Promotion Of Function

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Promotion Of Function

  1. 1. Promotion of function and health of residents  Chapter 4  PERSONAL CARE SKILLS  RESTORATIVE SKILLS  PSYCHOSOCIAL SKILLS  RECORDING AND REPORTING
  2. 2. Activities of daily living (ADLs) Assistant residents with activities of daily living, Is your primary responsibilities.
  3. 3. Personal care skills Hygiene
  4. 4. Daily Hygiene Needs  Bathing  Shampooing  Skin care hair  Back care  Hair care  Oral  Nail care hygiene  Perineal care  Shaving  Dressing and undressing
  5. 5. HYGIENE  Important for residents to feel clean and fresh  To keep the residents free from disease due to harmful bacteria that can enter the body through any skin break.  Includes: mucous membranes that line any body cavity.  With aging skin produces less oil, Which makes it dry, requiring less frequent bathing.  This does not mean that a daily partial bath is not needed to freshen the mouth and perineal area ( area of the body that includes the male and female genital and the anus)
  6. 6. Cleanliness  Removes body sweat, odors and other secretions.  Morning care ( AM CARE )  Including washing face and hands, tooth brushing or denture care before eating breakfast helps to decrease harmful bacteria.  Helps to maintain a pleasant appearance and increase a sense of well-being for resident.
  7. 7. Hygiene care before bedtime  Called HS ( hour of sleep) care  Accomplishes the same goals and promotes rest and sleep.  HS care might include a back rub to relax the resident.
  8. 8. Describe factors that affect a resident’s personal hygiene practices.
  9. 9. Factors That Affect Hygiene Practices  Culture  Family Practices  Illness  Individualpreferences –Bath in morning or before going to bed –Frequency of bathing, shaving –Shampooing hair daily or weekly
  10. 10. Factors That Affect Hygiene Practices (continued)  Economics –Unable to afford deodorant, shampo o, etc. –Unable to afford utilities
  11. 11. 12
  12. 12. Identify the purposes of bathing a resident. 13
  13. 13. Bathing Resident  Purpose of Bathing –Removes perspiration, dirt and microorganisms –Stimulates circulation –Exercises body parts 14
  14. 14. Bathing Resident (continued)  Purpose of Bathing (continued) –Refreshes, relaxes and promotes physical comfort –Removes odors –Allows for evaluation of skin condition 15
  15. 15. Discuss the various methods of bathing a resident. 16
  16. 16. Bathing Resident  Methods of Bathing –Partial bath –Complete bed bath –Tub bath –Shower 17
  17. 17. Identify guidelines for bathing a resident. 18
  18. 18. Guidelines for Bathing  Receive instructions from supervisor regarding method of bathing and skin care products to use  Provide privacy  Reduce drafts by closing windows, drapes and doors 19
  19. 19. Guidelines for Bathing (continued)  Use good body mechanics  Keep covered for warmth and privacy  Protect safety of resident: –never leave unattended in bathtub or shower –take precautions to prevent slips and falls –have temperature no higher than 105 F for tub or shower 20
  20. 20. BATHING  Resident’s bath schedule as determined by the care plan  Might require a complete bath, shower, or a partial bath.  General goals of skin care is to remove pathogens, promote comfort, cleanliness, help improve circulation and opportunity to inspect the skin, mobility.  Helps increase self-esteem.
  21. 21. General principles that apply to bathing  Standard precautions for personal care  Keep bathwater temperature at a safe level  Use mild soap or other cleansers per facility policy  Watching for resident allergies to bath products
  22. 22. When cleansing the body  Wash from the cleanest area to the dirtiest area  For complete bed bath, change water, wash cloth, and gloves prior to bathing the lower extremities.  Always provide privacy  Caution for residents who become weak dizzy or faint during the bath stop the bath process, stay with the resident and call for assistant, and report the incident to the licensed nurse immediately
  23. 23. DHSR Approved Curriculum-Unit 9 24
  24. 24. Discuss giving perineal care. 25
  25. 25. Perineal Care  Used to clean genital and anal areas –Prevents infection –Prevents odors –Promotes comfort 26
  26. 26. Perineal Care  Rules of medical asepsis and Standard Precautions followed –Work from cleanest to dirtiest area (front to back) urethral area – cleanest anal area – dirtiest 27
  27. 27. Perineal Care (continued)  Delicate area that needs special care –Use warm water –Wash gently –Rinse well –Pat dry 28
  28. 28. Oral Hygiene  Definition: measures used to keep mouth and teeth clean and free of microorganisms 29
  29. 29. Oral Hygiene (continued)  Purpose –Prevent odors –Prevent infections –Prevent tooth decay and loss of teeth –Prevent gum disease –Increase comfort –Enhance taste of food 30
  30. 30. Oral Hygiene (continued)  Oralhygiene is provided: –Before breakfast –After meals –At bedtime –Other times as requested or necessary 31
  31. 31. Oral Hygiene (continued)  Observationsto report: –Foul mouth odors –Bleeding –Loose or broken teeth or dentures –Sores in or around mouth –Coated tongue –Complaints of pain 32
  32. 32. List seven principles to practice when brushing teeth. 33
  33. 33. Principles For Brushing Teeth  Hold brush at 45 degree angle  Use circular motion to brush teeth  Brush well where teeth and gums meet  Brush all surfaces  Brush upper teeth first  Brush gently  Offer diluted mouth wash DHSR Approved Curriculum-Unit 9 34
  34. 34. Special Mouth Care Products  Swabs  Toothettes: –usually soaked in mouthwash or plain water –hydrogen peroxide, salt water solution if specified on care plan  Petroleum jelly for dry lips 35
  35. 35. Denture Care  Handle carefully – expensive to replace  Clean as often as natural teeth  Protect from loss or breakage  Store safely, when out of mouth, in labeled container  Never use hot water, which can warp dentures 36
  36. 36. Denture Care (continued)  Store dry, in water or in special solution  For long term storage, put container holding dentures in bedside stand 37
  37. 37. Grooming: Relationship To Self-Esteem Grooming 38
  38. 38. Grooming Nurse aides are the members of the health care team responsible for providing personal care and grooming for the resident. They encourage the resident to do as much as possible for themselves, but assist as needed with personal cleanliness, oral hygiene, nail care, shaving, dressing, care of hair and skin care.
