BAY AREA COLLEGE OF NURSING

Module 13: Long-Term Care Resident

I. Terminology Alzheimers Angina Anterior (front) Aphasia Arteries Atrophy Blood C.H.F. C.V.A. (stroke) Capillaries Cardiovascular System Cerebral Palsy Colostomy Confusion COPD Delusions Dementia Digestion Dyspnea Edema Epilepsy Exhalation Expiration Feces II. Structure and organization of the body A. The cell is the basic unit of body structure, building blocks of the body: 1. Function, size and shape of cells may differ. 2. Cells need food, water and oxygen to survive. B. Tissues are group of cells with similar functions. Four basic types of tissues in the body: 1. Epithelial tissue skin 2. Connective tissue bones two hundred six 3. Muscle tissue five hundred muscles are found in the body 4. Nerve tissue carries impulses to and from brain and back to body parts C. Organs group of tissues Hallucination Hemiplegia Ileostomy Inhalation Inspiration Mental Retardation Metabolism Muscle Osteoroporosis Paralysis Paranoia Posterior (back) Pruritus Reality Orientation Reminiscence Respiratory System Sensory Skeleton Skin Sundowning Urinary System

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Body systems, organ functions, common changes due to the aging process, common diseases and disorders and their common signs and symptoms in the elderly A. Nervous System controls, directs and coordinates functions to the body. The two major divisions are the central nervous system (CNS) and the peripheral nervous system. 1. Organs: a. Brain (part of CNS) 1) Center of conscious thought and voluntary action. 2) Motor coordination 3) Centers of control fro respiration, heart function and body temperature b. Spinal cord (part of CNS) transmission of impulses to and from brain c. Peripheral nerves transmission of impulses to and from spinal cord. d. Sensory organs provide information from environment: 1) eye - sight 2) nose smell 3) tongue taste 4) skin touch 5) ears hearing and balance 2. Normal sensory and neurologic changes due to aging: a. Decreased visual acuity b. Decreased sensitivity of taste buds c. Decreased sensitivity to touch d. Decreased ability to hear e. Slowed reaction time f. Decreased short-term memory g. changes in sleep patterns 3. Common disorders of neurologic function in the elderly: a. Stroke (Celebrovascular Accident) blockage of blood flow to brain 1) loss of sensation, paralysis, hemiplegia, aphasia 2) paralysis 3) hemiplegia 4) aphasia 5) sometimes called a Brain Attack b. Alzheimers disease progressive loss of brain function: 1) disorientation 2) agitation 3) confusion c. Glaucoma blurred vision d. Hearing loss loneliness, boredom, feeling of being left out B. Respiratory System provides oxygen to the body and removes carbon dioxide

1. Organs: a. Nose b. Trachea c. Lungs

2. Normal changes of respiratory function in elderly: a. Loss of lung elasticity dyspnea b. Weakening muscles unable to cough and clear airway 3. Common respiratory disorders of elderly: a. COPD (Chronic Obstructive Pulmonary Disease) 1) decreased elasticity of lungs 2) shortness of breath (dyspnea) 3) may require oxygen therapy b. Pneumonia infection in lungs 1) increased temperature and pulse 2) abnormal respiration 3) cough productive of thick, colored sputum c. Tuberculosis infection in the lungs cough, weight loss, night sweats, fever and extreme fatigue C. Cardiovascular System 1. Organs or parts a. Heart pumps blood which carries oxygen and nutrients to all body cells and removes waste products. b. Blood vessels: 1) arteries carry blood away from the heart 2) veins carry blood back to the heart 3) capillaries the smallest blood vessels which connect veins and arteries 2. Changes in cardiovascular function related to the aging process: a. Decrease in heart pumping effectiveness. b. Blood vessels easily broken. c. Blood supply to extremities decreased. 3. Common disorders of the cardiovascular system related to aging: a. Heart attack blockage of blood flow to heart muscle 1) chest pain (angina) 2) sudden loss of consciousness b. Anemia decreased normal red blood cell count 1) fatigue 2) paleness 3) increased pulse and respiration c. Congestive Heart Failure (CHF) 1) difficulty breathing 2) cough 3) increased sputum production 4) swelling of feet and ankles d. Hypertension elevated blood pressure

