Nursing Assistant

Long Term Care Resident

Basic Human Needs &

Interventions

Environmental/Physical
Safety

More light for better vision

Freedom from hazards
Support & adaptive devices
Good personal hygiene

Shelter
Appropriate living situation
Environmental control (heat/air-conditioning)

Nourishment
Balanced diet
Adequate fluids

Psychological Needs
Maintain

self-esteem

Respectful treatment
Recognition of individual differences
Adjustment

to role change & loss of

independence
Respect privacy
Give choices
Encourage activities

Social needs

Social interactions
Encourage family involvement
Encourage social/community activities

Adjustment to losses
Encourage verbalization/reminiscing
Encourage new social contacts
Death of spouse/friends

Financial
Changes in income
Refer to social service

Recreational Needs
Diversion

Encourage hobbies
Involve in facility/community events
Encourage family involvement
Self-esteem

Encourage involvement
Give compliments
Reinforce positive traits or abilities

Spiritual Needs
Provide

respect for individual choices

Provide opportunities to participate in
religious activities

Community Resources

AAA- Area Agency on Aging

Adult Day Care Center
Support groups

American Diabetes Association

Braille Institute or Blind Center
Alzheimers Society
Parkinsons Support
Multiple Sclerosis Support
Muscular Dystrophy
Hospice/Bereavement

County Health Center

More Community Resources

Hospitals & Hospice

IRS information
Long Term Care ombudsman
Meals on Wheels
Medicare & Social Security Office
Mental Health Dept
National Alliance for the Mentally ill
American Disability Act
Adult Protective Services
Red Cross/Blood Pressure Clinic

AND more resources

Senior

Centers & housing

Suicide prevention
Home health Agencies
Voter registration
AARP
Fraternal & social organizations
Churches & religious organizations

Organic Brain Syndrome

Also called dementia

Any disorder of the brain causing deficits in thinking, memory, or
judgment

Causes
Alzheimers disease causes plaques & tangles in the brains
nervous system. Brain decreases in size as cells are lost.
Incurable. Progressive
Multi-infarction dementia
Parkinsons disease
Syphilis
AIDS
Nutrition & medication problems
Depression & metabolic disorders

Schizophrenia

Mental disorder characterized by paranoia,

hallucinations, delusions, bizarre behavior, distortions of
reality
NA duties & responsibilities
Notify nurse if behavior worsens or endangers
Do not feed in to delusions, but do not try to convince them
of reality
Be aware of suicide precautions
Keep resident involved in reality activities
Report/document responses to meds & therapy
Monitor nutrition & fluid often wary of poison
Find ways to reduce fear & anxiety

Hypochondriasis
Resident

imagines or magnifies each

physical ailment
NA duties
Be supportive, may stem from depression
Do not overlook real illness
Report ALL complaints
Do not judge

Depression
Most

common functional disorder in the

elderly
Signs & symptoms
Feeling sadness
Lack of interest in & withdrawal from
environment
Feelings of worthlessness
Negative outlook on the future

NA duties for depression

Notify nurse for loss of appetite, weight loss,

severe fatigue, crying, sleeplessness
Notify nurse for statements I wish I could die
Remain non-judgmental
Listen with empathy
Encourage activities with others
Encourage aerobic activity & outdoor activity
(releases endorphins)

Suicidal Resident

Elderly are at risk, especially white males over

65 who live alone and the very old (>75)
NA duties

Report clues of attempts to nurse

Give constant care
Monitor activities
Work to preserve self-esteem
Help resident find support network, friends, clergy,
family, support groups
Never ignore a statement or threat about suicide

Developmentally Disabled

Significantly sub-average intellectual function

& low adaptive ability
NA duties

Provide a normal environment

Emphasize individual strengths
Encourage independence & self-care
Treat with dignity at age appropriate level
Respect privacy
Provide safe, structured environment

Cerebral palsy

Group of disorders characterized by motor

dysfunctions
NA duties

Provide safe, structured environment

Apply appropriate assistive devices
Emphasize individual strengths
Encourage independence
Treat with dignity
Respect privacy

