1. Chapter 18: Common chronic and acute conditions

2. Learning objectives
Describe common diseases and disorders of the integumentary system
Describe common diseases and disorders of the musculoskeletal system
Describe common diseases and disorders of the nervous system
Describe common diseases and disorders of the circulatory system
Describe common diseases and disorders of the respiratory system
Describe common diseases and disorders of the endocrine system
Describe common diseases and disorders of the reproductive system
Describe common diseases and disorders of the immune and lymphatic system
Identify community resources for residents who are ill

3. Diseases and disorders of the integumentary system
Shingles
Wounds
Dermatitis
Eczema
Stasis dermatitis
Fungal infections
NAs should know these facts about shingles:
Also called herpes zoster
Skin rash caused by varicella-zoster virus (VZV)
Anyone who has had chickenpox is at risk for shingles.
Signs and symptoms include pain, tingling, or itching, followed by rash.
Cannot be transmitted to others, but active rash can transmit chickenpox
Risk increases with age.
Treated with medication
Vaccine is available.
NAs should know these facts about wounds:
Type of injury to skin, either open or closed
Examined and cleaned with various solutions, such as tap water, sterile saline, or antiseptic solution
Bleeding may need to be stopped.
Dressings, bandages, sutures, staples or special strips/glue may need to be applied.
Dermatitis is a general term referring to inflammation (swelling) of the skin. There are two types of dermatitis: atopic dermatitis, also called eczema, and stasis dermatitis.
NAs should know these facts about eczema:
Commonly occurs with allergies
May be caused by physical/mental stressors
Symptoms include dry, itchy, inflamed skin, usually on cheeks, arms, legs.
Not contagious
Treated with special lotions and/or antihistamines
NAs should know these facts about stasis dermatitis:
Commonly affects lower legs and ankles
Occurs due to fluid build-up under skin
Can lead to severe skin problems
Early signs include rash; scaly, red area; and itching.
Other signs include swelling of legs/ankles; thin, tissue-like skin; darkening/thickening skin at ankles; leg pain. Report these signs to nurse.
Treatment includes surgery for varicose veins and medications to reduce fluids in body.
May need to apply elastic stockings to promote circulation
Resident may be on low-sodium diet.
NAs should know these facts about fungal infections:
Examples of fungi include mushrooms, mold, and yeasts (Candida).
Some types of fungi normally live on body.
Normal balances of fungi can change, resulting in infection.
Fungal infections include athlete’s foot, jock itch, vaginal yeast infection, and tinea.
Imbalances may result from weakened immune system or antibiotics.
Infections can be difficult to eliminate.
Treatment includes antifungal cream or lotion and/or oral or injected medications.

