Chapter 4 - Body Systems and Related Conditions

homeostasis

is the name for the condition in which all the body’s systems are working at their best

body’s metabolism

The process by which the body converts food into energy and nutrients for growth, repair, and maintenance

* must work at a steady level to achieve homeostasis

the integumentary system

* the skin
* the natural protective covering
* skin prevents excess loss of water
* skin is made up of tissues and glands
* sweat glands help to cool the body
* sebaceous glands that secrete oil to keep skin lubricated

the skin is a ______ organ

sense

* it feels heat, cold, pain, touch and pressure

how does skin change with age?

* thinner, drier more fragile → risk of skin tears
* less elastic
* protective fatty layer lost → person may feel colder
* hair thins and may turn gray
* wrinkles and brown spots
* nails are harder and more brittle
* dry, itchy skin may result from lack of oil from sebaceous glands

the musculoskeletal system

* muscles, bones, ligaments, tendons, and cartilage give the body shape and structure
* human body has 206 bones
* bones protect organs
* two bones meet at joint
* muscles are connected to bones by tendons
* muscles provide movement of body parts to maintain posture and produce heat

atrophy

the wasting of muscle (decreasing in size) from lack of use

* when atrophy occurs, muscles become weak

contracture

the muscle or tendon shortens, becomes inflexible and “freezes” in position

* this causes permanent disability of the limb

range of motion (ROM)

are exercises that put a joint through its full arc of motion and can help prevent atrophy and contractures

what are some age related changes to the musculoskeletal system?

* muscles weaken and lose tone
* body movement slows
* bones lose density → they become more brittle and are more likely to fracture
* joints stiffen and become painful
* height is gradually lost

symptoms/signs you should report in regards to the musculoskeletal system

* Changes in ability to perform routine movements and activities
* Any changes in a resident’s ability to perform ROM exercises
* Pain during movement
* Any new or increased swelling of joints
* White, shiny, red or warm areas over a joint
* Bruising
* Aches and pains that the resident reports to you

arthritis

it is a general term that refers to the inflammation or swelling of the joints

* it causes stiffness, pain, and decreased mobility
* can be the result of aging, but it can also be caused by an autoimmune disease

autoimmune disease

causes the body’s immune system to attack normal tissue in the body

osteoarthritis

can also be called degenerative joint disease (DJD) or degenerative arthritis → affects the elderly

* hips and knees which are weight bearing joints are often affected

rheumatoid arthritis

is an autoimmune illness and can affect people of any age

* joints become red, swollen, and painful
* deformities can result and movement is eventually restricted

treatment for arthritis

* Anti-inflammatory medication such as aspirin or ibuprofen, as well as other medication
* Local application of heat to reduce swelling and pain
* Range of motion exercises
* Regular exercise and/or activity routine
* Diet to reduce weight or maintain strength
* Activities of daily living (ADLs) may need to be adapted. There are many assistive devices residents can use to help bathe, dress and feed themselves

osteoporosis

is a condition in which bones lose density and become brittle (can break easily) → aka brittle bone disease

how is osteoporosis caused?

* lack of calcium in diet
* loss of estrogen
* lack of exercise
* reduced mobility
* older age

signs and symptoms of osteoporosis

* low back pain
* stooped posture
* becoming shorter over time
* fractures

osteoporosis is more common in women

true → more common in women after menopause

signs and symptoms of fractures

* pain
* swelling
* bruising
* changes in skin color at the site
* limited movement

PWB

partial weight bearing → the resident can support some body weight

NWB

non-weight bearing → the resident is unable to touch the floor or support any weight on one or both legs

FWB

full weight bearing → means that both legs can bear 100% of the body weight on a step

what is a knee replacement?

is the surgical replacement of the knee with a prosthetic knee

* performed to relieve pain and restore motion to a knee damaged by arthritis or injury

what helps prevent blood clots in the legs?