Alcoholism/Drug Abuse
Occurs when healthy coping mechanisms have
failed
15% of elderly suffer from this
Often triggered by

Retirement
Loss of self-esteem
Loneliness
Chronic pain
Decline in health
Stress

NA duties for alcoholism

Report any sign of resident being under the influence

Be sure alcohol/drugs are not available
Watch for mental impairment, loss of coordination, poor
judgment
Be careful when feeding, gag reflex may be impaired
Support groups AA
Notify nurse if signs of withdrawal
Alcohol shaking, tremors, agitation, seizures
Drugs- runny nose, depression, HA, pacing, poor coping
mechanisms, agitation

Follow care plan

Be aware of dangerous behavior

Agitated Resident

Use of inappropriate verbal, vocal, or motor activity

due to causes other than disorientation or real need
NA duties
Report aimless wandering, pacing, cursing, screaming,
spitting, biting, fighting, arguing, demanding, talking to self
Maintain quiet, calm environment
Encourage distracting activities
Check for constipation or other sources of pain
Loss of control increases agitation
Avoid restraints

Agitation continued

Allow resident to walk or rock in chair to

diffuse energy
Make sure you stay safe maintain area to
escape (way to the door)
Listen with empathy
Call for help if resident becomes violent
Do not attempt to control resident if they
become violent
Redirect

Bodys basic organization

Cell
Basic unit for structure, building block
Function, size, shape of cells differ
Need food, water, oxygen to survive

Tissues
Groups of cells with similar functions

Epithelial protective
Connective support & connect
Muscle shorten & lengthen
Nerve carry electrical messages

Organs
Made of different tissues & perform special functions

Integumentary System

Function

Protective barrier against microorganisms & infection

Provides sensory function pain, temp
Shields body from injury
Temp regulation heat & cold
Eliminates waste
Produces Vitamin D
Helps maintain fluid balance by preventing fluid loss &
perspiration
Largest organ of body

Epidermis top layer

Primarily

dry, dead cells that shed

continuously
Thin layer
No blood supply
Barrier to water loss
Prevents infection

Dermis middle layer

Varies in thickness in different areas of body

Naturally very moist
Gives skin strength
Contains blood vessels, lymph vessels, nerve
ending, oil glands, hair follicles
Function aid in body temp control & is the
origin of sense of touch, pressure, & pain

Subcutaneous deepest layer

Fatty

tissue, muscle, & bone

Do not tolerate lack of oxygen cell
death results easily

Skin Lesions/Wounds
Change

in skin structure caused by

injury, trauma, aging, or disease
Signs & Symptoms
Rash
Raised spots filled with pus or blood
Irregular reddened areas that itch (Pruritis)
Dry crusts, scabs
Break in skin integrity

NA duties for skin lesions

Observe & report abnormalities

Observe drainage on dressings
Tepid water when bathing
Gloves
Do not remove crusts
Notify nurse if skin lesions drain, drainage
changes, dressing needs changing, wound
has redness, red streaks, heat, pus, drainage

Pressure Sores (Decubiti)

Break in skin integrity that develops over a bony prominence
as a result of pressure
Stage One

Reversible, red area that does not go away after 30 minutes (may
look blue or black)

Stage Two
Reddened skin with abrasions, blisters, or shallow crater. Can
involve dermis & epidermis

Stage Three
All layers of skin destroyed, deep crater forms

Stage Four
Ulcer extends through skin & subq tissue. Bone, muscle, &
structures may be involved

NA duties for decubiti

Change position at least q 2 hours

Teach resident to shift position every 10 minutes
when sitting
Proper nutrition & hydration
Immediate removal of feces or urine
Inspect skin whenever personal care is given, esp
over bony prominences
Avoid hot water & friction
Lotion is your friend
Separate body areas to avoid rubbing

NA duties cont

Mechanical aids

Sheepskin
Alternation- pressure mattress
Pillows
Gel & air cushions
Heel protectors

Use draw sheet to move residents

Elevate HOB no more than 30 degrees
Check braces & restraints for fit
Check tubing for rubbing
Report changes to nurse
PREVENTION better than cure