4. Diseases and disorders of the musculoskeletal system
Arthritis
Facts
Treatment
Care guidelines
Osteoporosis
Signs and symptoms
How to prevent or slow
Fractures
Prevention
Cast care guidelines
Hip replacement
Facts
Reasons for hip replacement
Care guidelines
Signs and symptoms to report
Knee replacement
Reasons for knee replacement
Muscular dystrophy
Amputation
Guidelines for care
Arthritis is a general term that refers to inflammation of the joints, causing stiffness, pain, and decreased mobility.
NAs should know 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.
These are common treatments for arthritis:
Anti-inflammatory medications (aspirin or ibuprofen), as well as other medications
Local applications of heat
ROMs
Exercise
Dietary changes
Care guidelines:
Watch for stomach irritation or heartburn.
Encourage activity.
Adapt ADLs to allow independence.
Choose clothing that is easy to put on and fasten. Encourage use of handrails and safety bars. Use special utensils if needed.
Treat each resident as an individual.
Help maintain resident’s self-esteem by encouraging self-care.
NAs should know 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
The following are signs and symptoms of osteoporosis:
Low back pain
Stooped posture
Loss of height
Osteoporosis may be prevented or slowed in these ways:
Encourage residents to walk and do other light exercise as ordered.
Move residents with osteoporosis very carefully.
Follow care plan regarding medication and calcium and fluoride supplements, which might be used to treat osteoporosis.
A fracture is a broken bone. A closed fracture is a broken bone that does not break the skin. An open fracture is a broken bone that penetrates the skin; also known as a compound fracture.
Remember: Fall prevention is the key to preventing fractures. The bones of the elderly heal slowly, so prevention is very important.
Cast care guidelines:
Do not cover cast until dry. Assist with changing positions as ordered to help with drying. Place the cast on pillows.
Elevate extremity in cast.
Observe for swelling, skin discoloration, tightness, pressure, sores, changes in skin temperature, pain, burning, numbness or tingling, drainage, bleeding, or odor.
Protect resident’s 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.
When someone breaks a bone, the physician will give special orders regarding how much weight the person can put on the bone. Partial weight-bearing is a doctor’s order stating that a person is able to support some body weight on one or both legs. Non-weight-bearing is a doctor’s order stating that a person is unable to touch the floor or support any body weight on one or both legs. Full weight-bearing is a doctor’s order stating that a person has the ability to support full body weight (100%) on both legs.
NAs should know these facts about hip replacements:
Cause may be a fall or weakened bones.
Elderly bones heal slowly.
The elderly are at risk for secondary illnesses.
Hip replacements may be necessary for the following reasons:
Fracture does not heal properly.
Weakened hip due to aging
Painful and stiff hip
Care guidelines for hip replacement:
Keep often-used items within reach.
Dress affected side first.
Do not rush the resident. Use praise and encouragement.
Ask for pain medication if needed.
Have the resident sit to do tasks.
Follow the care plan exactly.
Do not perform ROM exercises on hip replacement side.
Hip cannot be bent or flexed more than 90 degrees. It cannot be turned inward or outward.
Follow orders for application and positioning with an abduction pillow.
Transfer resident carefully, with strong side leading when standing, pivoting, and sitting.
With chair or toilet transfers, operative leg/knee should be straightened. Strong leg should stand first.
NAs should observe and report the following signs and symptoms after hip replacement:
Red, draining, warm, or bleeding incision
Increase in pain
Numbness or tingling
Shortening and/or external rotation of affected leg
Abnormal vital signs
Inability to use equipment properly and safely
Unwillingness of resident to follow doctor’s orders for activity and exercise
Problems with appetite
Improvements such as increased strength and improved ability to walk
A knee replacement is a kind of prosthesis, a device that replaces a body part that is missing or deformed because of an accident, injury, illness, or birth defect; used to improve a person’s ability to function and/or his appearance.
Knee replacement may be performed for these reasons:
Relieves severe pain
Restores motion to damaged knee
Helps stabilize a knee that buckles or gives out
Remember: Recovery time after a knee replacement is generally shorter than recovery time for hip replacement.
Care guidelines for knee replacement:
Apply special stockings as ordered.
Perform ankle pumps as ordered.
Encourage fluids, especially fluids high in vitamin C.
Assist with deep breathing exercises.
Assist with continuous passive motion (CPM) as ordered.
Report to nurse if you notice redness, swelling, heat, or deep tenderness in one or both calves.
NAs should know these facts about muscular dystrophy (MD):
MD refers to a number of progressive diseases that cause a variety of physical disabilities due to muscle weakness.
MD is inherited.
It causes gradual wasting away of muscle, and weakness and deformity.
Most forms are present at birth.
NA should help with ADLs or ROM exercises.
NA should help with skin care and positioning.
Amputation is the surgical removal of some or all of a body part, usually a hand, arm, leg, or foot. This can lead to phantom sensation (warmth, itching, or tingling from a body part that has been amputated) or phantom limb pain (pain in a limb ,or extremity, that has been amputated).
NAs should remember these guidelines when caring for a resident who has had an amputation:
Be supportive during the continuing process of adjusting to the amputation.
Help with ADLs.
Assist with changes of position as ordered.
Perform ROM exercises as instructed.
Follow care plan.
More information on prosthesis care is in Chapter 21.
The following are some common complementary and alternative medicine practices:
Chiropractic medicine
Massage therapy
Acupuncture
Homeopathy
Herbs and dietary supplements
Some residents may use complementary or alternative medicine practices. NAs should never make judgments about treatments or discuss their opinions. If an NA has concerns about a resident’s medical practices she should talk to the charge nurse.

