CNA EXAM 3.txt

the break down of food physically and chemically so it can be absorbed for use by the cells

• -break down food
• -absorb nutrients
• -eliminate solid wastes from body

• -alimentary canal: mouth (bolus), pharynx, esophagus, stomach, small and large intestine
• -accessory organs: teeth, tongue, salivary glands, liver, gallbladder and pancreas

contains amylase to moisten and breakdown food particles to ease swallowing and begin digestion in mouth

• -connects throat above and stomach below
• -protects respiratory system and prevents aspiration

-hiatus sphincter: opening through diaphragm to accommodate esophagus

muscle contraction of the GI tract that moves food down the esophagus through the alimentary canal

muscular distensible organ because of rug allowing it to expand

secreted by a stomach gland to break down food in the stomach

brooked down food mixed with gastric juices in stomach. semi-liquid

20 feet

• duodenum: bile is added to the chyme here
• jejunum: most food absorption takes place here
• ileum: most food absorption takes place here

• -pancreas: secretes amylase for carb digestion, lipase for fat digestion and proteas for protein digestion
• -liver: secretes bile which is stored in gallbladder and breaks down fat

goblet cells to protect wall form sharp food particles

villi which are numerous in the duodenum and decrease through the jejunum and ileum

• -storage: of undigested chyme until bowel movement
• -dehydrator: The colon absorbs most of the water from the chyme.
• -manufatures vitamin k
• -then it releases the waste in to the rectum and then out of the anus

• -maintain homeostasis
• -remove waste products from blood
• -maintain water balance: retain glucose and large proteins, maintain osmotic pull in bodys vascular system

• -2 bean shaped organs in the upper abdomen
• -contains over a million tiny nephrons (working unit of kidney)

-each contains a convoluted tubule (tiny and coiled) which each contain a bowmans capsule at one end which surrounds a glomerulus

cluster of capillaries that filter blood and squeezes the fluid part of the blood into the bowmans capsule which then passes into tubule where water and substances are reabsorbed into blood

flows from tubule to collecting tubule which all drain into renal pelvis in the kidney

• -a tube attached to the renal pelvis of each kidney
• -carries urine from kind to the bladder

a hollow muscular sac with rug which is a storage cistern

when stretch receptors in the bladder are stimulated at about 250ml/1.5 pints of urine

• -urine passes from bladder through urethra
• -the meatus is an opening of the urethra through which urine passes from the body

-union of male sex cell and female sex cell

testes/gonads

• -produce male sex cells (sperm)
• -produce testosterone

• -reproductive organ function
• -development of secondary sex characteristics

scrotum

• -testes
• -epididymis: coiled tube on top of testes
• -vas deferens: each joins into a
• -seminal vesicle: store sperm and produce semen, each unite to form..
• -ejaculatory duct: which passes through the prostrate gland and joins with
• -urethra: outlest for urine and semen and contained within the penis

erectile tissue

fluid that carries sperm from the male reproductive tract

ovaries

ovum

release of the ovum

• -secrete estrogen and progesterone
• -needed for reproductive system function: cause endomentrium to thicken for pregnancy
• -develoment of secondary sex characteristics

• -ovary
• -fallopian tube
• -uterus: the place where a baby grows and is provided nutrients

• -main part called funds
• -narrow neck called cerevis
• -lines with endometrium with many blood vessels, egg and sperm unite and implant into endometrium

• -mons pubis: fatty upper part over pubic bone
• -labia major: outer fold of tissue around vaginal opening
• -labia minora: inner fold of tissue around vagina
• -clitoris: organ composed of erectile tissue

the break up of endometrium when pregnancy doesn't occur and the discharge of it through the vagina

every 28 days

about the 14th day of the cycle

• -when sperm and ovum unite into one cell, each containing 23 chromosomes and uniting to contain one cell with 46 chromosomes
• -unite in the fallopian tube and then travels back down the tube into the uterus

-glands called endocrine glands which secrete hormones in the blood

-regulate activities of other organs and glands in the body

pituitary gland divided into anterior and posterior

• -Growth Hormone (GH)": needed for muscle bone and organ growth
• -Thyroid Stimulating Hormone (TSH): needed for thyroid gland
• -Adrenocorticotropic Hormone (ACTH): stimulates the adrenal gland
• -hormones that stimulate the production of sex hormones

• -antidiuretic hormone (ADH): prevents kidneys from excreting too much water
• -oxytocin: contract uterine muscles during childbirth

the burning of food or heat and energy by the cells

-parathyroid hormone: regulates calcium use

severe muscle contraction and spasm due to insufficient amounts of calcium

• -adrenal medulla: epinephrine and norepinephrine
• -adrenal cortex: glucocorticoids to regulate carb metabolism and stress + inflammation and mineralocorticoids that regulate salt and water in kidneys

insulin

testosterone

estrogen and progesterone

person responsible for providing a child's basic needs

• -physical changes that are measured and that occur in a stead and orderly manner
• -measured in weight/height and changes in appearance and body functions

relates to changes in mental, emotional and social function

• -overlap, dependent, occur simultaneously
• -starts at fertilization until death
• -goes from simple to complex
• -occurs in certain directions like head to food and from center of body outward
• -occurs in sequence. complete one developmental task before going on to next one.
• -rate is uneven. no set pace
• -each stage has its own characteristics and developmental tasks

• -first year of life
• -learn to walk, eat food, talk, trust, develop stable sleep and eat patterns and form relationships

involuntary movements. newborns are born with them and they decline as CNS develops (rooting, moro/startle, sucking, grasp, step)

-each stage of psychosocial development marked by conflict which if overcome successfully result in a favorable virtue

