Module 13 Long-Term Care for Residents

Module 13, Long-Term Care Resident. Section 1, Define Key Terminology. A, Review the terms listed in the terminology section. B, Spell the listed terms accurately. C, Pronounce the terms correctly. And D, Use the terms in their proper context. Section 2, Common Basic Human Needs and Interventions for the Elderly Patient or Resident. Environmental. Psychological, social, recreational and spiritual. A. Environmental or physical. Safety, more light for better vision. Freedom from hazards. Support, such as adaptive devices. And good personal hygiene. Shelter, appropriate living situation. Environmental control, such as heating or air conditioning. Nourishment, balanced nutrition, and adequate fluids. Be psychological. Maintaining self-esteem through respectful treatment and recognition of individual differences. Adjustment to role change and loss of independence. Respect privacy. Give choices. And encourage activities. See social. Social interactions encourage family involvement and encourage social or community activities. Adjustment to losses, such as the death of a spouse or friend, encourage verbalization, such as reminiscing, and encourage new social contacts. Financial changes in income interfere with meeting basic needs of security, love, belonging, and self-esteem. Refer to social service. D. Recreational. Diversion. Encourage hobbies. Involve facility and community events. And encourage family involvement. Self-esteem. Encourage involvement. Give compliments. And reinforce positive traits or abilities. E. Spiritual. Provide respect for individual choices. and provide opportunities to participate in religious activities. Section 3, Common Community Resources to Meet the Needs of the Elderly. Area Agency on Aging, or the AAA. Adult Day Care Center. Support Groups, like the American Diabetes Association. Braille Institute or Blind Center. Alzheimer's Society. Parkinson's Support. Multiple sclerosis support, muscular dystrophy, and hospice or bereavement. County Health Center, community hospitals and their hospice, internal revenue service information, long-term care ombudsman, Meals on Wheels, Medicare office through Social Security, Mental Health Department, National Alliance for the Mentally Ill, American Disabilities Act. Adult Protective Services, Red Cross or Blood Pressure Clinic, Senior Center, Senior Housing, Social Security Office Suicide Prevention, Home Health Agencies, Voter Registration, American Association of Retired Persons, Fraternal and Social Organizations, Regional Centers, and Churches and Religious Organizations. Section 4. Special Needs of Persons with Developmental and Mental Disorders, including Intellectual Disabilities, Cerebral Palsy, Epilepsy, Parkinson's Disease, and Mental Illness. A. Epilepsy or Seizure Disorders. Different types of epilepsy and seizure disorders. General Seizure or Grand Mal, Partial Seizure, Petite Mal, Absent Seizure. Status epilepticus. Potential causes. Metabolic disorders. Nutrition problems and medication problems. Signs or symptoms. Depends on the type of seizure. May experience an aura or certain taste before entire body is involved. May experience loss of consciousness. Incontinence. May be followed by periods of fatigue, confusion, or disorientation. The nurse assistant duties and response. Stay with the person and call for assistance. Assist in laying down. Do not restrain movements or put anything in the mouth. Move away objects that may injure a person. Maintain airway by loosening clothing. Turn head so saliva or emesis drains to one side. Lift shoulder and allow head to tilt back. Parkinson's disease. Description and progression of disease. It's a progressive nervous disorder that affects movement. Early stages of Parkinson's disease may be mild and go unnoticed, but his symptoms worsen as the condition does progress over time. Certain nerve cells called neurons in the brain gradually break down or die, which causes a loss of neurons that produce a chemical messenger in your brain called dopamine. Signs and symptoms. They start gradually, sometimes starting with a... barely noticeable tremor in just one hand, tremors and pill rolling, muscle rigidity, a shuffling manner of walking, difficulty and slowness in carrying out voluntary motor activities, slurred speech, loss of expressiveness in the face, drooling, incontinence, constipation, urinary retention, mood swings, depression, and fatigue. The nurse assistant duties and responsibilities. Safety activities and concerns. Nutrition problems including swallowing and or chewing issues. Notify a licensed nurse if behavior worsens or becomes dangerous. Maintain a calm environment. Symptoms will worsen when the patient or resident is under stress. Assist in ADLs. Provide emotional support. Restorative care. such as exercises and dementia care. C, schizophrenia, a mental disorder characterized by paranoia, hallucinations, delusions, bizarre behavior, and distortions of reality. Know the signs and symptoms. Nurse assistant duties and responsibilities. Notify licensed nurse if behavior worsens or becomes dangerous. Do not feed into delusions. but do not try to convince them of reality. Be aware of suicide precautions. Keep the patient or resident involved in reality activities. Report and document observed responses to medication and psychotherapy. Monitor nutrition and fluid balance. These patients or residents often refuse to eat or drink out of fear of poisoning. And find ways of reducing the patient or resident's fear and anxiety. D. Hypochondriasis. The patient or resident imagines or magnifies each physical ailment. The nurse assistant duties and responsibilities include to be supportive. Some authorities feel this disorder stems from depression. Do not overlook real illness and report all complaints. And do not judge. E. Depression. The most common functional disorder in older people. Signs and symptoms. The feelings of sadness, lack of interest in and withdrawal from environment, feelings of worthlessness, and negative outlook on the future. Nurse assistant duties and responsibilities. Notify a licensed nurse if the patient or resident displays loss of appetite, weight loss, severe fatigue, crying, or sleeplessness. Notify a licensed nurse of the patient or resident. Make statements such as, I wish I could just die. Remain non-judgmental. Listen with empathy. Encourage activities with others. And encourage aerobic activity as well as outdoor activities. They release endorphins. E. Suicidal patient or resident. Elderly patients or residents are at risk of suicide behavior. Especially white males over the age of 65 who live alone and the very old, 75 years and above. Nurse assistant duties and responsibilities. Report clues of suicide attempts to a licensed nurse. Give constant care. Monitor activities. Work to preserve self-esteem. Help the patient or resident find a support network, such as friends, clergy, family, and support groups. Never ignore the person's statements or threats about suicide. F. Intellectual or developmental disabilities. A. Significant sub-average intellectual function and low adaptive ability. The nurse assistant duties and responsibilities include providing an environment as normal as possible, normalization, emphasize individual strengths, encourage independence such as self-care, treat with dignity at age-appropriate level, respect privacy, and provide a safe, structured environment. G. Cerebral Palsy, a group of disorders characterized by motor dysfunctions. The nurse assistant duties and responsibilities. Provide a safe and structured environment. Apply appropriate assistive devices. Emphasize individual strengths. Encourage independence. Treat with dignity and respect privacy. H, alcoholism or drug abuse. Abuse of alcohol or drugs. when healthy coping mechanisms have failed. 15% of elderly suffer from alcoholism. It's often triggered by retirement, loss of self-esteem, loneliness, chronic pain, a decline in health, and stress. The nurse assistant duties and responsibilities include report to the licensed nurse any sign that the patient or resident is under the influence of alcohol or drugs. Be sure alcohol or drugs are not available. Alcohol can be in products such as aftershave, perfume, cooking extracts, and cleaning products. Watch for mental impairment or loss of coordination and poor judgment. Be careful when feeding. Gag reflex may be impaired. Set boundaries. Avoid being manipulated. Be aware of support groups such as Alcoholics Anonymous or the Mental Health Association. Notify a licensed nurse if signs of withdrawal appear, alcohol tremors, shaking, agitation or seizures, drugs such as a runny nose, depression, headache, pacing, poor coping mechanisms or agitation. Follow the patient's or resident's care plan and be aware of dangerous behavior. I, the agitated patient or resident, uses inappropriate verbal, vocal, or motor activity due to causes other than disorientation or real need. The nurse assistant duties and responsibilities include reporting to a licensed nurse any sign of agitation, including aimless wandering, pacing, cursing, screaming, spitting, biting, fighting, arguing, demanding, and talking to self. Maintain a quiet, calm atmosphere. Encourage distracting activities. Check for constipation or other sources of discomfort or pain. Realize that the patient or resident may become more agitated due to feelings of loss of control. Avoid restraints. Allow the patient or resident to walk or rock in a chair to diffuse energy. Listen with empathy. Make sure you stay safe. Maintain an area to escape. Don't let the patient or resident get between you and the door. Call for help if the patient or resident gets violent and do not attempt to control the patient or resident if they become violent. Redirect. Section 5. Section 5. The special needs of persons with Alzheimer's disease and other related dementias. A. Causes and differences of delirium, depression, and dementia. Dementia is a general term for a decline in mental ability severe enough to cause a decrease in the ability to live. to interfere with daily life. Dementia describes a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with your daily life. Not a specific disease, but several different diseases may cause dementia. Delirium is a serious disturbance in mental abilities that results in confused thinking and reduction in awareness of the environment. Depression is a mood disorder. that causes a persistent feeling of sadness and loss of interest. It affects how you feel, think and behave, and can lead to a variety of emotional and physical problems. Dementia and delirium may be particularly difficult to distinguish, and a person may have both. The causes are not exactly known, but as with many mental disorders, a variety of factors may be involved, such as brain chemistry, hormones, Traumatic or stressful events Abuse of alcohol or recreational drugs Serious or chronic illness, including cancer stroke, chronic pain or heart disease, certain medications or drug toxicity, malnutrition or dehydration, and sleep deprivation. Common signs and symptoms include memory loss, which is usually noticed by a spouse or someone else, difficulty in communicating or finding words, difficulty with visual or spatial abilities, such as getting lost while driving, difficulty reasoning or problem solving. Difficulty in handling complex tasks. Difficulty with planning and organizing. Difficulty with coordination or motor functions. Confusion and disorientation. Personality changes. Anxiety. Paranoia. Agitation. Hallucinations. The signs and symptoms and progression of Alzheimer's disease and other dementias. Alzheimer's disease. Caused by plaques and tangles in the brain's nervous system, the brain decreases in size as cells are lost. It's progressive and incurable. Signs and symptoms stage 1. Mild dementia. Short-term memory loss. Personality changes. Disorientation to time. Poor judgment. Lack of safety awareness. Carelessness in appearance. Anxious. Depressed. Delusions of persecution. Stage 2. Moderate Dementia. Increased short-term memory loss. Complete disorientation. Wondering and pacing. Sundowning. Perseveration phenomena. Motor skills deteriorate. Speech, reading, writing deteriorates. Incontinent of bowel and bladder. And catastrophic episode. Severe dementia. Total dependence. Verbally unresponsive. and may have seizures. Explain the nursing care received by persons with Alzheimer's disease and other dementias. Protect the patient or resident from injury. Be compassionate, patient and calm. Maintain a sense of humor. Encourage independence as long as possible. Provide mental and physical activities within residents'capabilities. Support residents'dignity and self-esteem. Provide structured, quiet environment that is uncluttered. Use appropriate body language. The residents will read the staff's behavior and reflect the mood of the staff in their own behavior. Give one short simple direction at a time. Observe for signs and symptoms of physical ailments. Resident may be unaware of illness. Assist residents to maintain a dignified, attractive appearance by helping with grooming and dressing. Monitor food and fluid intake. Do not use plastic feeding utensils. Provide nutritious finger foods when the resident is unable to use a utensil. Be aware of swallowing difficulties. Prepare food, such as butter bread, cut into bites, and encourage the resident to feed self for as long as possible. Check food temperatures. Check the resident's mouth after eating for pocketing or hoarding food in the cheeks. Weigh resident to detect patterns of weight gain or loss. Use touch appropriately. Surprising