5. Common diseases and disorders of the nervous system
CVA/Stroke
Facts
Care guidelines
Parkinson’s disease
Multiple sclerosis
Head and spinal cord injuries
Facts
Care guidelines
Epilepsy
Vision impairment
NAs should know these facts about CVA/stroke:
CVA occurs when blood supply to a part of the brain is blocked or a blood vessel leaks or ruptures within the brain.
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.
Care guidelines for stroke:
Assist with exercises as ordered, keeping safety in mind.
Use terms weaker or involved to refer to weaker side, 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 proximity to heat and sharp objects.
Adapt procedures when caring for residents with one-sided paralysis or weakness.
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.
For assisting with eating:
Place food in resident’s field of vision.
Use assistive devices.
Watch for signs of choking.
Serve soft foods if swallowing is difficult.
Always place food in unaffected side of mouth. Make sure food is swallowed.
NAs should know 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.
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.
NAs should know these facts about multiple sclerosis:
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.
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 healthy diet with plenty of fluids.
Give excellent skin care.
Assist with ROM exercises.
NAs should know 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, and 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.
Care guidelines for head and spinal cord injuries:
Give emotional, as well as physical, support.
Prevent falls and burns.
Be patient with self-care.
Give careful 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.
NAs should know these facts about epilepsy:
Epilepsy causes seizures, but not all seizures are due to epilepsy.
Seizures can be violent or mild.
Causes are illness, injury, or unknown.
Diagnosed through a variety of tests, including EEG.
Treatment includes medication or surgery.
NAs should know these facts about vision impairment:
Vision impairment can affect people of all ages.
Some residents may wear eyeglasses or contacts.
People over 40 years old 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.
Dementia and Alzheimer’s disease, which are common disorders of the nervous system, are covered in detail in Chapter 19.

6. Diseases and disorders of the circulatory system
Hypertension (HTN)
Facts
Care guidelines
Coronary artery disease (CAD)
Heart attack/myocardial infarction
Congestive heart failure (CHF)
Facts
Care guidelines
Peripheral vascular disease (PVD)
NAs should know these facts about hypertension (HTN) or high blood pressure:
Causes:
Hardening and narrowing of blood vessels (atherosclerosis)
Kidney disease
Adrenal tumors
Pregnancy
Symptoms:
Headache
Blurred vision
Dizziness
Sometimes there are no noticeable symptoms
Care guidelines for hypertension
Offer regular trips to the bathroom. Answer call lights promptly.
Take blood pressure as ordered.
Encourage residents to follow their diet and exercise programs.
NAs should know these facts about coronary artery disease (CAD):
Vessels in coronary arteries narrow, reducing blood to heart
Angina pectoris (chest pain, pressure, or discomfort)
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 exposure to extreme weather.
NAs should know these facts about heart attack/myocardial infarction:
Caused by 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 7 covers warning signs.
Care guidelines for myocardial infarction:
Encourage residents to follow their exercise programs.
Encourage residents to follow their special diets.
Medications may be used to regulate heart rate and blood pressure.
Be supportive if residents are quitting smoking.
Help residents avoid stress and listen if they want to talk.
Residents may need to avoid cold temperatures.
NAs should know these facts about congestive heart failure (CHF):
Cause is the failure of the heart muscle to pump effectively due to damage
Fatigue
Trouble breathing
Coughing or gurgling with breathing
Confusion
Fainting
Pale or cyanotic skin
Low blood pressure
Swelling of feet and ankles
Bulging neck veins
Weight gain
Care guidelines for congestive heart failure:
Medications can help control CHF.
Answer call lights promptly. Keep a portable commode nearby if resident cannot get to the bathroom easily.
Encourage residents to follow diet orders and/or fluid restrictions.
Allow for rest periods.
Measure intake and output (I&O) as ordered.
Weigh residents as instructed.
Apply elastic leg stockings as ordered.
Assist with ROM exercises.
Extra pillows may help breathing. Keep the head of the bed elevated if it helps with breathing.
Assist with personal care and ADLs as needed.
High-potassium foods can help with dizziness.
NAs should know these facts about peripheral vascular disease (PVD):
Cause is fatty deposits in the blood vessels that harden
Cool arms and legs
Swelling in hands and feet
Pale or bluish hands or feet
Bluish nail beds
Ulcers of legs and feet
Anti-embolic stockings can help prevent swelling and blood clots and aid circulation.

