Elderly Care

lwho* tnstde thts Modut€l

Cardinal Signs of Life

Csre of the Elderly
I Confusion in the Elderly
I MedicalTerminologies
I lnfection Control
I Positioning and Hygiene
a The Residenfs Unit
I
Hygiene
 .There are many ways doctors and nurses
determlne changes in the body function and
illness.
.lt ls one of the oldest and most common way in
measuring the vhal signs
.lt reflects the function of the 3 most important
body processes essential for life

IrD txlrlon! ur mdc

lrd the tir to, cloffrtrg c.Rcauldon of body t€mpc,aturc
io Gcui i! ,ctud€d
IADA}I.

The Four Vital signs VITAL SIGNS

.-€'nperature
+r.dse r'Are used to detect changeg in norildd
*espiration
.bod pressure
) i (, ,,\.
can be

lai>Frr.Dk
[\Jr.LD*w
Purpose of getting the Vitat Signs
.Establish a database of rralue
for
individual patient/client
n goel settlng End tfeatrnent$

.Assisting with Sssessment

of patient3
ts$rponse totrdEtffiett di jttfiriff,
hs that affect the Vital Signs
a roudlhe for prryfrt g

.Theyare alsorneasr,lred when and

indMdual is admltted to a health faclltty

.They must be reported and recorded

accurately
enen minor changes in a person,s

rt- *r&r0f,ft#h.,in,t
f,s blance between the

as tte tody r* O&

ffi Ue skln, breathin6rr

2
rrshani56 of Temperature .Shinering increase tone of skeletal muscles

fr
rces the lumen o#
#i6ie bloo0 a SLrotn0rnri
b. i"? ,liilhdf ba'rrtad heat is lost Q
Oecrease sweat gland activlty
fiberection or Gooseflesh function to s lnslde the
erxr, 'arld
rap layer of insulating air near the
fin arrd decrease heat loss ,fuffi-.!ffi^-rt$f *'u,lo,rshnsursbry

which affect Body Temperature .The Fahrenheit (f) qpfl Centigrade or

Gelslns are$alG3Duse ln measutlhg
'teniperaturc.:
The common sitel for measuring body
tempcreture ard
alMotnffi
b)Rectumr
c)Axilla I undenym )

3
 NormalTemperature
L q[Foo,sites for.measuring tlodg .Uhgp.lxbody tempenture 98.6 degreeg
-'ngerature are:
frhrenheit or 37 tegrees Celsius tathi
r &rttr &5iii' "
f trh.rn .{o1pal body temperature Bectal 99.6
6 G (underarm) $;i Fahrenhelt or t7.S degrees
affi
.Average body temperature whgn tateru
on the axllla Is 97.Q*degrees Fahreriffeit '
or 35.5 degrees Ceffus

The Normal Ranges of Body

Temperature for Adults

"Oral - 97.6 to 99.6Fahrenhqit

365 to 375 Celciurs
.Rectal
- 98.6 to 100.5 Fahrenhelt
37 to 38.1 Celclu*
-A:<i I I a ry - ft etugeE,Fbhrenh&t

36 to 37 Ceicuts ,

].r
+ acrtable and fidtery operated ./&i

Yed ot$
f
trprrature is measured 2 to 50
G;G-
ffi heltrunlt lrtGlrt in a battery MH
q!r;'nen notin use.
&

4
 ADVANTAGES OF ELECTRONIC
THERMOMETER
.Has dfs.gosable wers.to reduce tbe
pcsl6tttty of spreading lotectton
.The tthermomet$t
can
.The temperature is measured rapidly
: themornetem are tnor€,
I than glass ohes. {

l. Disposable Oral Thermometers

f? .Fave Irmll chemical do.Is Whic}r change

.ThesethermometeE are used only oncp

.Setethpereture ls measured 45 seconds.

tape which is arrailable,

dorin nesponse to bodS

f d: tempenrture is normal
ililffitroesnor measure

5
 .lf the resident engaged in these
<I .rs.etry taken on older children and actiylties wait for 15 minutes befdre
you take an oral temperature
- rqdt is readilyaccessible
{llllh
and the .A glass therrnometer must refrain S
tr.:ncnt
notcause to I minr.rtes fior an atEurate
--rtdas rneasurernerts

are not taken orally if

.ls dellrious, restlesg confused or
lu=us
<ft_r- :r3ery or an injury to the face, dlsorlentid
.ls
t iEd rinotrth' panl@d on one side of the bodfl
.Has a sorc mouth
*rGirq*yg.h .

=rq€h t}re mouth instead of thE

-I
t i:Esrnc ruD€

. Wash hands
. ldemify the reslden! check the identification
.b E 3€ rgirent what are going to bracelet and call the fesident by name
[, lts DEi :r. ]''r€ir not tO eat,llou
drink, SrnOke Or . Pull the privacy curtaln
D lurnr tr i-S minutes. .Rinse the thermometer in cold
water if it has
{k tlu trloviq equipment been soaking in disinftctant. Dry from stem to
r. ]'...-a te r/digita I,/chem ica I strip bulb. Chec* the thermometer fur breaks or
=errrnome
6l lrtrrco,t hOkier. chips, shake down the thermometer to less than
L ]sre= 34 degrees centigrade.
: tsc :€?'iri€|rn€ter covers 'lf using a digital remove probe from the unit
t' brE Fn "P"h ? disposabh plastic probe at the tip end
of the thermometer-
r*tllg6, op€n th€ morrth.nd BtrG .Remorrc thc plastlc prcbe if used then wlpe the
b$G bulb end of thc thcrmoncter thermomcterwlti ttsue hom stem to bulb end.
for dbrt l dbc.d ptobe, wipe then prcssing the
rtbrEue. Glect butbtL
rtr! @\rrtrd pmUe at thi basc . Rcad the tlrcrmometlr.
.Record the rcadlng , TEport and then .return all
b lowertongue, close llps arcund GqulpmcnL for glass shake it down rlnse and
b hold lt ln place w6sh, place ln the holder wlth a plastlc protectlve
urrter in place fur 8 to 9 lninutes. oovtr.
ti 3 to 5 secs. Beforc h beep, tone
.Rcord the Gadint , report and then return all
tfp rtem end of the thermometer cqulpments, br
glass shake it down rlnse and
wash, place ln the holder with a plastic protective
aOv'El,

&rt is cornfurtable and signal RECTAT TEMPERATURE

.ls the most acculztte and reliable
Idant, then wash hands measurement of body temperature.
.However this route is not ordinarily
used acept when oraltemperatures
temperature to the nurse.
intfte patients drart. ennot be taken

7
 Reetal Thermometer taking
.Thernometer is lubrlcated so that it can be
easlly lnserted and not cause tlssue injury.
.lt ls held in place so that it is not lost into
the rectum or bmken.
.A glass thermometer should remain ln
place in the rectum for 3 to 4 minutes for
accurate measurement.

Rectal Thermometer Procedures

.Explaln to the resident what you are going to
do
.Collect all the following equipment
s. A rcctal thermometer and holder, a
electronic thermometer
b. Tollet tissue

s i $tIlYDtO
c. Plastic thermomet€r covers,
disposable probe coverc
umm.urY DBlom d. water soluble lubricant

. Remove the sterlle wrapper from the

thermometer ,'rinse in cold water if
has been soaked in disinfectant
the resident. Check the solution, then dry with tissues
. Check thermometer for breaks or
chips, remove protective probe for
digital thermometer, then , lubricate
the end of the thermometer
 rthe bed to a convenient height for . Make sure to wipe anal/anus
rd then posttion the cltent ii'Stm,s
. lnsert the covered probe 1 inch for glass
andk lnch for a digitaTelectronic
thermometer.
back top llnens to expose Just the
arE, make sure ask the cllent to
. Hold the probe ln place until 3 to 4
tltcn rubc the upper buttock to minutes furglass and for
dlglta/electronic walt for the
tone/flashing steady light is seen.

the thermometer, from stem to .Unscreen the resident

discard used tissues and wipe off
.Put errcrything away, return the
lubricant on anal area cover
thermometer on lts charglng unl! for gtass
thermometer shake down, rinse and wash
gloves. Read the thermometer.
place in a holder with disinfectant or in a
patients or resident name and
plastic cover
.Wash hands
sure client is comfortable and put
.Report any abnormal temperature
m the same position and signallight and
hln reach flecord with an R

. The axilla should be drywhen the

ttermometer is talcen
te the least reliable measurement of . 'ltre thermometer must be held in place
bdytemperature to maintain proper posilion.
trhy are used when the temperature
qrot . A glass thennometer is held in ptace for
be measured orally or rectally 10 to 11 minutes to obtain a reliable
lIs site should not be used right after measurement.
t axilla has been bathed

I
 e. Pen and paper
El Wash your hands
bthe resident what you are going
tr ldentify the resident, check the
identification bracelet and call
{ the followlng equipments
resldent by name
thermometer, electronlc
El Pullthe privary curtains
owens if used or oral orobe El Rlnse the thermometer ln cold water
bl lf lt has been soaked in dislnfectant
solutlon

flr tissues, if it is digital remove .Dry the axilla with tissues or towel
: frronr its unit insert a disposable .Placr the bulb end in the center of the
axilla, place affn across the chest to hold
thermometer in place
.\ltlbit fur 10 to 11 minutes if digital wait
lesitlentto remove an arm from for tone or flash of light to steady
of the gown, expose only the .Bemorrc the thermometer, wipe from
stem to bulb

.Shake down thermometer rinse

d record and
wash put in disinfectant, if digitat keep
dent to a comfortable position.
ft in its charging unit.
lhe residents name and .Unscreen the resident
.Take soiled materials and discard
to put back arm in proper
.Wbsh hands
.Report any abnormal temperature
rre patient is comfortable

10
 SITE FOR TAKING PULSE
as the beat of the heart felt
.The pulses are easy to feel at these sites.
?r ?1tery As a wave of blood passes
hdtItn the
tne artery
artery .:
.The arteries are close to the surface of the
be fult every time the heart beats body
.The radlal slte is used most frequently
because it is easily accessible
.The radial site can be taken with little
disturbance to exposure of resident

Equipment used
-Trmporal Stethoscope
{-stid rls an lnstrument used to listen to the
*adrial sounds produced by the hean, lungs
*crnoral and other body organs
*pliteal .ltamplifies the sounds so they can be
-. heard easily
Esalis pedis or pedal
tlcical

HOW TO USE A STETHOSCOPE

.Collecta. stethoscope with diaphragm

€-piece and alcoholwipes
*raural .Wash your hands
Q.6ber or plastic tubing .Wipe the earpieces and diaphragm
with
€€l alcohol wipes
-]rest piece .Warm the diaphragm in the palm
of
-)aphragm your hand
 tie-earplece tips ln your ears so that the
dthe tlps polnts fonrard PUTSE RATE
tie diaphragm overthe artery Hold the .ls the number of heartbeats
EST iT.4...: with your 2 rnid-dte lingen or pulses
adrlq mtsqte
middlefirUers)
flruent, felt in t minute.
.ls lnfluenced by many factors
ellow anythlng to touch the tublng
- Age
carpiece tips/diaphragm with alcohol - Elerated body temperature
rfien completed - Exercise
the stEthoscope to its proper place - Fear
- Anger

A C..otd
B R!.r.al

C Br*ltat
O Oo.siEM6
E Pctdfi Ttuer

F Fe@al

.A rate less tian 60 and greater

than 100
-hitement is considered abnotmal
- I{eat .When taking the pulse
attention must be
-bition ginen to its rhythm and force.
-ftan .The force of pulse relates
to its strength
- lledications/Drugs
.A forceful pulse is easy to feel and is
-rl,: adult pulse rate can range described as strcn& full, or bounding
between .A pulse that is hard to feel are
E to 100 beats per minute often
-- --'
described as weak, thready, feeble
rsed when taklng !,outtne vltalstgn. . Do not use the thumb when taklng a
by placlng the flrst thrce ffngers pulse, lt has its own could be mistaken
aalnst the odlal artery .
for the resident's pulse.
on the thumb slde of the wrlst. . The pulse is counted for 30 seconds the
number ls multlplied by 2 to obtain the
number of beats per minute.
/ . lf the pulse is irregular it needs to be
counted for l full minute

.Take the resident <ln his own room

e watch with a second hand , a
.Pul! the privacy curtain
.Make sure the resident is sitting or lying
down
.Locate the radialpulse with your 3 middle
fingers. Do not use thumb
.Note if pulse is strong or weak and regular
b$e resident what you are
or irregular

br APICAT PUISE
30 seconds. Multiply it by
b I minute if pulse is irregular .ts taken with a stethoscope.
lesilefit's name and pulse on .Are taken on residents who have
a nde aboutthe strength
heart diseases and who are taking
t rcsident, Wash your hand's, medications
fur irregularities, Record .lslocated on-the left side of the chest
EI h iB proper place PR slightly below the nipple
.lt is counted for 1 full minute

13
 .The heart beat normally sounds like a
'lub- dub "
.Each " tub
- Dub 'sound is counted
as one beat.
,Do not count the lub as one beat and
the dub as another.