  39. 39. Grooming: Relationship To Self- Esteem Introduction (continued) Personal grooming is important for a positive self-image and every effort should be made to encourage and assist the resident to maintain a pleasing and attractive appearance. 40
  40. 40. Provide for the resident’s personal care and grooming needs and identify the role of the nurse aide in meeting these needs. List the daily hygienic needs of an individual. 41
  41. 41. Daily Hygiene Needs  Bathing  Shampooing  Skin care hair  Back care  Hair care  Oral  Nail care hygiene  Perineal care  Shaving  Dressing and undressing 42
  42. 42. Personal Care and Grooming: Role of the Nurse Aide  Assist to follow their personal hygiene practices  Encourage to do as much of their daily care as possible  Assist residents to select their own clothing 43
  43. 43. Personal Care and Grooming: Role of the Nurse Aide (continued)  Promote independence and self esteem  Encourage use of deodorant, perfume, aftershave lotion, and cosmetics  Be patient and encouraging 44
  44. 44. 45
  45. 45. Discuss the nurse aide’s responsibility in assisting the resident with shaving. 46
  46. 46. Assisting Resident With Shaving  Daily activity for men  Promotes: –Physical comfort –Psychological well-being 47
  47. 47. Review the factors to consider when shaving a resident. 48
  48. 48. Assisting Resident With Shaving  Factors to consider: –Electric razor provides greatest safety –Use own equipment or a disposable safety razor –Soften beard and skin prior to shaving 49
  49. 49. 50
  50. 50. Discuss the care of the resident’s nails and feet. 51
  51. 51. Nail Care  Requires daily cleaning and trimming of fingernails and toenails as needed  Maintain nails by keeping nails: –short –clean –free of rough edges 52
  52. 52. List three purposes of nail and foot care. 53
  53. 53. Nail Care (continued)  Purpose –Prevent infection –Prevent injury –Prevent odors 54
  54. 54. Identify factors to be considered when giving a resident nail care. 55
  55. 55. Nail Care: Factors To Consider  Easier to trim and clean after soaking  Nail clipper used to cut and trim nails  Clip nails straight across  Softened cuticle can be pushed back with orange stick 56
  56. 56. Nail Care: Factors To Consider (continued)  Diabetics and residents with circulatory problems will have their nails trimmed only by a licensed nurse or podiatrist  Reviewresident care plan and check with supervisor prior to trimming nails 57
  57. 57. Identify factors to be considered when giving a resident foot care. 58
  58. 58. Factors To Consider In Foot Care  Wash feet using warm water and mild soap  Dry feet carefully, especially between the toes  Apply lotion to tops and bottoms of feet only, not between the toes to prevent skin breakdown 59
  59. 59. Factors To Consider In Foot Care (continued)  Do not use a heating pad on resident’s feet  Keep footwear on; residents never go barefoot  Change socks and shoes daily 60
  60. 60. Factors To Consider In Foot Care (continued)  Foot injuries and infections can lead to gangrene and amputation, especially in diabetics  Notify supervisor immediately of any unusual observations of the feet 61
  61. 61. 62
  62. 62. Describe ways to assist the resident with hair care. 63
  63. 63. Hair Care  Haircare includes –Daily brushing and combing –Styling –Shampooing 64
  64. 64. Review factors to consider for daily hair care. 65
  65. 65. Factors To Consider For Daily Hair Care  Because hair style is personal preference, ask about style  Make brushing and combing part of morning care 66
  66. 66. Factors To Consider For Daily Hair Care (continued)  Protect resident’s clothing by placing towel around shoulders  Cover pillow with towel for residents confined to bed 67
  67. 67. Factors To Consider For Daily Hair Care (continued)  Brushing hair: –refreshes resident –improves morale –stimulates circulation –distributes natural oils evenly –removes lint and dust  Handle hair gently when brushing or combing 68
  68. 68. Factors To Consider For Daily Hair Care (continued)  Section hair and work on one area at a time  Note appearance of scalp and hair  Hair style should be age appropriate 69
  69. 69. Factors To Consider For Daily Hair Care (continued)  Residents are encouraged to do as much as possible for themselves  Comb and brush are cleaned after use  Combs and brushes are never shared 70
  70. 70. Discuss considerations used when shampooing a resident’s hair. 71
  71. 71. Shampooing Considerations  Frequency individualized  Resident’s shampoo, conditioner and other hair care products are used  Resident assisted to beauty shop if available 72
  72. 72. List the various methods for shampooing hair. 73
  73. 73. Shampooing Considerations (continued)  Methods of shampooing: –during shower –at sink –using stretcher –in bed 74
  74. 74. Shampooing Considerations (continued)  Eyes and ears protected  Hair dried as fast as possible  Cold or drafty areas eliminated  Female residents assisted to curl or set hair 75
  75. 75. Shampooing Considerations (continued)  Barbers or beauticians may be contacted by facility to care for hair of residents  Care plan to be checked for any special instructions prior to shampooing 76
  76. 76. 77
  77. 77. Identify the general principles of dressing and undressing a resident. 78
  78. 78. Dressing And Undressing  Encourage resident to choose own clothing  Dress daily own clothing and underwear  Make sure clothes are in good repair  For confused resident take 2 cloths to choose 79
  79. 79. Dressing And Undressing (continued)  Dress weak or affected side first  Undress weak or affected side last  Ensure clothing is appropriate for weather and environment 80
  80. 80. Dressing And Undressing (continued)  Encourage resident to wear clothing that matches and is clean and neat  Dress should be age appropriate  Do not put clothing on backwards 81
  81. 81. Dressing And Undressing (continued)  Be gentle  Always be patient and provide time for residents to do as much as possible for themselves 82
  82. 82. 83
  83. 83. Demonstrate the procedure for dressing and undressing the resident. 84
  84. 84. Nutrition and Hydration nutrition 85
  85. 85. Nutrition and Hydration Introduction This unit introduces the nurse aide to the basic principles of nutrition and emphasizes the functions of the major nutrients required for health. 86
  86. 86. Nutrition and Hydration Introduction (continued) This unit covers the Food Guide Pyramid, the use of therapeutic diets, adaptive devices, alternative methods of feeding, providing water and nourishments, the procedure for feeding a resident, and the effects of good nutrition and poor nutrition. 87
  87. 87. Nutrition and Hydration Introduction (continued) Knowledge of nutrition will enable the nurse aide to recognize the important relationship between food and good health. 88