7. Skill: Putting elastic stockings on a resident
Equipment: elastic stockings
1. Identify yourself by name. Identify resident by name.
2. Wash your hands.
3 Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for resident’s privacy with curtain, screen, or door.
5. The resident should be in the supine position (on her back) in bed. With resident lying down, remove her socks, shoes, or slippers, and expose one leg. Expose no more than one leg at a time.
6. Turn stocking inside-out at least to heel area.
7. Gently place the foot of the stocking over toes, foot, and heel. Make sure the heel is in the right place (heel of foot should be in heel of stocking).
8. Gently pull the top of stocking over foot, heel, and leg.
9. Make sure there are no twists or wrinkles in stocking after it is applied. It must fit smoothly. Make sure the heel of stocking is over the heel of foot. If the stocking has an opening in the toe area, make sure the opening is either over or under the toe area, depending upon the manufacturer’s instructions.
10. Repeat for the other leg.
11. Place call light within resident’s reach.
12. Wash your hands.
13. Report any changes in resident to nurse.
14. Document procedure using facility guidelines.
Equipment: elastic stockings
1. Identify yourself by name. Identify resident by name.
2. Wash your hands.
3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for resident’s privacy with curtain, screen, or door.
5. The resident should be in the supine position (on her back) in bed. With resident lying down, remove her socks, shoes, or slippers, and expose one leg. Expose no more than one leg at a time.
6. Turn stocking inside-out at least to heel area.
7. Gently place the foot of the stocking over toes, foot, and heel. Make sure the heel is in the right place (heel of foot should be in heel of stocking).
8. Gently pull the top of stocking over foot, heel, and leg.
9. Make sure there are no twists or wrinkles in stocking after it is applied. It must fit smoothly. Make sure the heel of stocking is over the heel of foot. If the stocking has an opening in the toe area, make sure the opening is either over or under the toe area, depending upon the manufacturer’s instructions.
10. Repeat for the other leg.
11. Place call light within resident’s reach.
12. Wash your hands.
13. Report any changes in resident to nurse.
14. Document procedure using facility guidelines.

8. Common diseases and disorders of the respiratory system
Chronic obstructive pulmonary disease (COPD)
Facts
Symptoms
Care guidelines
Signs and symptoms
Asthma
Bronchiectasis
Upper respiratory infections (URIs)
Facts
Lung cancer
Tuberculosis
Chronic obstructive pulmonary disease (COPD) is a chronic, incurable lung disease that causes difficulty breathing.
NAs should know these facts about chronic obstructive pulmonary disease (COPD):
It is a chronic disease.
Residents with COPD have trouble breathing, especially getting air out of the lungs.
Two chronic lung diseases are grouped under COPD: chronic bronchitis and 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.
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
Difficulty breathing
Shortness of breath
Pale, cyanotic, or reddish-purple skin
Confusion
General weakness
Difficulty completing meals
Fear and anxiety
Care guidelines for COPD:
Observe and report signs of symptoms getting worse.
Help resident sit upright.
Offer plenty of fluids and small, frequent meals.
Encourage a well-balanced diet.
Keep oxygen supply available as ordered.
Be calm and supportive.
Use proper infection prevention practices.
Encourage independence with ADLs.
Encourage pursed-lip breathing.
Encourage residents to save energy. Encourage rest.
NAs should observe and report the following signs and symptoms of COPD:
Temperature over 101°F
Changes in breathing patterns
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
Asthma is a chronic inflammatory disease that causes difficulty with breathing, coughing, and wheezing.
NAs should know these facts about asthma:
Chronic inflammatory illness that occurs when the respiratory system is hyperactive to irritants, infection, cold air, or allergens
During an attack, the bronchi constrict, making breathing difficult.
Exercise and stress can cause or worsen asthma.
Causes coughing and wheezing
Exact cause is unknown.
Treatment includes medication in the form of sprays or inhalers.
Residents should avoid triggers.
Bronchiectasis is a chronic disease of the lungs that usually results from chronic bronchitis and cigarette smoking.
NAs should know these facts about bronchiectasis:
Permanent condition in which bronchial tubes are abnormally enlarged
May be acquired in childhood or later in life as a result of infections/inflammation
Cystic fibrosis is a common cause.
Causes chronic coughing, may cause recurrent pneumonia and weight loss
Treatment includes controlling infections and preventing complications; may include antibiotics, postural drainage
Upper respiratory infection (URI) is a viral infection of the nose, sinuses, and throat; commonly called a cold.
NAs should know these facts about upper respiratory infections (URIs):
Commonly called a cold
Result of viral infection of nose, sinuses, and throat
Symptoms include nasal discharge, sneezing, sore throat, fever, and fatigue.
Rest and extra fluids are effective treatments for most URIs.
Lung cancer is the growth of abnormal cells or tumors in the lungs.
NAs should know these facts about lung cancer:
Abnormal cells or tumors develop in lungs.
Symptoms include chronic cough, shortness of breath, and bloody sputum.
More information about cancer appears later in this chapter.
NAs should know these facts about tuberculosis:
It is a highly contagious lung disease.
Symptoms include the following:
Coughing
Low-grade fever
Weight loss
Fatigue
Bloody sputum
Chapter 5 includes more information about TB and care guidelines