the following equipment -

alcohol wipes, watch with a
lnnd and a paperand pen

bthe resident what you are

.Take the resident'to his or her own room

.Pull prlwry curtain
.Wipe the earpieces and diaphragm with
alcoholwipes
'Position the resident in a lying or sitting
position for alltypes of taking the pulse ,,1

14
 to_expose the nipple area .Count the pulse for
.{1e9wn
ty-"h":t, if not apical expose part 1 minute, note if it is
regularor lrregular
c.o as for pulse site .Cowrtte reslden!, remove the
rthe dlaphragm in your pat1n earpieces
from your ears
the earplece In your ears .Record the name of the
resident and the
the apical putse ptace the pulse as P note for abnormalities
2 to 3 lnches to the left of the .Make sure resident is comfortable
and
and helow the left nipple signal light is within reach

.Report to the nurse

ur earpieces and the diaphragm of a.Pulse rate lower than 60 beats per
t*eilfroscope minute or higher than 100 beats per
t n to proper place mintrte
dEt hands b.Whether pulse is irregular or regular
c.Arry unusual heart sounds

s to the act of breathing air into .The-drest rises

during inhalation and falls
lrgs (hhalation) and oJt of tt e ounng expirEtion.

is taken into the lungs

during
Lld*ion
-" n dioxide is
moved out of the
during expiration
El Espiration involves one inhalation
lore o<halation

15
 .Peopletend to change breathlng patterns
when they know their respintioni are belng
oounted when the resident is at rest counted
be po.sltloned so you can see the .The resldent should be unaware
that the
rlse and fall resplations are being counted
depth and rate of breathing can be 'lt is usually counted after taking the pulse
controlled to a certaln extent .Respiratlons are counted by
watching the rise
rQle tend to change breathlng and fall ofthe chest.
.They are counted for 30 seconds
;r@ms when they know their and
are being counted multiplied by 2
-frations .lf abnormal pattern is noted count
the
respintions for 1 full minute

in Taking respirations .Count the respirations for

30 sec. multiply
r! to hold the resldentt wrlst after taking by 2 if normal if abnormal or irregular
ffse respirations is noted count it for 1 full
dl the resident you are counting minute.
when you see the chest rlse. .Write the residents name
and record RR
:edr rlse and fall of the chest as one
.Make sure patien/resident is
comfortable and signal light within reach
r if respirztion5 are regular and if both sides .Wash your hands
drest rises equally.
.Report to the nurse the
olthe depth and has any paln ordifficutty Ete, equality,
F
Leathing. depth

PRESSURE
rdpther regular or irregular
.ls defined as the amount
D..i$ pain or difficulty of force exerted
against the walls of an artery by the blood
3-lfi resplratory noises
,ls controlled by the force
d, $normal patterns of heart
contractions.
.The amount of blood pumped
with each
heartbeat
.And how easily the blood
is abte to flow
through the blood vessels
 Systollc prcssure
of heart muscle contractlon is . it
Repr€sents the amount of force
tabs to pump btood out of the heart
of heart muscle relaxation ls into the arterial circulation
Uastole
qf blood pressure lnrclve
and diastollc pressure Dlastolic pr*sure
pressure is the highest .ls the lowest pressure
.lt reflects the pressure in the arteries
when the heart is at rest

Factors that affect blood pressure

in millimeters (mm) of
'Age
.Sex
prcssure is recorded over the
.Amount of blood ln the system
.Emotions
.Pain and exercise
.Bodysize

Fscrre ts around 100to 150 mmHgare Equipment

mrma!
.Stethoscope and a sphygmomanometer
Esirrrc ranges between 50 to 90
are used to rneasure blood pressure
dti values may be mnsidered as .Ttre sphygmomanometer is commonly
if systolk is above 150 mmft. known as the blood prcssure cuff it
priessure abore 9O mmHt. ls nceded consists of:
€uff ,t
bw lfl) mmHg. And a dhstolk .Measuring device
bGlof, 80 mmHg. Need lmmediate
&thts ls called Hypotenslon

17
 of Sphygmomanometer

-?:.*\
Y,^f

Aneroid
.Conslsts of a round dlal
.And a needle that point to
the
calibnations
.ls smalbrand easierto carry
than
mercurial type

Dorry .
.Another tube to connect
toue accurate than the aneroid type to cuff to the
{E a column of mercurywithin a small hand hetd bulb
.A ralve on the bulb
is turned to allow
-+rated fube inflation of the cuff as the bulb is squeeze
tod pressure cuffwrapped on upper .The inflated cuff causes
ifri pressure over the
brachialartery
ttig that connects the cuffto the
rurcter
 MEAURING THE BTOOD PRESSURE
B turned In the opposlte
br cuff deflailon .ls normally measured in the brachial
Ftssure ls rneasured as the euffls artery

when measuring Blood . The cuff is applied to the bare upper arm
not orrer clothing. The clothing can affect
tafe bbod pressure on an arm the measurement.
lV infrrslon or a cast, or an injured . The dlaphragm of the stethoscope is
placed firmly overthe artery
rilent has breast surgery btood . The entire diaphragm must be in contact
*rould not be taken on that side with the skin
the resldent to rest about 15 . The room should be quiet so that the
before the blood pressure is blood pressure can be heard

diaphragm must be in contact

drould be quiet so that the

,Essure can be heard
Ehvision, ladio and sounds from
can interfere with an accurate
so avoid having this around.

19
 .The point at which the radialputse
is no
longer felt Is where you should expect
artery ls located and the cuff is
to hear the flrst blood pressure sound.
.The first sound ls the sptolic
tre radlal pulse can no longer be fth .The point where the sound disappears
fris inflated an addiilonals-O mmXg.-
the cuff inflation to.an is ttrc diastollc pressure
hlgh pressure, whlch Is

PROCEDURES IN TAKING BTOOD

PRESSURE

the

.Wbshyourhands
.ldentify the resident

b the resident what you are going

.Position the arm at
level with the heart.
pnlracy curtain The palm should be iactng up
.Maike sure you are more
earpieces and diaphragm of the than 3 feet
auray from the spirygrnomanometer.
.A mercury modelshould be
the resident in a comfortable vertical on a
sitting or lying position flat surface and at eye level

20
 tlpe should be dlrectly ln front of
dThe cuff should be even and snugty fitted not
tL upper arm, fuld clothlng too tight and loose.
lh. cuff to expel arry rcmalnlng aF. .Place the earpieces ofthe stethoscope in your
eals.
lltc brachial artery at the inndr aspect .Locate the ndial artery.
.trflatc the cuff untll you ciin no longer ftel the
t rrow ma*lng on the cuffgvertlre ndhl pulse.

dr cuff around the residentt upper

E 1 lnch above the elbow or 2 to 3

the cuff 30mmHg. Beyond the .Note the point on the scale where you hear
- n'hich you last felt the pulse. the first sound
.This is the systolic pressure reading- you
over the brachial artery should hearthe sound near the point
dre qrffat an euen rate of Z to 4 where the radial putse disappeared.
per second . Turn the mlve .Continue to deflate the cuff. Note the point
where the sound disappears for diastolic
reading
.Deflate the cuff completely, remove it from
the residents arm, remove the stethoscope
from your ears

the residents name and blood

reading as BP .Clean earpiece and stethoscope
the cuffto the case or wall diaphragm with atcohol wipes
.Return equipment
sre the resident is comfortable .Wash hands
.Report blood pressure to nurse note any
abnormalities '1

21
 .Arrhythmia an iregular heart beat
means absence offever .Axilla anea uhder the arrn referred to
as
Manometer dial type of blood armplt
re equlpment .Bell bell shaped part of the stethoscope
pulse heart rate taken by placlng .Bracfiial Pulse heart feh on the inner
aspect ofthe bend ofthe etbow
temporary absence of breathing

.Celsius metdc rale fur rneasuring

adia a slow heart beat usually feh
e grlse rate is below 60 beats per temperature
.Cheyne Stokes an irregular pattern
of
breathing with periods of apnea (absence of
Fra slow breathing, respiration are
breathing)
tftan 10 respirations per minute
.Cyanosis a bluish discoloration
pertaining to a strong pulse fielt of skin, lips and
naib dueto lad of orygen
the pulse felt at a person throat .Diaphragm the muscles
that separat€s the
the carotid artery lungs frrom the abdominal cavity, and it is also
a part of the stethoscope flat and rnore larger
than the bell

is difficult or labored breathing .Pyrexia an elevaUon of

body temperature FEVER,
believe to asslst the body in fighting disease or an
irftcdon
.llypothermia prolong exposure
extreme high fever4l.l to cold, decrease
body temperature i14.4 degrees Celsiui serious
oondhion
.Tachypnea increase resp,ratory
rate more than 24
prolong exposure to cold, breaths per minute.
body temperature 34.4 degrees .HypgrvenUlation increase "l
in rate and depth of
rcspiration
.KussmauJ breaths that
are gesping or labored

22
 z The number of population
over 65 years of age i
tncreaslng everyday.
CARE OF THE ', Elderly individuals
are living
longer and healthier than
ELDERLY before.
rToday most people can
expect to live in their 70's.

Bln the early 1g00,s most r Aging or growing

people died in their 50,s
old is a
normal process.
many individuals in their r Normal changes occurs in
70's and BO's continue to
body structure and function
five healthy and happy lives
during the aging process.
in their own homes.
rBecause of these changes,
the elderly have special
needs.

, They are also at greater risk for Physical, Psychologicat and Social
ihess, chronic -disease and eftcts of Aging
irury. t The. .physical, psychological and
. However, illness and disabilitv social changes that occ-urs as a
ae not part of the normal aginfi
prDcess.
, Gerontology is the study of the
€rng process. Geriatrics is the r Retirement and death of a spouse,
care of the aged. relatives and ftiends are 'sociai
reminders.
 mdule shall emphasize Retlrement
rcle of the caregivers r People traditionally retire at the
th proper care and age of 65, some retire earlier.
of elderly v Others continue to work until
fostering their the age of age of 70's or
psychological and longer. Retirement is viewed
as a reward for a lifetime hard
work.

ldvUual has eamed the right t Poor health and medical

b rcrk and can now relax and expenses can make enjoying
retirement difficult, if not
leisure and doing whatever impossible.
Etts are the benefiB of z Some elderly is so ill and
Most people enjoy disabled that they can no longer
Others are not so
Some must retire live alone.
of chronic disease and z They often must live in long.
terfn care facilities.

people believe that Retrement is often accompanied

reduced income.
elderly persons.: live in t For many elderly, the monthlv sor
homes". security ched( E the only solroe
m@me.
fewer than 10o/o of There may still be rent or
people over 65 live in payments. Food. dothino.
term care settings. electricity water bills and ta-ies '1
other expenses.
t Car.. . expenses, home repairs,
medicine and health care add tb tne
individual's expenses.

2
 d these cause severE Soclal Relatlonchlps
difficulty. Some people ; Social relationship changes
planned for retirement. throughout life.
investments,
plans and insurance
r For many elderly people,
children have grown and left
are ways to plan for home and may have families on
which often makes their own.
ur salary as health care t Many live a long distance away
from their elderly parents.

and relatives may have Physical effects of Aging

eelay or died or disabled z Certain physical changes are a
normal part of the aging process
and occur in all individuals.
and separation from r The rate and degree of change
friends and the lack of
vary with each person.
with people their
z Physical changes during normat
ep are common cause of aging process are gradual and
may go unnoticed as the
individual adjust to them.

, the physical z Normal aging is not atways

of aging cause body accompanied by chronic illness
or disability.
arnount of energy and z Nor does the quality of life
efficiency of the body have to decline with age.

