Define the following terms:

Define the following terms:
Homeostasis the condition in which all of the body’s systems are working their best. Metabolism physical and chemical processes by which substances are produced or broken down into energy or products for use by the body. Dilate to widen. Constrict to narrow.

Transparency 4-1: The Integumentary System

1. Describe the integumentary system
Remember the following points about the integumentary system: Largest organ and system Natural protective covering Prevents excessive loss of water and injury to internal organs Skin made of tissue and glands Skin is a sense organ Regulates body temperature (Dilates if hot, which allows more blood to surface for sweat/evaporation. Constricts if cold to keep in body heat.)

Normal changes of aging include the following: Skin gets thinner and more fragile. Skin is drier and less elastic. Protective fatty tissue gets thinner and person may feel colder. Hair thins and turns gray. Wrinkles and brown spots appear. Fingernails and toenails thicken and become more brittle. Reduced circulation can cause skin dryness, itching, and irritation.

Think about this question: How can you help residents with the normal changes of aging to the integumentary system?

Observe and report the following regarding the integumentary system: Pale, white, reddened, or purple areas, blisters or bruises Dry or flaking skin Rashes or discoloration Cuts, boils, sores, wounds, abrasions Fluid or blood draining from skin Changes in moisture level Swelling

Observe and report, integumentary system (cont’d.): Blisters Changes in wound or ulcer Redness or broken skin between toes or around toenails Scalp or hair changes Skin that appears different from normal In ebony complexions, also look for change in the feel of the tissue (e.g. “orange peel” look)

Common disorders of this system include the following: Pressure sores (also called decubitus ulcers) occur where blood has poor circulation and bone is close to skin. Skin receives less oxygen and nutrients, cells die, and tissue breaks down. More information on pressure sores is found in chapter 6.

Atrophy the wasting away, decreasing in size, and weakening of muscles from lack of use. Contractures the permanent and often painful stiffening of a joint and muscle.

Transparency 4-2: The musculoskeletal system and related conditions

2. Describe the musculoskeletal system and related conditions
Remember the following points about the musculoskeletal system: Human body has 206 bones. Two bones meet at a joint (for movement). Joints make movement possible either in all directions or in one direction only. Muscles provide movement and produce body heat. Physical activity/exercise increases circulation, increasing blood flow to organs and tissues. Inactivity can cause depression, pneumonia, constipation, UTIs, loss of self- esteem, and blood clots. Muscles develop atrophy or contractures from inactivity. ROM exercises help prevent atrophy or contractures.

Normal changes of aging to the musculoskeletal system include the following: Muscles weaken and lose tone. Body movement slows. Bones lose density and become more brittle. Joints can stiffen/become painful. Height is gradually lost.

Think about this question: How can you help residents with the normal changes of aging to the musculoskeletal system?

Observe and report the following regarding the musculoskeletal system: Changes in movement and activity Changes in ability to do ROMs Pain during movement New or increased swelling of joints White, shiny, red, or warm joints Bruising Aches and pains reported by resident

Common disorders of this system include the following: Arthritis Osteoporosis Fractures Hip replacement Knee replacement

Inflammation swelling. Autoimmune illness an illness in which the body’s immune system attacks normal tissue in the body. Osteoarthritis a type of arthritis that usually affects hips and knees and joints of the fingers, thumbs, and spine. Rheumatoid arthritis a type of arthritis in which joints become red, swollen, and very painful, and movement is restricted.

Remember these facts about arthritis: Arthritis is inflammation of the joints causing stiffness and pain, and decreased mobility. Arthritis may be caused by aging, injury, or autoimmune illness. Two types are osteoarthritis and rheumatoid arthritis. Pain and stiffness increase in cold or damp weather.

Arthritis may be treated in these ways: Anti-inflammatory medications (aspirin or ibuprofen) Local applications of heat ROMs Exercise Diet

Transparency 4-3: Care Guidelines for Arthritis
Watch for stomach irritation or heartburn. Encourage activity. Adapt ADLs to allow independence. Choose clothing that is easy to put on and fasten. Use special utensils if needed. Treat each resident as an individual. Help self-esteem by encouraging self-care.

Osteoporosis a condition in which the bones become brittle and weak; may be due to age, lack of hormones, not enough calcium in bones, alcohol, or lack of exercise. Menopause the stopping of menstrual periods.

Remember these facts about osteoporosis: Causes bones to become brittle May be due to age, lack of hormones, lack of calcium, alcohol consumption, or lack of exercise Occurs more commonly in women after menopause

Remember these signs and symptoms of osteoporosis: Low back pain Loss of height Stooped posture

The following can be done to prevent or slow osteoporosis: Encourage residents to walk and do other light exercise as ordered. Move residents with osteoporosis very carefully. Follow care plan regarding medication, calcium, and fluoride supplements, which might be used to treat osteoporosis.

Partial weight bearing (PWB) able to support some weight on one or both legs. Non-weight bearing (NWB) unable to support any weight on one or both legs Full weight bearing (FWB) able to bear 100 percent of the body weight on one or both legs on a step.

REMEMBER: Fall prevention is the key to avoiding fractures.

Follow these guidelines when caring for a new cast: Do not cover until dry. Do not place on hard surface. Elevate extremity in cast. Observe for skin discoloration, tightness, swelling, sores, skin temperature, burning, numbness or tingling, drainage, bleeding, or odor. Protect residentís skin from edges of cast. Keep cast dry. Do not insert anything into cast. Tell the nurse if pain medication is needed. Use bed cradles as needed.

Remember these facts about hip fractures: Cause may be a fall or weakened bones Elderly bones heal slowly The following are common reasons for hip replacements: Fracture does not heal properly Weakened hip due to aging Painful and disabled hip

Transparency 4-4: Care Guidelines for Hip Replacement
Keep often-used items within reach. Dress affected side first. Never rush the resident. Use praise and encouragement. Ask for pain medication if needed. Have the resident sit to do tasks. Follow the care plan. Do not perform ROM exercises on a leg on hip replacement side. Hip cannot be at less than 90 degree angle. It cannot be turned inward or outward. Transfer resident carefully, with stron side leading in standing, pivoting and sitting. With chair or toilet transfers, operative leg/knee should be straightened. Strong leg should stand first.

