life
      “I always wanted to”
    • 228
      Five Stages of Grief, Death and Dying as Described by Dr. Elizabeth Kubler-Ross
      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.”
    • 229
      Signs of
    • 230
      Recognize the signs of approaching death.
    • 231
      Signs Of Approaching Death
      Changes in sensory functions and ability to speak
      increased secretions in corner of eyes
      blurred vision
      failing vision
      no eye movement/staring
    • 232
      Signs Of Approaching Death
      Changes in sensory functions and ability to speak (continued)
      becomes difficult
      hard to understand
      may be unable to speak
      Hearing - last function to be lost
    • 233
      Signs Of Approaching Death
      Changes in circulation and muscle tone
      heat gradually lost from body
      hands and feet cold to touch and mottled
      face becomes pale or gray and mottled
      perspiration may increase (diaphoresis)
    • 234
      Signs Of Approaching Death
      Changes in circulation and muscle tone (continued)
      Muscle tone
      body limp
      jaw may drop
      mouth may stay partly open
    • 235
      Signs Of Approaching Death
      Changes in Vital Signs
      may experience dyspnea, apnea, Cheyne-Stokes
      mucous collects in the throat and bronchial tubes (death rattle)
    • 236
      Signs Of Approaching Death
      Changes in Vital Signs (continued)
      weak and irregular
      Blood pressure drops
    • 237
      Nurse Aide's
      Role In
      Spiritual Preparation
      For Death
    • 238
      Define the role of the nurse aide ithe spiritual preparation for death.
      Contrast the spiritual preparation for death practiced by those of various religions.
    • 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
    • 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
    • 241
      Nurse Aide’s Role In Spiritual Preparation For Death(continued)
      Treat religious objects with care and respect:
      Encourage family and friends to be included
    • 242
      Nurse Aide's
      Role In
      Meeting Family
    • 243
      Identify the needs of the family as they encounter the dying process.
    • 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
    • 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
    • 246
      Hospice Care
    • 247
      Discuss the hospice philosophy.
    • 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
    • 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.
    • 250
      Hospice Care(continued)
      Provides counseling for individual and family:
      Family included in all aspects of care as desired
    • 251
      Postmortem Care:
      Care Of The Body
      After (Post) Death (Mortem)
    • 252
      Discuss the meaning of postmortem care.
    • 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
    • 254
      List five reasons for doing postmortem care.
    • 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
    • 256
      Return Demonstration
    • 257
      Demonstrate the procedure for postmortem care.
      (for chapter please read the clinical skills performance checklists page 91-122)
    • 258
      The End