1 The nursing assistant in LTC

LTC (Long term care) Is given in long-term care facilities for people who need 24-hour skilled care.

Skilled care Is medically necessary care given by a skilled nurse or therapist; it is available 24 hours a day

Their length of stay (the number of days a person stays in a care facility) may be short, such as a few days or months, or longer than six months.

Terminal illness- This means that the illness will eventually cause death.

Diagnoses- medical conditions determined by a doctor.

Home health care, or home care, is provided in a person’s home

Assisted living facilities are residences for people who need some help with daily tasks, such as showering, eating, and dressing. Help with medications may also be given. People who live in these facilities do not need 24-hour skilled care.

Adult day services are for people who need some help and supervision during certain hours, but who do not live in the facility where care is provided. Generally, adult day services are for people who need some help but are not seriously ill or disabled.

Acute care is 24-hour skilled care given in hospitals and ambulatory surgical centers. It is for people who require short-term, immediate care for illnesses or injuries.

Subacute care is care given in hospitals or long-term care facilities. It is used for people who need less care than for an acute (sudden onset, short-term) illness, but more care than for a chronic (long-term) illness. Treatment usually ends when the condition has stabilized or after the set time for treatment has been completed.

Outpatient care is usually given to people who have had treatments, procedures, or surgeries and need short-term skilled care. They do not require an overnight stay in a hospital or other care facility.

Rehabilitation is care given by specialists. Physical, occupational, and speech therapists help restore or improve function after an illness or injury.

Hospice care is given in facilities or homes for people who have about six months or less to live. Hospice workers give physical and emotional care and comfort until a person dies. They also support families during this process.

The typical long-term care facility offers personal care for all residents and focused care for residents with special needs. Personal care includes bathing; skin, nail, and hair care; mouth care; and assistance with walking, eating and drinking, dressing, transferring, and elimination. All of these daily personal care tasks are called activities of daily living, or ADLs.

Person-centered care emphasizes the individuality of the person who needs care, and recognizes and develops his or her capabilities

Trauma-informed care is an approach to patient care that recognizes that people may have experienced trauma in their lives.

Medicare (medicare.gov) is a federal health insurance program that was established in 1965 for people aged 65 or older.

Medicaid (medicaid.gov) is a medical assistance program for people who have a low income, as well as for people with disabilities. It is funded by both the federal government and each state. Eligibility is determined by income and special circumstances. People must qualify for this program.

A nursing assistant (NA) performs assigned nursing tasks, such as taking a resident’s temperature. A nursing assistant also provides personal care, such as bathing residents and helping with hair care. Promoting independence and self-care are other very important tasks that a nursing assistant does

Another duty of the NA is noting and recording important information about the resident. This is called charting, or documenting.

Responsibility for Residents

All residents are the responsibility of each nursing assistant. An NA will receive assignments to perform tasks, care, and other duties for specific residents. If he sees a resident who needs help, even if the resident is not on his assignment sheet, the NA should provide the needed care.

Assistive or adaptive devices - hearing aids,braille,magnifiers, etc

Resident as Member of Care Team All members of the care team should focus on the resident. The team revolves around the resident and his or her condition, treatment, and progress. Without the resident, there is no care team.

Chain of command- It describes the line of authority and helps to make sure that residents get proper health care. The chain of command also protects employees and employers from liability.

Liability is a legal term. It means that someone can be held responsible for harming someone else

A scope of practice defines the tasks that healthcare providers are legally allowed to do as permitted by state or federal law

The care plan is individualized for each resident. It is developed to help achieve the goals of care. The care plan lists the tasks that team members, including NAs, must perform

A policy is a course of action that should be taken every time a certain situation occurs.

A procedure is a method, or way, of doing something.

Professional means having to do with work or a job.

Personal refers to life outside a job, such as family, friends, and home life

Professionalism is behaving properly when on the job

The care plan must always be followed. Tasks not listed in the care plan or approved by the nurse should not be performed.

Compassionate means being caring,concerned, empathetic, and understanding.

Empathy means identifying with the feelings of others.

