CNA Chapter Five

Chap 5

Specialized care

• Specialized functions–Eye

•sense of sight•receives images and sends to brain

Discuss common disorders of the sensory organs

Common Disorders Of The Sensory Organs

• Cataract - lens of eye loses its transparency

• Glaucoma - increased pressure in the eye due to an excess of aqueous humor

• Conjunctivitis - inflammation of the eyelid lining

• Sty - tiny abscess at the base of an eyelash

Discuss changes in the sensory organs due to aging.

Changes In Sensory Organs Due to Aging

• Lens in eye becomes thick and cloudy• Sclera becomes more yellow• Less light reaches inner eye• Hearing structures of ear become less

moveable• Soft wax production decreases

Vision ImpairmentResident 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

• 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

Disorders of the Eye

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• 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)

• 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.

Sensory Organs

Earsense of hearing

transmits sounds to brain

Common Disorders Of The Sensory Organs

(continued)Otitis media - infection of the middle

earDeafness - 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 canalComplaint 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

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.

Identify the function and structure of the respiratory system.

The Respiratory System

• Respiration means to breathe in oxygen and breathe out carbon dioxide

• Exchange of oxygen and carbon dioxide necessary for life

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

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

The Respiratory SystemStructure(continued)

• Nose - lined with mucous membrane–air filtered by cilia–mucous membrane warms

and moistens air

• Lungs–right - 3 lobes– left - 2 lobes

• Pleura – membrane that encloses lungs• Diaphragm - muscle that separates the

chest and abdomen–contraction - draws air into lungs–relaxation - forces air out of lungs

Review common disorders of the respiratory system.

Common Disorders of Respiratory System

• URI – Upper Respiratory Infection - infection of nose, throat, larynx, trachea

• Pneumonia - inflammation or infection of the lungs

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

• 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

• Bronchitis - inflammation of the bronchi• Lung cancer - malignant tumors in the

lungs that destroy tissue

Discuss changes in the respiratory system due to aging.

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

List observations relating to the respiratory system.

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

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• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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

• 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.

• 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.

• 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.

• 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.

• 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

Heart Disorders

Identify functions of the circulatory system.

Circulatory System

• Circulation is continuous movement of blood throughout body

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

• Adult has 5 to 6 quarts (liters)• Consists of

–water - 90% (plasma)–blood cells–carbon dioxide and oxygen–nutrients, hormones and

enzymes–waste products

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

Blood Vessels

• Arteries - carry blood away from heart• Veins – carry blood to heart

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

Heart Chambers

• Heart divided into right and left side

• Atria – upper chambers – receive blood

• Ventricles – lower chambers – pump blood to lungs and body

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

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)

Heart Valves

• Located at entrance and exit of each ventricle

• Four heart valves

Heartbeat

• 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

Discuss common disorders of the circulatory system.

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

(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

(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

Discuss changes that occur in the circulatory system with aging.

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

List observations relating to the circulatory system.

Observations of the Circulatory System

• Changes in pulse rate and blood pressure

• Changes in skin color• Changes in skin temperature

– coldness

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

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.

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

List factors that influence blood pressure.

Factors Influencing Blood Pressure

• Weight• Sleep• Age• Emotions• Sex• Heredity• Viscosity of blood• Illness/Disease

Blood Pressure: Equipment

• Sphygmomanometer (manual)–cuff - different sizes–pressure control bulb–pressure gauge – marked with

numbers• aneroid• mercury

Blood Pressure: Equipment(continued)

• Stethoscope–magnifies sound–has diaphragm

Measuring Blood Pressure

• Normal blood pressure range–Systolic: 90-140 millimeters of

mercury–Diastolic: 60-90 millimeters of

mercury

Guidelines for Blood Pressure Measurements

• Measure on upper arm

• Have correct size cuff • Identify brachial

artery for correct placement of stethoscope

(continued)

• First sound heard – systolic pressure

• Last sound heard or change - diastolic pressure

(continued)

• Record - systolic/diastolic• Resident in relaxed position,

sitting or lying down• Blood pressure usually taken

in left arm

(continued)

• Do not measure blood pressure in arm with IV, A-V shunt (dialysis), cast, wound, or sore

(continued)

• Apply cuff to bare upper arm, not over clothing

• Room quiet so blood pressure can be heard

• Sphygmomanometer must be clearly visible

Blood Pressure: Reading Gauge

• Large lines are at increments of 10 mmHg

• Shorter lines at 2 mm intervals

• Take reading at closest line

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 lastUnaffected arm= remove gown first from

unaffected arm firstDress 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).

