Chapter 4 Flashcards
Homeostasis
The name for the condition in which all of the body systems are working at their best
Metabolism
Physical and chemical processes that must be working at a steady level to maintain homeostasis
10 systems of the human body
- Integumentary
- Muscoskeletal
- Nervous
- Circulatory
- Respiratory
- Urinary
- Gastrointestinal
- Endocrine
- Reproductive
- Immune and lymphatic
Normal changes of aging to the integumentary system
Skin is thinner, dryer and more fragile. It is more easily damaged
Skin is less elastic
Protective fatty tissue is lost, so the person may feel colder
Hair thins and may turn gray
Wrinkles and brown spots, or “liver spots” appear
Nails are harder and more brittle
Try, itchy skin may result from a lack of oil from the sebaceous glands
How the CNA can help
Give complete baths only twice a week, with Sponge baths everyday
Apply lotions as ordered to relieve dry skin
Be gentle. Elderly skin is fragile and can tear easily
Hair becomes drier needs to be shampooed less often
Gently brushing dry hair stimulates and distributes natural oils
Layer clothing for additional warmth
Bed linens should be kept wrinkle free
To not cut residence toenails
Encourage fluid intake
Observing and reporting: integumentary system
Pale, white, reddened or purple areas
Blisters or bruises
Complaints of tingling, warmth or burning
Dry or flaking skin
Itching or scratching
Rash or any skin discoloration
Swelling
Cuts, boils, sores, wounds or abrasions
Fluid or blood draining from the skin
Broken skin
Changes in an injury or wound (size, depth, drainage, color, odor)
Redness or broken skin between toes or a round toenails
Scalp or hair changes
In darker complexions, changes in skin tone
Changes in skin temperature and the feel of the tissue as compared to the skin nearby
Results of inactivity and immobility
Loss of self-esteem
Depression
Pneumonia
Urinary tract infections
Constipation
Blood clots
Dulling of the senses
Muscle atrophy or contractures
Atrophy
When the muscle waste away, decreases in size and becomes weak due to inactivity
Range of motion exercises can help prevent atrophy
Contractures
The muscle or tendon shortens, becomes inflexible and freezes in position. This causes permanent disability of the limb.
Range of motion exercises can help prevent contractures
Normal changes of aging in the muscoskeletal system
Muscles weaken and lose tone
Body movement slows
Bones lose density becoming more brittle and susceptible to breaks
Joints May stiffen and become painful
Height is gradually lost
How the CNA can help
Prevent calls by answering call light to mediately
Keep pathways clear, clean up spills and do not move furniture.
Walkers and canes need to be placed where residents can easily reach
Residents should wear non-skid shoes that are securely fastened
Encourage regular movement and self-care
Encourage residents to perform as many ADLs as possible
Assist with range of motion exercises as needed
Observing and reporting: signs and symptoms of the musculoskeletal system
Changes in ability to perform routine movements and activities
Any changes in a residence ability to perform range of motion exercises
Pain during movement
Any new or increased swelling of joints
Wait, shiny, red or warm areas over a joint
Bruising
Aches and pains
Arthritis
A general term referring to inflammation, or swelling of the joints.
It causes stiffness, pain and decreased mobility.
Arthritis may be the result of aging, injury or an autoimmune illness
Autoimmune illness
When the body’s immune system attacks normal tissues in the body
Rheumatoid arthritis
Joints become red, swollen and very painful. Deformities can result and may be severe and disabling. Movement is eventually restricted.
Fever, fatigue and weight loss are also symptoms.
Rheumatoid arthritis is considered an autoimmune disease
Arthritis treatments
Anti-inflammatory medication
Aspirin, ibuprofen as well as other medications
Local applications of heat to reduce swelling and pain
Range of motion exercises
Regular exercise and/or activity routine
Diet to reduce weight or maintain strength
Observing and reporting guidelines for arthritis
Watch for stomach irritation or heartburn caused by aspirin, ibuprofen or other medications. Report immediately
Encourage activity
Adapt ADLs to allow for Independence. Encourage self-care
Osteoporosis
The condition in which Bones lose density causing them to become porous and brittle.
Maybe caused by a lack of calcium in the diet, Loss of estrogen, lack of exercise, reduced mobility or age
It is more common in women after menopause
Menopause
The end of menstruation; occurs when a woman has not had a menstrual period for 12 months
Signs and symptoms of osteoporosis
Low back pain
Stooped posture
becoming shorter over time
fractures
How to slow osteoporosis
Encourage residents to walk and the other light exercise
Move residence very carefully
Medications and supplements
Fractures
Broken bones
Signs and symptoms of fractures
Pain
swelling
bruising
changes in skin color at the site
limited movement
Guidelines to assisting clients after hip replacements
Keep often used items within easy reach.