the resident can result in a catastrophic reaction. Avoid using logic, reasoning, or lengthy explanations. When the ability to speak is lost, the resident may communicate through non-verbal means, such as biting, scratching, and kicking to express displeasure. Facial expressions and body language may express moods. Identify specific activities. that would improve the quality of life for persons with Alzheimer's disease and other dementias. Use distraction and diversion when a resident is agitated. Take their hand and calmly walk to another activity. Realize that people with dementia are not responsible for what they say. They cannot change. They are not aware of what they are doing. They have poor impulse control. Allow them to save face by preserving their dignity. No one really knows what is happening in the mind of a person with dementia. Complement positive behavior and accomplishments, and encourage rocking chairs to diffuse nervous energy. Identify specific safety measures for Alzheimer's and dementia populations. Use Reality Orientation, RO, to regain connection to environment, especially effective in the first stages of Alzheimer's. Use a clock and a calendar. at bedside and call by name. Answer questions honestly, but do not give information they are unable to handle. For example, The resident asks if their deceased husband is coming to visit. Nurse assistant could respond by saying, tell me about your husband. Do not argue with the resident's reality. Use bulletin boards decorated for the season. Keep curtains open during the day. Make sure they have their glasses and hearing aids on. Do not expect resident to remember you. Identify yourself as needed. Incorporate validation therapy into all your interactions. with dementia resident. Maintains disoriented person's dignity by acknowledging the person's memories and feelings. Use reminiscing therapy. Incorporate music therapy. Incorporate animal therapy. Identify at-risk behaviors that include modifiable or non-modifiable factors, as well as increased risk for abuse. Research has shown that the same risk factors associated with heart disease may also increase the risk of Alzheimer's disease. These include lack of exercise, obesity, smoking or exposure to secondhand smoke, high blood pressure, high cholesterol, poorly controlled type 2 diabetes, sleep patterns, age, and family history and genetics. Section 6, the body's basic organization and composition. A, anatomy structure, physiology function. B, The cell, the basic unit of body structure, building blocks of the body. Their function, size, and shape of cells may differ. Cells need food, water, and oxygen to survive. C, tissues, groups of cells with similar functions. Four basic types of tissues in the body. Epithelial tissue, which is protective. Connective tissue, support and connect. Muscle tissue, shorten and connect. and lengthen. Nerve tissue, carrying electrical impulses. D, organs, made up of different types of tissues, and they perform special functions. E, systems, groups of organs that work together to perform specific functions. 10, major body systems. Integumentary system, respiratory system, cardiovascular system. Musculoskeletal system, endocrine system, nervous system, gastrointestinal system, urinary system, reproductive system, and immune system. F, health, state of mental, physical, and social well-being. G, disease, any change from the healthy state. Section 7. The body systems, including basic anatomy and physiology, common diseases of the elderly, signs and symptoms, and nurse assistant duties and observations. A. Integumentary system. Anatomy. The epidermis is the top surface layer. It is primarily dry, dead cells that shed continuously. It is a thin layer with no blood supply, functions as a barrier to water loss, and prevents infection. Dermis is the second layer, varies in thickness in different areas of the body, naturally very moist, gives skin its strength, contains blood vessels, lymph vessels, nerve endings, oil glands, and hair follicles. The function of the dermis is to aid in body temperature control and is the origin of our sense of touch, pressure, and pain. Subcutaneous tissues are deep tissues beneath the dermis. Tissues are fat, and connective tissue. These tissues do not tolerate lack of oxygen and cell death results easily. Functions. Provides a protective barrier against microorganisms and infection. Provides sensation through nerve endings. Shields the body's tissue from injury. Regulates body temperature. Eliminates waste products. Produces vitamin D for the body to use. Prevents loss of too much water and is the largest organ of the body. Diseases and disorders. Skin lesions and wounds are changes in the skin structure caused by injury, trauma, aging, or disease. Signs and symptoms. Rash. Raised spots filled with pus or fluid. C. Cardiovascular system. Anatomy and physiology. The heart pumps blood which carries oxygen and nutrients to cells. Blood. transports oxygen food and hormones to cells, removes carbon dioxide and other waste products from cells, Controls pH level and body temperature. Clots the blood and fights pathogens and poisons. Blood vessels. Arteries carry blood away from the heart. Veins carry blood towards the heart. Capillaries, the smallest vessels, they connect arteries and veins. Functions. Transportation system that delivers nutrition and oxygen to the cells and takes away waste products. It's a closed system. It's kept in motion by the force of the heart. Common diseases and disorders. Coronary artery disease occurs when the coronary arteries narrow, causing a reduction in blood supply to the heart, depriving the heart muscle with oxygen and nutrients. Signs and symptoms are chest pain, pain in the back, neck, jaw, arm, shoulder, or back, dyspnea, cyanosis of lips, mucous membranes, and nail beds, and dizziness. The nurse assistant duties and observations. Remain with the patient or resident. Notify a licensed nurse immediately if the above signs and symptoms are noted. Myocardial infarction or heart attack. Definition. A clot in the coronary artery causes a blockage of the blood supply to the heart. Damaged area can no longer function and turns to scar tissue. Signs and symptoms. Sudden, severe pain in the chest, usually described as crushing. Radiating pain to the arm, jaw, neck, or back. may present as indigestion or heartburn, diaphoresis, cool, clammy skin, dizziness, pallor or cyanosis, dyspnea, shortness of breath, weak irregular pulse, low blood pressure, loss of consciousness, nausea and vomiting, restless, anxious, feeling of impending doom, and denial. Nurse Assistant Duties and Observations. Notify a licensed nurse immediately if the above signs and symptoms are noted. Remain with the patient or resident. Place the patient or resident in a comfortable position and loosen clothing. Encourage the patient or resident to rest. Reassure the patient or resident that help is coming. Monitor vital signs. Do not give the patient or resident liquids or food and prepare to transfer to an acute care facility. Congestive heart failure. Definition. Occurs when the heart does not pump well enough to meet the body's needs. Normal cardiac output cannot meet the needs for activities of daily living. Can be left-sided or right-sided or both. Signs and symptoms. Hemoptysis. Spitting up blood. Cough. Dyspnea. Orthopnea. Difficult breathing while lying down. Fatigue. Decrease in ability to exercise and to be active. Confusion. Increased pulse. Possible irregular heartbeat. Increased frequency of urination at night. Cyanosis. Edema in the extremities. Moist respirations. High blood pressure. Nurse assistant duties and observations. A low sodium diet. Raise head of bed. Fluid restriction if ordered. Anti-embolic stockings, assist with ADLs, range of motion to improve muscle tone, assist with O2 therapy, measure intake and output, measure daily weight, bedside commode is indicated, check vital signs, monitor apical pulse for one full minute, report if drops below 60, and pace their activities. Peripheral vascular disease or PVD. Definition. A condition in which the blood supply to the legs, feet, arms, or hands is decreased due to poor circulation. Can be arterial or venous. Signs and symptoms. Painful cramping in the hips, thighs, or calves when walking. Painful cramping in the legs that does not go away. Cyanotic hands or feet. Blue or gray tinged. Arms or legs feel cool and cold to the touch. Edema in the hands and feet. Ulcers on the legs or feet that are slow to heal or don't heal. And gangrene. Nurse assistant duties and observations. Encourage the patient or resident to follow special diet or fluid restriction. Record accurately intake and output. Monitor for increased edema. Monitor vital signs and report any changes, especially in pulse or blood pressure. Report to nurse any complaints of pain or discomfort. Comfort in the hands, legs, or feet. Report any type of chest, back, jaw, or shoulder pain or discomfort. Apply anti-embolic stockings, if ordered. Anemia, a condition that results from a decrease in the quantity and quality of red blood cells. Signs and symptoms. Lethargy, pale or jaundiced. Dyspnea, digestive problems. Rapid pulse and increased respiratory rate. Cold and dizzy. Nurse assistant duties and observations. Provide nutritional meals. Increase iron-containing foods like red meat and green leafy vegetables. Notify licensed nurse of signs of bleeding or black stool. Monitor vital signs. Observe for and notify if above signs and symptoms appear or worsen. Hypertension. High blood pressure. Signs and symptoms. Blood pressure elevated above 140 systolic. and or 90 diastolic, a nosebleed, eye hemorrhage, dizziness, trembling, red complexion, headache, and blurred vision. The nurse assistant duties and observations. Monitor blood pressure. Assist with stress management techniques. A low sodium diet. Assist with weight loss efforts. Encourage regular exercise. Notify licensed nurse of above symptoms are noted. Other related subjects, optional, are pacemakers, angina, varicose veins, atherosclerosis, internal defibrillation, anemia, and blood types. D, musculoskeletal system, anatomy and physiology. Bones are the hard, rigid structures made of connective tissue and cells. Joints, the point at which two or more bones meet. and allow body movement. Muscle allows movement of body parts, maintains posture, and produces body heat. Functions gives shape and form, maintains posture, permits movement, protects internal organs, stores calcium and phosphorus, produces heat, and produces some blood cells. Forms the framework that supports the body and allows for movement. Common diseases and disorders. Arthritis. An inflammation of the joints consisting of rheumatoid, joint tissue lining is affected, osteoarthritis, cartilage covering the ends of bones deteriorates and ends of bones rub together causing pain and deformity, gout, a metabolic disease caused by deposits of crystals at joint due to increase in uric acid. The signs and symptoms are pain at the joint, deformity at the joint, swelling, tenderness, Heat at the inflamed site and fatigue. Nurse assistant duties and observations. Notify a licensed nurse if the patient or resident requests medication for discomfort. Balance, rest, and exercise. Range of motion when no pain or inflammation. Rest joint if pain or inflammation. Prevent contractures. Fractures. A break in the continuity of the bone. Signs and symptoms, and they vary with the type of fracture. Pain, swelling, bruising at the fracture site. Exposed broken bone through the skin, called a compound fracture. Immobility of the area affected and deformity. Nurse assistant duties and observations. Keep area immobilized. Cast or splint. Report pain. Reduce edema. Elevate area affected. Maintain alignment. Cast care. No breaks, chips. Check for distal pulses. Check color, movement and sensation, distal to cast. Report signs of infection. Osteoporosis, caused by lost bone mass and results in porous, spongy bones that are easily fractured. Most common in elderly females. The signs and symptoms. Fracture from very little or no trauma, often in the hip or low back. Curvature of spine. Loss of height. Progressive weakness. Nurse assistant duties and observations. Prevent further fractures. Report pain. Gentle range of motion. Apply splints or braces as ordered. Encourage high calcium meals such as milk, dairy products, and green leafy vegetables. Mechanical lift for transfers. Gentle handling and positioning. A fractured hip. Fracture of the femur. Most frequent causes falling and osteoporosis. The signs and symptoms. Cannot get up after a fall. Affected side is shortened and externally rotated. Severe pain. in the hip or knee, edema in the hip, thigh and groin, nurse assistant duties and observations. Pre-surgery hip precautions. Avoid moving the patient or resident until instructed by licensed nurse. Use a sheet or backboard to move. Post-surgery hip precautions. Do not flex hip more than 90 degrees. Do not cross affected leg over midline of body. Do not internally rotate hip. unaffected side. Do not passive range of motion, unaffected side. No weight bearing for several weeks after surgery. Use fracture bedpan. Maintain proper hip alignment. May use trochanter roll and abduction pillow. Other related subjects optional. Fibromyalgia, traction, continuous passive motion, CPM machine, back injuries. such as a ruptured disc or extremity amputation. E. Endocrine system. The anatomy and physiology. The pituitary gland. The master gland. Thyroid. Controls metabolism. Pancreas. Secrets insulin to promote glucose use by the cells. Adrenals. Secrets adrenaline