Monica Romanescu

Know the meaning of the words:

Calorie Urine Absorption

Carbohydrate Breathing Inflammation
Incontinence Irritation
Fiber
Lungs CVA
Lozenge
Respiration MI
Asepsis
Impairment CSF
Germ Immobility COPD
Paralysis Paralysis
Posture Autism
Sterilization
Capsules Down Syndrome
Caring Lozenges Hydrocephalus
Dominant Milliliters Thrush
Empathetic Bleach TB
Detergent TIA
Sensitive
Lotion HIV
Blood
Soap Hepatitis B
Incision
Stool Abrasion tablet
Malignant melanoma: deadly skin cancer

other skin cancers (squamous cell carcinoma, basal cell carcinoma) grow
slower, are less aggressive and more treatable.

Melanomas

Malignant Melanoma
Tumors
 Malignant: it means bad
– fast growing, multiple tumors (cancer)
• Chaotic cell growth:
 Benign: it means mild
- slow, single tumor (not cancer)

Brain cancer, spread from lungs (secondary tumors).

Advanced stage, treatment will be comfort measures: (pain
relief, prevention of complications, rest, etc.)

The secondary growths (orange-colored) are called metastasis.

In your textbook, there is a picture of a benign
tumor in the brain.
TRUE OR FALSE ?

There is no ‘benign’ growth in the brain.

 In your textbook, there is a picture of a benign tumor in
the brain.

TRUE OR FALSE ?
There is no ‘benign’ growth in the brain.

TRUE
Anything that grows under the skull crowds and squishes brain matter,
creating whole-body ill effects.

The tumor might be benign, but the effect in the brain & body is not
mild.
Causes/Risk factors:
• Genetics

• toxins

• Radiation

• Lifestyle factors: i.e.: smoking, obesity

high-sugar diet, high insulin levels
• Other, unknown causes ?????

Most cancers can only use glucose for energy, and there is research
showing that a low carbohydrate diet is a good diet for some cancers.
Brown: not for the test, just good to know
Symptoms:

Depend on the part of the body affected, size of tumor, and stage of disease
• Growth of a mass crowds other tissue: pain

• Growth might be felt, especially if superficial lumps, masses

• New growths hurt other tissues bleeding

• Lung cancer affects respiratory function cough

• Blockage of bowels constipation/ diarrhea/ indigestion

• Blockage of urinary tract dysuria/ blood in urine

• Change in color of moles/ birthmarks

• Itchy, bleeding, red skin

Treatment for Cancer:
Ideally started early
 Surgery
 Chemotherapy
 Radiation therapy
 Immunotherapy
Colostomy: watch the video first:
[Link]

• What color is the stoma?

• How often do you think she might change it?

• When is changing a bag necessary? What can happen if she delays

changing for too many hours?

• Does she wash around the stoma? Does she dry?

• Does she use deodorizer? Why?

• As a PSW, will you need to put on gloves? Regular or sterile?

Colostomy:

• Will her diet influence the frequency & consistency of her stools?
What should she do if she had any concerns regarding her diet?

• She is very young; can she still develop skin breakdown?

• She discards the stoma bag, as will most of your clients.

• Some clients will reuse their colostomy bags; that means you will
need to rinse the colostomy bag with water and re-apply it.

• An ileostomy is an opening in which part of the bowel? Is that part

of the small or large intestine?
More on food:

If your ct. has high cholesterol, what foods will she limit?

• Which food from those in the picture is high in

cholesterol & saturated fat? skim – no fat.

If your client has diabetes, his diet will be restricted in all below:

Calories
 More on feeding
At my age, I have a decreased cough reflex.

Cough reflex is a defense mechanism.

If your food goes downs the windpipe, you will cough it out before you
know it. That protects you from chocking & suffocating.

My decreased cough reflex puts me at high risk of chocking and its

consequences (suffocating).

If you notice I can’t speak and my lips turns blue, what is the first think
you do?

Call for help &Heimlich manoeuver

More on aging

At my age, do I produce more or less saliva?

Does my body produce more of anything?

Does my peristalsis increase? (what is peristalsis?)

Does anything increase at my age?

Do my senses (such as smell, taste, touch) change? How?

How does my metabolism change?

Do I need more or less calories than you do?