Observe and report the following about hip replacement: Red, draining, bleeding, or warm incision Increase in pain Numbness or tingling Abnormal vital signs Inability to use equipment properly and safely Resident not following doctor’s orders for activity and exercise Problems with appetite Increasing strength and improving ability to walk

The following are common reasons for knee replacement: Relieve severe pain Restore motion to damaged knee Help stabilize a knee that buckles or gives out

REMEMBER: Recovery time for knee replacement is generally shorter than for a hip replacement.

Transparency 4-5: Care Guidelines for Knee Replacement
Apply special stockings as ordered. Perform ankle pumps as ordered. Encourage fluids. Assist with deep breathing exercises. Ask for pain medication if needed. Report to nurse if you notice redness, swelling, heat or deep tenderness in one or both calves.

Transparency 4-6: The Nervous System

3. Describe the nervous system and related conditions
Remember the following points about the nervous system: Control and message center of body Controls and coordinates all body functions Interprets information from outside the body Two main parts: central nervous system (brain) and peripheral nervous system

Normal changes of aging to the nervous system include the following: Slower responses and reflexes Decrease in sensitivity of nerve endings in skin Some memory loss, more often with short-term memory

Think about this question: How can you help residents with the normal changes of aging to the nervous system?

Observe and report the following regarding the nervous system: Fatigue or pain with movement Shaking or trembling Inability to speak clearly Inability to move one side of body Disturbance in vision or hearing Changes in eating or fluid intake

Observe and report the following (cont’d.): Difficulty swallowing Bowel or bladder changes Depression or mood changes Memory loss or confusion Violent behavior Unusual change in behavior Decreased ability to perform ADLs

Common disorders of this system include the following: Dementia (covered in detail in Chapter 5) Alzheimer’s disease (covered in detail in Chapter5) CVA/Stroke Parkinson’s disease Multiple Sclerosis Head and spinal cord injuries

Hemiplegia paralysis on one side of the body. Hemiparesis weakness on one side of the body. Expressive aphasia inability to speak or speak clearly. Receptive aphasia inability to understand spoken or written words.

Emotional lability laughing or crying without any reason, or when it is inappropriate. Dysphagia difficulty swallowing.

Remember these facts about CVA/Stroke: Caused when blood supply to brain is cut off by a clot or ruptured vessel. Results in lack of oxygen to tissue, causing cells to die. Swelling, leaking blood, and clots affect surrounding healthy brain tissue. Weakness occurs opposite affected side of brain. Mild stroke may result in few, if any, complications.

Transparency 4-7: Care Guidelines for Stroke
Assist with exercises as ordered, keeping safety in mind. Use terms “weaker” or “involved,” not “bad.” Assist with speech therapy as needed. Use verbal and nonverbal communication to express positive attitude. Residents may experience confusion, memory loss, and emotions. Be patient and understanding. Encourage independence and self-esteem. Always check on resident’s body alignment. Pay special attention to skin care. If residents have lost sense of touch or sensation, be aware of potentially harmful situations such as closeness to heat and sharp objects. Adapt procedures when caring for residents with one-sided paralysis or weakness.

Transparency 4-7: Care Guidelines for Stroke (cont’d.)
For transfers: Always use gait belt. Stand on and support weaker side. Lead with stronger side. For assisting with dressing: Dress weaker side first. Undress stronger side first. Use assistive equipment to help resident dress himself.

Transparency 4-7: Care Guidelines for Stroke (cont’d.)
For assisting with communication: Keep questions and directions simple. Phrase questions so they can be answered with a “yes” or “no.” Agree on signals, such as shaking or nodding the head or raising a hand or finger for “yes” or “no.” Give residents time to respond. Listen attentively. Use a pencil and paper if the resident can write. Use verbal and nonverbal communication to express your positive attitude. Use pictures, gestures, or pointing. Use communication boards or special cards to aid communication. Keep the call signal within reach of residents.

Gait manner of walking.

Remember these facts about Parkinson’s disease: Progressive, degenerative disease Causes stiff muscles, stooped posture, shuffling gait, pill-rolling, tremors, and mask-like facial expression Tremors can make ADLs difficult

Transparency 4-8: Care Guidelines for Parkinson’s Disease
Protect residents from falls. Help with ADLs as needed. Assist with ROM exercises as ordered. Encourage self-care and be patient.

Remember these facts about Multiple Sclerosis (MS): MS is a progressive disease affecting the central nervous system. Protective sheath breaks down over time and nerves cannot send messages properly. Residents will have varying abilities. Symptoms can include blurred vision, fatigue, tremors, poor balance, trouble walking, weakness, numbness, tingling, incontinence, and behavior changes. MS can cause blindness, contractures, and loss of function in arms and legs.

Transparency 4-9: Care Guidelines for Multiple Sclerosis
Help with ADLs. Be patient with self-care and movement. Allow time for tasks. Offer rest periods. Give resident time to communicate. Prevent falls. Help avoid stressful situations. Listen to residents. Encourage proper diet. Give regular skin care. Assist with ROM exercises.

Paraplegia loss of function of lower body and legs. Quadriplegia loss of function of legs, trunk, and arms.

Remember these facts about head and spinal cord injuries: May result from diving, sports injuries, falls, car and motorcycle accidents, industrial accidents, war, and criminal violence. Can cause permanent brain damage, mental retardation, personality changes, trouble breathing, seizures, coma, memory loss, loss of consciousness, paresis, paralysis. Effects of spinal cord injuries depend on force of impact and where spine is injured. May cause paraplegia or quadriplegia. Rehabilitation is needed. Emotional support is important.

Transparency 4-10: Care Guidelines for Head and Spinal Cord Injuries
Give emotional, as well as physical, support. Be patient. Prevent falls and burns. Be patient with self-care. Give good skin care. Assist with position changes at least every two hours. Perform passive range of motion exercises. Encourage fluids and proper diet to prevent constipation. Give extra catheter care as needed. Offer rest periods as needed. Use special stockings as ordered. Encourage deep breathing exercises as ordered. Provide for privacy if involuntary erections occur. Assist with bowel and bladder training.

Transparency 4-11: Parts of the Eye

Transparency 4-12: The Ear

Think about this question: What are the other sense organs in the human body?

Normal changes of aging to the sense organs include the following: Reduced vision and hearing (sense of balance may be affected) Decreased senses of taste, touch and smell Decreased sensitivity to heat and cold

Think about this question: How can you help residents with the normal changes of aging to the sense organs?

