Comprehensive Care for Long-Term Residents

1. Nursing Assistant Long Term Care Resident

2. Basic Human Needs & Interventions • Environmental/Physical • Safety • More light for better vision • Freedom from hazards • Support & adaptive devices • Good personal hygiene • Shelter • Appropriate living situation • Environmental control (heat/air-conditioning) • Nourishment • Balanced diet • Adequate fluids

3. Psychological Needs • Maintain self-esteem • Respectful treatment • Recognition of individual differences • Adjustment to role change & loss of independence • Respect privacy • Give choices • Encourage activities

4. Social needs • Social interactions • Encourage family involvement • Encourage social/community activities • Adjustment to losses • Encourage verbalization/reminiscing • Encourage new social contacts • Death of spouse/friends • Financial • Changes in income • Refer to social service

5. Recreational Needs • Diversion • Encourage hobbies • Involve in facility/community events • Encourage family involvement • Self-esteem • Encourage involvement • Give compliments • Reinforce positive traits or abilities

6. Spiritual Needs • Provide respect for individual choices • Provide opportunities to participate in religious activities

7. Community Resources • AAA- Area Agency on Aging • Adult Day Care Center • Support groups • American Diabetes Association • Braille Institute or Blind Center • Alzheimer’s Society • Parkinson’s Support • Multiple Sclerosis Support • Muscular Dystrophy • Hospice/Bereavement • County Health Center

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

9. AND more resources • Senior Centers & housing • Suicide prevention • Home health Agencies • Voter registration • AARP • Fraternal & social organizations • Churches & religious organizations

10. Organic Brain Syndrome • Also called dementia • Any disorder of the brain causing deficits in thinking, memory, or judgment • Causes • Alzheimer’s disease causes plaques & tangles in the brain’s nervous system. Brain decreases in size as cells are lost. Incurable. Progressive • Multi-infarction dementia • Parkinson’s disease • Syphilis • AIDS • Nutrition & medication problems • Depression & metabolic disorders

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

12. Hypochondriasis • Resident imagines or magnifies each physical ailment • NA duties • Be supportive, may stem from depression • Do not overlook real illness • Report ALL complaints • Do not judge

13. Depression • Most common functional disorder in the elderly • Signs & symptoms • Feeling sadness • Lack of interest in & withdrawal from environment • Feelings of worthlessness • Negative outlook on the future

14. NA duties for depression • Notify nurse for loss of appetite, weight loss, severe fatigue, crying, sleeplessness • Notify nurse for statements “I wish I could die” • Remain non-judgmental • Listen with empathy • Encourage activities with others • Encourage aerobic activity & outdoor activity (releases endorphins)

15. Suicidal Resident • Elderly are at risk, especially white males over 65 who live alone and the very old (>75) • NA duties • Report clues of attempts to nurse • Give constant care • Monitor activities • Work to preserve self-esteem • Help resident find support network, friends, clergy, family, support groups • Never ignore a statement or threat about suicide

16. Developmentally Disabled • Significantly sub-average intellectual function & low adaptive ability • NA duties • Provide a normal environment • Emphasize individual strengths • Encourage independence & self-care • Treat with dignity at age appropriate level • Respect privacy • Provide safe, structured environment

17. Cerebral palsy • Group of disorders characterized by motor dysfunctions • NA duties • Provide safe, structured environment • Apply appropriate assistive devices • Emphasize individual strengths • Encourage independence • Treat with dignity • Respect privacy

18. Alcoholism/Drug Abuse • Occurs when healthy coping mechanisms have failed • 15% of elderly suffer from this • Often triggered by • Retirement • Loss of self-esteem • Loneliness • Chronic pain • Decline in health • Stress

19. NA duties for alcoholism • Report any sign of resident being under the influence • Be sure alcohol/drugs are not available • Watch for mental impairment, loss of coordination, poor judgment • Be careful when feeding, gag reflex may be impaired • Support groups – AA • Notify nurse if signs of withdrawal • Alcohol – shaking, tremors, agitation, seizures • Drugs- runny nose, depression, HA, pacing, poor coping mechanisms, agitation • Follow care plan • Be aware of dangerous behavior

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

21. Agitation continued • Allow resident to walk or rock in chair to diffuse energy • Make sure you stay safe – maintain area to escape (way to the door) • Listen with empathy • Call for help if resident becomes violent • Do not attempt to control resident if they become violent • Redirect

22. Body’s basic organization • Cell • Basic unit for structure, building block • Function, size, shape of cells differ • Need food, water, oxygen to survive • Tissues • Groups of cells with similar functions • Epithelial – protective • Connective – support & connect • Muscle – shorten & lengthen • Nerve – carry electrical messages • Organs • Made of different tissues & perform special functions

23. Integumentary System • Function • Protective barrier against microorganisms & infection • Provides sensory function – pain, temp • Shields body from injury • Temp regulation – heat & cold • Eliminates waste • Produces Vitamin D • Helps maintain fluid balance by preventing fluid loss & perspiration • Largest organ of body

24. Epidermis – top layer • Primarily dry, dead cells that shed continuously • Thin layer • No blood supply • Barrier to water loss • Prevents infection

25. Dermis – middle layer • Varies in thickness in different areas of body • Naturally very moist • Gives skin strength • Contains blood vessels, lymph vessels, nerve ending, oil glands, hair follicles • Function – aid in body temp control & is the origin of sense of touch, pressure, & pain

26. Subcutaneous – deepest layer • Fatty tissue, muscle, & bone • Do not tolerate lack of oxygen – cell death results easily

27. Skin Lesions/Wounds • Change in skin structure caused by injury, trauma, aging, or disease • Signs & Symptoms • Rash • Raised spots filled with pus or blood • Irregular reddened areas that itch (Pruritis) • Dry crusts, scabs • Break in skin integrity

