1. Describe common diseases and disorders of the integumentary system

1. 1. Describe common diseases and disorders of the integumentary system • Define the following terms: • acute illness • an illness that has severe symptoms, is treated immediately, and is usually short-term. • chronic illness • a disease or condition that is long-term or long-lasting and requires management of symptoms.

2. 1. Describe common diseases and disorders of the integumentary system • REMEMBER: • Pressure ulcers, a common disorder of the integumentary system, were covered in chapter 13, and burns were covered in chapter 7.

3. 1. Describe common diseases and disorders of the integumentary system NAs should know these facts about scabies: Caused by tiny mites Can spread quickly in LTC facilities Signs and symptoms include intense itching and rash-like burrow tracks. Treatment involves medicated creams/lotions and/or oral medications.

4. 1. Describe common diseases and disorders of the integumentary system NAs should know these facts about shingles: Also called herpes zoster Skin rash caused by varicella-zoster virus (VZV) Anyone who has had chickenpox is at risk for shingles. Signs and symptoms include pain, tingling, or itching, followed by rash. Cannot be transmitted to others, but active rash can transmit chickenpox Risk increases with age. Treated with medication Vaccine is available.

5. 1. Describe common diseases and disorders of the integumentary system NAs should know these facts about wounds: Type of injury to skin, either open or closed Examined and cleaned with various solutions, such as tap water, sterile saline, or antiseptic solution Bleeding may need to be stopped. Dressings, bandages, sutures, staples or special strips/glue may need to be applied.

6. 1. Describe common diseases and disorders of the integumentary system REMEMBER: Dermatitis is a general term referring to inflammation (swelling) of the skin. There are two types of dermatitis: atopic dermatitis, also called eczema, and stasis dermatitis.

7. 1. Describe common diseases and disorders of the integumentary system NAs should know these facts about eczema: Commonly occurs with allergies May be caused by physical/mental stressors Symptoms include dry, itchy, inflamed skin, usually on cheeks, arms, legs. Not contagious Treated with special lotions and/or antihistamines

8. 1. Describe common diseases and disorders of the integumentary system NAs should know these facts about stasis dermatitis: Commonly affects lower legs and ankles Occurs due to fluid build-up under skin Can lead to severe skin problems Early signs include rash; scaly, red area; and itching. Other signs include swelling of legs/ankles; thin, tissue-like skin; darkening/thickening skin at ankles; leg pain. Report these signs to nurse. Treatment includes surgery for varicose veins and medications to reduce fluids in body. May need to apply elastic stockings to promote circulation Resident may be on low-sodium diet.

9. 1. Describe common diseases and disorders of the integumentary system NAs should know these facts about fungal infections: Examples of fungi include mushrooms, mold, and yeasts (Candida). Some types of fungi normally live on body. Normal balances of fungi can change, resulting in infection. Fungal infections include athlete’s foot, jock itch, vaginal yeast infection, and tinea. Imbalances may result from weakened immune system or antibiotics. Infections can be difficult to eliminate. Treatment includes antifungal cream or lotion and/or oral or injected medications.

10. 2. Describe common diseases and disorders of the musculoskeletal system Define the following terms: arthritis a general term that refers to inflammation of the joints, causing stiffness, pain, and decreased mobility. inflammation swelling. autoimmune illness an illness in which the body’s immune system attacks normal tissue in the body.

11. 2. Describe common diseases and disorders of the musculoskeletal system Define the following terms: osteoarthritis a common type of arthritis that usually affects the hips, knees, fingers, thumbs, and spine; also called degenerative joint disease (DJD) or degenerative arthritis. rheumatoid arthrisis a type of arthritis in which joints become inflamed, red, swollen, and very painful, resulting in restricted movement and possible deformities.

12. 2. Describe common diseases and disorders of the musculoskeletal system NAs should know these facts about arthritis: Arthritis is inflammation of the joints, causing stiffness and pain and decreased mobility. Arthritis may be caused by aging, injury, or autoimmune illness. Two types are osteoarthritis and rheumatoid arthritis. Pain and stiffness increase in cold or damp weather.