Pediculosis, Lice, Scabies

Tiny

parasites living in body

Signs & Symptoms
Intense itching
Pediculosis areas of hair growth
Scabies follows blood vessels, seen in webs
of fingers, inside wrists & elbows, underarms,
waist & nipple areas

Rash

NA duties for parasites

Avoid

direct contact, wear gloves

Report any signs of disorder
Thorough washing of linen
Medicated shampoo & lotion

Normal changes of
integumentary system
Skin

becomes thin, fragile, dry, wrinkled

Blood supply to fingers & toes
decreases
Less sensitive to hot & cold
Hair loses color
Nails thicken
Bruises easily due to fragile blood
vessels

Respiratory System

Lifeline of the body

Brings oxygen into the body & eliminates
carbon dioxide from body
Organs

Nose
Trachea
Bronchi
Lungs
alveoli

Respiratory Diseases

URI upper respiratory infection

Signs & Symptoms

Fever
Runny nose & eyes
Cough
Sore throat

NA duties
Encourage rest & fluids
Dispose of tissues promptly to avoid spread
Report fever, dyspnea, change in rate or rhythm of resp, change in
mucus color from clear to green, yellow, or blood-tinged
Pallor, cyanosis
Signs that infection is moving to chest or lungs

Pneumonia

Infection/inflammation of lungs, often seen in

residents with poor immune
Signs & symptoms

Same as URI, only more severe

Chest pressure & discomfort
Extreme fatigue/weakness
cough

NA duties
As with URI
Monitor VS carefully, esp temp & resp
Orthopneic position as needed

COPD
Results

in chronic obstruction of the

resp system, irreversible
Signs & symptoms
Asthma breathing disorder caused by
reaction to allergen

Wheezing
Tight airways
Mucus blocks pathways
Labored breathing
Frequent cough

COPD cont
Chronic

bronchitis prolonged
inflammation in the bronchi due to
infection or irritants
Persistent cough
Sputum production, esp in a.m.
Respiratory distress

COPD cont

Emphysema occurs when air flow is

obstructed at alveolar level

Can bring oxygen in, but cant expel CO2

Triggered by pollutants, smoke, cold
Freq lung infections
Extreme dyspnea
Loss of appetite/weight loss
Irritability
Air hunger

NA duties with Resp diseases

Teach pursued lip breathing increases CO2

expiration
Calm resident prn
Orthopneic position
Oxygen therapy
Nutrient dense foods, freq snacks, not meals
Encourage fluids
Pace activities
Avoid raising arms over head

Tuberculosis

Occurs when microorganism enters body &

the inactive tubercle breaks down, bacteria
multiply & spread
Signs & Symptoms

Fatigue
Night sweats
Hemoptysis
Coughing
Fever
Loss of appetite & weight

Tuberculosis cont
NA duties

& observations

Annual PPD
Use of barriers if productive cough
Discard tissues & sputum promptly

Related subjects

Tracheostomy
Esophageal speech & electronic speech
SARS
Malignancies
Aging changes
Lung capacity decreases due to increased rigidity
in lungs
Coughing less effective
Gas exchange in lungs less effective

Cardiovascular System
Transportation

system that delivers

nutrition & oxygen to the cells & takes
away waste products
Closed system is kept in motion by the
force of the heart
Anatomy
Heart
Blood vessels arteries, veins, capillaries

Myocardial Infarction

Period in which heart cannot function properly

due to lack of blood supply to the cells of the
heart
Signs & symptoms

Crushing chest pain

Diaphoresis
Pallor/cyanosis
SOB
Radiating pain to arm, jaw, back
Loss of consciousness
N&V
Restless, anxious, feeling of impending doom

NA duties with MI
Remain

with resident
Notify LVN if signs & symptoms
Monitor VS
Prepare to transfer to acute care facility

CHF

Heart does not pump well enough to meet the

bodys needs
Signs & Symptoms

Hemoptysis
Cough
Dyspnea & orthopnea
Fatigue, confusion, cyanosis
Edema in extremities
Moist respirations
HTN
Irregular heartbeat