3
 The changes in the body s Muscle atrophy
focesses take place over Musculoskeletal s Decreasing bOne
Fars. and muscle
TEs will allow an individuat to strength
o Bones bone briftle
{,lstto reduced activity and and break easily
duced rnobility. e Joint become less
flexible
e Gradual loss of
weight

. !-fe"{ pumps with . Resoiratorv

r leSS IOrCe Respiratory mus'ciesw6akens
. Arteries are less . Lung tissue
elastic and becomes less
becomes fibrotic elastic
. Clogging of . Sensitivitv to
anenes allergens like dust,
. pollen etc
Valve
malfunctioning . Pulmonarv/ luno
,
Hypertension' infections, Asthha
. DOB

oKidneys decreases s Decrease saliva

Urinarv
' in size, function
-- oisGstl,G <.rrroht*rrner, B$r:*:"ppetite
may remains o Decrease secretion
of digestive juices
oFrequency to void, o Teeth mav be lost.
dental pain, fabd
lncontinence, - teeth
e Decreased,
retention peristalsis,
oStone formation, constipation,
intolerance, bowel
retention
frequent infection

4
 E Skin becomee lee o Msion and hearing
elastc, dry and rrwinkled
o Fatty tiseues layer of the
Nervous decreases
skin is lost e Decreese sense of taste
o Folds, lines, and wrinklee and srnell
appears e Reduced sense of touch
ai Dry skln devetops and sensitivity to pain
s lncrease sensltivity to o Progressive loss of brain
cold cells
a lMritening or graying of s Shorter memory
hair
o Stowed ability to respond
s Loss or thinning of hair

M usculoskeletal System
-Ih
b aging progresses eJoints becomes less flexible
there
sThe spinal column becomes
) and decreasing @mpressed, resulting in a
gradual loss of height
is lost from the eDecrease mobility due musde
Osteoporosis a weakness and endurance
eAches and pain are common
breaks more easily than may be due arthritis

lc long- term health care settino r Measures to prevent falls must be

dr person shoutd be encouragE
b 1s active as possibfe, Range practiced.
motion exercises and diet can , Tum and move each resident
prevent stiffness of joints and gently and carefully- Osteoporosis
can be so severe that turning in
iE dbt should be HIGH in protein, bed can result in fracture
4ilm and vitamins. r' Some may need support
tcause bones can break easilv. and
assistance when getting out of bed
Crty individuals need to bi;
rected from injury. and when ambulating.
 Cardiovascular System o Endurance is decreased;
heart muscle becomes less dctivities, exercises, excitement
ixrt with aging process and illness increase the body's
ispumped through the need for orygen and nutrients.
with less force. .Normally For a person with heart and
changes do not cause artery disease, the heart may
when the individual is be unable to meet these needs.
rest or during normal daily

lose their elasticity and . Elderly with heart and artery

narrow, less blood flows disease needs periods of rest
them causing poor during the day.
ion in many parts of the , Encourage to nap for an hour
after the noon meal.
a result, a weakened or . Over exertion should be
heart has to worked avoided.
to pump blood through
narrowed vessels

rnay not be able to walk eEncourage all residents to watk

distances, elimb .stairs or as much as possible, if this
heavy objects. ectivity is allowed
care items. ry e Daily exercise helps stimulate
and frequently used circulation, helps prevent
should be placed in formation of thrombi (blood clot)
in the legs veins

6
 or passive exeroisos ar€ System
lf the individual is weakens and
s less elastic
with severe cardiovascular Lung changes are not usually
' obvibus
or disease must have at rest, but endurance may
from doctor8 for be limited.
. An individual with severe lung
exercise rcstriction end
disease like emphysema may
become very short of breath
Heart (dyspnea) with slight exertion.
Heart attack. Ml

may not have enough e Measures must be practice to

to cough and clear promote normal respirations in
weak and elderly residents, heavy
ainrays secretions
linens should not cover the chest
ry infections may for they prevent normal chest
and can seriously expansions.
o Turning, repositioning and deep
breathing exercises helps prevent
respiratory complications from
bed rest

troantestanal system
i-foirler's position for
eThe senses of taste and
makes breathing
smell may become dulled and
may cause decreased
appetite
eSecretions of digestive juices
decreases- may cause
indigestion

7
 ELoss of teeth and ill fitting . Diets are adjusted to
denture make chewing provide soft or ground foods
fficult for these individuals
mChewing and swailowing .Decreased peristalsis
may be difficult for weak results in slower emptying of
and frail elderly the stomach and colon, may
lead to flatulence and
constipation.

eCiood oral hygiene and o Foodsthat provide soft bulk are

care helps the ability.to taste. often ordered for those with
chewing dffi culties or constipation.
ePeople may not have natural
beth or dentures. heir food s These foods include whote grain
have to be pureed or ground. cereals and cooked fruits and
vegetables.
s Bran is often added to cooked
cereals to provide bulk and fiber.

mThe elderly need fewer calories . Diet should include enough

tfun younger people, energy protein for tissue groMh and
Eryels and daily activity tevels
repair.
are usually lower.
mAdditional fluids are needed to
. Cancer, diabetes, lncrease
promote kidney function. cholesterol level,
Food that prevents constipation
and musculoskeletal changes
ae important

I
 ELoss of fatty tissue beneath the
eppeer
skin increases a penson's
davelops because of decrEasa oil sensitivity to cold, sweaters, lap
blankets, socks, and extra
and decubiti arc dangers blanket are often needed for
d f;atty tissue beneatti: the sHn
warmth. They must be
a peruonb ccnsitivity to cold,
bp bhnkeb, socke, and o<tm protected from drafts and
extreme cold.

tlry skin of elderly is easily . ONLY mild soap is used, often

and causes itching. soap is not used on arms, legs,
bath or tub baths should be back, chest and abdomen.

a complete bed bath is

' A lanolin-based lotion or bath oil
can help prevent drying and
itching
baths arc taken on the other
Such a bathing sctredule is
to maintain hygiene.

may become thick and tough e Fragile skin, poor circulation and
decreased sensitivity to heat and
with vascular disease may
cold increase the risk of bums
h poor circulation in the feet.
i*or cut can lead to a serious e You are reminded not to cut the
toenails of any residents.
hr are reminded not to cut the o Fragile skin, poor circulation and
tsrails of any residents. decreased sensitivity to heat and
cold increase the risk of burns.
 or gray hairs are a oBrushing the hair he
stimulate circulation and oil
occurs on the head, in production
pubic area and the axillary
sThe frequency of shampooing
tends to be dryer because
depends on the
preference.
trte decreased production of

shampooing is less The Nervous System

than during the oloss of vision and hearing
years. sLoss of taste and srnel!
is usually done qSense of touch and
or as often as sensitivity to pain are also
to maintain reduced
and comfort

cold and pressure may sThere is progressive loss of

be felt Safety measure brain cells, Memory is often
be practiced at all times shorter and forgetfulness
increases.
skin must be carefully
for sign of skin oAbility to respond is slower,
some become more "set in their
ways and do
not accept
changes easily

10
 often remember events sLess sleep is needed than
[te distant past better than during the younger yearsi,
in the recent past usually they rest or nap
people who keep during the ddy,
tally active and involved oThey frequently go to bed
ctrnent events show fever early and get up early.
in mental function

illness or injury may

-snlt to weakness to
palysis or disability, fatigue,
, movement
esorders, mood changes and
lperinitability etc.
, Alzheimer's disease,
H<inson disease etc

'1

11
 in the Elderly .Gradual memory loss, abillty to make judgments,
awareness of who people arc, the time or the
ln an elderlv peron can havc a
6uses thls wlll lncludethefollowlng: phce
.Transfer Trauma " from fam ilia I su rro u nd ng
I to
rtased learlng or slght- mislnterpret what
tcc or hCar
unfamiliar surrounding - home to hospital to long
tern care facllity
and lniury and as a reactlon to
.Confusion is initating and frustrating for the
fEcn clra4ges in the envaronment may also elderly and frlghtening
.Reallty Orlentatlon (RO) ls a from rehabllltatlon
'and resDFatory diseases cen lrducE
-oontus.on.
of blood'and orrygen to the braln almed at promoting and maintaining awareness of
the persons, tlme and place,

to minimize confusion
.fuk clear and simple question. Allow time to
prson and speak clearly and softly
respond
by name every time you are in contast
.Give short sirnple instructions
.Encourage client to wear glasses or hearing
name and your position lncludlng your
aid if needed
prson the date and the tinie each morning . Use tDuchto communlcate effectlvely
ftn as necessary. Xeep a calendar aM a r Allow person to place familiar objects,
piciltes aff personal effects within reach
tr you are golng to do and wlry
& and simple answers to the peront

tEwspaper and magazine. Read if

.Maintain the routine setfor individual includes
rse of W or radio meals, bathing, exercise, television program and
other activities done on schedule.
day night cycle. Open curtains, shades
.This encouages a sense of order and
durlng day tlme and close them at
anticipation what to expect.
.Encourage the individual to participate in self
care activities
dothes should be worn durlng the day
paiama or gowns
 'The peron ls fearful, anxlous or agitated
.The indlvldual does not seem want to talk or
member or a person caring br them answera quesUon
.The peson is restrained or locked in a certain area
unclean or lnadequate livlng condltlons for a long period of tlme unnecessarily
.Prtirate cgnv?rsadon is not allowed. The caregiver
loss due to poor nutrltlon and inadequate is ptesent all the Ume.
.Medication is not takEn properly, Meds. Are not
inlurles, old or new bruises are seen purchased, too mtrch is taken or too llttle.
.Frcqrrent visats to ER
Frson seems very quite and withdrawn
.The person may go frorn one doctor to another or
no doctor at all.

Ccriatrics Gerontology
.Study of the changes in the mind and body
gcialized branch of medicine that deals that accompany aging and problems
lh $e diseases of older person associated with them like normal changes in
.C is also a multi-disclplinary approach in elderly, Psychological aspects, Diseases and
rkrating, Treatment approach
diagnosing and treating eldedy
qrditions

rell{G True about Aging

.ls a oinplor pYocess
€dual changes in the body structure and .lt is unirrersal
trction which occur with the possage of .)t
th€ is intrinsic
.lt is protressive and irreversible
t does not result from disease or traurna
-Eease .lt is deleterious and inevitable
cause probability of death

2
 Flve l's Problems Related to Aging
:!J,;riir;\r - able to gauge r lntolhctual impairment
- vloible, noticeable
pleasing, advantageous -lmmobility
- possible, realistic, reasonable " lnstabilitl
.lncon6nence
.. latrogenic drug reaction

Significance
. Mental capacity of an individual
-Adulthood .Plryskal capacity
- Older person .ftrgth-vftor
-Elderly .Enduiance - slamina
-Old age .Fhrlbility
- Senile age .Phpiolqlcal capacrty of various system of the
body
.Oranges ln the normal structure
and functional of
yarious ofthe body
.Psyriologlcal capaclty and acceptance

3 PHASES OF AGTNG
{ftstyle 1. Pre- Retirement phase
.ffitudE
dris pfase en begin as early as age of 50.
l When
*ess the lndividual start to consciously
-t*redity wonder and tiink of life after adulthood
.Ervironment
.ftrancial resources
.Social and family
.Etrrcation
.IGO and Government support
 fYpes of Aglng

l r-hrcnollgir;ol Alii rt;z

by the aglng penon exhlblUng .The number sf years a pexson lives plays no
and dlsabllitles assoclated wlth
slgnlflcant factor ln aglng
.lt denotes ls the number of years you have llved
piry into thls phase ar€ likelyto,tarre
and notwhat has happened ln those years
problem as wellas physlcal
.Associated wlth time

NORMAI.AGE REIATED
-!t':1, CI{ANGES SEEN ]N ELDERLY
with the physical change that occurs

tlrat have occurned in the body. Bodyt

: 'l::'^"'
ftrent raEs and diffurent dranges
- ---'=:rr al /4ljinH Chonges
.Decrease response to pain sensation, temperature
account the individual personalfi and
changes and vibntion
.Loss of fat under the skin and fatty padding orcr
bony promlnences

EIIects
: rrinkled, thinner and more fragile -
.lnability or decrease ability to fuel hot or cold,
o stin lnjury weatjrer changies, prone to injury- burn
in tfie number of blood vessels .Pressures sol€
secretion of sweat and oil glands .Loss offialr
.IlifEculty of fluid balance
.Sldn dryness ard itdriress
.Graying ofhair
.Molet skin pigmentations

4
 -E-,.Vtpier:r

Chonges
- Clouding of lens
-[ess able to.sec small objecG, letters and slgnage
- Decrease abllity to focls
.Cplor bllndness or to dbtingulsh colorc
safe & clean envtronment , Scnsltlvtry to gbrc
lruulatlon to heat or cold * Preshtopla farlghtedness
skin care .lnqcesc lreductlon of tears - lacrimal slrnd
seqEuons Dry Eyes/ lrlftatbn
" Increasc/ Iresease eye reflex or blink
. Decrease latera! field vbion
- I{lgfit blindness
,Cataract

and responsibility
Chonges
placernents of important things .Reduced discrimination
to sounds -
Presbycussls
.Ealanced problems - Vertigo- dizziness
.Tinnih.rs- ringirg behind
Ure ear
.Decrease ability to hear
high frequenry sounds
. llearirg lost-
deafrress

'Maintain elre contact

.M-aintain normal disbnce
when speaking to
client
.Rephrasing words if not
dlent's attention before spe'bklng by understood
.Use vlsual cues to help
cing sounds brlng the message
.Av,oid making.nasty remark
t-aring aid or gestures
when not understood
dowlyand clearly easily understood by .Clean outer ear everyday
and inner ear once
a weer or as instructed
. Make pen/pencll
arailable
.Doctor appoantrnents

5
 D r.ilj t'6,. 151,', r'n",U,t.,,

Can outer ear ercryday and inner ear once

e:et or as Instructed Chonges (taste)
lEle pen/pehcfl a\raileble .Number of taste buds decreases or diminished
tcbr appolntments .Decrease sallra secreUon or productlon
.Altered sensatlon of bste( lntact bitt€r
and sour
sensaffon, decreased salty and sweetsensation
.Food becomes tasteless
.Uses more salt and sugar on their
diet
.Perlodontal and gum diseases is
common
. Lost of dentltlon or teeth- eating food becomes
difflcult

Task a nd responsibility

.lntroduce food rrarieties for taste

and aroma
.Cut food in bite sizes, colorful
and easily to digest
sensitivity to odor, perfume, cotogne . Proyide safe
envirofl ment
.Proper oral care or tnjgiene
re.sensitivity to dus! pollen etc. ; runny
.RegularfitUlg of dentures and
colds, cough, rhlniUs etc. mouth care
.flegular denAl visits

