18 Common Chronic and Acute Conditions 1 Describe

18 Common Chronic and Acute Conditions 1. Describe common diseases and disorders of the integumentary system Define the following terms: acute illness an illness that has severe symptoms, is treated immediately, and is usually short-term. chronic illness a disease or condition that is long-term or long-lasting and requires management of symptoms.

18 Common Chronic and Acute Conditions 1. Describe common diseases and disorders of the integumentary system REMEMBER: Pressure ulcers, a common disorder of the integumentary system, were covered in chapter 13, and burns were covered in chapter 7.

18 Common Chronic and Acute Conditions 1. Describe common diseases and disorders of the integumentary system NAs should know these facts about scabies: • Caused by tiny mites • Can spread quickly in LTC facilities • Signs and symptoms include intense itching and rash-like burrow tracks. • Treatment involves medicated creams/lotions and/or oral medications.

18 Common Chronic and Acute Conditions 1. Describe common diseases and disorders of the integumentary system NAs should know these facts about shingles: • Also called herpes zoster • Skin rash caused by varicella-zoster virus (VZV) • Anyone who has had chickenpox is at risk for shingles. • Signs and symptoms include pain, tingling, or itching, followed by rash. • Cannot be transmitted to others, but active rash can transmit chickenpox • Risk increases with age. • Treated with medication • Vaccine is available.

18 Common Chronic and Acute Conditions 1. Describe common diseases and disorders of the integumentary system NAs should know these facts about wounds: • Type of injury to skin, either open or closed • Examined and cleaned with various solutions, such as tap water, sterile saline, or antiseptic solution • Bleeding may need to be stopped. • Dressings, bandages, sutures, staples or special strips/glue may need to be applied.

18 Common Chronic and Acute Conditions 1. Describe common diseases and disorders of the integumentary system REMEMBER: Dermatitis is a general term referring to inflammation (swelling) of the skin. There are two types of dermatitis: atopic dermatitis, also called eczema, and stasis dermatitis.

18 Common Chronic and Acute Conditions 1. Describe common diseases and disorders of the integumentary system NAs should know these facts about eczema: • Commonly occurs with allergies • May be caused by physical/mental stressors • Symptoms include dry, itchy, inflamed skin, usually on cheeks, arms, legs. • Not contagious • Treated with special lotions and/or antihistamines

18 Common Chronic and Acute Conditions 1. Describe common diseases and disorders of the integumentary system NAs should know these facts about stasis dermatitis: • Commonly affects lower legs and ankles • Occurs due to fluid build-up under skin • Can lead to severe skin problems • Early signs include rash; scaly, red area; and itching. • Other signs include swelling of legs/ankles; thin, tissue-like skin; darkening/thickening skin at ankles; leg pain. Report these signs to nurse. • Treatment includes surgery for varicose veins and medications to reduce fluids in body. • May need to apply elastic stockings to promote circulation • Resident may be on low-sodium diet.

18 Common Chronic and Acute Conditions 1. Describe common diseases and disorders of the integumentary system NAs should know these facts about fungal infections: • Examples of fungi include mushrooms, mold, and yeasts (Candida). • Some types of fungi normally live on body. • Normal balances of fungi can change, resulting in infection. • Fungal infections include athlete’s foot, jock itch, vaginal yeast infection, and tinea. • Imbalances may result from weakened immune system or antibiotics. • Infections can be difficult to eliminate. • Treatment includes antifungal cream or lotion and/or oral or injected medications.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system Define the following terms: arthritis a general term that refers to inflammation of the joints, causing stiffness, pain, and decreased mobility. inflammation swelling. autoimmune illness an illness in which the body’s immune system attacks normal tissue in the body.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system Define the following terms: osteoarthritis a common type of arthritis that usually affects the hips, knees, fingers, thumbs, and spine; also called degenerative joint disease (DJD) or degenerative arthritis. rheumatoid arthrisis a type of arthritis in which joints become inflamed, red, swollen, and very painful, resulting in restricted movement and possible deformities.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system NAs should know 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 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system These are common treatments for arthritis: • Anti-inflammatory medications (aspirin or ibuprofen), as well as other medications • Local applications of heat • ROMs • Exercise • Dietary changes

18 Common Chronic and Acute Conditions Transparency 18 -1: 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. Encourage use of handrails and safety bars. Use special utensils if needed. • Treat each resident as an individual. • Help maintain resident’s self-esteem by encouraging selfcare.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system NAs should know 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

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system The following are signs and symptoms of osteoporosis: • Low back pain • Stooped posture • Loss of height

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system Osteoporosis may be prevented or slowed in these ways: • Encourage residents to walk and do other light exercise as ordered. • Move residents with osteoporosis very carefully. • Follow care plan regarding medication and calcium and fluoride supplements, which might be used to treat osteoporosis.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system Define the following terms: closed fracture a broken bone that does not break the skin. open fracture a broken bone that penetrates the skin; also known as a compound fracture.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system REMEMBER: Fall prevention is the key to preventing fractures. The bones of the elderly heal slowly, so prevention is very important.

18 Common Chronic and Acute Conditions Transparency 18 -2: Care Guidelines for Casts • Do not cover cast until dry. Assist with changing positions as ordered to help with drying. Place the cast on pillows. • Elevate extremity in cast. • Observe for swelling, skin discoloration, tightness, pressure, sores, changes in skin temperature, pain, burning, numbness or tingling, drainage, bleeding, or odor. • Protect resident’s skin from edges of cast. • Keep cast dry. • Do not insert anything into cast. • Tell the nurse if pain medication is needed. • Use bed cradles as needed.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system Define the following terms: partial weight-bearing (PWB) a doctor’s order stating that a person is able to support some body weight on one or both legs. non-weight-bearing (NWB) a doctor’s order stating that a person is unable to touch the floor or support any body weight on one or both legs. full weight-bearing (FWB) a doctor’s order stating that a person has the ability to support full body weight (100%) on both legs.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system NAs should know these facts about hip replacements: • Cause may be a fall or weakened bones. • Elderly bones heal slowly. • The elderly are at risk for secondary illnesses.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system Hip replacements may be necessary for the following reasons: • Fracture does not heal properly. • Weakened hip due to aging • Painful and stiff hip

18 Common Chronic and Acute Conditions Transparency 18 -3: Care Guidelines for Hip Replacement • Keep often-used items within reach. • Dress affected side first. • Do not rush the resident. Use praise and encouragement. • Ask for pain medication if needed. • Have the resident sit to do tasks. • Follow the care plan exactly. • Do not perform ROM exercises on hip replacement side. • Hip cannot be bent or flexed more than 90 degrees. It cannot be turned inward or outward. • Follow orders for application and positioning with an abduction pillow. • Transfer resident carefully, with strong side leading when standing, pivoting, and sitting. • With chair or toilet transfers, operative leg/knee should be straightened. Strong leg should stand first.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system NAs should observe and report the following signs and symptoms after hip replacement: • Red, draining, warm, or bleeding incision • Increase in pain • Numbness or tingling • Shortening and/or external rotation of affected leg • Abnormal vital signs • Inability to use equipment properly and safely • Unwillingness of resident to follow doctor’s orders for activity and exercise • Problems with appetite • Improvements such as increased strength and improved ability to walk

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system Define the following term: prosthesis a device that replaces a body part that is missing or deformed because of an accident, injury, illness, or birth defect; used to improve a person’s ability to function and/or his appearance.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system Knee replacement may be performed for these reasons: • Relieves severe pain • Restores motion to damaged knee • Helps stabilize a knee that buckles or gives out

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system REMEMBER: Recovery time after a knee replacement is generally shorter than recovery time for hip replacement.