Showing sympathy means sharing in the feelings and difficulties of others.

Honest: An honest person tells the truth and can be trusted

Being tactful means showing sensitivity and having a sense of what is appropriate when dealing with others.

People who are conscientious try to do their best. They are guided by a sense of right and wrong

Dependable: NAs must be able to make and keep commitments.

Patient: People who are patient do not lose their temper easily.

Respectful: Being respectful means valuing other people’s individuality.

Unprejudiced: NAs work with people from many different backgrounds

Tolerant: Being tolerant means respecting others’ beliefs and practices and not judging them

Ethics are the knowledge of right and wrong. An ethical person has a sense of duty toward others.

Laws are rules set by the government to help people live peacefully together and to ensure order and safety

The Omnibus Budget Reconciliation Act (OBRA) was passed in 1987. It has been updated several times since. OBRA was passed in response to reports of poor care and abuse in long-term care facilities

OBRA requires that the Nurse Aide Training and Competency Evaluation Program (NATCEP) set minimum standards for nursing assistant training. NAs must complete at least 75 hours of training that covers topics like communication, preventing infections, safety and emergency procedures, and promoting residents’ independence and legal rights. Training must also include basic nursing skills, such as how to measure vital signs. NAs must also know how to respond to mental health and social services needs, rehabilitative needs, and how to care for residents who are cognitively impaired. OBRA requires that NAs pass a competency evaluation (testing program) before they can be employed. NAs must also attend regular in-service education (a minimum of 12 hours per year) to keep their skills updated.

To cite means to find a problem through a survey

Residents’ Rights specify how residents must be treated while living in a facility.

Quality of life: Residents have the right to the best care available. Dignity, choice, and independence are important parts of quality of life.

Services and activities to maintain a high level of wellness: Residents must receive the correct care. Healthcare professionals at facilities must develop a care plan for residents, and their care should keep them as healthy as possible. A baseline care plan for residents, which includes instructions for providing person-centered care, must be developed within 48 hours of admission. Residents’ health should not decline as a direct result of the care given at the facility.

The right to be fully informed about rights and services: Residents must be told what services are available. They must be told the fee for each service. They must be informed of charges both orally and in writing. Residents must be given a written copy of their legal rights, along with the facility’s rules. Legal rights must be explained in a language they can understand. Residents must be given contact information for state agencies relating to quality of care, such as the ombudsman program (more information may be found later in the chapter). When requested, survey results must be shared with residents. Residents have the right to be notified about any change of room or roommate. They have the right to communicate with someone who speaks their language. They have the right to assistance for any sensory impairment, such as vision loss.

The right to participate in their own care: Residents have the right to participate in planning their treatment, care, and discharge. Residents have the right to see and sign their care plans after all significant changes. Residents have the right to be informed of risks and benefits of care and treatment, including treatment options and alternatives, and to choose the options they prefer. They have the right to request, refuse, and/or discontinue treatment and care. They can refuse restraints and refuse to participate in experimental research. Residents have the right to be told of changes in their condition. They have the right to review their medical record. They have the right to choose

Informed consent is the process by which a person, with the help of a doctor, makes informed decisions about his or her health care.

The right to make independent choices: Residents can make choices about their doctors, care, and treatments. They can make personal decisions, such as what to wear and how to spend their time.

The right to dignity, respect, and freedom: Residents must be respected and treated with dignity by caregivers. Residents must not be The right to security of possessions: Residents’ personal possessions must be safe at all times. Facilities must make an effort to protect residents’ property from loss or theft. Possessions cannot be taken or used by anyone without a resident’s permission. Residents have the right to manage their own finances or choose someone else to do it for them. Residents can request that the facility handle their money. If the care facility handles residents’ financial affairs, residents must have access to their accounts and financial records, and they must receive quarterly statements, among other things. Residents have the right to not be charged for any care that is covered by Medicaid or Medicare.

The right to privacy and confidentiality: Residents have the right to speak privately with anyone. They have the right to privacy during care and the right to confidentiality regarding every aspect of their lives.