--.: -l;'1 ,r1.1:-15l ,i1g;1:i

'rEh.dt
hllSjr.tii i:riltri t.t.,, 1,, i:,i.i i: i! I

tcreased sensitivity to touch and pressure

.Chong*inMtdes
ty notfeelheaL cold and pain
.Muscles decreases in size
tsance and number of muscle
.{Eease body swayin& unsteadiness fibers
of the feet .Declined flexiblllty and
.trred equilibrium reaction etastic of muscles

Est and responsibility

t*environment
<llr of asslstive devices
tistang in ADLt

6
 Task and responsibility
h bone mass it becomes porcus
bre denslty in the vertebnl dlsc (toose .Create a safe environment
.Aroid carrying hery load
.Properdiet- lncre:se calctum bke and protein
&crease muscle mass 1% per year
.Hare regulardi€t - light to moderate
tDrt to decrease bone mass
.Aroid smoking take rnoderate amount of
- muscle is replaced wlth fats alcohol, caffelne regulation
aerclse, estlmat€d muscle mass decllnes
h men and 23% ln women between 3O.ZO

Task and responsibility

.Regular exercise as prescribed
bt grows slighUy larger rnaybe covered
b and becomes less efficient .Proper dlet
iuease is systolic and
.Avoid vices
diastolic arterlal
.BP monitoring
(Xygen consumption durlng oterclse
h men by tffi.with each decade of aduh
*out 7.5 % in women
become less elastic and rigid
to fainting or syncope

:ci.y !y5 rEM

Task and responsibility
. Regular exerclse-
aerobics exercise
.Regular activiUes with rest periods
.lncrease fluld intake
may become rigid and stiff
.Breathing o<ercises
iroease in si?e but decrcase in number
 Task and responsibility

.Properdiet
.Food should be taken ln
bite sizes, small amount
and easy to dlgest wlth adequate ituids
saliva secretlon and becomes stlcky .Oral/dental tryglene
action ofthe asophagus and .Dentures care & malntenance
.Regular exercises
lrydrochlorlc acid and pepstnogen
Ithe stomach

Task and responsibility

.Regular elimination of urine

dglumeruli per kidney decrease .lncrease fluid lntake
lds retalned, morc water ls lost .No fluid intake 2 hours before
bedtime
tone ln the bladder .Wear loose clothing
abllity to @ncentrate /dilute uilne .Good skln care (genltals)
.Change diapen frequently

UEN Chonges-WOMEN Task and responsibility

testosterone .\6ginalsagging .GoodPerineal care

.Less pubic halr .Proper trygiene
hair .Decreased lubrlcaUon . Hormone replacement therapy
4.r.{!1.
(Mid-70's)
.Breastbecomeflatter
[;;
.Vaglnal dryness

8
 ava_ufl!.filr[ntr
Chonges
.AlEratlon of lmmune-competence
. Decr€ase lymphoc6es production
.Weaker WBC ln counteracting infection

Task and responsibility

.\hcclnatlon
ilGohoi .Proper nutrition
- increase in Vitamin. C & fluid
Ellng un-prescrlbed medlcatlons lnblte
.Adequate rest
.Preventexposure

Chonges
,- toss of brain cells
areas of dysfunction accompanying
- Bnin becomes smaller
. Reduced tnnsmission efficiency
, Reduced Fluid intelligence ( cognitive,
peed of motor activitles with slowing in performance, comprehension. Logical thinking
ofcentral processlng and abstract reasonlrtg.
in stature, proprioception and gait - Unchanged: crystallized intelligence (vocabulary
verbal abllity in infurmaUon and communietion

md responsibility -WatchingW
social functlon of the client by zVisiting friends/relatives
recreationa I activities .Gardening
-Trat€lling
recreational activities .- Painting cards

-Going to theater or movies

- Use of assistive devices
. @ordination exercise
-Re'orientation (Name, time, address, places and
placements of thingsl

I
 I Terminologies Pnflr
. Aword element placed at the beginning
of a uord tro ctrange the meaning of the
shortened form of a word or word.
Root
. Aword elementthat contains the basic
vowel added between,{wo meaning of the word
or a root and a suftix to Sultrx
pronunciation easier . Aword element place at the end of a
root to change the meaning of the word

circum - around
-r - Without or not contra - against, opposite
-Away from
de - down, from, away from,
- Towards
Not
- Before, fonrard
dia - across, through, apart
-Against
dis - separation, away from
- Self
- Double, two dys - bad, difiicult, abnormal
- Slow ecto - outer, outside

- in, into, within hypo - under, decreased,

- inner, inside less than normat
- over, on, upon in - in, into, within, not
- red inter - between
- out, out of from,
away from
intra - within
- half intro - into, within ,1

- excessive, too much, leuk - white

hish macro - large
lmal - bad, illnoss, disease por - by, through
rEga - large peri - around
licro - small poly - many, much
rono - single post - after, behind
rEo - new pre - before, in front of,
mn - not prior to
pro - before, in front of
re - again
retro - backward

ROOTS
. Part containing the basic
'- - above, over, ex@ss meaning of the word
- above, over . Can be combined with
- fast, rapid another root, prefixes or
- across suffixes, mait-ly from Greek
or Latin

Meaning cardio
Card, - heart
(o) - abdomen Cephalo - head
- gland Chole, chol(o) - bile
- adrenalgtand Chrond(o) - cartilage
- vessel Colo - colon, large l.
- artery Cost(o) - rib
- joint Crani(o) - skull
- bronchus, bronchi Cyan(o) - btue
 o) - bladder, cyst Flbr(o) - fibq ftbroue

) - cell Gastr(o) - stomach

o) - tooth
Gloss(o) - tongue
Gluc(o) - sweetness, glucose
- skin Glyc(o) - sugar
o) - duodenum Gyn, gyne, gyneco -woman
nl(o) - brain .,'
Hem, hema, hemo,
o) - intestines hemat(o) - blood
Hepat(o) - liver

Mast(o) - mammary gland,

breast
), ili (o) - ileum Meno - menstruation
- abdomen, loin, flank My(o) - muscle
Myel(o) - spinal cord, bone
marrow

o) - breast, mammary Necro - death

gland Nephr(o) - kidney

o) - nerve Ped(o) - child, foot

Pharyng(o) - pharynx
Phleb(o) - vein
lm(o) - eye
Pnea - breathing,
o) - straight, respiration
normal, correct
Pneum(o) - lung, air, gas
o) - bone
o) - ear
 - r€ctum Salping(o) - Eustachian tube,
uterine tube
- mind
Splen(o) - spleen
- lung Sten(o) - narowing
- pus Stem(o) - sternum
- rectum Stomat(o) - mouth
- nose Therm(o) - heat
Thorac(o) - chest
Thromb(o) - clot, thrombus

- thyroid Urin(o) - urine

- poison Uter(o) - uterus
- poison ,poisonous Vas(o) - blood vessel, vas
) - trachea deferens
- urine, urinary Ven(o) - vein
tract, Urination Vertebr(o) - spine, vertebrae

. lf the root word ends with a vowel,

is a word element placed and suffix begins with a vowel , the
the end of a root word to vowel at the end of the root is
"drop@"
the rneaning of the word.
cannot be used alone Suffix iieaninq
ing vowel is not
-algia - pain
if the root ends with a -asis - condition, usually
abnorma!
-cele - hernia, herniation, pouching
 - puncture & genic - producing, causing
aspiration of - gram - record
- cell €raph - record
- dilation, stretching -graphy -adiagram,recording
- excision, removal of instrument
- blood condition -iasis - condition of
- development, .:' -ism - a condition
production, creation -itis - inflammation

- the study of pathy - disease

- destruction of, -penia - lack, deficiency
decomposition
- enlargement
-phasia - speaking

- measuring instrument
-phobia - an exaggerated fear
- measurement -plasty - surgical repair
- tumor
or reshaping
- condition -plegia - paralysis

-falling, sagging, -stasis - maintenance maintaining a

dropping, down constant flow
, -rrhagia - oxcessive flow stomy, ostomy - creation of an
opening
- stitching, suturing
-tomy, otomy - incision, cutting into
- profuse flow,
discharge -uria - condition of the
urine
- examination using
a scope

5
 a. Medial- relating to or located at
(ventral) - located at or the side of the body or body part
the front of the body or
5. Posterior (dorsal) - located at or
toward the back of the
- the pert farthest form the body or body part.
or from the point oJ the
6. Proximal- the part nearest to the
center or to the point of
- relating to or located at
origin
sile of the body or body part

Abbreviation Meanins
forms or words or abd - Abdomen

, they are primarily in a.c. - Before meals

communication to save ADL - Activities of daily

and space. Some

lib
living

may use Ad
Adm (adm)
-As desired
- Admitted or
other than the admission
AM (am) - Moming

- Ambulatory - Cancer
- Catheter
- Amount
- Complete blood count
- Apical
- Complete bed rest
-Approximately
- Cubic centimeter
- Twice a day BRP - Bathroom privileges
(bm) - Bowel movement
- Blood pressure

6
 - Coronary care unit DON - director of nursing
- Complaint of drsg - dressing
- Gardiopulmonary Dx - diagnosis
nesuscitation ECG (EKG)- electrocardiogram
- Cerebro vascular EEG- electroencephalogram

(dc)
acoident, stroke
- Discontinue
ER - ernergency room
F - Fahrenheit

- fasting blood sugar H20 - water

- force fluids H.S. (h.s) - hour of sleep
- fluid Ht - height
- foot or feet ICU - intensive care unit
- gallon in - inch
- Gastrointestinal' I &O - intake and output
lV - intravenous

- Liter It - left
- laboratory LVN - licensed vocational
- pound
nurse
- liquid
- left lower quadrant
LUQ - left upper quadrant
- last menstrual period
Meds - mediations
- licensed practlcal mid noc - Midnight
nurse min - Minute

7
 - Milliliter 02 - Oxygen
- Nursing assistant OB - Obstetrics
- Negative OJ - Orange juice
- None OOB - Out of bed
- Number
OR - Operating room
- Midnight
- Nothing by mouth
Ord - Orderly
OT - Occupational therapy

- Ounce preop (pre op) - Preoperative

- Post anesthesia room prep - Preparation
- Afier meals p.r.n. - When necessary
- Pediatrics Pt (p0 - Patient
) - Afternoon PT - Physicat therapy
os) - by mouth q - Every
(post op) - Postoperative q.d. - Every day
q.h. - Every hour

q.3h. Etc - Every two hour, RLQ - Right lower guadrant

every three hour RN - Registered Nurse
- Every night at bed ROM - Range of Motion
time
RR - Recovery room
- Four times a day
RUQ - Right upper quadrant
' Every other day s - without
- Rectal Spec (spec)- specimens
temperature SSE - Soap suds enema

8
- At once, immediately - Teaspoon

- Surgery (U/A, ula) - Urinalysis

- Tablespoon (vs) - Mtal signs

- Three times a day - White blood count

- Wheelchair
- Tender loving care
- Weight
- Temperature, Pulse,
Respiration
 f,FECNONCONTROL lnfection-a dlsease state t'lat resulB from the
lnraslon and gtowth of hictoorganism in the body
dp absence of pathogens Host-the emrironment ln which microorganism live
-a pressure steam gterllizer and grow, reservoir
lnfection - a disease state that results from the
irnraslon and growth of microorganism in the body
Medical sepsls-the technlques and practices used
- the_process by whidt an obJect to prevent the spread of pathogens from one person
|s unclean
or place to another person or place, clean technique
; the process by which Pathogens a mlcroorganlsm
cnvironment in which mlcroorganlSm Mlcroorganism - a small living plant or animal that
x, reseryoir cannot be seen without the aid of a microscope: a
microbe

- a microorganism that does not

qre infection .Sterillzatiorr - the process by whiclt all
buna - mlcroorganism that usually live microorg'anism are destroyed
in certain location
.
-a microorganism that is harmful and Microorganism
oa small living plant or animal that cannot be seen
r-the environment ln which without the ald of a microscope: a microbe
live and grow; the host oareryrvhere ln the envlronment
a bacterlum protected by hard shell that ofound in the alr, food, mouth, nose, resplratory tract,
round the microorganism stomach, lntestlnes and on the skin
ocan befound in soil, water, animals, clothing;
-the absence of all microorganisms
beddings and even furniture's.

