CNA Mega Review (IL)
Chapter 1-4
OBRA- Law that regulates the care people receive in nursing facilities
OSHA- Regulates workplace safety
DHHS- Government agency for regulating health
PPO (Preferred Provider Organization)- Contract between healthcare providers and an insurance company
HMO (Health Maintenance Organization)- Managed care system that contracts with health care providers to provide healthcare services for a prepaid fee
Survey Process- Inspection of nursing home carried out by government
Accreditation- Official recognition of a facility meets standards
DON (Director of Nursing)- Registered nurse who directs all nursing care
RN- Registered Nurse
LPN- Licensed Practical Nurse; usually has less education than RN
MDS (Minimum Data Set)- Focuses on the degree of healthcare a resident needs
ADL’s- Activities of daily living
Sympathy
Conscientiousness
Professional
Professionalism
Work ethic
Accountability
Empathy
HIPAA- Rules regarding confidentiality in healthcare
Holistic approach to health care- Considering resident’s emotions
The Health Care System
Organizations:
Hospitals
Long-term care facilities- Provides care for people who are unable to care for themselves at home; nursing home
Skilled nursing facilities or subacute care unit- Unit that focuses on rehab and helps patient move from hospital to home
Assisted living facilities- Residents live in their own apartments but have close access to food and healthcare
Hospice organizations- For dying patients
Home health care agencies
Team nursing- Model for organizing the nursing team’s efforts in which a team leader determines all of the nursing needs
Primary nursing- One nurse is assigned multiple patients
Functional nursing- Each member of the nursing team carries out the same assigned task
Government and Private Regulations:
Government- DHHS (Dept of Health and Human Services)
Private- Joint Commission (Independent non-profit organization)
Medicare- Funded by social security; all people 65 or older can be eligible
Medicaid- Federally funded program to pay for healthcare for low income people
Delegation (5 rights)-
The right task
The right circumstance
The right person
The right direction
The right supervision
Scope of practice- What tasks nursing assistant is eligible to perform
Registry- Official record of people who completed nursing assistant training program
Reciprocity- Certification will be valid in other states
Competency
Legal Terms
Litigation- Lawsuit or legal action
Negligence- Failing to do what a careful and reasonable person would do
Abuse- Repetitive and deliberate infliction of injury
Assault- Threatening or attempting to touch a person without consent
Battery- Touching a person without consent
False imprisonment- Confining a person against their will
Defamation- Making untrue statements that hurt another person’s reputation
Larceny- Stealing
Beneficence- Doing good for others
What are the tasks beyond the nursing assistant’s scope of practice?
Tasks that require professional judgment
Tasks that require interpretation of data
What are the guidelines for accepting or refusing a task?
Not in job description
Harm to patient or resident
Illegal or unethical
No supervisor
Unclear directions
Lack of proper equipment
Inadequate training
Chapter 5
Define verbal and non-verbal communication
Verbal Communication- Use of language either spoken or written
Nonverbal Communication- Giving information through facial expressions/body language
List effective communication techniques from the text
Speak loudly and clearly
Speak face to face
Ask for feedback
What are the tactics that enhance good communication
Make sure your message is clear
Learn techniques for encouraging people to talk
Provide and seek feedback
Be mindful of your body language and tone of voice
Remember the value of silence and a comforting touch
Positive body language:
Facing the person
Nodding as they speak
Negative body language:
Crossing arms
Tapping feet
Rolling eyes
Why is silence and comforting touch important?
They say more than words can sometimes
Make sure your resident is comfortable with comforting touch
What are blocks to effective communication?
Not listening carefully
Being judgmental
Assuming what others are thinking
Name ways to resolve conflict
Ask to speak privately
Focus on the specific area of conflict
Be specific
Be gracious and apologize for misunderstandings
Ask for insight
What kind of info is the CNA responsible for reporting?
Subjective data: Information that can not be measured or assessed (i.e. complaints of pain)
Objective data: Information you can obtain directly, through measurements or through your senses
Why is it important to document?
So that everyone on the nursing team will be in the know, and they can track patterns
Define electronic medical record (EMR), medical record, Kardex
EMR: Computer information system that stores patient information
Medical Record (Chart): Legal document containing information about the person’s current condition
Kardex: Card file containing a condensed version of each patient’s medical record
What are the advantages and disadvantages to the EMR?
Advantages: Easy access, quick to update, etc
Disadvantages: Confidentiality could be compromised
What is the nursing process?
Assessment
Diagnosis
Planning
Implementation
Evaluation
Chapter 6
Growth and development
Occurs throughout a person’s life span
Head to toe
Simple tasks to complex,
Occurs at variable rates for each individual
List and give examples of Maslow’s Hierarchy of needs from basic to complex
Physiological
Safety and Security
Love and Belonging
Self-Esteem
Self-Actualization
What actions can the CNA take to help the resident meet each of these needs?
Help with ADLs
Perform safety protocol
Explaining procedures
Giving residents a smile or a kind word
Provide for privacy
Define and give examples of
acute illness: Rapid onset and short recovery time; pneumonia, broken bone
chronic illness: Ongoing condition; diabetes, asthma, arthritis
terminal illness: Recovery is not expected; cancer, emphysema, some heart conditions
Chapter 7: Overview of Long Term Care
What is the purpose of OBRA and what does it cover?