13. 2. Describe common diseases and disorders of the musculoskeletal system These are common treatments for arthritis: Anti-inflammatory medications (aspirin or ibuprofen), as well as other medications Local applications of heat ROMs Exercise Dietary changes

14. Transparency 18-1: Care Guidelines for Arthritis • Watch for stomach irritation or heartburn. • Encourage activity. • Adapt ADLs to allow independence. • Choose clothing that is easy to put on and fasten. Encourage use of handrails and safety bars. Use special utensils if needed. • Treat each resident as an individual. • Help maintain resident’s self-esteem by encouraging self-care.

15. 2. Describe common diseases and disorders of the musculoskeletal system NAs should know these facts about osteoporosis: Causes bones to become brittle May be due to age, lack of hormones, lack of calcium, alcohol consumption, or lack of exercise Occurs more commonly in women after menopause

16. 2. Describe common diseases and disorders of the musculoskeletal system The following are signs and symptoms of osteoporosis: Low back pain Stooped posture Loss of height

17. 2. Describe common diseases and disorders of the musculoskeletal system Osteoporosis may be prevented or slowed in these ways: Encourage residents to walk and do other light exercise as ordered. Move residents with osteoporosis very carefully. Follow care plan regarding medication and calcium and fluoride supplements, which might be used to treat osteoporosis.

18. 2. Describe common diseases and disorders of the musculoskeletal system Define the following terms: closed fracture a broken bone that does not break the skin. open fracture a broken bone that penetrates the skin; also known as a compound fracture.

19. 2. Describe common diseases and disorders of the musculoskeletal system REMEMBER: Fall prevention is the key to preventing fractures. The bones of the elderly heal slowly, so prevention is very important.

20. Transparency 18-2: Care Guidelines for Casts Do not cover cast until dry. Assist with changing positions as ordered to help with drying. Place the cast on pillows. Elevate extremity in cast. Observe for swelling, skin discoloration, tightness, pressure, sores, changes in skin temperature, pain, burning, numbness or tingling, drainage, bleeding, or odor. Protect resident’s skin from edges of cast. Keep cast dry. Do not insert anything into cast. Tell the nurse if pain medication is needed. Use bed cradles as needed.

21. 2. Describe common diseases and disorders of the musculoskeletal system Define the following terms: partial weight-bearing (PWB) a doctor’s order stating that a person is able to support some body weight on one or both legs. non-weight-bearing (NWB) a doctor’s order stating that a person is unable to touch the floor or support any body weight on one or both legs. full weight-bearing (FWB) a doctor’s order stating that a person has the ability to support full body weight (100%) on both legs.

22. 2. Describe common diseases and disorders of the musculoskeletal system NAs should know these facts about hip replacements: Cause may be a fall or weakened bones. Elderly bones heal slowly. The elderly are at risk for secondary illnesses.

23. 2. Describe common diseases and disorders of the musculoskeletal system Hip replacements may be necessary for the following reasons: Fracture does not heal properly. Weakened hip due to aging Painful and stiff hip

24. Transparency 18-3: Care Guidelines for Hip Replacement Keep often-used items within reach. Dress affected side first. Do not rush the resident. Use praise and encouragement. Ask for pain medication if needed. Have the resident sit to do tasks. Follow the care plan exactly. Do not perform ROM exercises on hip replacement side. Hip cannot be bent or flexed more than 90 degrees. It cannot be turned inward or outward. Follow orders for application and positioning with an abduction pillow. Transfer resident carefully, with strong side leading when standing, pivoting, and sitting. With chair or toilet transfers, operative leg/knee should be straightened. Strong leg should stand first.

25. 2. Describe common diseases and disorders of the musculoskeletal system NAs should observe and report the following signs and symptoms after hip replacement: Red, draining, warm, or bleeding incision Increase in pain Numbness or tingling Shortening and/or external rotation of affected leg Abnormal vital signs Inability to use equipment properly and safely Unwillingness of resident to follow doctor’s orders for activity and exercise Problems with appetite Improvements such as increased strength and improved ability to walk

26. 2. Describe common diseases and disorders of the musculoskeletal system Define the following term: prosthesis a device that replaces a body part that is missing or deformed because of an accident, injury, illness, or birth defect; used to improve a person’s ability to function and/or his appearance.