D. Gastrointestinal (GI) System (Digestive System) 1. Organs: a. Mouth, tongue, teeth b. Esophagus c. Stomach breaks up food into small particles and semi-liquid substance. d. Small intestine chemically breaks down foods and absorbs nutrients.

e. Large intestine (colon) absorbs fluid, transports waste and stores for elimination. f. Liver and gall bladder-produced digestive fluids g. Pancreas produces digestive enzymes and insulin 2. Common changes in GI functioning related to the aging process: a. Decreased bowel function and peristalsis which can lead to constipation. b. Decreased digestive enzymes, avoid dry, fried and fatty foods. c. Decreased nutrient absorbing ability. 3. Common disorders of GI functioning in the elderly is constipation, hard dry stools and impaction. E. Integumentary system provides body protection against bacteria, fluid loss, regulates body temperature and serves as sensory organ for touch. 1. Organ or parts: a. Skin epidermis, dermis b. Hair particularly of the nose, eyes and ears c. Nails protects the tips of the fingers and toes 2. Common changes in the integumentary system related to the aging process. a. Skin becomes thin, fragile, dry and wrinkled avoid daily baths b. Blood supply to finger tips and toes is decreased; decreased sensitivity to heat and cold. c. Hair loses color. d. Nails may become thickened. 3. Common disorders of the integumentary system Pruritus: dry, itchy skin F. Endocrine System secretes hormones which control body functions, regulates the activities of other organs and glands in the body. 1. Organs or glands: a. Thyroid controls metabolism b. Pancreas secretes insulin to promote sugar use by cells c. Adrenals helps react to stress 2. Common changes in the endocrine system related to the aging process: a. Decreased ability to use sugars adult onset diabetes b. Decreased levels of sex hormones

3. Common endocrine disorders found in the elderly Diabetes mellitus, hunger, thirst, increased urination, weight loss G. Musculoskeletal System provides structure and support 1. Organ or parts: a. Bones hard rigid structures made of connective tissue cells b. Joints point at which two or more bones meet; allow body movement c. Muscle allows movement of body parts, maintains posture and produces body heat 2. Common changes in the musculoskeletal system related to the aging process: a. Brittle bones break easily b. Loss of muscle mass decreased strength c. Changes in the joints stiffness, pain, limited movement d. Loss of height e. Decreased reflexes prone to injury and falls f. Postural changes lose balance easily g. Slowing of movement tires easily 3. Common disorders of the musculoskeletal system seen in the elderly: a. Arthritis joint pain and stiffness b. Fractures pain, loss of function, swelling, abnormal structure c. Osteoporosis loss of calcium from bones; leads to stooped posture, low back pain, loss of height and fractures. H. Urinary system removes waste products from the blood and maintains water balance. 1. Organs and parts: a. Kidneys filters the blood, forms urine b. Ureter tube carrying urine from the kidneys to the bladder c. Bladder storage for urine d. Uretha tube for passage of urine to outside during urination (voiding) 2. Common changes in the urinary system related to the aging process: a. Decreased kidney function leads to buildup of waste products in blood b. Difficulty emptying the bladder urinary incontinence may occur c. Decreased bladder capacity leads to frequency 3. Common disorders of the urinary system in the elderly resident: a. Frequent urination at night b. Bladder infection burning, painful urination, cloudy urine, elevated temperature, frequency c. Kidney infection elevation in temperature, bloody, cloudy urine, pain in the back, side and groin I. Reproduction System is responsible for reproduction and sexual activity. 1. Male organs: a. Penis contains tissue which enlarges during sexual arousal to introduce sperm into vagina. b. Testes secretes male hormone, produces sperm.

c. Prostate gland secretes fluid necessary for sperm activity

2. Common changes in the male reproductive system related to the

a. b. aging process: Slower sexual response Decrease in testes size c. Increase in size of prostate gland need to urinate more frequently, nocturia 3. Common disorders of the male reproductive system in the elderly: Enlarged prostate gland Difficulty beginning urinary stream Urinary retention Bladder infection Difficulty emptying bladder completely.