  88. 88. 89
  89. 89. Identify the general principles of basic nutrition. Identify factors that influence dietary practices. 90
  90. 90. Good Nutrition Promotes physical and mental health Provides increased resistance to illness Produces added energy and vitality 91
  91. 91. Good Nutrition (continued) Aids in healing process Assists one to feel and sleep better 92
  92. 92. Functions of Food Provides energy Growth and repair of tissue Maintenance and regulation of body processes 93
  93. 93. Factors Influencing Dietary Practices Personal preference Appetite Finance Illness Culture 94
  94. 94. Review cultural variations in diet. 95
  95. 95. Culture and Dietary Practices  The diets of Chinese, Japanese, Koreans and people from Far East include rice and tea  The diets of Spanish- speaking people include spicy dishes containing rice, beans 96
  96. 96. Culture and Dietary Practices (continued)  The Italian diet includes spaghetti, lasagna, and other pastas  Scandinavians have a lot of fish in their diets 97
  97. 97. Culture and Dietary Practices (continued)  Americans eat a lot of meat, fast foods, and processed foods  Use of sauce and spices are culturally related 98
  98. 98. Culture and Dietary Practices (continued)  Americans eat a lot of meat, fast foods, and processed foods  Use of sauce and spices are culturally related 99
  99. 99. Review the major classification of nutrients and their function in the body. 100
  100. 100. Nutrients  Nutrients are essential  Four classifications of nutrients 1.Fats - provide energy, help body use certain vitamins, conserve body heat and protect organs from injury 2.Proteins – build and repair tissue 101
  101. 101. Nutrients (continued)  Four classifications of nutrients (continued) 3. Carbohydrates - provide energy and fiber that help in bowel elimination 4. Vitamins and minerals - ingested through food and are necessary for carrying out and maintaining specific body functions 102
  102. 102. Nutrients (continued)  Fats, proteins and carbohydrates measured in calories 103
  103. 103. Nutrients (continued  Water- solvent for nutrients and metabolic waste products –Found in all body tissue –Essential for digestion of food –Makes up most of blood plasma –6 to 8 glasses necessary per day –Has no caloric value 104
  104. 104. Describe six factors that influence caloric needs. 105
  105. 105. Factors That Influence Caloric Need  Age  Sex  Size and activity level  Climate  State of health  Amount of sleep obtained 106
  106. 106. Cite nine age-related changes/factors that affect the resident’s nutritional status. 107
  107. 107. Age Related Changes/Factors Affecting Nutrition  Need for fewer calories  Vitamin and mineral requirements change  Drugs that affect how nutrients are absorbed and used  Teeth/dentures affect ability to chew food 108
  108. 108. Age Related Changes/Factors Affecting Nutrition (continued)  Diminished sense of taste and smell  Assistance required with eating  Decreased saliva and gastric juices production  Discomfort caused by constipation  Decreased appetite and thirst 109
  109. 109. Signs Of Good Nutrition (continued)  Restfulsleep patterns  Healthy appetite  Regular elimination habits  Appropriate body weight 110
  110. 110. Identify seven results of poor nutrition. 111
  111. 111. Results of Poor Nutrition  Hair and eyes appear dull  Irregular bowel habits  Weight changes  Osteoporosis and other diseases 112
  112. 112. Results of Poor Nutrition (continued)  Lack of interest - mental slowdown  Skin color and appearance poor 113
  113. 113. Results of Poor Nutrition (continued)  Anemia leading to: –tired feeling –pale skin –shortness of –poor sleep breath patterns –increased pulse –headaches –problems with digestion 114
  114. 114. 115
  115. 115. Discuss the six basic food groups from the Food Guide Pyramid that contribute to balanced nutrition. 116
  116. 116. Dietary Guide For Americans  Guidelines are the foundation of the Food Guide Pyramid and include nine key recommendations.  Key recommendation #1: Consume nutrient-dense foods and beverages within calories needed for age, sex and activity level. 117
  117. 117. Dietary Guide For Americans  Key recommendation #2: To maintain health body weight, balance calories consumed with calories expended.  Key recommendation #3: Engage regularly in a variety of physical activities and reduce sedentary activities. 118
  118. 118. Dietary Guide For Americans  Keyrecommendation #4: Encourage the following: –Choose variety of fruits and vegetables daily. –Half of daily grains should come from whole grains. –Consume 3 cups fat-free or low fat milk or equivalent milk products daily. 119
  119. 119. Dietary Guide For Americans  Key recommendation #5: Consume foods and beverages that are low in saturated fats, trans fats and cholesterol.  Key recommendation #6: For carbohydrates: Choose fiber-rich foods, vegetables and grains often. Reduce intake of sugar- and starch-containing foods. 120
  120. 120. Dietary Guide For Americans  Key recommendation #7: Consume less than a teaspoon of salt per day.  Key recommendation #8: Consume alcoholic beverages in moderation if alcohol intake is permitted.  Key recommendation #9: Prepare foods in a safe manner to avoid microbial foodborne illness. 121
  121. 121. Six Basic Food Groups From the Food Pyramid Guide Meat GRAINS Vegetables Fruits Milk & Beans 122
  122. 122. Food Pyramid Guide Grain Group (breads, cereal, rice, pasta)  Provides –carbohydrates –minerals –fiber 123
  123. 123. Food Pyramid Guide Grain Group (breads, cereal, rice, pasta) (continued) 1 ounce equivalent is about 1 slice of bread, about 1 cup of breakfast cereal or ½ cup cooked rice, cereal or pasta. 124
  124. 124. Food Pyramid Guide Grain Group (breads, cereal, rice, pasta) (continued)  Daily: –6 ounce equivalents for males over 60 –5 ounce equivalents for females over 60 125
  125. 125. Food Guide Pyramid Vegetable Group  Provides: –vitamins –minerals –fiber (roughage)  Easier to chew if cooked, chopped or diced 126
  126. 126. Food Guide Pyramid Vegetable Group (continued)  Chosefrom all five vegetable subgroups: –dark green –orange –legumes –starchy –other vegetables 127
  127. 127. Food Guide Pyramid Vegetable Group (continued)  Daily: –2½ cups for males over 60 –2 cups for females over 60 128
  128. 128. Food Pyramid Guide Fruit Group  Provides –vitamins –minerals –fiber Chose fresh, frozen, canned or dried fruits 129
  129. 129. Food Pyramid Guide Fruit Group (continued)  Daily: –2 cups daily for males over 60 –1½ cups daily for females over 60 130
  130. 130. Food Pyramid Guide Milk, Yogurt and Other Milk Products  Provides –proteins –vitamins (A) –minerals (calcium) –carbohydrates –Fat  Choose low-fat or fat-free milk and milk products 131
  131. 131. Food Pyramid Guide Milk, Yogurt, Cheese Group (continued)  Daily: –3 cups for males over 60 –3 cups for females over 60 132