for the fight or flight hormone. Function. Network of glands that secrete hormones into the bloodstream. Common diseases and disorders. Diabetes mellitus, a chronic disease that results from a deficiency of insulin or resistance to the effects of insulin. The body is unable to properly process food and convert food into energy. There are two types of diabetes. Type 1, insulin-dependent diabetes mellitus or IDDM. Type 2, non-insulin-dependent diabetes mellitus and IDDM. The signs and symptoms. The three polys. Polyuria. Excessive urination. Polydipsia. Excessive thirst. And polyphasia. Excessive hunger. Fatigue. Skin infections that are slow to heal. Itching. Burning on urination. Vision changes. Hyperglycemia. Caused by inadequate insulin for metabolic needs. This develops slowly over a 24-hour period. period, can cause confusion, drowsiness, slow slippage into coma, headache, a sweet fruity odor to the breath, deep breathing, low blood pressure, nausea or vomiting, flushed, dry, hot skin, unconsciousness, sugar in the urine, and high blood sugar on glucose monitoring. Hypoglycemia occurs when blood glucose is below normal. most commonly from overdose of insulin. Insulin shock or insulin reaction occurs rapidly. Hunger, weakness, dizziness, shakiness, skin moist and clammy, rapid and shallow respirations, nervous and excited, rapid pulse, unconscious, no sugar in the urine, and low blood sugar glucose monitoring. Nurse Assistant Duties and Observations. Know the signs and symptoms of hyperglycemia and hypoglycemia. Notify a licensed nurse immediately if diabetic symptoms appear. Offer meals and snacks at regular intervals. Report uneaten portions. Be aware that illness, stress, and infection can make blood sugars increase. Observe extremities for infection, trauma, or wounds, especially the feet. Notify a licensed nurse if the patient or resident vomits after a meal. Offer easily assimilated sources of carbohydrates if signs of hypoglycemia occur after notifying a licensed nurse. Make sure the right diet is given. Urine testing for sugar and acetone. Rarely done in LTC now. Special foot care. Wash daily and dry between toes. Inspect feet for signs of irritation. Toenails to be cut by licensed nurse or podiatrist only. Shoes and stockings to be worn at all times when out of bed. Never go barefoot. Check for anything that impairs circulation. Remember, diet, exercise, and medication are the most important components of diabetic treatment. Related subjects which are optional. Hyper and hypothyroidism. Cushing's and Addison's disease. And glucose monitoring. F. nervous system, anatomy and physiology, the brain, center of conscious thought, and Voluntary action. Motor coordination. Centers of control for respiration, heart function, and body temperature. The spinal cord. Transmission of impulses to and from the brain. Approximately 17 inches long and protected by a spinal column. Vertebrae. The peripheral nerves. Transmission of impulses to and from the spinal cord. Connects the CNS with various structures of the body. Sensory organs. Eyes, nose, tongue, skin, and ears. The functions. Controls, directs, and coordinates functions of the body. There are two major divisions. The central nervous system and the peripheral nervous system. Common diseases and disorders. Dementia. Any disorder of the brain that causes deficits in thinking, memory, and judgment. Causes. Alzheimer's disease, the most common. Multiple Infarction Dementia, Multiple TIAs, Parkinson's Disease, Syphilis, AIDS, Nutrition Problems, Medication Problems, Depression, and Metabolic Disorders. Alzheimer's Disease. Caused by plaques and tangles in the brain's nervous system. Brain decreases in size as cells are lost. It is progressive and incurable. Signs and Symptoms. Stage 1. Mild Dementia. Short-term memory loss, personality changes, disorientation to time, poor judgment, lack of safety awareness, carelessness in appearance, anxious and depressed, and delusions of persecution. Stage 2 moderate dementia, increased short-term memory loss, complete disorientation, wandering and pacing, sundowning, perseveration phenomenon, motor skills deteriorate. Speech, reading, and writing deteriorates. Incontinent of bowel and bladder. And catastrophic episode. Stage 3, severe dementia. Totally dependent, verbally unresponsive, and may have seizures. Nurse assistant duties and observations for patient or resident with dementia, all types. Protect the patient or resident from injury. Be compassionate, patient, and calm. Maintain a sense of humor. Encourage independence as long as possible. Provide mental and physical activities within patient or resident's capabilities. And support the patient or resident's dignity and self-esteem. Provide structured, quiet environment that is uncluttered. Use appropriate body language. Patient or residents will read the staff's behavior and reflect the mood of the staff in their own behavior. Give one short, simple direction at a time. Observe for signs and symptoms of physical ailments. The patient or resident may be unaware of illness. Assist the patient or resident to maintain a dignified, attractive appearance by helping with grooming and dressing. Monitor food and fluid intake. Do not use plastic feeding utensils. Provide nutritious finger food when the patient or resident is unable to use utensils. Be aware of swallowing difficulties. Prepare food. and encourage patient or resident to feed self as long as possible. Check food temperatures. Check patient or resident's mouth after eating for pocketing, such as hoarding food in the cheeks. Weigh patient or resident to detect patterns of weight gain or loss. Use touch appropriately. Surprising a patient or resident can result in a catastrophic reaction. Avoid using logic, reasoning, or lengthy explanations. When the ability to speak is lost, patient or resident may communicate through non-verbal means. Biting, scratching, and kicking to express displeasure. Facial expressions and body language may express moods. Observe for what triggers agitation or anger and work on prevention. Use distraction and diversion when a patient or resident is agitated. Take the hand and calmly walk to another activity. Realize that people with dementia are not responsible for what they say. They cannot change. They are not aware of what they are doing. They have poor impulse control. Allow them to save face by preserving their dignity. No one really knows what is happening in the mind of a person with dementia. Be aware of wondering and pacing concerns. Keep record to detect patterns of wondering and pacing. Some triggers are as follows. Noise. Keep quiet and avoid crowds. Boredom. Give activities. Unmeant physical needs. Evaluate needs. Stress, create a calm environment. Pain, evaluate for sources of discomfort. Hunger, offer frequent snacks. Thirst, encourage fluence. Need to use the restroom, take to restroom at least every two hours. Looking for companionship, security or loved one. Therapeutic touch, talk and consistency. Physical restraints, feel threatened. Looking for a state of mind. Not a physical location. If they are in an area that they shouldn't be, calmly take their hand and redirect them to a safe area. Avoid large members. Avoid large numbers of staff approaching the patient or resident. Use positive directions. Stay inside instead of don't go outside. Use gentle persuasion. Complement positive behavior and accomplishments. Encourage rocking chairs to diffuse nervous energy. Be aware that sundowning, increased agitation and confusion in late afternoon or evening, can occur and how to prevent it. Avoid over-fatigue. Encourage the patient or resident to remain awake as much as possible during the day. The evening meal should be at least two hours before bedtime. Eliminate caffeine. Evening activities should be quiet and calm. Soft music is calming. Give a massage or back rub. A light bedtime snack. Follow bedtime routine. Check with family members. Check lighting. Shadows and reflections can be disturbing. Discourage pillaging and hoarding. Label all patient or resident's belongings to identify if they are taken by confused patient or resident. Check room daily for stale food. Keep patient's or resident's hands busy. Provide a rummaging drawer or box for the patient or resident. Use Reality Orientation, RO, to regain connection to environment. Especially effective in the first stages of Alzheimer's. Use a clock or calendar at the bedside. Call by name. Answer questions honestly, but do not give information they are unable to handle. For example, the patient or resident asks if their deceased husband is coming to visit. Nurse assistants should respond by saying, Tell me about your husband. Do not argue with the patient or resident's reality. Use bulletin boards decorated for the season. Keep curtains open during the day. Make sure they have their glasses and hearing aids on. Do not expect the patient or resident to remember you. Identify yourself as needed. Use reminiscing therapy. Encourage sharing memories of past events. Use prompting questions to show interest in their history. Use active listening skills. Realize the need to reminisce increases as we age. Reminiscing serves as a life review and may validate the worth of their life. Acknowledge validity of feelings and emotions. Be comfortable with patient or resident's tears as well as laughter. Reminiscing helps people adapt to aging by maintaining self-esteem and working through personal loss. Incorporate validation therapy into all your interactions with dementia patient or residents. Maintains disoriented person's dignity. by acknowledging the person's memories and feelings. This therapy, developed by Naomi Fail, may be a way for the patient or resident to work through issues from the past that were unresolved. Helps them maintain identity and dignity by having pictures of reminders of who they once were in their room. Realize that there is a reason for all behavior. What appears to be confusion can be the person acting on an experience long ago. Disoriented people have the right to express emotions. Living must be resolved in order to prepare for dying. To live in reality is not the only way to live. Disoriented people have worth. They can still experience joy, pleasure, and the ability to appreciate kindness. Within each confused person is a human being that once was a child and later an adult, with hopes, joys, sadness, failures, and successes. They deserve to be respected, cared for, and loved in their final years. This therapy has been effective on lessening the need for restraints. Incorporate music therapy and incorporate animal therapy. Stroke, a complete or partial loss of blood supply to cells of the brain. Signs and symptoms, loss of sensation, paralysis, hemiplegia, aphasia, dysphagia. Emotional ability, loss of consciousness and confusion, cognitive impairments, the nurse assistant duties and observation. Report changes in level of consciousness, headache, or change in motor ability to a licensed nurse. Sudden onset of symptoms indicates probable stroke. Prevent complications of immobility. Begin restorative care. Assist with ADLs. Encourage the patient or resident to do as much as possible, but be supportive emotionally. Patience is vital. Explore alternative methods of communication. if unable to speak. Be aware of swallowing, choking difficulties when feeding. Incorporate reality orientation into care, such as a clock, calendar, open curtains, transient ischemic attacks or mini-strokes, multi-infarction dementia, multiple transient ischemic attacks or TIAs, caused by lack of oxygen to the brain cells. Signs and symptoms are temporary. and subside when circulation is improved. Parkinson's disease. Signs and symptoms. Tremors and pill rolling. Muscle rigidity. Difficulty and slowness in carrying out voluntary motor activities. Shuffling manner of walking. Slurred speech. Loss of expressiveness in face. Drooling. Incontinence. Constipation. Urinary retention. Mood swings. And depression. The nurse assistant duties and observations. Maintain a calm environment. Symptoms will worsen when patient or resident is under stress. Assist in ADLs. Provide emotional support. Restorative care such as exercises and dementia care. Seizure disorder. Reoccurring transient attacks of disturbed brain function. Signs and symptoms. Generalized seizure or a grand mal. may experience aura or certain taste before seizure occurs, jerking and twitching of the body occurs, entire body is involved, may experience loss of consciousness, incontinence and may be followed by period of fatigue, confusion and disorientation. A partial seizure or petite mal, momentary loss of muscle tone, may have periods of unconsciousness, may chew, blink or breathe rapidly. They can last from 2 to 10 seconds. Absence seizures in children can result in poor learning in school. Only one extremity or part of an extremity may be involved. Status epilepticus. Seizure lasts for a long time. It is a serious medical emergency and life-threatening. Death may resolve. Nurse assistant duties and observations. During a seizure, stay with the person and call for assistance. Assist in lying down. Do not restrain movements or put anything in the mouth. Move away objects that may injure a person. Maintain airway by loosening clothing. Turn head so saliva or emesis drains to one side. Lift shoulder and allow head to tilt back. Watch and observe so you can report type of seizure activity. After a seizure, allow to sleep. Clean if incontinence has occurred and check for vitals. Vision impairments. Following are common disorders of the eye that cause visual limitation and or blindness. Cataracts. The