Observe and report the following regarding the sense organs: Changes in vision or hearing Signs of infection Dizziness Complaints of pain in eyes or ears

Remember these facts about vision impairment: Vision impairment can affect people of all ages. Some residents may wear eyeglasses or contacts. People over 40 are at risk for developing cataracts, glaucoma, and blindness. Cataracts may be corrected surgically. Glaucoma can occur suddenly or gradually, and is treated with medication and sometimes surgery. Residents who are visually impaired may enjoy books on tape, large-print books, or Braille books (if they are trained to read Braille).

Transparency 4-13: The Circulatory System

4. Describe the circulatory system and related conditions
Remember the following points about the circulatory system: Made up of heart, blood vessels, and blood Blood carries food, oxygen, and essential substances. Major functions are to: Supply food, oxygen, and hormones to cells Produce and supply antibodies Remove waste products from cells Control body temperature

The circulatory system (cont’d.): Heart has four chambers (two atria/upper chambers and two ventricles/lower chambers) Heart functions in two phases: Resting phase, or diastole (chambers fill with blood) Contracting phase, or systole (ventricles pump blood)

The following are normal changes of aging to the circulatory system: Heart pumps less efficiently Decreased blood flow Narrowed blood vessels

Think about this question: How can you help residents with the normal changes of aging to the circulatory system?

Observe and report the following regarding the circulatory system: Changes in pulse rate Weakness or fatigue Loss of ability to perform ADLs Swelling of hands and feet Pale or blue hands, feet, or lips Chest pain Weight gain Shortness of breath Severe headache Inactivity, which can lead to circulatory problems

Common disorders of the circulatory system include the following: Hypertension (HTN) or high blood pressure Coronary artery disease Myocardial infarction (MI) or heart attack Congestive heart failure (CHF) Peripheral vascular disease (PVD)

Hypertension high blood pressure. Diuretics medications that reduce fluid volume in the body.

Remember these facts about hypertension: Causes: Hardening and narrowing of blood vessels (atherosclerosis) Kidney disease Adrenal tumors Pregnancy Symptoms: Headache Blurred vision Dizziness Sometimes there are no noticeable symptoms

Transparency 4-14: Care Guidelines for High Blood Pressure
Treatment to control it is vital. Encourage residents to follow their diet and exercise programs.

Angina pectoris the medical term for chest pain, pressure, or discomfort due to coronary artery disease.

Remember these facts about coronary artery disease (CAD): Cause: vessels in coronary arteries narrow, reducing blood to heart Symptoms: angina pectoris

Transparency 4-15: Care Guidelines for Angina Pectoris
Encourage rest. Nitroglycerin should be close by. Tell the nurse if a nitroglycerin patch comes off. Residents may need to avoid heavy meals, overeating, intense exercise, and extreme weather exposures.

Remember these facts about myocardial infarction (MI) or heart attack: Caused by complete block of blood flow to heart muscle, which results in tissue death Area of dead tissue may be large or small Can result in serious heart damage or death Chapter 2 covers warning signs

Transparency 4-16: Care Guidelines for Heart Attack
Residents may be placed on exercise program. Residents may be on low-fat/low-sodium diet. Medications may be used to regulate heart rate and blood pressure. Quitting smoking is encouraged. Stress management program may be started. Residents may need to avoid cold temperatures.

Remember these facts about congestive heart failure (CHF): Cause: failure of heart muscle to pump effectively due to damage Symptoms: Trouble breathing Coughing or gurgling with breathing Dizziness Confusion Fainting

Symptoms of congestive heart failure (cont’d.): Pale or blue skin Low blood pressure Swelling of feet and ankles Bulging neck veins Weight gain

Transparency 4-17: Care Guidelines for Congestive Heart Failure
Medications can help control CHF. Medications mean more trips to bathroom. Answer call lights promptly. Low-sodium diet or fluid restriction may be prescribed. Limited activity or bedrest may be prescribed. I&O may need to be measured. Residents may need to be weighed daily. Elastic leg stockings help reduce swelling. ROM exercises improve muscle tone. Extra pillows may help breathing. Help with personal care and ADLs as needed. High-potassium foods can help with dizziness. Report symptoms to the nurse.

Remember these facts about peripheral vascular disease (PVD): Cause: fatty deposits in the blood vessels that harden Symptoms: Cool arms and legs Swelling in hands and feet Pale or bluish hands or feet Bluish nail beds Ulcers of legs and feet Pain may be severe when walking but can decrease with rest Anti-embolic stockings can help prevent swelling and blood clots and aid circulation

Respiration the process of breathing air into the lungs and exhaling air out of the lungs. Inspiration breathing air into the lungs. Expiration exhaling air out of the lungs.

Transparency 4-18: The Respiratory System

5. Describe the respiratory system and related conditions
Remember the following points about the respiratory system: Has two functions: To bring oxygen into body To eliminate carbon dioxide produced by the body

Normal changes of aging to the respiratory system include the following: Loss of lung strength Decreased lung capacity Decreased oxygen in the blood Weakened voice

Think about this question: How can you help residents with the normal changes of aging to the respiratory system?

Observe and report the following regarding the respiratory system: Changes in respiratory rate Shallow breathing or breathing through pursed lips Coughing or wheezing Nasal congestion or discharge Sore throat, difficulty swallowing Need to sit after mild exertion Pale or bluish lips or extremities Pain in chest Yellow, green, gray, or bloody sputum

Remember these facts about chronic obstructive pulmonary disease (COPD), a common disorder of the respiratory system: It is a chronic condition. Residents with COPD have trouble breathing, especially getting air out of the lungs. Two chronic lung diseases are grouped under COPD: chronic bronchitis emphysema. Residents with COPD are at high risk of contracting pneumonia. All body systems are affected when the lungs and brain do not get enough oxygen. Residents may be in constant fear of not being able to breathe and might need to sit upright to improve lung expansion.

