Module H

Module H –Body Systems (Cell Theory)
Objectives
  1. Identify the structure and function of the cell and the integumentary, musculoskeletal, neurological, cardiovascular, respiratory, gastrointestinal, urinary, reproductive, endocrine, and immune systems.
  2. Describe the nurse aide’s role in the provision of care for a resident with cancer.
  3. Discuss changes in the integumentary, musculoskeletal, neurological, cardiovascular, respiratory, gastrointestinal, urinary, reproductive, endocrine, and immune systems due to aging.
  4. Compare and contrast normal findings and variation of normal findings of the integumentary, musculoskeletal, neurological, cardiovascular, respiratory, gastrointestinal, urinary, reproductive, endocrine, and immune systems.
  5. Describe common disorders of the integumentary, musculoskeletal, neurological, cardiovascular, respiratory, gastrointestinal, urinary, reproductive, endocrine, and immune systems.
  6. Describe the nurse aide’s role related to a resident’s integumentary, musculoskeletal, neurological, cardiovascular, respiratory, gastrointestinal, urinary, reproductive, endocrine, and immune systems.

Content / Notes
Cell Theory – Overview
  • Basic unit of all living tissues or organisms
  • All living organisms made of cells
  • Cellular function is essential process of living things
  • Cells have several functioning structures called organelle, that carry on work of cell

Structure and Function – Cells
  • Are building blocks of the human body
  • Microscopic in size
  • Combine to form tissue

Structure and Function – Tissue
  • Cells grouped together form tissue
  • Carry out a particular activity or function
  • Combine to form an organ

Structure and Function – Organ
  • Made of tissue, maybe several types of tissues
  • Carries on a special function; examples are heart, stomach, bladder
  • Some are paired;examples are kidneys, lungs
  • Combine to form a system

Structure and Function – Systems
  • Made of groups of several organs functioning together for a specific; purpose or purposes
  • Combine to form an organism
  • Systems of the body include urinary, musculoskeletal, neurological, respiratory, cardiovascular, gastrointestinal, integumentary, endocrine, and reproductive

Structure and Function – Organism
  • Made up of systems functioning together to perform activities of daily living needed for continued life
  • Examples of organisms includehumans, trees, cats, and ladybugs

Cells – Variation of Normal
  • Human organism may have problems occurring at cellular level, but show signs outside of body;examples:
  • Flu
  • Pneumonia
  • Diabetes
  • Cancer

Cells – Common Disorders
  • Tumor – group of abnormally-growing cells;may be benign (or non-cancerous) or malignant (cancerous)
  • Cancer (CA) – a disease in which abnormal cells grow in an uncontrolled manner, invade surrounding tissue and may spread to other areas of the body; can occur almost anywhere in or on the body, but commonly occurs on skin, in lung, colon, breast, prostate, uterus, ovary, bladder, and kidney

Cancer – Nurse Aide’s Role
  • Nurse aides should understand basic cellular theory to better understand approaches used in healthcare
  • Assist with care directed toward minimizing symptoms of cancer or symptoms of the treatment, such as measures to relieve/control pain, provide for nutrition/fluids, prevent skin breakdown, prevent bowel problems, provide for psychological/social/spiritual comfort
  • Offer emotional support to family/friends
  • Be aware of seven warning signs of cancer, spelling CAUTION

Seven Warning Signs of Cancer – CAUTION
  • C hange in bowel or bladder habits
  • A sore that does not heal
  • U nusual bleeding or discharge from any body opening
  • T hickening or lump in breast or elsewhere
  • I ndigestion or difficulty in swallowing
  • O bvious change in a wart or mole
  • N agging cough or hoarseness

Module H – Body Systems (Integumentary)
Content / Notes
Integumentary System – Overview
  • The skin
  • Largest organ and system in the body
  • Responsible for providing a natural protective covering of the body

Integumentary System – Structure
  • Three layers – epidermis, dermis, subcutaneous (fatty) tissue
  • Accessory structures include hair and nails

Integumentary System –Function
  • Protects body from injury and pathogens
  • Regulates body temperature
  • Eliminates waste through perspiration
  • Contains nerve endings for cold, heat, pain, pressure and pleasure
  • Stores fat and vitamins

Integumentary System – Normal Findings
  • Warm, dry
  • Absence of breaks, rash, discoloration, swelling

Integumentary System – Changes Due to Aging
  • Skin is thinner, drier, more fragile
  • Skin loses elasticity
  • Fatty layer decreases so person feels colder
  • Hair thins and may gray