• -generativity vs. stagnation (35-55/65)
• -virtue is production and care

• -integrity vs. despair (55/65 -death)
• -virtue is wisdom

• -recovering from midlife
• -self fulfillment
• -satisfied with contributions to life
• -acceptance of death
• -if successful, wisdom
• -if not, fear of death

holding head up

10 months

at 9 months

at 6 yrs old

• -longer life span
• -chronic illness or disability common among elderly
• -most live in family setting, alone or with friends
• -3% of over 65 live in nursing centers
• -it is normal
• -changes in body structure and function, psychological and social changes also occur (like loss of self-esteem and independence, reduced income, social relationships, death of partner and fiends)

75%

• -health
• -life experiences
• -finances
• -educaion
• -social support system

• young-old: 65-74
• old: 75-84
• old-old: 85 and up

study of the aging process

the care of aging people

• -loss of elasticity, strength and fatty tissue layer (more sensitive to cold)
• -thins and sags
• -blood vessels decrease in number leading to increased risk for skin tears and pressure ulcers and delayed healing
• -decreased secretions of oil and sweat lead to dry skin and hair
• -nails become thick and tough
• -feet may have poor circulation
• -brown spots on hands and wrists
• -hair thinning and facial hair increase in women
• -risk for skin cancer increases

• -decrease in collagen
• -decrease in new cell production
• -decrease in subcutaneous fat
• -uv radiation damamge
• -wearing of teeth

• -muscle cells decrease in number: increased atrophy and decreased strength
• -onset of osteoporosis: brittle bones cause loss of height and increased risk of fractures
• -prevent with exercise and diet high in protein, calcium and vitamins

• -nerve cells lost
• -nerve conduction and reflexes slow
• -blood flow to brain reduced: dizziness increases risk for falls
• -changes in brain cells affect personality and mental function
• -reduced blood flow to brain: memory shorter, forgetfulness increases
• -sleep patterns changes
• -taste and smell dulls
• -eyelids thin and wrinkle, tear secretion decreases
• -presbyopia:becoming farsighted due to aging
• -cataracts: leans yellows
• -eardrums atrophy
• -wax secretion decreases but becomes harder and thicker (cerumen impaction risk)

• -heart muscle weakens
• -arteries narrow, less elastic
• -if severe, rest is needed, avoid overexertion
• -respiratory muscles weaken
• -lung tissue less elastic
• -dypsnea: difficult or labored breathing may occur
• -may lack strength to couch and clear airway of secretions
• -semi fowlers best position for easy breathing

• -less saliva production
• -dysphagia: difficult swallowing a risk
• -taste and smell dull
• -digestive juices decrease: indigestion
• -fewer caloric need
• -peristalsis decrease

• -kidney function decreases and kidney atrophy
• -urine more concentrated
• -urteres, bladder and urethra lose tone and elsaticity
• -bladder decreases in size and weaken
• -urinary incontinence may occur
• -in men prostate enlarges putting pressure on urethra, difficult or frequent urination results
• -urinary tract infection risk
• -give plenty of fluids but not after 5pm

• -testosterone decreases in men: lack in strength, sperm production, atrophy of reproductive tissues, takes longer to achieve erection, takes longer to orgasm which is less forceful
• -menopause: menstruation stops. infertile, estrogen and progesterone decrease, uterus, vagina atrophy, vaginal walls thin and dry, orgasm less intense, arousal takes longer

• -the property of being male or female
• -remains throughout life span
• -need for intimacy remains through life

• -independent living
• -living with family with adult day care centers (don't provide personal care)
• -elder cottage housing optty (small cottage placed in yard of single family home)
• -apartments
• -home sharing
• -residential hotels
• -congregate housing
• -senior citizen housing (retirement communities) supported by state and federal funds
• -assisted living: need help with ADL
• -adult foster care
• -board and care homes (provides personal care)
• -continuing care retirement communities: services are added as needs change can start with complete independent living.
• -nursing centers: hospital long term care units

animals, plants and children play a key role in giving residents of nursing centers dignity and purpose

• OBRA- federal law that residents have same rights as every US citizen
• care must be provided in a manner that improves the person's quality of life, have rights in everyday lives and care in nursing center
• -nursing center must inform residents of their rights, before or during admission, in a way resident can understand

• -to information
• -to refuse treatment
• -to privacy and confidentiality
• -to personal choice
• -to voice disputes
• -not to work
• -to take part in groups
• -to care and security of personal items
• -to freedom from abuse, neglect and mistreatment
• -to freedom from restraint

include living wills and instructions about life support

separating a person from other against will

• -older american act is a federal law
• -requires long term care ombudsman in every state
• -someone who supports or promotes the needs and interest of another person
• -long term care ombudsman act on behalf of nursing center residents and assisted living residents
• -they protect the health safety welfare and rights of residents

protein foods

in their own homes

• -routine care given before breakfast
• -includes assist with elimination, pericare, changing dirty linens, hygiene, assist with dressing and hair, positioning for breakfast, clean unit and bed

• -care given after breakfast, hygiene more thorough at this time
• -includes assist with elimination, cleaning and pericare, changing soiled linens/garments, hygiene (face and hand washing, oral, bathing, back massage), grooming, activity (range of motion, ambulation), make bed, straighten up unit

• -routine care is done after lunch and before evening meal, before person takes a nape or has visitors
• -includes the same routine care as morning care

• -care given at bedtime, relaxing and promotes comfort
• -elimination, cleaning, changing wet/soiled linens and garnets, hygiene, change into sleepwear, straighten bed and unit

• keep mouth and teeth clean
• prevent mouth odors or infections
• increase comfort
• make food taste better
• reduce risk of cavities and periodontal disease

inflammation of tissues around the teeth

thin film that sticks to teeth

when plaque hardens, causes periodontal disease

removed plaque and tartar from mouth, also removes food from between teeth

denture cleaner, denture cup and denture brush or toothbrush

sponge swabs, apply lubricant to lips after cleaning

keep mouth open with padded tongue blade, don't use fingers, always explain what you are doing as they can still hear

breathing fluid, food, vomit or an object into lung

• -position onto side with head turned to side so excess fluid can run out of mouth
• -use minimal amount of fluid to clean mouth
• -dont insert dentures