  132. 132. Food Pyramid Guide Meat, Poultry, Fish and Beans Group  Provides –protein –fats –vitamins –Minerals –1 ounce of meat, poultry or fish is about ¼ cup cooked beans, 1 egg, 1 tablespoon of peanut butter or ½ ounce nuts or seeds 133
  133. 133. Food Pyramid Guide Meat, Poultry, Fish and Beans Group (continued)  Daily: –5½ ounce equivalents daily for males over 60 –5 ounce equivalents daily for females over 60 134
  134. 134. Food Pyramid Guide Oil Group = fats that are liquid at room temperature  Provides essential fatty acids High in calories Use sparingly  Keeptotal fat intake between 20% to 35% of calories 135
  135. 135. Food Pyramid Guide Oil Group = fats that are liquid at room temperature  Most fats consumed should be polyunsaturated and monounsaturated.  Make most fat sources from fish, nuts and vegetable oils.  Limit solid fats like butter, stick margarine, shortening and lard. 136
  136. 136. Types of Therapeutic Diets  Clear liquid  Full liquid  Bland  Low residue  Controlled carbohydrate (Diabetic)  Low fat/low cholesterol 137
  137. 137. Types of Therapeutic Diets  Clear liquid  Full liquid  Bland  Low residue  Controlled carbohydrate (Diabetic)  Low fat/low cholesterol 138
  138. 138. Types of Therapeutic Diets (continued)  High fiber  Low calorie  High calorie  Sodium restricted  High protein  Mechanical soft, chopped, pureed 139
  139. 139. Types of Therapeutic Diets (continued) Residents may have difficulty accepting special diets. 140
  140. 140. 141
  141. 141. Recognize adaptive devices used to assist residents with eating. 142
  142. 142. Adaptive Devices  Food Guards  Divided Plates  Built-up handled utensils  Easy grip Residents have to be mugs/glasses taught how to use these devices. 143
  143. 143. Discuss alternate methods of feeding. 144
  144. 144. Parenteral Fluids (Intravenous Infusion)  Fluids administered through vein. Little nutritional value  Responsibility of licensed nurse 145
  145. 145. Parenteral Fluids (Intravenous Infusion) (continued)  Observationsto report –Near-empty bottle/bag –Change in drip rate –Pain at needle site, and/or redness and/or swelling, if observable –Loose, non-intact, or damp dressing 146
  146. 146. Enteral Feeding Residents unable to take nutrients by mouth •Depressed •Comatose •Swallowing problem (stroke, Alzheimer’s or other medical conditions) •Disorders of digestive tract 147
  147. 147. Enteral Feeding (continued) Liquid formula administered through tube by licensed nurse •Nose to stomach - nasogastric tube •Directly into stomach - gastrostomy tube 148
  148. 148. Nurse Aide Responsibilities in Alternative Nutrition  Ensure that there is no tension or pulling on tube  Keep resident’s nose clean and free of mucus  Check that tube is securely taped to nose  Perform frequent oral care with nasogastric tube 149
  149. 149. Nurse Aide Responsibilities in Alternative Nutrition (continued)  Report any signs or symptoms related to aspiration or GI problems  Mitts may be ordered to prevent resident from dislodging tube 150
  150. 150. 151
  151. 151. Identify the responsibilities of the nurse aide in preparing residents for meals. Serve prepared food as instructed. 152
  152. 152. Preparing Residents for Meals  Meals enjoyable, social experience  Provide pleasant environment –Clean area –Odor-free area –Adequate lighting  Flowers/decorations and music add interest to dining area 153
  153. 153. Preparing Residents for Meals (continued)  Allresidents clean and dressed for meals  Hair combed  Oral care provided  Encourage to use bathroom or urinal/bedpan  Cleanse and dry incontinent residents 154
  154. 154. Preparing Residents for Meals  Face and hands washed  Provide for comfort –Raise head of bed –Position in chair –Transport to dining area  Provide clothing protector if appropriate 155
  155. 155. Preparing Residents for Meals (continued)  Check to be certain resident receives right tray and has correct diet  Food should be attractively served and placed within reach  Check tray to see that everything needed is there 156
  156. 156. Preparing Residents for Meals (continued)  Assistresident as needed with: –cutting meat –pouring liquids –buttering bread –opening containers 157
  157. 157. Preparing Residents for Meals (continued)  Blind residents made aware of food placement according to face of clock  Stroke residents approached from non-effected side 158
  158. 158. Preparing Residents for Meals (continued)  Residents should be encouraged to do as much as possible for themselves  Provide time for resident to complete meal  Display pleasant, patient attitude 159
  159. 159. Preparing Residents for Meals (continued)  Remove tray when meal finished  Report unconsumed food to supervisor  Record fluid intake if ordered  Assist to position of comfort 160
  160. 160. Preparing Residents for Meals (continued)  Call signal and supplies positioned within reach  Area should be left clean and tidy  Hands washed before and after care of each resident = because resident might touch the food or their mouth. 161
  161. 161. 162
  162. 162. Discuss the various types of supplementary nourishments. 163
  163. 163. Types of Nourishments  Milk  Juice  Gelatin  Custard, ice cream, sherbet  Crackers  Nutritional supplementation products (e.g., Ensure, etc.) 164
  164. 164. Supplementary Nourishments  Usuallyserved: –Midmorning –Mid-afternoon –Bedtime 165
  165. 165. Supplementary Nourishments (continued)  Ordered by physician  Serve as directed by supervisor  Provide necessary eating utensils, straw and/or napkin 166
  166. 166. 167
  167. 167. Demonstrate the procedure for serving supplementary nourishments. 168
  168. 168. 169
  169. 169. Identify the special fluid orders that the physician could write. 170
  170. 170. Providing Fresh Drinking Water  Fresh water should be provided periodically throughout day  Encourage to drink 6-8 glasses daily if appropriate 171
  171. 171. Providing Fresh Drinking Water (continued)  Noteresidents who have special fluid orders –N.P.O. –Fluid restrictions: Schedule 24-hour intake Remind resident 172
  172. 172. Providing Fresh Drinking Water (continued)  Note residents who have special fluid orders –Force fluids Offer fluids in small quantities Offer fluids (resident preference) without being asked Remind resident of importance of fluids in bodily173
  173. 173. Aging  Can affect the nervous system that controls elimination of body wastes  Like urine and feces ( also known as stool or solid waste)  The urge or need to void, or urinate (pass urine from the body) or defecate ( pass feces from the body)  Decreases with age, 
  174. 174. elimination  Decreased appetite and thirst, coupled with less food and fluid intake as well as slower digestion of foods, contribute to elimination problems.
