Module 3 and 4 for bhcc
- 2. WELCOME TO MODULE THREE!
- 4. Chapter 7: Body Structure and Function • Cell is the basic unit • We began as an ova and sperm cell
- 5. tissues • Groups of cells with similar functions combine to form tissues • Epithelial- covers internal and external body structures, lines nose, mouth, respiratory and GI tract- can produce mucus • Connective-anchors, connects, supports (tendons and ligaments, for ex.) *blood is connective tissue • Muscle- stretches and contracts to allow movement • Nervous- receives and carries impulses to brain and back to body
- 7. Organ systems • Groups of tissues with same function form organs. Systems are formed by organs that work together to perform specific functions
- 8. Integumentary system • Organs: skin, nails, hair, sweat and oil glands • Function: protective covering, prevents microbes from entering body, temperature regulation, sensory organ for pain, pressure, temp • Two skin layers
- 9. Musculoskeletal • Over 500 muscles and 650 bones to support, protect, create frame and upright posture while allowing for movement and produce body heat • Involuntary muscles work automatically, like your heart, blood vessels and intestines • Voluntary muscles do not work unless you move them • tendons, ligaments, cartilage
- 10. Nervous System • Organs: brain, spinal cord and nerves • CNS=brain and spinal cord PNS=nerves throughout body • Left side of brain controls right body, vice versa • Functions: movement, thinking, speech, sight, hearing, emotions, breathing
- 11. Circulatory system • Organs: heart, arteries (carry blood high in O2, bright red) and veins (carry blood low in O2, dark red) and capillaries (tiny blood vessels) • Function: circulate blood and blood products to body, defend against infection, heat regulation
- 12. Respiratory system • Organs: nose, pharynx, trachea, bronchi, lungs, alveoli, diaphragm • Function: take in O2 and remove CO2
- 13. Digestive system • Organs: mouth, tongue, teeth, salivary glands, pharynx, larynx, esophagus, stomach, gallbladder, liver, pancreas, large and small intestines • Function: take in food for digestion and remove solid waste
- 14. Urinary system • Organs: kidneys, ureters, bladder, urethra • Functions: removes waste from blood, maintain water balance •
- 15. Reproductive system • Female: breast, ovaries, fallopian tubes, uterus, vagina • Male: penis, scrotum, testes, prostate gland, vas deferens • Function: procreation and pleasure
- 16. Endocrine system • Organs that produce hormones to regulate/stimulate body functions • Pituitary gland-growth hormone, TSH (to stimulate thyroid gland) adrenocorticotropic hormone (ACTH to stimulate adrenal glands) • Ovaries-estrogen and progesterone • Testes- testosterone • Thyroid glands- thyroxine • Parathyroid glands- parathormone • Adrenal glands- glucocorticoids (metab of carbs and response to stress), mineralocorticoids (regulate amt of salt and water absorbed/lost) • Pancreas-insulin
- 18. Immune system • Organs: lymph nodes, tonsils, adenoids, lymphocytes, thymus gland, spleen • Function: protection from infection
- 19. CHAPTER 15: THE RESIDENT’S UNIT • Should be comfortable temperature (71-81 degrees) • Odor free • Ventilated • Quiet • Well-lit • Should be homelike • Have essential furniture; bed, bedside stand, overbed table, wardrobe (with shelves and a clothes rack) , privacy curtain (goes all the way around bed), stationary chair (with armrest), call bell, sink and toilet
- 21. BEDS • Manual beds operated by cranks or gatches. Center raises bed up or down, right operates head of bed and left operates knees • Always fold handles in to prevent accidents • Side rails must be on every bed, whether used or not, can be ½ or full
- 22. Bed Positions • Fowler’s- HOB raided 45-60 degrees- for mouthcare, shaving. meals, when SOB, watching TV • Hi- Fowler’s- HOB raised 60-90 degrees • Semi-Fowler’s- HOB raised 15-30 degrees • Trendelenberg- foot raised higher than head- ordered by MD • Reverse trendelenberg- Head raised and feet lowered • Pages 256-257 • *Side rails are dangerous and use must be ordered by MD and approved by resident or family- can cause entrapment
- 25. CHAPTER 16: BEDMAKING • A WRINKLE FREE BED PREVENTS SKIN BREAKDOWN, PROMOTES REST AND SLEEP; SHOULD BE MADE EVERYDAY • ALWAYS CHECK FOR DENTURES, HEARING AIDS AND EYEGLASSES IN BED • BRUSH AWAY CRUMBS AFTER MEALS • CHANGE IF SOILED OR WET • MAY ONLY CHANGE ON COMPLETE BEDBATH OR SHOWER DAYS (TWICE/WEEK)- CHECK FACILITY POLICY
- 26. OPEN BED CLOSED BED
- 27. Occupied bed
- 28. Guidelines for bedmaking • Collect in order of use • Place on clean, dry surface (chair or overbed table) • Hold linen away from your body • Make one side at a time • Raise bed to comfortable working height • Don’t fan the sheets • Wear gloves to strip linen (remove) • Don’t bring in extra linen- if unused, considered contaminated • No linen on the floor • Don’t expose body when making an occupied bed (cover with bath blanket)
- 29. Chapter 17: Hygiene Chapter 18: Grooming • Promotes comfort • Prevents infection • Improves self esteem • Prevents body odor
- 30. EARLY AM CARE • WAKE UP • ASSIST WITH TOILETING • WASH HANDS AND FACE • RINSE MOUTH/DENTURES • LEAVE IN UPRIGHT POSITION • NEEDS TO BE COMPLETED BEFORE BREAKFAST ARRIVES
- 31. PM Care • Undress • Toilet • Brush teeth or dentures • Wash hands and face • Give back rub • Change into night clothes
- 32. ASSISTING WITH PERSONAL CARE • ENCOURAGE INDEPENDENCE • BE AWARE OF PREFERENCES AND ROUTINES • EXPLAIN WHAT YOU ARE DOING • PRIVACY • OBSERVE AND REPORT FINDINGS • LEAVE ROOM CLEAN AND TIDY • LEAVE CALL BELL WITHIN REACH
- 33. Bathing Guidelines • Water temp between 110-115 degrees when you start because it will cool • No soap on the face • Change water if too soapy, cold or dirty • Bath from clean to dirty areas • Rinse soap well • Pat skin dry • Allow resident to do as much as possible for self • Privacy, only expose area being bathed, reduce drafts in room • Clean the eyes from inner to outer canthus using separate part of washcloth for each eye
- 34. Perineal Care • For female- clean from front to back using a separate part of washcloth for each side of labia, rinse well • For male, push back foreskin if uncircumcised; clean in circular motion from urinary meatus (opening) towards scrotum, using a separate part of washcloth for each stroke • Done during AM/PM care and incontinent care
- 35. Word Alert • Incontinent is the medical term for loss of bowel or bladder control • Never considered a normal part of aging • We are always expected to assist residents in regaining control (B & B training) • Never shame a resident for incontinence
- 36. Bony Prominences • Bony prominences are areas where the bone is close to the surface and are more prone to breakdown • Elbows, heels, ankles, hips, shoulders, wrists, etc, should all have lotion applied to them
- 37. Complete bedbath vs. Partial •Complete, the entire body is bathed •Partial includes eyes, face, axilla (under arms), hands, perineal area and back
- 38. A word about Showers…. •Never leave a resident unaccompanied in the shower area
- 39. Mouthcare • Oral hygiene prevents infection, improves appetite, improves self- esteem and reduces halitosis (bad breath) • Done at least BID- after breakfast and HS • Wear gloves! • Equipment: brush, paste, emesis basin, swabs • Report bleeding, odor, sores
- 40. Routine Mouthcare • Resident placed in Fowler’s position • Resident must be able to expectorate (spit) • Note and report any problems with oral cavity or teeth
- 41. Special Mouthcare • Done for people who cannot expectorate such as someone in a coma, very weak, very confused, or NPO (nothing by mouth) • Head is turned to the side! • Use mouth swabs or toothettes • Never put your hand/fingers inside a resident’s mouth- keep mouth open with tongue depressor • Performed Q2h • Goal is prevent aspiration: breathing fluid, food vomitus into lungs- keep head turned to side!
