Define%20the%20following%20terms:

1
Define the following terms

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

2
Transparency 4-1 The Integumentary System
3
1. Describe the integumentary system

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

4
1. Describe the integumentary system

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

5
1. Describe the integumentary system

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

6
1. Describe the integumentary system

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

7
1. Describe the integumentary system

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

8
1. Describe the integumentary system

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

9
Define the following terms

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

10
Transparency 4-2 The musculoskeletal system and
related conditions
11
2. Describe the musculoskeletal system and
related conditions

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

12
2. Describe the musculoskeletal system and
related conditions

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

13
2. Describe the musculoskeletal system and
related conditions

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

14
2. Describe the musculoskeletal system and
related conditions

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

15
2. Describe the musculoskeletal system and
related conditions

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

16
Define the following terms

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

17
2. Describe the musculoskeletal system and
related conditions

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

18
2. Describe the musculoskeletal system and
related conditions

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

19
Transparency 4-3 Care Guidelines for Arthritis

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

20
Define the following terms

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

21
2. Describe the musculoskeletal system and
related conditions

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

22
2. Describe the musculoskeletal system and
related conditions

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

23
2. Describe the musculoskeletal system and
related conditions

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

24
Define the following terms

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

25
2. Describe the musculoskeletal system and
related conditions

• REMEMBER
• Fall prevention is the key to avoiding fractures.
  

26
2. Describe the musculoskeletal system and
related conditions

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

27
2. Describe the musculoskeletal system and
related conditions

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

28
2. Describe the musculoskeletal system and
related conditions

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

29
Transparency 4-4 Care Guidelines for Hip
Replacement

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

30
2. Describe the musculoskeletal system and
related conditions

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

31
2. Describe the musculoskeletal system and
related conditions

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

32
2. Describe the musculoskeletal system and
related conditions

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

33
Transparency 4-5 Care Guidelines for Knee
Replacement

• Apply special stockings as ordered.
• Perform ankle pumps as ordered.
• Encourage fluids.
• Assist with deep breathing exercises.
• Ask for pain medication if needed.
• Report to nurse if you notice redness, swelling,
  heat or deep tenderness in one or both calves.

34
Transparency 4-6 The Nervous System
35
3. Describe the nervous system and related
conditions

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

36
3. Describe the nervous system and related
conditions

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

37
3. Describe the nervous system and related
conditions

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

38
3. Describe the nervous system and related
conditions

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

39
3. Describe the nervous system and related
conditions

• Observe and report the following (contd.)
• 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

40
3. Describe the nervous system and related
conditions

• Common disorders of this system include the
  following
• Dementia (covered in detail in Chapter 5)
• Alzheimers disease (covered in detail in
  Chapter5)
• CVA/Stroke
• Parkinsons disease
• Multiple Sclerosis
• Head and spinal cord injuries

41
Define the following terms

• 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.

42
Define the following terms

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

43
3. Describe the nervous system and related
conditions

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

44
Transparency 4-7 Care Guidelines for Stroke

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

45
Transparency 4-7 Care Guidelines for Stroke
(contd.)

• For transfers
• Always use gait belt.
• Stand on and support weaker side.
• Lead with stronger side.
• For assisting with dressing
• Dress weaker side first. Undress stronger side
  first.
• Use assistive equipment to help resident dress
  himself.

46
Transparency 4-7 Care Guidelines for Stroke
(contd.)

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

47
Define the following terms

• Gait
• manner of walking.

48
3. Describe the nervous system and related
conditions

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

49
Transparency 4-8 Care Guidelines for Parkinsons
Disease

• Protect residents from falls.
• Help with ADLs as needed.
• Assist with ROM exercises as ordered.
• Encourage self-care and be patient.

50
3. Describe the nervous system and related
conditions

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

51
Transparency 4-9 Care Guidelines for Multiple
Sclerosis

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

52
Define the following terms

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

53
3. Describe the nervous system and related
conditions

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

54
Transparency 4-10 Care Guidelines for Head and
Spinal Cord Injuries

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

55
Transparency 4-11 Parts of the Eye
56
Transparency 4-12 The Ear
57
3. Describe the nervous system and related
conditions

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

58
3. Describe the nervous system and related
conditions

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

59
3. Describe the nervous system and related
conditions

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

60
3. Describe the nervous system and related
conditions

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

61
3. Describe the nervous system and related
conditions

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

62
Transparency 4-13 The Circulatory System
63
4. Describe the circulatory system and related
conditions

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

64
4. Describe the circulatory system and related
conditions

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

65
4. Describe the circulatory system and related
conditions

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

66
4. Describe the circulatory system and related
conditions

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

67
4. Describe the circulatory system and related
conditions

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

68
4. Describe the circulatory system and related
conditions

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

69
Define the following terms

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

70
4. Describe the circulatory system and related
conditions

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

71
Transparency 4-14 Care Guidelines for High Blood
Pressure

• Treatment to control it is vital.
• Encourage residents to follow their diet and
  exercise programs.

72
Define the following terms

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

73
4. Describe the circulatory system and related
conditions

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

74
Transparency 4-15 Care Guidelines for Angina
Pectoris

• Encourage rest.
• Nitroglycerin should be close by.
• Tell the nurse if a nitroglycerin patch comes
  off.
• Residents may need to avoid heavy meals,
  overeating, intense exercise, and extreme weather
  exposures.