  175. 175. Factors interfere with normal elimination  Medications that could cause constipation or diarrhea, inactivity, pelvic muscle weakness due to aging, and nervous disorders  Small watery leakage of stool could indicate a fecal impaction, a condition in which hard feces is trapped in the large intestine and rectum and cannot be pushed out by the resident.
  176. 176. Elimination  Diarrhea is when food pass too quickly through the intestine so that water is not reabsorbed adequately.  This causes a watery brown liquid to be expelled.
  177. 177. 178
  178. 178. Discuss methods for assisting with bowel and bladder retraining. 179
  179. 179. Bowel And Bladder Retraining  Incontinence: Inability to control urination or defecation –Embarrassing for resident –Uncomfortable 180
  180. 180. Bowel Retraining  Plan developed to assist to return to normal elimination pattern and recorded on care plan  Information collected: –bowel pattern before incontinence –present bowel pattern –dietary practices 181
  181. 181. Bowel Retraining (continued)  Participants in plan –resident –family –all staff members 182
  182. 182. Guidelines For Bowel Retraining  Enemas may be ordered by physician and given by nurse aide, as directed by supervisor ( (follow facility policy before giving enema)  Regular, specific times to evacuate bowels established  Fluids encouraged on regular basis 183
  183. 183. Guidelines For Bowel Retraining (continued)  High bulk foods given, if not restricted – fruits – bread – vegetables – bran cereals 184
  184. 184. Guidelines For Bowel Retraining (continued)  Bowelaids ordered by physician and administered by licensed nurse only: – laxatives – suppositories stool softeners – •Regular exercise encouraged 185
  185. 185. Guidelines For Bowel Retraining (continued)  Ways nurse aide can assist with defecation process: –offer bedpan on set schedule –assist to bathroom when request is made –provide privacy –display unhurried attitude 186
  186. 186. Guidelines For Bowel Retraining (continued)  Ways nurse aide can assist with defecation process (continued): – offer warm drink – be patient – encourage with positive remarks – do not scold when accidents happen (abuse) – check on resident frequently 187
  187. 187. Bladder Retraining  Plan developed to assist to return to normal voiding pattern and recorded on care plan  Staff must be consistent and follow plan 188
  188. 188. Bladder Retraining  Individualized plan includes: –schedule that specifies time and amount of fluids to be given –schedule for attempting to void 189
  189. 189. Guidelines for Bladder Retraining  Get resident’s cooperation  Record incontinent times  Provide with opportunities to void: –when resident awakens –one hour before meals –every two hours between meals –before going to bed –during night, as needed 190
  190. 190. Guidelines for Bladder Retraining  Get resident’s cooperation  Record incontinent times  Provide with opportunities to void: –when resident awakens –one hour before meals –every two hours between meals –before going to bed –during night, as needed 191
  191. 191. Guidelines for Bladder Retraining (continued)  Provide stimuli as needed: –run water in sink –pour water over perineum –offer fluids to drink –place hands in warm water 192
  192. 192. Guidelines for Bladder Retraining (continued)  Provide good skin care to prevent skin breakdown  Retraining may take 6-10 weeks –be patient –be supportive –ignore accidents –respect resident’s feelings 193
  193. 193. Guidelines for Bladder Retraining (continued)  Followfacility procedure for use of: –incontinent pads –adult protective pants –incontinent briefs 194
  194. 194. Observing/reporting  Black or bloody stool, constipation and diarrhea  Dark concentrated urine, bloody or no urine output  Report to the nurse any abnormality  Never put bed pan or urinal to overhead table
  195. 195. Rest, Sleep and Comfort  Elders need as much sleep as other adults  Ability to sleep might influenced by the long-term care environment, especially when new admitted,  Their activity level, their general state of health, and their individual habits. 
  196. 196. Interfere with sleep  Pain or discomfort  Be careful to accept a resident’s report of pain or discomfort at face value  Report any abnormal reactions (known as adverse drug effects to analgesia can include a sudden drop in blood pressure or respirations, dyspnea (rapid breathing)
  197. 197. reporting  Rash on the body, unresponsive and emotional distress.  Using positioning devices to increase comfort.  Offer emotional support  This signs require immediate intervention, so report them immediately to the nurse.
  198. 198. Self-care and independence  Omnibus Budget and Reconciliation Act ( OBRA) of 1987 requires all long-term facilities to use every resource to help residents to reach or maintain their highest level of physical, psychological, and mental functioning.  The act requires that all residents have a right to have as many choices about their lives their care, and their
  199. 199.  Life style routine possible.  It is not only legal requirement determined by OBRA but as ethical principle as well.
  200. 200. Mobility/Immobility  Being able to move by one’s self, to walk, and to exercise to help maintain muscle function and improve a sense of independence and self-worth.  Moving, ambulating, and exercising help improve blood circulation and proper musculoskeletal functioning.
  201. 201. Immobility  Opposite of being mobile, effects the total well-being of the resident, that is, by exposing the resident to alteration in almost every body system.  In the circulatory system- an increased risk of blood clots (thrombi) and edema in the lower extremities, causing undue stress on the heart.