Facts about COPD (cont’d.): Residents may have poor appetites and not sleep well, leading to weakness and feelings of general poor health. COPD can result in these symptoms: Chronic cough or wheeze Trouble breathing Shortness of breath Pale, cyanotic, or reddish-purple skin Confusion General weakness Difficulty completing meals Fear and anxiety

Transparency 4-19: Care Guidelines for COPD
Observe and report symptoms getting worse. Help resident sit upright. Offer plenty of fluids and small, frequent meals. Encourage a balanced diet. Keep oxygen supply available as ordered. Be calm and supportive. Use good infection control. Encourage independence with ADLs. Remind residents to avoid exposure to colds and the flu. Make sure residents always have help ready. Encourage pursed-lip breathing. Encourage residents to save energy. Encourage rest.

Transparency 4-19: Care Guidelines for COPD (cont’d.)
Report any of these to the nurse: Temperature over 101˚F Changes in breathing patterns, including shortness of breath Changes in color or consistency of lung secretions Changes in mental state or personality Refusal to take medications as ordered Excessive weight loss Increasing dependence upon caregivers and family

Urinary incontinence the inability to control the bladder, which leads to an involuntary loss of urine.

Transparency 4-20: The Urinary System

6. Describe the urinary system and related conditions
Remember the following points about the urinary system: Composed of two kidneys, two ureters, one urinary bladder, and a single urethra Two functions are Eliminate waste products created by the cells Maintain water balance in the body

Normal changes of aging to the urinary system include the following: Ability of kidneys to filter blood decreases Bladder muscle tone weakens Bladder holds less urine, which causes more frequent urination Bladder may not empty completely, causing greater chance of infection

Think about this question: How can you help residents with the normal changes of aging to the urinary system?

Observe and report the following regarding the urinary system: Weight loss or gain Swelling in upper or lower extremities Pain or burning during urination Changes in urine (cloudiness, odor, color) Changes in frequency and amount of urination Swelling in abdominal/bladder area Complaints that bladder feels full or painful Urinary incontinence/dribbling Pain in kidney or back/flank region Inadequate fluid intake

Common disorders of the urinary system include the following: Urinary incontinence Urinary tract infection (UTI)

Remember these facts about urinary incontinence: Can occur in people who are confined to bed, ill, elderly, paralyzed, or who have circulatory or nervous system diseases or injuries Stress that incontinence is not a normal part of aging and may signal an illness. It is a major risk factor for pressure sores.

Transparency 4-21: Care Guidelines for Urinary Incontinence
Offer to assist with toileting often. Follow toileting schedules. Answer call lights and requests for help promptly. Document carefully and accurately any time a resident’s skin or anything touching resident’s skin is wet from urine, even if it is a small amount. Wash urine off immediately and completely. Incontinent residents who are bedbound should have plastic, latex or disposable sheets under them to protect the bed. Place a draw sheet over it to absorb moisture and protect skin. Use disposable incontinence pads or briefs as needed to keep body wastes away from skin. Change wet briefs promptly. Do not refer to them as “diapers.” Be reassuring and understanding.

Remember these facts about urinary tract infection (UTI): Being bedbound is a risk factor for increased incidence of UTIs. Women are more likely than men to contract a UTI. Women should wipe the perineal area from front to back after elimination.

Transparency 4-22: Preventing Urinary Tract Infections
Encourage residents to wipe front to back and do the same when providing perineal care. Give careful perineal care when changing incontinent briefs. Encourage plenty of fluids. Offer to assist with toileting often. Answer call lights promptly. Taking showers, rather than baths, helps prevent UTIs. Report cloudy, dark, or foul-smelling urine, or if resident urinates often and in small amounts.

Digestion the process of preparing food physically and chemically so that it can be absorbed into the cells. Elimination the process of expelling solid wastes made up of the waste produts of food that are not absorbed into the cells. Fecal/anal incontinence the inability to control the bowels, leading to involuntary passage of stool.

Transparency 4-23: The Gastrointestinal System

7. Describe the gastrointestinal system and related conditions
Remember the following points about the gastrointestinal system: Digestion prepares food for absorption into cells. Elimination is expelling solid wastes.

Normal changes of aging to the gastrointestinal system are as follows: Decreased saliva production affects chewing/swallowing Absorption of vitamins/minerals decreases Digestion takes longer, is less efficient Body waste moves more slowly through intestines; constipation more frequent

Think about this question: How can you help residents with the normal changes of aging to the gastrointestinal system?

Observe and report the following regarding the gastrointestinal system: Difficulty swallowing or chewing Fecal/anal incontinence Weight gain or loss Loss of appetite (anorexia) Abdominal pain or cramping Diarrhea Nausea and vomiting (especially coffee grounds type)

Observe and report (cont’d.): Constipation Flatulence Hiccups, belching Bloody, black, or hard stools Heartburn Poor nutritional intake

Common disorders/conditions of the gastrointestinal system include the following: Constipation Fecal impaction Hemorrhoids Diarrhea Gastroesophageal reflux disease (GERD) Ostomies

Constipation the inability to eliminate stool, or the difficult and painful elimination of a hard, dry stool. Enema a specific amount of water, with or without an additive, that is introduced into the colon to eliminate stool. Suppository a medication given rectally to cause a bowel movement.

Remember these facts about constipation: Causes: Decreased fluid intake Poor diet Inactivity Medications Aging Disease Ignoring the urge to eliminate

Facts about constipation (cont’d.): Symptoms: Abdominal swelling Gas Irritability No recent record of bowel movement Treatment: Increasing fiber and fluid intake Increasing activity level Possibly enema or suppository

Remember these facts about fecal impaction: Cause: hard stool that is stuck in the rectum and cannot be expelled; results from unrelieved constipation Symptoms: No stool for several days Oozing of liquid stool Cramping Abdominal swelling Rectal pain

Facts about fecal impaction (cont’.d): Treatment: Nurse or doctor inserts one or two gloved fingers into the rectum to break the mass into fragments so that it can be passed Prevention: High-fiber diet Plenty of fluids Increase in activity level Possibly medication

Remember these facts about hemorrhoids: Cause: enlarged veins in the rectum and/or outside the anus resulting from an increase in pressure in the lower rectum due to Straining during bowel movements Chronic constipation Obesity Pregnancy Sitting for long periods of time on the toilet

Facts about hemorrhoids (cont’d.): Symptoms: rectal itching, burning, pain, and bleeding Treatment: Medications Compresses Sitz baths Surgery may be necessary

REMEMBER: When cleaning the anal area, be careful to avoid causing pain and bleeding from hemorrhoids.