knee-high elastic stockings

* aids in circulation

the nervous system

is the control center and message center of the body

* it controls and coordinates all body functions
* senses and interprets information from outside the human body
* there are two parts:
* the CNS
* the PNS

central nervous system (CNS)

composed of the brain and the spinal cord

peripheral nervous system (PNS)

deals with the periphery or outer part of the body via nerves that extend throughout the body

age related changes in the nervous system

* responses and reflexes slow
* sensitivity of nerve endings in skin decreases
* memory loss → more often with short-term memory. long-term memory usually remains sharp

signs/symptoms to report regarding the nervous system

* fatigue or any pain with movement or exercise
* shaking or trembling
* inability to move one side of the body
* difficulty speaking or slurring of speech
* numbness or tingling
* disturbance or loss of balance
* difficulty swallowing
* memory loss of confusion
* decreased ability to perform ADLs
* unusual behavior changes

stroke (aka cerebral vascular accident - CVA)

occurs when blood supply to a part of the brain is blocked, or blood vessels leak or rupture within the brain

what is the most common type of stroke?

ischemic stroke

ischemic stroke

where the blood supply is blocked

* without blood, that part of the brain does not receive oxygen and brain cells begin to die

after a stroke, a resident might experience…

* hemiplegia
* hemiparesis
* expressive aphasia
* receptive aphasia
* emotional liability
* loss of sensations such as temperature or touch
* loss of bowel or bladder control
* cognitive problems such as poor judgement, memory loss
* dysphagia

hemiplegia

paralysis on one side of the body

hemiparesis

weakness on one side of the body

expressive aphasia

trouble communicating thoughts through speech or writing

receptive aphasia

difficulty understanding spoken or written words

emotional liability

inappropriate or unprovoked emotional responses

dysphagia

difficulty swallowing

post stroke care

* Range of motion exercises will help strengthen muscles and keep joints mobile
* Never refer to the weaker side as the “bad side”. Use terms weaker or involved to refer to the side with paralysis
* When transferring or ambulating (walking), stand on the \n weaker side. Support the weaker side and lead with the stronger side
* When dressing, always dress the weaker side first. This prevents unnecessary bending and stretching of the limb. When undressing, always undress the stronger side first.
* Keep questions and directions simple, use closed ended questions (yes or no answers)
* Give residents time to respond, be patient

Parkinson’s disease

* a progressive, incurable disease - a disease that gets worse over time
* a portion of the brain degenerates and it affects the muscles causing them to become stiff
* it causes stooped posture and a shuffling gait
* it can also cause a pill-rolling motion - a circular motion of the tips of the thumb and index finger that looks like rolling a pill
* tremors or shaking make it hard for the resident to perform ADLs such as eating and bathing

residents with parkinson’s disease are at high risk of __________

falling

Multiple Sclerosis (MS)

* a progressive disease that affects the CNS
* the myelin sheath that covers the nerves, spinal cord, and white matter of the brain breaks down over time
* without this sheath, nerve cannot send messages to and from the brain
* MS progresses slowly and unpredictably
* high fall risk due to vision problems, lack of coordination and fatigue

symptoms of MS

* blurred vision
* fatigue
* tremors
* poor balance
* trouble walking
* weakness, numbness, tingling

residents with head injuries may have the following problems…

* intellectual disabilities
* personality changes
* breathing problems
* seizures
* coma
* memory loss
* paresis
* paralysis

paresis

paralysis or loss of muscle function that affects only one part of the body

paraplegia

loss of function of lower body and legs

quadriplegia

loss of function from the neck down - legs, trunk and arms

residents with spinal cord and head injuries are at a greater risk for pressure injuries so they MUST be turned every ____ hours

2

what are the body’s major sense organs?

eyes, ears, nose, tongue, and skin

* they receive impulses from the environment and relay the impulses to the nerves

normal changes of aging regarding the sense organs

* vision and hearing decreases
* sense of balance may be affected
* sense of taste, smell, and touch decrease

cataracts

cloudiness over the lens of the eye that prevents light from entering the eye

* can be cured with surgery where a permanent lens is implanted into the eye

glaucoma

the pressure in the eye increases and eventually damages the retina and the optic nerve which can cause blindness

* this can be treated with eye drops and surgery

the circulatory system

* is made up of the heart, blood vessels, and blood
* the heart pumps blood through the blood vessels to the cells
* the blood carries food, oxygen, hormones and infection-fighting blood cells → it also removes waste products from cells and helps control body temp

age related changes regarding the circulatory system

* the heart pumps less efficiently
* blood flow decreases
* blood vessels narrow

signs/symptoms to report regarding the circulatory system

* Changes in pulse rate
* Weakness, fatigue
* Loss of ability to perform ADLs
* Swelling of ankles, feet, fingers or hands (edema)
* Pale or bluish hands, feet or lips
* Chest pain
* Weight gain
* Shortness of breath, changes in breathing patterns, inability to catch breath
* Severe headache
* Inactivity (which can lead to \n circulatory problems)

hypertension (HTN)

is diagnosed when blood pressure is consistently 130/80 or higher

major causes/symptoms of hypertension (HTN)