18 Common Chronic and Acute Conditions Transparency 18 -4: Care Guidelines for Knee Replacement • Apply special stockings as ordered. • Perform ankle pumps as ordered. • Encourage fluids, especially fluids high in vitamin C. • Assist with deep breathing exercises. • Assist with continuous passive motion (CPM) as ordered. • Ask for pain medication if needed. • Report to nurse if you notice redness, swelling, heat, or deep tenderness in one or both calves.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system NAs should know these facts about muscular dystrophy (MD): • MD refers to a number of progressive diseases that cause a variety of physical disabilities due to muscle weakness. • MD is inherited. • It causes gradual wasting away of muscle, and weakness and deformity. • Most forms are present at birth. • NA should help with ADLs or ROM exercises. • NA should help with skin care and positioning.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system Define the following terms: amputation the surgical removal of some or all of a body part, usually a hand, arm, leg, or foot. phantom sensation warmth, itching, or tingling from a body part that has been amputated. phantom limb pain in a limb (or extremity) that has been amputated.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system NAs should remember these guidelines when caring for a resident who has had an amputation: • Be supportive during the continuing process of adjusting to the amputation. • Help with ADLs. • Assist with changes of position as ordered. • Perform ROM exercises as instructed. • Follow care plan. • More information on prosthesis care is in Chapter 21.

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system The following are some common complementary and alternative medicine practices: • Chiropractic medicine • Massage therapy • Acupuncture • Homeopathy • Herbs and dietary supplements

18 Common Chronic and Acute Conditions 2. Describe common diseases and disorders of the musculoskeletal system REMEMBER: Some residents may use complementary or alternative medicine practices. NAs should never make judgments about treatments or discuss their opinions. If an NA has concerns about a resident’s medical practices she should talk to the charge nurse.

18 Common Chronic and Acute Conditions 3. Describe common diseases and disorders of the nervous system REMEMBER: Dementia and Alzheimer’s disease, which are common disorders of the nervous system, are covered in detail in Chapter 19.

18 Common Chronic and Acute Conditions 3. Describe common diseases and disorders of the nervous system NAs should know these facts about CVA/stroke: • CVA occurs when blood supply to a part of the brain is blocked or a blood vessel leaks or ruptures within the brain. • 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.

18 Common Chronic and Acute Conditions Transparency 18 -5: Care Guidelines for Stroke • Assist with exercises as ordered, keeping safety in mind. • Use terms weaker or involved to refer to weaker side, 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 resident’s body alignment. • Pay special attention to skin care. • If residents have lost sense of touch or sensation, be aware of potentially harmful situations such as proximity to heat and sharp objects. • Adapt procedures when caring for residents with one-sided paralysis or weakness.

18 Common Chronic and Acute Conditions Transparency 18 -5: Care Guidelines for Stroke (cont’d) • 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. • For assisting with eating: • Place food in resident’s field of vision. • Use assistive devices. • Watch for signs of choking. • Serve soft foods if swallowing is difficult. • Always place food in unaffected side of mouth. Make sure food is swallowed.

18 Common Chronic and Acute Conditions 3. Describe common diseases and disorders of the nervous system Home Care Focus: When caring for a client who has had a stroke, an HHA will need to remember the following safety tips: • Remove unnecessary clutter and any other hazards from home. • Unplug appliances when not in use. • Check the refrigerator and cabinets for spoiled food. • Report any suspected safety hazards to supervisor.

18 Common Chronic and Acute Conditions 3. Describe common diseases and disorders of the nervous system NAs should know these facts about Parkinson’s disease: • Progressive, degenerative disease • Causes stiff muscles, stooped posture, shuffling gait, pillrolling, tremors, and mask-like facial expression • Tremors can make ADLs difficult.

18 Common Chronic and Acute Conditions Transparency 18 -6: Care Guidelines for Parkinson’s Disease • Protect residents from falls. • Help with ADLs as needed. • Assist with ROM exercises as ordered. • Encourage self-care and be patient.

18 Common Chronic and Acute Conditions 3. Describe common diseases and disorders of the nervous system NAs should know these facts about multiple sclerosis: • 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.

18 Common Chronic and Acute Conditions Transparency 18 -7: 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 healthy diet with plenty of fluids. • Give excellent skin care. • Assist with ROM exercises.

18 Common Chronic and Acute Conditions 3. Describe common diseases and disorders of the nervous system NAs should know 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, and 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.

18 Common Chronic and Acute Conditions Transparency 18 -8: Care Guidelines for Head and Spinal Cord Injuries • Give emotional, as well as physical, support. • Prevent falls and burns. • Be patient with self-care. • Give careful 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.

18 Common Chronic and Acute Conditions 3. Describe common diseases and disorders of the nervous system NAs should know these facts about epilepsy: • Epilepsy causes seizures, but not all seizures are due to epilepsy. • Seizures can be violent or mild. • Causes are illness, injury, or unknown. • Diagnosed through a variety of tests, including EEG. • Treatment includes medication or surgery.

18 Common Chronic and Acute Conditions 3. Describe common diseases and disorders of the nervous system NAs should know these facts about vision impairment: • Vision impairment can affect people of all ages. • Some residents may wear eyeglasses or contacts. • People over 40 years old 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.

18 Common Chronic and Acute Conditions 4. Describe common diseases and disorders of the circulatory system NAs should know these facts about hypertension (HTN) or high blood pressure: • Causes: • Hardening and narrowing of blood vessels (atherosclerosis) • Kidney disease • Adrenal tumors • Pregnancy

18 Common Chronic and Acute Conditions 4. Describe common diseases and disorders of the circulatory system Facts about hypertension (HTN) or high blood pressure (cont’d): • Symptoms: • Headache • Blurred vision • Dizziness • Sometimes there are no noticeable symptoms

18 Common Chronic and Acute Conditions Transparency 18 -9: Care Guidelines for Hypertension • Offer regular trips to the bathroom. Answer call lights promptly. • Take blood pressure as ordered. • Encourage residents to follow their diet and exercise programs.

18 Common Chronic and Acute Conditions 4. Describe common diseases and disorders of the circulatory system Define the following terms: angina pectoris chest pain, pressure, or discomfort. nitroglycerin medication that helps to relax the walls of the coronary arteries, allowing them to open and get more blood to the heart; comes in tablet, patch or spray form.

