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Ch 4 Body Systems and Related Conditions Integumentary system • Largest organ and system • Natural protective covering • Prevents excessive loss of water and injury to internal organs • Skin made of tissue and glands • Skin is a sense organ • Regulates body temperature Normal changes of aging • Thinner skin, more fragile • Drier skin, less elastic • Thinning fatty tissue can cause person to feel colder • Thinner, gray hair • Wrinkles and brown spots • Nails harder and more brittle • Reduced circulation to skin can cause dryness, itching, irritation How you can help • Use lotions as ordered for moisture • Be gentle • Generally complete bath only twice a week, sponge baths daily • Shampoo hair less often and gently brush to distribute the natural oils • Layer clothing and bed covers for warmth • Keep linens wrinkle free • Be careful with nail care, do not cut toenails • Encourage fluids s/s to observe and report • Pale, white, reddened, or purple area, blisters or bruises • Dry or flaking skin • Rashes or discoloration • Cuts, boils, sores, wound, abrasions • Fluid or blood draining from skin • Changes in moisture level • Swelling • blisters More s/s to observe and report • Changes in wound or ulcer • Redness or broken skin between toes or around toenails • Scalp or hair changes • Skin that appears different from normal • In ebony complexions, also look for change in the feel of the tissue (e.g. “orange peel” look) Pressure sores • Pressure sores (decubitus ulcers) occur where blood has poor circulation and bone is close to skin. Skin receives less oxygen and nutrients, cells die, and tissue breaks down. • Reposition at least every two hours, encourage movement, good nutrition and hydration. Musculoskeletal system • Human body has 206 bones • Two bones meet at joint (for movement). Joints make movement possible in either all directions or in one direction only. • Muscles provide movement and produce body heat • Physical activity/exercise increases circulation, increasing blood flow to organs and tissues • Inactivity can cause depression, pneumonia, constipation, UTIs, loss of self-esteem, and blood clots. • Muscles develop atrophy or contractures from inactivity • ROM exercises help prevent atrophy or contractures Normal changes of aging • • • • • Muscles weaken and lose tone Body movement slows Bones lose density and become more brittle Joints can stiffen/become painful Height is gradually lost How you can help • Prevent falls keeping paths cleared, walkers in reach • Keep call bells in reach • Be sure residents have non-skid shoes on, laces tied • Immediately clean up spills • Encourage regular movement and self-care • Help with ROM s/s to observe and report • • • • • • • Changes in movement and activity Changes in ability to do ROMs Pain during movement New or increased swelling of joints White, shiny, red, or warm joints Bruising Aches and pains reported by resident Disorders of the musculoskeletal system • • • • Arthritis Osteoporosis Fractures Hip and knee replacement Arthritis • Arthritis is inflammation of the joints causing stiffness and pain, and decreased mobility • Arthritis may be caused by aging, injury, or autoimmune illness • Two types: osteoarthritis and rheumatoid arthritis • Pain and stiffness increase in cold or damp weather Arthritis tx (treatment) • Anti-inflammatory medications (aspirin or ibuprofen) • Local applications of heat • ROMs • Exercise • Diet Care guidelines for arthritis • • • • Watch for stomach irritation or heartburn Encourage activity Adapt ADLs to allow independence Choose clothing that is easy to put on and fasten • Use special utensils if needed • Treat each resident as an individual • Help self-esteem by encouraging self-care Osteoporosis • Causes bones to become brittle • May be due to age, lack of hormones, lack of calcium, alcohol consumption, or lack of exercise • Occurs more commonly in women after menopause s/s of osteoporosis • Low back pain • Stooped posture • Loss of height Prevention or slowing of osteoporosis • Encourage residents to walk and do other light exercise • Move residents with osteoporosis very carefully • Follow care plan regarding medication, calcium, and fluoride supplements, which might be used to treat osteoporosis Fractures and Hip and Knee replacements • Fall prevention is a key to preventing fractures • Partial weight bearing- resident is able to support some weight on one or both legs (PWB) • Non-weight bearing- unable to support any weight on one or both legs (NWB) • Full weight bearing- one or both legs can bear 100% of the body