What nutrients should I get enough of?

I have Arthritis

What do you think will help me?

• Warm applications (to relax muscles, relieve

pain and promote blood flow)

• Range of motion exercises (to lubricate joints)

• You (with ADLs, etc)

Treatment:
• Tylenol/ Anti-inflammatory meds,
• heat & cold applications
• ROM
• Joint replacement surgery – arthroplasty
Plastic surgery – reconstructive surgery
Arthritis comes in a few kinds:

• Osteoarthritis OA wear & tear

destruction of cartilage that happens with age and wearing away

• Rheumatoid arthritis RA autoimmune

the immune system attacks the connective tissues in the body in
joints & more (lungs, heart, eyes)

• Gout metabolic arthritis

painful deposits of uric acid, a food metabolite
Osteoarthritis OA (destruction in cartilage)
• Cartilage – cushions the ends of the bones
• What body systems are affected by osteoarthritis?
• Osteo(in bones)arthritis – the most common form of arthritis
• Affects weight-bearing joint (knees, hips, spine) & fingers
• Although not considered autoimmune, OA may respond to diet changes
(i.e: no wheat), which means it might have an autoimmune component
Rheumatoid Arthritis: Autoimmune;
• the immune system attacks the body
• Connective tissue in: joints, heart, lungs, eyes, & more also destroyed
 Gout: metabolic arthritis

• Uric acid in joints & tendons

• Sudden pain, redness, swelling, stiffness.

• Treatment: icepacks, pain & anti-inflammatory meds, diet

• Sources of Uric acid:— liver, meat, beans & peas, mushrooms, sugar
Remember osteoporosis?

• Which of the two bones is at higher risk for fractures?

• Can I break a bone (such as my hip) before I fall/ for reasons other
than falling?
More Osteoporosis

Bones become porous & brittle b/c of loss of bone matter (e.g.: Ca)

Risk: age: old

sex- women (postmenopausal)
activity level – sedentary

How can it be prevented?

•Exercise (weightbearing/ resistance)
•Sun exposure
•Good diet (real food, avoid sugar)
Fractures:

• Break in the bone closed fracture open fracture

simple fracture compound fracture

Cause: accidents/ falls & weak bones (osteoporosis, cancer)

Treatment: surgical reduction + immobilization

traction
monitor for complications
I have a cast; what can go wrong?

How do you check for excess pressure on my leg?

What are some signs my cast is too tight?
Can I get an infection?
What are some signs of infection?

My cast is wet. Will it dry if you cover it in plastic?

Does anything dry faster covered in plastic?

Yes, stupid questions do exist….

Traction • Follow care plan
• Good alignment
• Ct. has to lie on his back
• Do not touch the weights
• Assess cast
 Hip Fractures

• Follow Care Plan

Good (abducted hip)
• Ct should not lie on operative side
• Keep affected leg abducted (place pillow between legs)
• Prevent external rotation of hips (turning outward)
• Firm chairs only, straight back
• Ct should not cross legs
• Artificial hip joint can dislocate with adduction/ internal rotation/
exaggerate hip flexion (like sitting in low seats).

BAD: low seat external rotation

Amputation

Removal of an extremity

• Traumatic – by accident
• Surgical – performed in OR on a severely damaged limb (MVA)
• Surgical – performed to remove cancer, gangrenes (like diabetes foot)
Gangrene: tissue death (diabetes, frostbite, infection)
• Prosthesis – artificial limb
• Phantom limb pain – pain in the amputated limb (b/c of irritated nerves in the
stump)
Prosthesis gangrene phantom limb pain
It’s not contagious

I am not intellectually challenged because of my Epilepsy

The electricity in my brain goes haywire once in a while (b/c of brain

injuries/ infections/trauma/chemical imbalance in the past)

I might have an aura (symptoms that precede the seizures)

If I take my medication, it will control my seizures

My seizures can be either partial or generalized

Cerebrovascular accident/ stroke:

Blockage of blood circulation/ bleeding in the brain

Possible consequences:
hemiplegia: left or right paralysis (hemi – half; plegia- paralysis)
Paralyzed part- in grey

Quadriplegia: paralysis in arms, legs & trunk (quadri-four)

What symptoms of stroke do you remember?

If I had a stroke, what would be some of my emotional responses?