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b.

c. d. e.

4. Female organs and structures: a. Ovaries produce female hormone and eggs b. Fallopian tubes eggs travel through to the uterus c. Uterus internal pear-shaped organ in the pelvis; holds fetus during pregnancy d. Vagina receives penis during sexual activity e. Vulva the external female genitalia 5. Common changes in the female reproductive system related to aging process: a. Cessation of menstruation (menopause) b. Decrease of vaginal secretion c. Sagging breast tissue 6. Common disorders of the elderly female reproductive system: a. Cystocele bladder tips backwards into the vagina 1) Frequent urination 2) Incomplete bladder emptying 3) Incontinence b. Rectocele rectum falls forward into the vagina 1) Fecal soiling 2) Constipation IV. Common needs and interventions for the elderly resident A. Environmental/physical 1. Safety: a. More light for better vision. b. Freedom from hazards. c. Support (adaptive devices) d. Good personal hygiene 2. Shelter: a. Appropriate living situation b. Environmental control (heating, air conditioning) 3. Nourishment: a. Balanced nutrition b. Adequate fluids

B. Psychological 1. Maintain self-esteem: a. Respectful treatment b. Recognition of individual differences 2. Adjustment to role change and loss of independence a. Respect privacy b. Give choices c. Encourage activities C. Social 1. Social interactions: a. Encourage family involvement. b. Encourage social/community activities.

2. Adjustment to losses: a. Encourage verbalization, such as reminiscing. b. Encourage new social contacts. c. Death of spouse/friends. 3. Financial: a. Changes in income interfere with meeting basic needs of security, love, belonging and self-esteem. b. Refer to social service. D. Recreational 1. Diversion: a. Encourage hobbies. b. Involve in facility/community events. c. Encourage family involvement. 2. Self-esteem: a. Encourage involvement. b. Give compliments. E. Spiritual 1. Provide respect for individual choices. 2. Provide opportunities to participate in religious activities. V. Common community resources to meet the needs of the elderly A. Community Resources: 1. AAA (Area Agency on Aging) 2. Adult Day Care Center 3. Support groups: American Diabetes Association Braille Institute or Blind Center Alzheimers Society Parkinsons Support Multiple Sclerosis Support Muscular Dystrophy Hospice/Bereavement 4. County Health Center 5. Community Hospitals and their hospice

a. b. c. d. e. f. g.

6. Internal Revenue Service (IRS) information 7. Long Term Care Ombudsman 8. Meals on Wheels 9. Medicare Office (see Social Security Office) 10.Mental Health Department 11.Office of Aging 12.Red Cross/Blood Pressure Clinic 13.Senior Center 14.Senior Housing 15.Social Security Office 16. Suicide Prevention 17. Home Health Agencies 18. Voter Registration 19. AARP American Association of Retired Persons

20. Fraternal and social organizations 21. Regional Centers 22. Churches/religious organizations B. Customize resources of your area by listing phone numbers of the resources. VI. Developmental and mental conditions found in long-term care population, their unique needs and interventions A. Organic brain syndrome chronic brain syndrome 1. Alzheimers disease and other dementias: a. Brain diseases causing cognitive impairment including memory loss, disorientation, confusion, wandering/sundowning b. Some interventions: 1) maintain safe, structured environment 2) provide consistent schedule, personnel 3) assist with ADL, break tasks into small steps 4) monitor diet for adequate intake 5) treat with respect 6) use a calm, quiet nonthreatening approach 7) speak clearly and use words that are simple and specific, give directions in short sentences 8) try to relate what you say with information person already knows and understands 9) repeat information if necessary 10) never argue with the resident 11) avoid restraints 12) do not overwhelm with too many staff members or stimuli 13) use night lights