5 General types of Micro-organlsm

Requirements of microorganism
- Mkroscoplc plant life that muhlply rapldly;
dsinghd cell, often calhd germ a. Reseryoir or host to tlve and grow- human,
- Plaots that live on ather plant or animals. animals, plants, soils, food, water and other
)m, yeast, molds are examples -' materials
- Microscoplc one celled anlmals b. They need nourishment from the reservoir,
iae - Microscoplc furms of lih found ln the water, oxyBen
offleas, lice, tick and other insects, c. Preferwarm and dark environment

- Extremely small microscoplc organism that

 Practlaes - wsy to prevent the spGrd .Washlng cooklng and eatlng utenslls with soap
and uater after use.
Jter urlnatlng or havlng a bowe! .Observing sanitation practlces such as the
dlsposal ofgarbage and treatment ofsewage
before handllng or preparlng food
ud raw vegetables before eatlng and
HAtrtowAsHltrtc
url towels, wash cloths, toothbrush, . Using soap andwater is one of the easiest and
and other personal care hems for
most imporbnt ways to prevent the spread of
rse and mouth when coushln&
lnfectlon.
hrlngthe nose .Hands are used in almost every activity
halr, and brushlng teeth regularly

Rules in handwashing
easi'ly contaminated and can spread .Use warm running water
if you do not practlce . Use paper towel to fum on and off a hand
operated
before and after giving care to a faucets. Hand operated hucets are considered
contaminated
aregivers and health care providers are . Bar soap is held durlng the entire handwashing
risk of having infectton especlally lf procedure
system is a big question. .Rinse in running water after use and dropped into
the soap dish.
.Hands and forearms are held lower than your elbow
throughout the procedure, these prevent dirty water
from contaminating your hands and forearms

bwash areas that are frequendy Care of suoolles and equioments

handuashlng; thumbs, knuckles, .Most long term facilities harre a central supply
the hands and fingers, underneath the (xrm.
Itse small orange stlck to clean under your .Equlpment is stored, disinfucted, sterilized and
'E:k. dastributed from this rcom
btbn after handwashing to prevent .Much of equipments nowadays are disposable
and drying of the skin. some are not & they need proper dislnfection &
sterilization accordingly before they are used
.Much of equipments nowadays are disposable
some are not and they need proper disinfection
and sterilization accordingty before they are used

2
 rrinals, wash baslns, thermometers,
General Guldellnes ln cleaning equipment
&rfuction and sterlllzation,
.Rlnse the equipment in cold water first to remove
organlc materlals. Heat causes organic materials
to be destrcyed and removes to become thlck, sUcky and difficult to remove.
erials such as blood, pus, dninage .Use soap and hot water to wash eguipment
.Use brush tf necessary
.Rime and drythe equipment
.Disinfect and sterilize the equipments
.Disinfect equipment used for cleaning

BO]LING WATER
.Simple inexpensive method of disinfecting
smal! items done by placing the items/s in
boiling waterfor ,:ri lil:*'.i i,' 'i' ,!-,-r.; .;,,,.
Focess in which pathogenic

tpt destroy spores; hard shells that Chemicol disinfectonts ond Liquid Chemicols
.Generally used in cleaning instruments and
must be exposed to extremely high equipments and for housekeeping
.Used to clean conrmodes, wheelchairs,
stretchers and furniture's in the resident
methods usually do not destroy all
unats.
.Bleach and etc.

Health Care Measures to protect residents,

that destroy all non pathqgens,
visltors and health workers
.Hold equipment and linen away fro your uniform
hlgh temperature ln sterlllzlng .Avoid shaking llnen and other equipment
.Clean from the cleanest to the dirtiest
.Clean away from your body artd uniform
.Pour contaminated liquids directly into the sinks
steam sterilizer used for metal objecs sudr ortoilets. Avoid splashing onto other areas
lnstruments, baslru, bedpans and urlnals .Avoid sittint on a residentt bed.
.Do not take equipment or supplies from one
and rubber are not Autoclaved resident's room to use for another resident. Even
under pressure Gan usually sterlllze obJects ln if equipment has been used, it should not be
taken from one room to another.

3
 Baslc Bed Posltions
must be positioned whether Fowlert Position
e rheelchalr properly, ptryslcal
rell-belng are promoted wlth . Seml-stttlng positlon
changes and good body .lnvolvg elevatlng the head of the bed to a semi-
sttUng posltlons
wlllalso helps prevent rnany n
laltebed sores, defurmltlet lt atso
clrculatlon and helps patlent to

are ln bed or tn a wheetchalr must

'fffl]hffiSlns w' visitlnB and readins are easier in
irgqed il! leQs_t.{i'i!i['1 .Resldents wlth heart and respiratory dlsorders
l,,rv.Q :!.q.U{.!
usually can breathe easier ln thls po'sitlon

Scpile

.Dorsal recumbent position is the back lying position

.Good body alignment lnvolves having the bed flat,
,: d the tred is , ,;':;,ri ,! 5 degrees and the supporting the resldent's head and shoulder on a
plllor and placing the arms and hands at the
this very comfortable and prevents the resldent' sides.
from sliding down in bed. .Arms may be supportid wlth a regular size pillows.
Hides defines this posltion ln whlch the Hands may be supported with small pillows with the
J the bed is elerrated 30 degrees and the palm dorn.
.A smallfolded or rolled towel may be place under the
resUent! back and under the thigh as instructed

Lateral Posltions

nsident lle on thelr abdomens wlth thelr .Lateral or side lying positions lies on one side
.Pillows are used to maintain good allgnment,
a small pillow under the head. One under
place a pitlow under the resident's head and
ebdomen and one under the legs
shoulders. Support the upper leg and thigh with
elderly resident do not tolerate the prone pillor,vs.
well due to limlted nnge of motlon ln .Place a small pillow under the upper hand ,arms
and place a pillow against the residentt back
pressure created to their chest.
 Trendelenburg Posltlons
rlylng posluon with the upper leg as
flexed so that it is not on the loier .lwolves lowerlng the heod of the bed and
the loyuer arm ls behind the resldem. mlslng tlre foot of the bed.
body alignment involves placing a .Not used unless ordered by nurse or MD
'under the resident's head and
.C:n be achieved by putting blocks under the
the upper leg wlth a plllow and lower legs of the bed
a plllow under the upper arm and

a comfortable poshion for elderly

RESTRAI NTS( Protective Devices)

.Also called protecti\re devices used to protect
resident from harming themselves or others.
opposite of Trendelenburg position
.Applied to chest waist, wrist, or ankles
.Made either linen or leather
lH,d of the bed is elevoted and thefoot of
. Used to pre\rent client from
$ Falling out of bed.or from wheelchair or stretcher
are placed under the legs at the head of O Crawllng orcr side rails or fuot of the bed
tbed or the bed frame is tilted. C lnterferlq with therapies (pulling-out tubes,
remoning dressings or dlsconnectinB equipment
SHarmlng themselves or others; confused or
dlsorlentcd resldents do not know what they are doing.
Some have violent behavior and are dangerous to
themselnes and othen,

.Resident is checked frequently and fluids, bed

are for protecting residents not for staff pans or urinals is offered with each check.
.Restraint may have to be applied npidly
require doctor's order
.Gi\re repeated explanation and reassurance is
of a resldent unnecessarlly constitutes
imprisonment .l

rcstrained residentt basic needs must be met

nuning team. lt should be snug and ftrm but not

f $ould not_interfere circulation, breathing and

rrement.of the restrained part should be possible
a. limlted and safe extent,

2
 .OEGkthe rcsHent's drolatbn every 15 minutes.
Chcckthc pubc, ffngerand toes must be warm and
plnk ln color.
apply restralnt unless you have been lnstructed rNotlfy nurse lmmedaately br ary abnormalities
.Tle restraints with a square knot
sure resldent ls ln good body allgnmcnt before .Seqtre the restralnts to the bed frame not the side
ralb
bony areas and skin that may be lnjurcd. Padding . l(eep scissor handy in your pocket
Blct body pafts frcm pressure and lnlury .Rcmone Estralnts and rcpositlon the resident every 2
-{rylyRestralnt securely enough to protect the hours.
pqdent, but allow enough slack so that some .Make sure the resident receives food and fluids while
s€ment of the part possible- restralned. Offer drink of water and bedpan or urinals
sure the resldent can breathe easily lf the
every2 houts
.Ma&e sure sBrnal switch ls ahrays within reach.
rlraint is applled to the chest

Mitered Comer
blonket - a thin, light-weight cotton blanket .A way of tucking linens under the mattress.
sed to cover the resident during a bath or other .lt help to keep the linen stralght and smooth.
,ocedures. lt absorbs water and provides warmth
.Ourrt Sheet Plostic Drowsheet
- is a smaller size than the bottom .A draw sheet made of plastic
JEet or top sheet. . lt is placed between the bottom sheet and cotton
t b placed over the middle ofthe bottom sheet
draw sheet to keep the mattress and bottom linens
I help keeps the mattress and bottom sheet dry and
clean and dry.
can be used for turning and moving the residents on .Others made of rubber are called "Rubber sheet"
H.
- Often called 'rubber sheet'

Certoin Focts obout the bed .Bed making ls a very important part of your role
as a professlonal caregiver.
{orne patierrts or residents are out of bed while .Oean and neat beds help make your client more
drers must be ln bed at all times comfortable
.fhey eat their meals and are bathed ln bed
.Resldent/client depends on you for their comfort
{orne cannot get up to use the bathroom and and well being by keeping the beds clean dry and
Etrry are incontinent. wrankle free
trntinent residents @nnot oontrol the passage .These helps prevent skin breakdown and
of urine from their bladders and must have their decubitus ulcers which is often fatal to elderly
hd linens changed frequently. clients
{arry forms of treatment and procedures require .Beds are usually made after the resident are up
t Em to stay in bed or may be precautionary for ttrc day
nEasures to improve conditions
 arc confined to bed wlll harn thelr Bed are made ln the following ways:
ln the mornlng after brcakfast
(;LOSED EED
ent resldents linens are changed .A bed that wlll not be used by the resident until
tfie day whenerrcr they become bed tlme
.A bed that ls ready for a resident/clienvpatient
de and room ls cleaned before vlsltos
.Top llncns are not folded back

.Made forclients who will be out of bed by

that will soon be used by a resident
folding back the top linens
bp linens are folded back so that the .Made for clients who will be out of bed for
riLat can get into the bed easily
a short time
bed becomesan open bed byjust
- - rt back the top linens
fur clients who will be out of bed by
Eg backthe top linens
br clients who will be out of bed for a

StiRGlCA{ tttiti
.A bed that ls made so that a resident can be
moved fiom a stctcierto the bed
.aId that is made with the resident ln lt .fhe surgkal bed b abo called reconery bed. Post
€c when cllent ls unable to get of bed operattr= bed or anestheth bed
Iase of illnessor injury .Bottonr ofthe top llnerc are folded back onto
the bed The foU is even wlth the edge of the
+srJre to explain the procedure before it is mett eis
tre even lf the patient ls comatose or .Top llnens fan folded lengthwise to the opposhe
aamt respond
slde ofthe bed
.Top llnen fan fiolded from the head of the bed to
the foot

4
 f I i l ;l ; t r i il ii :r, i i r tli ijt'[.-r It *utt i n fi r: I il r': I
sD.dal attentlon
rrcdlcal asepsis when handllng .Linen bag for dirty linen
.Mattress pad
.Bottom sheet ( flat or contour sheet )
are glaccd on clean surfaces
put dlrty llnen on the f,oor .Plastlc drawsheet
llnen ln the order they wlll ne used .Cotton draw sheet
hcn6 ior lc3ldrntl pcrsonal caro. Plllour .Top sheet ( flat sheet )
ad extra blanket may be needed
. Blanket
Ut Ling extra llnen ln the cllentr room because
tsroqn ls consldcred contamlnated and cannot .Bedspread
bed for another resident .plllow case(s)

.Top sheet ( flat sheet

) .Llnens are pressed and fun folded in a certain
.Shnket way to pre\rent the spread of microorganism
.Sedspread .The center crease is placed in the center of the
.Pillow ese(s) bed from head to foot and unfolded in the
.8ath towels direction that they are placed
.Hand towel .The inside of the linen that touched the
.Wash cloth resident will be inside the roll
.Mattress pad, plastic drawsheet, blanket and
.llospital gown
bedspread may be reused if they are not soiled.
.Bath blanket

{ten flat sheet ls used as top sheet lt may

b rcused as bottom sheet .A disposable waterproof bed protector is now
.tlastic and rubber sheet protect the mattress arrailable is often called chax
ad bottom linen from becomlng damp and .Cotton drawsheet ls used to move and position
srriled the client in bed if it is used
{ plastic or rubber sheet is used it is reguired .For purpose of positioning it is not tucked
D us€ a cotton drawsheet to prctect$te
dent from cortact with plastic or rubber
dreet and to absorb molsture thls can cluse
dscomfort and skln breakdown

5
 .Move the mattress to the head of the bed
.Put the matbess pad on the mattress even
with
t,le mattress pad
.Place the bottom sheet on top of mattress
llnen on bedslde chair on the a. Unfulding lt lengthwise
dtebed
b. Place cent€r crease in the mlddle of the bed
begln on the slde near the door
c. PoslUon the lower edge of the sheet even of
dle bed to its highest horlzontal lenel the bottom of the mattress
3ood lerrcl for good body mechanics
d. Place the larger hem at the top of the
mattress and the small hem at the bottom
e. Face hem stltching toward the mattress pad

sheet up from the side to open it. Fan fold .Make a mitered corner
the other side of the bed. a. Raise the side of sheet onto the mattress.
dte head ofthe bed Top edge should be tucked in.
dE top of the sheet under the mattress. Uft b. Tuck the remaining portion of the sheet
down off the bed
sure the sheet is tight and smooth c. Bring the raised portion of the sheet down
off the bed

plastic drawsheet on the bed about

inches fiom the top matress .Pult bottom sheet and make
sure to tuck it so
the plastic drawsheet and fan folded it is Ught and no wrinkles
d the otier side of the bed .sheet
Qn now the cotton dnurheet over the
the
ftkdrawsheet, tuck both under the
Elrress then go to the other side and tuck iL . Do not yet tuck m, never tuck your top linens
on
!l*etbottom sheet and make sure to tuck it so
is tight and no wrinkles
the sides
 , Frt center crease in the middle Maklng an Otrl:ll BED
hem about 6 to 8 lnches from the top .The same ptocedure as making a closed bed
.Exceptdo notcoverthe bed up to the pillows
blanket and fan fold extra .Unfold back the top hem'part towards the
tie bedspread, should extend 18 mlddle area of the bed
tom top of the mattress

row plllow put on top of the bed the

crd should be away fuom the door.
bcd to lowest horizontal positibn

. Remove the bedspread and blanket separately.