Parkinson’s

• Drooling, pill-rolling and shuffling gait are some

of my symptoms.

• My symptoms are more severe when I am tired

• Stress and anxiety might increase my tremors

• I might become depressed and withdrawn

Cause: chemical imbalance (insufficient Dopamine- a neurotransmitter)

Multiple Sclerosis

Do you remember Courtney? [Link]

TRUE OR FALSE ?
Multiple sclerosis symptoms are characterized
by exacerbations and remissions.

Exacerbation- getting worse

Remission – getting better
 Do you remember Courtney?
[Link]

TRUE OR FALSE ?
Her symptoms are characterized by exacerbations & remissions

TRUE
In early in MS, symptoms can come and go. The severity goes
up and down with time, with a ‘down’ trend.
Famous people diagnosed with ALS (Amyotrophic Lateral Sclerosis)/ Lou
Gehrig’s Disease
ALS/ Lou Gehrig’s:

• nerve cells are gradually destroyed

• loss of muscle control
• hands / fingers usually affected first
• eventually all muscle control lost
• ability to move/ speak/swallow/ breathe
• client alert, intelligence not lost

Steven Hawking communicates through a computer, has a

tracheostomy and he is confined to a wheelchair.
 Spinal Cord Injury

Maggie (Million Dollar Baby) was pushed and her neck fell at high speed over a chair.
How do you think this might have affected her?
Spinal Cord Injury

paralysis related to spinal cord injury

Spinal Cord Injury

How do you think Maggie was affected? Chose from below:

Blue: normal
Grey: paralyzed
tetra/ quadri- four
para- legs/ lower body
Hemi-half

/quadriplegia

A: Quadriplegia.
Was the injury up or low on the spine?
Remember: the higher the injury, the biggest the effect (more muscles affected)
Hemiplegia is a result of stroke, which usually affects one hemisphere (half brain)
Remember the eye?
What can go wrong?
Match the following:

• Clouding of the lens

• Destruction of blood vessels
• Excess pressure in the eye
• Breakdown of the macula

Macular degeneration; glaucoma; diabetes retinopathy; cataract

1. Cataract: Clouding (blurry vision)
a) Affects mostly elderly people
b) Is characterized by changes in the eye lens (clouding; the lens is normally
transparent)

2. Diabetes retinopathy:
a) Is caused by changes in the blood vessels that supply the eye
b) It can cause blindness
1. Glaucoma: Tunnel Vision
Excess pressure in the eye

2. Macular degeneration (most common cause of blindness in middle & old age):
breakdown of the macula (central part of the retina); central vision most affected
Retina – inner layer of the eye, sensitive to light.
• [Link]

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What body systems affect O2 intake & O2needs?

• Respiratory: airways, air sacks, air exchange

• Cardiovascular: blood flow, red blood cells
• Nervous: Brain respiratory centers, nerve fibers
Age: with age, respiratory muscles become weak, lungs lose elasticity & # of
alveoli, coughing is more difficult, cough reflex is decreased.
More on O2 needs

• Exercise, pain, fever, anxiety, increase O2 needs; remember stress &

hyperventilation?

• Alcohol, drugs & meds (like morphine) can depress the respiratory
center in the brain
What supports and what harms breathing & O2 transport?

• Smoking & pollution can be harmful to your respiratory system

• Allergies can result in inflamed of airway & difficulty breathing

formation of
red blood cells

• Nutrition has a very important role in supporting O2 transport.

Which nutrients contribute to formation of red blood cells?
Respiratory patterns: fast

Oximeter: normal O2 saturation

• Normal: 12-20/minute, regular, effortless

• Tachypnea – fast and shallow breathing not normal

• Hyperventilation – fast and deep (fever, infections) bad

• Kussmaul – fast and deep breathing the worst

the body needs more O2 b/c of altered internal conditions: diabetic ketoacidosis
Respiratory patterns: slow

• Bradypnea – slow breathing not normal

• Hypoventilation – slow shallow (obstruction: asthma, pneumonia) Bad

• Dyspnea – difficulty breathing – heart disease, anxiety bad

• Cheyne –Stokes – hyperventilation, hypoventilation & apnea the worst

(agonic respiration/ deep sleep)

• Apnea- not breathing Dead

You get into your client’s room and you notice he is not breathing; what do you
do?
Terminology

• Hypoxia: insufficient O2 in the tissues

• Hypoxemia: insufficient O2 in the blood

• Cyanosis: blue color (lips, nail beds, skin, gums) b/c of hypoxemia

• Orthopnea: inability to breathe while lying down; sitting to breathe

• Tracheostomy: cut in the trachea (windpipe)

Orthopnea

Tracheostomy
Oxygen administration

• As a PSW, can you start O2?