• 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.

• 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.

• 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.

Provide oral care at least every two hours or more, raise the head of the bed at least 35 degrees, and report any abnormal

• 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.

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

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

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 Mellitus

• Hypoglycemia– low blood sugar

• Hyperglycemia– high blood sugar

Diabetes

• Is a disease of the endocrine system, is listed separately because it effects metabolism, impacts every system of the body, and is becoming an epidemic among Americans.

• Diabetes mellitus is a disease of the pancreas in which the body cannot use carbohydrates (sugars and starches) efficiently.

• The pancreas cannot produce enough insulin or does not use insulin properly to change carbohydrates to energy.

diabetes

• When this occurs, the body burns fats for energy instead, leading to a dangerous imbalance in ketones, the product of fat breakdown.

• The exact cause of diabetes is unknown but several factors such as age, obesity, and family history can contribute to developing diabetes.

• Residents with type 1 diabetes must take insulin to live; those with type 2 diabetes can control their disease with diet and medication.

• 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

• 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

Diabetes Mellitus (Cont’d)

• 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

Complications of Diabetes

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: 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

HIV Infection

• Having unprotected sex• Sharing needles• Receiving tissue transplants • Receiving transfusions of blood or blood products • Having an HIV-positive mother

Risk Factors

• 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

• Medication side effects: – Headache, dizziness, nausea, diarrhea, fever, skin

rash, severe anemia, and extreme fatigue

AIDS (Cont’d)

Attitudes Toward People With 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

Attitudes Toward 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!

Rights of People With HIV/AIDS

Caring for a Person With HIV/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

Caring for a Person With AIDS

• 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

– 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 Physical Needs (Cont’d)

• 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

– A person may have many fears about pain, his or her declining health, or death

– Clinical depression and suicide are common

Meeting the Emotional Needs (Cont’d)

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

Discuss disorders that cause confusion for residents.

Confusion

• Symptom or side effect of many disorders

• Disorders causing confusion–Stroke–Arteriosclerosis–Dementia–Alzheimer’s Disease–Huntington’s Chorea

Confusion(continued)

• Other Causes–Drug reactions–Depression–Environmental changes–Vision and/or hearing loss–Dehydration–Poor nutrition–Decreased oxygen levels in blood–Head injury

Confusion(continued)

• Condition can be permanent or temporary

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

(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

– Encouraging residents to wear glasses or hearing aides

– Communicating with touch and clear and simple comments and questions

– Encouraging use of radio, television, newspapers, and magazines

– Maintaining resident’s routine

– Giving only one direction at a time

– Keeping the environment calm and relaxed

– Providing clocks, calendars and bulletin boards to remind residents of time and activities

– Discussing current topics

– Reminiscing – Showing resident self-

image in mirror– Providing recreational

activities which reinforce reality orientation

(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.

Ways To Assist Combative Residents

• Display a calm manner• Avoid touching the

resident• Provide privacy for out-

of-control residents• Secure help if necessary

Ways To Assist Combative Residents(continued)

• Do not ignore threats• Protect yourself from

harm• Listen to verbal

aggression without argument

Identify the symptoms displayed by residents with dementia.

Dementia (Group Of Symptoms)

• Defined as a progressive loss of mental functioning

Dementia (Group Of Symptoms)(continued)

• Two categories of dementia–1st Category: Primary

• No known cause• Irreversible• May be treated but not completely

• Two categories of dementia–1st Category: Primary

• Examples of diseases causing dementia–Alzheimer’s disease–Parkinson’s disease–Huntington’s Chorea (genetic)

•Two categories of dementia–2nd Category: Secondary

• Usually has known cause• Treatable• Reversible to some degree

•Two categories of dementia–2nd Category: Secondary

• Examples of secondary causes of dementia

– depression– minor stroke– thyroid dysfunction– medication induced

Symptoms Of Dementia• Confusion• Inability to reason accurately• Recent memory loss• Detailed long-term memory• Repetitious speech• Self-centered behavior• Agitation• Disorientation• Confabulation

Review the psychosocial characteristics and care needs of a person with Alzheimer’s disease.