- tr': i.,)i,.(ilFlI i) $[,i,
. Place on linen bag if soiled if not fold each separately
and put at the bot of the bed
.Cover resident with batft blanket, place on top ofthe
top sheet
dean linen on .Then ask patient to hold and grasp tightly the bath
a clean chair
blanket then pull the top sheet under the bath blanket,
fold and put on the laundry bag
bed to highest horizontal level .Then ask patient to hold and grasp tightly the bath
blanket tfien pull the top sheet under the bath blanket,
bed side rail, opposite side rail up to fuld and put on the laundry bag.
!rect patient from not falling . Pcftion the resident on to the side of the bed away
top linen at the foot ofthe bed from you adjust pillow
.toosen bottom linen hom head to foot

. Go to the other slde unstuck the mattress,

bottom llnens one a tlme toward the clleni tf a bottom
pad ls golng to be reused do not fan bld bnrad sheeL phstic and cotton drawsheet from head to
bottom of bed then fold towards the center and discard
soiled linens
now clean linens, unfold the linen lengthwlse so the .Pull the clean sheet nour orcr to the side towards vou
crease is in the mlddle of the bed
h bottom sheet so hem sdtching is away from the .tucknowthesheeth€adtoiooa n."
lirelt the
amltered corner at the hea4 tuck sheet under the itching
raress fts6 the head b the fuot
.Top norysith bhnket and bedspread and then ask
the sheet towards you and tuck
cllent to hold and the pull the b.ath blanket at the
fftion the client nor,v to turn towards and then put up
ICde nils. pread, under the
to allow
 €nnge plllowcase CLEANLINESS AND SKIN CARE
Gs€ the side rall .AspiraUon - breathing fluid or an object into
tirc the nurse button the lungs
.ioyerthe .8ed sore-a decubltus ulcer, a pressure sore
bed
.Decubitus ulcer-an area where the skin and
{rt all mattrlals ln order
underlylng Ussues are ercded as a result of a
{lrcreen the client lack of blood flow due to pressure on bony
tct all dlrty linens arcasof the body
.Oral hyglene- measures performed to keep
dlbsh hands
the mouth and teeth clean
.Perlneal care - cleansing the genital and anal
areas of the body also called Pericare

.The mucous membrane of the mouth, genitals

AND SKIN CARE areas and anus needs to be kept clean and
intact
necessary for comfort, safety and heath .Besides cleaning good personal hygiene
skin is the body's first line of defunse practices prevents body and breath odors .

Cainst disease .Promotes also relaration and increase

.5bct skin prevents microorganism from circulation.
t'ering the body .The need for cleanliness and skin care is
{nd causing infection d

activity. The nurse supervisor decldes the

amount and type of personal hygiene you will
need to provide

{AILY CARE OF THE PATIENT

{ersonal hygiene practlces are performed as .Weak or disabled residents need help with
den as necessary to stay clean and irygiene measures.
onrfortable. .Routine care ls given throughout the day.
.ftople who qan are for themselves practlce
Remember to assist residents with personal
Dssonal lrygiene routinely and out of habit tryglene wheneyer neces$rry.
.lrushing the teeth, washing the face'and
tands and other trygiene measures may be
&ne routinely in the morning; before, and
after meals and before going to bed.

8
 ill'1,, l','!st'rlit:i (-"11rr ;;; r',1',rl r;7;6 :rning ua rrl
after breakfast
G the resldent ready for breakfast or dlagnrtlc
-a sdreduled early ln the day. Cleanllness and Skln crre measures are more
isonal hyglene measunes thorough
Crtrg bedparr or urlnals or asslstlng cllent to the OfErlng bedpan or urlnals or asslsting client to
Uroom the bathroom
fhing residenUcllent wash thelrlaces and hands Helping residenVclient wash their faces and
Elry rtsldr0ts wlth oral hplcne hands
Hioning client into Fqrlet's positlon or lnto Asslstlng resldents wlth oral hygiene
IGile chairs for beakfast Shavlng resldents
lbfhtening linens or flxlng bed .l
Provldlng showers, tub baths, or complete or
$ef,fitenlng resldent's units partlal bath

AEaqgn t"sLe
.Personal hygiene measures performed after lunch
Giving perineal care and supper
Giving back massaSe
Ferforming Range of motion exercises I. Offuring bed;nn or urinals or assisting client to
the bathroom
Granging gowns or pajamas or dressing
residents in street clothes as necessary
2. Helping resident/client wash their faces and
hands
Brushing and combing hair 3, Assistlng residents wlth oral hygiene
Assist in ambulation 4. Changing go,rlns or pafamas or clothes if needed
Changing bed Iinens 5. Brushlng and combing hair if needed
Straightening residentt units 6. Changing damp or soiled bed linens
7. Straightening resldentt units

HS Car,e lt-rvclve:!
Evenino Core
-=C r:1rr-l 1. ffif"S$"ltn or urinals or assisting client to
.Care given to residents in the evening at bed
2. ffiI[g resiaem/dient wash their faces and
tine 3. AssiitinS resldents with oral hygiene
.Fersonal hygiene measures performed rlght 4. Chancim damp orsoiled linens and
etnlgtrteinllu ill other linens
before the resident is ready for sleep.
5. eoms or pajamas or clothes if
.fhey help increase comfort and ability to relax ff;4f,r
and promote better sleep. 5. Helping, reslderts in street clothes to undress
and pdt ot gorns or pajamas
7. Back Massages
8. Glvlng stralghtening resident's units

I
 The Resldent's Unit @
Conditions that influence the ElHeatlng alr condltlonlng and ventllation are
Uual's comfort and furnishings deslgned to maintaln comfort and safety
DRoom temperature ranges from ebl+ or
19-23C usually comforbble for most healthy
people
and actlvity aftcts the ruldent's
trElderly and chronlcally ill persons generally
by temperature, ventllatio4 need hlgher room temperature to be more
odors in the erwlronment comfortable and contrary to physically active
usually to meet cllent's need lndividuals

air room and lingering odor cause a Odon

to be uncomfortable and unable to
0Pleasant or unpleasant
ventilation system provides fresh air OUnpleasant odors: draining wounds, vornitus,
ooves air about in the room bowel movements and urine can embarrass
resillents
client from draft by making sure they
enough clothlng, sweaters, lap robes
trBody, breath and smoking odors may be
. offensive to resldents, visitors and personnel
ElVisitors, careglvers and elderly may have or
may not have different sensitivlty to odors

Noise
incontinent cllent regularly El Confused cllent may consader sounds to be
and promptly wash residents who are dangerous, frightenirE, or lritating
ElThery may become upse! anxious and uncomfortable
ElMetal equipmcntsudt as bedpans, urinals and the
linen or clothing as soon as you have
llke dishes and meal trays, oud conversations from
stafiTV, radiq poorlyoiled equipment like
and wash bed pans and emesii basins wheeldralrs, stretcheB, utillty carts
Fomptly Q Controlled by changng metal equlpment to plastlc,
EIse room deodorizer when necessary drap6, carpet and the like helps
O Answerlng telephone lntercom promptly is
EDse deslgnated smoking area, wash hands
necessary, conEol loudness of their voice also helps
rfter smoking care for uniforms
 Room Furnlture and Equlpment

IHE BED
for safety and comfort
ElCan be adjusted electrlcally and manually
shadows and dull llghting can cause
headache and eyestraln ElCan be raised horlzontally to allow personnel
to give care without unnecessary bending or
lights allow cllent to rest and relax better
reachlng
room ls more cheerful and stlmulating
Ethe lowest horizontal position allows the
ls adjusted to meet changing neeG resident to get out of bed whh ease
dlents, shadet drapes etc. helps
trThe head and foot of the bed ls also
adJustable according to needs

oVERBED TABhE
control system or patient control switch
&ws caregiver and patients to change bed El Used for meal trays and for eating, reading,
psition as needed and as necessarlly writing and others
OMost have storage area underneath for make-
ups, hair care activities, shaving items and
personal grooming activities
and caster wheel - made of plastic or
ntber to allow movement easily O Can be a working iable to carers but only
Wheel should be locked at all times except clean and sterile items can be placed on the
table, never place bedpans, urinals or solid
linen

9rould be adJustable to a comfortable helght tr first strett

lcabinet) - wash basin and
br resldent ln bed or chalr personal items like soap and soap dish,
powder, lotion, deodorant, towels, washcloth,
bath blankeg clean gown or pajama, Emesis
basin or kldney basin
located next to the resldent's bed
El Lower shelf - bedpan and its cover; urinals,
Convenlent storage area for personal toilet paper
Delongings, personal care equipment
El Top ofthe bedside table -tissues, telephone,
Drawer - money, eyeglasses, book, personal radio, flowers, gift, cards and other items
lmportant to client
 CHAIRS
CURTAINS OB SCREEN
El Always has at least two for resident and
vlsltor use tr Pullod around to provlde privacy

Q Clean llnen may be placed on the seat of thls ElAlways pulled whlle care ls given
chair or a llnen bag can be placed over the Qprotest resident from being seen by others
back for dirty linen
O Never be used for both clean and dirty linen
at the same tlme

C-ollSvstem The Bothroom

O albw the resldent to signal for assistance El Health facllities have bathrooms in each
El Connected to a light above the room door Krom
and to a light panel or lntercom system at the OToilet, sink" call system, mirror, shower
nurse's station ElHand rails should be installed
B Attached to the bed or chair and should be ElTowel racks, tollet paper, soap, paper towel
within reach always dispense
O Tap bell

Bed Making
Other Eauloment
B - a thin, lightweight cotton
O Closet and additional drawers are also blanket used to cover the resident during a
provided bath or other procedures. lt absorbs water
tr Small fumlture chairs, footsteps, W, and provilJes warmth
radio, clocks, bulletin boards, pictures may O Drawgheet- smaller in size than a
help client feel at'home: bottom/top sheet placed over the middle of
Et Subacute units - BP apparatus Wail the bottom sheel. lt helps keep the
mounted mattress and the bottom sheet clean and
tr lV stands or poles dry and can be used to turn and move
residonts in bed. Often called a 'cotton
draw sheet"
 B Some patlents or resldents are out of bed
whlle others must be ln bed all the tlme
Mltered corner - a way of tucklng linens Cl They eat thelr meals and are bathed in bed
under the mattress to help keep the llnen
O Some cannot get up to use the bathroom and
straight and smooth
many are lncontlnent
Plastlc Drrw Sh.rt - a draw sheet made of
El lncontlnent resldents cannot control the
dastlc; lt ls placed between the bottom sheet passage of urlne from thelr bladders and must
and cotton draw sheetto keepthe mattress
have thelr bed linens changed frequently
and bottom linens clean and dry. Others ar€
made of rubber called "rubber sheet" El Many forms of treatment and procedures
requlre them to stay ln bed or may be
precautionary measures to improve
condltlons

O Beds are usually made after the residents

El Bed making is a very important part of your are up forthe day
mle as a professional caregiver
OThose Mro are confined to bed will have
g Clean and neat beds help make your client their beds changed in the morning after
more comfortable breakfast and after they have been bathed
O Resident/cllent depends on you for their O For incontinenl residents, linens are
comfort and well-belng by keeping the beds changed throughout the day whenever
dean, dry and wrinkle-free. These help they become wet, soiled or damp
preyent skln breakdown and decubitus ulcers
O Bed is made and room is cleaned before
which is fatal to elderly clients
visitorc anive

Beds are made in the followlng ways

Open Bed
Gbsed Bed E A bed that will soon be used by a resident

O A Ued that wlll not be used by the resldent El fhe top linens are folded back so that the
until bedtlme resldent can get lnto bed
that is ready for a resident / cllent El A closed bed becomes an open bed by folding
El A bed / back to the top linens
patient
C Top linens are not folded back El Made for clienG who will be out of bed for a
short tlme

4
 Surgical Bed
that ls made wlth the resldent ln It tr A b€d that is made so that a resident can be
when thc cllent ls unable to get out of moved from a stretched to the bed
tccause of lllnass or lnJury El The surglcal bed ls also called recovery bed.
lrne to explaln the procedure before lt ls Port op.ratlve bed or aesthetlc bed
sen if the cllent is comatose or@nnot O The top llnes are folded so that resldent can
be transferrcd from a stretcher to bed

Linens
lottorn of the top linens folded back onto
dte bed, the bed is even with the edge of the El Needs special attention
aattress El Follow medical asepsis when handling
Top linens fan-folded lengthwise to the tr Hold linen away from your body
El Never shake
Top linen fan-folded from the head ofthe El Lean linens are placed on clean surface
El Never put dlrty linen on the floor

Collect linen in the following order

1. Unen bag for dirty linen
El Always collect llnen ln the order they wlll be
used 2. Mattress pad
O Collect linens for resident's personal care. 3. Bottom sheet (flat or contour)
Plllow cases and extra blanket may be necded 4. Phstic drawsheet
El Don't brlng extra llnen ln the client's room 5. Cotton drawsheet
because their room is considered 6. Top sheet (flat sheet)
contamlnated and cannot be used frir another 7. Blanket
resldent
8. Eedspread
9. Pillow case/s
 Bath towel/s E Unens are pressed and folded in a certain
way to pnevent the spread of mlcroorganism
Hand toweUs
El The denter crea.se ls placed ln the center of
Wash cloth
the bed from head to foot and unfolded in the
Hospital gown direstion that they are placed
Eath Blanket El When removlng dirty linens from the bed, roll
them away from you
E The lnslde ofthe llnen that touched the
resHent will be indde the roll
El Mattress pad, plastlc drawsheet, blanket and
bedspread may be reused lf they are not
rclled

When flat sheet ls used the top sheet may be

reused as bottom sheet B Disposable waterproof bed protector is now
Plastic and rubber sheet protect the mattress available
and bottom linen from becoming damp or O Cotton drawsheet is used to move and
soiled posation the client in bed if it is used
lf plastic or rubber sheet is used it ls required E For the purpose of positioning it is not tucked
to use a cotton drawsheet to protect the
dient from contacl wlth plastic or rubber
sheet and to absorb rnoisture as thls can
cause discomfort and skin breakdown.