Rights during transfers and discharges: Residents have the right to be informed of and to consent to any location changes. Residents have the right to stay in a facility unless a transfer or discharge is needed. Residents can be moved from the facility due to safety reasons (their safety or others’ safety), if their health has improved or worsened, or if payment for 12 The Nursing Assistant in Long-Term Care 1 care has not been received for a determined period of time.

The right to security of possessions: Residents personal possessions must be safe at all times. Facilities must make an effort to protect residents' possessions at all times.

The right to complain: Residents have the right to make complaints and voice grievances without fear for their safety or care. Facilities must work quickly to address their concerns.

The right to visits: Residents have the right to visits from doctors, family members (including spouses and domestic partners), friends, ombudsmen, clergy members, legal representatives, or any other person. Visits cannot be restricted, limited, or denied on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability.

Rights with regard to social services: The facility must provide residents with access to social services. This includes counseling, assistance in solving problems with others, and help contacting legal and financial professionals.

Abuse is purposeful mistreatment that causes physical, mental, or emotional pain or injury to someone.

Physical abuse is any treatment, intentional or not, that causes harm to a person’s body. This includes slapping, bruising, cutting, burning, physically restraining, pushing, shoving, or even rough handling

Psychological abuse is emotional harm caused by threatening, scaring, humiliating, intimidating, isolating, or insulting a person, or by treating him or her as a child.

Verbal abuse is the use of spoken or written words, pictures, or gestures that threaten, embarrass, or insult a person.

Sexual abuse is the forcing of a person to perform or participate in sexual acts against his or her will. This includes unwanted touching or exposing oneself to a person. It also includes sharing pornographic material.

Financial abuse is the improper or illegal use of a person’s money, possessions, property, or other assets

Assault is a threat to harm a person, resulting in the person feeling fearful that he or she will be harmed. Telling a resident that she will be slapped if she does not stop yelling is an example of assault.

Battery is the intentional touching of a person without his or her consent. An example is an NA hitting or pushing a resident. This is also considered physical abuse. Forcing a resident to eat a meal is another example of battery.

Domestic violence is abuse by spouses, intimate partners, or family members. It can be physical, sexual, or emotional. The victim can be a man or woman of any age or a child.

False imprisonment is unlawful restraint that affects a person’s freedom of movement. Both the threat of being physically restrained and actually being physically restrained are types of false imprisonment. Not allowing a resident to leave the facility is also considered false imprisonment.

Involuntary seclusion is the separation of a person from others against the person’s will. An example is an NA confining a resident to his room.

Workplace violence is abuse of staff by other staff members, residents, or visitors. It can be verbal, physical, or sexual. This includes improper touching and discussion about sexual subjects.

Sexual harassment is any unwelcome sexual advance or behavior that creates an intimidating, hostile, or offensive working environment. Requests for sexual favors, unwanted touching, and other acts of a sexual nature are examples of sexual harassment.

Neglect is the failure to provide needed care that results in physical, mental, or emotional harm to a person. Neglect can be put into two categories: active neglect and passive neglect.

Active neglect is the purposeful failure to provide needed care, resulting in harm to a person.

Passive neglect is the unintentional failure to provide needed care, resulting in physical, mental, or emotional harm to a person. The caregiver may not know how to properly care for the resident, or may not understand the resident’s needs.

Negligence means actions, or the failure to act or provide the proper care for a resident, resulting in unintended injury. An example of negligence is an NA forgetting to lock a resident’s wheelchair before transferring her. The resident falls and is injured.

Malpractice occurs when a person is injured due to professional misconduct through negligence, carelessness, or lack of skill is the repeated use of legal or illegal drugs, cigarettes, or alcohol in a way that harms oneself or others. For the NA, substance abuse can lead to unsafe 14 The Nursing Assistant in Long-Term Care 1 practices that result in negligence, malpractice, neglect, and abuse. It can also lead to the loss of the NA’s certification.

In long-term care facilities in the United States, an ombudsman is assigned by law as the legal advocate for residents (ltcombudsman.org)

To respect confidentiality means to keep private things private.

