18
Common Chronic and Acute Conditions
Define the following terms:
Scabies
contagious skin condition caused by a tiny mite burrowing
into the skin, where it lays eggs; causes intense itching and a
skin rash that may look like thin burrow tracks.
Shingles
non-contagious skin rash caused by the varicella-zoster virus
(VZV), which is the same virus that causes chickenpox;
causes pain, tingling, or itching in an area, which later
develops into a rash of fluid-filled blisters.
18
Common Chronic and Acute Conditions
Define the following terms:
Wound
a type of injury to the skin.
Dermatitis
general term that refers to inflammation of the skin; usually
involves swollen, reddened, irritated, and itchy skin.
Inflammation
swelling.
18
Common Chronic and Acute Conditions
1. Describe common diseases and disorders of the integumentary
system
REMEMBER:
Pressure sores, a common disorder of the integumentary system,
were covered in Chapter 13, and burns in Chapter 7.
18
Common Chronic and Acute Conditions
1. Describe common diseases and disorders of the integumentary
system
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
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 now available
18
Common Chronic and Acute Conditions
1. Describe common diseases and disorders of the integumentary
system
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
Dermatitis
• General term referring to inflammation (swelling) of skin
• Two types of dermatitis: atopic dermatitis (eczema) and stasis
dermatitis
• 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
Dermatitis (cont’d.)
• Stasis dermatitis:
• Commonly effects 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
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, vaginal yeast
infection, ringworm.
• 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
Define the following terms:
Arthritis
a general term that refers to inflammation of the joints;
causes stiffness, pain, and decreased mobility.
Autoimmune illness
an illness in which the body’s immune system attacks normal
tissue in the body.
Osteoarthritis
a common type of arthritis that usually affects the hips,
knees, fingers, thumbs, and spine.
18
Common Chronic and Acute Conditions
Define the following terms:
Rheumatoid arthritis
a type of arthritis in which joints become red, swollen, and
very painful, and movement is restricted.
Osteoporosis
a common type of arthritis that usually affects the hips,
knees, fingers, thumbs, and spine.
Closed fracture
a broken bone that does not break the skin.
18
Common Chronic and Acute Conditions
Define the following terms:
Open fracture
a broken bone that penetrates the skin; also known as a
compound fracture.
Partial weight bearing
able to support some weight on one or both legs.
Non-weight bearing
unable to support any weight on one or both legs.
18
Common Chronic and Acute Conditions
Define the following terms:
Full weight bearing
able to bear 100 percent of the body weight on one or both
legs on a step.
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.
Muscular dystrophy
an inherited, progressive disease that causes a gradual
wasting of muscle, weakness, and deformity.
18
Common Chronic and Acute Conditions
Define the following terms:
Amputation
the removal of some or all of a body part, usually a foot,
hand, arm or leg; may be the result of an injury or disease.
Phantom sensation
pain or feeling from a body part that has been amputated;
caused by remaining nerve endings.
Complementary medicine
treatments that are used in addition to the conventional
treatments prescribed by a doctor.
Alternative medicine
practices and treatments used instead of conventional
healthcare methods.
18
Common Chronic and Acute Conditions
2. Describe common diseases and disorders of the
musculoskeletal system
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.
• Treatments for arthritis include the following:
• Anti-inflammatory medications (aspirin or ibuprofen)
• Local applications of heat
• ROMs
• Exercise
• Diet
18 Common Chronic and Acute Conditions
Transparency 18-1: Care Guidelines for Arthritis
•
•
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•
•
•
•
Watch for stomach irritation or heartburn.
Encourage activity.
Adapt ADLs to allow independence.
Choose clothing that is easy to put on and fasten.
Use special utensils if needed.
Treat each resident as an individual.
Help resident’s self-esteem by encouraging self-care.
18
Common Chronic and Acute Conditions
2. Describe common diseases and disorders of the
musculoskeletal system
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
Osteoporosis (cont’d.)
Signs and symptoms:
• Low back pain
• Stooped posture
• Loss of height
To prevent or slow osteoporosis:
• Encourage residents to walk and do other light exercise as
ordered.
• Move residents with osteoporosis very carefully.
• Follow care plan regarding medication, calcium, and fluoride
supplements, which might be used to treat osteoporosis.