* atherosclerosis
* kidney disease
* tumors of adrenal gland
* pregnancy
* some medications
* symptoms: headache, blurred vision, dizziness

atherosclerosis

hardening and narrowing of the blood vessels

hypertension can lead to…

* CVA or stroke
* heart attack
* kidney disease
* blindness

coronary heart disease (CAD)

* is caused by the narrowing of the arteries - this reduces the supply of blood, oxygen, and nutrients to the heart muscle - this can lead to heart attack or stroke

angina pectoris

is a type of CAD - the heart is not getting enough oxygen, and this causes chest pain, pressure or discomfort

care guidelines for angina pectoris

* encourage the resident to rest
* nitroglycerin is the medication used to treat angina - it should be kept close to the patient
* the resident should avoid activities that cause angina such as:
* heavy meals
* overeating
* intense exercise
* cold or humid weather

myocardial infarction (heart attack)

* the blood flow to the heart muscle is blocked and results in tissue death
* can cause serious heart damage or death

symptoms of MI

* sudden, severe chest pain
* pain in one or both arms
* indigestion or heart burn
* nausea or vomiting
* dyspnea (shortness of breath)
* dizziness
* cyanotic skin color
* weak, irregular pulse
* low blood pressure
* cold and clammy skin

cardiac rehab

* after a MI, cardiac rehab is normally ordered
* it is on ongoing program that consists of:
* Low-cholesterol, low-sodium and low-fat diet
* Regular exercise program
* Medications to regulate heart rate, BP, cholesterol and triglycerides
* Regular blood testing
* Smoking cessation
* Avoiding cold temperatures
* Stress management programs

congestive heart failure (CHF)

* when one or both sides of the heart stop pumping correctly → this happens due to damage to the heart
* CHF is serious, but it can be treated and controlled with medications
* medications help to remove excessive fluid-increased urination
* encourage residents to follow diet orders or restrictions
* allow for rest periods

Peripheral Vascular Disease (PVD)

* is a disease in which the legs, arms or hands do not have enough blood circulation due to fatty deposits in the blood vessels that harden over time
* treatment includes: quitting smoking, medication, exercise and surgery

symptoms of PVD

* cool arms and legs
* swelling in hands and feet
* pale or bluish hands or feet
* bluish nail beds
* ulcers on legs and feet
* pain maybe severe when walking, but can decrease with rest

the respiratory system

* is all about breathing
* it is the body taking in oxygen and removing carbon dioxide
* the respiratory process begins with inspiration through the nose or mouth. the air travels through the trachea and into the lungs via the bronchi.

inspiration

breathing in to take in oxygen

expiration

breathing out to remove carbon dioxide

changes of aging regarding the respiratory system

* lung strength decreases
* lung capacity decreases
* oxygen in the blood decreases
* the voice weakens

signs/symptoms to report in regards to the respiratory system

* Change in respiratory rate
* Shallow breathing or breathing through pursed lips
* Coughing or wheezing
* Nasal congestion or discharge
* Sore throat, difficulty swallowing or swollen tonsils
* The need to sit after mild exertion
* Pale, bluish or gray color of the lips, arms and/or legs
* Pain in the chest area
* Discolored sputum (green, yellow, blood-tinged or gray)

Chronic Obstructive Pulmonary Disease (COPD)

* is a chronic disease - a person can live with it for years, but there is no cure
* makes it difficult to breathe, especially in getting air out of the lungs

what are the 2 chronic lung disease that are grouped under COPD?