- 42. Denture Care • Dentures are expensive. Care must be taken to prevent damage to plate or teeth. • Store dentures in a labeled, covered container filled with cool water (never in a paper towel, or glass) • Rinse and brush dentures using cool water to prevent plate from warping (melting) • Line sink with a towel to prevent teeth from accidentally cracking
- 43. Back Rub • Performed to increase circulation and for relaxation • Should be offered with PM care or done when back is washed • Use warmed lotion and move in circular motion from buttocks to shoulder • 3 to 5 minutes with resident in lateral position • Never massage or rub over a RED area
- 44. Hand and foot care • Hands or feet should be soaked for 5-15 minutes • Check with facility before trimming fingernails, never clip toenails • Use an orangewood stick to clean under fingernails • Never apply lotion to palms of hands or in between toes
- 45. Hair Care • Performed as part of daily ADLs • If hair is tangled, comb from ends toward scalp in sections • Never cut the hair • Long hair should be pinned up or pulled back • Note/Report any problems to nurse • Style appropriately and use hair care products as provided • Shampoo on shower days • Pediculosis- lice, wingless insects that attach their nits (eggs) to hair and cause itching • Hirsutism- excessive body hair growth • Alopecia- baldness
- 46. Shaving • Never trim beards, mustaches or side burns • Wear gloves • Place towel across chest, wet face, apply liberal amount of shaving cream • Hold skin taut, shave in direction of hair growth with short strokes, rinsing blade often • If nick occurs- apply pressure, tell CN • If resident is on an anticoagulant (blood thinner)- must shave with electric razor • Dispose of razor in sharps container •
- 47. Dressing • If a person has a weak or affected (cast, IV, bandaged, contracted) arm or leg when removing clothes: UNdress Unaffected side 1st • Dress the affected side first • Bob has a cast on his left leg. Which leg is Undressed first? When putting clean pants on Bob which leg is Dressed first????? • If client has an IV, can only change if NOT attached to a pump. If running by gravity, pass IV bag through sleeve (p. 330)
- 48. Comfort and Sleep • Pain is a subjective finding. It is perceived differently for each of us. It is unpleasant • Types of: 1. Acute- comes on suddenly “stabbing” 2. Chronic- comes and goes “ache” 3. Radiating- moves from site of tissue damage to nearby areas 4. Phantom pain- experienced in an amputated limb • Pain is rated on a scale of 0-10
- 50. Chapter 23: Exercise and Activity
- 51. Bedrest • To reduce pain, regain strength, encourage rest, promote healing • Strict • Bedrest with bathroom privileges
- 52. Complications of bedrest • Atrophy • Contractures • Orthostatic hypotension-prevented by dangling • Footdrop • Pneumonia • Depression • Pressure ulcers
- 54. Positioning devices • Pillows • Bed boards • Trochanter rolls • Abduction wedges and pillows • Hand rolls • Splints
- 55. Range of Motion Exercises
- 56. Guidelines for ROM • Exercise to point of resistance • Stop if pain experienced and tell RN • Support above and below joint • Slow and smooth • Avoid neck • https://www.youtube.com/watch?v=t6hE_ntz4Ho
- 57. Joint Movements • Abduction- moving away from the body • Adduction-moving toward the body • Flexion- bending • Extension-straightening • Hyperextension-excessive straightening • Dorsiflexion-bending the toes and foot up at the ankle • Plantar flexion- bending the foot downward at the ankle • Rotation- turning around
- 58. Cane Use • Resident holds cane on strong side • Canes can be single or quad (4) tipped • Move cane, then weak leg even with cane, then strong leg ahead of cane • Make sure grips and tips are in good condition Walker Use • Walkers can be stationary or rolling • Resident must move walker 10-18 inches in front and then step into it
- 62. Chapter 31: Pressure Ulcers
- 63. Pressure Ulcers • Pressure ulcers are also known as decubitus ulcers or bedsores • Causes 1. Immobility 2. Incontinence 3. Poor hydration & nutrition 4. Friction 5. shearing
- 64. Areas prone to breakdown • Bony prominences such as elbows, knees, sacrum, shoulders, hips, buttocks, wrists • Also between thighs and under breasts, if obese
- 65. Preventing Pressure Ulcers • Turn and reposition every 2 hours • Keep skin clean and dry • Encourage good nutrition and hydration • Pad bony areas • Prevent friction • Prevent shearing
- 66. Preventing Friction and Shearing • Friction is the rubbing together of two surfaces. To prevent use a drawsheet to move person from side to side; use powder on sheets and to areas where skin touches skin • Shearing is when skin sticks to a surface while deeper tissues move downward. To prevent keep HOB no > 30 degrees
- 67. Stages of Pressure Ulcers • Stage 1: redness or discoloration • Stage 2: blister-like • Stage 3: open area, epidermis gone • Stage 4: both layers of skin gone, bone and muscle visible
- 69. Chapter 32: Hearing, Speech and Vision Problems
- 70. Ear disorders • Middle Ear infection aka Otitis Media • Tinnitus- ringing in the ears • Vertigo- dizziness, a feeling of whirling or spinning around • Cerumen- ear wax
- 71. Communication with hearing impaired persons • ASL • Use of hearing aids- check if turned on, check battery, clean as per manufacturer’s instructions • Reduce background noise • Face to face • Gain attention by touching lightly • Announce entrance and exit • Speak in normal tone and volume • Lower the pitch of your voice • Write it out • Act it out • Keep it short and simple
- 72. Speech disorders • Aphasia • Apraxia- can’t produce understandable speech • Dysarthria- slurred speech • Dysphasia can be expressive, receptive or both (global)
- 73. Communicating with the speech impaired • Be patient • Don’t finish sentences • Don’t pretend to understand • Allow for writing down messages • Use body language & communication boards **dysphasia is difficulty speaking **aphasia is lack of speech
- 74. Eye disorders
- 75. Macular Degeneration • Causes a blind spot in the center of vision • Normal signals not sent to the brain • Onset is gradual and painless • Leads to blindness • Won’t be able to read, sew, see faces, drive or see fine details • Increase risk with age, smoking, family hx, >females, light colored eyes, exposure to sunlight and heard disease • NO cure
- 76. Glaucoma • Glaucoma damages the optic nerve. It is caused by a build up of the fluid that bathes and nourishes the eye (vitreous humor). The excessive causes an increase in intraocular pressure and potential blindness • Onset can be sudden or gradual. If it occurs suddenly with pain, n&v- medical ER (closed angle glaucoma) • Open angle glaucoma develops slowly with decrease in peripheral vision, “tunnel” vision, blurred vision and halos around lights • Risk factors: Aas, >60, family hx, DM, HBP • Tx: no cure; eye drops to prevent further damage