  202. 202. Immobility  Respiratory complications like pneumonia, other infections of the respiratory tree, or failure to expand the lungs In the digestive system, amorexia or Decreased appetite, and constipation The musculoskeletal system suffers due to loss of calcium in the bones (called osteopenia)
  203. 203. IMMOBILITY  Atrophy, or muscle wasting and contractures (deformities of the limbs due to immobility  Pressure ulcers on the skin  Mentally and emotionally, the immobility resident might feel frustrated, isolated, depressed and helpless
  204. 204. health maintenance and restoration 205
  205. 205. Basic Nursing Skills Introduction This unit introduces the basic nursing skills the nurse aide will need to measure and record the resident’s vital signs, height and weight, and intake and output. The vital signs provide information about changes in normal body function and the resident’s response to treatment. 206
  206. 206. Basic Nursing Skills Introduction (continued) The resident’s weight, compared with the height, gives information about his/her nutritional status and changes in the medical condition. Intake and output records provide information on fluid balance and kidney function. 207
  207. 207. 208
  208. 208. Health maintenance and restoration  Includes measuring vital signs, height, and weight. Vital signs include temperature, pulse, respiration, and blood pressure  Accurate measurement and recording are important skills in determine the overall health of the resident.  Careful attention to vital signs can save life
  209. 209. Provide basic nursing skills. 210
  210. 210. Vital Signs  Reflect the function of three body processes that are essential for life. –Regulation of body temperature –Heart function –Breathing 211
  211. 211. Explain the meaning of vital signs and the abbreviations used for each vital sign. 212
  212. 212. Vital Signs (continued)  Abbreviations: –Temperature – T –Pulse – P –Respirations – R –Blood Pressure – BP –Vital signs - TPR and BP 213
  213. 213. Vital Signs (continued)  Purpose –Measured to detect any changes in normal body function –Used to determine response to treatment 214
  214. 214. 215
  215. 215. Define body temperature and discuss the way it is measured. 216
  216. 216. Temperature – Measurement Of Body Heat  Heat  Heatloss production –respiration –muscles –perspiratio –glands n –oxidation of –excretion food 217
  217. 217. Temperature – Measurement Of Body Heat (continued) Balance between heat production and heat loss is body temperature 218
  218. 218. List the factors that affect temperature. 219
  219. 219. Factors Affecting Temperature  Exercise  Infection  Illness  Emotions  Age  Hydration  Time of  Clothing day  Environment  Medication temperature/ air movement 220
  220. 220. Equipment - Thermometer  Instrumentused to measure body temperature  Types –Non-mercury glass oral rectal 221
  221. 221. Identify the normal temperature range, and the normal body temperature. 222
  222. 222. Normal Temperature Range For Adults  Oral- 97.6 - 99.6 F (Fahrenheit) or 36.5 -37.5 C (Celsius)  Rectal - 98.6 - 100.6 F or 37.0 - 38.1 C  Axillary - 96.6 - 98.6 F or 36.0 - 37.0 C 223
  223. 223. Read a non-mercury glass thermometer. 224
  224. 224. To Read A Non-mercury Glass Thermometer  Hold eye level  Locate solid column of liquid in the glass  Observe lines on scale at upper side of column of liquid in the glass 225
  225. 225. To Read A Non-mercury Glass Thermometer (continued)  Read at point where liquid ends  If liquid falls between two lines, read it to closest line –long line represents degree –short line represents 0.2 of a degree Fahrenheit 226
  226. 226. List and discuss the sites used to take a temperature. 227
  227. 227. Sites To Take A Temperature  Oral – most common  Rectal – registers one degree Fahrenheit higher than oral  Axillary – least accurate; registers one degree Fahrenheit lower than oral  Tympanic – probe inserted into the ear canal 228
  228. 228. Review safety precautions that should be considered when using a thermometer. 229
  229. 229. Temperature: Safety Precautions  Hold rectal and axillary thermometers in place  Stay with resident when taking temperature  Check glass thermometers for chips  Prior to use, shake liquid in glass down  Shake thermometer away from resident and hard objects 230
  230. 230. Temperature: Safety Precautions (continued)  Wipe from end to tip of thermometer prior to reading  Delay taking oral temperature for 10 - 15 minutes if resident has been smoking, eating or drinking hot/cold liquids. 231
  231. 231. 232
  232. 232. Define pulse and discuss the way it is measured. 233
  233. 233. Measurement of Pulse  Pulseis pressure of blood pushing against wall of artery as heart beats and rests  Pulseeasier to locate in arteries close to skin that can be pressed against bone 234
  234. 234. Sites For Taking Pulse  Radial – base of thumb  Temporal – side of forehead  Carotid – side of neck  Brachial – inner aspect of elbow  Femoral – inner aspect of upper thigh 235
  235. 235. Sites For Taking Pulse (continued)  Popliteal - behind knee  Dorsalis pedis – top of foot  Apical pulse – over apex of heart –taken with stethoscope –left side of chest 236
  236. 236. List the factors that affect the pulse. 237
  237. 237. Factors Affecting Pulse  Age  Sex  Position  Drugs  Illness  Emotions  Activity level  Temperature  Physical training 238
  238. 238. Identify the normal pulse range and characteristics. 239
  239. 239. Measurement of Pulse  Normal pulse range/characteristics: 60 -100 beats per minute and regular  Documenting pulse rate –Noted as number of beats per minute –Rhythm - regular or irregular –Volume - strong, weak, thready, bounding 240
  240. 240. 241
  241. 241. Define respiration and discuss how the respiratory rate is measured. 242
  242. 242. Measuring Respirations  Respiration– process of taking in oxygen and expelling carbon dioxide from lungs and respiratory tract 243
  243. 243. List the factors that affect the respiratory rate. 244
  244. 244. Measuring Respirations (continued) Factors Affecting Rate  Age • Sex  Activity • Illness level • Emotions  Position •  Drugs Temperature 245
  245. 245. Identify the qualities of normal respirations. 246
  246. 246. Measuring Respirations (continued)  Qualitiesof normal respirations –12-20 respirations per minute –Quiet –Effortless –Regular 247
  247. 247. Measuring Respirations (continued)  Documenting respiratory rate –Noted as number of inhalations and exhalations per minute (one inhalation and one exhalation equals one respiration) –Rhythm – regular or irregular –Character: shallow, deep, labored 248
  248. 248. 249
  249. 249. Define blood pressure and discuss how it is measured. 250
  250. 250. 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 251
  251. 251. 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 252
  252. 252. List factors that influence blood pressure. 253
  253. 253. Factors Influencing Blood Pressure  Weight  Sleep  Age  Emotions  Sex  Heredity  Viscosity of blood  Illness/Disease 254
  254. 254. Blood Pressure: Equipment  Sphygmomanometer (manual) –cuff - different sizes –pressure control bulb –pressure gauge – marked with numbers aneroid mercury 255