Cleanliness and Skin Care

Aspiration - breathlng fluld or an obJect lnto the ECleahliness and skin care necessary for
lungs
comfort, safety and health. The skln is the
El Bedsore - a decubhus ulcer; pressure sore body's first line ofdefense against disease.
E Decubitus ulcer - an area where the skin and lntact skin ptevents microorganism from
underlylng tlssues are eroded as a resuh of a tack enterlng the body and causing infection.
qf blood flow due to pt.essure on bony areas of
Ukewlse the mucous membrane of the
the body mouth, genita! areas and anus need to be
O Oral Hygiene - measures performed to'keepthe kept clean and intact
mouth and teeth clean
El Perineal Care - cleanslngthe genhal and anal
areas ofthe body

o
 IEesldes cleanlng; good personal hyglene
practlces prevent body and breath odors,
El Resldents usually need some help with
promotes relaxatlon and lncrease
clrculaloh personal hyglene because of weakness due
Cuhure and personat preferences lnfluence Itlness and the bodlly changes of agin!. The
hyglene practices. Some peoph prefer showerc need for cloanliness and skin care is affected
to tub baths, On person may bathe before golng
by persplratlon, vomitlng, urinary and bowel
to bed, anothar may prefer bathlng tn the
cllmlnatlon, dralnage from wounds or body
mornlng. The frequency of bathlng abo varles.
openlngs, bed rest and the amount of activity
Some people may not harrc hot water for
bathlng. Others may be unable to afford such O The nurse supervisor decides the amount and
drlngs as soap, deodorant, shampoo and type of personal hyglene you will need to
toothbrush or toothpaste provlde

Daily Care of the patient

hygiene practices are performed as often
Before Breakfast
ssary to stay clean and comfortable. people
can care for themsetves practice personal
El Often called Eorty Mornlng Core or AM Core
re routinely and out of habit/
Brushlng the
washlng the face and hands and othei O Get the resident ready for breakfast or
measures may be done routinely ih the diagnostic test scheduled early in the day
; before and after meals and before golng E Personal hygiene measures:
bed. Weak or dlsabled residentt need helfwit[ O Offering bedpan or urlnals or assisting client
to
iene measures, Routine care is given throughout the bathroom
day. Remember to assist resldents with 0 Helplng residenVclient wash thel, faces and
hygiene whenever necessary hands

After Breakfast
Cl Momlng Core; given after breakfast
'Posftlonlng client into Fowle/s posltlon El Cleanliness and skin care measures are
or lnto more
bedslde chalrc for breakfast
thorough :
l.Offiering bedpan or urinals or assisting client
to the bathroom
2. Helping residenVclient wash their faces and
hands
3. Asslstlng residents with oral hygiene
4.Shaving residents

7
 showers, tub baths or complete or
Afternoon Care
- Personal hygiene measures performed after
lunch and supper
E Offering bedpan or urinals or asslsting client
to the bathroom
ilng gowns or pajamas or dressing resldents
clothes as necessary tr Helplng residents/cllent wash thelr faces and
Brushlng and comblng hair hands
Assist in ambulation O Assisting residents with oral hygiene
Changing bed lines trChanging gowns or paJamas or clothes if
Straightening residents, units needed

Evening Care
Brushing and combing hair if needed
Changing damp orsoiled bed linens O HS Care
Straightening residents, units E Care given to residents in the evening at
bed time
E Personal hygiene measures performed
right before the resident is ready for sleep
O They help increase comfort and ability to
relax and promote better sleep

J Offerlng bedpan or urinals or assisting cllentto

the bathroom
J Helplng resident/client wash thelr faces
and
hands
J Asslstlng resldents wlth oral hyglene
J C_hanging damp or solld llnens and stralghtening
all other linens
3 Helping resldents in street clothes
to uddress
and out on gowns or pajanras
 Brushing and Combing
onet appearance and psychorogicat .Are usually part
of momlng care
l?;iT,::t .Thry are done at
other times lf aeeded
. Many resldcnts
ttke thelr hrair styled before vlsltors
residents arilre
;*1,5H ?:'JL[1i,fJJ''he
.Encourage rcsldents
needs asslstance.with to Derlbrm their own halr
hair care whenever asstst when necessery carg but

ure,in.combing or brushing
the
t's hair
.ldentify the .Be sure
client the resident is dressed or
.Explain robe and slippens if he has on a
to the resldent what you or she i,l, b;;. "
.ffliE: comb and brush, bath
are golng to do .Place the
towel across the residentt
towetand othertoitet
shoulders. place the
torr"t ,.ros tf,-" pillow if
equlpment at slde of bed/bed he orshe in bed.
frranee stand .}3!.1h" resident
':T]rge equtpment at stde of bed/bed to remove
.Wash your stanJ eyeglasses if thev
hands are.wom. put them in
.lowerslde ttre griss?a-;;;,;;.J
rall gtass case in the
bedside stand
.llelp resident
on to a chalr or sttflng
."fi
posltton on bed.
ff",H:Hll;,ffi f gffi ctio n s. rh e n

hak, starung at the

igil€ scatp. Brush toward
Sh,omoootao
by the resident.
:l"rH;il,:*ned r,,tJ;ff:*::
:ffi'llT:,t,Tflilffi : i[,,1];"
theside rail tf th"
*u.ii in u.a.
sure.the slgnal llght
ts wlthln reach. #iryjffi1#*t*y,",,,,T#l,T[-,ny.,,
'
il Hfl ffi :|,xf"i$;"#i3l;;,.txs prefer to s it
ff trT,::tsJHrfi
rii{L,,Hqfi ffi :fl 3fi ;;, tan be washed

be given in bed
be shampooed
 THE RESIDENT'S HAtR
to the resldent what you are golng to do.
4. Arrange eguipment in a convenient location.
5. ldentlfy the resldent. Check the ldentlflcatlon bracelet
to beth towels and call the resident by name.
ice towel or washcloth folded len8th wlse 5. Screen the resident to provide privacy.
SEmpoo
at condlfl oner lf ,.quenad 7, PoslUon tie resldent approprlately depending on the
Er lh?rnometlr method you are going to use.
8. Place a bath towel across the pillow under the
Eryipmem fror the shampoo in bed (lf neededf
'fougtt resldent's head.
bin or pail 9. Brush and comb hair thoroughly to remove snarls and
Iaterproof bed protaclor Engles.
bnb and brush

lbin water and keep it at approximately 110.F

i to 44 'C). 16. Rinse the hair with water.
Ask the resldent to hold the face towel or wash 17. Repeat steps 13 through 15
6r over the nose or mouth- 18. Rinse agpin thoroqhly.
i€ the pitcher or nozzle to wet the hair 19. Apply conditioner and rinse as directed
on the
container.
Jr€ a small amount of shampoo 20. Wrep the resident! head with a bath towel.

T* up., lather with both hands. Start at the

rine and work toward the back of the head.
21. Dry his or her face with the towel or washcloth
used to protect the eyes.
hssage the scalp by applying pressure with 22. Help the resident ralse his or her head if
lr hngertip_s. Avoid scratching the scalp wlth appropriate.
23. Rub.the hair and scalp with the towel.
Use the
second towel if the first becomes too wet.

b_thehalr to remove snarls and tangles. A Shqvlno

resldent may want her hair curled .A clean-s.haven
oirolled up. fa,ce promotes the physical
the hair as quickly as possible. comfort
and psychotogiot we[-being of m."v'rii"
the resident to a comfortabte posltion. . Residents use electric
i"iii_"t.
shavers others like blades
sure the signal light ls withln .You should soften the
reach. beard and skin before shaving
andreturn equlpment to its proper place. with a blade shaver
.Apply a warm wash cloth
!_a1y liseosabte equipment. etacesoiLd ltnen or face towel for a few
lrlen Darret or in the "dirty" utlllty minutes
room.
.Then lather the face with
soap and water or shaving
cream
.Ta&e care not to cut
or lrritate the skin while shaving

2
 SIIAVING THE RESIDENTWITH A BI.ADE SHAVER
1. Explaln to the rEsldent what you aic to do. 4. Arrenge the cgulpment on the over bed table.
tolng
2, Wash your hands
5. ldentlfythc esldent Chedr the ldentiflcatton
3. Collect the ,ollowlng equtpment:
a. Wash basln
bmcelet and call the resldent by name.
b, gath towel 6. Pull the prMacy curtaln
c, Face towel 7. Raise the bed to the best level for good body
d Washcloth
e, Beth thermometer
mechanlcs.
f, Dbposable nzor 8. Flllthe wash basin wlth water approxlmately 1lS.
g, Mlrrcr F (46'C).
h. Shavlng cream, soa9, or loflon
l. Shavlng brush 9. Phce t te urash basin on tfte over bed table on top
I, After*have lotlon (male resldents only) of the paperbweb,
k. Tlssues
10. bwerthesde rall.
l. P.p€r towels

1L. Posltion the resident in a seml sitflng poslton if

allowed, or on his or her back.
19. Apply shavlng cream with your hands. Or aoolv
a
*.theAdjust the lighting
resident's
so that you have a good view of generous amount of lather with a shaving
brusir.'
face. 20. Hold the skin taut with your other hand.
13, Place the towel over the chest.
21. Shave in the direction of hair growth. Use longer
14. Posltion the over bed table wlthln easy reach strokes around the chin and lips.
and at a
comfortable working height,
22. Rlnse the razor frequently and wipe with tissues.
15. Un screen the resldent
23. Apply dlrect pressire to any bleeding area.
16. Wash the reslderrt's face. Do not dry,
Z+.,.!tltslr offany remaining shaving cream or soap.
17. Place a washcloth or ftce towel ln the wash Dry
basin. wlth a towel.
Wet It thoroughly and wring it out.
25. Apply after*have lotlon lf requested.
{.fur3to5minutes
Apply the washcloth or towel to the resident,s face 25. Move the over bed table to the side of the
bed.