18
Common Chronic and Acute Conditions
2. Describe common diseases and disorders of the
musculoskeletal system
Fractures
Fall prevention is key to preventing fractures. Elderly bones heal
slowly.
18 Common Chronic and Acute Conditions
Transparency 18-2: Care Guidelines for Casts
•
•
•
•
•
•
•
•
•
Do not cover until dry.
Do not place on hard surface.
Elevate extremity in cast.
Observe for skin discoloration, tightness, swelling, sores,
skin temperature, burning, numbness or tingling, drainage,
bleeding, or odor.
Protect resident’s skin from edges of cast.
Keep cast dry.
Do not insert anything into cast.
Tell the nurse if pain medication is needed.
Use bed cradles as needed.
18
Common Chronic and Acute Conditions
2. Describe common diseases and disorders of the
musculoskeletal system
Hip Fractures
• Cause may be a fall or weakened bones
• Elderly bones heal slowly
• Possible reasons for hip replacements:
• 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.
Do not perform ROM exercises on hip replacement side.
Hip cannot be at less than 90-degree angle. It cannot be
turned outward.
• Transfer resident carefully, with strong side leading in
standing, pivoting and sitting.
• With chair or toilet transfers, operative leg/knee should be
straightened. Strong leg should stand first.
18
Common Chronic and Acute Conditions
2. Describe common diseases and disorders of the
musculoskeletal system
Hip Fractures
Signs and symptoms to observe and report include
• Red, draining, warm, or bleeding incision
• Increase in pain
• Numbness or tingling
• Abnormal vital signs
• Inability to use equipment properly and safely
• Resident not following doctor’s orders for activity and exercise
• Problems with appetite
• Increasing strength and improving ability to walk
18
Common Chronic and Acute Conditions
2. Describe common diseases and disorders of the
musculoskeletal system
Knee Replacement
• Possible reasons for knee replacement:
• Relieve severe pain
• Restore motion to damaged knee
• Help 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 for knee replacement is generally shorter than for
a 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.
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
Muscular Dystrophy
• MD is inherited.
• It causes gradual wasting 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
Amputations
• Do not ignore or ridicule phantom sensation.
• Be supportive.
• Help with ADLs.
• 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 alternative and complementary medical
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:
Do not make judgments, express opinions or make
recommendations to residents regarding complementary or
alternative medicine practices. Express any concerns to the
charge nurse.
18
Common Chronic and Acute Conditions
Define the following terms:
Parkinson’s disease
a progressive disease that causes the brain to degenerate;
causes stooped posture, shuffling gait, pill-rolling, and
tremors.
Multiple sclerosis
a progressive disease of the nervous system in which the
protective covering for the nerves, spinal cord, and white
matter of the brain breaks down over time; without this
covering, nerves cannot send messages to and from the brain
in a normal way.
Paraplegia
loss of function of the lower body and legs.
18
Common Chronic and Acute Conditions
Define the following terms:
Quadriplegia
loss of function of the legs, trunk, and arms.
Epilepsy
an illness of the brain that produces seizures.
Cataracts
a condition in which milky or cloudy spots develop in the eye,
causing vision loss.
Glaucoma
a condition in which the fluid inside the eyeball is unable to
drain; increased pressure inside the eye causes damage that
often leads to blindness.
18
Common Chronic and Acute Conditions
3. Describe common diseases and disorders of the nervous
system
NOTE:
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
Stroke
• Caused when blood supply to brain is cut off by a clot or
ruptured vessel.
• Results in lack of oxygen to tissue, causing cells to die.
• Swelling, leaking blood, and clots affect surrounding healthy
brain tissue.
• Weakness occurs opposite affected side of brain.
• Mild stroke may result in few, if any, complications.
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,” 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.
• Makes sure food is swallowed.
18
Common Chronic and Acute Conditions
3. Describe common diseases and disorders of the nervous
system
Remember the following safety tips when providing home care
for a client who has had a stroke:
• 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
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
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 proper diet.
Give excellent skin care.
Assist with ROM exercises.
18
Common Chronic and Acute Conditions
3. Describe common diseases and disorders of the nervous
system
Head and Spinal Cord Injuries
• May result from diving, sports injuries, falls, car and
motorcycle accidents, industrial accidents, war, and criminal
violence.
