Restorative Care Training for the Certified Nursing Assistant

Transcription

1 Restorative Care Training for the Certified Nursing Assistant Trainer Manual

2 TABLE OF CONTENTS Introduction Making the Most of the Training Making the Most of the Lesson Plans Making the Most of the Activities Trainer Preparation Welcome Module Activity T1 Welcome to the training Activity T2 Common Rules to Follow Activity T3 Successful Completion Activity T4 You will learn Trainer Preparation Module one Page T3 Page T3 Page T3 Page T4 Page T5 Page T7 Page T7 Page T8 Page T8 Page 7a Module one Page 8 Trainer Preparation Module two Page 27a Module two Page 28 Trainer Preparation Module three Page 35a Module three Page 37 Trainer Preparation Module four Page 104a Module four Page 105 Appendix A Feeding Assistance Page 114 Appendix B Fall Prevention Page 123 T2 Restorative Care; Training for the Certified Nursing Assistant

3 Introduction Welcome to the program Restorative Care. This is the trainer manual used by trainers to teach nurse assistants and home health aides about caring for the person with Restorative issues. This manual accompanies the student manual, Restorative Care. This training is activity based. Participants are encouraged to share in the training process, to talk about relevant experiences if they choose and to ask questions. Making the Most of the Training Program Use this training manual as a guide for training individually or in groups. If you train on an individual basis it will be more effective to brainstorm with them than to use the activities as written. Individual learners will find brain storming less threatening than having to answer questions or carry a discussion without the support of other participants. It can be taught in small blocks of time or over a series of days. The Restorative Care student and trainer materials cover all the content to advance a nurse assistant or home health aide s knowledge on this particular subject matter. You also have the option to use any of the lesson plans as part of an orientation for employment or as in-service education tools. The manual is designed to provide you with opportunities for creating facility-specific content, which will make the transfer of knowledge from the classroom to the facility floors, units or to a person s home easier. You can add any facility specific protocol, policies or procedures that are important for the nurse assistant or home health aide to know that relates to your facility or agency. Be sure to take advantage of the learning feature of Consider this and/or exercise at the end of a major heading in the student manual. The student can apply what they just learned and validate their knowledge in that section to a practical clinical situation or a case study relevant to the content and the fictional characters built into the manual. The exercises are a valuable tool for reinforcing the important information in each module and validating whether the student truly understands what was learned. Making the Most of the Lesson Plans Objectives for activities are provided on both the Trainer Preparation Page and at the beginning of each activity. Approximate time frames are given for the entire lesson plan on the trainer preparation page and for individual activities. Preparation for activities is described both on the trainer preparation page and at the beginning of each activity. You are also told what equipment and supplies are needed and what advanced preparation you need to make. You are given instructions to create and use flip charts and markers as part of the student interaction. When using the flip chart you will build the student content necessary as you train. *Note: Any medium, flip chart, overhead or Power Point can be used. Directions for you to train by are provided in the margins of the trainer manual surrounding each relevant page of the student content. Answers to the exercises are included in the trainer manual. T3

4 Making the Most of the Activities Guide the learning process by implementing the activities provided in each lesson plan. The most commonly used activities include the following. Content Review The entire content of the 4 modules of the student text, and the Appendix A, B is contained within the lesson plans. You should cover the key content completely to ensure that students understand all the information. Brainstorming Stimulate thought and encourage participation when leading off an activity with a brief brainstorming session. Throw out a question and encourage students to answer without thinking whether the answer is right or wrong. Write the exact students responses on the flip chart. Use their thoughts as a starting point when reviewing key points from the student content. Discussion Similar to brainstorming, discussion encourages students to volunteer and talk about experiences they ve heard of or had themselves. To maintain confidentiality, explain that students do not need to mention names when sharing their experiences. These discussions are great to lead into a review of content. Small Group Presentations The instructions for small group presentations are outlined within the lesson plans. Most instructions include dividing the students into two or more smaller groups. Assign specific sections of content for each group to review, and ask them to choose a spokesperson to present the key points to the entire group of students. You can also choose a recorder to write key points from the presentation onto the flip chart as the spokesperson is reviewing. This type of activity helps keep the students engaged in the learning process. Consider this These scenarios or case studies can be found throughout the module. These are real life situations that challenge the student to use critical thinking and apply knowledge just learned. The trainer is instructed to review the information on the fictional character then, pose the issue. Students are instructed to write in their solution(s) then, open the discussion to the group. EXERCISES A variety of exercises can be found throughout the module. The trainer is instructed to have students answer the questions then review and discuss the answers. T4 Restorative Care; Training for the Certified Nursing Assistant