- 77. Cataracts • Cataract is a clouding or opacity of the lens • People describe “waterfall” vision with cloud, blurry or dimmed vision, faded colors (especially blue and purple), sensitivity to light and glare, poor vision @ night, halo vision and double vision • Precipitating factors- DM, smoking, age, family history • Tx- surgery • Care postop: eye patch as directed, no rubbing, no bending at waist, no shower/shampoo as directed, report eye drainage or pain at once
- 79. Diabetic Retinopathy • Tiny blood vessels in retina are damaged • Affects both eyes and leads to blindness • Vision blurs and person sees floaters • Laser surgery may help
- 80. talking with visually impaired • Announce your arrival and departure • Tap lightly on shoulder • Don’t rearrange room, tell resident where items are located, especially call bell • Speak in normal voice • Make sure eyeglasses are clean (with lens paper) and being worn • Communicate in good lighting
- 81. Caring for the visually impaired • When ambulating he/she holds your arm and you walk slightly AHEAD • Braille • Corrective lenses • Contacts • Ocular prosthesis (p. 592)
- 82. Care for prosthetic eye when not in use • Wash eye with warm soap and water • Line container with 4x4 and fill with sterile water or saline solution and place eye in • Wash socket with warm water or saline, remove excess moisture When reinserting eye: • Rinse eye and place in wet socket
- 83. Chapter 33: Cancer, The Immune System & Skin Disorders • Cancer- cells that are abnormal and can spread to other areas; often referred to as a tumor • Benign growths- not cancer, don’t spread and may not cause symptoms • Malignant growths- are cancer and can metastasize • Risk factors include age, tobacco use, sunlight, radiation, chemicals, viruses, hormones, family history, poor diet, sedentary lifestyle and obesity • Treatments include surgical removal, radiation, chemotherapy, hormone therapy and immunotherapy
- 85. Caring for the person undergoing cancer treatment • Pain relief • Rest and exercise • Adequate fluid and nutrition • Dealing with side effects • Psychosocial needs • Spiritual needs • Sexual needs
- 86. Immune System disorders • Autoimmune disorders exist when the system attacks its own cells, tissue or organs • Graves’ disease (hyperthyroidism) causes thyroid gland to over produce thyroxine- s/sx include exophthalmos, insomnia, tachycardia, anxiety, weight loss, goiter • Lupus-an inflammatory disease affecting blood, joints, skin, kidneys, lungs, heart or brain • MS • RA • Type 1 DM
- 87. HIV (human immunodeficiency virus) • Leads to AIDS • Destroys body’s immune system allowing opportunistic infections to develop • MOA: unprotected sex with an infected partner, mom to baby, sharing needles and syringes, blood transfusions • Bloodborne pathogen • Initially “flu” then dormant (sleeping) for many years • May have thrush, wt loss, nightsweats, lymphadenopathy, diarrhea • With AIDS: PCP, KS, cervical cancer, peripheral neuropathies • Treated with “cocktails”- combination therapy of antiretroviral meds • No cure • Accidental exposure PEP with HART
- 88. KS
- 89. Skin disorders • Shingles- reactivation of herpes virus (chickenpox) typically in elderly- no cure, but meds available (zovirax) to put virus back to sleep- look for rash on body or face after period of burning and tingling- vaccine available
- 90. Chapter 34: Nervous system and MS disorders • CVA- or stroke dt ruptured aneurysm, blood clot; stops flow of blood and O2 to part of brain leading to cell death • Transient ischemic attacks (TIAs or mini-strokes)- same signs and sx, but resolves without permanent damage • Warning s/sx: sudden numbness/weakness on one side of body, sudden confusion, trouble seeing, incoordination, headache • Risk factors: age, family history, HBP, DM, smoker, elevated cholesterol, DM, race
- 92. Parkinson’s Disease • Slow, progressive do with no cure • S/sx include tremor, rigidity, shuffling gait, stooped posture, stony face and impaired balance • Medications (l-dopa) available to decrease sx, need help with ambulation, ADLs, meals, speech and swallowing
- 93. Multiple Sclerosis • Destruction of myelin sheath covering the spinal cord preventing nerve impulse from reaching the brain • Symptoms start in 20s, more in femals • S/sx: blurred vision, incontinence, numbness in extremities, problems with concentration, depression, difficulty ambulating, dysphasia • May be relapsing-remitting, primary progressive (no remissions), secondary progressive (worsens with each flare up)
- 94. Amyotrophic Lateral Sclerosis (ALS) • AKA Lou Gehrig’s disease • Strikes between 40-60yrs with 3-5 yr survival rate • Motor nerve cells in brain, brainstem and spinal c. die causing useless muscles to atrophy and twitch • Person is paralyzed and will eventually need mechanical ventilation to breathe • Mind remains sharp
- 95. TBI (traumatic brain injury) and Spinal Cord Injury • May lead to stupor (unresponsive state but can be aroused briefly), coma, vegetative state (no brain activity noted on EEG) • Persistent vegetative state (PES)- over 1 month • Lumbar injuries lead to paraplegia • Thoracic injuries lead to paraplegia and may require mechanical vent • Cervical injuries lead to quadriplegia • *Autonomic dysreflexia is a syndrome that affects those with injuries above mid-thoracid- HBP, bradycardia, headache, piloerection, cold and clammy skin • Usually occurs if constipated or full bladder
- 96. Care for person with paralysis • Safety • ROM • I&O • Prevent burns • Emotional support • Prevent skin breakdown • Assist with toileting
- 97. Tendons-bone to muscle ligaments-bone to bone
- 98. Arthritis • Osteo or DJD-from aging, obesity, joint injury-stiffness, swelling and pain with wt bearing and joint motion- affected by cold, damp weather; treated with anti-inflammatory meds, hot/cold applications, exercise, rest, wt control • RA (rheumatoid arthritis)-can begin in 20s- affects entire body, very debilitating and may lead to immobility; treated with pain meds, NSAIDS, and humira
- 100. Total Knee or Hip replacement • After procedure: IS, cough and deep breathing, elastic stockings, PT, no crossing legs, deep bending, adduction, skin care, turn on nonoperative side • Give grabber, use abduction wedge, elevate toilet seat (see page 609) • For total knee longer recovery (10-12 weeks minimum); will use a CPM
- 101. Osteoporosis • Bones become brittle and porous; break easily, especially hip, spine and ribs • More in women as menopause is entered (lack of E causes bone changes) • More in small framed, thin women with family history • Causes loss of height, stooped posture, back pain • Have your calcium! E may be ordered for women
- 102. Fractures • Closed (simple) • Open (compound)- bone through skin • Monitor for limited motion, pain, bruising, deformity of part, swelling • Either casted or reduced and fixated with nails, rods pins or screws • P of Paris cast take 24 hours to dry, handle with open palms, elevate on pillow, keep dry, nothing inserted into cast, use bedcradle, report rough cast edgesm report pain, odor, discoloration, temp change, numbness to RN (p. 612) • page 611
- 103. Pics of Fractures