75
4. Describe the circulatory system and related
conditions

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

76
Transparency 4-16 Care Guidelines for Heart
Attack

• Residents may be placed on exercise program.
• Residents may be on low-fat/low-sodium diet.
• Medications may be used to regulate heart rate
  and blood pressure.
• Quitting smoking is encouraged.
• Stress management program may be started.
• Residents may need to avoid cold temperatures.

77
4. Describe the circulatory system and related
conditions

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

78
4. Describe the circulatory system and related
conditions

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

79
Transparency 4-17 Care Guidelines for Congestive
Heart Failure

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

80
4. Describe the circulatory system and related
conditions

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

81
Define the following terms

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

82
Transparency 4-18 The Respiratory System
83
5. Describe the respiratory system and related
conditions

• Remember the following points about the
  respiratory system
• Has two functions
• To bring oxygen into body
• To eliminate carbon dioxide produced by the body

84
5. Describe the respiratory system and related
conditions

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

85
5. Describe the respiratory system and related
conditions

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

86
5. Describe the respiratory system and related
conditions

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

87
5. Describe the respiratory system and related
conditions

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

88
5. Describe the respiratory system and related
conditions

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

89
Transparency 4-19 Care Guidelines for COPD

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

90
Transparency 4-19 Care Guidelines for COPD
(contd.)

• Report any of these to the nurse
• Temperature over 101F
• Changes in breathing patterns, including
  shortness of breath
• Changes in color or consistency of lung
  secretions
• Changes in mental state or personality
• Refusal to take medications as ordered
• Excessive weight loss
• Increasing dependence upon caregivers and family

91
Define the following terms

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

92
Transparency 4-20 The Urinary System
93
6. Describe the urinary system and related
conditions

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

94
6. Describe the urinary system and related
conditions

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

95
6. Describe the urinary system and related
conditions

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

96
6. Describe the urinary system and related
conditions

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

97
6. Describe the urinary system and related
conditions

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

98
6. Describe the urinary system and related
conditions

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

99
Transparency 4-21 Care Guidelines for Urinary
Incontinence

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

100
6. Describe the urinary system and related
conditions

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

101
Transparency 4-22 Preventing Urinary Tract
Infections

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

102
Define the following terms

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

103
Transparency 4-23 The Gastrointestinal System
104
7. Describe the gastrointestinal system and
related conditions

• Remember the following points about the
  gastrointestinal system
• Digestion prepares food for absorption into
  cells.
• Elimination is expelling solid wastes.

105
7. Describe the gastrointestinal system and
related conditions

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

106
7. Describe the gastrointestinal system and
related conditions

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

107
7. Describe the gastrointestinal system and
related conditions

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

108
7. Describe the gastrointestinal system and
related conditions

• Observe and report (contd.)
• Constipation
• Flatulence
• Hiccups, belching
• Bloody, black, or hard stools
• Heartburn
• Poor nutritional intake

109
7. Describe the gastrointestinal system and
related conditions

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

110
Define the following terms

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

111
7. Describe the gastrointestinal system and
related conditions

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

112
7. Describe the gastrointestinal system and
related conditions

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

113
7. Describe the gastrointestinal system and
related conditions

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

114
7. Describe the gastrointestinal system and
related conditions

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

115
7. Describe the gastrointestinal system and
related conditions

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

116
7. Describe the gastrointestinal system and
related conditions

• Facts about hemorrhoids (contd.)
• Symptoms rectal itching, burning, pain, and
  bleeding
• Treatment
• Medications
• Compresses
• Sitz baths
• Surgery may be necessary

117
7. Describe the gastrointestinal system and
related conditions

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

118
7. Describe the gastrointestinal system and
related conditions

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

119
7. Describe the gastrointestinal system and
related conditions

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

120
7. Describe the gastrointestinal system and
related conditions

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

121
7. Describe the gastrointestinal system and
related conditions

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

122
Define the following terms

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

123
7. Describe the gastrointestinal system and
related conditions

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

124
7. Describe the gastrointestinal system and
related conditions

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

125
Caring for an ostomy

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

126
Caring for an ostomy (contd.)

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

127
Caring for an ostomy (contd.)

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

128
Caring for an ostomy (contd.)

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

129
Caring for an ostomy (contd.)

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

130
Caring for an ostomy (contd.)

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

131
Caring for an ostomy (contd.)

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

132
Caring for an ostomy (contd.)

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

133
Caring for an ostomy (contd.)

• Report any changes in resident to the nurse.
  Report if stoma is very red or blue, or if
  swelling or bleeding is present. Provides nurse
  with information to assess resident.
• Document procedure according to facility
  guidelines. What you write is a legal record of
  what you did. If you dont document it, legally
  it didnt happen.

134
Define the following terms

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

135
Transparency 4-24 The Endocrine System
136
8. Describe the endocrine system and related
conditions

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

137
8. Describe the endocrine system and related
conditions

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

138
8. Describe the endocrine system and related
conditions

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

139
8. Describe the endocrine system and related
conditions

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

140
8. Describe the endocrine system and related
conditions

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

141
8. Describe the endocrine system and related
conditions

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

142
Define the following terms

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

143
Define the following terms

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

144
8. Describe the endocrine system and related
conditions

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

145
8. Describe the endocrine system and related
conditions

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

146
8. Describe the endocrine system and related
conditions

• Complications of diabetes include the following
• Changes in the circulatory system can cause heart
  attack, stroke, poor extremity circulation, poor
  wound healing, and kidney and nerve damage.
• Damage t