NA role in CHF

Low sodium diet

Position in orthopneic position
Fluid restriction
TED hose
Assist with ADLS
O2 therapy
BSC as needed
I & O, check VS
Pace activities

Anemia

Condition resulting from a decrease in the

quantity or quality of RBCs
Signs & Symptoms

Lethargy
Pale or jaundiced
Dyspnea
Digestive problems
Rapid pulse, increased resp rate
Cold
Dizzy

NA duties with anemia

Provide

nutritious meals increase iron

containing foods meat, green leafy
veggies
Notify nurse for bleeding or black stool
Monitor VS

HTN high blood pressure

Signs

& symptoms

Blood pressure >140/90

Nosebleed
Red complexion
HA
Blurred vision

NA duties & observations

Monitor

BP
Assist with stress management
techniques
Low sodium diet
Assist with weight loss efforts
Encourage regular exercise
Notify nurse for signs & symptoms

Related subjects

Pacemakers
Angina
Varicose veins
Atherosclerosis
Internal defib
Aging changes

Heart rate slows less efficient circulation

Vessels lose elasticity
Longer recovery to normal pulse after exercise
Heart is less effective pump

Musculoskeletal System
Forms

framework that supports body &

allows for movement
Anatomy
Bones
Joints
muscle

Arthritis

Inflammation of joints
Rheumatoid
Joint tissue lining affected

Osteoarthritis
Cartilage covering ends of bones deteriorates &
ends of bones rub together

Gout
Metabolic disease caused by deposits of crystal at
joint

Arthritis

Signs & symptoms

Pain & deformity at joint
Swelling & tenderness
Heat at inflamed site

NA duties

Notify nurse if discomfort

Balance rest & exercise
ROM when no pain/inflammation
Rest joint if pain/inflammation
Prevent contractures

Fractures

Signs & symptoms

Pain, swelling, bruising at site

Exposed bone through skin compound
Immobility of area affected
deformity

NA duties

Keep area immobilized case, splint

Report pain
Decrease edema elevate area
Maintain alignment
Cast care no breaks, chips. Check distal pulses, CMS distal to
cast
Report signs of infection

Osteoporosis

Caused by bone loss and results in porous,

spongy bones that fx easily. Most common in
elderly females
Signs & Sx
Fracture from very little or no trauma often in hip
or low back
Curvature of spine
Loss of height
Progressive weakness

NA duties for osteoporosis

Prevent further fractures

Report pain
Gentle ROM
Apply splints or braces as ordered
High calcium meals milk, dairy, green leafy
veggies
Mechanical lift for transfers
Gentle handling & positioning

Hip fracture
Fx

of femur commonly caused by falls

or osteoporosis
Signs & sx
Cant get up after fall
Elevated side is shortened & externally
rotated
Severe pain in hip or knee
Edema in hip, thigh, groin

NA duties for hip fx

Pre-op
Avoid moving pt unless instructed by nurse
Use sheet or back board to move

Post-op

Do not flex hip > 90 degrees

Do not cross affected leg over midline of body
Do not internally rotate hip on affected side
Do not do passive ROM on affected side
No weight bearing for several weeks
Use fracture bedpan
Maintain proper hip alignment trochanter rolls, abduction
pillows

Related subjects

Fibromyalgia, traction, CPM machine, back

injuries, amputation, Lyme disease
Aging changes of M/s system

Loss of elasticity in muscles

Bones lose minerals, become brittle & easily broken
Less flexible
Posture becomes slumped
Degenerative changes in joints
Loss of height
Decreased reflexes, prone to injury & falls

Endocrine System

Network of glands secreting hormones

directly into bloodstream
Organs & glands
Pituitary master gland
Thyroid controls metabolism
Pancreas- secretes insulin to promote glucose use
by cells
Adrenals secretes adrenalin (flight or fight)

Diabetes Mellitus
Chronic

disease resulting from insulin

deficiency or insulin resistance. Body is
unable to properly process food &
convert food into energy
Type 1 insulin dependent
Type 2 non-insulin dependent