normally clear lens of the eye becomes cloudy. Signs and symptoms. Cloudy lens over the eye. Leading cause of vision loss in adults over the age of 55. Follow post-op protocol if surgery has been performed. Glaucoma. Increased pressure within the eye. Signs and symptoms. Eye pain. Difficulty adjusting to darkness. Unable to detect color. May see halos. Headache. Fatigue and blurred vision. Nurse assistant duties and observations for visual impairments. Announce yourself by name when entering the room. Encourage television or radio listening. Be careful in explaining what you're doing. Describe the food you are going to feed them. Is it hot? Is it cold? Describe food placement like the hands of a clock. Do not disturb the environment. Keep ADL supplies in the same place. Do not move furniture unless necessary and encourage independence. Hearing impairments. Autosclerosis. A progressive form of deafness with an unknown cause. Signs and symptoms are progressive loss of hearing. Related subjects optional. West Nile virus. Autonomic dysreflexia and mad cow disease. Nervous system complications inactivity, weakness, and limited mobility, insomnia, from sleeping during the day. Gastrointestinal system, anatomy and physiology, mouth, tongue, and teeth, esophagus, stomach, small intestine, large intestine, liver and gallbladder, and pancreas. Functions, extends from mouth to anus, responsible for breaking food into simpler substances that can be used by the body cells for nutrition. Common diseases and disorders. Malignancies, cancerous growths in the GI tract that can cause obstruction. They may result in surgery and or an ostomy. Signs and symptoms, vomiting, extreme abdominal discomfort, indigestion, constipation, blood in stool, flatus, and no bowel movement at all. Nurse assistant duties and observations. Monitor bowel movements. Report discomfort to a licensed nurse. Care of ostomy, or artificial opening in the abdominal wall for the elimination of solid waste and flatus. Standard precautions. Remove appliance gently to prevent irritation to skin. Follow facility policy. Empty bag and wash of reusable with soap and water. Secure clamp at base. Discard disposable bag in biohazard waste and replace with new bag. Observe stoma for redness, irritation and skin breakdown. Report the licensed nurse if this is noted. Wipe area around stoma gently after appliance is removed and wash with mild soap and water. Apply creams as ordered. Fit opening of appliance to stoma as needed. When applying appliance, seal well to prevent leaking. Observe color, character, amount, and frequency of stools and chart. Be matter of fact. Avoid looking repelled or disgusted. Patient or resident may be very self-conscious. Common problems with elimination. Constipation. Abdominal or rectal pain. Inability to pass stool. Loss of appetite. Feel urge to defecate but unable to pass stool. Bloating. Abdominal distension or hardness. Liquid stool or mucus seeping from rectum. Hard or dry stool. Feces that moves too slowly through the body. Caused by decreased fluids. Diet. Inactivity or ignoring the urge to defecate. Fecal impaction, stools unable to pass from the rectum, results from unrelieved constipation. Diarrhea, liquid or uninformed stool with increased frequency. Feces that moves rapidly through the intestines, caused by infection, medications, or irritating foods. Bowel incontinence, inability to control the passage of feces and gas. Possible cause due to injury or disease of the nervous system or sphincter damage. May result when patient or residents do not receive the assistance they need in a timely manner. Flatulence or gas. Excessive formation of gas in the stomach and intestines. Caused by foods, medications, or air swallowing. Nurse assistant duties and observations. Monitor and record bowel movements. Notify licensed nurse if above signs and symptoms develop. Encourage a high-fiber diet for constipation. Encourage liquids whenever in contact with a patient or resident. Encourage exercise to stimulate bowel activity. Prompt attention to the call light. Monitor skin integrity. Prompt attention to incontinence care. Note, nurse assistants never perform removal of impaction or digital disimpaction. Related subjects optional. Diarrhea. Bowel incontinence, gallbladder disease, choleocystitis, hernias, ulcerations, bowel training, enemas, rectal tube, hemorrhoids, gastroesophageal reflux disease or GERD. Urinary system, anatomy and physiology, kidneys, filters the blood, forms the urine. Urinar, tube carrying urine from the kidneys to the bladder. Bladder, storage for urine. Urethra. Tube for passage of urine to outside during urination or voiding. Functions. Filters blood and produces urine in which excess fluids and toxins are excreted. The body excretes 1,000 to 1,500 milliliters of urine per day. Characteristics of normal urine. Clear, amber, medium yellow color, mild odor. Approximately 1,000 to 1,500 cc's in a 24-hour period. Common diseases and disorders. Cystitis, which is an inflammation of the urinary bladder, especially common in women. Signs and symptoms of cystitis are common in women. Symptoms include dysuria, burning, frequent urination, cloudy urine, hematuria, bladder spasm, loss of appetite, fever. Confused patient or resident may exhibit agitation. Nurse assistant duties and observations. Encourage fluids. Observe for normal urine. Sits bath. Perineal care. Always wipe front to back. And rest. Urinary incontinence. Loss of control of urine. Signs and symptoms. Unable to control urination. Stress incontinence. Urinate when exerting, such as sneezing, standing up, or coughing. Nurse assistant duties and observations. Bladder training. Toilet the patient or resident regularly and answer call light promptly. Be positive when changing soil, linen, or garments and do not be critical. Perineal care. Avoid liquids after dinner. Related subjects optional. Renal dialysis, suppression, retention, renal calculi, specimen collection, urinary drainage systems, polynephritis, reproductive system, anatomy and physiology, structures and organs, male, penis, tissue enlarges during sexual arousal to introduce sperm into the vagina, testes, secretes male hormone and produces sperm, prostate gland, secretes fluid necessary for sperm. activity. Epididymis, coiled tube on top of the testes. The vas deferens, stores sperm. Structures and organs female. Ovaries, produces female hormone in eggs. Fallopian tubes, egg travels through the uterus. Uterus, internal pear-shaped organ in the pelvis, holds fetus during pregnancy. Vagina, receives penis during sexual activity. Vulva, the external female genitalia. Functions. Reproduction of human life. Production of some hormones. Common diseases and disorders. The male reproductive system. Enlarge prostate gland. Urethra passes through prostate and prostate enlarges. It strangles urethra, causing difficulty in starting stream and emptying bladder completely. Cancer of the prostate. Cancer of the testes. Female reproductive system. Cysticeal. Weakening of the muscles between the bladder and vagina. Signs and symptoms. Urinary incontinence. Frequent urinary tract infections. Rectocele. Weakening of muscles between wall of rectum and vagina. Signs and symptoms. Hemorrhoids. At constipation. Prolapsed uterus. Malignancies of the breast, ovarian, uterine, cervical. Nurse assistant duties and observations. Supportive care and notify licensed nurse if distress occurs. Sexually transmitted disease. Human immunodeficiency virus, HIV, AIDS. Viral infection transmitted primarily through direct contact with the bodily secretions of an infected person. Signs and symptoms. Flu-like symptoms. Fever. Night sweats. Fatigue. Swollen lymph nodes. Sore throat. GI upset. Headache. Kaposi sarcoma. Pneumocystitis carinii pneumonia. Nurse assistant duties and observations. Be aware that the virus is killed by 10 to 1 water to bleach solution. Potency of solution good for three days. Prevent secondary infections. Report new symptoms and complaints of discomfort to a licensed nurse and provide comfort measures. Related subjects vulvovaginitis, tumors of the reproductive tract, sexually transmitted diseases. Breast self-exam, testicular self-exam, immune system, special cells and substances function to produce immunity, white blood cells, antibodies, antigens, and T-cells, a type of cell that destroys invading cells. When the body senses an antigen, the immune system is activated, functions to provide the body with immunity, protection against a disease or condition, common diseases and disorders, AIDS, caused by HIV. Spread through certain body fluids, blood, semen, vaginal secretions, and breast milk. Affects the body's ability to fight other viruses and bacteria. Signs and symptoms. Loss of appetite, weight loss, fever, night sweats, diarrhea, painful or difficulty swallowing, tiredness, extreme or constant, skin rashes, swollen glands in the neck, underarms, and groin, cough, Sores or white patches in the mouth or in the tongue. Purple blotches or bumps on the skin that look like bruises but do not disappear. Confusion, forgetfulness, and dementia. Nurse assistant duties and observations. Practice standard precautions. Follow blood-borne pathogen standard. Provide daily hygiene. Avoid harsh soaps that irritate the skin. Provide oral hygiene before meals and at bedtime. Make sure the patient or resident uses a toothbrush with soft bristles. Provide oral fluids as ordered by a licensed nurse. Measure and record intake and output. Measure weight daily. Have patient or resident perform deep breathing exercises as ordered. Practice measures to prevent pressure sores. Assist with range of motion exercises and ambulation as ordered. Encourage the patient or resident to perform self-care as able. The person may need assistive devices such as walkers, commode, eating devices, etc. Encourage the patient or resident to be as active as possible. Change linens. gowns or pajamas as often as needed when fever is present. Be a good listener and provide emotional support. Other considerations. AIDS is often missed during diagnosis because of aging that can mask the signs and symptoms of AIDS. Some persons with HIV don't develop AIDS for as long as 10 to 15 years and may not show signs or symptoms. However, they are carriers and can spread the disease to others. Section 8. Changes in body systems associated with aging. A. Integumentary system. Skin becomes thin, fragile, dry, and wrinkled. Blood supply to fingers and toes decreases. Sensitivity to hot and cold decreases. Hair loses color. Nails thicken. Bruises easily due to fragile blood vessels. B. Respiratory system. Lung strength decreases. Air sacs become less elastic and decrease in number. Airways become stiff and less elastic. Lung capacity decreases. Cough reflex is less effective. Cough becomes weaker. And gas exchange in lungs is less effective. C. Cardiovascular system. Blood flow decreases, leading to less efficient circulation. Blood vessels narrow and lose elasticity. Longer recovery to normal pulse after exercise and heart is a less effective pump. D. Musculoskeletal. Muscles weaken and lose tone. Loss of elasticity in muscles. Loss of muscle mass causes weight loss. Less flexible. Bones lose minerals, become porous and brittle or easily broken. Height is gradually lost due to space between vertebrae shrinking. Posture slump. Joints are less flexible and stiffer, slows normal body movement, degenerative changes in joints, and decreased reflexes prone to injury and falls. E. Endocrine System Decrease in sex hormones such as estrogen and progesterone signals menopause and testosterone levels decrease. Insulin production decreases. Metabolism in body functions slow. Body is less able to handle stress. Body is less able to handle sugar. F. Nervous system. Slowing nerve transmissions result in delayed reaction time, poor coordination and balance, less effective temperature regulation, decreased sensitivity to pressure and temperature changes, decreased blood flow to brain, resulting in memory loss and confusion. Deep sleep is shortened. Naps are needed. G. Gastrointestinal system. Decreased saliva production causing dysphagia. Taste buds not as sensitive. Decreased gag reflux leading to chance of choking. Slow peristalsis leading to indigestion and constipation. Increased flatulence. Decreased digestive enzymes. Avoid dry, fried, and fatty foods. Decreased ability to absorb nutrients. Medication related to side effects. Sensitivity to sensation of full bowel. Urgency is exaggerated with the bowel. Urinary system. Kidneys decrease in size and are less efficient. Bladder loses tone, leading to retention and infection. Have patient or resident bear down after voiding to complete empty bladder. Decreased bladder capacity leads to frequency of urination. Kidney function increases at rest, causing urination at night. Prostate enlargement in males cause frequency, dribbling, and urinary retention. Elderly patient or resident may exhibit behavior changes with usual UTI signs and symptoms. Decreased sensitivity to sensation of full bladder. Urgency is exaggerated with the bladder. I. Reproductive system. Male reproductive system. Scrotum less firm. Number and capacity of sperm decreases. Sexual response delayed, increase in size of prostate gland, and hormone production decreases. Female reproductive system. Menopause when menstruation ends. Decreased production of estrogen and progesterone result in loss of calcium, causing brittle bones and osteoporosis. Fewer hormones are produced. Ovulation and menstrual cycle cease. Vagina becomes thinner, drier. Breast tissues decrease and muscles supporting breast weaken.