18 Common Chronic and Acute Conditions 4. Describe common diseases and disorders of the circulatory system NAs should know these facts about coronary artery disease (CAD): • Causes: • Vessels in coronary arteries narrow, reducing blood to heart • Symptoms: • Angina pectoris

18 Common Chronic and Acute Conditions Transparency 18 -10: 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 exposure to extreme weather.

18 Common Chronic and Acute Conditions 4. Describe common diseases and disorders of the circulatory system NAs should know these facts about heart attack/myocardial infarction: • Caused by 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 7 covers warning signs.

18 Common Chronic and Acute Conditions Transparency 18 -11: Care Guidelines for Myocardial Infarction • Encourage residents to follow their exercise programs. • Encourage residents to follow their special diets. • Medications may be used to regulate heart rate and blood pressure. • Be supportive if residents are quitting smoking. • Help residents avoid stress and listen if they want to talk. • Residents may need to avoid cold temperatures.

18 Common Chronic and Acute Conditions 4. Describe common diseases and disorders of the circulatory system NAs should know these facts about congestive heart failure (CHF): • Cause is the failure of the heart muscle to pump effectively due to damage • Symptoms: • Fatigue • Trouble breathing • Coughing or gurgling with breathing • Dizziness • Confusion • Fainting

18 Common Chronic and Acute Conditions 4. Describe common diseases and disorders of the circulatory system Facts about CHF (cont’d): • Symptoms (cont’d): • Pale or cyanotic skin • Low blood pressure • Swelling of feet and ankles • Bulging neck veins • Weight gain

18 Common Chronic and Acute Conditions Transparency 18 -12: Care Guidelines for Congestive Heart Failure • Medications can help control CHF. • Answer call lights promptly. Keep a portable commode nearby if resident cannot get to the bathroom easily. • Encourage residents to follow diet orders and/or fluid restrictions. • Allow for rest periods. • Measure intake and output (I&O) as ordered. • Weigh residents as instructed. • Apply elastic leg stockings as ordered. • Assist with ROM exercises. • Extra pillows may help breathing. Keep the head of the bed elevated if it helps with breathing. • Assist with personal care and ADLs as needed. • High-potassium foods can help with dizziness.

18 Common Chronic and Acute Conditions 4. Describe common diseases and disorders of the circulatory system NAs should know these facts about peripheral vascular disease (PVD): • Cause is 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 • Anti-embolic stockings can help prevent swelling and blood clots and aid circulation.

Putting elastic stockings on a resident Equipment: elastic stockings 1. Identify yourself by name. Identify resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for resident’s privacy with curtain, screen, or door.

Putting elastic stockings on a resident 5. The resident should be in the supine position (on her back) in bed. With resident lying down, remove her socks, shoes, or slippers, and expose one leg. Expose no more than one leg at a time. 1. Turn stocking inside-out at least to heel area. 7. Gently place the foot of the stocking over toes, foot, and heel. Make sure the heel is in the right place (heel of foot should be in heel of stocking).

Putting elastic stockings on a resident 8. Gently pull the top of stocking over foot, heel, and leg. 9. Make sure there are no twists or wrinkles in stocking after it is applied. It must fit smoothly. Make sure the heel of stocking is over the heel of foot. If the stocking has an opening in the toe area, make sure the opening is either over or under the toe area, depending upon the manufacturer’s instructions.

Putting elastic stockings on a resident 10. Repeat for the other leg. 11. Place call light within resident’s reach. 12. Wash your hands. 13. Report any changes in resident to nurse. 14. Document procedure using facility guidelines.

18 Common Chronic and Acute Conditions 5. Describe common diseases and disorders of the respiratory system Define the following terms: chronic obstrutive pulmonary disease (COPD) a chronic, incurable lung disease that causes difficulty breathing. bronchitis an irritation and inflammation of the lining of the bronchi. emphysema a chronic disease of the lungs that usually results from chronic bronchitis and cigarette smoking.

18 Common Chronic and Acute Conditions 5. Describe common diseases and disorders of the respiratory system Define the following terms: pneumonia a bacterial, viral, or fungal infection that causes acute inflammation in lung tissue. asthma a chronic inflammatory disease that causes difficulty with breathing, coughing, and wheezing. bronchiectasis a chronic disease of the lungs that usually results from chronic bronchitis and cigarette smoking.

18 Common Chronic and Acute Conditions 5. Describe common diseases and disorders of the respiratory system Define the following terms: upper respiratory infection (URI) a viral infection of the nose, sinuses, and throat; commonly called a cold. lung cancer the growth of abnormal cells or tumors in the lungs.

18 Common Chronic and Acute Conditions 5. Describe common diseases and disorders of the respiratory system NAs should know these facts about chronic obstructive pulmonary disease (COPD): • It is a chronic disease. • Residents with COPD have trouble breathing, especially getting air out of the lungs. • Two chronic lung diseases are grouped under COPD: chronic bronchitis and emphysema. • Residents with COPD are at high risk of contracting pneumonia.

18 Common Chronic and Acute Conditions 5. Describe common diseases and disorders of the respiratory system Facts about COPD (cont’d): • All body systems are affected when the lungs and brain do not get enough oxygen. • Residents may be in constant fear of not being able to breathe and might need to sit upright to improve lung expansion. • Residents may have poor appetites and not sleep well, leading to weakness and feelings of general poor health.

18 Common Chronic and Acute Conditions 5. Describe common diseases and disorders of the respiratory system COPD can result in these symptoms: • Chronic cough or wheeze • Difficulty breathing • Shortness of breath • Pale, cyanotic, or reddish-purple skin • Confusion • General weakness • Difficulty completing meals • Fear and anxiety

18 Common Chronic and Acute Conditions Transparency 18 -13: Care Guidelines for Chronic Obstructive Pulmonary Disease • Observe and report signs of symptoms getting worse. • Help resident sit upright. • Offer plenty of fluids and small, frequent meals. • Encourage a well-balanced diet. • Keep oxygen supply available as ordered. • Be calm and supportive. • Use proper infection prevention practices. • Encourage independence with ADLs. • Encourage pursed-lip breathing. • Encourage residents to save energy. Encourage rest.

18 Common Chronic and Acute Conditions 5. Describe common diseases and disorders of the respiratory system NAs should observe and report the following signs and symptoms of COPD: • Temperature over 101°F • Changes in breathing patterns • Changes in color or consistency of lung secretions • Changes in mental state or personality • Refusal to take medications as ordered • Excessive weight loss • Increasing dependence

18 Common Chronic and Acute Conditions 5. Describe common diseases and disorders of the respiratory system NAs should know these facts about asthma: • Chronic inflammatory illness that occurs when the respiratory system is hyperactive to irritants, infection, cold air, or allergens • During an attack, the bronchi constrict, making breathing difficult. • Exercise and stress can cause or worsen asthma. • Causes coughing and wheezing • Exact cause is unknown. • Treatment includes medication in the form of sprays or inhalers. • Residents should avoid triggers.