OBRA
The goal of OBRA is to improve the quality of care patients receive. This is done by setting standards for the facility, training requirements, and towards resident care.
Different Type of Healthcare Facilities
Hospital
A person who has a severe illness or whose condition is unstable and who requires a great deal of care and close monitoring would visit the hospital.
Nursing Home (Long Term Care Facilities)
This facility is for people who are unable to care for themselves at home, yet do not need to be hospitalized.
Skilled Nursing Facility
Patients go here after being released from a hospital. The care received at this facility is from a skilled healthcare professional.
Assisted Living Facility
Provides residents with limited assistance with tasks like personal care, transportation, meals, medication administration, etc.
Residents of assisted living facilities live in small apartments that have a kitchen, bathroom, living area, and bedroom. There are also common areas where the residents can socialize.
Adult Day Care
Like a normal day care, this facility plans out activities to keep the adult in supervised care during the day.
Continuing Care Retirement Community
The CCRC provides a continuum of care by including facilities for independent living, assisted living, and nursing home care.
What is the purpose of the Centers for Medicare and Medicaid Services (CMS)?
They monitor nursing homes to make sure they are following OBRA regulations and meeting the government’s standards.
Government payment for services depends on whether or not the facility is meeting the required standards.
Which facilities are overseen by the government?
Hospital, Nursing Homes, Skilled nursing facilities
What is required for a long term care stay to be paid for by medicare
3 consecutive days stayed and must be classified as a patient.
Chapter 8
What are coexisting medical conditions?
Multiple medical conditions at one time.
What is the difference between ADL’s and IADL’s
IADL
Instrumental Activities of daily living are more complex tasks that a person must be able to do in order to continue to live independently (telephone, groceries, preparing meals)
ADLS
Activities of daily living include bathing, toileting, eating, moving
What is a degenerative disease?
Degenerative diseases occur when the tissues of the body wear out or break down. Examples are arthritis, muscular dystrophy, osteoporosis, Alzheimer's disease.
How can the CNA assist in the transition for a newly admitted resident into a nursing home?
Include their family into the transition and allow the patient keep control over his schedule and activities.
What care guidelines are provided by OBRA for an older resident? A younger resident?
Same care guidelines for both residents.
Chapter 9
What is Dementia?
The permanent and progressive loss of mental functions, caused by damage to the brain tissue.
What would a person with dementia experience?
Problems with memory, especially short term memory
Difficulty communicating
Problems with judgement
Disorientation
An inability to manage activities of daily living.
How is Delirium different?
Delirium is the temporary state of confusion.
What is the Cause?
A symptom of an underlying disorder, such as an infection.
What are the stages of Dementia?
Early Stage
Memory Loss
Middle Stage
Difficulty communicating, difficult recognizing people, difficulty remembering steps to complete familiar tasks.
Late Stage
Loses the ability to walk, speak, swallow, smile, incontinent of urine and feces
Eventually dies.
Alzheimer’s Disease
When is the onset?
The risk increases with age, people 85 years and older are at the highest risk for developing the disease.
What are plaques and tangles?
Protein deposits found in the brains of people with Alzheimer's disease.
What is the cure?
Not curable
What is vascular dementia?
Mental functions are lost because multiple areas of the brain tissue die due to the lack of adequate oxygen and nutrition.
This affects what age group?
55-75 years
Define the difference b/w Lewy Body Dementia and Frontotemporal Dementia?
Frontotemporal Dementia
Caused by damage to the frontal and temporal lobes of the brain. The frontal lobe is the area of the brain that is responsible for personality and behavior.
Lewy Body Dementia
Caused by the built up of abnormal protein deposits in areas of the brain that are responsible for thinking and movement.
Define the following behaviors associated with Dementia
Wandering Pacing
People may stray away from home and this is especially dangerous because the person could be confused and disoriented.
Repetition/Perseveration
Repeating the same thing over and over again.
Rummaging
The person goes through drawers or closets, searching for an item that he is never able to find.
Delusions and Hallucinations
The person may think she is someone she is not, like the Queen of England, for example. Do not correct the delusions.
Agitation
The patient may become very upset and excited.
Catastrophic Reactions
Overreact to something that would cause a healthy person minimal or no stress.
Sundowning
The worsening of a person’s behavioral symptoms in the late afternoon and evening.
Inappropriate Sexual Behaviors
May attempt to get into bed with a resident who is not her spouse. Person could masturbate or undress in a public area as well.
Chapter 10
Microbe
Cause no harm and are actually essential for healthy living. Also known as a microorganism.
Opportunistic Microbe
Microbes that can change from harmless to pathogenic.
(Example E.COLI)
Pathogens
Microbes that can cause illness.
Bacteria
Can cause many of the infections encountered in the health care setting.
Illnesses caused by Bacteria
Strep throat, UTI, TB, Lyme disease
Viruses
The smallest of all microbes can only be seen using a special microscope.
Illnesses caused by Viruses
HIV/AIDS, hepatitis, fever blisters, common cold.
Fungi
A group of plant-like organisms that scientists have classified together because of certain characteristics.
Illnesses caused by Fungi
Ringworm, athletes foot, oral yeast infections
Parasites
Parasites live in or on a host, and use that host for food and protection.
Illnesses caused by Parasites
Scabies, pediculosis (lice)
Defense Against Communicable Diseases
1) IMMUNE SYSTEM-
Nonspecific Defense Mechanisms
Healthy intact skin and mucous membranes.