9. Skill: collecting a sputum specimen
Equipment: specimen container with completed label (labeled with resident’s name, date of birth, room number, date, and time) and lid, specimen bag, tissues, gloves, N95 or other ordered mask, laboratory slip
1. Identify yourself by name. Identify resident by name.
2. Wash your hands.
3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for resident’s privacy with curtain, screen, or door.
5. Put on mask and gloves. Coughing is one way that TB bacilli can enter the air. Stand behind the resident if the resident can hold the specimen container by himself.
6. Ask the resident to cough deeply, so that sputum comes up from the lungs. To prevent the spread of infectious material, give the resident tissues to cover his mouth while coughing. Ask the resident to spit the sputum into the specimen container.
7. When you have obtained a good sample (about two tablespoons of sputum), cover the container tightly. Wipe any sputum off the outside of the container with tissues. Discard the tissues. Apply label, and place the container in a clean specimen bag.
8. Remove and discard gloves and mask.
9. Wash your hands.
10. Place call light within resident’s reach.
11. Report any changes in resident to the nurse.
12. Take specimen and lab slip to proper area. Document procedure using facility guidelines.

10. Common diseases and disorders of the endocrine system
Diabetes
Types
Facts
Signs
Complications
Care guidelines
Signs and symptoms to report
Types of diabetes:
Type 1 diabetes is a type of diabetes in which the pancreas does not produce any insulin; is usually diagnosed in children and young adults and will continue throughout a person’s life.
Type 2 diabetes is a common form of diabetes in which either the body does not produce enough insulin or the body fails to properly use insulin; typically develops after age 35 and is the milder form of diabetes.
Pre-diabetes is a condition that occurs when a person’s blood glucose levels are above normal but not high enough for a diagnosis of type 2 diabetes.
Gestational diabetes is a type of diabetes that appears in pregnant women who have never had diabetes before but who have high glucose levels during pregnancy.
NAs should know these facts about diabetes:
Pancreas produces too little insulin or does not properly use 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.
The following can be signs of diabetes:
Excessive thirst
Extreme hunger
Frequent urination
Weight loss
Elevated blood sugar levels
Glucose (sugar) in urine
Sudden vision changes
Tingling or numbness in hands or feet
Feeling very tired much of the time
Very dry skin
Sores that are slow to heal
More infections than usual
Diabetes can lead to the following complications:
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 7).
Care guidelines for diabetes:
Follow diet instructions exactly.
Encourage the right portions of healthy food.
Encourage exercise.
Observe resident’s management of insulin doses.
Perform urine and blood tests as directed.
Give foot care as directed.
Encourage comfortable, leather footwear and cotton socks.
NAs should observe and report the following signs and symptoms in a resident with diabetes:
Skin breakdown
Change in appetite
Increased thirst
Change in urine output
Nausea or vomiting
Weight changes
Changes in mental status
Irritability
Nervousness or anxiety
Feeling faint or dizzy
Vision changes
Change in mobility
Change in sensation
Sweet or fruity breath
Numbness or tingling in arms or legs