5 Introduction to the Training Lesson Plan Summary Lesson Plan Summary Time: 2 hours Number of Activities: 4 Number of skills: 0 2 Learning Objectives At the completion of this introduction students will be able to: State your name and at least one classmate s name State the class rules List the criteria for successful completion State general information about the course calendar Explain the purpose of the training program Describe the student manual Describe the two characters Rosemarie and Jean Note to the trainer: This introductory module is about creating a positive beginning. If students are unfamiliar with you and each other it is important to create a supportive friendly environment for learning. This is a good time for you to communicate the goals of the training and criteria for successful completion. Using repetition allows students to hear key points over and over. Using role modeling for some activities allows students to use other senses during the learning process. The flip charts are numbered according to module. For example, in flip chart 1-1, the first number indicates module 1, the second number 1 refers to the first flip chart for the module. When asking for a student response to record on a flip chart always use the word(s) the student chooses. Do not change their words, by changing someone s words you are saying their words are not good enough. Remember as trainers we are always trying to build self esteem. Always applaud and thank students after completing work or doing a presentation even if you need to add key points they did not mention. After every activity ask the students if they have any questions. T5

6 R Trainer Preparation Obtain the following equipment and supplies Activity T-1 Activity T-1 Welcome Create a Flip chart T-1 labeled Welcome, My name is Marker One piece of paper for each student, pens or pencils Activity T-2 Activity T-2 Class Rules Create a Flip chart T-2 labeled Class Rules Add all the rules you would like to communicate to the students such as class time, eating and drinking in class, break times and smoking rules. Marker(s) ActivityT-3 Create a Flip chart labeled Successful Completion Add your criteria for successful completion. You may want to include your attendance policy and passing grade. Marker Activity T-4 Create a Training calendar Make one copy for each student One student manual for each student T6 Restorative Care; Training for the Certified Nursing Assistant

7 Restorative Care Introduction Activity T-1 Objective: At the completion of this activity students will know you and at least one classmate s name Supplies needed: Flip chart T-1 labeled Welcome My name is Marker One piece of paper for each student, pens or pencils Time: 1 hour 1. Begin this activity by displaying the flip chart labeled Welcome, My name is and greeting each student as they come into the classroom. 2. Introduce yourself and tell the class about your background as a trainer. If you feel comfortable share some personal information about yourself such as marital status, children, pets etc. 3. Divide the group into pairs and instruct each person to conduct an interview with the other. Give each student a piece of paper and pen/pencil if needed. Tell the students to interview their partner by asking for their name, where they were born, one personal fact they would like to share and why they are taking this course. Tell the person conducting the interview to write the answers on the piece of paper you have provided. Explain to the group that they do not have to share personal information if it makes them feel uncomfortable. Allow 5 minutes for the interviewing, and then ask each student to introduce the person they interviewed, sharing the information gathered. 5. Optional: You may have your own ice breaking exercise you prefer to use. Activity T-2 Class Rules Objective: At the completion of this activity students will be able to state the class rules Supplies needed: Flip chart T-2 labeled Class Rules with your added rules Marker(s) Time: 10 minutes 1. Begin this activity by displaying the flip chart labeled Class Rules and explain to the class in order for the training to be successful class rules must be established. Review your rules with the students. Be sure to cover information such as class times, breaks, rest rooms, smoking, drinking and eating, your expectation on class participation or not participating, respecting the opinions of others. This is also a good time for you to discuss behavior you find bothersome such as calling out answers without raising a hand or being rude to others. 2. Ask the students if there is anything they would like to add or negotiate. Be sure everyone is in agreement with all the rules. 3. Be sure to tell the students they are not required to share any personal information in this training. T7

8 Activity T-3 Successful Completion Objective: At the completion of this activity students will be able to list the criteria for successful completion. Supplies needed: Flip chart T-3 labeled Successful Completion Marker Time: 10 minutes 1. Begin this activity by displaying the flip chart labeled Successful Completion with your added criteria for successful completion. You may want to include your attendance policy and passing grade. 2. Review the criteria you have established with the class. Activity T-4 Training/ student Manual Objective: At the completion of this activity students will be able to: State general information about the Course calendar Explain the purpose of the training program Describe the student manual Describe the two characters Rosemarie and Jean Supplies needed: Course calendar, one for each student Student manual, one for each student Time: 40 minutes 1. Begin this activity by distributing copies of the course calendar to each student. Explain the schedule and answer any questions they may have. 2. Distribute copies of the Restorative Care student manual to each student and ask them to open to page 1. Read the section To the student, the purpose of this course, the note on the language used in the manual and the Introduction, or ask for a volunteer to read. Ask the students if they have any questions. Be sure the students understand the purpose of the training and the importance of knowing as much information as possible to be able to help the person needing restorative nursing care and their family members through this process. 3. Review the modules and briefly explain what they will be learning in each. 4. Explain there are various exercises and special learning aids that will help the students in the learning process. 5. Read the information about the two fictional characters the students will meet throughout the student manual. Explain that they will be presented with different scenarios or case studies based on Rosemarie and Jean. These scenarios will help the student think about how the information they learn can be applied to real life situations that may occur when a person is receiving restorative care. T8 Restorative Care; Training for the Certified Nursing Assistant