18 Common Chronic and Acute Conditions 5. Describe common diseases and disorders of the respiratory system NAs should know these facts about bronchiectasis: • Permanent condition in which bronchial tubes are abnormally enlarged • May be acquired in childhood or later in life as a result of infections/inflammation • Cystic fibrosis is a common cause. • Causes chronic coughing, may cause recurrent pneumonia and weight loss • Treatment includes controlling infections and preventing complications; may include antibiotics, postural drainage

18 Common Chronic and Acute Conditions 5. Describe common diseases and disorders of the respiratory system NAs should know these facts about upper respiratory infections (URIs): • Commonly called a cold • Result of viral infection of nose, sinuses, and throat • Symptoms include nasal discharge, sneezing, sore throat, fever, and fatigue. • Rest and extra fluids are effective treatments for most URIs.

18 Common Chronic and Acute Conditions 5. Describe common diseases and disorders of the respiratory system NAs should know these facts about lung cancer: • Abnormal cells or tumors develop in lungs. • Symptoms include chronic cough, shortness of breath, and bloody sputum. • More information about cancer appears later in this chapter.

18 Common Chronic and Acute Conditions 5. Describe common diseases and disorders of the respiratory system NAs should know these facts about tuberculosis: • It is a highly contagious lung disease. • Symptoms include the following: • Coughing • Low-grade fever • Shortness of breath • Weight loss • Fatigue • Bloody sputum • Chapter 5 includes more information about TB and care guidelines

Collecting a sputum specimen Equipment: specimen container with completed label (labeled with resident’s name, date of birth, room number, date, and time) and lid, specimen bag, tissues, gloves, N 95 or other ordered mask, laboratory slip 1. Identify yourself by name. Identify resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

Collecting a sputum specimen 4. Provide for resident’s privacy with curtain, screen, or door. 5. Put on mask and gloves. Coughing is one way that TB bacilli can enter the air. Stand behind the resident if the resident can hold the specimen container by himself.

Collecting a sputum specimen 6. Ask the resident to cough deeply, so that sputum comes up from the lungs. To prevent the spread of infectious material, give the resident tissues to cover his mouth while coughing. Ask the resident to spit the sputum into the specimen container.

Collecting a sputum specimen 7. When you have obtained a good sample (about two tablespoons of sputum), cover the container tightly. Wipe any sputum off the outside of the container with tissues. Discard the tissues. Apply label, and place the container in a clean specimen bag. 8. Remove and discard gloves and mask. 9. Wash your hands. 10. Place call light within resident’s reach. 11. Report any changes in resident to the nurse.

Collecting a sputum specimen 12. Take specimen and lab slip to proper area. Document procedure using facility guidelines.

18 Common Chronic and Acute Conditions 6. Describe common diseases and disorders of the endocrine system Define the following terms: diabetes a condition in which the pancreas produces too little insulin or does not properly use insulin a hormone that converts glucose into energy for the body. glucose natural sugar.

18 Common Chronic and Acute Conditions 6. Describe common diseases and disorders of the endocrine system Define the following terms: type 1 diabetes type of diabetes in which the pancreas does not produce any insulin; is usually diagnosed in children and young adults and will continue throughout a person’s life. type 2 diabetes common form of diabetes in which either the body does not produce enough insulin or the body fails to properly use insulin; typically develops after age 35 and is the milder form of diabetes.

18 Common Chronic and Acute Conditions 6. Describe common diseases and disorders of the endocrine system Define the following terms: pre-diabetes a condition that occurs when a person’s 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.

18 Common Chronic and Acute Conditions 6. Describe common diseases and disorders of the endocrine system NAs should know these facts about diabetes: • Pancreas produces too little insulin or does not properly use insulin. • Glucose collects in blood, causing circulatory problems. • Two types are Type 1 (diagnosed in children and young adults, will continue throughout a person’s 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.

18 Common Chronic and Acute Conditions 6. Describe common diseases and disorders of the endocrine system The following can be signs of diabetes: • Excessive thirst • Extreme hunger • Frequent urination • Weight loss • Elevated blood sugar levels • Glucose (sugar) in urine

18 Common Chronic and Acute Conditions 6. Describe common diseases and disorders of the endocrine system Signs of diabetes (cont’d): • Sudden vision changes • Tingling or numbness in hands or feet • Feeling very tired much of the time • Very dry skin • Sores that are slow to heal • More infections than usual

18 Common Chronic and Acute Conditions 6. Describe common diseases and disorders of the endocrine system Diabetes can lead to the following complications: • Changes in the circulatory system can cause heart attack, stroke, poor extremity circulation, poor wound healing, and kidney and nerve damage. • Damage to eyes can cause vision loss and • blindness. • Diabetes can lead to leg and foot ulcers, infected wounds, and gangrene due to poor circulation and impaired wound healing. • Insulin reaction and diabetic ketoacidosis are serious complications (see Chapter 7).

18 Common Chronic and Acute Conditions Transparency 18 -14: Care Guidelines for Diabetes • Follow diet instructions exactly. • Encourage the right portions of healthy food. • Encourage exercise. • Observe resident’s management of insulin doses. • Perform urine and blood tests as directed. • Give foot care as directed. • Encourage comfortable, leather footwear and cotton socks.

18 Common Chronic and Acute Conditions 6. Describe common diseases and disorders of the endocrine system NAs should observe and report the following signs and symptoms in a resident with diabetes: • Skin breakdown • Change in appetite • Increased thirst • Change in urine output • Nausea or vomiting • Weight changes • Changes in mental status

18 Common Chronic and Acute Conditions 6. Describe common diseases and disorders of the endocrine system Signs and symptoms of diabetes (cont’d): • Irritability • Nervousness or anxiety • Feeling faint or dizzy • Vision changes • Change in mobility • Change in sensation • Sweet or fruity breath • Numbness or tingling in arms or legs

Providing foot care for the diabetic resident Equipment: basin, bath thermometer, mild soap, washcloth, 2 towels, lotion, cotton socks, shoes or slippers, gloves 1. Identify yourself by name. Identify resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for resident’s privacy with curtain, screen, or door.

Providing foot care for the diabetic resident 5. Fill the basin halfway with warm water. Test water temperature with thermometer or against the inside of your wrist. Ensure it is safe. Water temperature should be no higher than 105°F. Have resident check water temperature. Adjust if necessary.

Providing foot care for the diabetic resident 6. Place basin on a bath towel on the floor (if the resident is sitting in a chair) or at the foot of the bed (if the resident is in bed). Make sure basin is in a position that is comfortable for the resident. Support the foot and ankle throughout the procedure. 7. Put on gloves. 8. Remove the resident’s socks, and completely submerge the resident’s feet in the water. Soak the feet for 10 to 20 minutes.

Providing foot care for the diabetic resident 9. Put soap on a wet washcloth. Remove one foot from the water. Wash the entire foot gently, including between the toes and around nail beds. 10. Rinse the entire foot, including between the toes. 11. Using a towel, pat the foot dry gently, including between the toes. 12. Repeat steps 9 through 11 for other foot.

Providing foot care for the diabetic resident 13. Starting at the toes and working up to the ankles, gently rub lotion into the feet with circular strokes. Your goal is to increase circulation, so take several minutes on each foot. Do not put lotion between the toes. 14. Observe the feet, ankles, and legs for dry skin, irritation, blisters, redness, sores, corns, discoloration, or swelling. 15. Help resident put on socks and shoes or slippers.