Specific Defense Mechanisms
Antibodies, which help our bodies to fight off specific microbes.
What are the S&S of INFECTION in the body
Difficulty breathing, coughing, fever
What are 2 types of bacteria that have become resistant to Antibiotics?
Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE)
Chain of Infection
Name the 6 key elements
Pathogen, Reservoir, Portal of exit, method of transmission, portal of entry, susceptible host.
What is Nosocomial Infection?
Infections acquired by patients or residents while they are in a healthcare facility.
Medical Asepsis
Physically removing or killing pathogens, primarily achieved through processes involving soap, water, antiseptics, disinfectants, or heat.
What are the 4 techniques?
Sanitization
Antisepsis
Disinfection
Sterilization
What is double bagging?
Double bagging helps to keep any pathogens that may be on the outside of the bag from spreading to other places.
Explain the difference between clean and dirty.
Dirty
When something is visibility soiled with dirt, blood, other body fluids or substances.
Clean
Something that is free from dirt, blood, body fluids, or other substances
Barrier Methods
A barrier is an object that physically prevents microbes from reaching a healthy care provider’s skin or mucous membranes.
PPE
What is PPE?
Personal protective equipment. Gloves, masks, gowns, protective eyewear
Name the components and the order of PPE and why
Isolation (transmission based) precautions
Airborne Precautions
Droplet Precautions
Contact Precautions
Chapter 11
Blood borne Pathogens
What is it and how is it transmitted?
Transmitted through blood or other body fluids.
Diseases Caused by Blood borne Pathogens
Hep B,C,D
AIDS
Malaria
Syphilis
Ebola
What is the Cna at most risk for?
Hepatitis and HIV pose the greatest occupational risk to the health care worker.
Types of Hepatitis Review
Hep A) Transmitted through the oral fecal route
Hep B) Bloodborne pathogen, transmitted through transfusion of infected blood.
Hep C) Bloodborne pathogen, most common cause of chronic viral hepatitis.
Hep D) Bloodborne pathogen found only in people infected with HBV.
Hep E) Transmitted through the oral fecal route like HAV.
What are the OSHA Bloodborne Pathogen standards?
People in the healthcare field must treat every patient or resident as if he or she may be infected with a blood borne pathogen.
People working in an are where exposure to bloodborne pathogens is possible must receive training on the risks associated with bloodborne pathogens.
Employees must make the hep b vaccine available to workers who are at risk.
Airborne Pathogens
Disease producing microbes that are transmitted through the air.
TB define and what does it affect?
Infection caused by a bacterium that usually infects the lungs.
Airborne Precautions? What are they and when do you need to use them?
High filtration respirators
A surgical mask should be placed over the patient’s face.
Chapter 12
ABC’s of Body Alignment
Alignment
Balance
Coordinated Movements
Evenly distribute weight by spreading your feet further apart
Transfer body weight to help movement
Use muscles in thighs hips and buttocks
Steps for lifting heavy object
Plant
Get close
Lift with legs
How to assist resident with falling
Keep body close
Squat with them
Sit with them
MSDS or SDS
Information on safety for each substance and what to do in the event of emergency
R.A.C.E.
Remove
Alarm
Contain
Extinguish
P.A.S.S.
Pull out safety pin
Aim the hose toward the base of the fire
Squeeze the handle
Spray the contents of the fire extinguish in sweeping motion
Beginning Tasks
ENding Tasks
Chapter 13
What puts residents at risk?
Age
Medication effects
Paralysis
Poor mobility
Sensory impairment
Limited awareness of surroundings
Entrapment
Head gets stuck between the rail and mattress
Paraplegia
Paralysis from waist down
Tetrapelegia
Paralysis from the neck down
Hemiplegia
Paralysis on one side of the body
Fall Prevention
Evaluate risk for fall
Include prevention measures in care plan
Preventing burns
Water can only be between 110F and 115F
Warn patients of hot food or drinks
Incident reports
Report immediately and an incident report is filed promptly
Used for follow up
Restraints
Stop freedom of movement
Prevent reaching for parts of body
Physical of chemical
Doctor orders
Nurse applies
Monitoring
Take off every two hours for ten minutes
Visit every 15 minutes
Alternatives
Help from family members
Use postural support
Tell nurse if
Shortness of breath
Blueness, paleness, or coldness of the skin
Complaints of pain, numbness, or tingling at or below a restraint body part
Skin is red, blistered, broken, or bruised
Person has become more confused, disorientated, or agitated
Chapter 14
Complications due to immobility
Pressure ulcers
Contractures
Pneumonia
Blood clots
Basic Positions
Supine
On back
Lateral
On left side
Sims’
on right
Prone
On stomach
Fowler’s Position
High
60 degrees
Normal
45 degrees
Low
30 degrees
Tell the Nurse if
Redness
Pale, white, or shiny skin over bony area
Tears, scapes, or skin that look burned
Hot, reddened, painful areas in the lower legs
New occurrence of urinary or bowel incontinence
New complaints of pain of movement
Any disconnected or heavily draining tubes or drains
Chapter 20
Pain management
Acute Pain
Short sharp pain that is healable and curable