11. Skill: providing foot care for the diabetic resident
Equipment: basin, bath thermometer, mild soap, washcloth, 2 towels, lotion, cotton socks, shoes or slippers, gloves
1. Identify yourself by name. Identify resident by name.
2. Wash your hands.
3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for resident’s privacy with curtain, screen, or door.
5. Fill the basin halfway with warm water. Test water temperature with thermometer or against the inside of your wrist. Ensure it is safe. Water temperature should be no higher than 105°F. Have resident check water temperature. Adjust if necessary.
6. Place basin on a bath towel on the floor (if the resident is sitting in a chair) or at the foot of the bed (if the resident is in bed). Make sure basin is in a position that is comfortable for the resident. Support the foot and ankle throughout the procedure.
7. Put on gloves.
8. Remove the resident’s socks, and completely submerge the resident’s feet in the water. Soak the feet for 10 to 20 minutes.
9. Put soap on a wet washcloth. Remove one foot from the water. Wash the entire foot gently, including between the toes and around nail beds.
10. Rinse the entire foot, including between the toes.
Equipment: basin, bath thermometer, mild soap, washcloth, 2 towels, lotion, cotton socks, shoes or slippers, gloves
1. Identify yourself by name. Identify resident by name.
2. Wash your hands.
3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for resident’s privacy with curtain, screen, or door.
5. Fill the basin halfway with warm water. Test water temperature with thermometer or against the inside of your wrist. Ensure it is safe. Water temperature should be no higher than 105°F. Have resident check water temperature. Adjust if necessary.
6. Place basin on a bath towel on the floor (if the resident is sitting in a chair) or at the foot of the bed (if the resident is in bed). Make sure basin is in a position that is comfortable for the resident. Support the foot and ankle throughout the procedure.
7. Put on gloves.
8. Remove the resident’s socks, and completely submerge the resident’s feet in the water. Soak the feet for 10 to 20 minutes.
9. Put soap on a wet washcloth. Remove one foot from the water. Wash the entire foot gently, including between the toes and around nail beds.
10. Rinse the entire foot, including between the toes.
Continue on next slide
Continue on next slide

12. Skill: providing foot care for the diabetic resident (continued)
11. Using a towel, pat the foot dry gently, including between the toes.
12. Repeat steps 9 through 11 for other foot.
13. Starting at the toes and working up to the ankles, gently rub lotion into the feet with circular strokes. Your goal is to increase circulation, so take several minutes on each foot. Do not put lotion between the toes.
14. Observe the feet, ankles, and legs for dry skin, irritation, blisters, redness, sores, corns, discoloration, or swelling.
15. Help resident put on socks and shoes or slippers.
16. Put soiled linens in appropriate container. Pour water into the toilet and flush it. Place basin in proper area for cleaning or clean and store it according to facility policy. Store supplies.
17. Remove and discard gloves.
18. Wash your hands.
19. Place call light within resident’s reach.
20. Report any changes in resident to the nurse.
21. Document procedure using facility guidelines.
11. Using a towel, pat the foot dry gently, including between the toes.
12. Repeat steps 9 through 11 for other foot.
13. Starting at the toes and working up to the ankles, gently rub lotion into the feet with circular strokes. Your goal is to increase circulation, so take several minutes on each foot. Do not put lotion between the toes.
14. Observe the feet, ankles, and legs for dry skin, irritation, blisters, redness, sores, corns, discoloration, or swelling.
15. Help resident put on socks and shoes or slippers.
16. Put soiled linens in appropriate container. Pour water into the toilet and flush it. Place basin in proper area for cleaning or clean and store it according to facility policy. Store supplies.
17. Remove and discard gloves.
18. Wash your hands.
19. Place call light within resident’s reach.
20. Report any changes in resident to the nurse.
21. Document procedure using facility guidelines.

13. Common diseases and disorders of the endocrine system
Hyperthyroidism
Facts
Hypothyroidism
NAs should know these facts about hyperthyroidism:
Thyroid produces too much thyroid hormone and cells burn too much food.
Causes weight loss, nervousness, hyperactivity
Usually treated with medication
Part of thyroid sometimes surgically removed
NAs should know these facts about hypothyroidism:
Thyroid produces too little thyroid hormone and body processes slow down.
Causes weight gain and physical and mental sluggishness
Sometimes treated with medication