Dress the affected (weaker) side first
Never rush the resident. Use praise and encouragement often. Do this for even small tasks
Ask the nurse to give pain medication prior to moving if needed
Have the residents set to do tasks in order to save energy
Follow the care plan exactly, even if the resident wants to do more
Never perform rage of motion exercises on the operative (affected) leg unless directed by the nurse
Tossing the resident not to sit with their legs crossed or turn their toes in where they’re outward
Do not bend or flex the hip more than 90°. It also cannot be turned inward or outward
An abduction pillow may be used for 6 to 12 weeks. The legs are secured to the sides of the pillow using straps in order to immobilize and position the hips and lower extremities
Use a pillow between the thighs to keep the legs separated when transferring from the bed. Raise the head of the bed. This allows the resident to move their legs over the side with the thighs still separated. Stand on the unaffected side. Strong side should lead in standing, pivoting and sitting
With chair or toilet transfers, the operative leg should be straightened.
The stronger leg should stand first then the foot of the affected leg can be brought back into the walking position
Partial weight bearing (PWB)
Means the resident is able to support somebody weight on one or both legs
Non-weight-bearing (NWB)
Means the resident is unable to touch the floor or support any weight on one or both legs
Full weight bearing (FWB)
Means that both legs can bear 100% of the body weight on a step
Observing and reporting changes after total hip replacement (THR)
Redness, drainage, bleeding or warmth in incision area
An increase in pain
Numbness or tingling
Tenderness or swelling in the calf of the affected leg
Shortening and/or external rotation of the affected leg
Abnormal vital signs, especially a change in temperature
Resident cannot use equipment properly or safely
Resident is not following doctor’s orders for activity and exercise
Any problems with appetite
Any improvements, such as increased strength and improved ability to walk
Total knee replacement (TKR)
Surgical replacement of the knee with a prosthetic knee
Is performed to relieve pain
Helps to stabilize
Knee replacement guidelines
To prevent blood clots, apply special stockings as ordered
Promote ankle pumps as ordered. These are simple exercises that promote circulation to the legs. They are done by raising the toes and feet toward the ceiling and lowering them again
Encourage fluids, especially cranberry and orange juices which contain vitamin C to prevent urinary tract infections
Assist with deep breathing exercises as ordered
Ask the nurse to give pain medication prior to moving and positioning if needed
Report redness, swelling, heat or deep tenderness and water both calves
Nervous system
Is the control and message center of the body
Controls and coordinates all bodily functions
Senses and interprets information from outside the body
Central nervous system
(CNS)
Composed of the brain and spinal cord
Peripheral nervous system (PNS)
Deals with the periphery, or outer part of the body via the nerves
Normal changes of aging within the nervous system
Responses and reflexes slow
Sensitivity of nerve endings and skin decreases
People may show some memory loss, more often with short-term memory.
How CNAs can help residence with nervous system conditions
Suggest residents make lists or write notes about things they want to remember
Place a calendar nearby
If the resident likes to reminisce take an interest in their past but asking to see photos or hear stories
Allow time for decision making
Avoid sudden changes in schedule
Allow plenty of time for movement
Encourage reading, thinking and other mental activities
Observing and reporting signs and symptoms of the central nervous system
Fatigue or any pain with movement or exercise
Shaking or trembling
Inability to move one side of the body
Difficulty speaking or slurring of speech
Numbness or tingling
Disturbance or changes in vision or hearing
Dizziness or loss of balance
Changes in eating patterns and/or fluid intake
Difficulty swallowing
Bowel and bladder changes
Depression or mood changes
Memory loss or confusion
Violent behavior
Any unusual or unexplained change in behavior
Decrease stability to perform ADLs
Cerebral vascular accident (CVA)/stroke
Cuz when blood supply to a part of the brain is blocks or a blood vessel leaks or ruptures within the brain
Ischemic stroke
Most common type.
The blood supply is blocked. Without blood, part of the brain does not receive oxygen. Brain cells begin to die.