- 104. Traction • System of pulleys and ropes that reduce and immobilize fractures • Applied to neck, arms, legs or pelvis • Skin- boots, wraps, tape or splints
- 105. Traction • Traction reduces and immobilizes fractures. A steady pull from two directions keeps the bone in place. Traction can be skin or skeletal • Skin traction is applied to skin as a boot, wrap or splint • Skeletal traction is applied directly to the bone with wires and pins • **cervical traction is applied to the skull**
- 106. Guidelines for care of a resident in traction • Never allow weights to touch floor • Keep person in good alignment • Do not add or remove weights from traction set up • Provide good skin care and assist with toileting • Never place weights on the bed • ROM to uninvolved joints are directed • Report redness, drainage or odor from skeletal traction
- 107. Pics of Traction
- 108. Amputation • Amputation affects body image, appearance, ADLs, mobility and work • Person fitted with a prosthesis - artificial body part • The remaining part of the limb is called the stump • May experience PHANTOM PAIN- normal reaction
- 109. Chapter 35: CV and Resp disorders • Hypertension- • Causes: renal or heart disease, pregnancy, adrenal gland tumors • Factors contributing: age, gender, race, obesity, lifestyle, high salt diet, stress • May be asymptomatic or c/o headache, bl. Vision, palpitations, fatigue • Treated with meds, diet, exercise
- 110. CV
- 111. Coronary Artery Disease (CAD) • The coronary arteries supply the heart with blood. With aging or disease they can become hardened and narrow. CAD is usually d/t atherosclerosis a buildup of plaque (fat & cholesterol) in the arteries S/SX: Chest pain SOB Treated with stents, intraortic balloon pump, CABG
- 112. CAD
- 113. Angina Pectoris • Feels like a heart attack, but is not • Associated with exertion (overdoing it) • Relieved with rest and nitroglycerin tabs taken sublingual (under the tongue)- if pills fail to stop pain after 3 doses, 5 minutes apart- 9-1-1 • May be precipitated by cold or hot weather and stress
- 114. Congestive Heart Failure • Build up of fluid in heart’s chamber from inefficient emptying or poor venous return- S/SX: • Edema • SOB/dyspnea • Wt gain • Cough • fatigue
- 116. COPD • Combination of chronic bronchitis- smoker’s cough + emphysema- enlarged alveoli that cannot expand and shrink with respirations causing air to be trapped causing a barrel chest + asthma- wheezing on expiration triggered by an allergen
- 118. Common Disorders of Respiratory SX • Chronic Obstructive Pulmonary Disease (COPD)- combination of ephysema and chronic bronchitis • Combination of chronic bronchitis- smoker’s cough + emphysema-enlarged alveoli that cannot expand and shrink with respirations causing air to be trapped causing a barrel chest + asthma- wheezing on expiration triggered by an allergen S/SX • Pain when exhaling • Cough with mucus (“smoker’s cough”) • SOB
- 119. Chapter 36: Digestive and Endocrine disorders • Gastroesophageal Reflux disease (GERD)-causes heartburn, chest pain with reclining, hoarseness in AM, dysphagia, sore throat, feeling food is stuck • Treated with meds, eating small meals, no smoking, leave up after meals • Hepatitis B- bloodborne pathogen spread same as HIV, causes jaundice, light stools, dark urine and hepatomegaly- no cure, meds to slow progression and vaccine to prevent • Hep A- fecal oral route, self limiting, vaccine available (esp for childcare workers and those working around food) • Hep C- most lethal but curable with Harvoni!-
- 120. GI
- 121. Diabetes • Type I: in young, pancreas makes little to no insulin, rapid onset • Type II: maturity onset, related to weight, body unable to use insulin well, slow onset • S/Sx: bl. Vision, wt loss, polyuria, polyphagia, polydipsia, poor wound healing, increased infections • Complications: heart disease, stroke, renal failure, amputations dt poor wound healing blindness • Treatment: insulin or oral antihyperglycemics, diet and exercise, eye care and footcare
- 122. Hyperglycemia (high BS)- too much food, not enough insulin, illness, stress, BS >200, can lead to Diabetic coma
- 123. Hypoglycemia- low BS from not eating enough, not taking insulin, over-exercising, can lead to insulin shock
- 124. REMEMBER…………………. •HOT AND DRY, SUGAR HIGH COLD AND CLAMMY, NEED SOME CANDY
- 125. Special Care for Diabetics • Feet: toenails only trimmed by podiatrist; should always wear socks with well-fitting shoes, never allow to go barefoot; examine feet for problems • Eyes checked annually • If meal not consumed- tell CN
- 126. Chapter 37: Urinary and Reproductive disorders • Prostate enlargement: gland grows larger with aging, referred to as benign prostatic hypertrophy; s/sx include urgency, frequency, nocturia, urinary retention, weak stream of urine; treated with a TURP • Urinary diversions: urostomy (p. 636) • Kidney stones (renal calculi)- flank pain, dysuria, urgency, fever and chills, N&V; treated with BR, pain meds, treated with a lithotripsy (crush n’ flush)- strain all urines
- 128. Renal Failure • If the kidneys are no longer able to clean the blood of waste, dialysis may be needed. Hemodialysis (HD)directly cleans the blood; Peritoneal dialysis (PD) indirectly cleans the blood thru the abdominal cavity. **Never take a blood pressure on the arm that is used for HD treatments**
- 131. CAPD continuous ambulatory peritoneal dialysis
- 132. Tenckhoff catheter
- 133. STIs • Genital herpes- pain, itching burning, tingling, vaginal discharge, blisters- no cure • GC- dysuria, discharge- txed with antibiotics • Chlamydia-may be asx, discharge, dyspareunia, N/V/D, dysuria- antbx • Pubic lice- intense itching, treated with OTC Kwell • Syphilis- chancres, followed by gen’l malaise, headache, sore throat, bone and joint pain followed by CNS damage (blind, organ failure, death)- treated with arsenic and bloodletting before antibiotics were discovered- Kennedy, Lincoln, Henry VIII, Hitler, Rasputin, Napoleon, Al Capone, Idi Amin, Lenin, Tolstoy, to name a few
- 134. • Syphilis- chancres, followed by gen’l malaise, headache, sore throat, bone and joint pain followed by CNS damage (blind, organ failure, death)- Kennedy, Lincoln, Henry VIII, Hitler, Rasputin, Napoleon, Al Capone, Idi Amin, Lenin, Tolstoy, to name a few • Tx with mercury and arsenic, holywood potions….bloodletting and much more •
- 135. Chapter 19: Nutrition and Hydration
- 136. You are what you eat!!! • Food is necessary for life. Essential nutrients give the body the fuel needed to perform at optimum level • Many factors affect nutrition: food preferences, lack of teeth, difficulty swallowing, illness, appetite, religion, culture, finances and age
- 137. Essential Nutrients • Carbohydrates (CHO)- needed for energy Sources: whole grains, fruits, fiber rich fruits • Protein-needed for healing and growth Sources: a. complete-meats, fish, fowl, milk b. incomplete-tofu, nuts, seeds • Fat-needed for storage of vitamins & energy Sources: oils, fish, nuts
- 138. Essential nutrients cont. • Vitamins, two categories 1. Water soluble-lost from body thru urine, sweat, feces- need to be replaced daily- B complex and C 2. Fat soluble-stored in body fat-A,D,E,K (HANDOUT)