  255. 255. Blood Pressure: Equipment (continued)  Stethoscope –magnifies sound –has diaphragm 256
  256. 256. Identify the normal blood pressure range. 257
  257. 257. Measuring Blood Pressure  Normalblood pressure range –Systolic: 90-140 millimeters of mercury –Diastolic: 60-90 millimeters of mercury 258
  258. 258. Guidelines for Blood Pressure Measurements  Measure on upper arm  Have correct size cuff  Identify brachial artery for correct placement of stethoscope 259
  259. 259. Guidelines for Blood Pressure Measurements (continued)  Firstsound heard – systolic pressure  Last sound heard or change - diastolic pressure 260
  260. 260. Guidelines for Blood Pressure Measurements (continued)  Record - systolic/diastolic  Resident in relaxed position, sitting or lying down  Blood pressure usually taken in left arm 261
  261. 261. Guidelines for Blood Pressure Measurements (continued)  Donot measure blood pressure in arm with IV, A-V shunt (dialysis), cast, wound, or sore 262
  262. 262. Guidelines for Blood Pressure Measurements (continued)  Apply cuff to bare upper arm, not over clothing  Room quiet so blood pressure can be heard  Sphygmomanomet er must be clearly visible 263
  263. 263. Blood Pressure: Reading Gauge (continued)  Gauge should be at eye level 300 290 280 270 260 250 240 230 220  Mercury column 210 200 190 180 170 160 150 140 gauge must not be 130 120 110 100 90 80 70 60 tilted 50 40 30 20 10  Reading taken from top of column of mercury 264
  264. 264. 265
  265. 265. Discuss height and weight and how it is measured. 266
  266. 266. Measuring Height And Weight  Baseline measurement obtained on admission and must be accurate.  Other measurements obtained as ordered. 267
  267. 267. Measuring Height And Weight (continued)  Height measurements –Feet –Inches –Centimeters  Weight measurements –Pounds –Ounces –Kilograms 268
  268. 268. Measuring Height and Weight (continued)  Reasons for obtaining height and weight –Indicator of nutritional status –Indicator of change in medical condition –Used by doctor to order medications 269
  269. 269. List three guidelines for weighing residents. 270
  270. 270. Measuring Height and Weight (continued)  Guidelinesfor weighing residents –Use same scale each time –Have resident void, remove shoes and outer clothing –Weigh at same time each day 271
  271. 271. Measuring Height and Weight (continued)  Scales –Remain more accurate if moved as little as possible. –Various types of scales bathroom scale standing scale scales attached to hydraulic lifts wheelchair scales bed scales 272
  272. 272. 273
  273. 273. Discuss measuring and recording intake and output, and conditions for which this procedure would be ordered. 274
  274. 274. Measuring Intake and Output Fluid Balance  Consume 2-  Eliminate 2- 1/2 to 3-1/2 1/2 to 3-1/2 quarts daily quarts daily –urine –eating –perspiration –drinking –water vapor through respirations –stool 275
  275. 275. Identify five symptoms of edema. 276
  276. 276. Edema  Edema – fluid intake exceeds fluid output –Retention of fluids frequently caused by kidney or heart failure or excessive salt intake 277
  277. 277. Edema (continued)  Symptoms –weight gain –swelling of feet, ankles, hands, fingers, face –decreased urine output –shortness of breath –collection of fluid in abdomen (ascites) 278
  278. 278. List eight symptoms of dehydration. 279
  279. 279. Dehydration  Dehydration: fluid output exceeds fluid intake  Common problem of long-term care residents 280
  280. 280. Dehydration (continued)  Symptoms –thirst –decreased urine output –parched or cracked lips –dry, cracked skin –fever –weight loss –concentrated urine –tongue coated and thick 281
  281. 281. Dehydration (continued)  Causesof dehydration –poor fluid intake –diarrhea –bleeding –vomiting –excessive perspiration 282
  282. 282. Dehydration (continued)  Fluids measured in cubic centimeters (cc) –30 cc = 1 ounce –cc - metric measure 283
  283. 283. Identify the liquids that would be measured and recorded as fluid intake. 284
  284. 284. Measuring and Recording Intake/Output  Physician orders intake and output  Intake includes: –All liquid taken by mouth –Food items that turn to liquid at room temperature –Tube feedings into stomach through nose or abdomen –Fluids given by intravenous 285
  285. 285. List the liquids that would be measured and recorded as fluid output. 286
  286. 286. Measuring and Recording Intake/Output (continued)  Output includes –Urine –Liquid stool –Emesis –Drainage –Suctioned secretions –Excessive perspiration 287
  287. 287. Demonstrate skills which incorporate principles of restorative care under the direction of the supervisor. 288
  288. 288. 289
  289. 289. Rehabilitation/Restoration  Definition- process of restoring disabled individual to highest level of physical, psychological, social and economic functioning possible 290
  290. 290. Rehabilitation/Restoration (continued)  Emphasis on existing abilities  Encourages independence  Promotes productive lifestyle 291
  291. 291. Rehabilitation/Restoration (continued)  Goals include: –Prevention of complications –Retraining in lost skills –Learning new skills 292
  292. 292. Identify the nurse aide’s role in rehabilitation/restoration. 293
  293. 293. Rehabilitation/Restoration (continued)  NurseAide’s Role –Encourage resident –Praise accomplishments –Review skills taught –Report progress or need for additional teaching 294
  294. 294. Rehabilitation/Restoration (continued)  Nurse Aides Role (continued) –Promote independence praise all attempts at independence overlook failures show confidence in resident’s ability 295
  295. 295. Rehabilitation/Restoration (continued)  Nurse Aides Role (continued) –Promote independence (continued) be patient and allow time for residents to do things for themselves –Be sensitive and understanding 296
  296. 296. 297
  297. 297. Provide training in and the opportunity for self-care according to the resident’s capabilities. 298
  298. 298. Self-Care According To Resident’s Capabilities  Training in self-care requires that three questions be answered prior to starting: 1. What is the goal to be achieved? 2. What approaches are used to help the resident achieve the goal? 3. How will progress or lack of progress be measured? 299
  299. 299. self-Care According To Resident’s Capabilities  Residentincluded in goal-setting process, whenever possible
  300. 300. Self-Care According To Resident’s Capabilities (continued  Functional losses cause: – Resentment – Anger – Frustration – Withdrawal – Depression – Grief
  301. 301. Guidelines To Assist With Restorative Care And Training  Assist resident to do as much as possible for himself/herself  Be realistic  Never offer false hope  Explain what is going to be done  Begin tasks at resident’s level of functioning 302
  302. 302. Guidelines To Assist With Restorative Care And Training (continued)  Provide encouragement and reinforcement  Praise successes  Emphasize abilities  Treat resident with respect  Explain what resident needs to accomplish, and how you will help. 303
  303. 303. Guidelines To Assist With Restorative Care And Training (continued)  Accept residents and encourage them to express their feelings  Help to put new skills into use immediately  Assist the resident to recognize his or her progress 304