• Can cause permanent brain damage, mental retardation,
personality changes, trouble breathing, seizures, coma,
memory loss, loss of consciousness, paresis, paralysis.
• Effects of spinal cord injuries depend on force of impact and
where spine is injured.
• May cause paraplegia or quadriplegia.
• Rehabilitation is needed.
• Emotional support is important.
18 Common Chronic and Acute Conditions
Transparency 18-8: Care Guidelines for Head and Spinal Cord Injuries
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•
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•
•
Give emotional, as well as physical, support.
Be patient.
Prevent falls and burns.
Be patient with self-care.
Give good skin care.
Assist with position changes at least every two hours.
Perform passive range of motion exercises.
Encourage fluids and proper diet to prevent constipation.
Give extra catheter care as needed.
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
Epilepsy
• Epilepsy causes seizures.
• Seizures can be violent or mild.
• Exact cause of most cases is unknown.
• Main goal during a seizure is to keep resident safe.
• Do not restrain the person.
• Do not force anything between the person’s teeth.
• Notice the time and report the length of seizures.
18
Common Chronic and Acute Conditions
3. Describe common diseases and disorders of the nervous
system
Vision Impairment
• Vision impairment can affect people of all ages.
• Some residents may wear eyeglasses or contacts.
• People over 40 are at risk for developing cataracts, glaucoma,
and blindness.
• Cataracts may be corrected surgically.
• Glaucoma can occur suddenly or gradually, and is treated with
medication and sometimes surgery.
• Residents who are visually impaired may enjoy books on tape,
large-print books, or Braille books (if they are trained to read
Braille).
18
Common Chronic and Acute Conditions
Define the following terms:
Atherosclerosis
a hardening and narrowing of the blood vessels.
Angina pectoris
the medical term for chest pain, pressure, or discomfort due
to coronary artery disease.
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
Define the following terms:
Myocardial infarction (MI)
a condition that occurs when the heart muscle does not
receive enough oxygen because blood vessels are blocked;
also called a heart attack.
Congestive heart failure (CHF)
a condition in which the heart is no longer able to pump
effectively; blood backs up into the heart instead of
circulating.
Peripheral vascular disease (PVD)
a disease in which the legs, feet, arms, or hands do not have
enough blood circulation due to fatty deposits in the blood
vessels that harden over time.
18
Common Chronic and Acute Conditions
4. Describe common diseases and disorders of the cardiovascular
system
Hypertension (HTN) or High Blood Pressure
• Causes:
• Hardening and narrowing of blood vessels (atherosclerosis)
• Kidney disease
• Adrenal tumors
• Pregnancy
• Symptoms:
• Headache
• Blurred vision
• Dizziness
• Sometimes there are no noticeable symptoms
18 Common Chronic and Acute Conditions
Transparency 18-9: Care Guidelines for High Blood Pressure
• Treatment to control it is vital.
• 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 cardiovascular
system
Coronary Artery Disease
• Cause: 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 extreme weather exposures.
18
Common Chronic and Acute Conditions
4. Describe common diseases and disorders of the cardiovascular
system
Heart Attack or Myocardial Infarction
• Caused by complete block of blood flow to heart muscle,
which results in tissue death
• Area of dead tissue may be large or small
• Can result in serious heart damage or death
• Chapter 7 covers warning signs
18 Common Chronic and Acute Conditions
Transparency 18-11: Care Guidelines for Heart Attack
• Residents may be placed on exercise program.
• Residents may be on low-fat/low-sodium diet.
• Medications may be used to regulate heart rate and blood
pressure.
• Quitting smoking is encouraged.
• Stress management program may be started.
• Residents may need to avoid cold temperatures.
18
Common Chronic and Acute Conditions
4. Describe common diseases and disorders of the cardiovascular
system
Congestive Heart Failure (CHF)
• Cause: failure of heart muscle to pump effectively due to
damage
• Symptoms:
• Trouble breathing
• Coughing or gurgling with breathing
• Dizziness, confusion, fainting
• Pale or blue 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.
• Medications mean more trips to bathroom. Answer call
lights promptly.
• Low-sodium diet or fluid restriction may be prescribed.
• Limited activity or bedrest may be prescribed.
• I&O may need to be measured.
• Residents may need to be weighed daily.
• Elastic leg stockings help reduce swelling.
• ROM exercises improve muscle tone.