14. Common diseases and disorders of the reproductive system
Sexually transmitted infections (STI)
Chlamydia
Syphilis
Gonorrhea
Genital herpes
Prostatic hypertrophy
Facts
Vaginitis
A sexually transmitted infection (STI) is an infection caused by sexual contact with infected people; signs and symptoms are not always apparent.
NAs should know these facts about sexually transmitted infections (STIs):
Diseases are passed through sexual contact, which includes intercourse (vaginal and anal), contact of the mouth with the genitals or anus, and contact of hands with the genitals.
Latex condoms can reduce the chances of STIs.
STIs are very common and can cause serious health problems.
Residents may be unaware of or embarrassed by symptoms.
HIV/AIDS is discussed in detail in the next learning objective.
NAs should know these facts about chlamydia:
Can cause pelvic inflammatory disease
Symptoms: yellow or white discharge from penis or vagina, burning with urination
Treatment: antibiotics
NAs should know these facts about syphilis:
If left untreated, can cause brain damage, mental illness, and death (untreated infection spreads to heart, brain, and other vital organs)
Symptoms: chancres, rash, sore throat, fever
Treatment: penicillin or other antibiotics
NAs should know these facts about gonorrhea:
Can cause sterility if untreated
Symptoms: men show greenish or yellowish discharge from the penis, burning with urination; women show no early symptoms
NAs should know these facts about genital herpes:
Caused by a virus
Treatment: antiviral drugs, but genital herpes cannot be cured
Person may have repeated outbreaks for life.
Symptoms of outbreaks: burning, painful, red sores on genitals
Babies born to infected women can be infected at birth.
Remember: STIs are not the only common disorders of the reproductive system. The following conditions are not STIs, but do affect the reproductive system.
NAs should know 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 or surgery
Remember: Men are at increased risk for prostate cancer as they age. Prostate cancer is usually slow-growing and responsive to treatment, so early detection is important.
NAs should know these facts about vaginitis:
Causes: bacteria, protozoa, or fungus
Bacterial vaginosis (BV) occurs when there is an overgrowth of normal bacteria inside vagina
Symptoms: white vaginal discharge, itching, burning
Treatment: oral medications, vaginal creams

