Download Ch 4 Body Systems and Related Conditions

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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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:
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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:
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Surgery
Chemotherapy
Radiation
Or combination of them
Care guidelines for cancer
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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
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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