Signs & Symptoms of diabetes

Polyuria excessive urination

Polydipsia excessive thirst
Polyphagia excessive hunger
Fatigue
Skin infections that are slow to heal
Itching
Burning on urination
Vision changes

More signs & symptoms

Hyperglycemia
Develops slowly over 24 hours
Confusion, drowsiness, slow slippage into coma

Headache
Sweet fruity odor to breath
Deep breathing
Low blood pressure
N&V
Flushed, dry, hot skin
Unconsciousness
Sugar in urine & high sugar in blood

Hypoglycemia
Occurs when blood glucose in below normal
Most common from insulin OD
Symptoms occur rapidly

Hunger, weakness, dizziness, shakiness

Moist & clammy
Rapid, shallow respirations
Nervous & excited
Rapid pulse
Unconscious
No sugar in urine & low sugar in blood

NA duties with
hypo/hyperglycemia

Know signs & symptoms & notify nurse if present

Offer meals & snacks at regular intervals &
report uneaten portions
Illness, stress, & infection cause unregulated
blood sugar
Check extremities for infection, trauma, wounds
Notify nurse if vomiting after meals
Offer easily digested CHO if signs of
hypoglycemia after notifying nurse

More NA duties

Make sure right diet is given

Urine testing for sugar & acetone
Foot care

Wash feet daily, dry between toes

Inspect feet for signs of irritation
Toenails to be cut by nurse or podiatrist ONLY
Shoes & stockings worn at all times when out of bed (no
barefoot)
Check for anything impairing circulation
Diet, exercise, medication are most important
components of diabetic treatment

Related subejcts
Hypo

& hyperthyroidistm
Cushing & Addisons disease
Glucose monitoring
Aging changes in endocrine system
Decrease in sex hormones
Body less able to handle sugar
Metabolism & body functions slow

Nervous System

Controls, directs, & coordinates functions of

body
2 division CNS, PNS
Anatomy

Brain
Spinal cord
Peripheral Nerves
Sensory organs eye, nose, tongue, skin, ears

Dementia

Any disorder of brain causing deficit in thinking,

memory, & judgment
Signs & Symptoms
Mild dementia Stage One

Short term memory loss

Personality changes
Disorientation to time
Poor judgment
Lack of safety awareness
Careless in appearance
Anxious, depressed
Delusions of persecution

Stage 2 moderate dementia

Increased short term memory loss

Complete disorientation
Wandering & pacing
Sundowning
Preservation phenomena
Motor skills deteriorate
Speech, reading, writing deteriorates
Incontinent of bowel & bladder
Catastrophic episode

Stage three severe dementia

Totally

dependent
Verbally unresponsive
May have seizures

NA duties for dementia

Protect resident from injury

Be compassionate, calm, patient, maintain sense
of humor
Encourage independence as long as possible
Provide mental & physical activities within
residents capabilities
Provide structured quiet environment that is
uncluttered
Use appropriate body language resident reads
staff behavior & reflects mood

More NA duties

Give one short, simple direction at a time

Observe for signs of physical illness resident may be
unaware
Assist with grooming & dressing
Monitor food & fluid intake

Do not use plastic utensils

Provide nutritious finger foods when resident unable to use utensils
Be aware of swallowing difficulties
Prepare food & encourage resident to self feed as long as possible
Check food temps
Check residents mouth for squirreling
Weigh residents to detect gain or loss

More NA duties

Use touch appropriately surprising resident can

result in catastrophe
Avoid using logic, reasoning, or lengthy
explanations
When ability to speak is lost, watch non-verbal
Biting, scratching, kicking show displeasure
Facial expressions & body language show mood
Observe for triggers of agitation or anger & avoid

Use distration & diversion when resident is agitated,

take hand & calmly walk to another activity

More NA duties
Realize

people with dementia are not

responsible for what they say
They cannot change
They are not aware of what they are doing
They have poor impulse control
Allow them to save face by preserving
their dignity
No one really knows what is happening in
the minds of people with dementia