Providing foot care for the diabetic resident 16. Put soiled linens in appropriate container. Pour water into the toilet and flush it. Place basin in proper area for cleaning or clean and store it according to facility policy. Store supplies. 17. Remove and discard gloves. 18. Wash your hands. 19. Place call light within resident’s reach. 20. Report any changes in resident to the nurse. 21. Document procedure using facility guidelines.

18 Common Chronic and Acute Conditions 6. Describe common diseases and disorders of the endocrine system NAs should know these facts about hyperthyroidism: • Thyroid produces too much thyroid hormone and cells burn too much food. • Causes weight loss, nervousness, hyperactivity • Usually treated with medication • Part of thyroid sometimes surgically removed

18 Common Chronic and Acute Conditions 6. Describe common diseases and disorders of the endocrine system NAs should know these facts about hypothyroidism: • Thyroid produces too little thyroid hormone and body processes slow down. • Causes weight gain and physical and mental sluggishness • Sometimes treated with medication

18 Common Chronic and Acute Conditions 7. Describe common diseases and disorders of the reproductive system Define the following term: sexually transmitted infection (STI) infections caused by sexual contact with infected people; signs and symptoms are not always apparent.

18 Common Chronic and Acute Conditions 7. Describe common diseases and disorders of the reproductive system NAs should know these facts about sexually transmitted infections (STIs): • Diseases are passed through sexual contact, which includes intercourse (vaginal and anal), contact of the mouth with the genitals or anus, and contact of hands with the genitals. • Latex condoms can reduce the chances of STIs. • STIs are very common and can cause serious health problems. • Residents may be unaware of or embarrassed by symptoms. • HIV/AIDS is discussed in detail in the next learning objective.

18 Common Chronic and Acute Conditions 7. Describe common diseases and disorders of the reproductive system NAs should know these facts about chlamydia: • Can cause pelvic inflammatory disease • Symptoms: yellow or white discharge from penis or vagina, burning with urination • Treatment: antibiotics

18 Common Chronic and Acute Conditions 7. Describe common diseases and disorders of the reproductive system NAs should know these facts about syphilis: • If left untreated, can cause brain damage, mental illness, and death (untreated infection spreads to heart, brain, and other vital organs) • Symptoms: chancres, rash, sore throat, fever • Treatment: penicillin or other antibiotics

18 Common Chronic and Acute Conditions 7. Describe common diseases and disorders of the reproductive system NAs should know these facts about gonorrhea: • Can cause sterility if untreated • Symptoms: men show greenish or yellowish discharge from the penis, burning with urination; women show no early symptoms • Treatment: antibiotics

18 Common Chronic and Acute Conditions 7. Describe common diseases and disorders of the reproductive system NAs should know these facts about genital herpes: • Caused by a virus • Treatment: antiviral drugs, but genital herpes cannot be cured • Person may have repeated outbreaks for life. • Symptoms of outbreaks: burning, painful, red sores on genitals • Babies born to infected women can be infected at birth.

18 Common Chronic and Acute Conditions 7. Describe common diseases and disorders of the reproductive system REMEMBER: STIs are not the only common disorders of the reproductive system. The following conditions are not STIs, but do affect the reproductive system.

18 Common Chronic and Acute Conditions 7. Describe common diseases and disorders of the reproductive system NAs should know these facts about benign prostatic hypertrophy: • Occurs in men as they age • Causes: enlarged prostate causes pressure on the urethra, which leads to problems urinating and emptying the bladder • Treatment: medications or surgery

18 Common Chronic and Acute Conditions 7. Describe common diseases and disorders of the reproductive system REMEMBER: Men are at increased risk for prostate cancer as they age. Prostate cancer is usually slow-growing and responsive to treatment, so early detection is important.

18 Common Chronic and Acute Conditions 7. Describe common diseases and disorders of the reproductive system NAs should know these facts about vaginitis: • Causes: bacteria, protozoa, or fungus • Bacterial vaginosis (BV) occurs when there is an overgrowth of normal bacteria inside vagina • Symptoms: white vaginal discharge, itching, burning • Treatment: oral medications, vaginal creams

18 Common Chronic and Acute Conditions Handout 18 -1: Vaginal Irrigation A vaginal irrigation may be ordered to clean the vagina, introduce medication to treat an infection or condition, or to relieve discomfort. A vaginal irrigation, or douche, is a solution that is inserted into the vagina and then immediately drains out. Nursing assistants may be allowed to assist with a vaginal irrigation if trained to do so. They should follow these guidelines: Guidelines: Vaginal Irrigation G Provide plenty of privacy for this procedure. Pull the curtain and close the door. G Wear gloves while assisting with this procedure. G The woman will be placed in the dorsal recumbent position. G Inspect the nozzle or tip for any breaks, cracks, or rough edges before use. This helps prevent injury to the vagina. If you observe any problems with the nozzle, do not use it, and notify the nurse. G To prevent infection, clean the container, tubing, and nozzle before use. Reusable equipment should be washed with hot, soapy water after use.

18 Common Chronic and Acute Conditions Handout 18 -1: Vaginal Irrigation (cont’d) G Follow the care plan’s instructions to make sure the irrigation solution is the right temperature. G If using a commercially-prepared irrigation, follow instructions on the package. G Allow some of the solution to run through the tubing to remove air before the tubing is inserted. G Do not force the nozzle of the douche into the vagina if you meet resistance. If you are unable to insert the nozzle, stop and notify the nurse. G The same amount of solution should return as was put into the vagina. The solution should be the same color as before it was inserted. It should be clear with a mild odor. G Report any of the following to the nurse: • Fatigue • Pain • Unusual amount, unusual color (pink or streaked with red), unusual odor of solution, or any material in solution, such as mucus or particles

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems Define the following terms: acquired immune deficiency syndrome (AIDS) the final stage of HIV infection, in which infections, tumors, and central nervous system symptoms appear due to a weakened immune system that is unable to fight infection. AIDS dementia complex a group of symptoms including memory loss, poor coordination, paralysis, and confusion that occur in the late stages of AIDS due to damage to the central nervous system. Kaposi’s sarcoma a rare form of skin cancer that appears as purple, red, or brown skin lesions.

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems Define the following terms: opportunistic infections that invade the body when the immune system is weak and unable to defend itself. neuropathy numbness, tingling, and pain in the feet and legs.

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems NAs should know these facts about HIV/AIDS: • Acquired immunodeficiency virus is caused by HIV (human immunodeficiency virus). • HIV attacks the immune system and disables it. • AIDS is the final stage of HIV infection in which infections, tumors, and central nervous system symptoms appear. • HIV is transmitted by sexual contact, blood, infected needles, or from mother to fetus. • Symptoms at transmission are like flu. • Later symptoms include infections, tumors, and central nervous system symptoms. • Late stage is AIDS dementia complex.