  304. 304. Self-Care According To Resident’s Capabilities  Treatment initiated by: –Physical therapist –Occupational therapist –Speech therapist –Licensed nurse 305
  305. 305. Self-Care According To Resident’s Capabilities (continued)  ADL considerations for resident: –Resident to control how and when activities carried out, when possible –Use tact in making resident aware of hygiene needs 306
  306. 306. Self-Care According To Resident’s Capabilities (continued)  ADL considerations for resident (continued): –Encourage use and selection of clothing –Be patient and allow time for slower paced activities 307
  307. 307. Self-Care According To Resident’s Capabilities (continued)  ADL considerations for resident (continued): –Provide for rest periods –Assist to exercise –Promote independence by having do as much of activity, as possible –Encourage use of adaptive devices 308
  308. 308. New admission  Findout from the nurse before get a resident out bed to chair or ambulate and exercising. Even giving anything to eat or drink find out from the nurse
  309. 309. Psychological Effects of Aging 310
  310. 310. Psychological Effects Of Aging This unit deals with the feelings, emotional stress and psychological adjustments that are part of the aging process. It explores the physical and psychosocial needs of residents, and teaches the skills that the nurse aide will need to develop to provide understanding and compassionate care. 311
  311. 311. Psychological Effects Of Aging (continued) Other topics covered include: age appropriate behavior, sexuality, reality orientation, dementia, Alzheimer’s disease, confusion and developmental disabilities. 312
  312. 312. Culture needs  Be aware of unique needs, desires, meaning in life based on their cultural practices.  Look on page 56 table 4.1
  313. 313. 314
  314. 314. Discuss ways to meet the resident’s basic human needs for life and mental well-being. 315
  315. 315. Physical Needs For Survival And Care To Be Given  Oxygen –elevate head of bed –assist to sit up in chair –report to supervisor if resident is cyanotic or short of breath –assist with 316
  316. 316. Physical Needs For Survival And Care To Be Given (continued)  Food –Feed residents unable to feed themselves 317
  317. 317. Physical Needs For Survival And Care To Be Given (continued)  Food –Serve food with proper temperature in friendly manner in pleasant environment in appropriate amounts –Make sure dentures are in place 318
  318. 318. Physical Needs For Survival And Care To Be Given (continued)  Water –make available within resident’s reach –provide fresh water at periodic intervals 319
  319. 319. Physical Needs For Survival And Care To Be Given (continued)  Shelter –provide for warmth with extra blankets –be sure residents are dressed properly –avoid drafts or drafty areas 320
  320. 320. Physical Needs For Survival And Care To Be Given (continued)  Sleep –Minimize noise and lights during hours of sleep –Give back rub to relax resident 321
  321. 321. Physical Needs For Survival And Care To Be Given  Sleep(continued) –Report complaints of pain to supervisor –Listen to concerns or worries the resident may wish to express –Leave night light on in the resident’s room, if requested
  322. 322. Physical Needs For Survival And Care To Be Given (continued)  Elimination –Assist to bathroom as needed –Provide bedpan and/or urinal –Provide for privacy 323
  323. 323. Physical Needs For Survival And Care To Be Given (continued)  Elimination (continued) –Change soiled linen immediately –Following routine for bowel and bladder retraining as directed 324
  324. 324. Physical Needs For Survival And Care To Be Given (continued)  Activity –ROM exercises as directed –Turn and reposition at least every two hours 325
  325. 325. Safety And Security Needs  Provide for warmth  Establish familiar surroundings –explain procedures –talk about “their” room –keep your promises –provide a safe environment –promote use of personal belongings 326
  326. 326. Spiritual Needs  Residents have the right to worship and express their faith freely. 327
  327. 327. Spiritual Needs (continued)  Guidelines for the nurse aide: –respect resident’s beliefs –respect resident’s religious objects –inform residents of the time and place for religious services 328
  328. 328. 329
  329. 329. Recognize how age, illness and disability affect sexuality. 330
  330. 330. Sexuality  Expressed by individuals of all ages  A way to show feminine or masculine qualities –Clothing styles and colors –Hairstyles –Hobbies and interests –Sexual habits (continue into old age) –Gestures 331
  331. 331. Sexuality (continued)  May be expressed by: –Sexual intercourse –Caressing, touching, holding hands –Masturbation  Is a right of all residents to 332
  332. 332. Guidelines For The Nurse Aide In Dealing With Resident Sexuality  Assist to maintain sexual identity by dressing residents in clothing appropriate for men or women  Assist with personal hygiene 333
  333. 333. Guidelines For The Nurse Aide In Dealing With Resident Sexuality (continued)  Assistto prepare for special activities by “dressing up” –selecting attractive clothing –fixing hair in a special way –applying cosmetics 334
  334. 334. Guidelines For The Nurse Aide In Dealing With Resident Sexuality (continued)  Help to develop a positive self- image  Show acceptance and understanding for resident’s expression of love or sexuality –provide privacy –always knock prior to entering a room at any time –assure privacy when 335
  335. 335. Guidelines For The Nurse Aide In Dealing With Resident Sexuality (continued)  Never expose the resident  Accept the resident’s sexual relationships 336
  336. 336. Guidelines For The Nurse Aide In Dealing With Resident Sexuality (continued)  Provide protection for the non- consenting resident  Be firm but gentle in your rejection of a resident’s sexual advances 337
  337. 337. Possible Effects Of Injury Or Illness On Sexuality  Disfiguringsurgery may cause a person to feel: –unattractive and ugly to others –mutilated and deformed –unworthy of love or affection 338
  338. 338. Possible Effects Of Injury Or Illness On Sexuality (continued)  Chronicillness and certain medications can affect sexual functioning 339
  339. 339. Possible Effects Of Injury Or Illness On Sexuality (continued)  Disorders that cause impotence –diabetes mellitus –spinal cord injuries –multiple sclerosis –alcoholism 340
  340. 340. Possible Effects Of Injury Or Illness On Sexuality (continued)  Surgerycan have both physical and/or psychological effects –removal of prostate or testes –amputation of a limb –removal of uterus –removal of ovaries –removal of a breast –colostomy –ileostomy 341
  341. 341. Possible Effects Of Injury Or Illness On Sexuality (continued)  Disorders affecting the ability to have sex: – stroke – nervous system disorders – heart disease 342
  342. 342. Possible Effects Of Injury Or Illness On Sexuality (continued)  Disorders affecting the ability to have sex: –chronic obstructive pulmonary disease –circulatory disorders –arthritis or conditions affecting mobility/ flexibility 343
  343. 343. Reporting collection and reporting  Reportingany abnormalities to the nurse read page 61 for more info.
  344. 344. 345

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