- 139. Minerals • Calcium • Sodium • Potassium • Iron
- 140. Diets • Regular or house- no restrictions • Low sodium- for HBP, heart & renal disease • Clear liquid- pre-testing, postop, if vomiting • Full liquid- milkshakes, custards • Low fat- for heart and liver disease • Diabetic-1500 cal ADA or exchange diet • Pureed- mechanically altered or blended, for edentulous resident or with dysphagia • Mechanical soft- scrambled eggs
- 141. vitamins
- 142. minerals
- 143. SAMPLE EXCHANGES FOR DM • STARCH: 1 SLICE BREAD, ½ BAGEL, ½ C PASTA, 1 BAKED POTATO, 3 CUPS OF POPCORN • MILK: 1 C OF MIL, ¾ YOGURT • FRUIT: ½ C UNSWEETETENED APPLESAUCE, 1 SM BANANA, ½ C OJ, 2 T RAISINS • VEG: ½ C COOKED VEG, 1 C RAW VEG • MEAT: 1 OZ MEAT, 1 EGG, ½ C DRIED BEANS
- 144. Thickened liquids • Ordered for residents with dysphagia to prevent aspiration (inhalation of food/liquids into lungs, can cause pneumonia) • Medium thick- like V-8 • Honey thick • Yogurt thick- need a spoon • pureed
- 146. Managing Dysphagia • Monitor and report pocketing or squirreling food, coughing, drooling, spitting out food, eating slowly, especially solids • Position in high fowler’s, body in good alignment, feed slowly alternating food with liquids, leave sitting up for 1 hour pc (after meal)
- 147. PREVENTING ASPIRATION • POSTION IN A STRAIGHT, UPRIGHT POSITION • OFFER SM PIECES OF FOOD • FEED SLOWLY • MAKE SURE MOUTH IS EMPTYING • LEAVE UPRIGHT AT LEAST 30 MINUTES POST MEAL
- 148. Meal time • Toilet, allow to wash hands, rinse mouth out • Serve trays in order assigned by health team • If food not correct temperature- get another tray • Always check menu cards • Sit to feed • Allow for choices • Use eating utensils for designed for special needs • Set food up like face of clock for blind person
- 149. Nourishments and Supplements • Nourishments are ‘snacks’ offered between meals such as ½ sandwich, ice cream, cookies and juice, piece of fruit • Supplements are ordered by the dietician for people who are not eating enough to satisfy caloric needs or losing weight such as Boost, HealthShakes, or Glucerna
- 150. Supplements- are expensive! Pour into cup and assist with intake. If resident doesn’t take, report to RN
- 151. Guidelines for feeding • Sit! • Describe meal, ask what the resident would like first • Alternate food and liquids • Encourage “swallowing” • Use spoon only- 1/3 full • Cut food up in to small pieces
- 152. CHAPTER 20: Nutritional Support • If a person is unable to eat by mouth or is not taking enough enough nutrients, may require nutritional support via IV, Parenteral nutrition or a Feeding Tube
- 153. Intravenous therapy • Provides fluid when they cannot be taken by mouth or additional fluids • Replace minerals (such as sodium and potassium) and vitamins • Provide sugar for energy (dextrose)
- 154. Safety Measures for IVs • Don’t remove needle • Protect IV bag, tubing and needle when person walks • Move IV bag to the side of the bed on which the person is facing • Tell RN at once if bleeding occurs from insertion site or blood is filling tubing
- 155. COMPLICATIONS OF IV THERAPY • Bleeding • Pale or reddened skin • Complaints of pain at or above IV site • Hot or cold skin near site • Puffiness, swelling or leaking fluid
- 156. Parenteral Nutrition • Giving nutrients through a catheter inserted into a vein; Para-beyond and Enteral-relates to bowel • Nutrient solution contains water, proteins, CHOs, vitamins, minerals, and fat • Indications: disease of GI tract, severe trauma, NPO > 5-7 days, prolonged coma, prolonged anorexia • Inserted into subclavian vein in neck=TPN (total) • Inserted into arm=PPN (peripheral)
- 158. Feeding Tubes- Enteral Nutrition • Types of feeding tubes: 1. Nasogastric tube (NGT) 2. Gastrosotomy tube (GT) 3. Jejunostomy tube- inserted into a part of sm. Intestine 4. Percutaneous endoscopic gastrostomy (PEG)
- 161. Delivery of feeding • Scheduled feedings (intermittent) feeding given via a syringe (bolus feedings) • Continuous feedings-given over 8, 12 or 24 hours via a pump
- 162. Guidelines for caring for a resident with a feeding tube • HOB elevated during feeds • People with NGT are always NPO- special mouthcare • Some people with GTs are allowed “comfort” foods, some are NPO • Clean nostrils and apply tape, if NGT • Keep tubing kink free • Never stop feeding or place on “hold” • Report N&V, diarrhea, regurgitation, swollen or hard abdomen, redness, swelling at ostomy site
- 163. Hydration • Water is needed to live • Fluid intake must be in balance with output • Edema (swelling) occurs when too much fluid is taken in and output is not equal (fluid retention) • Dehydration occurs when not enough fluid is taken in or too much out
- 164. S/SX of Edema & Dehydration • Edema: 1. Swollen ankles, feet, hands, wrists 2. Weight gain 3. SOB • Dehydration 1. Dry skin 2. Dry mucous membranes (tongue, gums) 3. Dark, scant amt of urine 4. Sunken periorbital (around the eyes) spaces
- 165. How much fluid is needed? • 1 ounce of fluid = 30 milliliters (ml) • 1 ml is equal to 1 cubic centimeter (cc) • 1 liter is = to 1000cc/ml • Humans need at least 1500 ml to survive (or 1.5 liters/day) • For fluid balance 2000-2500ml are needed
- 166. Measuring Intake and Output • If ordered, you may need to record all fluids taken in: juice, water, soup, hot cereals, yogurt, ice cream, etc AND all fluids put out: urine, diarrhea, wound drainage, emesis • Fluids out must be measured in a GRADUATE container • Total I & O at the end of the shift
- 167. Special Fluid Needs • Force fluids- if a person is at risk of or suffering from dehydration: 1. Offer a small amt (6 oz) of different types of fluids Q2h while awake
- 168. Restrict fluids- if • if a person is retaining fluids: 1. Remove water pitcher and cup 2. Resident can only drink fluids that are served 3. A set amount is allowed per shift
- 169. NPO • Remove water pitcher and cup • Post sign over bed reminding staff/visitors • No gum, no ice chips, nothing allowed by mouth • Give special mouthcare Q2h to keep mouth moistened
- 170. How much fluid in?? • Calculate John’s fluid intake… 4 ounces juice 8 ounces coffee 4 ounces of skim milk 10 ounces oat meal
- 172. Chapter 21: Urinary Elimination
- 173. terms • Polyuria- excessive urination • Oliguria- scant amount of urination (<500 ml in 24 hrs) • Dysuria- painful urination • Hematuria- blood in urine • Nocturia- nighttime urination
- 174. Urinary Elimination • Urination is also called voiding • Urine should be clear, without a strong odor, pale yellow, straw- colored or amber • Hematuria (blood in urine) and dysuria (pain with urination) must be reported • Urinary urgency and frequency may signal prostatitis for men or a UTI for women
- 175. Bedpans,Urinals & Commodes • Standard- wide part placed toward the head • Fracture- handle placed toward the feet • Never placed on overbed table or bedside stand • Urinals are used for male voiding; hooked on side rail after use • A commode is a portable, bedside toilet