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

Alzheimer’s Disease(continued)

• Affects more women than men• Always ends in death 3-15 years after

symptoms begin

Alzheimer’s Disease: Signs And Symptoms

• Irreversible loss of memory• Speech and writing difficulties• Disorientation• Difficulty walking

– loss of balance–short steps–spatial disorientation

(continued)• Deterioration of mental functions

–Unable to make decisions–Loss of ability to make judgments–Changes in behavior

• restless• angry• depressed• irritable

(continued)

• Possible seizures• Coma and death

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

(continued)

• Maintain calm, consistent environment

• Complete ADL at the same time each day

• Use reality orientation

(continued)• Same caregivers assigned

to resident• Involve in simple, limited

activities• Follow routines• Treat with patience and

compassion

(continued)

• Support family• Communicate with

simple phrases• Don’t pose questions

or ask to make choices

Identify symptoms of depression and define the nurse aide’s role in caring for a depressed resident.

Depression

• Reasons for depression–Loss of independence–Death of spouse or friend–Loss of job or home–Decreased memory–Terminal illness

Common Signs And Symptoms Of Depression

• Change in sleep pattern• Loss of appetite and

weight loss• Crying, withdrawal from

activities, appearing sad

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.

Terminally Ill ResidentCaring For Resident When Death Is Imminent and Following Death

Caring for Resident When Death Is Imminent and Following Death

IntroductionDeath 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.

Explore personal feelings concerning the concept of death.

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

(continued)

• Factors influencing attitudes –Religion

• Belief in life after death • Reunion with loved ones • Reincarnation • Punishment for sins • No afterlife

(continued)

• Factors influencing attitudes –Age

• Children view death as temporary

(continued)• Factors influencing attitudes

–Age • Adults may develop fears of:

–pain and suffering–dying alone–separation from loved ones

• Elderly generally have fewer fears

Identify the special needs of a dying resident.

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

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

Identify eight comfort measures that may be used with the dying resident.

• Comfort Measures–Attention to skin care–Good personal hygiene–Oral hygiene - denture care–Bedding changed as

needed–Back massages

• Comfort Measures–Frequent position changes

• every two hours• P.R.N.

–Good body alignment• supportive devices• prevention of deformities and

pressure ulcers

• Comfort Measures–Head of bed elevated to facilitate

breathing• Modified diet

Describe the nurse aide’s role in relationship to the to the needs of the dying.

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.

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

Review the various reactions residents may have as they face death.

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

List and describe the five stages of grief, death and dying.

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

• DENIAL (continued)–Resident may avoid

discussion of death–Feeling of, “This can’t be

happening to me.”

• ANGER–Bitterness and turmoil–Sense of unfairness–Blame of others such as

health care workers–Feeling of, “Why me?”

• BARGAINING–Turn to religious and

spiritual beliefs–Promises to God and

others–Comfort and hope when

all seems lost

• BARGAINING (continued)–Generally know this

won’t work–Frustration and anger

dissolve into depression–“If only...I will”

• DEPRESSION–Belief that hope is lost–Overwhelming despair–Introverted and withdrawn–Reminiscing and reviewing life–Sleeplessness–“I always wanted to”

• 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.”

Recognize the signs of approaching death.

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

• 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

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)

• Changes in circulation and muscle tone (continued)–Muscle tone

• body limp• jaw may drop• mouth may stay partly open

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)

• Changes in Vital Signs (continued)–Pulse

• rapid• weak and irregular

–Blood pressure drops–Temperature

• elevated• subnormal

Define the role of the nurse aide i the spiritual preparation for death.

Contrast the spiritual preparation for death practiced by those of various religions.

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

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

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

Identify the needs of the family as they encounter the dying process.

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

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

Discuss the hospice philosophy.

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

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.

Hospice Care(continued)

• Provides counseling for individual and family:–Emotional–Psychological–Spiritual–Financial–Bereavement

• Family included in all aspects of care as desired

Discuss the meaning of postmortem care.

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

List five reasons for doing postmortem care.

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

Demonstrate the procedure for postmortem care.

(for chapter please read the clinical skills performance checklists page 91-122)

CNA Chapter Five

Health & Medicine

Transcript of CNA Chapter Five

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