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10 Restorative Care Training for the Certified Nursing Assistant Second Edition Authors, Margaret Casey-Mederios and Kathleen Masucci Copy Design Matthew Ross Masucci CC&R Health Care Solutions Winthrop, MA Copy Edit Tom Lochhaas Independent Consultant Newburyport, MA Cover Design Rick Michaud Graphic Group Burlington, MA Content Support Janice Young CC&R Health Care Solutions Winthrop, MA Photos and Illustrations Robert Cavanaugh American Health Care Association Washington, D.C. Contributors Pat Caron Carol Kapolka Caroline Kirton Gregg McCutcheon Betsy McIntrye Karen Shack Content Copyright 2008 by The Schrafft Center 529 Main Street. Suite 1M8 Boston, MA Format Design Copyright 2005 CC&R Health Care Solutions CC&R Heath Care Solutions P.O. Box Winthrop, MA All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means without permission in writing from. 2 Restorative Care: Training for the Certified Nursing Assistant 2 Restorative Care; Training for the Certified Nursing Assistant

11 Restorative Care Training for the Certified Nursing Assistant Second Edition Acknowledgment: would like to acknowledge those who reviewed the second edition and provided great feedback to enhance the quality of these materials. Donna Howie, SunBridge Care and Rehabilitation Lauri Toohey In addition would like to thank all the contributors to the first edition of these materials. We acknowledge: Kenneth O. Bean Margaret Sullivan Linda McLinden Lutheran Home of Worcester Mary Jane Cavallo Cheryl Trimby Notre Dame Long Term Care Margaret Macksey Oakdale Skilled Nursing and Rehabilitation Center Virginia L Bassi Consultant Lena L. Deter, Educational Services and Consulting Alfred Gray, Jr. Greenberg & Traurig David Siddle Assumption College We wish to also acknowledge the Commonwealth of Massachusetts and the Executive Office of Labor and Workforce Development for the ongoing financial support of the Extended Care Career Ladder initiative, which has made this publication possible. 3 3

12 Restorative Care As you grow in your career, you have the unique opportunity to develop special sets of skills that allow you to advance your knowledge. This growth further enhances your ability to be more involved with the person* you are caring for, their family, and other team members. In this course you will learn about restorative care. Although in your daily caregiving you already practice many of these skills, this program focuses primarily on mobility issues as well as on you taking on the role of teacher and coach. To help the person you care for maintain or restore their optimum level of functioning, these roles are necessary to ensure the person s mobility. In the appendices of this manual you will learn additional knowledge needed to prevent falls, assist with feeding, and provide bowel bladder training. Remember, as in all caregiving, you must maintain the person's privacy, dignity, and confidentiality. *Note: This manual throughout refers to the resident, client, or patient as the person you care for. This Restorative Care course is organized in four modules. Following is an overview of the main topics in each: Module One The Influence of Movement on the Body Module Two Key Elements in Restorative Care Module Three Mobility Activities: For Maintenance and Restoration Module Four Additional Knowledge and Skills Appendices A Preventing Falls B Feeding Assistance 4 Restorative Care: Training for the Certified Nursing Assistant 4 Restorative Care; Training for the Certified Nursing Assistant

13 Learning Aids In addition to presenting information, this manual includes exercises and scenarios to help you learn the information and be successful in practice. The following special learning aids will help you master the knowledge. 1. Objectives. Objectives are statements at the beginning of each module that tell you the key ideas you must learn. They also state what you will be able to do after completing the module. The objectives are numbered. 2. Key Terms. When acquiring any new skill, you must learn the special words related to that skill or activity. These key terms will help you understand specific vocabulary related to restorative care. These terms are defined at the beginning of each module. 3. Consider This. Throughout each module you will see problems under the heading Consider This. These are real-life situations that challenge you to apply your new knowledge. These problems also teach you what can happen if you do not follow a particular procedure. In some cases there may be several right answers. The key is to think about the situation, jot down your solutions, and discuss them with your co-workers and trainer. 4. Exercises. Throughout the modules, exercises are included to help you make sure that you understand the information you just read. Review exercises at the end of each module help you determine whether you have learned the module s important ideas. 5. Summary. This conclusion summarizes key information you have learned in the module. A note on language. This manual uses some terms that may be different from what you use where you work. For example, the people for whom you care may be called resident, patient, or client. This manual refers to them as the person or people. Since various health care practitioners and specialists may write orders and direct a person s care, this manual refers to them as the health care provider. The staff caring for the person are generally referred to as the health care team. 5 5

14 In addition to the learning aids you will meet two fictional characters named Jean and Rosemarie. They will appear throughout this program. Getting to know them will help you apply the knowledge and skills you need when providing restorative care and will help you through your training. One of these characters has a chronic condition, which will help you to understand the importance of restorative activities to maintain the person s optimal level of functioning. The other person recently has had a stroke. The goal for this person is to restore them to their optimal level of functioning. Meet Jean Jean is an 84-year-old woman who has osteoarthritis. Osteoarthritis is caused by a lifetime of wear and tear on joints. The cartilage in joints between bones thins and breaks down, resulting in less shock absorbency. Because of this, bony protuberances (swelling, bumps) appear at the sides of the joints. Jean has been in your facility for a year because she could no longer care for herself. She has great difficulty walking. She uses a walker with support and adaptive devices for eating. She needs support with all activities of daily living. She has one son and two daughters who visit frequently. Meet Rosemarie Rosemarie is a 78-year-old woman with high blood pressure. She lives at home with her 80-year-old husband. Rosemarie is being admitted to your facility following hospitalization for a cerebral vascular accident (stroke). A stroke is a condition that occurs when blood flowing to the brain is interrupted. The stroke left her with right-sided weakness that seems to affect her arm more than her leg. She is being admitted for rehabilitation. She will be discharged back home with services provided in her home. Rosemarie has one son. 6 Restorative Care: Training for the Certified Nursing Assistant Restorative Care; Training for the Certified Nursing Assistant

