Handouts-Section 2

 

Mobility and Ambulation Techniques

Safety Precautions Wheelchair/Geriatric Chair Safety

• Check brakes
• Check for flat or loose tires
• Make sure wheel spokes intact and not damaged
• Have Residents feet on footplates
• Push chair forward when transporting/back into elevators
• Lock both brakes before transferring/ and when chair not moving
• Do not stand on footplates
• Ensure w/c accessories in place per POC
• Remove armrests for transfers if removable
• Move footrests out of way or remove for transfers
• Clean w/c per facility policy
• Keep blankets and tubing away from wheels
• Use w/c that has been designated for that Res.

Types of lifts and Purpose

• Manual or hydraulic lifts
• Electric lifts
• Purpose: used to move Res. Who cannot assist and/or who are too heavy for staff to lift safely

Safety When Using a Lift

• Must be trained to use lift
• Ensure lift in working condition
• Check sling, chains, straps, and hooks in good repair
• ALWAYS operate lift with two staff
• Lock all brakes, bed, w/c and/or lifts
• Securely fasten all straps and slings
• Raise Res. Slowly
• Reassure Res. While transferring

Safe Use of Walkers, Canes and Crutches

• Device should have skid proof tips
• Resident wears Non-skid socks/shoes
• Walkers: ensure all four legs solidly on floor taking one step at a time
• Crutches: space between axilla and top of crutch. Elbow flexed slightly and weight supported on palms
• Cane: quad cane (more stable) ensure four feet put on floor.

Safety Techniques When Walking the Resident

• Res. Wears Non-skid socks
• Change Res. Position slowly to avoid dizziness
• Assist on Residents weaker side
• Residents use strong sides to hold rails
• For visually impaired walk slightly ahead and have them hold your arm. Explain hazards in walking path
• Use transfer belt (gait belt)
• Help the Resident stand, grasp the gait belt at each side
• Stand at the Residents side while they gain balance
• Encourage Resident to stand erect
• Walk to the side and slightly behind, while holding onto gait belt
• Encourage normal walk pattern, heel strikes first

Promoting  the Residents Independence

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Physical Losses

• Physical health
• Reduced mobility
• Sensory limitations
• Activities of Daily Living

Psychosocial Losses

• Previous Lifestyle
• Family members and loved ones
• Personal property

Losses When Entering LTC Facility

• Choice of living alone
• Choice of Roommate
• Choice of Room Location
• Foods
• Transportation
• Eating
• Wake/Sleep time
• Losses of family and friends
• Pets

Techniques to promote independence

• Find out how Resident coped with loss prior to LTCF
• Encourage use of positive coping skills
• Use strengths that counterbalance loss and adjust to environment
• Encourage to participate in ADL’s
• Assist with participation in Resident and family activities

Choices

• When to eat
• Where to eat
• What to eat
• What to wear
• What activities to attend
• Which Residents to associate with
• When to sleep
• When to do daily care

Resident Rights

• Residents in LTCF have rights
• Listed in the ORBR (Ohio Resident Bill of Rights)
• Rights must be read and signed by each Resident and/or legal rep. and included in chart
• Rights must be posted at LTCF

Resident Rights NA can most directly help to ensure

• Voting
• Privacy
• Confidentiality
• Personal choices to accommodate individual needs
• Grievances or complaint resolution
• Participation in activities
• Security of personal possessions
• Freedom from abuse, neglect, mistreatment, misappropriation
• Elimination of need for physical or chemical restraints

 

Ways to respect residents’ rights

• Know the ORBR
• Practice respecting residents’ rights
• Encourage Residents to exercise their rights
• Report infractions to the charge nurse
• Report to the nurse when rights conflict with safety issues

Observational Skills

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Importance of making observations

• Can alert you to possible changes
• Observe continuously during Resident care. Be alert at all times

• Types of data: subjective and objective

Observation Techniques

• See: Changes you see i.e. skin rashes, redness, edema, blue lips, bruise etc.
• Feel: Changes you feel, i.e. fever, pulse, coldness of extremity
• Hear: Changes you hear, i.e. breath sounds, Residents complaints
• Smell: Changes you smell, i.e. odor of urine, drainage from a wound, smell of breath

Observations during care, compare to previous day’s observations

• General appearance: tidy, untidy?
• Alertness: confused, drowsy?
• Activity level
• Color of skin, mouth, fingernails
• Condition of breathing: easy, labored
• How Resident manages eating, drinking, elimination?
• What is his/her mood/behavior

Recognizing Changes in Body Functioning

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Specific visual changes that may accompany aging

• Reduced ability to focus vision
• Decreased sharpness of vision
• Loss of peripheral vision
• Decreased ability to acclimate to darkness
• Poss. Impairment of color vision from cataracts
• Sensitivity to glare