Remember these facts about diarrhea: Cause: frequent elimination of liquid or semi-liquid feces resulting from Infections Microorganisms Irritating foods Medications

Facts about diarrhea (cont’d.): Symptoms: Abdominal cramps Urgency Nausea and vomiting can accompany diarrhea Treatment: Medication Change of diet - bananas, rice, apples, and tea/toast (BRAT diet)

Remember these facts about gastroesophageal reflux disease (GERD): Chronic condition in which the liquid contents of the stomach back up into the esophagus Liquid can inflame and damage the lining of the esophagus, causing bleeding or ulcers Scars from tissue damage can narrow the esophagus and make swallowing difficult Heartburn is the most common symptom of GERD Treatment is usually medications.

Remember these care guidelines for GERD: Serve evening meal three to four hours before bedtime. Keep resident upright at least two to three hours after eating. Give residents an extra pillow so the body is more upright during sleep. Serve the largest meal of the day at lunchtime and serve several small meals throughout the day. Reduce fast foods, fatty foods, and spicy foods. Stopping smoking, not drinking alcohol, and wearing loose-fitting clothes may also help.

Ostomy a surgically-created opening from an area inside the body to the outside. Stoma an artificial opening in the body.

Remember these facts about ostomies: May be necessary due to bowel disease, cancer, or trauma The terms “colostomy” and “ileostomy” tell what part of the intestine was removed and the type of stool that will be eliminated. In a colostomy, stool will generally be semi-solid. With an ileostomy, stool may be liquid. Disposable bag fits over the stoma to collect the feces and is attached to the skin by adhesive. A belt may also be used to secure it.

Remember these guidelines for ostomy care: Make sure resident receives good skin care and hygiene. Ostomy bag should be emptied and cleaned or replaced whenever stool is eliminated. Always wear gloves and wash hands carefully. Teach proper handwashing techniques to residents with ostomies. Be sensitive and supportive when working with residents with ostomies. Always provide privacy for ostomy care.

Wash hands. Provides for infection control.
Caring for an ostomy Equipment: disposable bed protector, bath blanket, clean ostomy bag and belt/appliance, toilet paper or gauze squares, basin of warm water, soap or cleanser, washcloth, skin cream as ordered, 2 towels, plastic disposable bag, gloves Wash hands. Provides for infection control.

Caring for an ostomy (cont’d.)
Identify yourself to resident by name. Address resident by name. Resident has right to know identity of his or her caregiver. Identifying resident by name shows respect and establishes correct identification. Explain procedure to resident, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible. Promotes understanding and independence.

Provide for resident’s privacy during procedure with curtain, screen, or door. Maintains resident’s right to privacy and dignity. Adjust bed to a safe working level, usually waist high. Lock bed wheels. Raise head of bed. Prevents injury to you and to resident.

Place bed protector under resident. Cover resident with a bath blanket. Pull down the top sheet and blankets. Only expose ostomy site. Offer resident a towel to keep clothing dry. Maintains resident’s right to privacy and dignity. Put on gloves. Provides for infection control.

Remove ostomy bag carefully. Place it in plastic bag. Note the color, odor, consistency, and amount of stool in the bag. Changes in stool can indicate a problem. Wipe area around stoma with toilet paper or gauze squares. Discard the paper/gauze in plastic bag.

Using a washcloth and warm soapy water, wash the area in one direction, away from the stoma. Pat dry with another towel. Apply cream as ordered. Keeping skin clean and dry prevents skin breakdown. Place the clean ostomy appliance on resident. Make sure the bottom of the bag is clamped.

Remove disposable bed protector and discard. Place soiled linens in proper container. Remove bag. Discard the bag in the proper container. Remove and discard gloves. Wash hands. Provides for infection control.

Return bed to lowest position. Remove privacy measures. Lowering the bed provides for safety. Place call light within resident’s reach. Signaling device allows resident to communicate with staff as necessary.

Report any changes in resident to the nurse. Report if stoma is very red or blue, or if swelling or bleeding is present. Provides nurse with information to assess resident. Document procedure according to facility guidelines. What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen.

Glands structures that produce substances in the body. Hormones chemical substances created by the body that control numerous body functions.

Transparency 4-24: The Endocrine System

8. Describe the endocrine system and related conditions
Remember the following points about the endocrine system: Glands are structures that produce substances. Hormones are chemical substances created by the body that regulate essential body processes. Hormones are carried by the blood to organs in order to Maintain homeostasis Influence growth and development Regulate blood sugar levels Regulate calcium levels in bones Regulate the body’s ability to reproduce Determine how fast cells burn food for energy

Normal changes of aging to the endocrine system include the following: Decrease in levels of hormones, such as estrogen and progesterone Less production of insulin Less able to handle stress

Think about this question: How can you help residents with the normal changes of aging to the endocrine system?

Observe and report the following regarding the endocrine system: Headache* Weakness* Blurred vision* Dizziness* Hunger* Irritability* Sweating* Change in behavior* Change in mobility*

Observe and report (cont’d.): Change in sensation* Numbness or tingling in arms or legs* Weight gain/loss Loss of appetite/increase in appetite Increased thirst Frequent urination Dry skin Skin breakdown Sweet or fruity breath Sluggishness or fatigue Hyperactivity *Report these immediately

Common disorders of the endocrine system include: Thyroid disorders include hyperthyroidism (too much thyroid hormone) and hypothyroidism (too little). Diabetes occurs when the body does not produce enough or properly use insulin. Two major types are: Type I (juvenile, appears in childhood) Type II (most common, develops slowly after age 35)

Diabetes a condition in which the pancreas does not produce enough or does not properly use insulin. Insulin a hormone that converts glucose into energy for the body. Glucose natural sugar.

Pre-diabetes a condition in which a person’s blood glucose levels are above normal but not high enough for a diagnosis of type 2 diabetes. Gestational diabetes type of diabetes that appears in pregnant women who have never had diabetes before but who have high glucose levels during pregnancy.

Remember these facts about diabetes: Pancreas does not produce enough insulin. Glucose collects in blood causing circulatory problems. Two types are type 1 (diagnosed in children and young adults, will continue throughout a person’s life) and type 2 (adult-onset and milder). Pre-diabetes describes blood glucose levels above normal but not high enough for a diagnosis of type 2 diabetes.