Chronic Pain
Long-lasting pain
Breakthrough pain
Pain that comes between normal schedule of medication
Pain threshold
Point at which you feel pain
Pain tolerance
Point at which you need medication for pain
Radiating pain
Pain moves away from original site
Pain scale
Tool that helps translate subjective experience of pain into objective data
Treatments
Medication
Used for patients when pain has become intolerable
Physical Therapy
Exercise
Musculoskeletal pain
Ultrasound
Sound waves cause tissue and blood vessels to relax
Transcutaneous electrical nerve stimulation (TENS)
Shock therapy helps block pain signals
Cold application
Decreases bleeding and swelling, constrict blood vessels
Heat applications
Relaxes muscles, promotes blood flow to area, relieves pain
Sleep
Sleep Apnea
Difficulty breathing caused by tongue
CPAP
Continuous pressure airway pathway
Make sure it fits and is on
Difficulty with sleep
Insomnia
Sleep onset
Cant go to sleep
Sleep maintenance insomnia
Cant stay asleep
Chapter 21
AM Care
Toileting, bathing, oral care, shaving, hair care, dressing, make up
Afternoon Care
After lunch and dinner
Toileting
washing hands, face
Oral care
HS Care
Preparation for sleep
Change clothes
Oral care
Relaxing activities (music)
PRN Care
As needed (needs to use the bathroom often)
Edentulous
Without teeth
Peri-care
Clean to dirty
Oral Care
Hold at 45
Dental Caries
Cavities
Halitosis
Bad breath
Gingivitis
Inflammation of the gums
Periodontitis
Inflammation of tissue supporting teeth
Dentures
Use lukewarm water
Bathing
Partial Bath
Only face, hands, armpits, back, buttocks,and perineal area
Bed Bath
Wash clothes or bag bath cloths
Shower
Use chair
Chapter 22
Tinea Pedis
Fungal infection of feet
Athlete's foot
Tinea Capitis
Fungal infection of scalp
Alopecia
Hair loss
Pediculosis capitis
lice
Nits
Eggs of lice
Nail
Cut straight to avoid hangnails
Podiatrist for feet
Dressing
POW
Put on weak
TOSS
Take off strong side
Adaptive devices
Shaving
Electric
Safety razor
Chapter 23
Types of diets
House Diet
No restrictions
Mechanical diet
Remove foods that are hard to digest
Clear liquids
Liquids at room temp
Transparent
Full liquid
Clear liquids along with anything liquid at room temp
Pureed
Blended to a smooth consistency similar to pudding
Low cholesterol
Less fats
Low-carb
For diabetes
Less glucose and carbohydrates
NPO
Nothing by mouth
Supplements
Usually come in small gummies or pills
Serving
Hot foods hot (140F until served)
Cold foods cold
Relaxed environment encourages appetite
Preparing for meals
Toileting
Basic hygiene
Position for eating
Pleasant environment
Feeding
Use assistive utensils
Rock blade to cut
Place cup hold on drink
Always use spoon
Fill one third full
Other ways for feeding
IV Therapy
Tell nurse about
IV is disconnect
Bag is empty
Not dripping
Blood in IV tubing
Complaints of pain
Swelling or redness
Enteral nutrition
Placing food directly in stomach
Dehydration
Too little fluid
Enema
Too much fluid
Lack of kidney function
Intake
Restrict or push fluids
encourage or limit
Only liquids
Output
Only liquid
Vomiting, urine
Chapter 15
Respiratory arrest
Breathing has stopped
Cardiac arrest
Heart has stopped
Clinical death
Breathing has stopped
Reversible
Biological death
Brain dies
Not reversible
CNA’s responsibilities
Recognize Emergency
Decide to act
Check for consciousness
Activate EMS
Provide care until EMS arrive
Record care you provided
Signs of problems
Heart Attack
Pain in chest which may extend out
Pale skin
Excessive sweating
Trouble breathing
Nausea or heartburn like pain
Stroke
Unconsciousness or difficult to arouse
Sudden confusion
Slurs speech
Drooling
Eyelid or mouth drooping
Sudden headache
Weakness or paralysis in arms, fingers, leg, or side of face
Change in vitals
Syncope (fainting)
Dizziness
Temporary loss of vision
Clammy skin
Slow breathing
Weak pulse
Seizures
Grand mal
Violent jerking
Petit mal
Absence seizure
Momentary
Hemorrhage
Arterial
Spurts or pulses
Venous
Steady flow
Shock
Hemorrhagic
Massive blood loss
Septic
Bacterial infection
Cardiogenic
Heart is unable to pump out enough oxygen
Anaphylactic
Severe allergic reaction
BLS
CPR
CAB
Compressions
Airway
Breathing
30 to 2 for adult
30 to 2 for child/infant
15 to 2 for two ppl
Chapter 19
Hypertension
high blood pressure
Orthostatic hypertension
Sudden decrease in blood person when someone gets up
Febrile
Having a fever
Afebrile
Without fever
Palpate
Examine by touch
Auscultation
Listening with a stethoscope
Tachycardia
Excessively fast heart rate
Bradycardia
Slow heart rate
Respiration
Dyspnea
Difficult respirations
SOB
Short of breath
Tachypnea
Higher than normal respiration
Normal ranges (breaths/min)
Infant: 30-60
Toddler: 20-40
Preschooler: 20-34
School Age:15-25
Adolescent: 15-20
Adult: 12-20
Pulse
Pulse rate
Number of pulses in one minute
Pulse rhythm
Pattern of pulsations
Pulse amplitude
Strength of pulsations
Popliteal
Behind knee
Apical
Chest
Carotid
Neck
Femoral
Groin
Radial
Wrist
Brachial
Inside of elbow
Record after 1 min
Normal ranges (beats/min)
Infant: 80-180
Toddler: 80-140
Preschooler: 80-120
School Age: 75-110
Adolescent: 60-100
Adult: 60-100
Blood Pressure
Factors
Age
Gender
Race
Place on brachial artery on arm
Normal ranges (mmHg)
Infant: 73/55
Toddler: 90/55
Preschooler: 95/75
School Age: 100/62
Adolescent: 102/80