weight on a step (FWB) Guidelines of care for a new cast • • • • • • • • • Do not cover until dry Do not place on hard surface Elevate extremity in cast Observe for skin discoloration, tightness, swelling, sores, skin temperature, burning, numbness or tingling, drainage, bleeding, or odor Protect resident’s skin from edges of cast Keep cast dry Do not insert anything into cast Tell the nurse if pain medication is needed Use bed cradles as needed Hip fractures • Cause may be a fall or weakened bones • Elderly bones heal slowly • Hip replacements reasons: • Fracture doesn’t heal properly • Weakened hip due to aging • Painful and disabled hip Care guidelines for hip replacement: • Keep often-used items within reach • Dress affected side first • Do not rush the resident. Use praise and encouragement • Ask for pain medication as needed • Have the resident sit to do tasks • Follow the care plan More care guidelines, hip replacement: • Do not perform ROM exercises on hip replacement side • Hip cannot be at less than 90 degree angle. It cannot be turned inward or outward. • Transfer resident carefully, with strong side leading in standing, pivoting, and sitting. • With chair or toilet transfers, operative leg/knee should be straightened. Strong leg should stand first. s/s to observe and report • • • • • • Red, draining, warm, or bleeding incision Increase in pain Numbness or tingling Abnormal vital signs Inability to use equipment properly and safely Resident not following doctor’s orders for activity and exercise • Problems with appetite • Increasing strength and improving ability to walk Knee replacement • • • • Reasons for knee replacement: Relieve severe pain Restore motion to damaged knee Help stabilize a knee that buckles or gives out. • Recovery time for knee replacement is generally shorter than for a hip replacement Care guidelines for knee replacement • • • • • • Apply special stockings as ordered Perform ankle pumps as ordered Encourage fluids Assist with deep breathing exercises Ask for pain medication if needed Report to nurse if you notice redness, swelling, heat or deep tenderness in one or both calves Nervous System • • • • Control and message center of body Controls and coordinates all body functions Interprets information from outside the body Two main parts: central nervous system (brain and spinal cord) and peripheral nervous system Normal changes of aging • Slower responses and reflexes • Decrease in sensitivity of nerve endings in skin • Some memory loss, more often with shortterm memory How you can help • Help with memory loss- suggest residents make lists or write notes about things they want to remember • Put calendar nearby • Encourage to reminisce, ask to see photos, hear stories • All time for decision making • Avoid sudden changes in schedule • Allow plenty of time for movement, never rush the person • Encourage reading, thinking, and other mental activities s/s to observe and report • • • • • • • • • • • • • Fatigue or pain with movement Shaking or trembling Inability to speak clearly Inability to move one side of body Disturbance or change in vision or hearing Changes in eating or fluid intake Difficulty swallowing Bowel or bladder changes Depression or mood changes Memory loss or confusion Violent behavior Unusual change in behavior Decreased ability to perform ADLs Dementia and Alzheimer’s disease • (covered in chapter 5) CVA/Stroke • Caused when blood supply to brain is cut off by a clot or ruptured vessel • Results in lack of oxygen to tissue, causing cells to die • Swelling, leaking blood, and clots affect surrounding healthy brain tissue • Weakness occurs opposite affected side of brain • Mild stroke may result in few, if any, complications • Hemiplegia- paralysis on one side of the body • Hemiparesis- weakness on one side of the body • Expressive aphasia- inability to speak or speak clearly • Receptive aphasia- inability to understand spoken or written words • Emotional lability- laughing or crying without any reason, inappropriately • Dysphagia- difficulty swallowing Care guidelines for stroke • Assist with exercises as ordered, keeping safety in mind • Use terms “weaker” or “involved”, not “bad” • Assist with speech therapy as needed • Use verbal and nonverbal communication to express positive attitude • Residents may experience confusion, memory loss, and emotions. Be patient and understanding • Encourage independence and self-esteem More care guidelines for stroke • Always check on resident’s body alignment • Pay special attention to skin care • If residents have lost sense of touch or sensation, be aware of potentially