These are possible signs of diabetes: Excessive thirst Extreme hunger Frequent urination Weight loss High levels of blood sugar Sugar in urine Sudden vision changes Tingling or numbness in hands or feet Feeling very tired Very dry skin Sores that are slow to heal More infections than usual

Complications of diabetes include the following: Changes in the circulatory system can cause heart attack, stroke, poor extremity circulation, poor wound healing, and kidney and nerve damage. Damage to eyes can cause vision loss and blindness. Diabetes can lead to leg and foot ulcers, infected wounds, and gangrene due to poor circulation and impaired wound healing. Insulin reaction and diabetic ketoacidosis are serious complications (see Chapter 2).

Transparency 4-25: Care Guidelines for Diabetes
Follow diet instructions exactly. Encourage exercise. Observe residentís management of insulin doses. Perform urine and blood tests as directed. Give foot care as directed. Encourage comfortable, leather footwear and cotton socks.

Reproduce to create new life. Gonads sex glands.

Transparency 4-26: The Reproductive System

9. Describe the reproductive system and related conditions
Note the following about the reproductive system: Reproductive organs are different in males (testes, scrotum, testosterone) and females (ovaries, fallopian tubes, estrogen).

Normal changes of aging to the reproductive system include the following: Female: Menstruation ends. Decrease in estrogen leads to loss of calcium, causing brittle bones. Drying and thinning of vaginal walls occurs. Male: Sperm production decreases. Enlargement of the prostate gland occurs.

Think about this question: How can you help residents with the normal changes of aging to the reproductive system?

Observe and report the following regarding the reproductive system: Discomfort or difficulty with urination Discharge Swelling of genitals Blood in urine or stool Breast changes, lumps, or discharge Sores on genitals Reports of impotence Reports of painful intercourse

Common disorders of the reproductive system include Vaginitis Benign prostatic hypertrophy

Remember these facts about vaginitis: Causes: Bacteria Protozoa Fungus Hormonal changes after menopause Symptoms: White vaginal discharge Itching and/or burning Treatment Oral medication Vaginal gels or creams

Remember these facts about benign prostatic hypertrophy: Occurs in men as they age Causes: Enlarged prostate causes pressure on the urethra, which leads to problems urinating and emptying the bladder Treatment Medications Surgery

REMEMBER: Men are also at increased risk for prostate cancer as they age. Prostate cancer is usually slow-growing and responsive to treatment, so early detection is important.

Handout 4-1: Sexually Transmitted Diseases and Infections
Sexually transmitted diseases (STDs), also called venereal diseases, are diseases passed through sexual contact with an infected person. This contact includes sexual intercourse, contact of the mouth with the genitals or anus, and contact of the hands to the genitals. A person may be infected, and may potentially infect others, without showing signs of the disease. This is called a sexually transmitted infection (STI). Using latex condoms during sexual contact can reduce the chances of being infected with or passing on some STDs and STIs. The human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), and some kinds of hepatitis can be sexually transmitted. STDs are very common. They can cause serious health problems. Residents may be unaware of or embarrassed by symptoms of an STD. Be professional when dealing with STDs and STIs. This can help put residents at ease.

Handout 4-1: Sexually Transmitted Diseases and Infections (cont’d.)
Chlamydia infection is caused by organisms in the mucous membranes of the reproductive tract. Chlamydia can cause serious infection, including pelvic inflammatory disease (PID) in women. PID can cause sterility. Signs of chlamydia infection are yellow or white discharge from the penis or vagina and burning with urination. It is treated with antibiotics. Syphilis can be treated effectively in the early stages, but if left untreated, it can cause brain damage, mental illness, and even death. Babies born to mothers with syphilis may be born blind or with other serious birth defects. Syphilis is easier to detect in men than in women. This is due to open sores called chancres that form on the penis soon after infection.

The chancres are painless and can go unnoticed. If untreated, the infection spreads to the heart, brain, and other vital organs. Common symptoms at this stage include rash, sore throat, or fever. When detected, syphilis can be treated with penicillin or other antibiotics. The sooner it is treated, the better the chances of preventing long-term damage and avoiding infection of others. Gonorrhea, like syphilis, can be treated with antibiotics and is easier to detect in men than in women. If untreated, gonorrhea can cause sterility in both men and women. Most women with gonorrhea show no early symptoms. This makes it easy for women to spread the disease. Men with gonorrhea will often show a greenish or yellowish discharge from the penis within a week after infection. Burning with urination is another common symptom in men.

Herpes simplex 2, unlike the other STDs discussed here, is caused by a virus. It cannot be treated with antibiotics. Once infected with the herpes virus, a person cannot be cured. The person may have repeated outbreaks of the disease for the rest of his or her life. A herpes outbreak includes burning, painful, red sores on the genitals. These heal in about two weeks. The sores are infectious, but a person with herpes virus can also spread the infection when sores are not present. Some people infected with herpes never have repeated outbreaks. The later episodes may not be as painful as the first outbreak. Antiviral drugs can help people stay symptom-free longer. Babies born to women infected with herpes simplex 2 can be infected during birth. Pregnant women experiencing a herpes outbreak are usually delivered by cesarean section, or C-section.

Define the following term:
Lymph A clear yellowish fluid that carries disease-fighting cells called lymphocytes.

Transparency 4-27: The Lymphatic System

10. Describe the immune and lymphatic systems and related conditions
Remember the following points about the lymphatic system: Function of system is to remove excess fluids and waste products as well as to help the immune system to fight infections. It is closely related to the circulatory system because lymph fluid, after being purified in the lymph nodes, flows into the bloodstream. It has no pump, but is circulated by muscle activity, massage, and breathing. Nonspecific immunity protects the body from disease in general. Specific immunity protects against a particular disease that is invading the body at a given time.

Normal changes of aging to the immune and lymphatic systems include the following: Increased risk of infections due to weaker immune system Decreased response to vaccines

Think about this question: How can you help residents with the normal changes of aging to the lymphatic and immune systems?

Observe and report the following regarding the immune and lymphatic systems: Recurrent infections Swelling of lymph nodes Increased fatigue

HIV/AIDS affects the immune and lymphatic systems: Acquired immunodeficiency syndrome (AIDS) is caused by HIV (human immunodeficiency virus). HIV attacks the immune system and disables it. HIV is transmitted by sexual contact, blood, infected needles, or from mother to fetus. Symptoms at transmission are like flu. Later symptoms include infections, tumors, and central nervous system symptoms. Late stage is AIDS dementia complex.