Adult: 120/80
Temperature
Rectal
1 inch for adults
Half inch for children
Chapters 16
Types of rooms
Hospitals
Private single occupancy
More specialized furniture
Long term care facility
Home-like
Residents encouraged to bring furniture and personal items
Assisted Living facilities
Resident’s unit remains almost entirely independent
Work Areas
Nurses’ Station
Base of operations for nurses and CNA's
Medication room
Stores medication and supplies for administering medications
Clean Utility room
All clean linens and sterile supplies
Soiled utility room
All dirty supplies
Nourishment room
Snacks and beverages stored
OBRA Patient comfort
Size of room
Lighting must be available
Temperature of facility (71F - 81F)
Air quality
Noise control
Furnishings
Safety modifications
Allowance for personal items
Privacy
Lighting
General lighting
Illumination for all corners of room
Required for safety
Task lighting
Focused light aimed at helping one perform specific task
Beds
Gatches
Adjustable points of bed
Trendelenburg's position
Feet up, head flat
Shock, central line
Reverse Trendelenburg’s Position
Feet flat, head up
Spinal cord injury or in traction
Chapter 17
Admissions process
Doctor writes order for specific needs of person
Arrival to healthcare facility; admissions handler completes admissions sheet
Name, address, date of birth, social security number
Taken to room
CNA helps resident unpack
Nursing history
Completed my nurse about preferences specific to patient
Family is encouraged to help with admissions process
Second source of information
Make resident feel more comfortable
Admissions materials
Admissions pack
Basin
Water pitcher
Drinking cup
Tissues
Personal care items
Resident inventory sheet
Lists all of residents items objectively
Transfers
From one room to another
One unit to another
One facility to another
CNA responsibilities
Pack personal items
Assisting in transporting
Reporting personal care assistance information
Discharges
Ama
Without doctor's order
Tell nurse
Discharge Planning
As soon as they are admitted
Make sure they continue to receive high quality care
Chapter 18
Bed Making
Mattress Pad
Placed on top of mattress to make it more comfortable
May be waterproof
Bottom sheet
Can be fitted or no fitted but is placed directly on mattress pad
Top sheet
Flat sheet on top of bottom sheet
Draw sheet
Small flat sheet placed in middle of bed
Protects mattress from moisture
Protects person skin from rubbing against rubber (if draw sheet is rubber)
Lift sheet
Can also be draw sheet
Placed in middle and used to lift resident
Bed Protector
Absorbent fabric soiree that is used to create waterproof layer above mattress and bottom sheet
Blankets
Bedspreads
May come from home
Pillows
Bath Blanket
Used for privacy in bath
Pressure relieving mattress
Stops skin breakdown through the use of foam pads
For people who have to stay in bed for long periods
Bed board
Piece of wood under mattress
Keeps mattress from sagging
Bed cradle
Placed between top sheet, blanket, and person’s feet
Stops skin breakdown in the feet
Footboard
Upright board at foot of bed
acts as rest to keep feet in alignment
Stack linens in order they are used
Types of beds
Closed bed
Empty bed (no one sleeps there)
Open bed
Ready to receive a patient
Fanfolded
Surgical bed
Opened bed with linens fan folded to either left or right
Occupied bed
Bed is made while person is still in bed
Chapter 27
Cell
Basic unit of life
Organelles
Tissues
Epithelial tissue
Protect body
Connective
Supports parts of body
Bones, blood, cartilage, ligaments, tendons, fatty tissues
Muscle tissue
Produces movement
Skeletal
Smooth
Cardiac
Nervous tissue
Made of up nerve that send impulses
Diseases
Acute
Short
Degenerative
Gets worse over time
Neoplastic
Tumor (cancer)
Homeostasis
State of balance in body
Body systems
Integumentary
Skin protects body
Skeletal
Serves as framework for body
Muscular
Allows for movement
Respiratory
Allow o2 movement
Cardiovascular
Moves blood through to cells
Nervous
Sends impulses to control functions
Endocrine
Controls bodily function through hormones
Digestive
breaks down food
Urinary
Gets rid of waste
Reproductive
Creates new life
Chapter 28
Integumentary system
Protections
Fluid balance
Regulation of temperature
Sensation
Vitamin d production
Elimination and absorption
Necrosis
Cell death
Erythema
Reddening of skin
Excoriation
Scratching
Fissure
Crack in skin
Ulcer
Crater in skin formed by pressure
SKin color
Jaundice
Yellow
Liver disorders
Flushing
May be normal
Sickness/fever
Pallor
Paleness
Cyanosis
Blue
Not enough oxygen
Glands
Sebaceous
Secretes sebum
Lubricates skin to prevent drying
Apocrine
Axillae and perineum
Mix with bacteria to make body odor
Exocrine
Sweat glands
Signs of aging
Wrinkles (loss of collagen)
Age spots and gray hair (loss of melanin)
Pressure ulcers
Stage I
Reddened area on skin that does not return to normal after pressure is removed
Stage II
Looks like blister, abrasion, or small crater
Epidermis is broken
Stage III
Epidermis and dermis are gone
May be drainage
Stage IV
Crater extends to bone
Wounds
Intentional
Made for a reason (surgical)
Unintentional
Trauma that causes wound in skin
Pressure ulcer
Crater caused my immobility
Burns
1st degree
Epidermis is damaged
Goes away after a few days
2nd degree
Break into dermis