Integumentary System – Changes Due to Aging
  • Folds, lines, wrinkles and brown spots may appear
  • Nails harden and become more brittle
  • Reduced circulation to skin, leading to dryness and itching
  • Development of skin tags, warts and moles

Integumentary System – Variation of Normal
  • Breaks in skin
  • Rash, itching or skin discoloration
  • Pale, white or reddened areas
  • Black and blue areas

Integumentary System – Variation of Normal
  • Dry or flaking skin
  • Ulcers, sores, or lesions
  • Swelling
  • Fluid or bloody drainage
  • Abnormal temperature
  • Changes in scalp or hair

Integumentary System – Common Disorders
  • Eczema – red, itchy areas on the surface of skin
  • Dermatitis – inflammation of skin
  • Tears and abrasions
  • Pressure ulcer (also called pressure sore, decubitus ulcer, bed sore)
  • A serious wound caused by poor circulation, resulting from pressure
  • Typically at points where body bears much of the weight (pressure points), called bony prominences (areas of body where bone is close to the skin) – elbows, shoulder blades, sacrum, hips, knees, ankles, heels, toes, back of head, and back of neck
  • Stages – 1 through 4 (5 and 6 also – by some sources)

Integumentary System – Nurse Aide’s Role
  • Older adults do not need complete baths every day, but a couple times a week, supplemented with sponge baths on non-bath days
  • Use lotions for moisture
  • Be gentle with movement and care because of fragility of skin
  • Gently brush hair daily to stimulate scalp
  • Layer clothes for extra warmth
  • Encourage fluids
  • Inspect skin every time care is provided
  • Observe for and report early signs of pressure ulcers – pale, white, or reddened skin (light skin) or purple skin (darker skin)
  • Prevent pressure ulcers by turning/repositioning dependent residents at minimum of every two (2) hours; performing regular skin care; keeping skin clean and dry; keeping linens dry, clean, and wrinkle-free; using pillows to separate skin surfaces; and encouraging fluids and good nutrition

Module H – Body Systems (Musculoskeletal)
Content / Notes
Musculoskeletal System – Overview
  • Provides structure and movement for the body

Musculoskeletal System – Structure and Function
  • The skeleton
  • Has 206 bones
  • Framework
  • Bones
  • Outside is hard and rigid
  • Bone marrow, located inside, is soft and spongy
  • Bones are connected to other bones by ligaments
  • Allows body to move
  • Protects organs of the body
  • Stores calcium
  • Makes and stores blood cells

Musculoskeletal System – Structure and Function
  • Muscles
  • May be voluntary (skeletal) or involuntarily (smooth and cardiac)
  • Body has over 600 muscles made up of elastic tissue
  • Some are connected to bones by tendons
  • Help body stay erect
  • Produce most of body heat
  • Give body form
  • Powers movement of skeleton
  • Provide for movement of organs

Musculoskeletal System – Structure and Function
  • Joints
  • Point where bones meet
  • Made up of cartilage and connective tissue that cushion the bones
  • May be movable (ankle), slightly movable (backbone), or immovable (skull)
  • Allows for the movement in the area

Musculoskeletal System – Normal Findings
  • Ability to perform routine movements and activities of daily living
  • Ability to perform full range of motion exercises bilaterally, without pain
  • Able to perform the following movements

Musculoskeletal System – Normal Findings
  • Abduction bilaterally without pain

Musculoskeletal System – Normal Findings
  • Adduction bilaterally without pain

Musculoskeletal System – Normal Findings
  • Extension of arm bilaterally without pain

Musculoskeletal System – Normal Findings
  • Flexion of arm bilaterally without pain

Musculoskeletal System – Normal Findings
  • Extension of leg bilaterally without pain

Musculoskeletal System – Normal Findings
  • Flexion of leg bilaterally without pain

Musculoskeletal System – Normal Findings
  • Pronation

Musculoskeletal System – Normal Findings
  • Supination

Musculoskeletal System – Normal Findings
  • Dorsiflexion

Musculoskeletal System – Normal Findings
  • Plantar flexion

Musculoskeletal System – Normal Findings
  • Opposition

Musculoskeletal System – Changes Due to Aging
  • Muscles weaken and lose tone
  • Bones lose density and become brittle
  • Joints stiffen, become less flexible, and become painful causing decrease in range of motion and flexibility
  • Height decreases from 1 to 2 inches, between age 20 and 70
  • Slowed recovery from position changes and sudden movement
  • Pain when moving
  • Reaction time, movement speed, agility, and endurance decrease
  • Poorer response to stimuli
  • Slower muscle and nerve interaction