Signs and symptoms of HIV/AIDS include the following: Appetite loss Involuntary weight loss Flu-like symptoms Night sweats Swollen lymph nodes Severe diarrhea Dry cough Skin rashes

Signs and symptoms of HIV/AIDS (cont’d.): Painful white spots in mouth Cold sores Warts on the skin and in mouth Inflamed and bleeding gums Low resistance to infection Bruising that does not go away Kaposiís sarcoma AIDS dementia complex

REMEMBER: Opportunistic infections invade the weakened body of a resident with AIDS. Treatment is medication. Drugs slow the progress but there is no cure for the disease.

Handout 4-2: Myths About HIV and AIDS
Myth: If I am HIV positive, that means I have AIDS. Fact: HIV positive means that your body was exposed to the virus. Since your body was exposed, there is a good chance that you are infected with the virus. But it does not mean that you have AIDS. AIDS develops over time. Myth: HIV is the same as AIDS. Fact: HIV is the virus that causes AIDS. AIDS is a group of symptoms that develop during the last stage of HIV infection.

Handout 4-2: Myths About HIV and AIDS
Myth: I can get HIV from an infected person by shaking hands, hugging, or kissing. Fact: HIV is not spread through casual contact. There is a slight possibility that you could become HIV infected through kissing if you and the infected person both have open bleeding sores in your mouths and the infected person’s blood gets into yours. If you are really worried about this, do an oral exam on your partner before kissing him or her. Myth: I can get HIV from telephones. Fact: The HIV virus can't live outside of the body. You cannot become infected through saliva. Myth: I can get HIV from doorknobs, tables, chairs, or push buttons. Fact: The HIV virus can't live outside of the body.

Handout 4-2: Myths About HIV and AIDS (cont’d.)
Myth: I can get HIV from eating food that was prepared by an infected person. Fact: Once again, HIV dies very quickly outside the body. Even if the food prep person cut his finger and then attractively arranged your food on your plate, you would not become infected from eating this food. Once any body fluid is dry, you can be absolutely sure that the virus is dead. Just about the only way you could become infected this way is if the food prep person cuts off a finger, and as he is bleeding in your food, you are eating it at that exact moment. This scenario is rather extreme.

Myth: I can get HIV from toilets. Fact: Toilets have been blamed for just about everything, from getting you pregnant to giving you sexually transmitted diseases (STD). The only way you might possibly become HIV infected from a toilet seat is to have unprotected sex while sitting on it! Myth: I can get HIV from mosquitoes. Fact: Although it sounds very possible, you cannot become HIV infected through mosquitoes, fleas, ticks, or lice. For this to happen, the HIV would have to survive in the insect saliva and salivary glands. HIV is a human virus and cannot survive outside of the human body. As a result, HIV will not and does not survive in mosquitoes, fleas, ticks, or lice. If this were a route of transmission, we would all have been infected a very long time ago.

Myth: I can get HIV from breathing the same air as an infected person. Fact: HIV does not spread through the air. You cannot get HIV by being in the same room with someone who is infected with the virus.

Transparency 4-28: Care Guidelines for HIV/AIDS
Wash hands often. Follow Standard Precautions, and keep everything clean. High-protein, high-calorie, high-nutrient meals can help maintain healthy weight. Help make mealtimes pleasant and relaxing. Know residents’ favorite foods. Notify nurse of appetite loss/difficulty eating. If residents have infections in the mouth they may need food that is low in acid/spice and neither cold nor hot. Good mouth care is vital. Small, frequent meals can help with nausea. Help ensure adequate fluid intake.

Transparency 4-28: Care Guidelines for HIV/AIDS (cont’d.)
If diarrhea is severe, doctor may order “BRAT” diet (bananas, rice, apples, toast). This is helpful short-term. Good rehydration fluids include water, juice, soda and broth. Avoid caffeinated beverages. Numbness, tingling, and pain in the feet and legs is usually treated with medications. Going barefoot or wearing loose, soft slippers may help. Bed cradle may be used. Treat residents with respect and provide emotional support. Provide safe environment and close supervision in ADLs.

Think about these questions: Why might a resident with AIDS be under extra emotional stress? Why might be some of the special challenges of caring for residents with AIDS?

REMEMBER: Results of HIV testing (whether of residents or staff) are confidential and cannot be discussed with anyone. Serious violations apply under HIPAA if confidentiality is breached.

Define the following term:
Tumor a group of abnormally growing cells.

Cancer is a disorder of the immune and lymphatic systems: General term meaning many types of malignant tumors. Tumors can be benign (non-cancerous, usually grow slowly) or malignant (cancerous, grow rapidly). There is no cure. It may spread to other areas of the body, affecting other body systems. Cancer often first appears in breast, colon, rectum, uterus, prostate, lungs or skin

The following are risk factors for cancer: Tobacco use Exposure to sunlight Excessive alcohol use Some food additives Exposure to some chemicals and industrial agents Radiation Poor nutrition Lack of physical activity

The American Cancer Society has identified warning signs of cancer: Unexplained weight loss Fever Fatigue Pain Skin changes Change in bowel or bladder habits

Warning signs of cancer (cont’d.): Sores that do not heal Unusual bleeding or discharge Thickening or lump in breast or other part of body Indigestion or difficulty swallowing Recent change in wart or mole Nagging cough or hoarseness

Treatments for cancer include Surgery Chemotherapy Radiation

Transparency 4-29: Care Guidelines Cancer
Each case is different. Do not make assumptions. Respect residents’ needs and be sensitive. Have a positive attitude. Try plastic utensils for residents receiving chemotherapy. Encourage a variety of food. Watch for signs of pain and report them to the nurse. Give back rubs for comfort. Reposition residents. Use lotion on dry skin. Do not remove markings. Give back rubs. Assist with oral care often. Use a soft-bristled toothbrush and baking soda rinse. Provide help with grooming. Encourage visitors. Suggest good times of the day for visits. Get to know residents’ interests. Be alert to needs not being met or stresses.