Painful and increases risk of infection
3rd degree
Damage reaches subcutaneous tissue
Severe disfigurement and contractures
Wound drain
Allows excess fluid to move out of wound, preventing further infection
Rashes
Take precautions based on reason for rash
Local
In one place
Systemic
All over the body
Lesions
Break in skin
Chapter 29
Musculoskeletal system
Protection
Support
Movement
Heat production
Calcium storage
Production of blood cells
Osteoarthritis
Wear and tear on joints causes breakdown of cartilage of joints
Specific ambulation instructions
Rheumatoid arthritis
Autoimmune disorder where immune system attacks joints’ cartilage
Muscle atrophy
Muscles lose strength
Osteoporosis
Severe loss of bone tissue
Handly r/p gently
Gangrene
Tissue death
Only treatment is amputation
Hip replacement
Ambulation
No where and where not to bear weight
Toileting
Abduction pillow
Prevents legs from crossing
Traction
Skin
Weight is suspended from traction unit and exert pull to keep bone in alignment
Skeletal
Pins driven into bone to support weight
ROM Exercises
Stops bone tissue loss and muscular dystrophy
AROM
Nurse gives verbal instructions
PROM
No active involvement from r/p
AAROM
r/p performs exercise with some hands-on help
Chapter 30
Respiratory System and Aging
Less efficient ventilation
Tired more easily
Increased risk for infections
Disorders and Symptoms
Pneumonia
Fever
Pain when breathing
Cyanosis
Productive cough
sputum/phlegm
Hemoptysis
Blood in sputum
Pleurisy
Often comes with pneumonia
Pain while breathing
Bronchitis
Dry barking cough
Can turn into pneumonia
Influenza
Sore throat
Dry cough
Stuffy nose
Headache and body aches
weakness
Fever
Pneumothorax
Air in chest cavity
Hemothorax
Blood in chest cavity
ASTHMA
Bronchi and bronchioles constrict
Treated with bronchodilators
COPD
Emphysema and chronic bronchitis
Emphysema
Damage to alveoli
Chronic bronchitis
Long term irritation of bronchi and bronchioles
Respiratory Therapy
Treatment to help reach satisfactory respiration
Oxygen therapy
Oxygen provided to increase amount of oxygen inhaled
Safety
Fire hazard
Pulse oximeter
Measure of oxygenated blood
Normal is 95-100
Report anything 90 and under
Mechanical Ventilation
Breathes for a person who can't
Endotracheal Tube
Inserted in nose of mouth
Secured with balloon
Tracheostomy
Surgical opening into trachea through neck
Chapter 31
The Heart
Arteries
Carry blood away
More smooth muscle
pressure
Veins
Carry blood to heart
Blood Pressure
Systole
Heart constricts, blood moves out
Top number
Diastole
Heart relax blood rushes back in
Bottom number
Disorders
Myocardial Infarction
Reduced blood flow to heart causes tissue death
Heart attack
Angina pectoris
Chest pain
Heart muscle doesn't receive enough oxygen
Ischemia
Abnormal beating of heart
Edema
Swelling
Anemia
Red blood cells cannot carry oxygen as well
Leukemia
Excessive production of white blood cells
Lymphatic System
Returns fluid that leaks out back into blood stream
Aging
Less efficient contraction of heart
Tires easily
Decreased elasticity
Blood pressure is harder to control
Decreased number of blood cells
Higher risk for infections
Diseases
Bleeding Disorder
Thrombi
Blood clot
Embolus
Clot that moves
Blood can either clot too easily or not clot enough
Heart Failure
Monitor fluid intake and output
Coronary Artery Disease
Coronary arteries narrow, heart is unable to meet needs of activity
Deep vein thrombosis
Clotting in deep veins
Signs
Pain, redness, swelling, and warmth in lower legs
Chapter 32
Nervous System
Sends and receives information
Sensory neurons
receive sensations
Motor neurons
Control muscles
Aging
SLow conduction times
Slower reflexes and reactions
Memory changes
Loose short term memories more easily
Dementia
Significant loss of mental capabilities
Transient Ischemic Attacks
Temporary episodes of dysfunction
Caused by reduced blood flow to part of brain
Symptoms
Dizziness, nausea, blurring, loss of vision, partial paralysis of face, inability to speak of swallow
Stroke (CVA)
Signs
personality changes
Drooping of eyelid or corner of mouth
Slurring of speech
Paralysis
Severe headache
Loss of consciousness
Causes
Impeded blood flow to brain
Effects
Hemiplegia
Aphasia
Expressive
Damage to motor centers for mouth
Cannot form words, difficult to swallow
Receptive
Difficulty understanding words
Treatment
Depends of specifics of stroke
Aggressive physical therapy
Parkinson’s
Causes
Insufficient dopamine production
Effects
Tremors
Rigidity
stiffness
Akinesia
Slowed movement
Postural instability
Difficulty with balance
Treatment
Dopamine medication
Speech therapy
Physical therapy
Epilepsy
Chronic seizure activity
Multiple Sclerosis
Auto-immune disorder where immune system attacks myelin sheaths
Chapter 33
Definitions
Myopia
Nearsightedness
Hyperopia
Farsightedness
Astigmatism
Abnormally curved cornea
Cerumen
Ear wax
Otitis media
Infection of middle ear
Otitis externa
Infection of lining of ear canal
Vertigo
Periodical episodes of dizziness
Referred pain
Same as radiating pain
Eyes
Disorders
Glaucoma
Pressure is increased within eye
Conjunctivitis (pink eye)
Inflammation of conjunctiva
Cataract
Gradual yellowing and hardening of lens
Diabetic Retinopathy
Blood vessels in retina burst continually, damaging retina
Macular Degeneration
Deposits build up in macula
Causes blindness
Caring for….