Congress passed the Health Insurance Portability and Accountability Act (HIPAA) (hhs.gov/hipaa) in 1996. It has been further defined and revised since then. One reason this law was passed is to help keep health information private and secure. All healthcare organizations must take special steps to protect health information.

Protected health information (PHI) is information that can be used to identify a person and relates to the patient’s condition, any health care that the person has had, and payment for that health care.

Document care immediately after it is given. This makes details easier to remember. Do not record any care before it has been done.

It is called the Minimum Data Set (MDS). The MDS is a detailed form with guidelines for assessing residents. It also lists what to do if resident problems are identified.

An incident is an accident, problem, or unexpected event during the course of care. It is something that is not part of the normal routine. A mistake in care, such as feeding a resident from the wrong meal tray, is an incident

Communication is a process of exchanging information with others. it is the process of sending and receiving messages.

Verbal communication uses spoken or written words.

Nonverbal communication is communicating without using words.

Different languages

NAs should speak in a language that residents can understand or find an interpreter to help (family members should not be asked to interpret medical information)

If a resident has chest pain- immediately tell nurse because it could mean a heart attack

Never pick up an elderly if they fall, instead call the nurse and report everything you saw.

NAs should ask open ended questions

NAs should call residents by the name they prefer

Objective information is based on what a person sees hears touches or smells

Subjective information is something a person cannot or did not observe. It is based on something that the resident reported that may or may not be true. It is also called symptoms.

Incontinence is the inability to control the bladder or bowels. Breath order could suggest use of alcohol or tobacco in digestion or poor mouth care.

Defense mechanisms are unconscious behaviors used to release tension or cope with stress.

Body mechanics is the way the parts of the body work together when a person moves

Base of support is the foundation that supports an object

Scalds are Burns caused by hot liquids

An abrasion is an injury that rubs off the surface of the skin

The occupational safety and health administration (OSHA) is a federal government agency that makes rules to protect workers from hazards on the job.

Being conscious means being mentally alert and having awareness of surroundings sensations, and thought

First aid is emergency care given immediately to an injured person by the first people to respond to an emergency.

Cardiopulmonary Resuscitation (CPR) refers to medical procedures used when a person's heart or lungs have stopped working. CPR is used until medical help arrives.

Center of gravity is where the most weight is concentrated

Fracture is a broken bone

Pull pin

myocardial infarction (MI) or heart attack

fainting also called syncope

diabetic ketoacidosis (DKA) Is caused by having too l

Aim

Squeeze handle

Sweep back and forth

Remove ppl from danger

Activate alarm

Contain fire

Extinguish

when something is blocking the tube through which air enters the lungs comma the person has an Obstructed Airway

abdominal thrusts are a method of attempting to remove an object from the airway of someone who is choking. these thrust work to remove the blockage upward out of the throat

cyanotic-blue tinged skin

shock occurs when organs and tissue in the body do not receive an adequate blood supply

ittle insulin in the body

Transient ischemic attack (TIA) is a warning sign of a CVA (stroke).

F.A.S.T.

(F)ace: is one side drooping?

(A)RMS: is one arm numb or weak?

(S)peech: is it slurred?

(T)ime: if any symptoms then report to nurse immediately

Emesis / vomiting

Infection prevention is the set of methods practiced in healthcare facilities to prevent the spread of a disease.

Microorganism (MO) / microbe is a living thing so small that can only be seen under a microscope which is always present.

Infections occur when harmful MOs called pathogens invade the body and multiply.

A localized infection is limited to a specific location in the body.