Musculoskeletal System – Variation of Normal
  • History of falls
  • Difficulty with holding or lifting objects
  • Loss of muscle strength and tone
  • Generalized weakness and tiredness
  • Bruising
  • White, shiny, red, or warm areas over a joint

Musculoskeletal System – Variation of Normal
  • Slow and unsteady body movement
  • Complaints of pain in joints or muscles
  • Swelling, redness, and warmth of joints
  • Complaints of pain with movement
  • Inability to move joints

Musculoskeletal System – Common Disorders
  • Muscle atrophy – muscle mass decreases in size
  • Contracture – permanent shortening of muscle, joints become frozen
  • Muscle strain – damage of muscle caused by trauma
  • Sprain – stretched or torn ligaments or tendons
  • Osteoporosis – spongy type bone that breaks easily

Musculoskeletal System – Common Disorders
  • Fracture – break in the bone
  • Arthritis – inflammation of the joints
  • Osteoarthritis – affects weight-bearing joints, with aches, stiffness, limited motion
  • Rheumatoid arthritis – systemic, crippling disease causing deformities, with stiff, painful, swollen joints
  • Amputation – removal of all or part of a limb

Musculoskeletal System – Nurse Aide’s Role
  • Prevent falls by keeping paths clear, furniture in the same place, walkers/canes within easy reach.
  • Encourage regular movement, activity, self-care with ADLs.
  • Encourage resident to walk, do light exercise, and active range of motion.

Module H – Body Systems (Neurological)
Content / Notes
Neurological System – Overview
  • Also called the nervous system
  • The control and message center of the body
  • Reflex centers for heartbeat and respiration
  • Senses and responds to changes inside of and outside of the body

Neurological System – Structure and Function
  • Brain
  • Located in the skull and consists of three parts – cerebrum, cerebellum, and the brainstem
  • Cerebrum – center of the brain where thought and intelligence occur
  • Cerebellum – located just below the cerebrum and controls balance and regulates movement
  • Brainstem – controls breathing, opening and closing of blood vessels, heart rate, swallowing, gagging, and coughing

Neurological System – Structure and Function
  • Spinal cord
  • Located within the spine
  • Connected to the brain
  • Conducts messages between the brain and the body by pathways
  • Nerves
  • Are made up of nerve cells or neurons
  • Carry messages to and from the brain and to and from the rest of the body

Neurological System – Structure and Function
  • Sensory Organs
  • Include skin, tongue, nose, eyes, and ears
  • Receive impulses from environment and relay impulses to brain

Neurological System – Normal Findings
  • Alert and oriented, with clear short-term/long-term memory
  • Ability to sense heat, cold, pain
  • Ability to hear and see without difficulty
  • Ability to taste and smell without difficulty

Neurological System – Changes Due to Aging
  • Loss of nerve/brain cells
  • Slowed response and reflex time
  • Reduced sense of touch and sensitivity to pain
  • Reduced blood flow to the brain
  • Forgetfulness
  • Each of the senses decrease in function
  • Sensitivity to heat and cold decreases
  • Some hearing loss occurs
  • Appetite decreases
  • Less tear production
  • Vision decreases
  • Problems seeing blue and green
  • Pupils less responsive to light
  • Changes in memory, most likely with short-term memory

Neurological System – Variation of Normal
  • Jerking motions or tremors
  • Changes in gait or movement
  • Speech, vision, or hearing changes
  • Complaints of numbness, dizziness, nausea

Neurological System – Variation of Normal
  • Complaint of loss of feeling or inability to move one side of the body
  • Paralysis
  • Seizures
  • Confusion

Neurological System – Common Disorders
  • CVA (or stroke) – damage to part of brain due to blood clot or hemorrhage cutting off blood supply
  • Head or spinal cord injuries
  • Dementia – progressive loss of mental abilities, such as thinking, remembering, etc
  • Parkinson’s disease – progressive nervous disease due to destruction of brain cells
  • Hearing loss – not being able to hear normal range of sounds that can be heard with normal hearing
  • Deafness – hearing loss
  • Cataract – lens of eye becomes cloudy
  • Glaucoma – damage to optic nerve caused by pressure
  • Blindness – loss of eyesight
  • Otitis media – infection of the middle ear

Neurological System – Nurse Aide’s Role
  • Encourage the use of sensory aids, such as hearing aids and glasses
  • Face the resident when speaking and speak slowly, clearly in a low-pitched voice
  • Repeat words when necessary
  • Enhance food enjoyment by providing good oral care and providing foods with a variety of tastes and texture
  • Be careful with heat extremes during resident care, such as compresses, bath water, and liquids to drink
  • Reorient when necessary when residents are confused