15 Introduction As a member of the interdisciplinary team, you have a role in ensuring that all people who enter the facility maintain at least the level of ability they had when they were admitted. What this means is if a person with arthritis in their hands is able to eat independently, every effort must be made to help that person continue to eat independently. Staff should not feed the person unless they develop a physical problem that interferes with their ability to do so on their own. Ensuring improvement or maintenance of a person s independence in nursing care is known as restorative nursing. Restorative activities promote a person s independence in activities of daily living (ADLs) like eating, bathing, dressing, toileting, continence, mobility, and positioning. Restorative activities are ways you can support people to regain or maintain their ability to care for themselves. The goal of restorative activities is to help the person achieve their optimal, or best, level of functioning in their ADLs. All the caregiving you do should involve a restorative approach. When caring for a person, you must always ask yourself, How can I help this person be as independent as possible? Ask yourself whenever you are helping a person, What can I do to help this person regain or maintain their independence? 7 7

16 MODULE 1 The Influence of Movement on the Body Lesson Plan Summary Lesson Plan Summary Time: 3 hours 30 minutes Number of Activities: 4 Number of Skills: 0 2 Learning Objectives for Module One: At the completion of this module students will be able to: Provide an overview of the body systems Describe what happens to the body when movement is a problem Describe at least one common condition that affects movement Describe one of the more common acute conditions that affect movement R Trainer Preparation Obtain the following supplies and equipment Activity 1-1 Create Flip chart 1- Create Flip chart 1-1 labeled Cognitive Impairment Create Flip chart 1-2 labeled Dementia Create Flip chart 1-3 labeled Symptoms of Dementia Marker Option 1 Flip charts, markers, tape, blank flip chart paper Option 2 Create flip chart 1-1 labeled Integumentary System Create flip chart 1-2 labeled Musculoskeletal System Create flip chart 1-3 labeled Respiratory System Create flip chart 1-4 labeled Circulatory System Create flip chart 1-5 labeled Digestive System Create flip chart 1-6 labeled Urinary System Create flip chart 1-7 labeled Nervous System Create flip chart 1-8 labeled Endocrine System Create flip chart 1-9 labeled Sensory System, Eye and Ear Create flip chart 1-10 labeled Male Reproductive System Create flip chart 1-11 labeled Female Reproductive System 7A Restorative Care; Training for the Certified Nursing Assistant

17 Activity 1-2 Create flip chart 1-12 labeled How Movement Effects the Body Activity 1-3 Create flip chart 1-13 labeled Common Conditions that Affect Movement Marker, tape, blank flip chart paper Activity 1-4 Create flip chart 1-14 labeled Common Acute Conditions that Need Restorative Activities Marker, tape, blank flip chart paper C. Review the Introduction to module one with the students or ask for a volunteer to read it. Each module begins with a short introduction to the information the student will be learning. 7B

18 MODULE 1 The Influence of Movement on the Body 1a Review the objectives for Module One, The Influence of Movement on the Body. Explain the objectives are listed at the beginning of each module and represent the key knowledge and skills students should learn. 1a OBJECTIVES After studying this module you will be able to: Provide an overview of the body systems Describe what happens to the body when movement is a problem Describe at least one common condition that affects movement Describe one of the more common acute conditions affecting movement and requiring rehabilitation 1b Review the Key Terms. The key terms are listed alphabetically at the beginning of each module. Each term is defined. Explain that the student may see these terms used in other modules also. 1b KEY TERMS Hemiparesis- weakness affecting one side of the body Hemiplegic- paralysis of one side of the body Paresis- weakness usually involving the limbs 8 Restorative Care: Training for the Certified Nursing Assistant 8 Restorative Care; Training for the Certified Nursing Assistant