harmful situations such as proximity to heat and sharp objects • Adapt procedures when caring for residents with one-sided paralysis or weakness (stroke) For transfers • Always use gait belt • Stand on and support weaker side • Lead with stronger side (stroke) for assisting with dressing • Dress weaker side first. Undress stronger side first • Use assistive equipment to help resident dress himself (stroke) for assisting with communication • Keep questions and directions simple • Phrase questions so they can be answered with a “yes” or “no” • Agree on signals, such as shaking or nodding the head or raising a hand or finger for ‘yes” or “no” • Give residents time to respond. Listen attentively. More communication hints • Use a pencil and paper if the resident can write. • Use verbal and nonverbal communication to express your positive attitude. • Use pictures, gestures, or pointing. Use communication boards or special cards to aid communication. • Keep the call signal within reach of residents. Parkinson’s Disease • Progressive, degenerative disease • Causes stiff muscles, stooped posture, shuffling gait (walk), pill-rolling, tremors, and mask-like facial expression • Tremors can make ADLs difficult Care guidelines for Parkinson’s Disease • • • • Protect residents from falls Help with ADLs as needed Assist with ROM exercises as ordered Encourage self-care and be patient Multiple Sclerosis (MS) • A progressive disease affecting the central nervous system • Protective sheath breaks down over time and nerves cannot send message properly • Residents will have varying abilities • Symptoms can include blurred vision, fatigue, tremors, poor balance,, trouble walking, weakness, numbness, tingling, incontinence, and behavior changes • Can cause blindness, contractures, and loss of function in arms and legs. Care guidelines for MS • • • • • • • • • Help with ADLs Be patient with self-care and movement Allow time for tasks. Offer rest periods Give resident time to communicate Prevent falls Help avoid stressful situations. Listen to residents. Encourage proper diet Give regular skin care Assist with ROM exercises Head and Spinal Cord Injuries • May result from diving sports injuries, falls, car and motorcycle accident, industrial accidents, war, and criminal violence. • Can cause permanent brain damage, mental retardation, personality changes, trouble breathing, seizures, coma, memory loss, loss of consciousness, paresis (weakness), paralysis • Effects depend on force of impact and location of injury • May cause paraplegia(loss of function of lower body and legs) or quadriplegia (unable to use legs, trunk and arms • Rehabilitation is needed • Emotional support is important Care guidelines for head and spinal cord injuries • • • • • • • • • • • • • Give emotional and physical support Be patient Prevent falls and burns Give good skin care Assist with position changes at leaset every two hours Perform PROM exercies Encourage fluids and proper diet to prevent constipation Give extra catheter care as needed Offer rest periods as needed Use special stockings as ordered Encourage deep breathing exercises as ordered Provide for privacy if involuntary erections occur Assist with bowel and bladder training Eye and ear, nose, tongue and skin: sense organs • Eyes include sclera, cornea, iris, pupil and retina • Ears include outer ear( auricle, auditory canal, eardrum), middle ear (eustachian tube and ossicles), and inner ear (internal auditory canal, cochlea; transfers message to rain and controls balance) Normal changes of aging • Reduced vision and hearing (sense of balance may be affected) • Decreased senses of taste, touch and smell • Decreased sensitivity to hear and cold How you can help • Encourage use of eyeglasses, keep them clean • Encourage use of hearing aids and keep them clean • Speak slowly and clearly, do not shout • Encourage good oral care. • Provide a variety of food tastes and textures • Assist as needed with regular bathing • Be careful with hot drinks and hot bath water s/s to observe and report • • • • Changes in vision or hearing Signs of infection Dizziness Complaints of pain in eyes or ears Vision impairment • Can affect people of all ages • Corrected by eyeglasses or contacts • People over 40 are at risk for developing cataracts, glaucoma, and blindness • Cataracts (lens of eye becomes cloudy) may be corrected surgically • Glaucoma (Pressure in eye increases and damages retina and optic nerve) can occur suddenly or gradually and is treated with medication and sometimes surgery • Residents may enjoy books on tape, large-print books, or Braille books