Module 13, Long-Term Care Resident. Section 1, Define Key Terminology. A, Review the terms listed in the terminology section. B, Spell the listed terms accurately. C, Pronounce the terms correctly.

And D, Use the terms in their proper context. Section 2, Common Basic Human Needs and Interventions for the Elderly Patient or Resident. Environmental.

Psychological, social, recreational and spiritual. A. Environmental or physical.

Safety, more light for better vision. Freedom from hazards. Support, such as adaptive devices. And good personal hygiene. Shelter, appropriate living situation.

Environmental control, such as heating or air conditioning. Nourishment, balanced nutrition, and adequate fluids. Be psychological.

Maintaining self-esteem through respectful treatment and recognition of individual differences. Adjustment to role change and loss of independence. Respect privacy. Give choices.

And encourage activities. See social. Social interactions encourage family involvement and encourage social or community activities.

Adjustment to losses, such as the death of a spouse or friend, encourage verbalization, such as reminiscing, and encourage new social contacts. Financial changes in income interfere with meeting basic needs of security, love, belonging, and self-esteem. Refer to social service. D.

Recreational. Diversion. Encourage hobbies.

Involve facility and community events. And encourage family involvement. Self-esteem. Encourage involvement.

Give compliments. And reinforce positive traits or abilities. E.

Spiritual. Provide respect for individual choices. and provide opportunities to participate in religious activities.

Section 3, Common Community Resources to Meet the Needs of the Elderly. Area Agency on Aging, or the AAA. Adult Day Care Center.

Support Groups, like the American Diabetes Association. Braille Institute or Blind Center. Alzheimer's Society. Parkinson's Support. Multiple sclerosis support, muscular dystrophy, and hospice or bereavement.

County Health Center, community hospitals and their hospice, internal revenue service information, long-term care ombudsman, Meals on Wheels, Medicare office through Social Security, Mental Health Department, National Alliance for the Mentally Ill, American Disabilities Act. Adult Protective Services, Red Cross or Blood Pressure Clinic, Senior Center, Senior Housing, Social Security Office Suicide Prevention, Home Health Agencies, Voter Registration, American Association of Retired Persons, Fraternal and Social Organizations, Regional Centers, and Churches and Religious Organizations. Section 4. Special Needs of Persons with Developmental and Mental Disorders, including Intellectual Disabilities, Cerebral Palsy, Epilepsy, Parkinson's Disease, and Mental Illness.

A. Epilepsy or Seizure Disorders. Different types of epilepsy and seizure disorders. General Seizure or Grand Mal, Partial Seizure, Petite Mal, Absent Seizure.

Status epilepticus. Potential causes. Metabolic disorders. Nutrition problems and medication problems.

Signs or symptoms. Depends on the type of seizure. May experience an aura or certain taste before entire body is involved.

May experience loss of consciousness. Incontinence. May be followed by periods of fatigue, confusion, or disorientation. The nurse assistant duties and response. Stay with the person and call for assistance.

Assist in laying down. Do not restrain movements or put anything in the mouth. Move away objects that may injure a person. Maintain airway by loosening clothing.

Turn head so saliva or emesis drains to one side. Lift shoulder and allow head to tilt back. Parkinson's disease. Description and progression of disease. It's a progressive nervous disorder that affects movement.

Early stages of Parkinson's disease may be mild and go unnoticed, but his symptoms worsen as the condition does progress over time. Certain nerve cells called neurons in the brain gradually break down or die, which causes a loss of neurons that produce a chemical messenger in your brain called dopamine. Signs and symptoms.

They start gradually, sometimes starting with a... barely noticeable tremor in just one hand, tremors and pill rolling, muscle rigidity, a shuffling manner of walking, difficulty and slowness in carrying out voluntary motor activities, slurred speech, loss of expressiveness in the face, drooling, incontinence, constipation, urinary retention, mood swings, depression, and fatigue. The nurse assistant duties and responsibilities.

Safety activities and concerns. Nutrition problems including swallowing and or chewing issues. Notify a licensed nurse if behavior worsens or becomes dangerous. Maintain a calm environment.

Symptoms will worsen when the patient or resident is under stress. Assist in ADLs. Provide emotional support.

Restorative care. such as exercises and dementia care. C, schizophrenia, a mental disorder characterized by paranoia, hallucinations, delusions, bizarre behavior, and distortions of reality. Know the signs and symptoms.

Nurse assistant duties and responsibilities. Notify licensed nurse if behavior worsens or becomes dangerous. Do not feed into delusions. but do not try to convince them of reality. Be aware of suicide precautions.

Keep the patient or resident involved in reality activities. Report and document observed responses to medication and psychotherapy. Monitor nutrition and fluid balance. These patients or residents often refuse to eat or drink out of fear of poisoning. And find ways of reducing the patient or resident's fear and anxiety.

D. Hypochondriasis. The patient or resident imagines or magnifies each physical ailment. The nurse assistant duties and responsibilities include to be supportive. Some authorities feel this disorder stems from depression.

Do not overlook real illness and report all complaints. And do not judge. E. Depression. The most common functional disorder in older people.

Signs and symptoms. The feelings of sadness, lack of interest in and withdrawal from environment, feelings of worthlessness, and negative outlook on the future. Nurse assistant duties and responsibilities.

Notify a licensed nurse if the patient or resident displays loss of appetite, weight loss, severe fatigue, crying, or sleeplessness. Notify a licensed nurse of the patient or resident. Make statements such as, I wish I could just die.

Remain non-judgmental. Listen with empathy. Encourage activities with others.

And encourage aerobic activity as well as outdoor activities. They release endorphins. E.

Suicidal patient or resident. Elderly patients or residents are at risk of suicide behavior. Especially white males over the age of 65 who live alone and the very old, 75 years and above. Nurse assistant duties and responsibilities.

Report clues of suicide attempts to a licensed nurse. Give constant care. Monitor activities.

Work to preserve self-esteem. Help the patient or resident find a support network, such as friends, clergy, family, and support groups. Never ignore the person's statements or threats about suicide. F.

Intellectual or developmental disabilities. A. Significant sub-average intellectual function and low adaptive ability. The nurse assistant duties and responsibilities include providing an environment as normal as possible, normalization, emphasize individual strengths, encourage independence such as self-care, treat with dignity at age-appropriate level, respect privacy, and provide a safe, structured environment. G.

Cerebral Palsy, a group of disorders characterized by motor dysfunctions. The nurse assistant duties and responsibilities. Provide a safe and structured environment.

Apply appropriate assistive devices. Emphasize individual strengths. Encourage independence. Treat with dignity and respect privacy.

H, alcoholism or drug abuse. Abuse of alcohol or drugs. when healthy coping mechanisms have failed.

15% of elderly suffer from alcoholism. It's often triggered by retirement, loss of self-esteem, loneliness, chronic pain, a decline in health, and stress. The nurse assistant duties and responsibilities include report to the licensed nurse any sign that the patient or resident is under the influence of alcohol or drugs. Be sure alcohol or drugs are not available.

Alcohol can be in products such as aftershave, perfume, cooking extracts, and cleaning products. Watch for mental impairment or loss of coordination and poor judgment. Be careful when feeding. Gag reflex may be impaired.

Set boundaries. Avoid being manipulated. Be aware of support groups such as Alcoholics Anonymous or the Mental Health Association.

Notify a licensed nurse if signs of withdrawal appear, alcohol tremors, shaking, agitation or seizures, drugs such as a runny nose, depression, headache, pacing, poor coping mechanisms or agitation. Follow the patient's or resident's care plan and be aware of dangerous behavior. I, the agitated patient or resident, uses inappropriate verbal, vocal, or motor activity due to causes other than disorientation or real need.

The nurse assistant duties and responsibilities include reporting to a licensed nurse any sign of agitation, including aimless wandering, pacing, cursing, screaming, spitting, biting, fighting, arguing, demanding, and talking to self. Maintain a quiet, calm atmosphere. Encourage distracting activities. Check for constipation or other sources of discomfort or pain.

Realize that the patient or resident may become more agitated due to feelings of loss of control. Avoid restraints. Allow the patient or resident to walk or rock in a chair to diffuse energy.

Listen with empathy. Make sure you stay safe. Maintain an area to escape. Don't let the patient or resident get between you and the door. Call for help if the patient or resident gets violent and do not attempt to control the patient or resident if they become violent.

Redirect. Section 5. Section 5. The special needs of persons with Alzheimer's disease and other related dementias. A. Causes and differences of delirium, depression, and dementia. Dementia is a general term for a decline in mental ability severe enough to cause a decrease in the ability to live.

to interfere with daily life. Dementia describes a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with your daily life. Not a specific disease, but several different diseases may cause dementia.

Delirium is a serious disturbance in mental abilities that results in confused thinking and reduction in awareness of the environment. Depression is a mood disorder. that causes a persistent feeling of sadness and loss of interest.

It affects how you feel, think and behave, and can lead to a variety of emotional and physical problems. Dementia and delirium may be particularly difficult to distinguish, and a person may have both. The causes are not exactly known, but as with many mental disorders, a variety of factors may be involved, such as brain chemistry, hormones, Traumatic or stressful events Abuse of alcohol or recreational drugs Serious or chronic illness, including cancer stroke, chronic pain or heart disease, certain medications or drug toxicity, malnutrition or dehydration, and sleep deprivation. Common signs and symptoms include memory loss, which is usually noticed by a spouse or someone else, difficulty in communicating or finding words, difficulty with visual or spatial abilities, such as getting lost while driving, difficulty reasoning or problem solving.

Difficulty in handling complex tasks. Difficulty with planning and organizing. Difficulty with coordination or motor functions. Confusion and disorientation. Personality changes.

Anxiety. Paranoia. Agitation. Hallucinations.

The signs and symptoms and progression of Alzheimer's disease and other dementias. Alzheimer's disease. Caused by plaques and tangles in the brain's nervous system, the brain decreases in size as cells are lost.

It's progressive and incurable. Signs and symptoms stage 1. Mild dementia. Short-term memory loss. Personality changes.

Disorientation to time. Poor judgment. Lack of safety awareness.

Carelessness in appearance. Anxious. Depressed. Delusions of persecution.

Stage 2. Moderate Dementia. Increased short-term memory loss. Complete disorientation. Wondering and pacing.

Sundowning. Perseveration phenomena. Motor skills deteriorate. Speech, reading, writing deteriorates. Incontinent of bowel and bladder.

And catastrophic episode. Severe dementia. Total dependence.

Verbally unresponsive. and may have seizures. Explain the nursing care received by persons with Alzheimer's disease and other dementias.

Protect the patient or resident from injury. Be compassionate, patient and calm. Maintain a sense of humor. Encourage independence as long as possible.

Provide mental and physical activities within residents'capabilities. Support residents'dignity and self-esteem. Provide structured, quiet environment that is uncluttered.

Use appropriate body language. The residents will read the staff's behavior and reflect the mood of the staff in their own behavior. Give one short simple direction at a time. Observe for signs and symptoms of physical ailments.

Resident may be unaware of illness. Assist residents to maintain a dignified, attractive appearance by helping with grooming and dressing. Monitor food and fluid intake. Do not use plastic feeding utensils.

Provide nutritious finger foods when the resident is unable to use a utensil. Be aware of swallowing difficulties. Prepare food, such as butter bread, cut into bites, and encourage the resident to feed self for as long as possible.

Check food temperatures. Check the resident's mouth after eating for pocketing or hoarding food in the cheeks. Weigh resident to detect patterns of weight gain or loss. Use touch appropriately. Surprising the resident can result in a catastrophic reaction.

Avoid using logic, reasoning, or lengthy explanations. When the ability to speak is lost, the resident may communicate through non-verbal means, such as biting, scratching, and kicking to express displeasure. Facial expressions and body language may express moods.

Identify specific activities. that would improve the quality of life for persons with Alzheimer's disease and other dementias. Use distraction and diversion when a resident is agitated. Take their hand and calmly walk to another activity. Realize that people with dementia are not responsible for what they say.

They cannot change. They are not aware of what they are doing. They have poor impulse control. Allow them to save face by preserving their dignity. No one really knows what is happening in the mind of a person with dementia.