19 1c 1d Introduction to Module One n this module you will review the body systems. You will learn the role of movement in keeping Ithem healthy as well as some of the more common and acute conditions that affect movement and influence your work in restorative activities. Although all body systems are influenced by restorative activities, the skills in this program primarily focus on mobility. Mobility influences almost every body system. As you read the following overview of the body systems, think about what can happen if a person could not move. Overview of Body Systems Before you can fully understand the impact of movement on the body, you need a general sense of what each body system does, its structure and function, and what happens in the body system as the body ages. Integumentary System (Skin) Structures The skin has two main layers: The epidermis is the top layer you can see and feel. The dermis is the thicker layer beneath the epidermis. Beneath the two layers of skin is a cushion of subcutaneous tissue. This cushion of fatty tissue helps the skin look smooth. Five structures within the skin help the skin stay healthy and help protect the body: The oil glands, called sebaceous glands, help keep the skin moist. The sweat glands help the body get rid of heat and waste products. Hair roots and hair over parts of the body can add to the person s appearance and help protect the skin. Melanocytes are the cells that give color to the skin. Blood vessels nourish the skin and help control body temperature (Fig. 1). Figure 1 The skin and its components. Module 1 9 1c Review the Introduction to module one with the students or ask for a volunteer to read it. Each module begins with a short introduction to the information the student will be learning. 1d Overview of the Body Systems At the completion of this activity students will be able to: Identify the structure, function and agingrelated changes of each of the 11 body systems There are 2 options for this activity. Supplies needed option 1: flip charts, markers, tape, blank flip chart paper Time: 2 hours / both options Supplies needed option 2: flip chart 1-1 labeled Integumentary System flip chart 1-2 labeled Musculoskeletal System flip chart 1-3 labeled Respiratory System flip chart 1-4 labeled Circulatory System flip chart 1-5 labeled Digestive System flip chart 1-6 labeled Urinary System flip chart 1-7 labeled Nervous System flip chart 1-8 labeled Endrocrine System flip chart 1-9 labeled Sensory System, Eye and Ear flip chart 1-10 labeled Male Reproductive System flip chart 1-11 labeled Female Reproductive System Option 1 Activity Begin this activity by making the following statement, before you can fully understand the impact of movement on the body you need a general sense of what the body does, its structure and function, and what happens to the body systems as the body ages. 2. Explain that the body systems will be reviewed as a group activity. 3. Explain the following group activity. Divide the students into 11 groups representing the 11 body systems. (the number of students in each group will depend on the number of students enrolled in the training). 9

20 Tell the students to read the information on their assigned body system. Explain that each group should present the key points about the body system they are assigned from under the headings structure of the system, functions of the system, and aging changes of the system. Each group should choose a spokesperson to present the information. Each group has the option to choose a recorder to write key points onto the flip chart as the spokesperson speaks. Provide flip chart paper, markers, and tape for the groups that want to display key points. Tell the groups they have 15 minutes to prepare and 10 minutes to present. 4. After each presentation, add any key points from the student manual not presented. 5. Thank each participant for a job well done. Functions The skin is important because it protects the body in two ways: It prevents germs in the environment from entering the body. This is the first line of defense against infection. It helps control body temperature. When it is hot, the skin sweats to let out body heat by dilating blood vessels. When it is cold, blood vessels constrict to keep heat in. Some changes as you age: Skin is less able to retain moisture. The dermis layer of the skin thins. Elasticity of the skin decreases. The hypodermis layer of skin shrinks due to loss of fatty tissue. Musculoskeletal System Structures The musculoskeletal system is made up of bones, muscles, tendons, ligaments, and joints: Bones are the frame for the body. Muscles allow the body to move. Tendons attach muscles to bones. Ligaments attach bones to other bones. Joints are where two or more bones come together (Fig. 2). 6. Ask the students if they have any questions about the presentations. Option 2 This preparation is for you, if you want to present the information on the 11 body systems 1. Begin this activity by displaying the flip chart labeled Integumentary System. Make 3 columns with the headings Structures, Functions, and Aging Changes. 2. Ask the students if they can recall the structures of the Integumentary system. 3. Write the student s responses on the flip chart. Figure 2 The musculoskeletal system and its components 4. Discuss the student s responses. 5. Ask the students if they can recall the functions of the Integumentary system. 6. Write the student s responses on the flip chart. 10 Restorative Care: Training for the Certified Nursing Assistant 7. Discuss the student s responses. 8. Ask the students if they can recall what happens to the Integumentary system as a person ages. 9. Write the student s responses on the flip chart. 10. Discuss the student s responses. 11. Review the key points from the student content under the headings Overview of the Body Systems, Integumentary System, Structures, Functions, and Some Changes as you Age. 12. Write the key points you want students to remember on the flip chart. 13. Continue this activity by following the same steps for the remaining ten body systems. 10 Restorative Care; Training for the Certified Nursing Assistant

21 Functions The musculoskeletal system helps give the body its shape and enables it to move. Movement is important for good health. Some changes as you age: The spinal column shortens due to compression of vertebrae and changes in posture. Minerals are lost from bones. Muscle mass diminishes. Elasticity in the muscles is lost. Respiratory System Structures The main structures of the respiratory system are: The nasopharynx is the nasal passage. The oropharynx is the mouth and oral passage. The trachea connects the mouth and nose to the bronchi. The right and left bronchi are the airway passages into the lungs. The bronchioles are branches from each bronchus. These air passages inside each lung look like an upside-down tree. The lungs take air in, move oxygen into the blood, and remove carbon dioxide from the blood. The alveoli (air sacs) look like hundreds of blossoms on the bronchioles (Fig. 3). Figure 3 The respiratory system and its components Module 1 11