More NA duties

Be aware of wandering & pacing

Record patterns
Triggers can include

Noise keep quiet avoid crowds

Boredom give activities
Unmet physical needs evaluate
Stress- create calm environment
Pain evaluate for discomfort
Hunger offer freq snacks
Thirst encourage fluids
Need to toilet- take to restroom every 2 hours
Looking for companionship, security, or loved one therapeutic touch, talk,
consistency
Physical restraints feel threatened
Looking for a state of mind, not location

More NA duties

If they are in area they shouldnt be, calmly take

by hand & redirect
Avoid large numbers of staff approaching resident
Use positive directions stay inside instead of
dont go outside
Use gentle persuasion
Compliment positive behaviors &
accomplishments
Encourage rocking chairs to diffuse energy

More NA duties

Be aware of sundowning & prevent

Avoid over-fatigue
Encourage resident to stay awake in day
Evening meal should be at least 2 hours before bedtime
Eliminate caffeine
Evening activities should be calm & quiet
Soft music is calming
Give massage/back rub
Light bedtime snack
Follow bedtime routine
Check lighting shadows & reflections can be scary

More NA duties
Discourage

pillaging & hoarding

Label all residents belongings

Check room daily for stale food
Keep residents hands busy
Provide a rummaging drawer or box for
resident

More NA duties

Use reality orientation to regain connection to

environment

Especially affective in Stage One

Use clock & calendar at bedside
Call by name
Answer questions honestly, but do not give information they
are unable to handle (asks about deceased husband)
Do not argue with residents reality
Use bulleting boards decorated for season
Keep curtains open during day
Make sure they wear glasses/hearing aids
Do not expect resident to remember you

More NA duties

Use reminiscing therapy

Encourage sharing memories of past
Use prompting questions to show interest in their
history
Use active listening skills
Reminiscing serves as life review & may validate
self-worth
Acknowledge validity of feelings & emotions
Reminiscing helps people adapt by working
through personal loss

More NA duties

Incorporate validation therapy

A way for residents to work through issues that were
unresolved
Have pictures or reminders of past in room
Realize there is a reason for all behavior
Living must be resolve in order to prepare for dying
To live in reality is not the only way to live
Disoriented people have worth still experience joy,
pleasure, & ability to appreciate kindness
Remember every person was a child, teenager, adult, just
like you

Incorporate music & animal therapy

CVA

Complete or partial loss of blood supply to cells

of brain
Signs & Symptoms

Loss of sensation
Paralysis/hemiplegia
Aphasia
Dysphagia
Emotional liability
Loss of consciousness/confusion
Cognitive impairments

NA duties for CVA

Report changes in level of motor activity,

consciousness, or HA
Prevent complications of immobility
Begin restorative care assist with ADLs,
encourage self care
Be supportive emotionally PATIENCE
Explore alternative methods of communication if
unable to speak
Be aware of swallowing/choking when feeding
Incorporate reality orientaiton

TIA Transient Ischemic Attack

Mini

stroke

caused by lack of oxygen to brain cells

Signs & symptoms are temporary
Signs subside when circulation is improved

Parkinsons Disease

Signs & Symptoms

Tremors & pillrolling

Muscle rigidity
Difficulty & slowness in carrying out voluntary motor activities
Shuffling walking
Slurred speech
Loss of expressiveness in face
Drooling
Incontinence
Constipation & urinary retention
Mood swings & depression

NA duties for Parkinsons

Maintain

calm environment symptoms

worsen with stress
Assist in ADLs
Provide emotional support
Exercises for restorative care
Dementia care

Seizure disorder

Recurrent, transient attacks of disturbed brain

function
Signs & symptoms Generalized seizure

aura or taste before seizure activity

Jerking & twitching of body
Entire body involved
Person may lose consciousness
Incontinence
May be followed by period of fatigue, confusion,
disorientation

Signs & Symptoms Partial

seizure
Momentary

loss of muscle tone

May have periods of unconsciousness
May chew, blink, or breathe rapidly
Lasts 2 10 seconds
absence seizures in children
Only one extremity or part of extremity
may be involved