chronic bronchitis and emphysema

chronic bronchitis

* usually caused by cigarette smoking
* symptoms include:
* coughing up phlegm (mucus)
* breathlessness and wheezing
* treatment includes:
* smoking cessation
* medications

emphysema

* chronic disease of the lungs that usually results from smoking and chronic bronchitis
* symptoms include:
* difficulty breathing
* coughing
* breathlessness
* fast heart rate
* treatment includes:
* smoking cessation
* managing symptoms and pain
* oxygen therapy
* medications

care guidelines for people with COPD

* Colds/ Viruses make symptoms \n worse
* Help the resident sit upright or lean forward. Offer pillows for support
* Offer plenty of fluids and small, frequent meals
* Use infection prevention practices- hand washing!!
* Encourage a well-balanced diet
* Keep oxygen supply available as ordered
* Be calm and supportive
* Encourage independence with ADLs
* Encourage pursed lip breathing –inhale slowly through the nose and exhale slowly through pursed lips (as if about to whistle)
* Encourage conservation of energy

signs/symptoms to report in regards to COPD

* Temperature over 101 degrees Fahrenheit
* Changes in breathing patterns- shortness of breath (SOB)
* Changes in color or consistency of lung secretions
* Changes in mental state or personality
* Refusal to take meds as ordered
* Excessive weight loss
* Increasing dependence

the urinary system

* the urinary system is composed of:
* 2 kidneys
* 2 ureters
* urinary bladder
* urethra
* meatus - opening where urine exits the body

function of urinary system

* eliminates waste products from the body
* maintains the water balance in the body

age related changes in regards to the urinary system

* the ability of the kidneys to filter blood decreases
* bladder muscle tone weakens
* the bladder holds less urine, which causes more frequent urination
* the bladder may not empty completely, causing a greater risk of infection

signs/symptoms you should report in regards to the urinary system

* Weight loss or weight gain
* Swelling upper or lower extremities
* Pain or burning during urination
* Changes in urine such as cloudiness, odor or color(urine should \n normally be pale yellow)
* Changes in frequency and amount of urination
* Swelling in the abdominal/bladder area
* Complaints that bladder feels full or painful
* Urinary incontinence/dribbling – the inability to control the \n bladder, which leads to involuntary loss of urine
* Pain in the kidney or back/flank region
* Inadequate fluid intake
* Confusion

Urinary Tract Infection (UTI)

* is a bacterial infection of the urethra, bladder, ureter, or kidney
* symptoms include:
* painful burning during urination
* frequent feeling of needing to urinate

why are females more susceptible to an UTI?

* the female urethra is shorter than the male urethra
* the female urethra is located directly in front of the vagina and anus and is closer to potential sources of bacteria

residents should wipe ___ __________ after elimination to help prevent UTIs.

front to back

is urinary incontinence a normal part of aging?

no, this should be reported to the nurse

* offer a bedpan, urinal, commode or trip to the bathroom often
* answer call lights and requests for help immediately

the gastrointestinal system

* also called the digestive system
* the GI system has 3 functions:
* digestion
* absorption
* elimination

digestion

the process of preparing food physically and chemically so that it can be absorbed into the cells

absorption

the transfer of nutrients from the intestines into the cells

elimination

the process of expelling wastes (made up of the waste products of food and fluids) that are not absorbed into the cells - bowel movement

age related GI changes

* Decreased saliva production affects the ability to chew and swallow
* Dulled sense of taste may result in poor appetite
* Decreased absorption of vitamins and minerals
* Digestion process takes longer and is less efficient
* Body waste moves slowly through the intestines, causing more frequent constipation

signs/symptoms to report regarding the GI system

* Difficulty chewing and swallowing, including denture problems, tooth pain, or mouth sores
* **Fecal incontinence** – inability to control the bowels leading to an involuntary passage of stool
* Weight gain or loss
* Loss of appetite/poor nutritional intake
* Abdominal pain and cramping
* Diarrhea
* Nausea and vomiting (especially vomit \n that looks like coffee grounds)
* Constipation
* Flatulence
* Hiccups or belching
* Bloody, black or hard stools
* Heart burn

constipation

the inability to eliminate stoll (have a bowel movement) or the infrequent, difficult and often painful elimination of a hard, dry stool

* constipation occurs when the feces moves too slowly through the intestine

constipation can result from…

* decreased fluid intake
* poor diet
* inactivity
* medications
* aging
* ignoring the urge to eliminate

symptoms of constipation

* abdominal swelling
* gas
* irritability
* no record of a recent BM

treatment of constipation

* increasing fiber and fluid intake
* increasing activity level
* sometimes medication including an enema will be ordered