CARE FOR PATIENT WITH SPECIAL NEEDS

BY: RIZZA MARIEL F. YOSORES, R.N

Objectives: At the end of this course the student will be able to: 1. Discuss concepts of growth and development in relation to elderly. 2. Identify physiologic changes in the elderly 3. Recognize signs and symptoms of common illness affecting the elderly 4. Discuss simple treatment and medication in the care of the elderly.

GERIATRICS
A BRANCH OF MEDICINE THAT DEALS WITH THE PROBLEMS AND DISEASES OF OLD AGE AND AGING PEOPLE REFERS TO THE KNOWLEDGE AND CARE OF THE ELDERLY

NEED TO KNOW
The elderly population has been increasing steadily for the past few decades. However, longevity in most cases brings along poorer health. This implies an increased demand for the provision of health cares services for elderly people.

GERIATRIC MANAGEMENT ( Care for the elderly) Is the process of planning and coordinating care of the elderly and others with physical and/or mental impairments to meet their long term care needs, improve their quality of life, and maintain their independence for as long as possible. It entails working with persons of old age and their families in managing, rendering and referring various types of health and social care services

What does it mean to be a Caregiver?

Primary Caregiver The main person who provides care for the patients daily needs. This is usually a family member or close friend of the patient. Supporting Caregivers The people who assist the primary caregiver (family, friends, neighbors, volunteers, etc.) Characteristics of a Successful Primary Caregiver 1. 2. 3. 4. 5. Good communication skills Flexible with their schedule Can multi-task well Has their own transportation Being in good health-physically able to care for someone who may be unable to assist themselves. 6. Remaining positive during a difficult time 7. Willingness to make the commitment

What are some roles and responsibilities of a caregiver?

The overall role of the caregiver is to find ways to successfully meet the daily and long term needs of the family member near the end of life

ADVISOR Offering recommendations to help a loved one identify potential challenges, talking about concerns, sharing information and considering alternatives that may help to maximize his or her independence and quality of life. ADVOCATE Looking out for a loved ones best interests as an authorized agent (e.g., Power of Attorney). Ensuring the person you serve gets the information, care, support and treatment he or she needs and deserves. COORDINATOR Arranging for services, such as professional care giving, physical therapy, lawn mowing, snow removal and heating/air conditioning repair, scheduling appointments, coordinating deliveries, helping to facilitate end-of-life planning and more.

EVALUATOR Assessing a loved ones ability to live independently, handle his or her own personal care, manage medications, operate a motor vehicle and more. Also, identifying and evaluating appropriate programs and services that best match a care receivers needs and wishes.

MEDIATOR Helping family members and others communicate with health care and social service providers, make decisions and resolve issues in a positive and helpful manner.
PROTECTOR Taking charge when necessary to help ensure the safety and well being of a loved one.

PROVIDER Providing assistance when a loved one is not able to care for him- or herself due to physical or cognitive limitations. Assistance often addresses the following types of needs: o EMOTIONAL Listening and responding to concerns, providing encouragement and moral support, and simply being there for someone. o FINANCIAL Organizing bills, writing checks, balancing the checkbook, and providing money to help cover expenses. o PHYSICAL Assisting with daily living activities, including personal care, household chores, meals, driving, etc. o SOCIAL Maintaining regular contact and minimizing isolation and boredom through relationships and keeping loved ones in the loop. o SPIRITUAL Helping people find meaning and purpose in life, maintaining hope, coping and finding peace through prayer, meditation and cultural and religious preferences.

Caregiver Responsibilities
The responsibilities of the Caregiver are the specific tasks and actions that are done on a daily or regular basis.

The Caregiver may need training to learn how to give shots and medications, help the family member with limited mobility and other physical needs.

If the Caregiver is unable to perform any of the above tasks, they may need to seek help from other family members or health care providers.

SPECIFIC RESPONSIBILITIES Personal Care Assistance 1. Assists in shower, sponge bath and personal hygiene 2. Provide personal grooming, hair, nails and oral care 3. Transferring the client from bed to wheelchair 4. Toileting assistance and incontinence care 5. Encourage activities in accordance with the client's needs and capabilities 6. Maintain a professional image and demonstrate commitment in personal growth

Health Care

1. Monitoring of vital signs, blood pressure, pulse, temperature and respiration 2. Documentation of the client's care in appropriate forms 3. Reminding of prescribed and/or over the counter medication/medications 4. Reporting of sudden changes of the client's physical, mental or emotional health to the agency and to His/Her family 5. Provide good skin care and avoid bed sores

Household Management 1. Maintain the cleanliness of the client's house 2. Make the client's bed and change the bed sheet regularly 3. Wash and dry the client's clothes regularly 4. Wash the dishes and all kitchen's utensils

Example of what may be included in a caregivers schedule

What bathing Doctor appt.