28. NA duties for skin lesions • Observe & report abnormalities • Observe drainage on dressings • Tepid water when bathing • Gloves • Do not remove crusts • Notify nurse if skin lesions drain, drainage changes, dressing needs changing, wound has redness, red streaks, heat, pus, drainage

29. Pressure Sores (Decubiti) • Break in skin integrity that develops over a bony prominence as a result of pressure • Stage One • Reversible, red area that does not go away after 30 minutes (may look blue or black) • Stage Two • Reddened skin with abrasions, blisters, or shallow crater. Can involve dermis & epidermis • Stage Three • All layers of skin destroyed, deep crater forms • Stage Four • Ulcer extends through skin & subq tissue. Bone, muscle, & structures may be involved

30. NA duties for decubiti • Change position at least q 2 hours • Teach resident to shift position every 10 minutes when sitting • Proper nutrition & hydration • Immediate removal of feces or urine • Inspect skin whenever personal care is given, esp over bony prominences • Avoid hot water & friction • Lotion is your friend • Separate body areas to avoid rubbing

31. NA duties cont • Mechanical aids • Sheepskin • Alternation- pressure mattress • Pillows • Gel & air cushions • Heel protectors • Use draw sheet to move residents • Elevate HOB no more than 30 degrees • Check braces & restraints for fit • Check tubing for rubbing • Report changes to nurse • PREVENTION better than cure

32. Pediculosis, Lice, Scabies • Tiny parasites living in body • Signs & Symptoms • Intense itching • Pediculosis – areas of hair growth • Scabies – follows blood vessels, seen in webs of fingers, inside wrists & elbows, underarms, waist & nipple areas • Rash

33. NA duties for parasites • Avoid direct contact, wear gloves • Report any signs of disorder • Thorough washing of linen • Medicated shampoo & lotion

34. Normal changes of integumentary system • Skin becomes thin, fragile, dry, wrinkled • Blood supply to fingers & toes decreases • Less sensitive to hot & cold • Hair loses color • Nails thicken • Bruises easily due to fragile blood vessels

35. Respiratory System • Lifeline of the body • Brings oxygen into the body & eliminates carbon dioxide from body • Organs • Nose • Trachea • Bronchi • Lungs • alveoli

36. Respiratory Diseases • URI – upper respiratory infection • Signs & Symptoms • Fever • Runny nose & eyes • Cough • Sore throat • NA duties • Encourage rest & fluids • Dispose of tissues promptly to avoid spread • Report fever, dyspnea, change in rate or rhythm of resp, change in mucus color from clear to green, yellow, or blood-tinged • Pallor, cyanosis • Signs that infection is moving to chest or lungs

37. Pneumonia • Infection/inflammation of lungs, often seen in residents with poor immune • Signs & symptoms • Same as URI, only more severe • Chest pressure & discomfort • Extreme fatigue/weakness • cough • NA duties • As with URI • Monitor VS carefully, esp temp & resp • Orthopneic position as needed

38. COPD • Results in chronic obstruction of the resp system, irreversible • Signs & symptoms • Asthma – breathing disorder caused by reaction to allergen • Wheezing • Tight airways • Mucus blocks pathways • Labored breathing • Frequent cough

39. COPD cont • Chronic bronchitis – prolonged inflammation in the bronchi due to infection or irritants • Persistent cough • Sputum production, esp in a.m. • Respiratory distress

40. COPD cont • Emphysema – occurs when air flow is obstructed at alveolar level • Can bring oxygen in, but can’t expel CO2 • Triggered by pollutants, smoke, cold • Freq lung infections • Extreme dyspnea • Loss of appetite/weight loss • Irritability • Air hunger

41. NA duties with Resp diseases • Teach pursued lip breathing – increases CO2 expiration • Calm resident prn • Orthopneic position • Oxygen therapy • Nutrient dense foods, freq snacks, not meals • Encourage fluids • Pace activities • Avoid raising arms over head

42. Tuberculosis • Occurs when microorganism enters body & the inactive tubercle breaks down, bacteria multiply & spread • Signs & Symptoms • Fatigue • Night sweats • Hemoptysis • Coughing • Fever • Loss of appetite & weight

43. Tuberculosis cont • NA duties & observations • Annual PPD • Use of barriers if productive cough • Discard tissues & sputum promptly

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

45. Cardiovascular System • Transportation system that delivers nutrition & oxygen to the cells & takes away waste products • Closed system is kept in motion by the force of the heart • Anatomy • Heart • Blood vessels – arteries, veins, capillaries

46. Myocardial Infarction • Period in which heart cannot function properly due to lack of blood supply to the cells of the heart • Signs & symptoms • Crushing chest pain • Diaphoresis • Pallor/cyanosis • SOB • Radiating pain to arm, jaw, back • Loss of consciousness • N & V • Restless, anxious, feeling of impending doom

47. NA duties with MI • Remain with resident • Notify LVN if signs & symptoms • Monitor VS • Prepare to transfer to acute care facility

48. CHF • Heart does not pump well enough to meet the body’s needs • Signs & Symptoms • Hemoptysis • Cough • Dyspnea & orthopnea • Fatigue, confusion, cyanosis • Edema in extremities • Moist respirations • HTN • Irregular heartbeat

49. NA role in CHF • Low sodium diet • Position in orthopneic position • Fluid restriction • TED hose • Assist with ADLS • O2 therapy • BSC as needed • I & O, check VS • Pace activities

50. Anemia • Condition resulting from a decrease in the quantity or quality of RBCs • Signs & Symptoms • Lethargy • Pale or jaundiced • Dyspnea • Digestive problems • Rapid pulse, increased resp rate • Cold • Dizzy