22 Functions Breathing (respiration) is the exchange of oxygen and carbon dioxide in the lungs. This is one of the most basic and important body functions. The respiratory system takes in oxygen through the nose or mouth as we breathe in (inhale or inspire) air. The air passes through the bronchi and bronchioles and into the alveoli. The oxygen then passes into the blood vessels and is carried by the blood to all body parts. Oxygen is exchanged for carbon dioxide in the blood. The air that we breathe out (exhale or expire) gets rid of the carbon dioxide from the body. The heart and lungs work together to oxygenate the blood. Some changes as you age: The chest wall and lung structures become more rigid. Respiratory muscle strength decreases. Less air is exchanged with each breath. Circulatory System Structures The heart and blood vessels working together make up the circulatory system. The heart is a muscular organ with four chambers. It is located behind the ribs and between the two lungs; the largest part lies in the left side of the chest. The heart pumps blood through the blood vessels to every part of the body. Every time you count a person s pulse, you are counting how fast the heart pumps blood through the body. Three types of blood vessels carry blood to and from the heart and organs throughout the body: Arteries carry oxygenated blood from the lungs and heart to the organs. Capillaries, which are tiny blood vessels, connect arteries and veins and exchange oxygen for carbon dioxide inside the organs. Veins carry deoxygenated blood from the organs back to the heart and lungs (Fig. 4). Figure 4 The heart and its components 12 Restorative Care: Training for the Certified Nursing Assistant 12 Restorative Care; Training for the Certified Nursing Assistant

23 Functions The circulatory system carries oxygen from the lungs and other vital nourishment to all the cells of the body. It also carries waste products to some organs so the body can get rid of them. Some changes as you age: The heart muscle wall thickens, becomes stiffer, and may increase in size. The blood vessels become more rigid and stiff. Sensors that regulate blood pressure with position changes are less sensitive. The heart rate decreases. Digestive System Structures The mouth takes in food and fluid. Food is chewed and mixed with saliva, beginning the digestive process. The esophagus is a tube that passes swallowed food and fluid from the mouth to the stomach. The stomach is a sac-like organ that mixes food and fluid with digestive juices, preparing it for absorption. The small intestine is a long tube-like structure where most of the absorption of nutrients takes place. The liver produces bile, which helps digest fatty foods. The gallbladder stores bile. The pancreas produces digestive juices, which help break down foods for nutrients to be absorbed, and insulin, which regulates the body s blood sugar level. The large intestine is a long tube-like structure that moves the remaining food and waste through the body to the rectum and out of the body through the anus. The large intestine absorbs fluids the body needs. The anus is the opening from which food wastes, in the form of feces, come out in a bowel movement (Fig. 5). Figure 5 The digestive system and its components Module

24 Functions The function of the digestive system is to provide the body with a supply of nutrients and fluid and to remove food waste products. Some changes as you age: Food passes through the digestive system more slowly. The amount and effectiveness of digestive juices are decreased. Urinary System Structures The urinary system is one of the most important systems in the body. It helps the body maintain fluid balance (the amount of water in the body) and eliminate liquid wastes. The urinary system has these major structures: The right and left kidneys maintain the body s fluid balance by filtering out waste products and producing urine. The right and left ureters are tubes that carry urine from the kidneys to the bladder. The bladder is a sac-like muscle that stores urine until it is eliminated. The urethra is the tube that carries the urine from the bladder outside the body (Fig. 6). Figure 6 The urinary system and its components Functions The urinary system eliminates waste materials from the blood and reabsorbs the proper amount of water and salt for the body. Some changes as you age: Decreased size of kidneys Decreased bladder capacity Decreased bladder muscle tone Decrease in hormones that regulate fluid volume 14 Restorative Care: Training for the Certified Nursing Assistant 14 Restorative Care; Training for the Certified Nursing Assistant

25 Nervous System Structures The nervous system has three major parts: The brain is located within the protective skull. Messages are received and interpreted in the brain, which is the body s communication center. Information is processed and stored. Thinking, reasoning, and judgment are brain functions. The spinal cord contains nerves that control movement. It extends down the back and is protected within the spine (vertebral column). The nerves are fibers that extend from the spinal column to all parts of the body. The nerves carry messages in both directions between the body and brain. Information received from the outside world is taken to and processed in the brain, and messages from the brain travel back to the body to control functions (Fig. 7). Figure 7 The nervous system and its components Functions The nervous system is like a communication center. It helps you make sense of the world. The nervous system works with the sensory and endocrine systems to direct all other body systems. Some changes as you age: Nerve impulses slow. Blood flow to certain areas of the brain decreases. Module