Systemic infection affects the whole body

healthcare associated infections (HAI) is an infection acquired in a healthcare setting during the delivery or medical care.

chain of infection is a way of describing how disease is transmitted from one human to another

Causitive agent is a pathogenic microorganisms that causes disease.

reservoir is where the pathogen lives and multiplieds

portal of exit is any body opening on an infected person that allows pathogens to leave like the nose and the mouth

the mode of transmission describes how the pathogen travels

direct contact happens by touching the infected person or their secretions

indirect contact results from touching an object terminated by the infected person such as a needle dressing or tissue

portal of entry is any body opening on an uninfected person that allows pathogens to enter

mucus membranes are the membranes that line body cavities that open to the outside of the body like Linings of the mouth nose eyes rectum and genitals

a susceptible host is an uninfected person who could get sick like healthcare workers and anyone and their care who is not already infected

transmission ( passage or transfer) almost infectious diseases can be blocked by using proper infection prevention practices like hand washing

Medical asepsis refers to measures used to reduce and prevent the spread of pathogens Surgical asepsis also known as sterile technique makes an object or area free of all MOs (not just pathogens)

the Centers for Disease Control and prevention CDC is a federal government agency that issues guidelines to protect and improve the health of individuals and communities

standard precautions means treating blood and other body fluids non-intact skin like abrasions pimples are open sores and mucus membranes as if they were infected

sputum which is mucus coughed up

hand hygiene is washing hands with soap and water or using an alcohol-based hand rub (ABHR) also called hand sanitizer

personal protective equipment PPE is equipment that helps protect employees from serious injuries or illnesses resulting from contact with workplace hazards

Don means put on doff means remove

perineal care is caring for the genital and anal era area non-intact skin is skin that is broken by abrasions Cuts rashes Etc

an object is called clean if it has not been contaminated with pathogens

an object that is dirty has been contaminated with pathogens

sterilization is a cleaning measure that destroys all microorganisms including those that form spores

disinfection is a process that destroys most but not all pathogens

disposable means it is discarded after one use

transmission based precautions are precautions that are used for persons who are infected or may be infected with certain diseases

hepatitis is inflammation of the liver caused by certain viruses or other factors such as alcohol abuse medications and Trauma

tuberculosis or TB is highly contagious disease

covid-19 is a droplet and airborne disease

MRSA is a strain of this bacterium that has developed resistance to methicillin

VRE is Vancomycin resistant

all human beings have the same basic physiological needs like food water protection shelter activities sleep rest and comfort

people also have psychosocial needs which involves love affection emotions intellect and spirituality

Six psychosocial needs :

1

Masturbation:

holisticare means caring for the whole person the mind as well as the body

cultural diversity refers to the variety of people with different backgrounds and experiences living together in the world

race is physical characteristics shared by people with common ancestry

ethnicity may involve a combination of race culture nationality language and other factors

cognitive means related to thinking and learning

developmental disabilities are disabilities that are present at birth or emerged during childhood up to age 22

depression is characterized by a loss of interest in everything a person once cared about and may interfere with the person's ability to work sleep and eat

apathy is a lack of interest and activities

bipolar disorder causes a person to have mood swings and changes in energy levels and the ability to function anxiety is unevenness worry or fear

generalized anxiety disorder GAD is an anxiety disorder characterized by chronic anxiety and Worthy even when there is no reason for concern

panic disorder is characterized by Panic attacks

social anxiety disorder means having intense anxiety and extreme discomfort in social situations

a phobia is an intense irrational fear

obsessive compulsive disorder OCD is the disorder characterized by intrusive Behavior or thoughts that cause anxiety or stress

post-traumatic stress disorder PTSD is a disorder caused by experiencing a traumatic event such as being a victim of a violent crime

schizophrenia affects a person's ability to think and communicate clearly

hallucinations are false or distorted sensory perceptions delusions are persistent false beliefs

Psychotherapy involves talking about one's problems with mental health professionals

connective behavioral therapy CBT is a type of psychotherapy that is often used to treat anxiety and depression

terminal illness is a disease or condition that will eventually cause death

grief is a deep distress or sorrow over a loss

advance directives are legal documents that allow people to decide what kind of medical care they wish to have if they are unable to make the decisions themselves

When an advance directive is in place

• NAs may be asked to continue to monitor vital signs and report readings to the nurse

• Comfort measures, such as pain medication, will continue to be used

• Depending on the details of the advance directive, CPR and extraordinary measures may be prohibited

a living will outlines that Medical Care a person wants or does not want in case the person becomes unable to make those decisions

a durable power of attorney for health care is a sign dated and witness legal document that point someone else to make medical decisions for a person

do not resuscitate DNR order is another tool that helps medical providers honor wishes about care