- 176. Standard & fracture bedpans
- 177. Types of incontinence • Stress- dribbling that occurs with sneezing, lauging, coughing- >common in women during menopause as pelvic muscles weaken • Urge-urine is lost in response to sudden urgent need to void, associated with AD, UTIs, bladder cancer and enlarged prostate • Overflow-small amounts leak from a full bladder, weak stream • Functional- due to immobility, restraints, unanswered call bell, confusion • Reflex- urine is lost at predictable intervals when the bladder is full, person doesn’t feel the need to void dt CNS disorders and injuries
- 178. Indwelling Urinary Catheter • Catheters are inserted under sterile conditions and must be kept clean to prevent introduction of bacteria into body • Guidelines for use: 1. Never allow collection bag to touch floor 2. Keep tubing kink free 3. Keep bag below level of bladder at all times** 4. Secure catheter to body with adjustable strap or tape to abdomen/inner thigh 5. Empty collection bag at end of shift 6. Perform catheter care after BM & during bath 7. Attach bag to frame of bed, never the side rail (page 344)
- 180. Catheter Care • Hold the catheter @ the insertion site • Clean from the insertion site toward the bag about 4 inches down • Use a prepackaged kit or soap and water • Done after each BM and with AM/PM care
- 181. Condom Catheters • Also referred to as Texas Catheters • For men who are active and don’t want a catheter inserted into the body • Rolled on same as regular condom with about an inch between end of penis and catheter • Secured with elastic adhesive tape • Attached to collection bag
- 182. Condom catheters
- 183. Chapter 22: Bowel Elimination • Feces should be brown, formed, semisoft • Ideally, a person has (1) BM/day • Blood in the stool is called melena • Black or tarry stool may indicate bleeding, but also beets, tomato juice, red Jell-o • Clay colored or white stools may be rt liver disease • Note odor, consistency, presence of mucus, shape and frequency of defecation
- 184. Factors affecting BM • Privacy • Habits • Diet • Fluids • Activity • Drugs • Disability • Aging- slows down peristalsis, may have incontinence
- 185. Common Disorders of the GI Sx • Constipation- infrequent passage of hard, dry stool d/t not enough fluid, inactivity, not enough fiber in diet • Diarrhea- loose stool- usually d/t bacterial infection or a food source • Fecal Impaction- serious form of constipation
- 186. Fecal Impaction • Prolonged retention of feces in rectum that is hard or putty-like and cannot pass • More water is absorbed from the already hard feces and liquid stool passes around the hard mass and seeps from anus • There is abdominal distention, nausea, cramping, rectal pain • The RN does a digital exam and may remove the mass with a lubricated, gloved finger
- 187. Terms • Flatulence-excessive formation of gas • Flatus-passing gas • Fecal impaction- prolonged retention of feces in rectum- must be removed by nurse (digitally or with enemas) • Bowel retraining- done to address incontinence, remove diaper at regular intervals, sit on toilet/bedpan
- 188. Enemas • Introduction of water, saline, or water and soap into the intestines to stimulate a BM and break up hard stool • Done pre and post tests and surgery, for constipation • Place resident in sims position with bed well padded and bedpan ready to use, encourage slow deep breathing and insert tube 2 to 4 inches, as fluid is allowed to enter body; fluid suspended on IV pole 12-18 inches high (runs by gravity) • Always show the CN the “return” before flushing • Pg 363
- 189. Types of enemas • Saline- salt and water • Soapsuds (SSE) water and castile liquid soap • Tap water enema (TWE) • Small volume (fleets) • Oil-retention- made with mineral or olive oil
- 190. Enema bag
- 191. Ostomies • A person may require an ostomy after bowel cancer, an injury or to treat certain GI diseases such as crohns or ulcerative colitis • Two types: a) colostomy- opening into large intestine to create a stoma, solid stool will drain b) ileostomy-opening into small intestine, liquid stool removed
- 192. Colostomy Care • Stoma should be pink and fleshy • Keep skin clean and dry • Remove, change or clean pouches PRN • Encourage diet that doesn’t stimulate gas and odor (deodorants are available to put in pouch) • Treat person with dignity and respect
- 193. Colostomy, Stoma and Pouch
- 194. Chapter 24: Comfort, rest and sleep • Comfortable temp, clean linens, clean and odor fee, quiet environment with no more than 4 to a room • Pain disrupts comfort: is it acute, chronic, radiating or phantom pain? • Factors affecting pain: past experience, anxiety, value or meaning of pain, support system, culture and age • Note location, onset, factors causing pain, other s/sx and description of pain • Try distraction, relaxation, guided imagery, massage, warm liquids, and positioning for pain
- 196. Sleep and rest • Seniors need approx. 5-7 hours of sleep • Factors affecting sleep: illness, nutrition, exercise, environment, drugs, substances, life style changes • Promote sleep by backrub, warm drink, soft lights, quiet, TV, reading, music, positioning, keeping active during day, bedtime snack,
- 197. Chapter 25: Oxygen Needs • Kussmaul’s- in diabetics, very deep and rapid RR • Cheyne-Stokes- periods of apnea with shallow RR • Tachypnea >20 • Bradypnea <12 • Apnea- no breathing • Dyspnea- difficulty breathing
- 198. Promoting respirations • Positioning- orthopneic used with COPD • Cough and deep breathing exercises • IS
- 199. Oxygen Therapy • If a resident is ordered supplemental O2 therapy do the following: 1. Post “No smoking” sign outside door 2. Remove smoking materials, small electrical appliances (hair dryer), flammables (aftershave, nail polish) and wool items 3. Prepare O2 setup- can be nasal cannula or mask
- 200. Chapter 25: Oxygen Needs • Kussmaul’s- in diabetics, very deep and rapid RR • Cheyne-Stokes- periods of apnea with shallow RR • Tachypnea >20 • Bradypnea <12 • Apnea- no breathing • Dyspnea- difficulty breathing
- 201. Promoting respirations • Positioning- orthopneic used with COPD • Cough and deep breathing exercises • IS
- 202. O2 delivery systems
- 203. Oxygen Therapy • If a resident is ordered supplemental O2 therapy do the following: 1. Post “No smoking” sign outside door 2. Remove smoking materials, small electrical appliances (hair dryer), flammables (aftershave, nail polish) and wool items 3. Prepare O2 setup- can be nasal cannula or mask
- 204. O2 Responsibilities of nurse aide • Keep O2 tubing unkinked • Clean mask or nasal cannula tubing PRN • Inform CN if humidifier bottle is empty or not bubbling • Note rate of O2 ordered, if changed, inform CN • Order: NC O2 @ 2L/min • Shut off O2 in case of fire as directed by CN
- 205. Chapter 26: Measuring Vital Signs
- 206. Vital Signs • Vital signs are a reflection of health. They should be relatively stable unless illness occurs • May be taken at time of admission & then monthly or more often as needed • Vital signs include temperature (T), pulse (P), respirations (R) and blood pressure (BP).