• -place a towel in the basin for safety of denture as they easily chip and break
• -do not use hot water, causes dentures to warp
• -store in container of cool water so they don't dry out

oversized towel used, completely wet with a cleansing solution (water, cleaning agent and skin softening agent, drying agent)

contain 8-10 washcloths in plastic bag that are moist with cleaning agent that doesn't need rinsing, warm them in microwave, new washcloth used for each body part, skin air dries

bathing face, hands, armpits, back, butt and perineal area

110 to 115

no longer than 20 min.

transfer bench, tub with side entry door, wheelchair or stretcher life, mechanical lift

• -given after bath and with evening care
• -or after repositioning or helping person relax
• -last 3-5 minutes
• -look for skin tears
• -warm lotion before massage by rubbing between hands or placing in warm water
• -afterwards apply lotion to keep skin soft

hair care, shaving, nail and foot care. allow them to groom themselves to promote independence

prevent infection and promote comfort

hair loss, excessive body hair, dandruff, life, scabies

hair loss

excessive body hair, heredity and excessive testosterone causes

• -lice, infestation of wingless insects
• -capitis: on scalp
• -pubis: on pubic hair
• -corporsis" on body

skin disorder caused by mites, burrows into skin and lays eggs

early morning care, morning care and afternoon care or whenever needed

-use wide-tooth comb, start at neckline lifting upwards and outwards

• cover person with towel in front
• ask person to hold washcloth over the eyes
• use water at 105
• wet hair
• apply shampoo and lather up at hairline then work towards back of head
• massage scalp
• rinse until water runs clear
• apply conditioner
• cover hair with towel
• dry person face
• rub hair with towel
• comb, dry and style hair as quickly as possible

with persons taking anticoagulant drugs

protect bed linen, place towel under part being shaved, place towel over person chest and shoulders, soften skin before shaving, hold skin taut, shave in direction of hair growth for face and underarms, for legs, shave against the grain, rinse afterwards, apply pressure on any nicks or cuts and notify nurse

after bathing because skin is soft

prevents infection, injury and odors

diabetes and vascular disease

gangrene and amputation

5 to 10 minutes

15-20 min

• -place hands and feet in basin filled with warm water
• -clean under fingernails and toenails with organic stick, use towel to wipe the stick after each nail
• -soap, rinse and dry hands in between each finger/toe
• -clip fingernails straight across and shape with emery board
• -push back cuticles
• -apply lotion

the strong side

the weak side

scalp and work towards hair end

follow the care plan

caffeine, alcohol, drugs like diuretic and cardiac medication

• Toileting habits
• Available toilet facilities
• Disease
• Benign prostatic hyperplasia
• UTIs
• Amount of fluid intake
• Dehydration
• Activity
• Work
• Sleep

1500 ml or 3 pints a day

• Pale to dark yellow or amber, faint mineral odor, clear with no particles
• Drug therapy and foods may change urine color or odor
• Blue - Methylyn blue
• Green - Daunorubicin
• Red / Rust - Adriamycin
• Beets, blackberries, rhubarb
• Fluorescent yellow - Fluoriscene
• Carrots, sweet potatoes

urination, emptying of bladder

when person cant get out of bed

at its lowest position, nearest floor

higher up to your comfort.

loss of bladder control

• -change adult brief
• -apply condom catheter
• -for indwelling catheter: provide catheter care, empty drainage bag, change from leg bag to drainage bag

urine leaked with pressure on bladder due to exercise

sudden urgent need to void

Small amounts of urine leak from persistently full bladder. caused by diabetes, enlarged prostate or some drugs

has bladder control but cant get to bathroom in tummy

• Cannot feel urge to void resulting in predictable intervals of urine loss
• caused by nervous system disorders or injuries

More than one type of incontinence existing together

intestinal, rectal or reproductive system surgeries, physical illness

good skin care and dry garments and linens

tube used to drain or inject fluid through body opening

drains bladder and then is removed

is left in the bladder to drain urine contrantly

• -process of inserting catheter
• -used before, after and during surgery

• -collect sterile urine specimens
• -measure amount of urine left in bladder after person voids

• cover with bath blanket
• place waterproof pad under buttocks
• separate labia or retract foreskin
• give pericare
• apply soap to clean wet washcloth
• hold catheter by meatus
• clean catheter down tube about 4 inches with one stroke
• rise with clean washcloth both genitals and catheter
• pat dry
• secure catheter, coil and secure tubing
• remove waterproof pad
• cover the person

• always kept lower than bladder
• do not place on bed rails

• tell nurse
• clean hands, put on gloves
• wipe end of tube with antiseptic wipe
• wipe end of catheter with antiseptic wipe
• do not put them down or touch them after cleaning
• connect the tubes together
• discard wipes in biohazard bag
• remove gloves and wash hands

• at the end of every shift
• when changing from a leg bag to drainage bag and vice a versa
• when bag is becoming full

• -some are self adhesive or you can attach with elastic tape in a spiral fashion
• - a 1 inch space is left between penis and catheter
• never use adhesive tape to secure this! doesn't expand cuts off blood flow to penis

• useful for people who are incontinent or who just had an indwelling catheter removed
• -person used toilet/bedpan/commode at certain times and is given 15-20 min to start voiding
• -if person has catheter, it is clamped to prevent urine flow from bladder, at first only clamped for an hour, and then increased to 3-4hours. when catheter removed, voiding encouraged every 3-4 hours or as directed by care plan

good skin care

excretion of waster from the GI system

• Privacy
• Habits
• Diet
• Fluids
• Activity

brown, soft, formed, moist and shaped like rectum

• constipation: passage of hard, dry stool, slow movement result in more water absorption from fecal mass
• fecal impaction: prolonged buildup of feces in rectum, liquid feces pass around it
• diarrhea: frequent passage of liquid stools