Eyeglasses
Use special cloth and solution
Contact lenses
Keep in case with correct solution
Prosthetic Eyes
Clean properly review procedure
Ears
Deafness/ imparied hearing
Communication
Face person
Write instructions on notepad
Make sure person understands
Consider sign language
Aging
Taste and Smell
Chemoreceptors are lost
Taste is less intense
Less sensitive to dangerous smells or tastes
Gas leak or spoiled food
Chapter 34
Function
Control other organs through hormones
Normal Aging
Hormone decrease
Metabolisms decrease
Menopause
Thyroid Gland
Controls metabolism
Thyroxine
Hyperthyroidism
Thyroxine is too high
Metabolism is too fast
Increased hunger, weight loss
Hypothyroidism
Thyroxine is too low
Metabolism is too slow
Fatigue, weakness, weight gain, constipation
Diabetes
Type 1
Body cannot produce insulin by itself
Type 2
Cells in body become unable to respond to insulin
More common
Risk factors
Obesity
Increasing age
How to manage
Diet
Exercise
Medication
Blood Glucose
Normal is between 70 and 120 mg/dL
Liver stores excess glucose as glycogen
Hyperglycemia
Blood glucose is too high
Hypoglycemia
Blood glucose is too high
DIabetes
Atherosclerosis
Hypertension
Heart disease
Kidney disease
Diabetic retinopathy
Blindness
Nerve damage
Chapter 35
Accessory organs
Teeth, tongue, salivary glands, liver, gallbladder and pancreas.
Peristalsis
Movement of the smooth muscle along GI tract
Endoscopy
Method of view digestive tract through mouth
Colonoscopy
Method of viewing digestive tract through anus
Chemical digestions
Digestive by enzymes
Mechanical digestion
Digestion by physically breaking down food
Effects of again
Less efficient chewing and swallowing
Increased risk for choking
Less efficient digestion
Increased risk for constipation
Slowing passage through digestive tract leads to drier feces
Hernias
Inguinal/femoral
Loop of intestine breaks through abdominal wall
Umbilical
Around navel
Hiatal
Stomach passes through hiatus
Small frequent meals
Sit up for 2 hours after meal
Strangulated
Muscle tightens around trapped tissue
Ulcers
Mucosa becomes worn away
Causes
Smoking
Pain medications
Helicobacter pylori (bacteria)
Uncomfortable or nauseous after eating
Stomach pain after eating
Cancer
S&S
Loss of appetite
Indigestion
Pain
Vomiting
Constipation
Blood in stool
Changes in bowel movements
Gallstones
Block bile flow out of gall bladder
S&S
Serve pain
Indigestion
Pale or floating feces
Treatments
Laser or surgery
Chapter 36
Renal
Involving the kidneys
Neurogenic bladder
Bladder that is either overactive or underactive as a result of nerves losing control of bladder.