27. Make sure the resldent ls comfortable, Care of Nails and Feet
28. Make sure the slgnal flght ls wlthln reach. . Regulr€s spcct.t rttlntlon to pr€vlnt lnbction, injury
29, Raise the slde nil. and
odor
. liangnallg lngrown nalls and nalls that torn away
from the
sklncausc breals lnthc skln
.
.".
. Oeadng elrd trlmmlnt n lk Ire eesler rlght after
!14, Place soiled linen ln the linen barrel or lnlhe a tub bath
"dlrty, or shryr btdr or efor t ey hae been soaked
utility room. . Ilo nd uje scissors b ort ffruErnalls
35. Wash your hands. . Be r'e y (.rEfrJl urhcn dippang ard trlmming
fingemails to
36, Report any niclc or bleeding to the nu6e. prcvrnt damale to the sur?oundlng ussue
. Nursing asslstanB are not usually allowed to
cut or trim
nalls, ask the nurse supervircr abour your facilityt
poltcy

3
 1. &plaln to he restdent whet you are golng
to do. tl, Arnngc the equlpment
2. Wash your hands. on the overbed table.
3. Collect the foilowing equlpment: 5. ldenUfy the resldent Check the identiflcatioi
a. Wash basln bracelet and calt the resldent by name.
b, Bath thermometer 6. Pull the prlvacy curtaln.
c. Tlxo bath towels 7. Asslst tie Esldent to the bedslde
chalr and posltion
d. Face towel the slgnal llght wlthln reach.
e. Washcloth 8. Place one bath towel on the floor
under the
f. Emesis basln resldent's fuct
g- Nail clippers 9. Fill the wash bastn wlth 105. F water (42.
C) if the
h, Orange stlct resldent h.s not had a tub bath or
shower.
L Emery board or nail flle 10. Place tie wash basin on the flooron
the- towel.
-- --v" MrP
Heln
,. Lotion or petrotatumJelly the resldent put the feet lnto the basln.
k. Paper towels

Pg:itio.n the overbed table ln

front of the res,deht, tt
uld be low and close to the resk
ent.
Fill the emesls basin wlth water
the same
rpe.ilture as for the foot soak.
. Place the emesis
basin on the overbed table on
top
the paper iowels,
Put the resident,s flngers into the
emesls basln.
itlon the arms so that he or sh" f.
.omfort.Oi".'
Allow_the feet and flngernails to
soak for 15 to 20
rutes, Re warm the water lnlo
mlnutes.
. Clean under the fingernails
with tieoinge stlck.
. Remove the emesls basln
ana OrV tfre nng'ers

26. Ralse the slde rall

lfthe resldent ls ln bed. Changing Hospital gowns or ctothing
27-. Put socksand shoes or sllppers
on resldents who
rlllremaln out of b€d. . ls normally changed after bathlng
and whenever lt
becomes wet orsolled
3*.:_.:l
,roper places. :jum :q.utpment and supplies to their
Dlscard dbposaUc suppties. . fhe change is easy lfthe resldent
can move his or
z,. Un screen the resldent her arns and legs.
30. lake soiled linen to the linen
barret ln the hallray
. Spedal measures are needed
or to the 'dirtlr" uflllty room
where there is an arm
lnjury or pamlysls or an IV lnfirsion
31. Wash your hands. . ,f ,t* j: an arm or teg inJury or paralysis,
12. to tie nuRe: Frment is rcrnoved
the
from the unaffea"O ,ii" n.rt.
r ellused areas . Thm the afteted limb is supported while the
Eprment is Emoved.
. A clean garmeot is placed
on the affected limb ffrst
then on the unaffected part limb.

4
 Changlng the Gown of a Resident wlth an lV
Explaln to the r$ldent what you arc golhg to do. .10. Rcmove the lV bottle ftlm thc pole. Sllde the bottle
and tublrry through tfi! rleetre. Do not pull on the tublng.
Wash your hands.
Xeep the bottle above the resldent's arm.
Get a clean gown, .11. Hang the lV bottle on the pole.
ldentlfy the resldent, Check the ldentlflcaUon braelet
12. Gatherthe slecve ofthe clean gown that wlll be put on
and call the resldent by name.
the erm wltft the lV lnfirslon.
Pull tho prlv.cycurt ln.
13. Rcmow the lV bottle from the pole. Qulckly sllp the
Unhsten the back of the gown. Free any parts that the Epthered slecve over the lV bottle at the shoulder part of
the gown. Hang the lV bottle on the pole.
Rcmove the gown frcm the srm wlthout thd lV 14. Sllde the gsthsred sleeve over the tubln& hand, arm,
Gather up the sleeve wlth the lV. Sllde the sleeve over and, and M slte. Then sllde the sleeve onto the resldent's
the lV slte and tublng, Remove the resldent's arm and shoulder.
hand from the sleeve 15, Put the other slde of the gown on and fasten the back.
Xeep the slewe gathercd. Sllde your arm along the

Changing Trousers or Slack

16. Make sure the resldent is comfortable and the
signal light is within reach. 1. Explaln to the resident what you are golng to do
17. Make sure the side ralls are up and the bed ls in the 2. Wash your hands.
lowest horlzontal position, 3. Collect
18. Un screen the resident. a. Clean underpanE and trousers or slacks
l!r. Take the soiled llnen to the linen barrel or to the " b, Waterproof covering for the bed
dirty" utlllty room, c Equlpnient for perineal care
x), Wash your hands. 4. Pull the prlracy curtain.
21. Ask the nurse to check the lV flow rate. 5. Place the waterproof coverlng on the bed.
6, Put the bed ln the lowest horizontal position.
7. Raise the side rail opposite you.
8. Assist the r6ident onto the bed. position the
resldent ln the supine posltion.

9. Raise t,le bed to the best leveJ for good body 13. Glve perineal carc as lndlcated.
mechanlcs.
14. Place dean underpants over the resident! feet and
10. Place the bath blanket over the resldent pull them up over the knees. Do the same with the
11. Reech under the bath blanket and remove the trousers.
trousers and underpants by asking the resldent to 15. Pull the underpants and then the trousers up over
alse hls or her hlps. the hlps by asklng the resldent to raise hts or her hips.
12. Do the followlng lf the resldent ls unable to ralse 15. Do the following if the resldent ls unable to raise the
the hlps. hlps:
r. Place the rcsldem ln thc slde-lylng posltloo byturnlng
e. Pbce the rcddent ln the sidFlylng posiflon by tumlng the
the resldent tow8rd you, -
Gsid€artbmd lou.
b, Pull the trousers and underpents d* *",tlr" ,pp., b. Pull the undcrpanE and then tfte tmusers up owr the
hlp'
upp€r hlp.
e Tum the rcsldent tg the other side and repeat stsp.
c. Tum the resideflt to the other side and repeat step b.

5
 17. Remove the bath blanket. Button and zip
BOWET ETIMINATIO]T
the
trousers, .Bowel ellminatlon lnvolves the excretion of
It.Lower the bed to lts lowest horizontal posltion. wastes from the gastrolntestinal svstem
19. Transfer the resldent to the chalr or wheelchair. Chyme portiolly digested tood and fluld that
pass frpm the stomach lnto the small intestine.
. Further dlgestlon and absorptlon of nutrlents
occurs as t}te ctryme passes through the small
bowel.
.The chyme becomes less fluld and more solid in
conslstency in the colon.

Feces the semisolid mass of waste products in

the colon.
De{eetion is the process of excreting feces from the
. Feces move through the intestines by perlsta&fs, the rectum throuSh the anus; a bowel movement.
altemating, contractlon and relaxation of intestinal
Stool is the term for feces that have been excreted.
muscles.
. The feces move through the large intestine untll
they
. reach the rectum,
Normol Bowel Movements
.The frcquency of bowel movements is highly
. Feces are normally soft, formed, and shaped like the
indlvidualized.
rectum.
.Some individuals may have bowel movements every
. Feces that move rapldly through the intestine are
day after breakfast or ln the evening.
watery and unformed is known as diorrheo.
.Others have bowel movements every 2 to 3 days,
. Feces have chaGcterlstic odor. The odor ls due to the
actlon of bacterla ln the lntestlnes.

Many people, especially the elderly, believe

What to Report to the Nurse Ihey Jnust have a bowel lnovement daily to be
healthy.
. Before disposal, stools should be
carefully observed for
@lor, amount, conslstenLy, odor and any resldent
complains of pain need to be reported, Factors that affect Bowel Movement
. Be sure the nurce observes arry ilormal defecation ls influenced by many faaors,
abnormal stool before
it is discarded. REgularlty, frequency, consistency, colot and odor of
stools can be affeAed by both psychological and
physlcal factors.
 2. Disability and Age
1. Privacy .Marry parapleglc residents lack voluntary
. Like urination, bowel ellrninatlon is consldered control of bowel movements.
a prlvate act. .Elderly residents may also anal incontinence
'Lack of privacy may prevent a person from because of changes in the body due to aglng
defecatlng even though the urge is present. or illness
.The odors and sounds that accompany a bowel
movement can be embarrassing.
3. Diet
.Some residents may ignore the urye to .A well-balanced diet helps maintain
defecate to avoid havlng a bowel movement ln normal bowel elimination. A certain
the presence of others. amount of bulk is necessary for normal
ellmination.

4. Fluid
. Fecalmaterial contains a certain amount of
water, which is absorbed as the feces moves 6. Medications
through the large intestine .Medications nray be given to control diarrhea
or prevent constipation.
5. Activity .Drugs glven to relieve pain often cause
.Exercise and activity maintain muscle tone constipation.
and stimulate peristalsis.
I
.lrregular bowel elimination is often due to
inactivity and bed rest.
.lnactivity may result from disease, surgery
injury and aging.

1. Constipation
.Constipation is the passage of a hard, dry nool.
Common Problems .Constipation occui: when fuces move through
. Regular bowel elimlnation ls important. the intestine slowly, allowing more time for
absorption of water from the fecal material.
Common problems that can affect normal bowel
.Caus€s of constipation include ignoring the urge
elimination include constipatlon, fecal
impaction, diarrhea, anal incontinedce, and to defecate,
. diet,
flatulence.
.decreased fl uid intake,
' inactivity,
.medications,
.aging and certain diseases.

,,"ciC
 2. Fecal lmpaction
.A hcal lmpactlon ls the prolonged retentlon and
accumulatlon Of ftcal matcrlal ln the rcctum. 4. Anal lncontinence
.The lndlvldual wlth a fecal lmpactlon maytry .Anal, orfecal, Incontlnence ls the lnabllity to
scveral tlmes to have a bowel moviement. control the passaSe of feces and gas through the
anu3.
.Dlseases or injuries to the neryous system may
3. Diarrhea
.The frequent passage of llquld stools. Fecal cause anal lncontlnence.
meterla! moves through the intestlnes mpldly. 'Frustrdtlon, embarrassment, anger, and
.The causes of diarrhea include infectlons, certaln humilhtlon may be experienced by the resident-
medlcatlon, lrrltatlnS foods, and mlcroorganlsm
ln food and water

Comfort and Safety during Elimination

5. Flatulence .Certain measures help promote normal bowel
.Flatulence is the excesslve formation of gas ln elimination.
the stomach and intestines. Enemos
.Gas or air ln the stomach or intestlnes is known .Enema.isthe introduction of fluid into the rectum
as flatus.
and lower colon.
.Swallowing air whlle eating and drlnklng and .Enemas are ordered by doctors to remove feces
bacterial action ln the intestines are the and to relieve constipation or fecal impaction.
common source of flatus. Clean the bowel of feces prior to certain x-Ety
procedures.

Enema Solutions
.Tap water water from the faucet.
- Generol Rules
.Soap suds llquld soap and water
- .Giving an enema is generally a safu procedure.
.Sallne - salt and water. Marry peoph glve themselves enemas at home.
.Oil - minera! oil and olive oil, .Enemas are also dangerous fur people with
cerbin heart and kidney diseases.
Equlpment
.You should glve an enema only after receiving
Dlsposable enema ktts. The llt includes a plastlc
enema bag (or buckct), tublng, a ctamp forthe
clear lnstructlons and after revlewlng the
procedure with the nurse.
tubing, and a waterproof bed ptutector. Gstlh
soap, lubrlcant, bath thermometer, dlspo;bb
gloves, and bedpan.
 ThetentnercicJll\/ prepored f tefi)tl
Tltt' Lltrnsitta Inena .The commercially prepared enema is ready to
.Cleansing enemas are often glven to clean the be administered. The solution is usually given
bowel offeces and flatus, at room temPerature.
.TaD water enemas can be dangerous. The large .The plastic bottle contains the enema
indestlne may absorb some of the water lnto solutlon. lt is squeezed and rolled up from the
the bloodstream. bottom to administer the solutlon'
. The enema tublng ls lnserted 2 to 4 lnches lnto
the rectum, i-i:t O!I Retetttlrln [.,tt,irtcl
.A rcsident ls recelvlng an enema ln the left .Commercially prepared oil retention enemas are
Sims' position. The lV pole ls posltloned so that administered like other commercially enemas'
the eriema bag ls 1.2 inches above the anus and
18 inches above the mattress. .The tip of the commercially prepared enema is
inserted 2 inches into the rectunl.

,'lil -':;i i r,'..,:'

.A rectal tube is inserted into the rectum to relie\re
flatulence and intestlnal distention. .Cancer, bowel diseases, and trauma are
.The rectal tube is removed after 20 to 30 minutes.
This helps prevent the rectum from becoming common reasons for intestinal surgery. Many
lrritat€d. times it is necessary to perform an Ostomv,the
rAfter being inserted the rectal tube is taped to the surgical creation of an artificial opening.
resident'sbuttocks and the flatus bag rests on the
bed. The tube is lnserted 2 to 4 lnches lnto the
nectum,
.The Resident with an OstomY
.Sometimes it is necessary to surgical remove part of
the lntestines.

@@t lleos;tomv
.A colostomy tlre surgical creation of an artificial
is .An ileostomy is the surgical creation of an
opening between the colon and abdomen. artificial opening between the ileum (small
.The individual with a colostomy needs to wear a intestine) and the abdomen.
colostomy appliance, a disposable plastlc bag . An ileostomy. The entire large intestine is
applied overthe stoma.
surgically removed during the operation.
. A colostomy appliance is in place overthe stoma .Dlsposable and rcusable ileostomy appliances
and secured wlth a colostomy belt.
are available.
.Colostomy sites with the shaded area indicating
the part ofthe bowel that has been surglcally
removed.