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems The following can be signs and symptoms of HIV/AIDS: • Flu-like symptoms • Appetite loss • Weight loss • Night sweats • Swollen lymph nodes • Severe diarrhea • Dry cough • Skin rashes

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems Signs and symptoms of HIV/AIDS (cont’d): • Painful white spots in mouth • Cold sores • Warts on the skin and in mouth • Inflamed and bleeding gums • Bruising that does not go away • Low resistance to infection • Kaposi’s sarcoma • Pneumocystis pneumonia, a lung infection • AIDS dementia complex

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems REMEMBER: Opportunistic infections invade the weakened body of a resident with AIDS and worsen her condition. Treatment is medication. Drugs slow the progression of the disease, but there is no cure.

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems The following are high-risk behaviors for HIV/AIDS: • Sharing drug needles • Having unprotected or poorly-protected sex with an infected person • Having sexual contact with many partners • Sexual activity that involves exchange of body fluids with someone who has not tested negative for HIV or who has had many sexual partners

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems These measures can protect against the spread of HIV and AIDS: • Never sharing needles • Not having unprotected sex and using condoms during sexual contact • Staying in a monogamous relationship • Practicing abstinence • Getting tested for HIV • Following Standard Precautions

18 Common Chronic and Acute Conditions Handout 18 -2: Myths about HIV and AIDS Myth: If I am HIV positive, that means I have AIDS. Fact: HIV positive means that your body was exposed to the virus. Since your body was exposed, there is a good chance that you are infected with the virus. But it does not mean that you have AIDS develops over time. Myth: HIV is the same as AIDS. Fact: HIV is the virus that causes AIDS is a group of symptoms that develop during the last stage of HIV infection. Myth: I can get HIV from an infected person by shaking hands, hugging, or kissing. Fact: HIV is not spread through casual contact. There is a slight possibility that you could become HIV infected through kissing, if you and the infected person both have open, bleeding sores in your mouths, and the infected person’s blood gets into yours. If you are really worried about this, do an oral exam on your partner before kissing him or her.

18 Common Chronic and Acute Conditions Handout 18 -2: Myths about HIV and AIDS (cont’d) Myth: I can get HIV from telephones. Fact: The HIV virus cannot live outside of the body. You cannot become infected through saliva. Myth: I can get HIV from doorknobs, tables, chairs, or push buttons. Fact: The HIV virus cannot live outside of the body. Myth: I can get HIV from eating food that was prepared by an infected person. Fact: Once again, HIV dies very quickly outside the body. Even if the food prep person cut his finger and then attractively arranged your food on your plate, you would not become infected from eating this food. Once any body fluid is dry, you can be absolutely sure that the virus is dead. Just about the only way you could become infected this way is if the food prep person cuts off a finger, and as he is bleeding in your food, you are eating it at that exact moment. This scenario is rather extreme.

18 Common Chronic and Acute Conditions Handout 18 -2: Myths about HIV and AIDS (cont’d) Myth: I can get HIV from toilets. Fact: Toilets have been blamed for just about everything, from getting people pregnant to giving people sexually-transmitted infections. The only way you might possibly become HIV infected from a toilet seat is to have unprotected sex while sitting on it! Myth: I can get HIV from mosquitoes. Fact: Although it sounds very possible, you cannot become HIV infected through mosquitoes, fleas, ticks, or lice. For this to happen, the HIV would have to survive in the insect saliva and salivary glands. HIV is a human virus and cannot survive outside of the human body. As a result, HIV will not and does not survive in mosquitoes, fleas, ticks, or lice. If this were a route of transmission, we would all have been infected a very long time ago. Myth: I can get HIV from breathing the same air as an infected person. Fact: HIV does not spread through the air. You cannot get HIV by being in the same room with someone who is infected with the virus.

18 Common Chronic and Acute Conditions Handout 18 -2: Myths about HIV and AIDS (cont’d) Myth: I can get HIV from breathing the same air as an infected person. Fact: HIV does not spread through the air. You cannot get HIV by being in the same room with someone who is infected with the virus.

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems REMEMBER: NAs do not need to be frightened of working with residents who have AIDS. There is no danger of transmission through casual contact like handshakes and hugs. Residents with AIDS need warm care and support just like all other residents.

18 Common Chronic and Acute Conditions Transparency 18 -15: Care Guidelines for HIV/AIDS • Residents with poor immune systems are more sensitive to infections. Wash hands often, follow standard precautions, and keep everything clean. • High-protein, high-calorie, high-nutrient meals can help maintain healthy weight. • Some people with HIV/AIDS lose their appetites. Help make mealtimes pleasant and relaxing, and know residents’ favorite foods. Notify nurse of appetite loss/difficulty eating. • If residents have infections in the mouth, they may need food that is low in acid/spice and neither cold nor hot. Good mouth care is vital. • Small, frequent meals can help with nausea. When nausea and vomiting persist, encourage liquids and salty foods. Help ensure adequate fluid intake.

18 Common Chronic and Acute Conditions Transparency 18 -15: Care Guidelines for HIV/AIDS (cont’d) • If diarrhea is severe, doctor may order a BRAT (bananas, rice, applesauce, toast) diet. This is a helpful short-term solution. • Good rehydration fluids include water, juice, soda, and broth. Avoid caffeinated beverages. • Neuropathy is usually treated with medication. Going barefoot or wearing loose, soft slippers may help. A bed cradle may be used to keep sheets and blankets off legs and feet. • Residents may experience anxiety/depression. Treat them with respect and provide emotional support. • Provide safe environment and close supervision with ADLs.

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems REMEMBER: Residents with AIDS may experience emotional stress and losses beyond those experienced by other residents. They may feel stigmatized by their illness and judged by those around them. They may have lost friends and loved ones to the disease, as well, or lost the love and friendship of people dear to them as a result of their diagnosis. NAs should be sensitive to these issues and provide support and care without judgment.

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems REMEMBER: A resident’s HIV/AIDS status is confidential and cannot be discussed with anyone. This is the ethical way for an NA to work and it is also the law. Under HIPAA there are serious consequences for violations of resident confidentiality.

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems Home Care Focus REMEMBER: In caring for a client with HIV/AIDS an HHA must be especially careful to follow guidelines for safe food preparation and storage. Foodborne illnesses can be especially dangerous for these clients.

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems Define the following terms: cancer general term to describe a disease in which abnormal cells grow in an uncontrolled way. tumor a cluster of abnormally-growing cells. benign tumors that are considered non-cancerous.

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems Define the following terms: malignant tumors that are cancerous. mastectomy the surgical removal of all or part of the breast and sometimes other surrounding tissue.