• Extra pillows may help breathing.
• Help with personal care and ADLs as needed.
• High-potassium foods can help with dizziness.
18
Common Chronic and Acute Conditions
4. Describe common diseases and disorders of the cardiovascular
system
Peripheral Vascular Disease (PVD)
• Cause: fatty deposits in the blood vessels that harden
• Symptoms:
• Cool arms and legs
• Swelling in hands and feet
• Pale or bluish hands or feet
• Bluish nail beds
• Ulcers of legs and feet
• Anti-embolic stockings can help prevent swelling and blood
clots and aid circulation.
Putting elastic stockings on a resident
Equipment: elastic stockings
1. Wash your hands.
2. Identify yourself by name.
Identify resident by name.
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 (cont’d.)
5. With resident lying down,
remove his or her socks,
shoes, or slippers, and
expose one leg.
6. 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 (cont’d.)
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.
10. Repeat for the other leg.
Putting elastic stockings on a resident (cont’d.)
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
Define the following terms:
Chronic obstructive pulmonary disease (COPD)
a chronic lung disease that cannot be cured; causes difficulty
breathing.
Bronchitis
an irritation and inflammation of the lining of the bronchi.
Emphysema
a chronic disease of the lungs that usually develops as a
result of chronic bronchitis and smoking.
Pneumonia
a bacterial, viral, or fungal infection that causes acute
inflammation in a portion of lung tissue.
18
Common Chronic and Acute Conditions
Define the following terms:
Asthma
a chronic inflammatory disease that causes difficulty with
breathing and coughing and wheezing.
Bronchiectasis
condition in which the bronchial tubes are permanently
enlarged, causing chronic coughing and thick sputum; may
be result of chronic infections and inflammation.
Upper respiratory infection (URI)
a bacterial or viral infection of the nose, sinuses, and throat;
commonly called a cold.
Lung cancer
the development of abnormal cells or tumors in the lungs.
18
Common Chronic and Acute Conditions
5. Describe common diseases and disorders of the respiratory
system
Chronic obstructive pulmonary disease (COPD)
• It is a chronic disease.
• May result 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.
• 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 COPD
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•
Observe and report symptoms getting worse.
Help resident sit upright.
Offer plenty of fluids and small, frequent meals.
Encourage a balanced diet.
Keep oxygen supply available as ordered.
Be calm and supportive.
Use good infection control.
Encourage independence with ADLs.
Make sure residents always have help ready.
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
Signs and symptoms of COPD to report:
• 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
Asthma
• Chronic inflammatory illness that occurs when the respiratory
system is hyperactive to irritants
• During an attack the bronchi constrict, making breathing
difficult
• Exercise and stress can bring on attacks
• Causes coughing and wheezing
• Exact cause 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
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
Upper Respiratory Infection
• Commonly called a cold
• Result of bacterial or viral infection of nose, sinuses, and
throat
• Symptoms include nasal discharge, sneezing, sore throat,
fever, fatigue
• Rest and extra fluids are effective treatments for most URIs.
• Antibiotics might be required for bacterial infection
18
Common Chronic and Acute Conditions
5. Describe common diseases and disorders of the respiratory
system
Lung Cancer
• Abnormal cells or tumors develop in lungs
• Symptoms include chronic cough, shortness of breath, bloody
sputum
• More information about cancer later in this chapter
18
Common Chronic and Acute Conditions
5. Describe common diseases and disorders of the respiratory
system
Tuberculosis
TB guidelines are found in Chapter 5, pp. 73-74 in the textbook.
Collecting a sputum specimen
Equipment: specimen
container and lid with label
(labeled with resident’s
name, room number, date
and time), tissues, plastic
bag, gloves, mask
1. Wash your hands.
2. Identify yourself by
name. Identify resident
by name.
3. Explain procedure to
resident. Speak clearly,
slowly, and directly.
Maintain face-to-face
contact whenever
possible.
Collecting a sputum specimen (cont’d.)
4. Provide for resident’s
privacy with curtain,
screen, or door.
5. Put on mask and gloves. If
the resident has known or
suspected TB or another
infectious disease, wear a
mask when collecting a
sputum specimen.
Coughing is one way TB
droplets can enter the air.
Stand behind the resident
if the resident can hold the
specimen container by
himself.