Circulatory system • Made up of heart, blood vessels, and blood • Blood carries food, oxygen, and essential substances to cells • Major functions are to: – Supply food, oxygen, and hormones to cells – Produce and supply antibodies – Remove waste products from cells – Control body temperature • Heart has four chambers (two atria/upper chambers and two ventricles/lower chambers) • Heart functions in two phases: – resting phase-diastole (chambers fill with blood) – Contracting phase- systole (ventricles pump blood) Normal changes of aging • Heart pumps less efficiently • Decreased blood flow • Narrowed blood vessels How you can help • • • • • Encourage movement and exercise Allow enough time to complete activities Prevent residents from tiring Layer clothing to keep residents warm Use sock, slippers, or shoes to keep the feet warm s/s to observe and report • • • • • • • • • • Changes in pulse rate Weakness or fatigue Loss of ability to perform ADLs Selling of hands and feet Pale or blue hands, feet or lips Chest pain Weight pain Shortness of breath Severe headache Inactivity, which can lead to circulatory problems Hypertension (HTN)/ high blood pressure • Causes: hardening and narrowing of blood vessels (atherosclerosis), kidney disease, adrenal tumors, or pregnancy • Symptoms: headache, blurred vision, and dizziness… sometimes there are no noticeable symptoms Care guidelines for HTN • Treatment to control is vital ( can lead to CVA, heart attack, kidney disease, or blindness) • Encourage residents to follow their diet and exercise programs • Diuretics- drugs that reduce fluid in the body, help lower blood pressure if prescribed. Coronary Artery Disease (CAD) • Cause: vessels in coronary arteries narrow, reducing blood to heart • Symptoms: angina pectoris (chest pain, pressure or discomfort from the heart muscle not getting enough oxygen especially increased oxygen need during exercise, stress or a heavy meal) Care guidelines for Angina pectoris • Encourage rest • Nitroglycerin should be close by • Tell the nurse if a nitroglycerin patch comes off • Residents may need to avoid heavy meals, overeating, intense exercise, and extreme weather exposures Myocardial Infarction (MI) or heart attack • Caused by complete block of blood flow to heart muscle, which results in tissue death • Area of dead heart muscle tissue may be large or small • Can result in serious heart damage or death • (warning signs covered in chapter 2) Care guidelines for heart attack • May be placed on exercise program • May be on low-fat/low-sodium diet • Medications may be used to regulate heart rate and blood pressure • Quitting smoking is encouraged • Stress management program may be started • Residents may need to avoid cold temperatures Congestive Heart Failure (CHF) • Cause: failure of heart muscle to pump effectively due to damage • Symptoms: trouble breathing, coughing or gurgling with breathing, dizziness, confusion, fainting, pale or blud skin, low blood pressure, swelling of feet and ankles, bulging neck veins, weight gain Care guidelines for CHF • Medications can help control • Medications mean more trips to bathroom. Answer call lights promptly • Low-sodium diet or fluid restriction if prescribed • Limited activity or bedrest if prescribed • I & O may need to be measured • Residents may need to be weighed daily More care guidelines for CHF • • • • • • Elastic leg stockings help reduce swelling ROM exercises improve muscle tone Extra pillows may help breathing Help with personal care and ADLs as needed High-potassium foods can help with dizziness Report symptoms to the nurse Peripheral Vascular Disease (PVD) • Cause: fatty deposits in the blood vessels that harden • Symptoms: cool arms and legs, swelling in hands and feet, pale or bluish hands or feet, bluish nail beds, ulcers of legs and feet • Pain may be severe when walking but can decrease with rest • Anti-embolic stockings can help prevent swelling and blood clots and aid circulation Respiratory System • Has two functions: – To bring oxygen into body – To eliminate carbon dioxide produced by the body – Inspiration- breathing in – Expiration- breathing out – Respiration- the body taking in oxygen and removing carbon dioxide Normal changes of aging • • • • Loss of lung strength Decrease lung capacity Decrease oxygen in the blood Weakened voice How you can help • Provide rest period as needed • Encourage exercise and regular movement • Encourage and assist with deep breathing exercises as ordered • Do not expose to cigarette smoke or polluted air • May be more comfortable sitting up s/s to observe and report • Changes in respiratory