Cheyne stokes is alternating periods of slow irregular respirations or rapid shallow respirations along with short periods of not breathing

postmortem care is care of the body after death

Hospice Care is a term for the special care that a dying person needs

palliative care is in hospice care where the goals are the comfort and Dignity of the resident

homeostasis is the name for the condition in which all the body systems are balanced and are working out their best to be in homeostasis the body's metabolism or physical and chemical processes must be working at a steady level

anterior or ventral is the front of the body or body part

posterior or dorsal is the back of the body

Superior is towards the head

inferior is away from the head

medial is towards the midline of the body

lateral to the side

proximal is closer to the Torso

Distal is farther away from the Torso

an example of superior is that my elbow is superior to my knee

the integumentary system:

dilate: means to widen or open

constrict means to narrow or close

signs are something you see,here,or feel

a symptom is something a patient tells

you never put lotion in between diabetic toes

pressure injuries are a common disorder of the integumentary system which are also called pressure ulcers

when atrophy occurs the muscle wastes away it decreases in size and it becomes weak

when a contracture develops the muscle or tendon shortens and becomes inflexible AKA freezes in position

inflammation is the swelling of the joints

an autoimmune illness causes the body's immune system to attack normal tissues in the body

rheumatoid arthritis can affect people of any age and it is considered an autoimmune disease it comes from using something too many times

osteoarthritis affects the elderly and it occurs with aging or overtime usually the hips and knees are affected

osteoporosis is a condition in which Bones lose density

menopause is the end of menstruation which occurs when a woman has not had their menstrual period for 12 months

partial weight bearing pwb means the resident is able to support bodyweight on one leg

non weight bearing NWB means the resident is unable to touch the floor or support any bodyweight on one or both legs

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

the nervous system has two main parts the central nervous system CNS and the peripheral nervous system pns

the central nervous system is composed of the brain and spinal cord the pns deals with a periphery or other part of the body it consists of the nerves that extend throughout the body

Paralysis on one side of the body is called hemiplegia

weakness on one side of the body is called hemiparesis

trouble communicating thoughts through speech or writing is called expressive aphasia

difficulty understanding spoken or Written words is called receptive aphasia

inappropriate or unprovoked emotional responses including laughing crying anger are called emotional lability

difficulty swallowing is called dysphagia

if a stroke happens on a residence right side then the left side will become weak

a gate is a walk

Parkinson's disease is a progressive incurable disease and it makes residents be a high risk for Falls

multiple sclerosis (MS) is a progressive disease that affects central nervous system. people with MS may have trouble forming their thoughts and it's needed to be patient

paraplegia is the loss of function of the lower body and legs

quadriplegia is loss of function in the legs, trunk, arms

Eyes Ears Nose tongue and skin are the body's major sense organs

the circulatory system is made up of the heart blood vessels and blood and IT supplies food oxygen and hormones to cells

hypertension (HTN) is high blood pressure hypertension can develop at any age coronary artery disease CAD occurs when the blood vessels in the coronary arteries narrow diabetics or medications that reduce fluid in the body and increased the need to pee

the heart muscle that is not getting enough oxygen causes chest pain pressure and discomfort called angina

myocardial infarction (MI) AKA heart attack is when blood flow to heart muscle is blocked oxygen and nutrients fail to reach the cells in that area congestive

heart failure CHF is when one or both sides of the heart stop pumping blood properly

respiration is the body taking in oxygen and removing carbon dioxide

inspiration is breathing in

expiration is breathing out

dyspnea is residents who have difficulty breathing

REMEBER ALWAYS

Provide privacy

Bed lowered

Signal

Wash hands

5 stages of dying

Denial, anger, bargaining, depression, acceptance

How to care for residents who are dying

• Rigor mortis may make the body difficult to move. Talk to the nurse if you need assistance.

• Bathe the body gently. Place drainage pads where needed.