• Encourage high fiber diet and plenty of fluid
• Ambulate often
• Assist to bathroom or bedside commode as often as requested.
• Monitor I & O accurately, describe character of stool
• Provide suppositories and enemas
• NAs are able to administer non-medicated enemas & OTC suppositories

• gain control of bowel movements
• develop regular pattern of elimination

• intro of fluid into rectum and lower colon
• used to remove feces, relieve constipation, clean bowel of feces before surgery

sims or left side lying

• for constipation
• room temp
• tip inserted 2 inches into rectum

• relieve constipation and fecal impaction
• retained for 30-60 min

surgical procedure to remove part of the intestine and create an opening in the abdomen where stool drains out

surgically created opening called a stoma

• Stoma color is purple or black
• Stoma bleeds when gently washed
• Presence of tissue sloughing
• Pouch leaking
• Blood in stool
• Pills noted in drainage
• Remarkable change in character or amount of drainage
• Burning, itching or draining around stoma
• Skin irritation
• Color change or edema in stoma
• Abdominal discomfort

stoma between colon and abdominal wall

stoma between ileum and ab wall

• every 3-7 days
• frequent pouch changes can damage skin

• good hygiene
• emptying pouch
• avoiding gas inducing food
• putting deodorants in pouch

1-2 hours later to allow adhesive time to seal

oil

partial or complete blockage of the bowel

• Incarcerated hernia
• Tumor - Within or outside of GI tract
• Adhesions
• Torsion - Bowel twists on itself
• Intussusception - Bowel telescopes on itself
• Obstipation

• Decompression - nasogastric tube inserted to relieve ab distention and vomitting
• surgery -remove obstruction or damaged portion of the intestine

• -Basic physical need
• -Social / Pleasurable - Important for optimal nutrition
• -Dietary practices - Selection, Preparation and Serving

• Increased risk for infection
• Increased risk of acute / chronic illness
• Healing problems
• Increased risk for accident / injury

process involved in the ingestion, digestion, absorption and use of foods and fluids by the body

• substance that is ingested, digested and absorbed and used by the body
• -fats 9cal/1g
• -proteins 4 cal/1g
• -carb 4cal/1g
• -vitamins
• -minerals
• -water

daily calories to maintain weight plus 3500 extra calories a week

• promote health
• reduce the risk of chronic diseases

• High in fruits/vegetables
• High in whole grains
• Fat free or low fat dairy
• 1% milk contains fat = a small serving french fries
• Lean meats - Poultry, Fish, Beans, Eggs, Nuts
• Non-saturatedfats
• Limit intake d/t high calorie content
• Low in fat, cholesterol, salt and added sugar
• Salt is leading contributor to hypertension

• Catabolized Amino Acids
• What they do:
• Tissue growth & repair
• Enzyme production

• Catabolized into sugars
• What they do:
• Short term energy
• Fiber

• Catabolized
• Fatty acids
• Triglycerides
• 3 lipid molecules attached to a glucose molecule
• Stored as fats
• What they do:
• Flavor dispersers
• Vitamin E
• Omega 3s

• Variety of precursor chemicals in the body
• Fat soluble - A,D,E & K, Stored in fatty areas of body
• Water soluble - B complex & C, Not stored and must be ingested daily

• -Calcium (Bone & tooth formation, blood clotting, muscle contraction, heart & nerve function) Found in Milk products, Green Leafies, Whole grains, Egg yolks and Legumes & nuts
• -Phosphorus (Bone & tooth formation, use of proteins, fats & carbs, muscle contraction, heart & nerve function) Found in Meats, fish, poultry Milk products, egg yolks and Legumes & nuts
• -Iron (RBC iron carrying capacity) found in Liver, meats,Green leafs, Breads & cereals** and Legumes
• Iodine (thyroid) found in Iodized salt, Seafood, Shellfish
• -Sodium* (fluid balance, nerve & muscle function) found in Almost all foods
• Canned foods, Packaged foods, Smoked foods
• -Potassium (Nerve and heart function, muscle contraction) found in Fruitsm Vegetables, Cereals, Meats and Legumes

• orange = grains
• green = veggies
• red = fruits
• yellow = oils
• blue = milk
• purple = meats/beans

• Reduce risk of coronary artery disease
• Help prevent constipation
• Help with weight management
• Prevent certain birth defects like Neural tube defects
• for 2000 calorie diet need 6 oz of grains daily

• Reduced risk for stroke, coronary artery disease, other cardiovascular diseases
• Reduced risk for T2DM
• Protection against certain cancers
• May reduce risk for renal stones
• May reduce risk for osteoporosis
• May help lower calorie intake - Naturally low in fat & calories
• for 2000 calorie diet, 2.5 cups of veggies needed daily

• Reduced risk for stroke, coronary artery disease, other cardiovascular diseases
• Reduced risk for T2DM
• Protection against certain cancers
• May reduce risk for renal stones
• May reduce risk for osteoporosis
• May help lower calorie intake-Naturally low in fat & calories
• for 2000 calorie diet, 2 cups of fruit needed

• Builds & maintains bone mass through life span
• Reduced risk of osteoporosis
• Improves overall diet quality
• 2000 calorie diet, 3 cups of milk needed daily

• 2000 calorie diet, 5.5 oz of meat/beans needed daily
• provide protein, omega 3 fatty acids and b + e vitamins, along with iron, zinc and magnesium

• saturated; solid at room temp
• unsaturated: liquid at room temp
• -flavor dispersant and source of energy
• -source of fatty acids and vitamin e
• 2000cal diet, 6tsp of oil needed daily

5% considered low and 20% considered high

2000 calories

• What are the factors affecting nutrition?
• Age - Declining taste and smell, Appetite decreases and Secretions of digestion reduced
• Culture - Food choices and Food preparation
• Religion - Restrictions on preparation and choice, All, some or none
• Finance - Malnutrition in the face of obesity
• Appetite - Many factors like Illness, Drugs, Anxiety / depression and Pain
• Personal Choice - Likes and dislikes formed in childhood and Culture and religious influence
• Body Reaction - Allergies
• illness
• disability - dysphagia, tube feedings