Warning signs of vision problems

• Increased trouble with coordination i.e. reaches for things inaccurately
• Squinting when looking at things
• Choosing odd color combinations for clothes
• Walking hesitantly/ bumping into things

Diseases causing  visual impairment

• Cataracts
• Glaucoma
• Blood vessel changes damaging the retina from DM, HTN
• Stroke (CVA): may remove part of vision field

Environmental safety for visually impaired

• Keep objects in same place each day
• Keep surroundings uncluttered
• Good lighting, avoid glare
• Large print on signs; black on white
• Keep doors open or shut
• Wear glasses

Care for the visually impaired

• Ask Resident what they can see
• Use normal voice tone
• Identify yourself before touching resident
• Provide help with activities PRN i.e. TV, reading
• Ensure resident can reach furniture or wall
• Care of eyeglasses: wearing correct glasses, clean and fit well, store properly, assist resident with glasses
• Assist with walking

Hearing changes with aging

• Reduced ability to hear high-pitched sounds
• Reduced acuity

Warning signs of hearing impairment

• Speaks louder than normal
• Asks for things to be repeated
• No reaction to sounds out of visual field
• Gets irritable with situations where good hearing needed
• Seems confused or withdrawn
• Increase volumes of TV or radio
• Covering for not hearing

Ways to communicate with hearing impaired

• Speak clearly, slowly, facing Resident
• Use body language, touch
• Turn off background noise
• Do not stand in a glare

Use and care of hearing aids

• Assist with wearing device correctly
• Check to ensure hearing aid is functioning
• Care of hearing aid: replace batteries, clean according to instructions, notify nurse if not functioning, and store as per directions

Actions to prevent injury to Resident with impaired sense of touch

• Protect from injury
• Check for potentially harmful situations (heat, cold and sharp objects)
• If unable to sense or move part of the body, check and change position to prevent pressure

Loss of taste and smell, observe for behavioral changes

• Diminished appetite
• c/o food is tasteless
• Resident may be adding more salt, pepper or sugar
• Unaware of body odor

Loss of taste and smell, ways to assist resident

• Encourage good oral hygiene
• Provide foods with a variety of tastes/textures
• Use foods that are visually appealing
• Assist as needed (PRN) with personal hygiene

Physiological/resulting changes in GI tract r/t aging process

• Decreased motility
• Decreased digestive secretions
• Fewer specialized cells to absorb food/nutrition
• Loss of sphincter control
• Worn down or missing teeth

Special care of Resident with digestive disorder

• Special diet (low fiber, low spices, low fat)
• Food in a special form (mechanically soft or pureed)
• Supplemental feedings &/or multiple small meals
• Allowing adequate time for eating
• Monitoring weight
• Positioning techniques(elevation of head of bed)

Reproductive system disorders

• Vaginitis: inflammation/infection of vaginal lining that causes foul smelling drainage and irritation
• Benign Prostatic Hypertrophy (BPH): enlargement of the prostate gland that may impair the outflow of urine. Causes hesitancy in starting of flow, decrease size and force of stream

Musculoskeletal system changes affected by age

• Osteoporosis: minerals leave the bone. Bone becomes brittle and may lead to fractures of the spine, hip and wrist
• Arthritis(osteoarthritis): inflammation of joints d/t the aging process can affect all parts of the body

Posture in frail elderly residents

• Head and neck are flexed slightly forward
• Eyes look down
• Spinal column is flexed forward and shortened
• Hips and knees are slightly flexed
• Small shuffling steps are taken
• Unsteady balance may be result of reduced strength of muscles

Musculoskeletal: ways NA can assist resident

• Encourage as much activity as possible within the limits of pain and disabilities
• Prevent falls and injury

Recognizing signs and symptoms of common diseases

• Systems reviewed: cardiovascular, respiratory, endocrine, urinary, nervous system

Cardiovascular: changes d/t aging

• Heart pumps less efficiently
• Heart cannot accommodate to meet for increased needs
• Arteries lose elasticity
• Blood pressure may increase
• Blood flow to brain/organs may decrease
• Veins have decrease ability to return blood to heart

Cardiovascular: consequences of system changes

• Decreased ability to tolerate great amounts of activity
• Changes in circulation affect blood pressure/ fluid balance
• Dizziness from abrupt position changes
• Discoloration ,coldness and swelling of legs with decreased circulation

Cardiovascular: NA actions

• Pace residents activity, allow rest periods
• Be aware of dietary restrictions
• Assist to change positions slowly, report to nurse if dizziness occurs
• Remove/apply anti-em hose if ordered
• Be alert of any changes and report them to the nurse

Cardiovascular: common diagnosis

• Hypertension (HTN)
• Myocardial infarction (MI)
• Coronary artery disease (CAD)
• Congestive Heart Failure (CHF)
• Peripheral vascular disease (PVD)