After a stroke, a resident may experience the following:
Hemiplegia: paralysis on one side of the body
Hemiparesis: weakness on one side of the body
Tendency to ignore one side of the body, called one-sided neglect
Loss of the ability to tell where affected body parts are
Expressive aphasia: trouble communicating thoughts through writing
Receptive aphasia: difficulty understanding spoken or written words
Emotional liability: inappropriate or unprovoked emotional responses, including laughing, crying and anger
Loss of sensations such as temperature or touch
Loss of bowel or bladder control
Cognitive problems, such as poor judgment, memory loss, loss of problem solving abilities and confusion
Dysphagia: difficulty swallowing
Stroke guidelines
Apply range of motion exercises to strengthen muscles and keep joints mobile. Perform leg exercises to aid circulation.
Loss of movement we usually require occupational therapy
Never refer to the weaker side as the “bad side.” Use terms like weaker or involved to refer to the side with paralysis.
Help those with speech loss or communication problems recognize written or spoken words. Evaluated resonance swallowing ability. Thickened liquids may be necessary
Keep a routine of care. Memory loss is upsetting. People often cry for no apparent reason. Be patient and understanding.
Encourage Independence and self-esteem. Let the resident do things for themselves whenever possible. Praise efforts and even the smallest successes
Always check your residence body alignment. Sometimes an arm or a leg can be caught in the resident is unaware
Pay special attention to skin care and observe for changes in the skin of a resident is unable to move
If there is a loss of touch or sensation check for potentially harmful situations (for example heat and sharp objects.) If unable to move, check and change positioning often to prevent pressure injuries
Adapt procedures when caring for residents with one-sided paralysis or weakness
Always use a gait belt during transfers or walking. Stand on the weaker side. Lead with the stronger side
Dress the affected/weaker side first. Place the weaker arm or leg into clothing first.
Undress the stronger side first then remove the affected/weeker arm
Is assistive equipment to help the resident dress themselves. Encourage self-care
Assisting the stroke victim 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 residence time to respond. Listen attentively
Use a pencil and paper if the resident can write. A thick handle or tape around the pencil may help the resident hold it more easily
Keep the call signal within reach.
You smiles, touches and gestures to let the resident know you have confidence in their abilities. Gestures and pointing can also help give information or allow the resident to communicate
He’s communication boards are special cards to aid communication
Parkinson’s disease
A disease that causes a section of the brain to degenerate. It affects the muscles, causing them to be stiff. It causes stooped posture and a shuffling gait. Tremors make it hard to perform ADLs.
It is progressive and incurable
Parkinson’s disease guidelines
Visual and spatial impairments may occur. Protect residents from unsafe areas and conditions. Help with ambulation as needed
Assist with ADLs as needed
Assist with range of motion exercises to prevent contractures and to strengthen muscles
Observe for any swallowing problems and report them to the nurse
Encourage self-care. Be patient with self-care and communication
Multiple sclerosis (MS)
A progressive disease that affects the central nervous system. A breakdown of the myelin sheath that covers the nerves, spinal cord and white matter of the brain results in nerves not being able to send messages to and from the brain in a normal way
Symptoms of multiple sclerosis
Weakness
numbness
tingling
incontinence
behavior changes
Blindness
contractures
loss of function in the arms and legs
Multiple sclerosis guidelines
Assist with ADLs as needed. Allow enough time for tasks. Offer rest periods as necessary
Give the resident plenty of time to communicate. Be patient. Do not rush
Prevent falls which may be due to vision loss, fatigue or lack of coordination
Stress can worsen the effects of ms. Be calm. Listen to the residents when they want to talk
Symptoms can sometimes change daily; offer support and encouragement and adapt care to the symptoms reported
Encourage a healthy diet with plenty of fluids
Sis with range of motion exercises to prevent contractures and to strengthen muscles
Paresis
Paralysis, or loss of muscle function that affects only one part of the body. Often paresis describes a weakness or loss of ability on one side of the body
Paraplegia
Loss of function of the lower body and legs
Quadriplegia
Loss of function in the legs, trunk and arms
Head and spinal injuries
The higher the injury on the spinal cord, the greater the loss of function
Head and spinal cord injury guidelines
Be careful residents do not burn themselves. People who are paralyzed have no sensation
Encourage exercise, fluids and a high fiber diet
Male residents may have involuntary erections. Provide for privacy.
Assist with bowel and bladder training is if needed
Normal changes of aging on the nervous system: sense organs
Vision and hearing decrease. Senses of taste, smell and touch decrease as well
Sense of balance may be affected
How the CNA can help
Keep residence eyeglasses clean
Bright colors and proper lighting help vision
Make sure hearing aids are kept clean and that they are worn
Face the resident and speak slowly and clearly. Avoid shouting
Help as needed with regular bathing
Be careful with hot drinks and hot bath water