15. Common diseases and disorders of the immune and lymphatic systems
HIV/AIDS
Facts
Signs and symptoms
Opportunistic infection
High-risk behaviors
Measures to protect against spread
Care guidelines
Cancer
Facts
Risk factors
Warning signs
Treatments
Care guidelines
Things to observe and report
NAs should know these facts about HIV/AIDS:
Acquired immunodeficiency virus is caused by HIV (human immunodeficiency virus).
HIV attacks the immune system and disables it.
AIDS is the final stage of HIV infection in which infections, tumors, and central nervous system symptoms appear.
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.
The following can be signs and symptoms of HIV/AIDS:
Flu-like symptoms
Appetite loss
Weight loss
Night sweats
Swollen lymph nodes
Severe diarrhea
Dry cough
Skin rashes
Painful white spots in mouth
Cold sores
Warts on the skin and in mouth
Inflamed and bleeding gums
Bruising that does not go away
Low resistance to infection
Kaposi’s sarcoma
Pneumocystis pneumonia, a lung infection
AIDS dementia complex
Remember: Opportunistic infections invade the weakened body of a resident with AIDS and worsen her condition. Treatment is medication. Drugs slow the progression of the disease, but there is no cure.
The following are high-risk behaviors for HIV/AIDS:
Sharing drug needles
Having unprotected or poorly-protected sex with an infected person
Having sexual contact with many partners
Sexual activity that involves exchange of body fluids with someone who has not tested negative for HIV or who has had many sexual partners
These measures can protect against the spread of HIV and AIDS:
Never sharing needles
Not having unprotected sex and using condoms during sexual contact
Staying in a monogamous relationship
Practicing abstinence
Getting tested for HIV
Following Standard Precautions
Remember: NAs do not need to be frightened of working with residents who have AIDS. There is no danger of transmission through casual contact like handshakes and hugs. Residents with AIDS need warm care and support just like all other residents.
Care guidelines for HIV/AIDS:
Residents with poor immune systems are more sensitive to infections. Wash hands often, follow standard precautions, and keep everything clean.
High-protein, high-calorie, high-nutrient meals can help maintain healthy weight.
Some people with HIV/AIDS lose their appetites. Help make mealtimes pleasant and relaxing, and 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. When nausea and vomiting persist, encourage liquids and salty foods. Help ensure adequate fluid intake.
If diarrhea is severe, doctor may order a BRAT (bananas, rice, applesauce, toast) diet. This is a helpful short-term solution.
Good rehydration fluids include water, juice, soda, and broth. Avoid caffeinated beverages.
Neuropathy is usually treated with medication. Going barefoot or wearing loose, soft slippers may help. A bed cradle may be used to keep sheets and blankets off legs and feet.
Residents may experience anxiety/depression. Treat them with respect and provide emotional support.
Provide safe environment and close supervision with ADLs.
Remember: Residents with AIDS may experience emotional stress and losses beyond those experienced by other residents. They may feel stigmatized by their illness and judged by those around them. They may have lost friends and loved ones to the disease, as well, or lost the love and friendship of people dear to them as a result of their diagnosis. NAs should be sensitive to these issues and provide support and care without judgment.
A resident’s HIV/AIDS status is confidential and cannot be discussed with anyone. This is the ethical way for an NA to work and it is also the law. Under HIPAA there are serious consequences for violations of resident confidentiality.
Cancer is a general term to describe a disease in which abnormal cells grow in an uncontrolled way.
NAs should know these facts about cancer:
General term used to describe a disease in which abnormal cells grow in an uncontrolled way
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 (metastasize), affecting other body systems.
Often first appears in breast, colon, rectum, uterus, prostate, lungs, or skin
The following may be risk factors for cancer:
Age
Race
Gender
Family history
Tobacco use
Alcohol use
Poor diet/obesity
Lack of physical activity
Chemicals and food additives
Radiation
Exposure to sunlight
The American Cancer Society has identified these warning signs of cancer:
Unexplained weight loss
Fever
Fatigue
Pain
Skin changes
Change in bowel or bladder habits
Sores that do not heal
Unusual bleeding or discharge
Thickening or lump in breast, scrotum, or other parts of body
Indigestion or difficulty swallowing
Recent change in wart or mole
Nagging cough or hoarseness
There are three primary treatments for cancer:
Surgery
Chemotherapy
Care guidelines for cancer:
Each case is different. Do not make assumptions.
Respect residents’ needs and be sensitive. Maintain a positive attitude.
Try plastic utensils for residents receiving chemotherapy. Encourage a variety of foods.
Watch for signs of pain and report them to the nurse.
Offer back rubs and repositioning to help with comfort and increase circulation.
Use lotion on dry skin. Do not remove markings.
Reposition residents.
Help residents with oral care often. Use a soft-bristled toothbrush and baking soda rinse. Be gentle.
Provide help with grooming.
Encourage visitors. Suggest good times of the day for visits. Get to know residents’ interests.
Be alert to unmet needs or stresses.
NAs should observe and report the following signs and symptoms of cancer:
Increased weakness or fatigue
Nausea, vomiting, diarrhea
Changes in appetite
Fainting
Signs of depression (Chapter 20)
Confusion
Blood in stool or urine
Change in mental status
Changes in skin
New lumps, sores, rashes
Increase in pain or unrelieved pain
Blood in the mouth
Women commonly get breast cancer and may have a mastectomy as treatment. Special arm exercises or deep breathing exercises may be ordered for residents who have had a mastectomy. NAs should always follow the care plan and the nurse’s instructions.
There are many services and support groups available for people who are ill and for the families and caregivers.

16. Community resources for residents who are ill
The following groups may be of assistance:
American Cancer Society (cancer.org)
National Association of Area Agencies on Aging (n4a.org) provides Eldercare Locator.
Many organizations assist those dealing with HIV/AIDS:
aids.gov
cdc.gov/hiv
aidsinfo.nih.gov
The following groups may be of assistance:
American Cancer Society (cancer.org)
National Association of Area Agencies on Aging (n4a.org) provides Eldercare Locator.
Many organizations assist those dealing with HIV/AIDS:
aids.gov
cdc.gov/hiv
aidsinfo.nih.gov

17. review
Describe common diseases and disorders of the integumentary system
Describe common diseases and disorders of the musculoskeletal system
Describe common diseases and disorders of the nervous system
Describe common diseases and disorders of the circulatory system
Describe common diseases and disorders of the respiratory system
Describe common diseases and disorders of the endocrine system
Describe common diseases and disorders of the reproductive system
Describe common diseases and disorders of the immune and lymphatic system
Identify community resources for residents who are ill
Common diseases for each of the body systems were discussed as well as special care considerations for the NA to understand. Community resources for residents who are ill were provided.