Report the following signs and symptoms and cancer: Increased weakness or fatigue Weight loss Nausea, vomiting, diarrhea Changes in appetite Fainting Signs of depression

Signs and symptoms of cancer to report (cont’d.): Confusion Blood in stool or urine Change in mental status Changes in skin New lumps, sores, rashes Increase in pain or unrelieved pain

Chapter Exam Multiple Choice. 1. Which of the following statements is true of the skin? (A) It feels heat, cold, pain, touch, and pressure. (B) It becomes more elastic as a person ages. (C) It is the chemical substance that is created by the body and controls body functions. (D) It becomes thicker as a person ages. 2. A resident with a head or spinal cord injury should be repositioned at least every ___hours. (A) 2 (B) 3 (C) 4 (D) 5

Chapter Exam (cont’d.) 3. One way a nursing assistant can help with normal changes of aging related to the integumentary system is to (A) Withhold fluids so a resident will not go to the bathroom often. (B) Clip toenails frequently. (C) Keep sheets wrinkle-free. (D) Rub lotion into red or irritated spots on the resident’s skin. 4. When atrophy occurs, (A) The muscle slowly becomes stronger (B) The muscle increases in size (C) The muscle stays about the same (D) The muscle decreases in size

Chapter Exam (cont’d.) 5. When a hip has been replaced (A) Dress the unaffected, or stronger, side first (B) Place items far away from the resident to force him to walk (C) The hip cannot be bent or flexed more than 90 degrees (D) Perform range of motion exercises on the side that has the hip replacement 6. Arthritis can be the result of an autoimmune illness. With an autoimmune illness the body’s ______system attacks normal tissue. (A) Immune (B) Lymphatic (C) Circulatory (D) Endocrine

Chapter Exam (cont’d.) 7. Which of the following is a function of the nervous system? (A) Gives the body shape and structure (B) Provides a natural protective covering to the body (C) Produces and supplies antibodies and other infection-fighting blood cells (D) Senses and interprets information from outside the body 8. The eye and ear are part of (A) The body’s sense organs (B) The integumentary system (C) The dermis (D) The circulatory system

Chapter Exam (cont’d.) 9. Which of the following is helpful when providing skin care for a resident with cancer? (A) Do not use lotion on dry, delicate skin. (B) Do not offer backrubs. (C) Avoid applying lotion to areas receiving radiation therapy. (D) Avoid moving the resident at all. 10. Which of the following statements is true of assisting a resident with one-sided weakness after a stroke? (A) Lead with the weaker side. (B) Stand on the weaker side. (C) Use the terms “bad” or “messed up” to refer to weaker side. (D) A gait belt is not helpful during transfers.

Chapter Exam (cont’d.) 11. Guidelines for caring for a resident with multiple sclerosis include (A) Rushing resident through tasks (B) Administering medications (C) Preventing falls (D) Encouraging the resident to speak faster 12. Osteoporosis causes (A) Menopause (B) Stooped posture (C) Supplements (D) Lack of hormones

Chapter Exam (cont’d.) 13. Residents with COPD have trouble with (A) Breathing (B) Urination (C) Losing weight (D) Vision 14. How should a resident with COPD be positioned? (A) Flat on his back (B) Sitting upright (C) Lying on his stomach (D) Lying on his side

Chapter Exam (cont’d.) 15. Which of the following is one of the functions that the circulatory system performs? (A) Senses and interprets information from the environment (B) Cushions the brain and spinal cord (C) Allows humans to reproduce (D) Supplies food, oxygen, and hormones to cells 16. Which of the following is helpful for numbness, tingling, and pain in the feet for a resident who has AIDS? (A) Wrapping the feet tightly in elastic bandages (B) Wearing snug, firm slippers (C) Wearing rigid, high-topped shoes (D) Going barefoot

Chapter Exam (cont’d.) 17. Respiration consists of (A) Narrowing of blood vessels (B) Inspiration and expiration (C) Circulating blood in the heart (D) Urinary elimination 18. The respiratory system is made up of (A) Arteries, veins, capillaries (B) Brain, spinal cord, nerves (C) Trachea, bronchi, lungs (D) Atria, ventricles, aorta

Chapter Exam (cont’d.) 19. High blood pressure (A) Can be detected just by looking at a person (B) Cannot be treated with medication (C) Is never a serious condition (D) Is a measurement of 140/90 or higher 20. Which of the following is helpful for a resident who has had a heart attack? (A) Smoking (B) High-fat diet (C) Regular exercise (D) Cold temperatures

Chapter Exam (cont’d.) 21. Residents with congestive heart failure may (A) Be on a high-sodium diet (B) Take medications that cause them to urinate less often (C) Have a “force fluids” order (D) Use elastic stockings to reduce swelling in feet and ankles 22. What is one good way a nursing assistant can assist residents with normal changes of aging related to the urinary system? (A) Offer frequent trips to the bathroom. (B) Withhold fluids. (C) Scold residents who are incontinent. (D) Make sure every resident wears incontinence briefs.

Chapter Exam (cont’d.) 23. Why are females more likely to have urinary tract infections than males? (A) Due to the different location of the meatus (B) Due to having a shorter urethra (C) Due to not filtering blood properly in the kidneys (D) Due to incontinence 24. Normal changes of aging for the female reproductive system include: (A) Menstruation continues (B) Increased moisture of vaginal walls (C) Voice weakens (D) Loss of calcium

Chapter Exam (cont’d.) 25. The yellowish fluid that carries disease-fighting cells is called (A) Sperm (B) Lymph (C) Urine (D) Blood 26. How does the immune system protect the body from disease? (A) Through nonspecific and specific immunity (B) Through hormones (C) Through digestion and elimination (D) Through changes in pulse rate

Chapter Exam (cont’d.) 27. A diabetic resident should (A) Skip meals (B) Go barefoot (C) Receive careful foot care (D) Avoid exercise 28. What can a nursing assistant do to help prevent urinary tract infections (UTIs)? (A) Restrict fluids (B) Encourage baths, rather than showers (C) Wipe from front to back when giving perineal care (D) Ask the resident not to drink cranberry or blueberry juice

Chapter Exam (cont’d.) 29. What can be done to help a resident who has gastroesophageal reflux disease (GERD)? (A) Serve spicy foods. (B) Ask the resident not to lie down for at least two to three hours after eating. (C) Serve the largest meal of the day at dinner. (D) Assist the resident to eat in a reclined position.

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