- 207. Temperature • The amount of heat in the body • Affected by outside temp, emotions, exercise, illness, age, pregnancy and menstrual cycle • Lowest in morning, before rising • A fever is also known as pyrexia
- 209. Measuring T Route Time Range Guidelines for use Axillary (ax) 7-11 min 96.6-98.6 least accurate, arm across chest to keep thermometer in place Oral (o) 3-5 min 97.6-99.6 Place under tongue, to one side don’t take if comatose, confused under 4 yrs, mouth breather, recent seizure activity wait 15-20 min after hot/cold liquids, heavy exercise or cig Rectal (r ) 1-3 min 98.6-100.6 Hold in place, wear gloves, lubricate a rectal thermometer covered Don’t take if severe constipation/diarrhea hemorrhoids, rectal disease or colostomy
- 210. Other routes for measuring temp • Tympanic Membrane (aural) thermometers measure temp in the ear • Temporal artery- on the forehead • Temperature sensitive tape • Tempa-dots
- 212. Pulse https://www.youtube.com/watch?v=K8ryHOgfTtY • Pulse is the number of times the heart beats • Should also note quality (strong, weak, thready) and the rhythm (regular or irregular) • Radial pulse is used- thumb side of wrist • Use 2-3 fingertips, never your thumb, pressing lightly (too hard blocks the pulse) • Count for 1 full minute, 30 seconds (multiply by 2) or 15 seconds (multiply by 4). • Keep arm at heart level
- 213. Pulse cont. • An apical pulse requires the use of a stethoscope- placed over apex of heart to auscultate (listen to) heart beat • An apical-radial deficit is the difference between the apical and radial pulses- take at same time by nurse and nurse aide
- 214. Other body pulses
- 215. Word Alert • Tachycardia is a HR >100 • Bradycardia is a HR <60 • Normal heart rate is between 60-100 • HR may increase with emotions, illness, certain drugs, exercise, caffeine and nicotine • HR may decrease with extreme grief, meds • Note rhythm & force (weak, bounding, thread)
- 216. Respirations • Each breath in of oxygen is followed by a breath out of carbon dioxide • One inspiration (inhalation) + one expiration (exhalation) = 1 Respiration • Normal respiratory rate is 12-20 breaths/minute • Normal respirations are quiet, effortless, symmetrical (same on both sides) • RR increases with illness, emotions, body positions • Don’t tell a person you are measuring their RR, he will change the breathing pattern, count immediately after Pulse
- 217. Blood Pressure • BP measures the force of blood within the walls of an artery • Arteries that are narrowed, blood that is very viscous (thick) and stress make the resistance greater and raise BP • BP is measured as an inverted fraction (top number > than lower number) • Normal BP is less than 140/90
- 218. Parts of a stethoscope
- 219. Blood Pressure cont. • Systolic pressure is created when blood is being pumped as the heart contracts (top number) • Diastolic pressure is created when the heart is at rest (bottom number)
- 220. Number Game… • A systolic of >140 = hypertension • A systolic of <90=hypotension • A diastolic of >90= hypertension • A diastolic of < 60= hypotension
- 221. • The new guidelines are based on a rigorous review of nearly 1,000 studies on the subject, which took the authors three years to complete. • The new guidelines now classify people's blood pressure measurements into the following categories: • Normal: Less than 120 mm Hg for systolic and 80 mm Hg for diastolic. • Elevated: Between 120-129 for systolic, and less than 80 for diastolic. • Stage 1 hypertension: Between 130-139 for systolic or between 80-89 for diastolic. • Stage 2 hypertension: At least 140 for systolic or at least 90 mm Hg for diastolic.
- 222. Guidelines for measuring BP • Roll up long sleeves • Rest arm at heart level • Place BP cuff 2-3 inches above brachial artery • Inflate cuff to 180 mmHg • Slowly deflate cuff listening for first sound=systolic reading • Continue to listen until last sound heard=diastolic reading
- 223. BP Guidelines continued • Clean stethoscope ear pieces and bell between uses • Don’t overinflate cuff • Don’t take BP in one arm > 3 times • Left arm best • No BP in arm which has dialysis access or on side of a mastectomy
- 224. Factors affecting BP • Gender- men higher • Race-esp in AAs • Blood volume- decrease with hemorrhage, increase with fluid retention of IVs • Stress- raises • Pain-raise • Exercise-raises • Weight-raises • Diet- esp high in NA • Position- higher when lying down • Smoking-raises • Alcohol-raises
- 225. Chapter 28: Collecting specimens
- 226. Rules for collecting specimens • Standard precautions • Use correct container • Don’t touch inside of container or lid • Identify person, check id band against requisition slip • Label the container • Collect at proper time • Place specimen in biohazard bag • Take to lab or specimen fridge
- 227. Urine Specimens • Routine urinalysis (U/A) 1. Simple have resident void in cup, attach label and lid • Mid-Stream Clean Catch 1. Separate labia, clean from front to back, begin to void then collect urine in middle of stream 2. For men, clean in circular motion, then void and collect urine • Strain Urine for stones 1. Place signs to strain all urine over toilet 2. Use a strainer to collect any stones which are place in specimen cut and sent to lab for analysis **urine must be refrigerated or kept on ice**
- 228. 24 Hour Urine Collection • Supplies: large collection jug, signs posted over bed and toilet, specimen collection ‘hat’ • When person awakes on first day and voids, DISCARD the first specimen. The 24 hour collection will begin with the second void • If John wakes up and voids at 10am on Tuesday and then again at 12:30pm, when is the 24 hour collection completed????