Complement positive behavior and accomplishments, and encourage rocking chairs to diffuse nervous energy. Identify specific safety measures for Alzheimer's and dementia populations. Use Reality Orientation, RO, to regain connection to environment, especially effective in the first stages of Alzheimer's.

Use a clock and a calendar. at bedside and call by name. Answer questions honestly, but do not give information they are unable to handle. For example, The resident asks if their deceased husband is coming to visit. Nurse assistant could respond by saying, tell me about your husband.

Do not argue with the resident's reality. Use bulletin boards decorated for the season. Keep curtains open during the day. Make sure they have their glasses and hearing aids on.

Do not expect resident to remember you. Identify yourself as needed. Incorporate validation therapy into all your interactions.

with dementia resident. Maintains disoriented person's dignity by acknowledging the person's memories and feelings. Use reminiscing therapy.

Incorporate music therapy. Incorporate animal therapy. Identify at-risk behaviors that include modifiable or non-modifiable factors, as well as increased risk for abuse.

Research has shown that the same risk factors associated with heart disease may also increase the risk of Alzheimer's disease. These include lack of exercise, obesity, smoking or exposure to secondhand smoke, high blood pressure, high cholesterol, poorly controlled type 2 diabetes, sleep patterns, age, and family history and genetics. Section 6, the body's basic organization and composition.

A, anatomy structure, physiology function. B, The cell, the basic unit of body structure, building blocks of the body. Their function, size, and shape of cells may differ. Cells need food, water, and oxygen to survive.

C, tissues, groups of cells with similar functions. Four basic types of tissues in the body. Epithelial tissue, which is protective. Connective tissue, support and connect.

Muscle tissue, shorten and connect. and lengthen. Nerve tissue, carrying electrical impulses. D, organs, made up of different types of tissues, and they perform special functions. E, systems, groups of organs that work together to perform specific functions.

10, major body systems. Integumentary system, respiratory system, cardiovascular system. Musculoskeletal system, endocrine system, nervous system, gastrointestinal system, urinary system, reproductive system, and immune system.

F, health, state of mental, physical, and social well-being. G, disease, any change from the healthy state. Section 7. The body systems, including basic anatomy and physiology, common diseases of the elderly, signs and symptoms, and nurse assistant duties and observations. A.

Integumentary system. Anatomy. The epidermis is the top surface layer. It is primarily dry, dead cells that shed continuously.

It is a thin layer with no blood supply, functions as a barrier to water loss, and prevents infection. Dermis is the second layer, varies in thickness in different areas of the body, naturally very moist, gives skin its strength, contains blood vessels, lymph vessels, nerve endings, oil glands, and hair follicles. The function of the dermis is to aid in body temperature control and is the origin of our sense of touch, pressure, and pain. Subcutaneous tissues are deep tissues beneath the dermis.

Tissues are fat, and connective tissue. These tissues do not tolerate lack of oxygen and cell death results easily. Functions.

Provides a protective barrier against microorganisms and infection. Provides sensation through nerve endings. Shields the body's tissue from injury. Regulates body temperature. Eliminates waste products.

Produces vitamin D for the body to use. Prevents loss of too much water and is the largest organ of the body. Diseases and disorders. Skin lesions and wounds are changes in the skin structure caused by injury, trauma, aging, or disease.

Signs and symptoms. Rash. Raised spots filled with pus or fluid.

C. Cardiovascular system. Anatomy and physiology. The heart pumps blood which carries oxygen and nutrients to cells.

Blood. transports oxygen food and hormones to cells, removes carbon dioxide and other waste products from cells, Controls pH level and body temperature. Clots the blood and fights pathogens and poisons.

Blood vessels. Arteries carry blood away from the heart. Veins carry blood towards the heart.

Capillaries, the smallest vessels, they connect arteries and veins. Functions. Transportation system that delivers nutrition and oxygen to the cells and takes away waste products.

It's a closed system. It's kept in motion by the force of the heart. Common diseases and disorders. Coronary artery disease occurs when the coronary arteries narrow, causing a reduction in blood supply to the heart, depriving the heart muscle with oxygen and nutrients. Signs and symptoms are chest pain, pain in the back, neck, jaw, arm, shoulder, or back, dyspnea, cyanosis of lips, mucous membranes, and nail beds, and dizziness.

The nurse assistant duties and observations. Remain with the patient or resident. Notify a licensed nurse immediately if the above signs and symptoms are noted. Myocardial infarction or heart attack. Definition.

A clot in the coronary artery causes a blockage of the blood supply to the heart. Damaged area can no longer function and turns to scar tissue. Signs and symptoms. Sudden, severe pain in the chest, usually described as crushing.

Radiating pain to the arm, jaw, neck, or back. may present as indigestion or heartburn, diaphoresis, cool, clammy skin, dizziness, pallor or cyanosis, dyspnea, shortness of breath, weak irregular pulse, low blood pressure, loss of consciousness, nausea and vomiting, restless, anxious, feeling of impending doom, and denial. Nurse Assistant Duties and Observations.

Notify a licensed nurse immediately if the above signs and symptoms are noted. Remain with the patient or resident. Place the patient or resident in a comfortable position and loosen clothing. Encourage the patient or resident to rest. Reassure the patient or resident that help is coming.

Monitor vital signs. Do not give the patient or resident liquids or food and prepare to transfer to an acute care facility. Congestive heart failure. Definition. Occurs when the heart does not pump well enough to meet the body's needs.

Normal cardiac output cannot meet the needs for activities of daily living. Can be left-sided or right-sided or both. Signs and symptoms. Hemoptysis.

Spitting up blood. Cough. Dyspnea. Orthopnea.

Difficult breathing while lying down. Fatigue. Decrease in ability to exercise and to be active.

Confusion. Increased pulse. Possible irregular heartbeat. Increased frequency of urination at night. Cyanosis.

Edema in the extremities. Moist respirations. High blood pressure.

Nurse assistant duties and observations. A low sodium diet. Raise head of bed. Fluid restriction if ordered.

Anti-embolic stockings, assist with ADLs, range of motion to improve muscle tone, assist with O2 therapy, measure intake and output, measure daily weight, bedside commode is indicated, check vital signs, monitor apical pulse for one full minute, report if drops below 60, and pace their activities. Peripheral vascular disease or PVD. Definition.

A condition in which the blood supply to the legs, feet, arms, or hands is decreased due to poor circulation. Can be arterial or venous. Signs and symptoms.

Painful cramping in the hips, thighs, or calves when walking. Painful cramping in the legs that does not go away. Cyanotic hands or feet. Blue or gray tinged. Arms or legs feel cool and cold to the touch.

Edema in the hands and feet. Ulcers on the legs or feet that are slow to heal or don't heal. And gangrene.

Nurse assistant duties and observations. Encourage the patient or resident to follow special diet or fluid restriction. Record accurately intake and output. Monitor for increased edema.

Monitor vital signs and report any changes, especially in pulse or blood pressure. Report to nurse any complaints of pain or discomfort. Comfort in the hands, legs, or feet. Report any type of chest, back, jaw, or shoulder pain or discomfort. Apply anti-embolic stockings, if ordered.

Anemia, a condition that results from a decrease in the quantity and quality of red blood cells. Signs and symptoms. Lethargy, pale or jaundiced.

Dyspnea, digestive problems. Rapid pulse and increased respiratory rate. Cold and dizzy.

Nurse assistant duties and observations. Provide nutritional meals. Increase iron-containing foods like red meat and green leafy vegetables. Notify licensed nurse of signs of bleeding or black stool.

Monitor vital signs. Observe for and notify if above signs and symptoms appear or worsen. Hypertension. High blood pressure.

Signs and symptoms. Blood pressure elevated above 140 systolic. and or 90 diastolic, a nosebleed, eye hemorrhage, dizziness, trembling, red complexion, headache, and blurred vision. The nurse assistant duties and observations. Monitor blood pressure.

Assist with stress management techniques. A low sodium diet. Assist with weight loss efforts.

Encourage regular exercise. Notify licensed nurse of above symptoms are noted. Other related subjects, optional, are pacemakers, angina, varicose veins, atherosclerosis, internal defibrillation, anemia, and blood types.

D, musculoskeletal system, anatomy and physiology. Bones are the hard, rigid structures made of connective tissue and cells. Joints, the point at which two or more bones meet. and allow body movement.

Muscle allows movement of body parts, maintains posture, and produces body heat. Functions gives shape and form, maintains posture, permits movement, protects internal organs, stores calcium and phosphorus, produces heat, and produces some blood cells. Forms the framework that supports the body and allows for movement.

Common diseases and disorders. Arthritis. An inflammation of the joints consisting of rheumatoid, joint tissue lining is affected, osteoarthritis, cartilage covering the ends of bones deteriorates and ends of bones rub together causing pain and deformity, gout, a metabolic disease caused by deposits of crystals at joint due to increase in uric acid. The signs and symptoms are pain at the joint, deformity at the joint, swelling, tenderness, Heat at the inflamed site and fatigue.

Nurse assistant duties and observations. Notify a licensed nurse if the patient or resident requests medication for discomfort. Balance, rest, and exercise.

Range of motion when no pain or inflammation. Rest joint if pain or inflammation. Prevent contractures. Fractures.

A break in the continuity of the bone. Signs and symptoms, and they vary with the type of fracture. Pain, swelling, bruising at the fracture site. Exposed broken bone through the skin, called a compound fracture. Immobility of the area affected and deformity.

Nurse assistant duties and observations. Keep area immobilized. Cast or splint. Report pain.

Reduce edema. Elevate area affected. Maintain alignment. Cast care.

No breaks, chips. Check for distal pulses. Check color, movement and sensation, distal to cast. Report signs of infection.

Osteoporosis, caused by lost bone mass and results in porous, spongy bones that are easily fractured. Most common in elderly females. The signs and symptoms.

Fracture from very little or no trauma, often in the hip or low back. Curvature of spine. Loss of height.

Progressive weakness. Nurse assistant duties and observations. Prevent further fractures.

Report pain. Gentle range of motion. Apply splints or braces as ordered.

Encourage high calcium meals such as milk, dairy products, and green leafy vegetables. Mechanical lift for transfers. Gentle handling and positioning. A fractured hip.

Fracture of the femur. Most frequent causes falling and osteoporosis. The signs and symptoms.

Cannot get up after a fall. Affected side is shortened and externally rotated. Severe pain.

in the hip or knee, edema in the hip, thigh and groin, nurse assistant duties and observations. Pre-surgery hip precautions. Avoid moving the patient or resident until instructed by licensed nurse. Use a sheet or backboard to move.

Post-surgery hip precautions. Do not flex hip more than 90 degrees. Do not cross affected leg over midline of body. Do not internally rotate hip. unaffected side.

Do not passive range of motion, unaffected side. No weight bearing for several weeks after surgery. Use fracture bedpan. Maintain proper hip alignment.

May use trochanter roll and abduction pillow. Other related subjects optional. Fibromyalgia, traction, continuous passive motion, CPM machine, back injuries. such as a ruptured disc or extremity amputation.

E. Endocrine system. The anatomy and physiology. The pituitary gland. The master gland.

Thyroid. Controls metabolism. Pancreas.

Secrets insulin to promote glucose use by the cells. Adrenals. Secrets adrenaline for the fight or flight hormone. Function.

Network of glands that secrete hormones into the bloodstream. Common diseases and disorders. Diabetes mellitus, a chronic disease that results from a deficiency of insulin or resistance to the effects of insulin.

The body is unable to properly process food and convert food into energy. There are two types of diabetes. Type 1, insulin-dependent diabetes mellitus or IDDM. Type 2, non-insulin-dependent diabetes mellitus and IDDM. The signs and symptoms.

The three polys. Polyuria. Excessive urination.

Polydipsia. Excessive thirst. And polyphasia.