Collecting a sputum specimen (cont’d.)
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 or her mouth.
Ask the resident to spit the
sputum into the container.
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. Put the container
in the plastic bag and seal
the bag.
Collecting a sputum specimen (cont’d.)
8. Remove and dispose of
gloves and mask.
9. Wash your hands.
10.Place call light within
resident’s reach.
11.Report any changes in
resident to the nurse.
12.Document procedure using
facility guidelines.
18
Common Chronic and Acute Conditions
Define the following terms:
Diabetes/Diabetes mellitus
a condition in which the pancreas does not produce enough or
does not properly use insulin.
Insulin
a hormone that converts glucose into energy for the body.
Glucose
natural sugar.
18
Common Chronic and Acute Conditions
Define the following terms:
Type 1 diabetes
type of diabetes in which the body does not produce enough
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.
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.
18
Common Chronic and Acute Conditions
Define the following terms:
Gestational diabetes
type of diabetes that appears in pregnant women who have
never had diabetes before but who have high glucose levels
during pregnancy.
Hyperthyroidism
condition in which the thyroid produces too much thyroid
hormone, causing the cells to burn too much food.
Hypothyroidism
condition in which the thyroid produces too little thyroid
hormone, causing the body processes to slow down; weight
gain and physical and mental sluggishness result.
18
Common Chronic and Acute Conditions
6. Describe common diseases and disorders of the endocrine
system
Diabetes
• Pancreas does not produce enough insulin.
• Glucose collects in blood causing circulatory problems.
• Type 1 is diagnosed in children and young adults and will
continue throughout a person’s life.
• Type 2 is 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 are signs of diabetes:
• Excessive thirst
• Extreme hunger
• Weight loss
• High levels of blood sugar
• Sugar in urine
• Frequent urination
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
• 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
Complications of diabetes include the following:
• Changes in the circulatory system can cause heart attack,
stroke, poor extremity circulation, poor wound healing, and
kidney and nerve damage.
• Damage 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
Remember these signs and symptoms to report about diabetes:
• Skin breakdown
• Change in appetite
• Increased thirst
• Nausea or vomiting
• Weight change
• Changes in mental status
18
Common Chronic and Acute Conditions
6. Describe common diseases and disorders of the endocrine
system
Signs and symptoms to report about 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 of warm
water (water temperature
should be no more than 105°
F), mild soap, washcloth, soft
towel, lotion, cotton socks,
shoes or slippers, gloves
Support the foot and ankle
throughout procedure.
1. Wash your hands.
2. Identify yourself by
name. Identify resident
by name.
Providing foot care for the diabetic resident (cont’d.)
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.
5. Put on gloves.
6. Using the washcloth and
soap, wash the feet
gently. Rinse with the
warm water.
Providing foot care for the diabetic resident (cont’d.)
7. Pat the feet dry gently,
wiping between the toes.
8. 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.
9. Observe the feet, ankles,
and legs for dry skin,
irritation, blisters, redness,
sores, corns, discoloration,
or swelling.
Providing foot care for the diabetic resident (cont’d.)
10. Help resident put on socks
and shoes or slippers.
11. Put soiled linens in
appropriate container.
Pour water into the toilet.
Clean and store basin and
supplies.
12. Remove and dispose of
gloves.
Providing foot care for the diabetic resident (cont’d.)
13. Wash your hands.
14. Place call light within
resident’s reach.
15. Report any changes in
resident to the nurse.
16. Document procedure
using facility guidelines.
18
Common Chronic and Acute Conditions
6. Describe common diseases and disorders of the endocrine
system
Hyperthyroidism
• Thyroid produces too much thyroid hormone and cells burn
too much food
• Causes weigh 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
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
Define the following terms:
Sexually transmitted diseases (STDs)
diseases caused by sexual contact with an infected person;
also called venereal diseases.
Sexually transmitted infections (STIs)
infections caused by sexual contact with an infected person; a
person may be infected, and may potentially infect others,
without showing signs of the disease.
Chlamydia
sexually transmitted disease that causes yellow or white
discharge from the penis or vagina and burning with
urination.
18
Common Chronic and Acute Conditions
Define the following terms:
Syphilis
sexually transmitted disease that can cause chancres on the
penis and, if untreated, rash, sore throat, or fever.
Chancres
open sores.
