PSW 168 Final Exam Review

• Final Exam Review for PSW 168

Celiac Disease

• It is an inborn metabolic disorder where the individual cannot tolerate gluten protein.
• Adults and children can be affected.
• Symptoms include abdominal distension, vomiting, very large amounts of diarrhea, muscle wasting, and lethargy.
• A gluten-free diet is the most effective treatment.

Ileostomy

• It is a surgically created opening between the ileum and the abdominal wall.
• The entire colon is removed.
• Liquid drainage occurs.

The Urinary System

• The components kidneys, ureter, bladder, sphincter and urethra are involved.

PSW Role

• Measures and records hourly urine output.
• Records intake and restricts fluids.
• Monitors daily weight.
• Provides frequent oral care.
• Implements infection prevention techniques.
• Prevents bed rest complications.

Diabetes

• It is a disorder in which the body cannot produce or properly use insulin.
• Insulin is a hormone secreted by the pancreas.
• Insulin is needed for the appropriate use of sugar (glucose).
• Hyperglycemia occurs when there is not enough insulin in the body.
• If the cells do not have sugar for energy they cannot perform their functions.
• Untreated diabetes can lead to long-term complications.
• Severe hyperglycemia can be life-threatening.

What is Occurring in Diabetes?

• There is a deficiency of insulin available to cells.
• Sugar builds up in the blood, resulting in hyperglycemia.
• The kidney's ability to conserve glucose is exceeded, and excess sugar is excreted in urine, a condition called glycosuria.
• Osmosis causes water to follow glucose into the urine which results in extreme thirst, called polydipsia.
• When the body shifts from using carbohydrates to using fats for energy it causes weight loss, extreme hunger, called polyphagia.
• Excessive urination, micturition, and voiding is called polyuria.
• When fat is metabolized, it results in the production of ketones, called ketoacidosis.
• Nutritional and energy requirements determine diabetes meal planning.

Hyperthyroidism

• It is an overactive thyroid gland that causes too much thyroid hormone to be produced.
• All other bodily functions speed up.
• Signs and symptoms of hyperthyroidism include weight loss, increased hunger, hyperactivity, palpitations, nausea, vomiting, irritability, and depression.
• Treatments include surgical removal of some or all of the thyroid gland.
• The administration of one dose of radioactive iodine destroys some of the thyroid cells.
• Medications can inhibit the production of the thyroid hormone.

Hypothyroidism

• It is caused by an underactive thyroid gland.
• A decreased production of thyroid hormones = body process slows.
• Signs and symptoms of hypothyroidism: weight gain, impaired memory, fatigue, sluggishness, irritability, constipation and slow heart rate.
• Treatment includes a thyroid supplement.

IDDM (Insulin-Dependent Diabetes Mellitus), Type 1

• Occurs most often in children and young adults.
• The pancreas does not produce insulin.
• Leads to severe hyperglycemia.
• Develops early symptoms of the disease.
• Treatment: Daily insulin injections.

NIDDM (Non-Insulin-Dependent Diabetes Mellitus), Type 2

• It is the most common type of diabetes.
• Usually occurs after the age of 40, but is increasingly seen in younger individuals due to increasing rates of obesity.
• The pancreas does not produce enough insulin, or the body does not effectively use the insulin produced.
• Treatment: Diet and exercise, oral medications and insulin may be needed sometimes.

Hypoglycemia (Low Blood Sugar)

• Causes of Hypoglycemia:
  • Too much insulin or diabetes medication.
  • Omitting or delaying a meal or snack.
  • Eating too little food.
  • Too much exercise.
  • Vomiting.
• Signs and Symptoms of Hypoglycemia:
  • Hunger, weakness.
  • Trembling, shakiness.
  • Sweating.
  • Headache, dizziness.
  • Faintness, irritability, anxiety.
  • Disorientation, confusion.
  • Rapid pulse & rapid shallow breathing.
  • Changes in vision.
  • Cold, clammy skin.
  • Unconsciousness.
  • Convulsions.

Hyperglycemia (High Blood Sugar)

• Causes of Hyperglycemia:
  • Undiagnosed diabetes.
  • Not enough insulin or diabetes medication.
  • Overeating or eating the wrong kind of foods.
  • Too little exercise.
  • Stress: physical or emotional.
• Signs and Symptoms of Hyperglycemia:
  • Tiredness or fatigue.
  • Hunger, thirst.
  • Frequent urination.
  • Leg cramps, blurred vision.
  • Dry, itchy skin.
  • Flulike achiness.
  • Headache, flushed face.
  • Rapid, weak pulse.
  • Low blood pressure.
  • Sweet breath odor.
  • Slow, deep & labored breathing.
  • Confusion, nausea & vomitting.
  • LOC, convulsions.

Foot Care

• It is very very important to observe your client's feet every day.
• Especially for a diabetic clients due to Neuropathy.
• Foot and leg wounds have very serious consequences like infections and gangrene.