26 Endocrine System Structures The endocrine system includes many different glands. Glands are organs that make and release hormones, which are substances that needed by different organs. The following are the major structures in the endocrine system: The pituitary gland, located in the brain, secretes hormones and regulates other glands such as the ovaries and testes. It is often called the master gland. The adrenal glands, located on top of the kidneys, secrete hormones that regulate metabolism. They also help regulate sodium, water, and potassium levels in the body. Adrenal glands release hormones that increase blood sugar, control blood vessel constriction, and help us to react in emergency situations. Cells called the islets of Langerhans, located in the pancreas, secrete insulin, which controls the breakdown of carbohydrates (sugars) in the body. The thyroid and parathyroid glands, located in the neck, secrete hormones that help regulate metabolism, the process of producing energy. The female ovaries, located in the pelvic area, secrete hormones that control sexual function and are involved in pregnancy. The male testes or testicles, located in a sac behind the penis, secrete a hormone controlling sexual function and sperm production (Fig. 8). Pituitary Thyroid Parathyroid Thymus Adrenals Pancreas Ovaries Testes Figure 8 The endocrine system and its components Functions The endocrine system makes hormones that help the body work properly. Their vital functions include the regulation of body energy, the breakdown of sugar for energy, and reproductive fertility. Some changes as you age: Glands have a slower rate of releasing hormones. Insulin production decreases. The amount of hormones produced by the ovaries is dramatically decreased. Male hormone production decreases but does not stop. 16 Restorative Care: Training for the Certified Nursing Assistant 16 Restorative Care; Training for the Certified Nursing Assistant

27 Sensory System The organs of the sensory system are the eyes, ears, nose, tongue, and skin. The sensory system gives us information from the outside world. The senses receive and send information to the brain. Aging influences the function of the senses. Sight and hearing are most commonly affected by aging. Some changes as you age: Smell the ability to identify or detect odors decreases with age, more commonly in men than in women. Taste the ability to taste salty and sweet tastes may decrease because of changes in the tongue. Touch the sensitivity of touch receptors and response to painful stimuli decrease. The Eye Structures The eye is a round ball with several major structures: The sclera is the white of the eye. The iris is the color of the eye. It helps regulate the amount of light that enters the eye by controlling the size of the pupil. The pupil is the opening through which light passes to get to the retina. The cornea protects the iris. The iris and lens direct and focus light on the retina. The retina is the back of the eye, where light images become nerve impulses to the brain. The brain interprets and processes the impulses into pictures (Fig. 9). Cornea Pupil Lens Retina Figure 9 The eye and its components Pupil Iris Functions Sight gives us knowledge about our surroundings. This is important so that we can care for ourselves. Some changes as you age: The cornea flattens. The lens becomes more yellow. The lens becomes more rigid or less elastic. The pupil becomes smaller. The retina becomes less efficient. The iris becomes more rigid. Module

28 The Ear Structures The ear has three areas: the inner ear the middle ear the outer ear (Fig. 10) Outer ear Middle ear Inner ear Figure 10 The ear and its components These areas have different structures involved in hearing. Sound enters the outer ear and is transmitted through the middle ear to the inner ear. Nerve impulses resulting from sounds go from the inner ear to the brain for interpretation. Other structures inside the ear help the body maintain its balance. If these structures are not working properly, a person may feel dizzy. Functions The ear lets us hear. Hearing, like vision, helps us be aware of the world around us. Sounds provide clues to dangers as well as communication and pleasure. The inner ear also helps us maintain our balance. Some changes as you age: Hearing structures in the ear become stiff. Structures in inner ear related to balance begin to degenerate. 18 Restorative Care: Training for the Certified Nursing Assistant 18 Restorative Care; Training for the Certified Nursing Assistant

29 Male Reproductive System Structures The main structures of the male reproductive system are: The penis is used for sexual intercourse and urination. The testes are two oval-shaped glands, sometimes called the sex glands or gonads. They produce sperm cells and the male sex hormone testosterone. Sperm cells leave the body in semen. The scrotum is the sac that holds the testes outside the body. The prostate gland secretes one of the fluids that make up semen. Semen is produced by the seminal vesicle (Fig. 11). Penis Prostate gland Testis Scrotem Figure 11 The male reproductive system and its components Functions The reproductive system provides sexual pleasure and allows humans to reproduce. Some changes as you age: Male hormone production decreases but does not stop. The prostate gland enlarges. Testicular tissue mass decreases. Module

30 Female Reproductive System Structures The main structures of the female reproductive system are: The ovaries are two almond-shaped glands located in the pelvis. The ovaries hold the eggs and produce the hormones estrogen and progesterone. The fallopian tubes are two tubes that carry the eggs from the ovaries to the uterus. The uterus is the muscular organ that holds the fetus during pregnancy and sheds its lining during menstruation. The vagina is the muscular canal between the uterus and the outside of the body and is used for sexual intercourse, childbirth, and the passage of menstrual flow. The vulva is the external structure of the female sex organs. It is made up of the labia major and minor, which are the skin flaps located on both sides of the vagina, and the clitoris, which gives sexual pleasure to females (Fig. 12). Fallopian tubes Ovary Ovary Clitoris Vulva Labia minora Uterus Vagina Labia majora Figure 12 The female reproductive system and its components Functions The reproductive system provides sexual pleasure and allows humans to reproduce. Some changes as you age: The amount of hormones produced by the ovaries dramatically decreases. Vaginal lubrication decreases. Your knowledge of each of these systems will help you in your caregiving. As you continue through this program, think about the body system being affected by the activities of restorative care. If necessary, refer back to this module to help you understand why what you are doing is so important for maintaining the optimal function of each system. 20 Restorative Care: Training for the Certified Nursing Assistant 20 Restorative Care; Training for the Certified Nursing Assistant