Gonorrhea
sexually transmitted disease that causes greenish or
yellowish discharge from the penis and burning with urination
in men.
18
Common Chronic and Acute Conditions
Define the following terms:
Herpes simplex 2
a sexually-transmitted, incurable disease caused by a virus;
repeated outbreaks of the disease may occur for the rest of
the person’s life.
Benign prostatic hypertrophy
a disorder that occurs in men as they age, in which the
prostate becomes enlarged and causes pressure on the
urethra, leading to frequent urination, dribbling of urine,
difficulty in starting the flow of urine, and urinary retention.
18
Common Chronic and Acute Conditions
Define the following terms:
Vaginitis
an infection of the vagina that may be caused by a bacteria,
protozoa (one-celled animals), or fungus (yeast).
Douche
putting a solution into the vagina in order to cleanse the
vagina, introduce medication to treat an infection or
condition, or to relieve discomfort.
18
Common Chronic and Acute Conditions
7. Describe common diseases and disorders of the reproductive
system
Remember these points about STDs/STIs:
• Diseases are passed through sexual contact, which includes
intercourse, contact of the mouth with the genitals or anus,
and contact of hands to the genitals.
• Person may be infected, and potentially infect others, without
showing signs of illness. This is called sexually transmitted
infection (STI).
• Latex condoms can reduce the chances of STDs/STIs.
• STDs/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
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
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
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
Herpes simplex 2
• Caused by a virus
• Treatment: antiviral drugs, but 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
NOTE:
The following slides deal with disorders of the reproductive
system - the disorders described are not STDs.
18
Common Chronic and Acute Conditions
7. Describe common diseases and disorders of the reproductive
system
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
• Men are also 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
Vaginitis
• Causes: bacteria, protozoa, fungus, or hormonal changes
after menopause
• Symptoms: white vaginal discharge, itching, burning
• Treatment: oral medications, vaginal gels or creams
18
Common Chronic and Acute Conditions
7. Describe common diseases and disorders of the reproductive
system
Depending on state and/or facility rules, NAs may assist with or
give a douche to a female resident. Remember the following
guidelines:
• Provide plenty of privacy.
• Wear gloves.
• Resident will be placed in dorsal recumbent position.
• Inspect nozzle or tip of douche for breaks, cracks, or rough
edges to prevent injury. Notify nurse if you observe any
problems.
18
Common Chronic and Acute Conditions
7. Describe common diseases and disorders of the reproductive
system
Guidelines for douche (cont’d.):
• Clean the container, tubing and nozzle before use. Reusable
equipment should be washed in hot, soapy water after use.
• Follow care plan’s instructions carefully.
• If using commercial douche, follow manufacturer’s
instructions carefully.
• Allow some of the solution to run through the tubing to
remove air before tubing is inserted.
18
Common Chronic and Acute Conditions
7. Describe common diseases and disorders of the reproductive
system
Guidelines for douche (cont’d.):
• Do not force nozzle into vagina if you meet resistance. Notify
nurse if this occurs.
• Same amount of solution should return as was put into the
vagina, and it should be the same color—clear with a mild
odor.
• Report any of the following to the nurse:
• Fatigue
• Pain
• Anything unusual about returned solution (amount, color,
odor, presence of mucus or particles)
18
Common Chronic and Acute Conditions
Define the following terms:
Acquired immune deficiency syndrome (AIDS)
disease caused by the human immunodeficiency virus (HIV)
in which the body’s immune system is weakened and unable
to fight infection.
AIDS dementia complex
memory loss, poor coordination, paralysis, and confusion
caused by damage to the central nervous system in the late
stages of AIDS
Kaposi’s sarcoma
a rare form of skin cancer that appears as purple or red skin
lesions.
18
Common Chronic and Acute Conditions
Define the following terms:
Opportunistic infections
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.
Tumor
a group of abnormally growing cells.
18
Common Chronic and Acute Conditions
Define the following terms:
Benign tumors
tumors that are considered non-cancerous.
Malignant tumors
tumors that are considered to be 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
HIV/AIDS
• Acquired immunodeficiency virus is caused by HIV (human
immunodeficiency virus).
• HIV attacks the immune system and disables it.
• HIV is transmitted by sexual contact, blood, infected needles,
or from mother to fetus.
