Specialized functions Eye sense of sight receives images and sends to brain
Discuss common disorders of the sensory organs Objective
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. Objective
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 Blindness 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 observations
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 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)
Sensory Organs Ear 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 The Respiratory System
27 Objective 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) 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 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) Lungs 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 Objective 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 Objective 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 Objective 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 Sneezing Gasping for breath Anxiety
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 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.
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. NERVER ADJUST OR DISCONTINUE THE OXYGEN RESIDENT WITH DIFFICULTY BREATHING ELEVATE THE HEAD OF THE BED.
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 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
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).
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 The Circulatory System
65 Objective 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 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 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 Blood Vessels Arteries - carry blood away from heart Veins – carry blood to heart
71 Objective Discuss how the blood vessels relate to the pulse and blood pressure.
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 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
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)
76 Valves Heart Valves Located at entrance and exit of each ventricle Four heart valves
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 Objective 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 Objective 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 Objective 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) 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
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 Measuring Blood Pressure
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 Objective List factors that influence blood pressure.
95 Factors Influencing Blood Pressure Weight Sleep Age Emotions Sex Heredity Viscosity of blood Illness/Disease
96 Blood Pressure: Equipment Sphygmomanometer (manual) cuff - different sizes pressure control bulb pressure gauge – marked with numbers aneroid mercury
97 Blood Pressure: Equipment(continued) Stethoscope 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
101 118 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
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
105 300 290 280 270 260 250 240 230 220 210 200 190 180 170 160 150 140 130 120 110 100 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
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
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 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
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 16 156 Confusion
157 Objective Discuss disorders that cause confusion for residents.
158 Confusion Symptom or side effect of many disorders Disorders causing confusion Stroke Arteriosclerosis Dementia Alzheimer’s Disease Huntington’s Chorea
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
160 Confusion(continued) Condition can be permanent or temporary
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
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
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
164 Reality Orientation Used For Confusion(continued) Includes: Encouraging use of radio, television, newspapers, and magazines Maintaining resident’s routine
165 Reality Orientation Used For Confusion(continued) Includes: Giving only one direction at a time Keeping the environment calm and relaxed
166 Reality Orientation Used For Confusion(continued) Includes: Providing clocks, calendars and bulletin boards to remind residents of time and activities Discussing current topics
167 Reality Orientation Used For Confusion(continued) Includes: Reminiscing Showing resident self-image in mirror Providing recreational activities which reinforce reality orientation
168 Reality Orientation Used For Confusion(continued) Includes: 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
173 Objective 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 Irreversible 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
Reversible to some degree
178 Dementia (Group Of Symptoms)(continued)
Two categories of dementia
2nd Category: Secondary
Examples of secondary causes of dementia
179 Symptoms Of Dementia Confusion Inability to reason accurately Recent memory loss Detailed long-term memory Repetitious speech Self-centered behavior Agitation Disorientation Confabulation
180 Alzheimer's Disease
181 Objective 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 Disorientation 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 restless angry depressed irritable
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
192 Objective Identify symptoms of depression and define the nurse aide’s role in caring for a depressed resident.
193 Depression 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. 196
197 Terminally Ill ResidentCaring For Resident When Death Is Imminent and Following Death
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.
199 Factors Influencing Attitudes
200 Objective Explore personal feelings concerning the concept of death.
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
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
203 Caring For Resident When Death Is Imminent and Following Death(continued) Factors influencing attitudes Age Children view death as temporary
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
205 Special Needs Of Dying Resident
206 Objective 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 Pictures Mementos Cards Flowers Religious objects
209 Objective 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 P.R.N. 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 Objective 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) Empathetic Calm and efficient Normal tone of voice Good listening skills Help them make a wish list if they ask Non-judgmental
217 Individual Resident's Reaction to Death
218 Objective 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 Hostile Thoughtful and meditative
220 Five Stages Of Grief, Death And Dying As Described By Dr. Elisabeth Kubler-Ross
221 Objective 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 DENIAL 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 ANGER 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 BARGAINING 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 DEPRESSION Belief that hope is lost Overwhelming despair Introverted and withdrawn Reminiscing and reviewing life Sleeplessness “I always wanted to”
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.”
229 Signs of Approaching Death
230 Objective Recognize the signs of approaching death.
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
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
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)
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 Respirations slower shallow labored 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) Pulse rapid weak and irregular Blood pressure drops Temperature elevated subnormal
237 Nurse Aide's Role In Spiritual Preparation For Death
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.
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: medals pictures statues bibles Encourage family and friends to be included
242 Nurse Aide's Role In Meeting Family Needs
243 Objective 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 Objective 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: Emotional Psychological Spiritual Financial Bereavement Family included in all aspects of care as desired
251 Postmortem Care: Care Of The Body After (Post) Death (Mortem)
252 Objective 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 Objective 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 Demonstration and Return Demonstration
257 Objective Demonstrate the procedure for postmortem care. (for chapter please read the clinical skills performance checklists page 91-122)