Retinopathy

• Retinopathy is a disease of the retina which results in impairment or loss of vision.
• It is caused by high blood sugar due to diabetes.

Role of the PSW

• Report signs and symptoms of hyperglycemia or hypoglycemia to your supervisor immediately.
• May make meals and needs to follow a diabetic meal plan.
• Serve meals and snacks on time.
• Records the amount of food the client eats at every meal and snack.
• Calories not consumed at a meal or snack must be replaced during the day or a reaction may occur.

The Neuro System

• Includes the brain and spinal cord.

Scalp injuries:

• This includes lacerations (cuts).
• Hematoma (collection of blood-blood blister).
• Contusion (bruise).
• Abrasion to the skin (scrape).

Concussion

• Signs of a concussion include:
  • Potential loss of consciousness > 5 min.
  • Not remembering what caused the injury to the head.
  • Dizziness.
  • Blurry vision.
  • Headache.
  • Nausea and/or vomiting.
  • Unclear thinking processes-confusion.
  • Repeating phrases, for example, "What happened?".

Cerebral Palsy

• It is a disorder affecting muscle control and is progressive.
• Causes include injury, abnormality in the motor region of the brain (cerebral) and lack of oxygen to the brain.

Parkinson's Disease

• It is a neurodegenerative disease.
• Movement is normally controlled by dopamine: chemical carries signals between nerves in the brain.
• When dopamine-producing cells die, symptoms of Parkinson's appear.
• Sings: Impaired speech that is monotonous and soft.
• Loss of automatic movements like fixed staring expression or an unblinking eyes, lack of animation when speaking or a masked face.
• Therapy includes physical therapy to improves mobility, flexibility, balance as well as speech therapy and ocupational therapy to help with ADL's.
• Exercise such as walking, swimming, gardening, and dancing helps client.

Falls

• Precautions to avoid includes wearing walking shoes (not running shoes).
• The person should also check posture (stand straight, feet 8-10 inches apart) if shuffling.
• If a person gets stuck in place, also called freezing, they should rock side to side or pretend you're stepping over an object.
• A client is encouraged to take long steps and exaggerate lifting legs and swing arms.

Avoiding Falls

• Practice Tai Chi: may improve balance.
• Remove throw rugs.
• Install handrails.
• Grab bars in the bathroom and tub.
• Carry a cordless phone.

Therapy

• Improves mobility, flexibility, balance.
• Can involve speech therapy and occupational therapy too.
• Beneficial exercise includes walking, swimming, gardening, and dancing.

Stroke - CVA (Cerebral Vascular Accident)

• It is a sudden loss of brain function
• Causes: interruption of blood flow to brain (ischemic), rupture of brain blood vessels (hemorrhagic) or death of neurons.

Transient Ischemic Attack (TIA)

• Referred to as a "mini-stroke."
• It is a temporary decrease in blood flow to the brain.
• It is a warning sign of increased risk of stroke.
• A patient may not know that TIA's are occuring.

Effects of a Stroke

• Hemiplegia: paralysis of one side of the body.
• Loss of facial muscle control.
• Changes emotions.
• Dysphasia: difficulty swallowing.
• Dimmed vision or loss of vision.
• Inability to speak or understand others.
• Changes in sight, touch, movement, & thought.
• Urinary frequency, urgency, or incontinence.
• Aphasia: loss of speech.

Rehabilitation

• Goals are to restore function to former levels.
• To improve functional abilities.
• To learn new skills.
• To prevent further disability and illness.

HIV Infection

• HIV is spread when there is exchange of certain body fluids, this includes seminal fluid, vaginal fluid, breast milk and infected blood.
• High Risk Activities:
  • Vaginal or anal sex without a condom.
  • Sharing used needles includes tattooing or body piercing.
  • HIV +ve mom breast feeding.
  • Re-using condoms.
  • Unsafe sex under the influence of drugs/alcohol.

Hepatitis

• Hepatitis A, B, and C are the most common types.

Influenza

• Respiratory tract infection caused by a virus.
• The flu season is from November - May.
• It is spread by droplet infection.
• It is highly contagious with a sudden onset.

Tuberculosis

• Signs and symptoms include : positive skin test, fever, chills, night sweats, weight loss, SOB, coughing, hemoptysis.
• Diagnostic tests: Skin Test, Chest X-ray, Sputum Samples.

Ménière’s Disease

• There is an increase of fluid in the inner ear causing pressure in the middle ear, usually one ear is affected.
• Symptoms include vertigo, tinnitus, hearing loss, pain/pressure in the affected ear, severe dizziness(nausea/vomiting).
• Safety measures are needed during vertigo, fall risk so the resident should lie down.

Vision Impairment

• Differentiate Glaucoma from Cataracts.

Age-Related Macular Degeneration (AMD or ARMD)

• Also called AMD or ARMD
• It blurs central vision and causes damage to the macula located in the centre of the retina.
• The macula is responsible for seeing fine details.