• Nutritional & dietary needs are met
• Diet is well balanced, nourishing, well seasoned & tasty
• Food is appetizing & attractive with an appealing aroma
• Hot food is served hot; cold food is served cold
• Food is prepared to meet each person�s needs.
• Substitute foods are offered for residents who refuse meal.
• Substitution must have nutritional values similar to food refused.

within 15 min of preparation

• Clear liquid - Foods that are fluid at body temperature, that you can see through
• Full liquid - Foods fluid at room temperature or melt at body temperature
• Mechanical soft - Semi solid foods that are easily chewed or digested
• Low fat / low salt - less than 2000 mg of sodium daily
• dysphasia diet - food thickened

• fluid intake is equal to fluid output
• adult needs 1500 ml of water daily to survive
• 2000-2500 ml of water a day for normal fluid balance

• Encourage fluids
• Fluid restriction
• NPO (nil per os / nothing by mouth)
• Thickened fluids

• measured in ML, all fluids taken measured and all urine or diarrhea measured
• kept by bedside
• totals recoded in person's chart at end of shift

• -eye glasses and hearing aids in place
• -hygiene: oral, wash hands, toilet
• -position: high fowlers in bed and 90 degrees for dining table

• -check to see if dietary card matches items on tray
• -check id of patient, match patient to tray
• -serve within 15 min, is food warm
• -remove cover, cut food, open cartons, assist as needed
• -place napkin/clothing protector on resident
• -place adaptive equipment and utensils within reach
• -measure and record intake
• -offer supplement if patient eats less that 75% of meal

• -id person
• -feed them in the order that the person prefers
• -offer fluids throughout
• -use spoon about 1/3 full
• -allow time for chewing and swallowing

on flow sheet

40 to 140 degrees, pathogens grow rapidly at this temp

clean, separate, cook and chill

explain that added salt is not allowed on the diet

3 regular means and bedtime snack

no

• on admission, then daily, weekly or monthly
• no shoes, void before, weight at same time each day, use same scale, balance it to zero

label the container, clean the peri area with towelletes, open sterile container, open labia, start to pee for a few seconds, pass container into urine, place lid on it, wipe outside of it, set on paper towel, put in plastic bag with biohazard label on it

all urine voided in a day is collected and chilled on ice or refrigerated. the first void of the day is discarded and all remaining urine is collected

fresh fractional urine specimen is used to test for glucose and ketones

• -ph: acidic or alkaline
• -glucose and ketones: glucose for diabetics and ketones for people who break down fat for energy. ie diabetics
• -for blood: hematuria

block, tarry stool, shows bleeding in stool

to find kidney stones

30 min before meals and at bedtime

disease, injury, surgery and birth defects

• any lost, absent or impaired physical or mental function
• Causes are acute (recovery completed) or chronic ( controlled but not cured).
• Disabilities are short-term ( ie fx leg) or long-term (spinal cord injury).
• The person may depend totally or in part on others for basic needs.

• To prevent and reduce the degree of disability
• Helping the person adjust

• process of restoring the person to his or her highest possible level of physical, psychological, social or economic function
• prevent further loss of function

care that helps persons regain health, strength, and independence. Persons weak and not able to perform daily functions need restorative care

• Self-care
• Elimination
• Positioning
• Mobility
• Communication
• Cognitive function

CNA with special training in restorative nursing and rehab skills

when the person first seeks care, complications are prevented like bowel and bladder problems, contractors and pressure ulcers

• promote the person's independence
• prevent decline in function

• Cardiac rehabilitation
• Brain injury rehabilitation
• Spinal cord rehabilitation
• Stroke rehabilitation
• Respiratory rehabilitation
• Musculoskeletal rehabilitation
• Rehabilitation for complex medical and surgical conditions wound care, diabetes ,burns

was the residents quality of life increased

• Protect the right to privacy. Learn and practice old and new skills in private, be able to make mistakes in private. Protect dignity and self-respect
• Encourage personal choice. Give as much control as possible. Person to be a part of planning
• Protect the right to be free from abuse and mistreatment. Staff takes time, have patience, give encouragement
• Learn to deal with your anger and frustration.
• Remember the patients frustration
• Encourage activities. Be hopeful and winning outlook. Stress person's abilities and strengths
• Provide a safe setting. Report signs of abuse
• Show patience, understanding, and sensitivity.
• Do not give pity or sympathy.

contractors and pressure ulcers

• gastroesophageal reflux disease: stomach contents flow back into esophagus
• causes irritation and heartburn, risk for barrettes esophagus which is pre cancerous
• disfunction of esophageal sphincter
• risk factors are overweight, alcohol use pregnancy and smoking

• Presence of the pouches in wall or colon
• May be fragile
• Tear causing stool to spill from colon into abdominal cavity
• Results in infection
• Abscess
• Peritonitis
• Diverticulitis is inflammation of those pouches
• risk factors - old age and low fiber diet
• treatment - antibiotics and surgery

• Abdominal pain- Usually left lower abdomen but can be anywhere
• Abdominal cramping
• Chills
• Fever
• Nausea/Vomiting
• Constipation or diarrhea
• Rectal bleeding
• Weight loss

• Assist with elimination
• Dispose of stools promptly and safely
• Give good skin care
• Encourage fluids and a high fiber diet
• Monitor I & O
• Record and report abnormalities

• hardening of bile into stone like pieces. they can get lodged in the common bile duct and block the flow of bile
• pain in back between the shoulder blades
• caused by too much cholesterol or bilirubin in bile

jaundice, fever, clay colored stool, nausea, excess gas, indigestion and ab fullness

• inflammation of the liver
• hep a: spread by fecal-oral. vaccine provided
• hep b" caused by hep b virus present in blood and body fluids
• hep c: spread by blood contaminated by hep c virus

• Inflammation of the large intestine
• Results in swelling, small sores
• Drain pus and blood