31 CONSIDER THIS Remember Jean? Jean is an 84-year-old woman who has osteoarthritis. Osteoarthritis is caused by a lifetime of wear and tear on joints. The cartilage in joints between bones thins and breaks down, resulting in less shock absorbency. Because of this, bony protuberances (swelling, bumps) appear at the sides of the joints. Jean has been in your facility for a year because she could no longer care for herself. She has great difficulty walking. She uses a walker with support and adaptive devices for eating. She needs support with all activities of daily living. She has one son and two daughters who visit frequently. Because of her arthritis, Jean has a tendency to eat and move slowly. She recently started complaining about constipation (difficulty eliminating feces). Describe the aging changes that may be causing Jean s constipation. Write your answers in the spaces provided. EXERCISES Consider This Ask for a volunteer to read the information about Jean. Explain that these scenarios or case studies help students think about information they just learned and apply it to real life practical situations. They also help students learn to think about other view points and different ways to think about situations. Because Jean s arthritis is causing her to eat and move slowly she has developed constipation. What aging changes may be causing Jean s constipation. Ask the students to write down what aging changes may be causing Jean s constipation. Allow 5 minutes to write their answers. Ask a few students to read their responses and discuss each. 1e List the systems you believe are most affected by slowed or lack of movement. Write your answers in the spaces provided. integumentary circulatory respiratory musculatory digestive nervous How movement Affects the Body The human body is designed for constant movement. The body systems are always changing. When a person stops moving or has restricted movement, the body changes and slows down. Because body systems are connected together, even a small change in movement can affect all body systems. Because aging also slows down the functioning of body systems, the elderly living in long term care are affected even more by movement restrictions. Someone who has been in bed for even a short time may feel stiff or weak because of muscular system changes. They may have a decreased appetite or become constipated because of digestive system changes. They may feel short of breath or dizzy when moving because of circulatory and respiratory system changes. Their skin may become red in places because of integumentary system changes, and their movements may slow because of nervous system changes. Movement is essential for keeping all body systems functioning well. Think about how your body is always moving. Have you ever been sitting in a meeting or at the movies and found yourself crossing one leg and then the other or shifting your weight from side to side? Sometimes you move consciously, such as when you change position to feel more comfortable. Sometimes movement occurs without conscious thought, such as when you change position in sleep to keep the blood flowing freely to all parts of your body and to prevent 6. Write the student s responses on the flip chart. 7. Discuss the student s responses. Module 1 8. Review the key points from the student content under the heading How Movement Affects the Body. 9. Write the key points you want students to remember on the flip chart. 21 EXERCISES Allow the students 5 minutes to complete the exercise. Review the correct answers. Ask the students if they have any questions about this exercise. 1d How Movements Affects the Body Objective: At the completion of this activity students will be able to: Describe what happens to the body when movement is a problem Supplies needed: Flip chart 1-12 labeled How Movement Affects the Body Marker Time: 30 minutes Activity Begin this activity by displaying the flip chart labeled How Movement Affects the Body. 2. Ask the students what happens to a person s body when they stop moving. 3. Write the student responses on the flip chart. 4. Discuss the student s responses. 5. Ask the students what body systems are affected by lack of movement and to explain how they are affected. 21

32 stiffness. Movement of your limbs and whole body is very important. Each person you care for may differ in how much support they need for moving, but your goal is always to help them optimize their mobility. Some will have difficulty helping with their own care, but you still need to find ways for them to participate in their care and be as independent as possible. In addition, certain areas of the body are more likely to be damaged by lack of movement, particularly the skin. This can result in a pressure ulcer. Usually pressure ulcers can be prevented by proper moving and position changes. Moving and positioning can also reduce swelling and stiffness in limbs. Moving and positioning also help a person be as comfortable as possible (Fig. 13). Moving our bodies is also emotionally important. Without freedom of mobility, a person has trouble meeting basic needs, which may affect their self-esteem and independence. Figure 13 Movement keeps the blood flowing and prevents joints from becoming stiff. Consider This Ask for a volunteer to read the information about Rosemarie. Explain that these scenarios or case studies help students think about information they just learned and apply it to real life practical situations. They also help students learn to think about other view points and different ways to think about situations. Why do you think Rosemarie is angry? Tell students to write their answer in the space provided. Allow 5 minutes to write their answer. Ask a few students to read their responses and discuss each. 22 CONSIDER THIS Remember Rosemarie? Rosemarie is a 78-year-old woman with high blood pressure. She lives at home with her 80-year-old husband. Rosemarie is being admitted to your facility following hospitalization for a cerebral vascular accident (stroke). A stroke is a condition that occurs when blood flowing to the brain is interrupted. The stroke left her with right-sided weakness that seems to affect her arm more than her leg. She is being admitted for rehabilitation. She will be discharged back home with services then provided in her home. Rosemarie has one son. When Rosemarie is admitted to the facility, she is very angry. She often yells at the staff and her husband. What do you think is going on with Rosemarie? Write your answers in the spaces provided. Restorative Care: Training for the Certified Nursing Assistant 22 Restorative Care; Training for the Certified Nursing Assistant