Excessive hunger. Fatigue. Skin infections that are slow to heal.

Itching. Burning on urination. Vision changes.

Hyperglycemia. Caused by inadequate insulin for metabolic needs. This develops slowly over a 24-hour period.

period, can cause confusion, drowsiness, slow slippage into coma, headache, a sweet fruity odor to the breath, deep breathing, low blood pressure, nausea or vomiting, flushed, dry, hot skin, unconsciousness, sugar in the urine, and high blood sugar on glucose monitoring. Hypoglycemia occurs when blood glucose is below normal. most commonly from overdose of insulin.

Insulin shock or insulin reaction occurs rapidly. Hunger, weakness, dizziness, shakiness, skin moist and clammy, rapid and shallow respirations, nervous and excited, rapid pulse, unconscious, no sugar in the urine, and low blood sugar glucose monitoring. Nurse Assistant Duties and Observations. Know the signs and symptoms of hyperglycemia and hypoglycemia.

Notify a licensed nurse immediately if diabetic symptoms appear. Offer meals and snacks at regular intervals. Report uneaten portions. Be aware that illness, stress, and infection can make blood sugars increase.

Observe extremities for infection, trauma, or wounds, especially the feet. Notify a licensed nurse if the patient or resident vomits after a meal. Offer easily assimilated sources of carbohydrates if signs of hypoglycemia occur after notifying a licensed nurse. Make sure the right diet is given. Urine testing for sugar and acetone.

Rarely done in LTC now. Special foot care. Wash daily and dry between toes.

Inspect feet for signs of irritation. Toenails to be cut by licensed nurse or podiatrist only. Shoes and stockings to be worn at all times when out of bed.

Never go barefoot. Check for anything that impairs circulation. Remember, diet, exercise, and medication are the most important components of diabetic treatment. Related subjects which are optional. Hyper and hypothyroidism.

Cushing's and Addison's disease. And glucose monitoring. F. nervous system, anatomy and physiology, the brain, center of conscious thought, and Voluntary action.

Motor coordination. Centers of control for respiration, heart function, and body temperature. The spinal cord. Transmission of impulses to and from the brain.

Approximately 17 inches long and protected by a spinal column. Vertebrae. The peripheral nerves.

Transmission of impulses to and from the spinal cord. Connects the CNS with various structures of the body. Sensory organs. Eyes, nose, tongue, skin, and ears. The functions.

Controls, directs, and coordinates functions of the body. There are two major divisions. The central nervous system and the peripheral nervous system. Common diseases and disorders.

Dementia. Any disorder of the brain that causes deficits in thinking, memory, and judgment. Causes.

Alzheimer's disease, the most common. Multiple Infarction Dementia, Multiple TIAs, Parkinson's Disease, Syphilis, AIDS, Nutrition Problems, Medication Problems, Depression, and Metabolic Disorders. Alzheimer's Disease. Caused by plaques and tangles in the brain's nervous system.

Brain decreases in size as cells are lost. It is progressive and incurable. Signs and Symptoms. Stage 1. Mild Dementia. Short-term memory loss, personality changes, disorientation to time, poor judgment, lack of safety awareness, carelessness in appearance, anxious and depressed, and delusions of persecution.

Stage 2 moderate dementia, increased short-term memory loss, complete disorientation, wandering and pacing, sundowning, perseveration phenomenon, motor skills deteriorate. Speech, reading, and writing deteriorates. Incontinent of bowel and bladder. And catastrophic episode.

Stage 3, severe dementia. Totally dependent, verbally unresponsive, and may have seizures. Nurse assistant duties and observations for patient or resident with dementia, all types. Protect the patient or resident from injury. Be compassionate, patient, and calm.

Maintain a sense of humor. Encourage independence as long as possible. Provide mental and physical activities within patient or resident's capabilities. And support the patient or resident's dignity and self-esteem.

Provide structured, quiet environment that is uncluttered. Use appropriate body language. Patient or residents will read the staff's behavior and reflect the mood of the staff in their own behavior.

Give one short, simple direction at a time. Observe for signs and symptoms of physical ailments. The patient or resident may be unaware of illness. Assist the patient or resident to maintain a dignified, attractive appearance by helping with grooming and dressing. Monitor food and fluid intake.

Do not use plastic feeding utensils. Provide nutritious finger food when the patient or resident is unable to use utensils. Be aware of swallowing difficulties.

Prepare food. and encourage patient or resident to feed self as long as possible. Check food temperatures. Check patient or resident's mouth after eating for pocketing, such as hoarding food in the cheeks.

Weigh patient or resident to detect patterns of weight gain or loss. Use touch appropriately. Surprising a patient or resident can result in a catastrophic reaction. Avoid using logic, reasoning, or lengthy explanations.

When the ability to speak is lost, patient or resident may communicate through non-verbal means. Biting, scratching, and kicking to express displeasure. Facial expressions and body language may express moods.

Observe for what triggers agitation or anger and work on prevention. Use distraction and diversion when a patient or resident is agitated. Take the hand and calmly walk to another activity.

Realize that people with dementia are not responsible for what they say. They cannot change. They are not aware of what they are doing. They have poor impulse control.

Allow them to save face by preserving their dignity. No one really knows what is happening in the mind of a person with dementia. Be aware of wondering and pacing concerns.

Keep record to detect patterns of wondering and pacing. Some triggers are as follows. Noise.

Keep quiet and avoid crowds. Boredom. Give activities. Unmeant physical needs. Evaluate needs.

Stress, create a calm environment. Pain, evaluate for sources of discomfort. Hunger, offer frequent snacks.

Thirst, encourage fluence. Need to use the restroom, take to restroom at least every two hours. Looking for companionship, security or loved one. Therapeutic touch, talk and consistency.

Physical restraints, feel threatened. Looking for a state of mind. Not a physical location.

If they are in an area that they shouldn't be, calmly take their hand and redirect them to a safe area. Avoid large members. Avoid large numbers of staff approaching the patient or resident.

Use positive directions. Stay inside instead of don't go outside. Use gentle persuasion.

Complement positive behavior and accomplishments. Encourage rocking chairs to diffuse nervous energy. Be aware that sundowning, increased agitation and confusion in late afternoon or evening, can occur and how to prevent it. Avoid over-fatigue. Encourage the patient or resident to remain awake as much as possible during the day.

The evening meal should be at least two hours before bedtime. Eliminate caffeine. Evening activities should be quiet and calm.

Soft music is calming. Give a massage or back rub. A light bedtime snack. Follow bedtime routine.

Check with family members. Check lighting. Shadows and reflections can be disturbing.

Discourage pillaging and hoarding. Label all patient or resident's belongings to identify if they are taken by confused patient or resident. Check room daily for stale food. Keep patient's or resident's hands busy. Provide a rummaging drawer or box for the patient or resident.

Use Reality Orientation, RO, to regain connection to environment. Especially effective in the first stages of Alzheimer's. Use a clock or calendar at the bedside. Call by name. Answer questions honestly, but do not give information they are unable to handle.

For example, the patient or resident asks if their deceased husband is coming to visit. Nurse assistants should respond by saying, Tell me about your husband. Do not argue with the patient or resident's reality.

Use bulletin boards decorated for the season. Keep curtains open during the day. Make sure they have their glasses and hearing aids on.

Do not expect the patient or resident to remember you. Identify yourself as needed. Use reminiscing therapy. Encourage sharing memories of past events. Use prompting questions to show interest in their history.

Use active listening skills. Realize the need to reminisce increases as we age. Reminiscing serves as a life review and may validate the worth of their life. Acknowledge validity of feelings and emotions. Be comfortable with patient or resident's tears as well as laughter.

Reminiscing helps people adapt to aging by maintaining self-esteem and working through personal loss. Incorporate validation therapy into all your interactions with dementia patient or residents. Maintains disoriented person's dignity.

by acknowledging the person's memories and feelings. This therapy, developed by Naomi Fail, may be a way for the patient or resident to work through issues from the past that were unresolved. Helps them maintain identity and dignity by having pictures of reminders of who they once were in their room. Realize that there is a reason for all behavior.

What appears to be confusion can be the person acting on an experience long ago. Disoriented people have the right to express emotions. Living must be resolved in order to prepare for dying. To live in reality is not the only way to live. Disoriented people have worth.

They can still experience joy, pleasure, and the ability to appreciate kindness. Within each confused person is a human being that once was a child and later an adult, with hopes, joys, sadness, failures, and successes. They deserve to be respected, cared for, and loved in their final years.

This therapy has been effective on lessening the need for restraints. Incorporate music therapy and incorporate animal therapy. Stroke, a complete or partial loss of blood supply to cells of the brain. Signs and symptoms, loss of sensation, paralysis, hemiplegia, aphasia, dysphagia. Emotional ability, loss of consciousness and confusion, cognitive impairments, the nurse assistant duties and observation.

Report changes in level of consciousness, headache, or change in motor ability to a licensed nurse. Sudden onset of symptoms indicates probable stroke. Prevent complications of immobility.

Begin restorative care. Assist with ADLs. Encourage the patient or resident to do as much as possible, but be supportive emotionally. Patience is vital. Explore alternative methods of communication.

if unable to speak. Be aware of swallowing, choking difficulties when feeding. Incorporate reality orientation into care, such as a clock, calendar, open curtains, transient ischemic attacks or mini-strokes, multi-infarction dementia, multiple transient ischemic attacks or TIAs, caused by lack of oxygen to the brain cells.

Signs and symptoms are temporary. and subside when circulation is improved. Parkinson's disease.

Signs and symptoms. Tremors and pill rolling. Muscle rigidity.

Difficulty and slowness in carrying out voluntary motor activities. Shuffling manner of walking. Slurred speech.

Loss of expressiveness in face. Drooling. Incontinence.

Constipation. Urinary retention. Mood swings.

And depression. The nurse assistant duties and observations. Maintain a calm environment. Symptoms will worsen when patient or resident is under stress.

Assist in ADLs. Provide emotional support. Restorative care such as exercises and dementia care. Seizure disorder.

Reoccurring transient attacks of disturbed brain function. Signs and symptoms. Generalized seizure or a grand mal.

may experience aura or certain taste before seizure occurs, jerking and twitching of the body occurs, entire body is involved, may experience loss of consciousness, incontinence and may be followed by period of fatigue, confusion and disorientation. A partial seizure or petite mal, momentary loss of muscle tone, may have periods of unconsciousness, may chew, blink or breathe rapidly. They can last from 2 to 10 seconds.

Absence seizures in children can result in poor learning in school. Only one extremity or part of an extremity may be involved. Status epilepticus.

Seizure lasts for a long time. It is a serious medical emergency and life-threatening. Death may resolve. Nurse assistant duties and observations. During a seizure, stay with the person and call for assistance.

Assist in lying down. Do not restrain movements or put anything in the mouth. Move away objects that may injure a person.

Maintain airway by loosening clothing. Turn head so saliva or emesis drains to one side. Lift shoulder and allow head to tilt back.

Watch and observe so you can report type of seizure activity. After a seizure, allow to sleep. Clean if incontinence has occurred and check for vitals.

Vision impairments. Following are common disorders of the eye that cause visual limitation and or blindness. Cataracts.

The normally clear lens of the eye becomes cloudy. Signs and symptoms. Cloudy lens over the eye.

Leading cause of vision loss in adults over the age of 55. Follow post-op protocol if surgery has been performed. Glaucoma. Increased pressure within the eye.

Signs and symptoms. Eye pain. Difficulty adjusting to darkness. Unable to detect color. May see halos.

Headache. Fatigue and blurred vision. Nurse assistant duties and observations for visual impairments.

Announce yourself by name when entering the room. Encourage television or radio listening. Be careful in explaining what you're doing.

Describe the food you are going to feed them. Is it hot? Is it cold?