• -infection
• -autoimmune disorders
• -lack of blood flow to bowel

chronic inflammation of GI tract

• end result of chronic liver disease, results in scarring and dysfunction
• caused by alcohol abuse, hep b and c, autoimmune disease, meeds

• Easily bruised
• Blood in stool
• Vomiting blood
• Nosebleed or bleeding gums
• Bl Ascites (fluid in or swollen abdomen)
• Swelling of the legs or throughout the body
• Decreased urine output
• Abdominal pain eeding hemorrhoids
• High blood levels of ammonia
• jaundice
• clay colored stools
• fevers/ab pain

fluid in or swollen ab

inflammation of the stomach lining

avoid aspirin, treat H. pylori infection with antibiotics and acid reducer

• Abdominal pain
• Belching or bloating
• Dark or tarry stools
• Loss of appetite
• Nausea
• Vomiting
• Vomiting blood or coffee-ground like material

• inflammation of the GI tract caused by bacteria or vies
• causes dehydration

• infection occurring anywhere in urinary systems
• -urethritis - in urethra
• -cystitis - bladder
• -ureteritis - one or both ureters
• -pyelonephritis - one or both kidneys

2000 ml a day

women, mean with BPH because of residulal urine and older people

• nephrons in kidney damaged by infection
• cloudy urine with blood or pus
• back pain
• nausea

overproduction of testosterone causes it. the enlarged prostate presses against urethra which obstructs urine flow. bladder function gradually lost

• Medications to shrink prostate or relax bladder smooth muscle
• Many unwanted side effects
• Turp - carve out prostate so urethra has more room

Pathway for exit of urine after surgical removal of bladder

• cancer
• traumatic injury

• kidney stones
• risk factors: white male between 20-40, bed rest, immobility, poor fluid intake
• treatment: less than 5mm, watch an wait, antibiotics and pain meeds if stone is larger than 5mm, surgery

• kidneys fail, waste products not removed from body
• first oliguria: urine output less than 400 ml a day
• then diuresis: large amounts of urine produced
• diet hi in carbs low in protein

decreased blood flow to kidneys due to injury, MI, heart failure, burns, infection, allergic reaction

• Destruction of nephrons over a long time period
• Cure: Kidney transplant
• 75% loss of kidney function
• Waste cannot be cleared from body
• Every body system affected
• Treatments similar to acute renal failure
• Hemodialysis or peritoneal dialysis necessary

a new pathway for urine to exit the body

measuring urine output every hour

• Inability to cope with stress
• Inability to adjust to stress
• Chemical imbalances
• Genetics
• Drug or substance abuse
• Social and cultural factors

Coping with & adjusting to everyday stresses in socially acceptable ways

Disturbance in the ability to cope with or adjust to stress.

response of change in the body caused by any emotional, physical, social or economic factor

• a persons set of: Attitudes, Values, Behaviors and Traits.
• Unmet needs at any age affects personality development.
• Growth and development also affect personality development.

• Vague, uneasy feeling in response to stress.
• Anxiety often occurs when needs are not met.
• Persons with mental health problems have higher levels of anxiety.
• Signs and symptoms depend on the degree of anxiety.

• unconscious reactions that block unpleasant or threatening feelings.
• Some use of defense mechanisms is normal.
• With mental health problems, defense mechanisms are used poorly

• highest level of anxiety.
• an intense and sudden feeling of fear, anxiety, terror, or dread.
• A panic attack can last for 10 minutes or longer.

An intense fear of: Object, Situation or Activity

• Obsession: Recurrent, unwanted thought, idea, or image
• Compulsion: Repeating an act over and over again (a ritual)

• occurs after a terrifying ordeal.
• Involves physical harm or the threat of physical harm.

Reliving the trauma in thoughts during the day and in nightmares during sleep.

• Severe, chronic, disabling brain disorder involving:
• Psychosis (a state of severe mental impairment)
• Delusion (a false belief)
• Hallucination
• Paranoia (belief that someone is trying to harm you)
• Delusion of grandeur (an exaggerated belief of one�s importance, wealth, power, or talents)
• Delusion of persecution (the false belief that one is being mistreated, abused, or harassed)

• Mood or affect relates to feelings and emotions.
• Mood (or affective) disorders involve feelings, emotions, and moods.

• (manic-depressive illness) has severe extremes in mood, energy, and ability to function.
• Tends to run in families
• Usually develops in the late teens or in early adulthood
• Requires life-long management

• Depression involves the body, mood, and thoughts.
• Symptoms affect work, study, sleep, eating, and other activities.
• The person is very sad.
• The person loses interest in daily activities.
• Depression may occur because of a stressful event.
• Some physical disorders can cause depression.
• Hormonal factors may cause depression in women.

• involve rigid and maladaptive behaviors.
• Maladaptive means to change or adjust in the wrong way.
• Those with personality disorders cannot function well in society.

• The person is at least 18 years old and has poor judgment.
• The person lacks responsibility and is hostile.
• Morals and ethics are lacking.
• The rights of others do not matter.

• The person has problems with moods, interpersonal relationships, self-image, and behavior.
• Aggression, self-injury, and drug or alcohol abuse may occur.
• The person may have other mental health disorders.

• occurs when a person overuses or depends on alcohol or drugs.
• The person's physical and mental health are affected.
• The welfare of others is affected.
• Substances involved in abuse and addiction affect the nervous system.
• They affect the mind and thinking.

craving, loss of control, physical dependence, high tolerance

• Drug abuse is the overuse of a drug for non-medical or non-therapy effects.
• Drug addition is a chronic, relapsing brain disease.
• The person has an overwhelming desire to take a drug.
• The person repeatedly takes the drug because of its effect.
• Often higher doses are needed.
• The person cannot stop taking the drug without treatment.