Signs & Symptoms status

epilepticus
Lasts

long period
Serious medical emergency
Life threatening
Death may result

NA duties during seizure

During seizure

Stay with person, call for help

Assist to lay down
do not restrain or put anything in mouth
Move away objects that may hurt person
Maintain airway by loosening clothing, turn head
so saliva/emesis drains out, lift shoulder & allow
head to tilt back
Watch & observe so you can report type of seizure

NA duties after seizure

Allow

to sleep
Clean if incontinence has occurred
Check VS

Vision impairments
Cataracts

normally clear lens

becomes cloudy
Signs & Symptoms
Cloudy lens over eye
Leading cause of vision loss in adults over age
55

Follow post-op protocol if surgery has been

performed

Glaucoma

Increased pressure within eye

Signs & symptoms

Eye pain
Difficulty adjusting to darkness
Unable to see color
May see halos
HA
Fatigue
Blurred vision

NA duties with vision

impairments

Announce yourself by name when entering room

Encourage tv or radio listening
Be extra careful in explaining what you are
doing
Describe food placement like hands of clock
Do not disrupt environment, keep ADL supplies
in same place
Do not move furniture unless necessary
Encourage independence

Hearing impairments

Otosclerosis progressive form of deafness,

unknown cause
Related subjects West Nile Virus,
autonomic dysreflexia, Mad Cow Disease
Nervous system complications of immobility
Weakness, limited mobility
Insomnia from sleeping during day

Nervous System Aging changes

Slowing nerve transmission results in delayed

reaction time, poor coordination, & balance
Less effective temp regulation
Decreased sensitivity to pressure & temp
changes
Decreased blood flow to brain results in
memory loss & confusion
Deep sleep is shortened, need naps

Gastrointestinal System

Responsible for breaking food into simpler

substances that can then be used by body cells for
nutrition
Organs

Mouth, teeth, tongue

Esophagus
Stomach
Small intestine
Large intestine
Liver & gall bladder
pancrease

Malignancies of GI system

Cancerous growths in GI tract that can cause

obstruction & may result in surgery &/or ostomy
Signs & symptoms

Vomiting
Extreme abd discomfort
Indigestion
Constipation
Blood in stool
Flatus
No bowel movement at all

NA duties for malignancy

Monitor BM & report discomfort

Care of ostomy artificial opening in abd wall for elimination
of solid waste & flatus

Standard precautions
Remove appliance gently to prevent skin irritation
Empty bag & wash if reusable with soap & water
Secure clamp at base
Discard disposable bag in biohazardous waste bag & replace
Observe stoma for redness, irritation, & skin breakdown
Wipe area around stoma gently, wash with soap & water
Apply creams, fit opening of appliance to stoma
Seal well to prevent leakage
Observe color, character, amt, freq of stools

Constipation

Abd or rectal pain

Inability to pass stool
Loss of appetite
Feel urge to defecate but unable to
Bloating/abd distension
Liquid stool or mucus seeping from rectum
Hard, dry stool
Caused by decreased fluids, diet, inactivity,
meds, or ignoring urge to defecate

Fecal impaction
Stool

unable to pass from rectum

Results from unrelieved constipation

Diarrhea
Liquid

or unformed stool with increased

frequency
Feces moves rapidly through the
intestines
Caused by infection, meds, irritating
foods

Anal incontinence
Inability

to control passage of feces &

gas
possible cause due to injury or
diseases of nervous system or sphincer
damage
May result when residents do not
receive the assistance they need in a
timely manner

Flatulence
Excessive

formation of gas in stomach

& intestines
Caused by foods, meds, or air
swallowing

NA duties with GI difficulties

Monitor & record BM, notify nurse with problems

Encourage high fiber diet if constipation
FF
Encourage exercise to stimulate BM
Prompt attention to call light
Monitor skin integrity
Prompt attention to incontinence care
NEVER perform digital removal of an impaction

Related subjects
Gall

bladder disease
Hernias
Ulcerations
Bowel training
Enemas
Rectal tube
Hemorrhoids

GI system aging changes

Decreased saliva production causing dysphagia

Taste buds not as sensitive
Decreased gag reflex leads to change of choking
Slowed peristalsis leads to indigestion &
constipation
Decreased ability to absorb nutrients
Meds related to side effects
Sensitivity to sensation of full bowel
Urgency is exaggerated with bowel