27. 2. Describe common diseases and disorders of the musculoskeletal system Knee replacement may be performed for these reasons: Relieves severe pain Restores motion to damaged knee Helps stabilize a knee that buckles or gives out

28. 2. Describe common diseases and disorders of the musculoskeletal system REMEMBER: Recovery time after a knee replacement is generally shorter than recovery time for hip replacement.

29. Transparency 18-4: Care Guidelines for Knee Replacement Apply special stockings as ordered. Perform ankle pumps as ordered. Encourage fluids, especially fluids high in vitamin C. Assist with deep breathing exercises. Assist with continuous passive motion (CPM) as ordered. Ask for pain medication if needed. Report to nurse if you notice redness, swelling, heat, or deep tenderness in one or both calves.

30. 2. Describe common diseases and disorders of the musculoskeletal system NAs should know these facts about muscular dystrophy (MD): MD refers to a number of progressive diseases that cause a variety of physical disabilities due to muscle weakness. MD is inherited. It causes gradual wasting away of muscle, and weakness and deformity. Most forms are present at birth. NA should help with ADLs or ROM exercises. NA should help with skin care and positioning.

31. 2. Describe common diseases and disorders of the musculoskeletal system Define the following terms: amputation the surgical removal of some or all of a body part, usually a hand, arm, leg, or foot. phantom sensation warmth, itching, or tingling from a body part that has been amputated. phantom limb pain pain in a limb (or extremity) that has been amputated.

32. 2. Describe common diseases and disorders of the musculoskeletal system NAs should remember these guidelines when caring for a resident who has had an amputation: Be supportive during the continuing process of adjusting to the amputation. Help with ADLs. Assist with changes of position as ordered. Perform ROM exercises as instructed. Follow care plan. More information on prosthesis care is in Chapter 21.

33. 2. Describe common diseases and disorders of the musculoskeletal system The following are some common complementary and alternative medicine practices: Chiropractic medicine Massage therapy Acupuncture Homeopathy Herbs and dietary supplements

34. 2. Describe common diseases and disorders of the musculoskeletal system REMEMBER: Some residents may use complementary or alternative medicine practices. NAs should never make judgments about treatments or discuss their opinions. If an NA has concerns about a resident’s medical practices she should talk to the charge nurse.

35. 3. Describe common diseases and disorders of the nervous system REMEMBER: Dementia and Alzheimer’s disease, which are common disorders of the nervous system, are covered in detail in Chapter 19.

36. 3. Describe common diseases and disorders of the nervous system NAs should know these facts about CVA/stroke: CVA occurs when blood supply to a part of the brain is blocked or a blood vessel leaks or ruptures within the brain. Results in lack of oxygen to tissue, causing cells to die Swelling, leaking blood, and clots affect surrounding healthy brain tissue. Weakness occurs opposite affected side of brain. Mild stroke may result in few, if any, complications.

37. Transparency 18-5: Care Guidelines for Stroke Assist with exercises as ordered, keeping safety in mind. Use terms weaker or involved to refer to weaker side, not bad. Assist with speech therapy as needed. Use verbal and nonverbal communication to express positive attitude. Residents may experience confusion, memory loss, and emotions. Be patient and understanding. Encourage independence and self-esteem. Always check on resident’s body alignment. Pay special attention to skin care. If residents have lost sense of touch or sensation, be aware of potentially harmful situations such as proximity to heat and sharp objects. Adapt procedures when caring for residents with one-sided paralysis or weakness.

38. Transparency 18-5: Care Guidelines for Stroke (cont’d) For transfers: Always use gait belt. Stand on and support weaker side. Lead with stronger side. For assisting with dressing: Dress weaker side first. Undress stronger side first. Use assistive equipment to help resident dress himself. For assisting with eating: Place food in resident’s field of vision. Use assistive devices. Watch for signs of choking. Serve soft foods if swallowing is difficult. Always place food in unaffected side of mouth. Make sure food is swallowed.