• What precaution should you take when your client has O2?

• Are you using an electric machine to shave a client who receives Oxygen
therapy?

• Can your client smoke while oxygen is running?

 Urinary tract infection

Risk factors:
• Gender: female (why? What do germs like? Where does a woman’s
urethra ends compared to a men’s?)
• Men with enlarged prostate
• Age: older (how does age affect risk of infection?)
• Urinary catheters

What are some symptoms you can think of ?

Symptoms:
• Dysuria : painful urination, usually burning pain
• Abdominal pain
• Urgency: frequent, small amounts (oliguria; olig- scant/ small)
• Changes in smell, hematuria
• Fever, chills
• Confusion if I am old

Treatment: Antibiotics
Infections in the urinary system/ UTIs

• Cystitis: inflammation of the bladder

• Pyelonephritis: inflammation of the pelvis or kidneys

Symptoms:
 Liver Conditions

………..

Common symptoms of liver conditions:

- nausea/ vomiting
- jaundice
- change in color of stool (clay) and urine (orange)
- fatigue

Common treatment strategies:

-rest
-low fat, bland diet
Liver Conditions: cholecystitis

………..

Cholecystitis – inflammation of the gallbladder; possible gallbladder

stones (gallstones)

Symptoms: - severe abdominal pain (severe pain is usually associated

with stones: think kidney stones)
- nausea/ vomiting
- jaundice
Liver Conditions: hepatitis & Cirrhosis

To my early demise!
Hepatitis – inflammation & scarring of the liver
Causes: viral infection (from Hepatitis A to Hep G) or alcohol

Cirrhosis:
• Result of chronic live damage (hepatitis, alcohol)
• Scar tissue replaces normal tissue & impairs liver function
• Symptoms: jaundice, large liver, fatigue, weight loss, fluid in the
abdomen
• No cure
Inflammatory bowel diseases

• Colitis chronic inflammation fever

of the colon abdominal pain
ulcerations: rectal bleeding
Treatment: diet (low carb), surgery.

• Crohn’s Disease chronic inflammation abdominal pain

of the GI tract diarrhea/ bloody diarrhea
No cure; symptom treatment. weight loss

Assess, record & report changes in symptoms.

Respiratory Disorders

Glucose monitoring: before insulin administra

• Without insulin, my body cannot use glucose for energy

P: [Link]
A: [Link]
COPD: [Link]
A: [Link]
TB: [Link]
• High blood glucose during pregnancy
• After delivery, blood glucose comes back to normal
• Increased risk of Type 2 Diabetes later in life
For many women, pregnant or not, a vaginal/ yeast infection is the first sign
of diabetes. Sugar in urine attracts yeast.
Symptoms of diabetes

• Polyuria (pee a lot)

• Hungry, thirsty
• Fatigue

• Weight changes ( )
• Slow healing wounds

• Vision impairment
• Loss of sensitivity (feet)
Complication of Type 2 D related to glucose levels:

Low blood glucose (acute) High blood glucose (chronic)

Acute Complications: Hypoglycemia (low blood sugar)
It’s an emergency! (give me some sugar fast!)

• Hypoglycemia usually after medications & missed meals

• Insufficient glucose to brain can lead to loss of consciousness
• Hypoglycemia after insulin is very dangerous; call for help/ give
glucose to client
 Diabetic ketoacidosis: it’s an emergency!

The person with Diabetic Ketoacidosis presents like he is drunk: tired, drowzy, dizzy, smelly,
Nauseous.
 Diabetic ketoacidosis: it’s an emergency!

The person with Diabetic Ketoacidosis presents like s/he is drunk: tired, drowzy, dizzy, smelly,
nauseous. They also pee a lot of this sugar – dehydration.
Assist clients with hypoglycemia/ ketoacidosis
Matters of the heart

Heartburn – where does the burn come from?