rate • Shallow breathing or breathing through pursed lips • Coughing or wheezing • Nasal congestion or discharge • Sore throat, difficulty swallowing • Need to sit after mild exertion • Pale or bluish lips or extremitites • Pain in chest • Sputum is yellow, green, gray, or bloody Chronic Obstructive Pulmonary Disease (COPD) • It is a chronic disease • Have trouble breathing, especially getting air out of the lungs • At high risk of contracting pneumonia • Two chronic lung diseases are grouped under COPD: – chronic bronchitis -irritation and inflammation of the lining of the bronchi, symptoms include coughing that brings up sputum and mucus, breathlessness and wheezing – and emphysema- trouble breathing, breathlessness, fast heartbeat, treated by managing symptoms and pain, oxygen • All body systems are affected when the lungs and brain do not get enough oxygen • Residents may be in constant fear of not being able to breathe and might need to sit upright to improve lung expansion. • Residents may have poor appetites and not sleep well, leading to weakness and feeling of general poor health. s/s of COPD • • • • • • • • Chronic cough or wheeze Trouble breathing Shortness of breath Pale, cyanotic, or reddish-purple skin Confusion General weakness Difficulty completing meals Fear and anxiety Care guidelines for COPD • • • • • • • • Observe and report symptoms getting worse Help resident sit upright Offer plenty of fluids and small, frequent meals Encourage a balance diet Keep oxygen supply available as ordered Be calm and supportive Use good infection control Encourage independence with ADLs More care guidelines for COPD • Remind residents to avoid exposure to colds and the flu • Make sure residents always have help ready • Encourage pursed-lip breathing • Encourage residents to save energy. Encourage rest. s/s of COPD to report • Temperature over 101 degrees F • Changes in breathing patterns • Changes in color or consistency of lung secretions • Changes in mental state or personality • Refusal to take medications as ordered • Excessive weight loss • Increasing dependence Urinary System • Composed of two kidneys, two ureters, one urinary bladder, and a single urethra • Has two important functions: eliminates waste products created by the cells and maintains the water balance in the body Normal changes of aging • Ability of kidneys to filter blood decreases • Bladder muscle tone weakens • Bladder holds less urine, which causes more frequent urination • Bladder may not empty completely, causing greater chance of infection How you can help • Encourage residents to drink plenty of fluids • Offer frequent trips to the bathroom • If residents are incontinent, do not show frustration or anger. (Urinary incontinencethe inability to control the bladder which leads to an involuntary loss of urine.) • Keep residents clean and dry s/s to observe and report • • • • • • • • • • Weight loss or gain Swelling in upper or lower extremities Pain or burning during urination Changes in urine, such as cloudiness, odor, or color Changes in frequency and amount of urination Swelling in the abdominal/bladder area Complaints that bladder feels full or painful Urinary incontinence/dribbling Pain in the kidney or back/flank region Inadequate fluid intake Urinary incontinence • Can occur in people who are confined to bed, ill elderly, paralyzed, or who have circulatory or nervous system diseases or injuries • Stress that incontinence is not a normal part of aging and may signal an illness. It is a major risk factor for pressure sores. Care guidelines for urinary incontinence • • • • • • • • Offer to assist with toileting often Follow toileting schedules Answer call lights and requests for assistance promptly Document carefully and accurately any time a residents’ skin or anything touching resident’s skin is wet from urine, even if it is a small amount. Wash urine off immediately and completely Incontinent residents who are bedbound should have disposable sheets under them to protect the bed. Place a draw sheet over it to absorb moisture and protect skin. Use disposable incontinence pads or briefs as needed to keep body wastes away from skin. Change wet briefs promptly and DO NOT refer to them as “diapers”. Be reassuring and understanding. Urinary Tract Infection (UTI) • Being bedbound is a risk factof for increased incidence of UTI. • Women are more likely than men to contract UTI • Women should wipe the perineal area from font to back after elimination Guidelines for preventing UTIs • Encourage residents to wipe from front to back and do the same when providing peri care • Give careful