• occurs when a person has an intense fear of weight gain or obesity.
• It occurs mainly in teenage girls and young women.
• The person believes she is fat despite being dangerously thin
• Intense exercise and vomiting are common.
• Some people abuse laxatives and enemas.
• Diuretic abuse may occur.
• Death is a risk from cardiac arrest or suicide

• Bulimia occurs mainly in teenage girls and young women.
• Binge eating occurs.
• The person eats large amounts of food.
• Then the body is purged (rid) of the food eaten to prevent weight gain.

• suicide
• Highest rate of suicide was among white men aged 85 years and older.
• Firearms was the most common method for men and women.
• More men than women die by suicide.
• Women attempt suicide more often than men do.

• Bipolar disorder
• major depression
• Schizophrenia
• Alcoholism
• Substance abuse
• Certain personality disorders

Exposure to suicide or suicidal behaviors within the family, peer group, or media reports of suicide which:

compulsion

acute confusion that is temporary

• loss of cognitive function that interferes with routine personal, social and occupational activities
• not a normal part of aging
• if changes in brain have not occurred, dementia can be reversed by removing its cause like drugs, depression, tumor, heart problems etc.

signs and symptoms of dementia with not changes in the brain

• state of temporary but acute mental confusion, sudden onset
• signals physical illness in older persons and persons with dementia

type of memory change, may develop alzheimers

• brain disease that damages nerve cells affect memory, thinking, reasoning, judgement, language, behavior, mood and personality
• gradual in onset then gets worse and worse
• 8-10 years alive after diagnosis
• more women than men have it
• 50% of people over 85 have it

gradual loss of short term memory

• wandering
• sundowning - symptoms increase during hours of darkness
• hallucinations: seeing, hearing, smelling or feeling something unreal
• delusions: false beliefs
• catastrophic reactions: extreme responses
• agitation and restlessness: meet basic needs and provide calm quiet environment
• aggression and compativeness: hitting, pinching grabbing
• screaming
• abnormal sexual behaviors: mistakes other person for loved one, can also hint at UTI, soiled underwear
• repetitive behaviors: distract person, give them a walk

• -all behavior has meaning
• -development occurs in order and certain tasks must be completed during each stage of development
• -a person may return to the past to resolve such issues and emotions
• -caregivers need to listen and provide empathy
• -don't remind patient of reality, ask them to talk about what they a reliving, like tell me about your husband, tell me about playing ball

• A disability occurring before 22 years of age is a developmental disability (DD).
• Causes of DD occur before, during, or after birth.
• Childhood illness and injuries can result in disabilities.
• Some infants have birth defects. Causes include:
• Genetic problems
• Problems with the number of chromosomes
• Problems with the structure of chromosomes

• limited in three or more life skills like
• Self-care
• Understanding and expressing language
• Learning
• Mobility
• Self-direction
• Capacity for independent living
• Economic self-sufficiency

• Have the same rights as every citizen in the United States
• Have rights protected by the Americans With Disabilities Act of 1990 (ADA) right to live, learn, work and enjoy life
• Have rights protected by the Developmental Disabilities Assistance and Bill of Rights Act of 2000

• An IQ (Intelligence Quotient) score of about 70 or below.
• A significant limit in at least one adaptive behavior- skills used to function in everyday life, to live, work, & play
• The condition being present before 18 years of age
• brain development impaired

• Persons with intellectual disabilities must be able to enjoy and maintain a good quality of life.
• Children should live in a family.
• Children should learn and play with children without disabilities.
• Adults should control their lives to the greatest extent possible.
• The right to sexual relationships, including marriage
• The right to choose birth control or to have and raise children

• DS is the most common genetic cause of mild to moderate intellectual disabilities.
• It is caused by an error in cell division.
• In DS, an extra 21st chromosome is present.
• The DS child has certain features caused by the extra chromosome.
• Many children with DS have other health problems.
• Dementia may appear in adults

small head, flat face. short wide neck, large tongue, wide flat nose, small ears, short wide hands, oval shaped slanty eyes, simian crease

• CP is a term applied to a group of disorders involving muscle weakness or poor muscle control.
• The defect is in the motor region of the brain.
• Abnormal movements, posture, and coordination result.
• It occurs before, during, or within a few years after birth.
• Causes include:
• Lack of oxygen to the brain
• Brain defects from faulty brain development
• There is no cure.

• Are premature
• Have low birth weight
• Do not cry within the first 5 minutes after birth
• Need mechanical ventilation
• Have bleeding in the brain
• Have heart, kidney, or spinal cord defects
• Have blood problems
• Have seizures
• Have fetal alcohol syndrome

• Spastic cerebral palsy- uncontrolled contractions of skeletal muscles
• Athetoid cerebral palsy- cannot control movements
• Hemiplegia - The arm and leg on one side are paralyzed.
• Diplegia means that similar body parts are affected on both sides of the body. Both arms or both legs are paralyzed.
• Quadriplegia - Both arms, both legs and the trunk and neck muscles are paralyze

• Autism is a brain disorder with no cure.
• The child has:
• Problems with social skills
• Verbal and nonverbal communication problems
• Repetitive behaviors and routines
• Narrow interests
• more common in boys

• a defect of the spinal column.
• The defect occurs during the first month of pregnancy.
• Hydrocephalus often occurs with spina bifida.
• In spina bifida, vertebrae do not form properly.
• This leaves a split in the vertebrae.
• The split leaves the spinal cord unprotected.
• Spina bifida can occur anywhere in the spine.
• The lower back is the most common site.

• The vertebrae are closed.
• The spinal cord and nerves are normal.
• The person has a dimple or tuft of hair on the back.
• Often there are no symptoms.
• Foot weakness and bowel and bladder problems can occur.

• Part of the spinal column is in a pouch or sac.
• A membrane or a thin layer of skin covers the sac.
• The pouch is easily injured.
• Infection is a threat

• Meningocele
• Myelomeningocele (or meningomyelocele)

• The sac does not contain nerve tissue.
• The spinal cord and nerves are usually normal.
• Nerve damage usually does not occur.
• Surgery corrects the defect.