39. 3. Describe common diseases and disorders of the nervous system Home Care Focus: When caring for a client who has had a stroke, an HHA will need to remember the following safety tips: Remove unnecessary clutter and any other hazards from home. Unplug appliances when not in use. Check the refrigerator and cabinets for spoiled food. Report any suspected safety hazards to supervisor.

40. 3. Describe common diseases and disorders of the nervous system NAs should know these facts about Parkinson’s disease: Progressive, degenerative disease Causes stiff muscles, stooped posture, shuffling gait, pill-rolling, tremors, and mask-like facial expression Tremors can make ADLs difficult.

41. Transparency 18-6: Care Guidelines for Parkinson’s Disease Protect residents from falls. Help with ADLs as needed. Assist with ROM exercises as ordered. Encourage self-care and be patient.

42. 3. Describe common diseases and disorders of the nervous system NAs should know these facts about multiple sclerosis: Progressive disease affecting the central nervous system Protective sheath breaks down over time, and nerves cannot send messages properly. Residents will have varying abilities. Symptoms can include blurred vision, fatigue, tremors, poor balance, trouble walking, weakness, numbness, tingling, incontinence, and behavior changes. MS can cause blindness, contractures, and loss of function in arms and legs.

43. Transparency 18-7: Care Guidelines for Multiple Sclerosis Help with ADLs. Be patient with self-care and movement. Allow time for tasks. Offer rest periods. Give resident time to communicate. Prevent falls. Help avoid stressful situations. Listen to residents. Encourage healthy diet with plenty of fluids. Give excellent skin care. Assist with ROM exercises.

44. 3. Describe common diseases and disorders of the nervous system NAs should know these facts about head and spinal cord injuries: May result from diving, sports injuries, falls, car and motorcycle accidents, industrial accidents, war, and criminal violence Can cause permanent brain damage, mental retardation, personality changes, trouble breathing, seizures, coma, memory loss, loss of consciousness, paresis, and paralysis Effects of spinal cord injuries depend on force of impact and where spine is injured. May cause paraplegia or quadriplegia Rehabilitation is needed. Emotional support is important.

45. Transparency 18-8: Care Guidelines for Head and Spinal Cord Injuries Give emotional, as well as physical, support. Prevent falls and burns. Be patient with self-care. Give careful skin care. Assist with position changes at least every two hours. Perform passive range of motion exercises. Encourage fluids and proper diet to prevent constipation. Give extra catheter care as needed. Offer rest periods as needed. Use special stockings as ordered. Encourage deep breathing exercises as ordered. Provide for privacy if involuntary erections occur. Assist with bowel and bladder training.

46. 3. Describe common diseases and disorders of the nervous system NAs should know these facts about epilepsy: Epilepsy causes seizures, but not all seizures are due to epilepsy. Seizures can be violent or mild. Causes are illness, injury, or unknown. Diagnosed through a variety of tests, including EEG. Treatment includes medication or surgery.

47. 3. Describe common diseases and disorders of the nervous system NAs should know these facts about vision impairment: Vision impairment can affect people of all ages. Some residents may wear eyeglasses or contacts. People over 40 years old are at risk for developing cataracts, glaucoma, and blindness. Cataracts may be corrected surgically. Glaucoma can occur suddenly or gradually and is treated with medication and sometimes surgery.

48. 4. Describe common diseases and disorders of the circulatory system NAs should know these facts about hypertension (HTN) or high blood pressure: Causes: Hardening and narrowing of blood vessels (atherosclerosis) Kidney disease Adrenal tumors Pregnancy

49. 4. Describe common diseases and disorders of the circulatory system Facts about hypertension (HTN) or high blood pressure (cont’d): Symptoms: Headache Blurred vision Dizziness Sometimes there are no noticeable symptoms

50. Transparency 18-9: Care Guidelines for Hypertension Offer regular trips to the bathroom. Answer call lights promptly. Take blood pressure as ordered. Encourage residents to follow their diet and exercise programs.