•GERD (gastro intestinal Reflux Disease).
•Cause: relaxation of the stomach sphincter.
•Stomach acid goes up on the esophagus: sour taste, burning &
belching

Precipitating factors:
•Large meals
•protein-rich meals
•fatty meals
•Lying down after meals
Matters of the heart: hypotension

Hypotension: How low is too low? (less than 100/60)

My BP is 90/55 lying down; what if I get from lying to sitting suddenly?

What could happen if I have a long, hot bath?
What could happen on a hot summer day if I sweat heavily?
What can happen during a bowel movement?
More matters of the heart: blood clots

Thrombus: blood clot in a blood vessel

Embolus: traveling blood clot

What can go wrong if I get a blood clot in my coronary artery?

What happens if I get a blood clot in my brain?

Activity can prevent blood clots; review risks of prolonged bedrest.

More matters of the heart

Hypertension: How is HBP diagnosed? (over 140/90 x 2)

Causes:
• narrow, inflexible arteries, that comes with age
• Medical conditions: Diabetes, kidney disorders, & more
Hypertension - symptoms:
• Initially, there is none (the silent killer)
• Later: headache, blurred vision, dizziness, depending on complications

Risk Factors:
• genetics, age, ethnicity
• obesity/ diabetes
• alcohol/ smoking
• repeated stress
More matters of the heart

HBP Complications

• Enlarged, weak heart (congestive heart)

• Pressure on blood vessels: hemorrhagic stroke, MI

• tissue damage (eyes, kidneys)

 More of the heart
Coronary Artery Disease:
1. Angina (pectoris) – is there any permanent heart damage? (NO)

2. MI: is there any permanent heart damage? (YES).

Angina vs. MI: Questions to ask me:
• Do I have any other symptoms?
• Has it happen to me before?
• Does it go away if I rest?
• Do I take Nitroglycerin for angina?
• Does it go if I take nitroglycerin now?
More heart

Congested heart failure: overstretched, weak pump that cannot do

its job properly.
Blood backs up: excess fluid upstream from (or before) the weak heart.
Left-sided heart failure

Think about the left heart:

Where is the blood coming from? Lungs

Where does it go? Body

Like a traffic jam, an inefficient heart does not allow blood to easily go
through. Blood backs up, and there is not enough blood supply forward.

In left side heart failure, fluid builds up in the lungs, and has a hard time
going to the aorta/ the body. What will the symptoms be?
More heart

In left side heart failure, fluid builds up in the lungs: difficulty breathing
(like drowning from the inside), and fatigue.
Right-sided heart failure

Think about the right heart:

Where is the blood coming from? body
Where does it go? lungs

Like a traffic jam, an inefficient heart does not allow blood to easily go
through. Blood backs up, and there is not enough blood supply forward.

In right side heart failure, fluid builds up in the body, and has a hard time
going to the lungs. What will the symptoms be?
More heart

In right side heart failure, fluid builds up in the body: swelling (edema)
in the lower body, especially the legs, and fatigue.

One-sided heart failure will progress to global heart failure.

Heart valves (don’t memorize the names)

Q:What are valves?

mitral - left (or bicuspid – two cusps)
tricuspid - right - three cusps
A: doors in the heart that open to allow blood flow
When listening to a heart sound, you hear the closing of the valves.

Valve: device controlling the passage of fluid /air through

a pipe/ duct, allowing flow in one direction only.
Valve disorders: (not covered in textbook)

1. Stenosis – narrowing of the valve; increases the workload of the heart

2. Prolapse –displacement of the valve; small amount of blood ‘leaks’ back

3. Insufficiency – regurgitation of blood b/c the valve does not close properly;
part of the blood flows backwards

Symptoms: angina, SOB (shortness of breath), swelling b/c of blood backing up

Treatment: diuretics (to decrease swelling), surgical reconstruction of valve.

Cardiac Arrest: what it is and what do you do?

• Client’s heart stopped beating

• Call 911/ a code (blue)
• Start chest compressions; stop when helps arrives/ you are utterly
exhausted
• Every second counts
• What if your client is DNR?

Codes: examples
• Code red: fire
• Code blue: cardio-respiratory arrest