• The pouch contains nerves, spinal cord, meninges, and cerebrospinal fluid.
• Nerve damage occurs.
• Loss of function occurs below the level of damage.
• The defect is closed with surgery.

• cerebrospinal fluid collects in and around the brain.
• The head enlarges.
• Pressure inside the head increases.
• Intellectual disabilities (mental retardation) and neurological damage occur without treatment.

• A shunt is placed in the brain to allow cerebrospinal fluid to drain from the brain.
• The shunt must remain open (patent).

the disability is severe and permanent

lack of o2 to the brain

physical activities involving the reproductive organs

physical, emotional, social, cultural and spiritual factors that affect a persons feelings and attitudes about his or her sex

• dress and behave like the opposite sex
• Provides emotional and sexual relief

• Belief that they are members of the opposite sex
• They often feel trapped in the wrong body.

• Broad term used to describe people who express their sexuality or gender in other than the expected way.
• The term also is used to describe persons who are undergoing hormone therapy or surgery for sexual reassignment.

• Injury
• Illness
• Surgery
• Sexual ability may change
• Most chronic illnesses affect sexual function.
• Reproductive system surgeries have physical, mental & emotional effects
• Removal of the uterus, ovaries, or a breast affects women
• In men, prostate or testes removal affects erections

• Inability to have or sustain an erection.
• Causes:
• Psychological factors
• Diabetes
• Spinal cord injuries
• Multiple sclerosis
• Prostate problems
• Alcoholism
• Heart and circulatory disorders
• Drugs and drug abuse
• Deconditioning

• Reproductive organs change with aging.
• Frequency of sex decreases for many older persons.
• Some older people do not have intercourse
• Sexual partners are lost through:
• Death
• Divorce or relationship break-ups
• Need for hospital or nursing center care
• Sexual needs / desires may not be lost
• Often needs are expressed in other ways

• Some people want the health team to meet their sexual needs.
• Often there are reasons for the person's behavior.
• Understanding this helps you deal with the matter

• Nervous system disorders
• Confusion, disorientation, and dementia
• The person may confuse someone with his or her partner.
• The person cannot control behavior.
• Drug side effects
• Fever
• Poor vision

• Sometimes touch serves to gain attention
• Masturbation may be a sexually aggressive behavior
• Soreness and itching
• Urinary or reproductive system disorders
• Poor hygiene and being wet or soiled from urine or feces
• Sometimes the purpose of touch is sexual.
• Be professional about the matter
• Ask the person not to touch you
• Tell the person that you will not do what he or she wants
• Tell the person the behaviors make you uncomfortable
• Provide the person with privacy if person becomes aroused
• Discuss the matter with the nurse

closet the privacy curtain so no one can hear them

• Illness or injury for which there is no reasonable expectation of recovery.
• Exact time of death cannot be predicted.
• May have days, months, weeks, or years to live
• Hope and the will to live strongly influence living and dying.

• Experiences
• Culture
• Religion
• Age
• Evolution expected with aging and change of circumstance.

• Pain and suffering
• Dying alone
• The invasion of privacy
• Loneliness and separation from loved ones
• Adults worry about the care and support of those left behind.
• Adults often resent death because it affects plans, hopes, dreams, and ambitions.

denial, anger, bargaining, depression and acceptance

• Physical
• Comfort measures
• Psychological
• Listen and use touch
• Touch shows caring and concern when words cannot.
• Social
• Allow family members to participate
• Do not make assumptions
• Spiritual
• Some may want to see a spiritual leader.
• Some may want to take part in religious practices.
• Provide privacy during prayer and spiritual moments.
• Be courteous to the spiritual leader.
• Handle religious objects with care and respect.

• -Vision blurs and gradually fails, May turn toward light, Darkness may frighten person
• -Speech becomes harder, Anticipate needs, Do not ask questions needing long answers
• -Hearing last function lost, Continue talking to the person and Encourage family members
• -Crusting and irritation of the nostrils can occur, Nasogastric and other tubes not uncommon
• -Circulation fails, Body temperature rises as death nears, The skin is feels cool, pale, and mottled (blotchy)
• -Change in bowel & bladder function, Urinary and fecal incontinence may occur., Constipation and urinary retention are common.

semi fowlers

• Medical prognosis of death within 6 months
• Goal to improve the dying person's quality of life.
• Focus is dying persons and their families
• Physical needs
• Emotional needs
• Social needs
• Spiritual needs of
• Not concerned with cure or life-saving measures.
• Pain relief and comfort are stressed.
• Hospice services include:
• Hospice training for the health team
• Follow-up care and support groups for survivors
• Support for the health team

• Consent needed for any treatment.
• Person makes care decisions when able
• The Patient Self-Determination Act and OBRA:
• People have the right to accept or refuse medical treatment
• People have the right to make advance directives
• An advance directive is a document stating a person's wishes about health care when that person cannot make his or her own decisions.

• Patient generated document
• Patient instructions in life sustaining / maintaining measures.
• Not to start measures that prolong dying
• To remove measures that prolong dying

• Gives health care decision power to another person.
• Person may decide on Do Not Resuscitate (DNR) or No Code orders
• DNR/No Code means that the person will not be resuscitated.

• Movement, muscle tone, and sensation are lost.
• GI functions slow down.
• Circulation fails.
• Body temperature rises.
• The respiratory system fails.
• Pain decreases as the person loses consciousness.

• Nurses give postmortem care
• NA may be asked to assist.
• Postmortem care begins after death prounounced by doctor
• Postmortem care is done to maintain a good appearance of the body
• Family may want to view body prior to going to funeral home

• Stiffness or rigidity of skeletal muscles that occurs after death
• Develops within 2 to 4 hours after death
• The body is positioned in normal alignment before rigor mortis sets in.

• An autopsy is the examination of the body after death
• Follow agency procedures when an autopsy is to be done
• Postmortem care may be delayed or canceled

temporary

use touch and listen

good body aligment