• Symptoms at transmission are like flu.
• Later symptoms include infections, tumors, and central
nervous system symptoms.
• Late stage can involve AIDS dementia complex.
18
Common Chronic and Acute Conditions
8. Describe common diseases and disorders of the immune and
lymphatic systems
Signs and symptoms of HIV/AIDS include the following:
• Appetite loss
• Involuntary weight loss
• Flu-like symptoms
• 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
• Low resistance to infection
• Bruising that does not go away
• Kaposi’s sarcoma
• 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. They worsen
AIDS. Treatment is medication. Drugs slow the progress, but
there is no cure for the disease.
18
Common Chronic and Acute Conditions
8. Describe common diseases and disorders of the immune and
lymphatic systems
These are high-risk behaviors for HIV/AIDS:
• Sharing drug needles
• Having unprotected sex
• Having many sexual 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
Ways to protect against the spread of HIV and AIDS include
• Never share needles.
• Practice safer sex.
• Stay in a monogamous relationship.
• Practice abstinence.
• Get tested.
• Follow Standard Precautions with all residents.
18
Common Chronic and Acute Conditions
8. Describe common diseases and disorders of the immune and
lymphatic systems
REMEMBER:
A myth is a false story or idea that many people think is true.
There are many myths about HIV and AIDS. Handout 18-1
outlines myths and facts.
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 appetite. 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 “BRAT” diet
(bananas, rice, apples, toast). This is helpful short-term.
• 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. 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 in ADLs.
18
Common Chronic and Acute Conditions
8. Describe common diseases and disorders of the immune and
lymphatic systems
REMEMBER:
• AIDS brings tremendous emotional stress in addition to the
physical symptoms. Be sensitive to residents’ emotional
needs.
• HIV/AIDS status is confidential and cannot be discussed with
anyone.
• In home care for a client with HIV/AIDS it is very important 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
Cancer
• General term meaning many types of malignant tumors.
• 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, 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
Risk factors for cancer include the following:
• Tobacco use
• Exposure to sunlight
• Excessive alcohol consumption
• Exposure to some chemicals and industrial agents
• Some food additives
• Radiation
• Poor nutrition
• Lack of physical activity
18
Common Chronic and Acute Conditions
8. Describe common diseases and disorders of the immune and
lymphatic systems
The following are warning signs of cancer as identified by the
American Cancer Society:
• 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 as identified by the American Cancer
Society (cont’d.):
• Sores that do not heal
• Unusual bleeding or discharge
• Thickening or lump in breast or other part of body
• Indigestion or difficulty swallowing
• Recent change in wart or mole
• Nagging cough or hoarseness
18
Common Chronic and Acute Conditions
8. Describe common diseases and disorders of the immune and
lymphatic systems
There are three 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. Have 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.
• Use lotion on dry skin. Do not remove markings. Give back
rubs.
• Reposition residents.
• Assist with oral care often. Use a soft-bristled toothbrush
and baking soda rinse.
• Provide help with grooming.
• Encourage visitors. Suggest good times of the day for
visits. Get to know residents’ interests.
• Be alert to needs not being met or stresses.
18
Common Chronic and Acute Conditions
8. Describe common diseases and disorders of the immune and
lymphatic systems
Remember these signs and symptoms to report about cancer:
• Increased weakness or fatigue
• Weight loss
• Nausea, vomiting, diarrhea
• Changes in appetite
• Fainting
• Signs of depression (will be covered in Chapter 20)
18
Common Chronic and Acute Conditions
8. Describe common diseases and disorders of the immune and
lymphatic systems
Signs and symptoms to report about 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
18
Common Chronic and Acute Conditions
8. Describe common diseases and disorders of the immune and
lymphatic systems
NOTE:
Special arm exercises or deep breathing exercises may be
ordered for residents who have had a mastectomy. Follow the
care plan and the nurse’s instructions.
18
Common Chronic and Acute Conditions
9. Identify community resources for residents who are ill
There are many services and support groups for people who are
ill and for their families or caregivers, including the following:
• American Cancer Society (cancer.org)
• National Association of Area Agencies on Aging (n4a.org)
provides Eldercare Locator.
• Many organizations assist those dealing with HIV/AIDS.
• Look in phone book or on the Internet for other resources.
• Speak with a nurse if you feel a resident needs more help.