Renal Calculi
Kidney stones
Dialysis
Machine helps filter out waster due to lack of kidney function
Ureterostomy
Uteruses are brought through the abdominal wall and into ostomy bag
Urostomy
Ureters are attached to small intestine and then into ostomy bag
Anuria
No urine
Oliguria
Scant urine
Polyuria
Excessive urination
Hematuria
Blood in urine
Aging
Less efficient filtration
Decreased muscle tone
Enlargement of prostate gland (men)
Increased risk of UTI
Water
Vital for filtration process
Allows for liquid for waste to be flush into
Infections
Urethritis
Infection of urethra
Cystitis
Infection of bladder
Pyelonephritis
Infection of kidney
UTI’s
S&S
Burning,
Cramping
Older p/r
Change in voiding habits
Change in appearance or odor of urine
Renal failure
Acute
Emergency causes decreased blood flow to kidney
Chronic
Gradual decrease in kidney’s ability
Signs
Dehydration
Swelling in tissues
Hypertension
Oliguria
Diagnosis
Urinalysis
Collect urine sample to be tested
Imaging Studies
Ways of seeing abnormalities in bladder
Cystoscopy
scope is inserted through urethra to view inside bladder
Ureteroscopy
Scope is inserted in urethra to view it
Chapter 37
Aging
Difficulty becoming pregnant
Decreased production of hormones
Female
Amenorrhea
No menstruation after puberty
Dysmenorrhea
Painful menstruation
Menorrhagia
Excessive bleeding during period
Infertility
Inability to carry a pregnancy to term
Cysts
Growths inside ovaries
Fibroids
Masses that form on muscle wall of uterus
Prolapse
Organ shifts down and ito vagina wall
Cancer
Cervical
Endometrial
Ovarian
Breast
Male
Aging
Decreased frequency and duration of erections
Enlargement of prostate
Disorders
Erectile dysfunction
Cancer
Testicular
Prostate
Penile
STI’s
Herpes simplex
Cold sores
Blisters
Gonorrhea
Burning and green discharge in men
Pelvic inflammatory disease in women
Chlamydia
Genital Warts
Wart like growths around genitals
Chapter 38
Disability
Impaired function
Rehabilitation
Help person return to highest level of functioning
Restorative Care
Care provided to support rehab
Supportive Devices
Stabilize joints or limbs
Assistive devices
Make tasks easier
Prosthetic devices
Artificial replacements
Phases of Rehabilitation
Acute
Aims to keep person alive
Subacute
Focused on stabilizing medical condition
Chronic
Addition of rehabilitation care program
Chapter 39
Developmental Disabilities
Acquired
Developed after trauma or illness
Congenital
From birth
Levels
Mild
Trouble reading writing
Can reach a third to sixth grade level
Moderate
Difficulty with motor and speech development
Can reach second grade level
Trouble with socially appropriate behavior
Severe
Can only learn basic communication and life care skills
Profound
Need constant assistance with ADLs and supervision
Down Syndrome
Congenital developmental disability
May have cardiovascular defects and frequent respiratory tract infections due to muscle weakness
Autism
Difficulty communicating or relating to surroundings
No specific cause known
Main problems center on social skills
Cerebral palsy
Can be congenital or acquired
damaged cerebrum can cause spasms and/or shortening
Fragile X syndrome
Congenital
Defect in X chromosome causes intellectual disability, delayed communication skills
Fetal Alcohol syndrome
Congenital disability that can be both physical and intellectual
Spina Bifida
Congenital
Spinal deformity that can vary from case to case
Hydrocephalus
Congenital disability where spinal fluid builds in brain
Can also be acquired
Chapter 40
Coping mechanisms
Positive
Healthy, promote growth
Negative
Unhealthy and can lead to further problems
Compensation
Making up for loss with another thing (food)
Conversion
Changing unwanted emotion into something more reasonable
Fear turns into excitement
Denial
Refusal to accept reality
Displacement
Moving emotions onto less intimidating object
Projection
Cast own emotions onto someone else
Rationalization
Finding precarious rationales for events
Repression
Inability to remember traumatic event(s)
Mental illness
Anxiety disorders
Panic disorder
May feel like a heart attack
Many of the same symptoms
Obsessive compulsive disorder
Obsessions and compulsions control behavior
Phobias
irrational fears
Post traumatic stress disorder
Variety of negative psychological effects of trauma
Mood disorders
Depression
Bipolar Disorder
Schizophrenia
Difficulty discerning reality from delusions and hallucinations
Substance Abuse and addiction
S&S
Tremors
Mood changes
Delirium
Hallucinations
Restlessness
Anxiety and fear
Insomnia
Nausea and vomiting
Sweating
Heart palpitations
Seizures
Eating Disorders
Anorexia Nervosa
Refuse to eat
Bulimia Nervosa
Binge eat and then purge
Binge eating
Continual eat even though they are full
Aging
Risk for mental illness increases
May have imparied ability to perform ADL’s
Chapters 25 and 26
Stages of Grief
Denial
Anger
Bargaining
Depression
Acceptance
Wills
Legal document that outlines that distribution of possessions
Advance Directive
Medical guidelines outlined by patient before they are incapacitated
Durable Power of Attorney
Person put in place of patients health care decisions
Palliative Care
Focuses on making patient comfortable
Supportive care
Makes person more comfortable
Chapter 41
Tumors
Benign
Not cancerous
Malignant
Cancerous
Will divide rapidly (Metastasis)
Risk Factors
Environtent
Lifestyle
Herediary
Chapter 42
AIDS
Usually die from infection they cant fight off
HIV
Flu like symptoms for first 2 to 4 weeks
Symptoms
Loss of appetite
Weight loss
Fever
dysphagia
Fatigue
Swollen lymph nodes
Pneumonia
Sores
Kaposi’s sarcoma
Dementia
Vision loss
Confusion
Transmitted through bodily fluids
Take standard precautions
Chapter 43
Anesthetics
General Anesthesia
Loss of consciousness
Risk for nausea or vomiting
Regional Anesthesia
Loss of sensation in part of body
Person is still conscious
Local Anesthesia
Loss of sensation in small part of body
Eye surgeries
Peri-operative Care
Pre-op
NPO status
Prevents vomiting or aspiration
Pre-op teaching
Bathing
Grooming
Dressing
Enema
Intra-op
In surgery
Post-op
Placed in PACU
Prepare equipment for arrival
Coughing exercises and deep breathing
Thrombus prevention
Chapters 46 and 47
Home health
Respite
Caregiver leaves and comes back
Insurance controls time and length of each visit
Home health Aide
Responsibilities
In care plan
Do not accept compensation or gifts from client
Tote bag
Place specimens in plastic bag in dirty side
Prioritize individual needs
Be prepared/ plan out day and route