Module H – Body Systems (Cardiovascular)
Content / Notes
Cardiovascular System – Overview
  • Also called the circulatory system
  • The continuous movement of blood though the body

Cardiovascular System – Structure and Function of the Heart
  • The pump of the cardiovascular system
  • About the size of a closed fist
  • Consists of 4 chambers – right and left atria, and right and left ventricles
  • Has 2 phases – (1) the working phase, or systole, when the heart is pumping blood to the body, and the top number of a blood pressure reading and (2) the resting phase, or diastole, when the heart fills with blood, and the bottom number of a blood pressure reading
  • Pulse is the beat of the heart felt at an artery, as a wave of blood passes through the artery and is the numbers of heart beats per minute

Cardiovascular System – Structure and Function
  • Blood Vessels
  • Arteries carry blood with oxygen and nutrients away from the heart and to the cells
  • Veins carry blood with waste products away from the cells and to the heart
  • Blood
  • Adult has 5 to 6 quarts
  • Consists of water (90%), blood cells, carbon dioxide, oxygen, nutrients, hormones, enzymes, waste products

Cardiovascular System – Normal Findings
  • Pulse rate of 60 to 100 beats per minute, regular and strong
  • Blood pressure of systolic 100 – 139, and diastolic 60 – 89

Cardiovascular System – Changes Due to Aging
  • Heart muscle less efficient
  • Blood pumps with less force
  • Arteries lose elasticity and become narrow
  • Blood pressure increases

Cardiovascular System – Variation of Normal
  • Change in pulse rate and rhythm
  • Weakness and tiredness
  • Loss of ability to perform ADLs
  • Swelling of hands and feet
  • Pale or bluish lips, hands, or feet
  • Weight gain
  • Chest pain
  • Shortness of breath, changes in or difficulty breathing

Cardiovascular System – Common Disorders
  • Coronary Artery Disease (CAD) – a condition in which blood vessels in the coronary arteries narrow, lowering blood supply to the heart and depriving it of oxygen
  • Congestive Heart Failure (CHF) – when one or both sides of the heart stop pumping effectively
  • Myocardial Infarction (MI), also known as a heart attack – a condition where the heart muscle does not receive enough blood and lacks oxygen, causing damage or death to that area of the heart
  • Anemia – low red blood cell count
  • Varicose veins – enlarged, twisted veins usually in the legs
  • Hypertension – high blood pressure

Cardiovascular System – Nurse Aide’s Role
  • Provide rest periods at intervals
  • Encourage exercise, regular movement; range of motion, when inactive
  • Prevent resident from tiring
  • Layer clothing to help with warmth

Module H – Body Systems (Respiratory)
Content / Notes
Respiratory System – Overview
  • Involves the breathing in of oxygen (inspiration) and the breathing out of carbon dioxide (expiration)

Respiratory System – Structure and Function
  • Thorax
  • Closed cavity of the body that contains the structures needed for respiration
  • Extends from the base of the neck to the diaphragm, and surrounded by muscles and ribs
  • Upper Respiratory Tract
  • Consists of nose, mouth, sinuses, pharynx, larynx, and top of trachea
  • Lower Respiratory Tract
  • Consists of lower trachea, bronchi, and lungs

Respiratory System – Structure and Function
  • Lungs
  • Elastic, spongy, cone-shaped air-filled structures
  • Left lung has two lobes and right lung has three lobes
  • As lung inhales, air (or oxygen) is pulled in through nose and into pharynx, then into the larynx, down the trachea, into each of the two bronchi, then into lungs; oxygen is exchanged with carbon dioxide
  • Carbon dioxide is exhaled from the lungs, into the bronchi, to the trachea, through the larynx, through the pharynx, and then out the nose and mouth

Respiratory System – Normal Findings
  • Rate of 12 to 20 breaths per minute
  • Character is quiet, even, and without effort

Respiratory System – Changes Due to Aging
  • Respiratory muscles weaken
  • Lung tissue gradually becomes less elastic
  • Shortness of breath upon exertion
  • Lung capacity decreases
  • Oxygen in the blood decreases
  • Muscles of the diaphragm become weaker
  • Limited expansion of the chest due to changes in posture

Respiratory System – Variation of Normal
  • Shallow breathing or breathing through pursed lips
  • Coughing or wheezing
  • Nasal congestion or discharge, or productive cough
  • Noisy respirations
  • Gasping for breaths