Urinary System
Filters

flood & produces urine in which

excess fluids & toxins are excreted
1000 1500 cc of urine /day
Characteristics of normal urine
Clear
Amber
Mild odor

Anatomy of urinary system

Kidneys

filter blood, produce urine

Ureter tube from kidneys to bladder
Bladder storage for urine
Urethra tube from bladder to outside

Cystitis

Signs & Symptoms

Dysuria, burning
Frequent urination
Cloudy urine
Hematuria
Bladder spasm
Loss of appetite
Fever
Confused resident may become agitated

NA duties for cystitis

Encourage

fluids
Observe urine
Siz bath
Perineal care
Always wipe front to back
Rest

Urinary incontinence

Signs
Unable to control urination
Stress incontinence

NA duties

Bladder training
Toilet regularly
Answer call light promptly
Be positive when changing, not critical
Perineal care
Avoid liquids after dinner

Urinary System Aging Changes

Kidneys decrease in size & are less efficient

Bladder loses tone, leading to retention & infection
Decreased bladder capacity leads to nocturia
Kidney function increases at rest, causing urination at
night
Prostate enlargement in men causes frequency,
dribbling, & urinary retention
Elderly may exhibit behavior changes with usual UTI
signs
Decreased sensitivity to sensation of full bladder
Urgency exaggerated with bladder

Reproductive system
Produces

hormones & responsible for

reproduction
Anatomy
Male penis, testes, prostate
Female ovaries, fallopian tubes, uterus,
vagina, vulva

Common diseases of
reproductive system

Male
Enlarged prostate gland urethra passes through
prostate, as it enlarges, it strangles urethra, causing
difficulty in starting stream & emptying bladder
CA of prostate or testes

Female
Cystocele weakening of muscles between bladder
& vagina
Urinary incontinence
Frequent UTI

Female disorders

Rectocele weakened muscles between

rectum & vagina
Hemorrhoids
Constipation

Prolapsed uterus
Malignancies breast, ovarian, uterine, cervical
NA duties
Supportive care
Notify nurse if distress

STD

HIV viral infection

Signs & symptoms

Flu-like
Fever
Night sweats
Fatigue
Swollen lymph nodes
Sore throat
GI upset
HA
Kaposkis sarcoma
Pneumocystis carinii pneumonia

NA duties for HIV

Be

aware virus if killed by 10:1 water to

bleach solution, solution good for 3
days
Prevent secondary infections
Report new symptoms & discomfort to
nurse
Provide comfort measures

Aging changes

Male
Scrotum less firm
Increase in size of prostate gland
Hormone production decreases

Female

Fewer hormones produced

Ovulation & menstrual cycle cease
Vagina becomes thinner, drier
Breast tissue decreases & muscles supporting
breasts weaken

Immune System
Protects

body against disease

Special cells
WBC
Antibodies
Antigens
T cells destroy invading cells
When

body sense an antigen, immune

system is activated

AIDS
Caused

by HIV
Spread through body fluids
Blood
Semen
Vaginal secretions
Breast milk
Affects

bodys ability to fight other

viruses and bacteria

S & S of AIDS

Loss of appetite
Weight loss
Fever & night sweats
Diarrhea
Painful or difficult swallowing
Extreme & constant fatigue
Skin rashes
Swollen lymph nodes
Cough
Sores or white patches in mouth or on tongue
Purple blotches or bumps on skin
Confusion & forgetfulness
dementia

NA duties with AIDS

Standard precautions & blood borne pathogen standard

Daily hygiene avoid harsh soaps
Oral hygiene before meals & at bedtime, toothbrush with
soft bristles
I & O, encourage fluids
Daily weight
Encourage deep breathing
Prevent pressure sores
Assist with ROM & ambulation
Encourage self care, may need assistive devices

NA duties with AIDS

Change

linen, gown as often as needed

when fever present
Be good listener & provide support
Considerations
AIDS often missed because aging masks
S&S of AIDS
May take 10 15 years to develop AIDS