- 229. 24 hour collection jug
- 230. 24 hour urine • Test restarted if: • A voiding not saved • Toilet tissue was discarded in specimen • Specimen contains feces
- 231. Stool specimens • For occult blood, page 514
- 232. Chapter 41: Rehab and Restorative Care
- 233. Restorative Nursing • Care that helps persons regain health, strength, and independence • Restorative nursing programs help: 1. Prevents unnecessary decline 2. Promotes self care 3. Assists with elimination 4. Assists with mobility 5. Assists with communication 6. Assists with cognitive functions
- 234. Protective Devices • Bed cradle • Heel and elbow protectors • Heel and foot elevators • Eggcrate mattress • Sheepskin • Special beds
- 235. CNA Guidelines in Restorative Care • Allow resident to do as much as possible for self • Offer realistic reassurances, praise for efforts • Emphasize what resident can do instead of what cannot be done • Be patient, use empathy • Remember not all disabilities are permanent • Disabilities affect the WHOLE person: spiritually, emotionally, socially, physically
- 237. Restorative Devices • Long handled combs/brushes • Button hook • Shoe horn • Doorknob turner • Splints • Transfer boards • Grabbers
- 238. Chapter 43: Mental Health Problems
- 239. Mental Health/Mental Illness • Mental health- able to cope and adapt to everyday life stresses in a socially acceptable manner • Mental illness- maladjustment to life stressors • Factors affecting: chemical imbalance, genetics, psychological factors, physical factors, SA and ETOHism, social and cultural factors
- 240. Anxiety • A vague feeling that something is wrong with a known or unknown cause • Can be a good thing- leads to increase productivity, willingness to make changes • Manifests itself as sweating, chest pain, SOB, tachycardia, insomnia, lump in stomach, nausea, diarrhea • Relieved with coping mechanisms and defense mechanisms (p. 684) • Types of anxiety disorders include panic do, phobias, OCD, PTSD
- 242. Schizophrenia • A split mind, a physical, chronic, disabling brain disorder • Characterized by delusions, hallucinations, paranoia, delusions of grandeur/persecution, poor self care, neologisms, echolalia, perseveration, waxy flexibility, catatonia • Treated with psychotropics that have challenging side effects such as lip smacking, grimacing, writhing (tardive dyskinesia), Parkinsonism and dystonia • Begins in young (12-20) • Stigmatized
- 243. Mood Disorders • Bipolar disorder (manic-depression)- chemical imbalance of NE, serotonin and Da • Person has excessive highs (mania) and lows (depression) • May cycle • Treated with Neurontin, Lithium, Depakote • Major Depression
- 245. Suicide and elderly • Greatest risk presented by elderly white male • Risk factors include depression, previous attempt, family hx of, stressful life event, easy access to lethal methods, incarceration, firearms in home, hx of SA or ETOHism • “I just don’t want to live anymore” • “I wish I was dead” • “Everyone would be better off without me” • Report! Stay with person!
- 246. Chapter 44: end of life care
- 247. Death and Dying • A terminal illness is one in which there is no reasonable chance of recovery • Attitudes about death are affected by a person’s culture, religion, age, and the cause of death • Death can be by suicide, homicide, an accident, an acute illness, or after a chronic illness
- 248. HARDEST DEATHS ARE • THOSE BY SUICIDE, HOMICIDE • THOSE IN CHILDREN, THOSE CLOSE TO YOUR AGE • THOSE OF SPOUSE, CHILD
- 249. KUBLER-ROSS’ STAGES OF GRIEF • NO PARTICULAR ORDER, MAY REPEAT A STAGE • NOT EVERY STAGE MUST BE MET, BUT BETTER IF ALL ARE EXPERIENCED • FAMILY ALSO EXPERIENCE STAGES • A “GOOD” DEATH IS ONE THAT YOU KNEW WAS COMING AND HAD TIME TO PREPARE FOR….
- 250. Stages of Dying according to Kubler-Ross • Denial “no way, I’m too young!” • Anger “it’s not fair, why me?” • Bargaining “please God, cure me” • Depression “why has God abandoned me?” • Acceptance “OK, I’m ready”
- 251. Special Needs • Spiritual- private visits with clergy; keep rosary beads, Bible nearby, listen • Social- allow family private visits, extend visiting hours, if allowed • Psychological- listen, hold hands, encourage person to cry, vent feelings
- 252. Physical Needs of the Dying Resident • Vision, hearing and speech 1. Soft lighting, pupils reacting slower to change in light; eyes may be ½ open cleanse 2. Hearing is last sense to go; continue to explain all procedures 3. May not be as verbal, develop system for communicating
- 253. Mouth, Nose, Skin • Mouth may be dry, jaw not completely closed, give mouthcare Q2h, sips of liquids or ice chips, vaseline to lips • Nose may be irritated and dry if receiving oxygen therapy, apply vaseline • Skin may feel cold, but person is perspiring, place light sheet on resident, sponge baths prn, change gown/sheets as needed
- 254. Elimination • May be incontinent or constipated • Enemas may be ordered • Perineal care PRN
- 255. Comfort and Positioning • Inform CN if complaints of pain offered • Turn and repos Q2h • Use pillows to pad bony areas • Elevate HOB to ease breathing
- 256. The Family • This is a difficult time- give privacy, but be available- use touch to show concern, listen to feelings and fear, be courteous and empathetic to their experience
- 257. Hospice Care • Hospice was developed to allow people to die with dignity- either in the comfort of their own home or in a facility • Pain relief is given, but no treatments or hospitalization will be provided should the person’s health start to deteriorate • This person has signed a Do Not Resuscitate (DNR) order
- 258. Legal Stuff • Do not witness a will, inform CN if a family or resident request it • An advance directive is similar to a living will- it gives healthcare providers pre instructions for what care a person wants/does not want in case he or she is unable to do so at a later time
- 259. Signs of Death • Movement, muscle tone and sensation may be lost • Jaw drops open, eyes may not close completely • Peristalsis slows (don’t feed) • Body temp rises, but skin feels cold and is pale • Breathing becomes irregular • Pulse is fast, weak, irregular and BP drops • Pain decreases as person loses consciousness
- 260. Postmortem Care (PMC) • Determine if family will be visiting • Determine if an autopsy will be performed • Supplies: PMC kit, wash basin, soap, towel, disposable diaper • Standard Precautions, privacy, treat body with dignity • Handle body with open palms • Two caregivers will perform • Need to complete before rigor mortis (stiffening of body) occurs in 2-4 hours
- 262. PMC cont. • Wash face, eyes, perineal area and put on disposable diaper • Close eyes • Leave dentures in • Remove all jewelry except wedding ring (tape in place) • Apply chin strap • Straighten arms/legs and secure together with string • Tag body (big toe, outside of shroud) • Place wallet, watch, eyeglasses in small bag • Leave in gown with face exposed if family visiting, if not, wrap entire body