perineal care when changing incontinent briefs • Encourage plenty of fluids • Offer to assist with toileting often. Answer call lights promptly. • Taking showers, rather than baths, helps prevent UTIs • Report cloudy, dark, or foul-smelling urine, or if resident urinates often and in small amounts. Gastrointestinal System • Digestion- the process of preparing food physically and chemically so that it can be absorbed into the cells • Elimination is the process of expelling solid wastes made up of the waste products of food that are not absorbed into the cells • Fecal/anal incontinence- inability to control the bowels, leading to involuntary passage of stool • Anorexia- loss of appetite Normal changes of aging • Decreased saliva production affects chewing/swallowing • Absorption of vitamins/minerals decreases • Digestion takes longer, is less efficient • Body waste moves more slowly through intestines; constipation more frequent How you can help • • • • • Encourage fluids and nutritious, appealing meals Allow time to eat Make mealtime enjoyable Provide good oral care Make sure dentures fit properly and are cleaned regularly • Provide plenty of fluids with meals and have diet containing fiber to prevent constipation • Encourage daily bowel movements, give an opportunity around the same time each day s/s to observe and report • • • • • • • • • • • • • Difficulty swallowing or chewing Fecal/anal incontinence Weight gain or less Anorexia Abdominal pain or cramping Diarrhea Nausea and vomiting (especially coffee grounds type) Constipation Flatulence Hiccups, belching Bloody, black, or hard stools Heartburn Poor nutritional intake constipation • Inability to eliminate stool or the difficulty painful elimination of a hard, dry stool • Cause: decreased fluid intake, poor diet, inactivity, medications, aging, disease, or ignoring the urge to eliminate • Symptoms: abdominal swelling, gas, irritability, and record of no recent bowel movement • Treatment: increasing fiber and fluid intake, increasing activity level, and possible enema (specific amount of water introduced into the colon to eliminate stool) or suppository (medication given rectally to cause a bowel movement) Fecal impaction • Cause: A hard stool that is stuck in the rectum and cannot be expelled. Results from unrelieved constipation • Symptoms: no stool for several days, oozing of liquid stool, cramping, abdominal swelling, and rectal pain • Treatment: nurse or doctor inserts one or two gloved fingers into the rectum to break the mass into fragments so that it can be passed • Prevention: a high-fiber diet, plenty of fluids, an increase in activity level and possibly medication Hemorrhoids • Cause: enlarged veins in the rectum and/or outside the anus resulting from an increase in pressure in the lower rectum due to straining during bowel movements, chronic constipation, obesity, pregnancy, and sitting for long periods of time on the toilet • Symptoms: rectal itching, burning, pain, and bleeding • Treatment: medications, compresses, and sitz baths; surgery may be necessary • **when cleaning the anal area, be careful to avoid causing pain and bleeding from hemorrhoids Diarrhea • Cause: frequent elimination of liquid or semiliquid feces resulting from infections, microorganisms, irritating foods, and medications • Symptoms: abdominal cramps, urgency, nausea, and vomiting can accompany diarrhea • Treatment: medication and a change of dietbananas, rice, apples, and tea/toast (BRAT diet) Gastroesophageal Reflux Disease (GERD) • Chronic condition in which the liquid contents of the stomach back up into the esophagus • Liquid can inflame and damage the lining of the esophagus, causing bleeding or ulcers • Scars from tissue damage can narrow the esophagus and make swallowing difficult • Heartburn is the most common symptom of GERD • Treatment is usually medications. GERD guidelines • Serve evening meal three to four hours before bedtime • Keep resident upright at least two to three hours after eating • Give resident an extra pillow so the body is more upright during sleep • Serve the largest meal of the day at lunchtime and serve several small meals throughout the day. • Reduce fast foods, fatty foods, and spicy foods • Stop smoking, drinking alcohol • Wear loose-fitting clothes Ostomies • Ostomy is an operation to create an opening from an area inside the body to the outside. • Stoma- the artificial opening in the abdomen through which the end of the intestine is brought out of the body • May be necessary due to bowel disease, cancer , or trauma • Colostomy, the colon is removed and opened to the abdomen, the