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems NAs should know these facts about cancer: • General term used to describe a disease in which abnormal cells grow in an uncontrolled way • Tumors can be benign (non-cancerous, usually grow slowly) or malignant (cancerous, grow rapidly). • There is no cure. • It may spread to other areas of the body (metastasize), affecting other body systems. • Often first appears in breast, colon, rectum, uterus, prostate, lungs, or skin

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems The following may be risk factors for cancer: • Age • Race • Gender • Family history • Tobacco use • Alcohol use • Poor diet/obesity • Lack of physical activity • Chemicals and food additives • Radiation • Exposure to sunlight

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems The American Cancer Society has identified these warning signs of cancer: • Unexplained weight loss • Fever • Fatigue • Pain • Skin changes • Change in bowel or bladder habits

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems Warning signs of cancer (cont’d): • Sores that do not heal • Unusual bleeding or discharge • Thickening or lump in breast, scrotum, or other parts of body • Indigestion or difficulty swallowing • Recent change in wart or mole • Nagging cough or hoarseness

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems There are three primary treatments for cancer: • Surgery • Chemotherapy • Radiation

18 Common Chronic and Acute Conditions Transparency 18 -16: Care Guidelines for Cancer • Each case is different. Do not make assumptions. • Respect residents’ needs and be sensitive. Maintain a positive attitude. • Try plastic utensils for residents receiving chemotherapy. Encourage a variety of foods. • Watch for signs of pain and report them to the nurse. • Offer back rubs and repositioning to help with comfort and increase circulation. • Use lotion on dry skin. Do not remove markings. • Reposition residents. • Help residents with oral care often. Use a soft-bristled toothbrush and baking soda rinse. Be gentle. • Provide help with grooming. • Encourage visitors. Suggest good times of the day for visits. Get to know residents’ interests. • Be alert to unmet needs or stresses.

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems NAs should observe and report the following signs and symptoms of cancer: • Increased weakness or fatigue • Weight loss • Nausea, vomiting, diarrhea • Changes in appetite • Fainting • Signs of depression (Chapter 20)

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems Signs and symptoms of cancer (cont’d): • Confusion • Blood in stool or urine • Change in mental status • Changes in skin • New lumps, sores, rashes • Increase in pain or unrelieved pain • Blood in the mouth

18 Common Chronic and Acute Conditions 8. Describe common diseases and disorders of the immune and lymphatic systems REMEMBER: Special arm exercises or deep breathing exercises may be ordered for residents who have had a mastectomy. NAs should always follow the care plan and the nurse’s instructions.

18 Common Chronic and Acute Conditions 9. Identify community resources for residents who are ill REMEMBER: There are many services and support groups available for people who are ill and for the families and caregivers.

18 Common Chronic and Acute Conditions 9. Identify community resources for residents who are ill Think about this question: Do you know about any services or support groups for residents who are ill, or for their families?

18 Common Chronic and Acute Conditions 9. Identify community resources for residents who are ill The following groups may be of assistance: • American Cancer Society (cancer. org) • National Association of Area Agencies on Aging (n 4 a. org) provides Eldercare Locator. • Many organizations assist those dealing with HIV/AIDS: • aids. gov • cdc. gov/hiv • aidsinfo. nih. gov

18 Common Chronic and Acute Conditions Exam Multiple Choice. Choose the correct answer. 1. How is scabies transmitted? (A) Through droplets from an infected person (B) Through direct contact with an infected person (C) By breathing the same air as an infected person (D) Through indirect contact with personal protective equipment 2. Which of the following statements is true of a closed wound? (A) A puncture wound is an example of a closed wound. (B) A closed wound has skin that is not intact. (C) A contusion (bruise) is an example of a closed wound. (D) A surgical incision is an example of a closed wound.

18 Common Chronic and Acute Conditions Exam 1. A common sign or symptom of eczema is (A) Reddened skin (B) Persistent coughing (C) Foul-smelling sputum (D) Cloudy urine 2. Rheumatoid arthritis is an autoimmune illness. With an autoimmune illness, the body’s ______ system attacks normal tissue. (A) Immune (B) Lymphatic (C) Circulatory (D) Endocrine

18 Common Chronic and Acute Conditions Exam 1. Which of the following statements is true of osteoarthritis? (A) The jaw and neck are usually affected. (B) Pain and stiffness increase in cold or damp weather. (C) Surgery is the first method of treatment for osteoarthritis. (D) Antibiotics are usually the first type of medication used to treat osteoarthritis. 2. Osteoporosis causes (A) Bones that can break easily (B) Vision impairment (C) Weakening of the immune system (D) Problems with breathing

18 Common Chronic and Acute Conditions Exam 1. When helping a resident who has had a hip replacement get dressed, how should the nursing assistant (NA) begin? (A) Start with the stronger side (B) Start with the left side (C) Start with the weaker side (D) Start with the feet and move upward 2. Which of the following statements is true of casts? (A) The NA should keep the cast wet or damp. (B) The NA should place a wet cast on a hard surface. (C) The NA should elevate an extremity that is in a cast. (D) The NA should use a long, angled scratcher when the resident needs to scratch the skin underneath the cast.

18 Common Chronic and Acute Conditions Exam 1. A(n) ______ stocking is a special stocking that can help with circulation after a knee replacement. (A) Anti-embolic (B) Sheer (C) Clotting (D) Sleeve 2. After an amputation, a resident may experience phantom sensation. Phantom sensation is (A) Not real (B) Tingling or itching in the area where the limb was amputated (C) An artificial body part (D) The surgical removal of a body part due to disease or injury

18 Common Chronic and Acute Conditions Exam 1. Why is it important for the NA to let the nurse know if she is aware that a resident is taking herbal remedies? (A) They may interact with the resident’s medications. (B) They do not work. (C) They will make the resident very sick. (D) The nurse needs to set the dosage. 2. Which of the following statements is true of how an NA should assist a resident with one-sided weakness after a stroke? (A) The NA should lead with the weaker side. (B) The NA should stand on the weaker side. (C) The NA should use the terms bad or messed up so it is clear which side is the weaker side. (D) The NA should not use a gait belt during transfers.

18 Common Chronic and Acute Conditions Exam 1. When assisting residents who have had a stroke, the NA should (A) Place food in the unaffected/stronger side of the resident’s mouth (B) Place food in the affected/weaker side of the resident’s mouth (C) Offer another bite of food before the resident has swallowed the last bite (D) Encourage the resident to take large bites 2. Where should the NA stand when helping a resident, who is recovering from a stroke, walk? (A) On either side, but very close to the resident (B) On the resident’s stronger side (C) On the resident’s weaker side (D) A few feet in front of the resident

18 Common Chronic and Acute Conditions Exam 1. Guidelines for caring for a resident with multiple sclerosis include which of the following? (A) Rushing the resident through tasks to help with decision-making skills (B) Administering medications (C) Preventing falls (D) Encouraging the resident to speak faster to improve cognition 2. Which of the following is true of spinal cord injuries? (A) Residents with spinal cord injuries will not be able to perform any selfcare. (B) Rehabilitation is not helpful with spinal cord injuries. (C) The lower the injury, the greater the loss of function. (D) The higher the injury, the greater the loss of function.