Describe food placement like the hands of a clock. Do not disturb the environment. Keep ADL supplies in the same place.

Do not move furniture unless necessary and encourage independence. Hearing impairments. Autosclerosis.

A progressive form of deafness with an unknown cause. Signs and symptoms are progressive loss of hearing. Related subjects optional.

West Nile virus. Autonomic dysreflexia and mad cow disease. Nervous system complications inactivity, weakness, and limited mobility, insomnia, from sleeping during the day. Gastrointestinal system, anatomy and physiology, mouth, tongue, and teeth, esophagus, stomach, small intestine, large intestine, liver and gallbladder, and pancreas. Functions, extends from mouth to anus, responsible for breaking food into simpler substances that can be used by the body cells for nutrition.

Common diseases and disorders. Malignancies, cancerous growths in the GI tract that can cause obstruction. They may result in surgery and or an ostomy.

Signs and symptoms, vomiting, extreme abdominal discomfort, indigestion, constipation, blood in stool, flatus, and no bowel movement at all. Nurse assistant duties and observations. Monitor bowel movements. Report discomfort to a licensed nurse. Care of ostomy, or artificial opening in the abdominal wall for the elimination of solid waste and flatus.

Standard precautions. Remove appliance gently to prevent irritation to skin. Follow facility policy.

Empty bag and wash of reusable with soap and water. Secure clamp at base. Discard disposable bag in biohazard waste and replace with new bag. Observe stoma for redness, irritation and skin breakdown. Report the licensed nurse if this is noted.

Wipe area around stoma gently after appliance is removed and wash with mild soap and water. Apply creams as ordered. Fit opening of appliance to stoma as needed. When applying appliance, seal well to prevent leaking. Observe color, character, amount, and frequency of stools and chart.

Be matter of fact. Avoid looking repelled or disgusted. Patient or resident may be very self-conscious.

Common problems with elimination. Constipation. Abdominal or rectal pain. Inability to pass stool.

Loss of appetite. Feel urge to defecate but unable to pass stool. Bloating.

Abdominal distension or hardness. Liquid stool or mucus seeping from rectum. Hard or dry stool. Feces that moves too slowly through the body. Caused by decreased fluids.

Diet. Inactivity or ignoring the urge to defecate. Fecal impaction, stools unable to pass from the rectum, results from unrelieved constipation.

Diarrhea, liquid or uninformed stool with increased frequency. Feces that moves rapidly through the intestines, caused by infection, medications, or irritating foods. Bowel incontinence, inability to control the passage of feces and gas. Possible cause due to injury or disease of the nervous system or sphincter damage.

May result when patient or residents do not receive the assistance they need in a timely manner. Flatulence or gas. Excessive formation of gas in the stomach and intestines.

Caused by foods, medications, or air swallowing. Nurse assistant duties and observations. Monitor and record bowel movements. Notify licensed nurse if above signs and symptoms develop.

Encourage a high-fiber diet for constipation. Encourage liquids whenever in contact with a patient or resident. Encourage exercise to stimulate bowel activity.

Prompt attention to the call light. Monitor skin integrity. Prompt attention to incontinence care. Note, nurse assistants never perform removal of impaction or digital disimpaction.

Related subjects optional. Diarrhea. Bowel incontinence, gallbladder disease, choleocystitis, hernias, ulcerations, bowel training, enemas, rectal tube, hemorrhoids, gastroesophageal reflux disease or GERD. Urinary system, anatomy and physiology, kidneys, filters the blood, forms the urine.

Urinar, tube carrying urine from the kidneys to the bladder. Bladder, storage for urine. Urethra. Tube for passage of urine to outside during urination or voiding.

Functions. Filters blood and produces urine in which excess fluids and toxins are excreted. The body excretes 1,000 to 1,500 milliliters of urine per day. Characteristics of normal urine.

Clear, amber, medium yellow color, mild odor. Approximately 1,000 to 1,500 cc's in a 24-hour period. Common diseases and disorders. Cystitis, which is an inflammation of the urinary bladder, especially common in women. Signs and symptoms of cystitis are common in women.

Symptoms include dysuria, burning, frequent urination, cloudy urine, hematuria, bladder spasm, loss of appetite, fever. Confused patient or resident may exhibit agitation. Nurse assistant duties and observations. Encourage fluids.

Observe for normal urine. Sits bath. Perineal care. Always wipe front to back. And rest.

Urinary incontinence. Loss of control of urine. Signs and symptoms. Unable to control urination. Stress incontinence.

Urinate when exerting, such as sneezing, standing up, or coughing. Nurse assistant duties and observations. Bladder training. Toilet the patient or resident regularly and answer call light promptly.

Be positive when changing soil, linen, or garments and do not be critical. Perineal care. Avoid liquids after dinner.

Related subjects optional. Renal dialysis, suppression, retention, renal calculi, specimen collection, urinary drainage systems, polynephritis, reproductive system, anatomy and physiology, structures and organs, male, penis, tissue enlarges during sexual arousal to introduce sperm into the vagina, testes, secretes male hormone and produces sperm, prostate gland, secretes fluid necessary for sperm. activity. Epididymis, coiled tube on top of the testes. The vas deferens, stores sperm.

Structures and organs female. Ovaries, produces female hormone in eggs. Fallopian tubes, egg travels through the uterus. Uterus, internal pear-shaped organ in the pelvis, holds fetus during pregnancy.

Vagina, receives penis during sexual activity. Vulva, the external female genitalia. Functions. Reproduction of human life. Production of some hormones.

Common diseases and disorders. The male reproductive system. Enlarge prostate gland.

Urethra passes through prostate and prostate enlarges. It strangles urethra, causing difficulty in starting stream and emptying bladder completely. Cancer of the prostate. Cancer of the testes. Female reproductive system.

Cysticeal. Weakening of the muscles between the bladder and vagina. Signs and symptoms. Urinary incontinence. Frequent urinary tract infections.

Rectocele. Weakening of muscles between wall of rectum and vagina. Signs and symptoms.

Hemorrhoids. At constipation. Prolapsed uterus.

Malignancies of the breast, ovarian, uterine, cervical. Nurse assistant duties and observations. Supportive care and notify licensed nurse if distress occurs. Sexually transmitted disease.

Human immunodeficiency virus, HIV, AIDS. Viral infection transmitted primarily through direct contact with the bodily secretions of an infected person. Signs and symptoms. Flu-like symptoms. Fever.

Night sweats. Fatigue. Swollen lymph nodes. Sore throat. GI upset.

Headache. Kaposi sarcoma. Pneumocystitis carinii pneumonia. Nurse assistant duties and observations.

Be aware that the virus is killed by 10 to 1 water to bleach solution. Potency of solution good for three days. Prevent secondary infections.

Report new symptoms and complaints of discomfort to a licensed nurse and provide comfort measures. Related subjects vulvovaginitis, tumors of the reproductive tract, sexually transmitted diseases. Breast self-exam, testicular self-exam, immune system, special cells and substances function to produce immunity, white blood cells, antibodies, antigens, and T-cells, a type of cell that destroys invading cells. When the body senses an antigen, the immune system is activated, functions to provide the body with immunity, protection against a disease or condition, common diseases and disorders, AIDS, caused by HIV. Spread through certain body fluids, blood, semen, vaginal secretions, and breast milk.

Affects the body's ability to fight other viruses and bacteria. Signs and symptoms. Loss of appetite, weight loss, fever, night sweats, diarrhea, painful or difficulty swallowing, tiredness, extreme or constant, skin rashes, swollen glands in the neck, underarms, and groin, cough, Sores or white patches in the mouth or in the tongue. Purple blotches or bumps on the skin that look like bruises but do not disappear. Confusion, forgetfulness, and dementia.

Nurse assistant duties and observations. Practice standard precautions. Follow blood-borne pathogen standard.

Provide daily hygiene. Avoid harsh soaps that irritate the skin. Provide oral hygiene before meals and at bedtime. Make sure the patient or resident uses a toothbrush with soft bristles.

Provide oral fluids as ordered by a licensed nurse. Measure and record intake and output. Measure weight daily. Have patient or resident perform deep breathing exercises as ordered.

Practice measures to prevent pressure sores. Assist with range of motion exercises and ambulation as ordered. Encourage the patient or resident to perform self-care as able. The person may need assistive devices such as walkers, commode, eating devices, etc. Encourage the patient or resident to be as active as possible.

Change linens. gowns or pajamas as often as needed when fever is present. Be a good listener and provide emotional support. Other considerations. AIDS is often missed during diagnosis because of aging that can mask the signs and symptoms of AIDS.

Some persons with HIV don't develop AIDS for as long as 10 to 15 years and may not show signs or symptoms. However, they are carriers and can spread the disease to others. Section 8. Changes in body systems associated with aging.

A. Integumentary system. Skin becomes thin, fragile, dry, and wrinkled.

Blood supply to fingers and toes decreases. Sensitivity to hot and cold decreases. Hair loses color. Nails thicken. Bruises easily due to fragile blood vessels.

B. Respiratory system. Lung strength decreases. Air sacs become less elastic and decrease in number. Airways become stiff and less elastic.

Lung capacity decreases. Cough reflex is less effective. Cough becomes weaker.

And gas exchange in lungs is less effective. C. Cardiovascular system.

Blood flow decreases, leading to less efficient circulation. Blood vessels narrow and lose elasticity. Longer recovery to normal pulse after exercise and heart is a less effective pump. D. Musculoskeletal.

Muscles weaken and lose tone. Loss of elasticity in muscles. Loss of muscle mass causes weight loss.

Less flexible. Bones lose minerals, become porous and brittle or easily broken. Height is gradually lost due to space between vertebrae shrinking. Posture slump. Joints are less flexible and stiffer, slows normal body movement, degenerative changes in joints, and decreased reflexes prone to injury and falls.

E. Endocrine System Decrease in sex hormones such as estrogen and progesterone signals menopause and testosterone levels decrease. Insulin production decreases. Metabolism in body functions slow.

Body is less able to handle stress. Body is less able to handle sugar. F. Nervous system. Slowing nerve transmissions result in delayed reaction time, poor coordination and balance, less effective temperature regulation, decreased sensitivity to pressure and temperature changes, decreased blood flow to brain, resulting in memory loss and confusion.

Deep sleep is shortened. Naps are needed. G.

Gastrointestinal system. Decreased saliva production causing dysphagia. Taste buds not as sensitive. Decreased gag reflux leading to chance of choking.

Slow peristalsis leading to indigestion and constipation. Increased flatulence. Decreased digestive enzymes.

Avoid dry, fried, and fatty foods. Decreased ability to absorb nutrients. Medication related to side effects. Sensitivity to sensation of full bowel. Urgency is exaggerated with the bowel.

Urinary system. Kidneys decrease in size and are less efficient. Bladder loses tone, leading to retention and infection. Have patient or resident bear down after voiding to complete empty bladder.

Decreased bladder capacity leads to frequency of urination. Kidney function increases at rest, causing urination at night. Prostate enlargement in males cause frequency, dribbling, and urinary retention.

Elderly patient or resident may exhibit behavior changes with usual UTI signs and symptoms. Decreased sensitivity to sensation of full bladder. Urgency is exaggerated with the bladder.

I. Reproductive system. Male reproductive system. Scrotum less firm.

Number and capacity of sperm decreases. Sexual response delayed, increase in size of prostate gland, and hormone production decreases. Female reproductive system. Menopause when menstruation ends. Decreased production of estrogen and progesterone result in loss of calcium, causing brittle bones and osteoporosis.

Fewer hormones are produced. Ovulation and menstrual cycle cease. Vagina becomes thinner, drier.

Breast tissues decrease and muscles supporting breast weaken.

Transcript for:Module 13 Long-Term Care for Residents

Transcript for:
Module 13 Long-Term Care for Residents