stool will be semi-solid • Ileostomy, the ileum is removed and opened to the abdomen, the stool may be liquid. • Disposable bag fits over the stoma to collect the feces and is attached to the skin by adhesive. A belt may aslo be used to secure it. Guidelines for ostomies • Make sure resident receives good skin care and hygiene. Ostomy bag should be emptied and cleaned or replaced whenever stool is eliminated. • Always wear gloves and wash hands carefully • Teach proper handwashing techniques to residents with ostomies • Be sensitive and supportive when working with residents with ostomies. Always provide privacy for ostomy care. Endocrine System • Glands are structures that produce substances. • Hormones are chemical substances created by the body that regulate essential body processes. They are carried by the blood to organs to: – – – – – – Maintain homeostasis Influence growth and development Regulate blood sugar levels Regulate calcium levels in bones Regulate body’s ability to reproduce Determine how fast cells burn food for energy Normal changes of aging • Decrease in levels of hormones, such as estrogen and progesterone • Less production of insulin • Less able to handle stress How you can help • Encourage proper nutrition • Try to eliminate or reduce stressors • Offer encouragement and listen to residents s/s to observe and report • Report immediately: – – – – – – – – – – – Headache Weakness Blurred vision Dizziness Hunger Irritability Sweating Change in behavior Confusion Change in mobility or sensation Numbness or tingling in arms or legs More s/s to observe and report • • • • • • • • • Weight gain/loss Loss of appetite/increase appetite Increased thirst Frequent urination or change in urine output Dry skin Skin breakdown Sweet or fruity breath Sluggishness or fatigue hyperactivity Diabetes • Pancreas does not produce enough insulin • Insulin is a hormone that converts glucose, or natural sugar, into energy for the body. • Glucose collects in blood causing circulatory problems • Two types are: type 1 (diagnosed in children and young adults, continues throughout life) treated with insulin and diet • and type 2 (adult-onset) milder, controlled with diet and/or oral medications pre-diabetes describes blood glucose levels above normal but not high enough for a diagnosis of type 2 diabetes Gestational diabetes- having high blood sugar during pregnancy Signs of diabetes • • • • • • • • • • • • Excessive thirst Extreme hunger Frequent urination Weight loss High levels of blood sugar Sugar in urine Sudden vision changes Tingling or numbness in hands or feet Feeling very tired Very dry skin Sores that are slow to heal More infections than usual Complications of diabetes • Changes in the circulatory system can cause heart attack, stroke, poor extremity circulation, poor wound haling, and kidney and nerve damage • Damage to eyes can cause vision loss and blindness • Diabetes can lead to leg and foot ulcers, infected wounds, and gangrene due to poor circulation and impaired wound healing • Insulin reaction and diabetic ketoacidosis are serious complications Care guidelines for diabetes • • • • Follow diet instructions exactly Encourage exercise Observe resident’s management of insulin doses [Perform urine and blood tests as directed (not all states allow you to do this, SC does not)] • Give foot care as directed • Encourage comfortable, leather footwear and cotton socks Reproductive System • Males- testes, scrotum, testosterone • Females- ovaries, fallopian tubes, estrogen • Sex glands are called gonads Normal changes of aging • Male- decrease in sperm production – Enlargement of the prostate gland – Female- menstruation ends – decrease in estrogen leads to loss of calcium, causing brittle bones – drying and thinning of vaginal walls How you can help • Provide privacy when necessary for sexual activity. • Respect your resident’s sexual needs. • Never make fun o or judge any sexual behavior • Do report any behavior that makes you uncomfortable or seems inappropriate. s/s to observe and report • • • • • • • • Discomfort or difficulty with urination Discharge Swelling of genitals Bood in urine or stool Breast changes, lumps, or discharge Sores on genitals Reports of impotence Reports of painful intercourse Vaginitis • Infection of the vagina • Causes: bacteria, protozoa, fungus, or hormonal changes after menopause • Symptoms: white vaginal discharge, itching, burning • Treatment: oral medications, vaginal gels or creams Benign Prostatic Hypertrophy (BPH) • The prostate becomes enlarged as men age • Causes: enlarged prostate causes pressure on the urethra, which