18 Common Chronic and Acute Conditions Exam 1. A resident with a head or spinal cord injury should be repositioned at least every ___ hours. (A) 2 (B) 3 (C) 4 (D) 5 2. Parkinson’s disease typically causes (A) A shuffling gait (B) Extremely straight posture (C) Memory loss (D) Aggressive behavior

18 Common Chronic and Acute Conditions Exam 1. The (A) (B) (C) (D) 2. High blood pressure (A) Can be detected just by looking at a person (B) Cannot be treated with medication (C) Is never a serious condition (D) Is a measurement of 140/90 or higher medical term for high blood pressure is Angina Atherosclerosis Pectoris Hypertension

18 Common Chronic and Acute Conditions Exam 1. Which of the following is helpful for a resident who has had a heart attack? (A) High-cholesterol diet (B) High-fat diet (C) Regular exercise (D) Cold temperatures 2. The (A) (B) (C) (D) medical term for chest pain, pressure, or discomfort is Atherosclerosis Nitroglycerin Hypertension Angina pectoris

18 Common Chronic and Acute Conditions Exam 1. Which of the following statements is true of congestive heart failure (CHF)? (A) Residents may take medication that makes them urinate more often. (B) Residents will usually have a force fluids order directing them to drink more fluids. (C) The NA will administer nitroglycerin to relieve painful episodes. (D) Residents with CHF will generally need to eat a diet high in sodium to eliminate swelling. 2. Residents with chronic obstructive pulmonary disease (COPD) have trouble with (A) Breathing (B) Urination (C) Losing weight (D) Vision

18 Common Chronic and Acute Conditions Exam 1. How should a resident with COPD be positioned? (A) Flat on his back (B) Sitting upright (C) Lying on his stomach (D) Lying on his side 2. What time of day is best to collect a sputum specimen? (A) Late evening (B) Around lunchtime (C) Early morning (D) Right before bedtime

18 Common Chronic and Acute Conditions Exam 1. Which of the following are symptoms commonly experienced by people who have diabetes? (A) Excessive thirst, extreme hunger, frequent urination (B) Weight gain, poor appetite, leg swelling (C) Diarrhea, hyperactivity, dark yellow urine (D) Infrequent urination, swollen lymph nodes, excessive energy 2. Which of the following statements is true of diabetes? (A) To best conserve energy, people with diabetes should skip meals when they are not hungry. (B) People with diabetes must be very careful about what they eat. (C) People with diabetes must avoid exercise so that they do not burn too much glucose. (D) Monitoring a diabetic resident’s intake of protein is more important than monitoring his intake of carbohydrates.

18 Common Chronic and Acute Conditions Exam 1. The (A) (B) (C) (D) most common form of diabetes is Type 1 diabetes Type 2 diabetes Pre-diabetes Gestational diabetes 2. The (A) (B) (C) (D) best way for an NA to provide foot care for a diabetic resident is to Cut the resident’s toenails to keep them short and clean Encourage the resident not to wear socks Make sure the resident is barefoot most of the time Observe the feet regularly for signs of irritation

18 Common Chronic and Acute Conditions Exam 1. What kind of shoes are best for diabetic residents to wear? (A) Leather shoes (B) Plastic shoes (C) Pleather shoes (D) Rubber shoes 2. Sexually-transmitted infections are passed through sexual contact. Sexual contact includes (A) Deep kissing (B) Contact of hands with the breasts (C) Holding hands (D) Contact of the mouth with the genitals

18 Common Chronic and Acute Conditions Exam 1. Which of the following sexually-transmitted infections (STIs) cannot be cured? (A) Chlamydia (B) Gonorrhea (C) Genital herpes (D) Syphilis 2. A resident with AIDS who has an infection of the mouth may need to eat food that is (A) Spicy (B) Soft (C) Dry (D) Hot

18 Common Chronic and Acute Conditions Exam 1. A resident with AIDS who has nausea and is vomiting should eat (A) Small, frequent meals (B) Quickly (C) High-fat dairy products (D) Spicy foods 2. Which of the following is helpful for numbness, tingling, and pain in the feet for a resident who has AIDS? (A) Wrapping the feet tightly in elastic bandages (B) Wearing snug, firm slippers (C) Tucking the sheet around the feet (D) Going barefoot

18 Common Chronic and Acute Conditions Exam 1. HIV (A) (B) (C) (D) 2. The key treatment for malignant tumors of the skin, breast, bladder, colon, rectum, stomach, and muscle is (A) Surgery (B) Chemotherapy (C) Radiation (D) Herbal supplements can be transmitted by Telephones Toilets Hugs Blood

18 Common Chronic and Acute Conditions Exam 1. Which of the following is the best way an NA can communicate with a resident who has cancer? (A) The NA should insist that the resident tell the NA what he is going through. (B) The NA should give the resident medical advice if the resident asks for it. (C) If the resident is worried, the NA should tell him, “It’ll all be fine. ” (D) The NA should listen to the resident if he feels like talking. 2. Which of the following is helpful when providing skin care for a resident with cancer? (A) Do not use lotion on dry, delicate skin. (B) Do not offer backrubs. (C) Avoid applying lotion to areas receiving radiation therapy. (D) Avoid moving the resident at all.

18 Common Chronic and Acute Conditions Exam 1. 2. Which of the following would be the best response by the NA if a resident with cancer is experiencing pain? (A) The NA should assist with comfort measures, such as repositioning. (B) The NA should encourage the resident by telling her that she has to be tougher to fight the cancer. (C) The NA should make light of the pain and tell the resident to think about cheerful things. (D) The NA should tell the resident to pray and God will take away her pain. What should an NA do when providing oral care for a resident with cancer? (A) The NA should use a commercial mouthwash for rinsing. (B) The NA should use a hard-bristled toothbrush. (C) The NA should assist the resident with brushing and flossing regularly. (D) The NA should avoid giving oral care or give limited oral care.

18 Common Chronic and Acute Conditions Exam 1. What is the best response by an NA if he feels a resident or family member needs more support in dealing with a resident’s illness? (A) The NA should speak to the nurse. (B) The NA should tell the resident she needs to talk to a social worker. (C) The NA should tell his coworkers the resident is having a hard time and suggest they go cheer her up. (D) The NA should tell the resident’s clergyperson that the resident needs a visit.

18 Common Chronic and Acute Conditions CHAPTER 18 PRACTICE 1. A common sign or symptom of eczema is (A) Reddened skin (B) Persistent coughing (C) Foul-smelling sputum (D) Cloudy urine 2. Guidelines for caring for a resident with multiple sclerosis include which of the following? (A) Rushing the resident through tasks to help with decision-making skills (B) Administering medications (C) Preventing falls (D) Encouraging the resident to speak faster to improve cognition. 3. The medical term for high blood pressure is (A) Angina (B) Atherosclerosis (C) Pectoris (D) Hypertension 4. Which of the following is helpful when providing skin care for a resident with cancer? (A) Do not use lotion on dry, delicate skin. (B) Do not offer backrubs. (C) Avoid applying lotion to areas receiving radiation therapy. (D) Avoid moving the resident at all.

18 Common Chronic and Acute Conditions CHAPTER 18 PRACTICE ANSWERS 1. 2. 3. 4. A-REDDENED SKIN C-PREVENTING FALLS D-HYPERTENSION C-AVOID APPLYING LOTION TO AREAS RECEIVING RADIATION THERAPY