• Do not remove tubes or other equipment.

• Put in dentures if instructed by the nurse.

• Close the eyes.

Chronic obstructive pulmonary disease COPD is a chronic progressive disease that means a person may live for years with it but never be cured. Residents with COPD have trouble breathing, especially with getting air out of the lungs. There are two chronic lung diseases that are grouped under COPD chronic bronchitis and emphysema

bronchitis is an irritation and inflammation of the lining of the bronchi chronic bronchitis is a form of bronchitis that usually called by cigarette smoking symptoms include coughing that brings up sputum or phlegm and mucus

urinary incontinence is the inability to control the bladder which leads to an involuntary loss of urine residents should be kept clean and dry

a urinary tract infection a UTI is a bacterial infection of the urethra bladder ureter or kidney these are those in pain or burning during urination it also causes the frequent feeling of needing to urinate

fecal incontinence is the inability to control the bowels leading to involuntary passage of stool

constipation is the inability to eliminate stool or the infrequent difficult and often painful elimination of hard drive stool

enema is a specific amount of water with or without an additive that is introduced into the colon to eliminate stool

fecal impaction is a hard stool that is stuck in the rectum and cannot be expelled it results from unrelieved constipation

hemorrhoids are enlarged veins in the rectum they may also be visible outside the anus.

Diarrhea is a freaking elimination of liquid or semi liquid feces

gastroesophageal reflux disease GERD is a chronic conditioner which liquid contents of the stomach back up into the esophagus stomach acids causes a burning cessation often called heartburn in the esophagus and can inflame and damage the lining of the esophagus

ostomy is a surgical creation of an opening from an area inside the body to the outside this opening is called a stoma

glands are organs that produce and secrete chemical chemicals called hormones

hormones are chemical substance created by the body that control numerous body functions

diabetes mellitus commonly called diabetes occurs when the pancreas produces no insulin too little insulin or does not properly use insulin

insulin is a hormone that works to move glucose

glucose is a natural sugar from the blood and into the cells for energy for the body

pre-diabetics occurs when a person's blood glucose levels are above normal but not high enough for a diagnosis of type 2 diabetes

pregnant women who have never had diabetes before but have high glucose levels during pregnancy time gestational diabetes

the reproductive system allows human beings to reproduce or create new human life

sex glands are called the gonads

vaginitis is an inflammation of the vagina

Benign prostatic hyperplasia BPH is a disorder that is common in men over the age of 60 the prostate becomes enlarged and causes pressure on the urethra the pressure leads to frequent urination, dribbling of urine, and difficulty in storing the flow of urine

acquired immunodeficiency syndrome AIDS is the disease caused by the human and one deficiency virus( HIV)

HIV attacks the body's immune system it gradually weakens and disables it

aids is caused by acquiring HIV through blood or body fluids from an infected person. AIDS is the final stage of HIV infection

you can have HIV but not have AIDS but you cannot have AIDS and not having HIV

a tumor is a group of abnormally growing cells betting tumors are considered non-cancerous they usually grow slowly and local arrows areas

cancer is a general term used to describe a disease in which abnormal solid grow in an uncontrolled way cancers usually occur in the form of tumors

confusion is the inability to think clearly and logically

delirium is a state of severe confusion that occurs suddenly it is usually temporary as a person ages

some of the ability to think logically and clearly may be lost this ability is called cognition

when some of this ability is lost a person will have cognitive impairment

dementia is a general term that refers to a serious loss a mental abilities such as thinking, remembering, reasoning, and communicating

Alzheimer's disease (AD) causes Tangled nerve fibers and protein deposits to form in the brain they eventually cause dementia

many people with ad will repeat words phrases questions or actions this is called preservation

Sundown is when a person with AD gets restless and agitated in the late afternoon evening or night it is called sundowning

catastrophic reaction is when a person with AD overreacts something

residents with AD may try to elope or leave a facility unsupervised and unnoticed

a resident who sees, heres, smells, taste or feels things that are not there that is hallucinations

a resident who believes things that are not true is having delusions

validating means giving value to or approving suspicion