leads to problems urinating and emptying the bladder • Treatment: medications or surgery • Men are also at increased risk for prostate cancer as they age. It is slow-growing and responsive to treatment, so early detection is important. Immune System, Lymphatic System • Immune system protects the body from disease-causing bacteria, viruses, and organisms in two ways. – Non-specific immunity protects the body from disease in general – Specific immunity protects against a particular disease that is invading the body at a given time. • Lymphatic system’s function is to remove excess fluids and waste products as well a to help the immune system to fight infections • It is closely related to the circulatory system because lymph fluid, after being purified in the lymph nodes, flows into the blood streatm • It has no pump, but is circulated by muscle activity, massage, and breathing. Normal changes of aging • Increased risk of infections due to weaker immune system • Decreased response to vaccines How you can help • • • • • • Follow rules for preventing infection. Wash hands often. Keep the resident’s environment clean. Encourage and help with good personal hygiene. Encourage proper nutrition and fluid intake. Promote a comfortable environment that allow for enough rest. • Take accurate vital sign measurements. s/s to observe and report • Recurrent infections • Swelling of lymph nodes • Increase fatigue HIV and AIDS • Acquired immunodeficiency virus is caused by human immunodeficiency virus. • HIV attacks the immune system and disables it. • HIV is transmitted by sexual contact, blood, infected needles, or from mother to fetus. • Symptoms at transmission are like flu. • Later symptoms include infections, tumors, and central nervous system symptoms • Late stage is AIDS dementia complex s/s of HIV/AIDS • • • • • • • • • • • • • • • • Appetite loss Involuntary weight loss Flu-like symptoms Night sweats Swollen lymph nodes Severe diarrhea Dry cough Skin rashes Painful white spots in mouth Cold sores Warts on the skin and in mouth Inflamed and bleeding gums Low resistance to infection Bruising that does not go away Kaposi’s sarcoma AIDS dementia complex • Opportunistic infections invade the weakened body. They worsen AIDS. • Treatment is medication. Drugs slow the progress but there is no cure for the disease. • Practice standard precautions with all residents. Care guidelines for HIV/AIDS • Wash hands often, follow standard precautions, keep everything clean • High-protein, high-calorie, high-nutrient meals • Make mealtimes pleasant and relaxing • Good mouth care • Small, frequent meals, ensure adequate fluid intake • Allow to go barefoot or wear loose, soft slippers for the neuropathy, bed cradle to keep sheets off of feet • Treat with respect and provide emotional support • Confidentiality Cancer • Cancer is a general term meaning many types of malignant tumors • Tumor- a group of abnormally growing cells – Benign tumors grow slowly in local areas and are non-cancerous – Malignant tumors grow rapidly, invade surrounding tissues, are cancerous • There is no known cure, only treatment • It may spread to other areas of the body, affecting other body systems • Cancer often first appears in breast, colon, rectum, uterus, prostate, lungs or skin • Harder to treat if it has spread from primary site. Risk factors for Cancer • • • • • • • • Tobacco use Exposure to sunlight Excessive alcohol use Some food additives Exposure to some chemicals and industrial agents Radiation Poor nutrition Lack of physical activity Warning signs of cancer • • • • • • • • • • • • Unexplained weight loss Fever Fatigue Pain Skin changes Change in bowel or bladder habits Sores that do not heal Unusual bleeding or discharge Thickening or lump in breast or other part of body Indigestion or difficulty swallowing Recent change in wart or mole Nagging cough or hoarseness TX for cancer • • • • Surgery Chemotherapy Radiation Or combination of them Care guidelines for cancer • • • • • • Be sensitive, have a positive attitude Try plastic utensils for residents receiving chemo Watch for signs of pain and report Give back rubs for comfort. Reposition residents. Use lotion on dry skin, don’t remove markings Assist with oral care often, use soft-bristled toothbrush and baking soda rinse • Provide help with grooming s/s to observe and report • • • • • • • • • • • • Increased weakness or fatigue Weight loss Nausea, vomiting, diarrhea Changes in appetite Fainting Signs of depression Confusion Blood in stool or urine Change in mental status Changes in skin New lumps, sores, rashes Increase in pain or unrelieved pain