14) find out what makes them feel safe, cared for and reinforce these things 15) use distraction and diversion 16) reminiscing may serve to reduce anxiety 17) avoid daytime naps 18) have bedtime rituals, e.g, backrub, etc 19) make use of techniques which have been established for interacting with people who have dementia: a) reality orientation refer to manual skills procedure Reality Orientation (p. 13.20) b) validation therapy refer to guidelines for Validation Therapy (p. 13.21) c) best friends approach refer to Elements of Knack (pp. 13.23 13.29) B. Schizophrenia (sometimes referred to as split personality) 1. Common symptoms are hallucinations, delusions, paranoia, bizarre behavior and distortion of reality. 2. Hallucinations, delusions and paranoia may be experienced by other residents who do not have schizophrenia. They often occur because an older person cannot see or hear well enough to correctly understand his or her environment.

C. Hypochondriasis all thoughts are turned inward toward himself or herself. Bodily functions become the subject of every conversation. 1. Care must be taken to be sure this person does not have a significant, painful, physical problem. If no physical cause for illness can be found, it is useless to try to persuade this person of that fact. 2. This is a functional disorder; this person is ill and does not need the attention he or she is seeking. D. Depression this is the most common functional disorder. Depression may be a reaction to serious loss. 1. Psychological symptoms include deep sadness, lack of interest in and withdrawal from the environment, feelings of worthlessness, and a gloomy outlook on the future. 2. Physical symptoms include a slowing of movements, loss of appetite, weight loss, severe fatigue, sighing, crying, constipation and sleeplessness. 3. The CNA may help this persons grieving over loss by maintaining the residents dignity and self-esteem, providing diversion and by being non-judgmental. E. Mental Retardation: 1. Mental retardation is significant subaverage intellectual function and low adaptive ability. 2. Interventions:

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Normalization (provide an environment as normal as possible). Emphasize individual strengths. Encourage independence, self-care. Treat with dignity at age appropriate level. Respect privacy. Provide safe, structured environment.

F. Celebral Palsy: 1. Group of disorders characterized by motor dysfunctions. 2. Intervention. a. Provide safe, structured environment. b. Apply appropriate assistive devices. c. Emphasize individual strengths. d. Encourage independence. e. Treat with dignity at age appropriate level. f. Respect privacy. G. Epilepsy 1. Episodic uncontrolled brain activity resulting in uncontrolled muscle activity and unconsciousness. 2. Interventions: a. Treat with respect at age appropriate level. b. Protect from injury (protective equipment). c. Follow seizure precautions. 1) Help resident to lie down. 2) Place pillow or something soft under head. 3) Move furniture objects away to prevent injury. 4) Turn residents head to side to promote drainage of saliva or vomitus. 5) 6) 7) 8) 9) Do not force or place anything in residents mouth. Do not try to move or restrain resident. Stay with resident. Use call signal to get help. Note observations area affected, length of time of seizure.

H. Alcoholism affects 15% of senior population. 1. Causes: a. Retirement b. Loss of self-esteem c. Loneliness d. Family stress 2. Effects of alcohol a. Altered consciousness slows mental process. b. Confusion c. Loss of motor control d. Slurred speech 3. Long-term effects: a. Chronic brain disorders b. Liver disease 4. Care approaches for acute toxicity protect from injury and falls I. CNA intervention:

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1. 2. 3. 4. 5.

Follow residents care plan. Encourage self care. Provide positive reinforcement. Report any changes in behavior. Provide safer environment. a. May be harmful to others. b. Make use of behavior interventions.

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