Respiratory: Changes d/t aging

• Lung capacity decreases
• Ability to cough is less effective
• Shortness of breath (SOB) on exertion
• Airway size decreases

Respiratory: consequences of changes

• Shortness of breath(SOB)
• Infections
• Choking
• Fatigue-activity intolerance

Respiratory: NA actions

• Position comfortably, usually upright
• Keep personal items within ease of reach, i.e. TV control, phone etc.
• Be aware of dietary restrictions
• Pace activities, allow rest periods
• Follow policies regarding oxygen use
• Report any respiratory changes to nurse
• Good infection control, calm and supportive

Endocrine system: changes in elderly

• More prone to problems with water and electrolyte balance
• Dehydration most common water and e-lyte imbalance
• Vitamin deficiencies common
• At risk for under nutrition
• Type II diabetes mellitus (NIDDM) more common in elderly with upper body obesity
• Residents with DM have greater risk of hypothermia, probably d/t vascular disease
• Reduce effectiveness of sweating in cooling the body, can lead to hyperthermia

Endocrine: consequences of system changes

• Causes of fluid imbalances, illness, hospitalization, use of medication and extremes of temperature
• Dehydration, can cause altered mental status changes, lethargy, lightheadedness/syncope, dry mucus membranes, hypotension, poor skin turgur
• Vitamin deficiency: causes cognitive impairment, anemia, poor wound healing, increase infections
• Under nutrition: causes fatigue, pressure sores, decreased strength, infections, hypotension and edema to lower extremities
• Mild hypothermia is medical emergency and should be monitored in hospital
• Hyperthermia: causes heat cramps, heat exhaustion and heatstroke
• Diabetes mellitus: increase risk of macrovascular disease, can lead to stroke, CAD, skin breakdown, infection , retinopathy, nephropathy, peripheral neuropathy, impacted by years of poorly controlled DM

Diabetes: hyperglycemia s/s

• Hunger
• Weakness
• Rapid weak pulse
• Headache
• Slow labored breathing
• Thirst
• Sweat fruity breath
• unconsciousness
• Dry skin
• Flushed cheeks
• Abdominal pain

Diabetes: hypoglycemia s/s

• Shakiness
• Hunger
• Weakness
• Cold/clammy
• Low blood pressure
• Rapid pulse
• confusion
• Nervousness
• Numb lips/tongue
• unconsciousness

Endocrine: diabetes NA actions

• Monitor fluid intake
• Provide appropriate diet and watch food intake
• Monitor for s/s of hypoglycemia or hyperglycemia
• Check feet, lotion feet daily, NEVER cut nails (toes or fingers)
• Check to see if shoes fit well
• Be alert to skin changes/breaks in skin and notify nurse
• Be aware of body temperature changes and notify nurse

Urinary system: changes in elderly

• Urinary system includes: kidneys, bladder, ureter, urethra
• Kidneys decrease in size
• Urine production less efficient
• Less bladder capacity and increased frequency
• Kidney function increases at rest
• Weakened bladder muscles cause leaking
• Enlarged prostate causes dribbling and retention

Urinary system: consequences of system changes

• Incontinence:  unable to make it to bathroom and has accidents
• Urinary tract infections (UTI): very common, symptoms : dysuria, frequency, flank pain, fever, confusion, cloudy/bloody urine, foul odor
• Skin irritation r/t incontinence causing infections or pressure sores

Urinary system: NA actions

• Encourage liquid intake
• Record resident voiding
• Assist with bathroom as per POC
• Be alert to urinary problems and report

Nervous system: changes in elderly

• Nerve impulses slow impacting speed, balance, coordination and fine motor skills
• Nerve terminals (provide info. To brain about movements) deteriorate and impact balance/coordination
• Deep sleep shortened
• Brain cells lost, intelligence remains unless disease impacts
• Decreased sensitivity of nerve receptors (touch)

Nervous system: common disorders

• CVA or stroke-destruction of a portion of brain tissue
• Parkinson’s disease-chronic, progressive degenerative Dz. Producing muscle problems i.e. tremors
• Seizures-brain malfunction that results in convulsions
• Alzheimer’s disease-progressive decline in cognitive function
• Dementia-group of diseases sharing a gradual onset, global decline in intellectual capacity and performance/progressive social incapacitation

Nervous system: consequences of changes

• Responses slower and decrease blood flow to brain increasing risk for falls
• Sleep patterns change, have harder time falling asleep resulting in fatigue
• Decreased sensitivity (touch) at risk for injury
• Consequences of stroke: increase sleep problems, trouble with feeding and eating, incontinence, confusion, falls and skin breakdown. Depression is common after a stroke.

Nervous system: NA actions

• Provide safety for residents
• Encourage activity as tolerated
• Prevent injury to paralyzed parts
• Consider resident first, disease/ condition second
• Assist with daily functioning i.e. eating, feeding, toileting etc.

 

 

 

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