When ~noon 2:00 p.m.

Who Lisa Jane

Mary

preparing meals and breakfast feeding and lunch

Caregivers Notebook Organization is key for the caregiver and with so many details to remember we suggest starting a caregivers notebook to keep track of things.

The Caregiver Notebook is a central place where patient schedules, activities, and a daily log can be kept. Daily notes Daily schedules Doctor Contact Information Medication log Visitor notes It should be kept with the patient at all times.

SPECIAL CONSIDERATIONS
SAFETY! Assist your client in accepting his limitations and making the right choice for safetys sake EXERCISE! Advise your client to always consult his physician before starting an exercise regimen

SLEEP CHANGES! Try to determine what the routine was before his illness. MEDICATIONS! Assist your client with a safe medication schedule. ACCOMPANYING A CLIENT TO THE DOCTOR! Documentation is important SEXUALITY! Closeness and sexuality are necessary at all ages. ABUSE! BE ALERT FOR SIGNS OF ABUSE OR NEGLECT

GROWTH and DEVELOPMENT

Growth and Development is an ongoing process that begins at conception and continues through the remainder of our lives Growth is a physical change that can be weighed and measured. Development is psychological and social changes to the individual such as behaviors and thinking patterns.

WHAT CAUSES AGING?

Biologically, a person begins to age after physical maturity around age 25, when cells die faster than they reproduce. Being old is a state of mind and not a specific period of life.

Wisdom: Ego Integrity vs. Despair (Seniors, 65 years onwards)

Psychosocial Crisis: Ego Integrity vs. Despair Main Question: "Have I lived a full life?" Virtue: Wisdom As we grow older and become senior citizens we tend to slow down our productivity and explore life as a retired person. It is during this time that we contemplate our accomplishments and are able to develop integrity if we see ourselves as leading a successful life. If we see our life as unproductive, or feel that we did not accomplish our life goals, we become dissatisfied with life and develop despair, often leading to depression and hopelessness.

The final developmental task is retrospection: people look back on their lives and accomplishments. They develop feelings of contentment and integrity if they believe that they have led a happy, productive life. They may instead develop a sense of despair if they look back on a life of disappointments and unachieved goals.

Principles and Theories of Growth and Development The biologic changes associated with aging are influenced by hereditary and environmental factors. Aging occurs gradually throughout life, but different from individual to individual. Some person age more rapidly than others. Elderly can be sub-classified into young old ( ages 65-74), and old old (over 80-85 years old). Decreased function of one or more organ system Decreases stress tolerance Increased psychological stress Impaired immunity Increased susceptibility to diseases. Altered pharmacokinetics Decrease physical conditioning

PROCESS OF AGEING

Aging is a continuous, complex, and dynamic process that begins with birth and ends with death The exact combinations of physical, mental and social changes vary from person to person.

A. PHYSICAL CHANGES Nervous System EENT Digestive System Cardiovascular System Respiratory System Integumentary System Musculo-skeletal System Genito-urinary System

NERVOUS SYSTEM
Change in reaction time and in verbal and vocabulary skills Memory loss may occur after age 50 Decrease in deep sleep Decrease in need for sleep

POSSIBLE PROBLEMS
Slowed reactions and reflexes, inability to learn quickly. Recall, recognition may slow slightly. (ex: where are my keys?). Periods of wakefulness during sleep hours Hours of sleep may change

EYES and EARS

Clouding of lenses Decrease in ability to focus Decrease in production of tears Inability to blink quickly Less light reaching the retina EARS Decrease in ability to hear high frequency sounds.

POSSIBLE PROBLEMS
For the Eyes: Development of Cataracts Difficulty seeing at night Dry eyes Easier to get foreign body in the eyes For the Ears: Hearing loss Distortion of sounds and pain if volume is too high.

Major Cardiovascular Changes with Aging

The maximum heart rate decreases and it takes longer for heart rate and blood pressure to return to normal resting levels after exertion. The aorta and other arteries becomes thicker and stiffer which may bring a moderate increase in systolic blood pressure with aging. In some individuals, this may result in hypertension. The valves between the chambers of the heart thicken and become stiffer. As a result heart murmurs are fairly common among older adults.

The baroreceptors which monitor blood pressure become less sensitive. Quick changes in position may cause dizziness from orthostatic hypotension.

CAREGIVER INTERVENTION
1.

2.
3.

4. 5.

Avoid sudden changes in position Educate older person on the effect of smoking and alcohol Cardio-vascular conditions that are lifestyle modification associated is greater with aging, educate them on the risk factors in developing coronary artery disease. Monitor blood pressure Fluid and dietary management

Major Age-related Changes in the Respiratory System

The lungs become stiffer, muscle strength and endurance diminish, and the chest wall becomes more rigid. There is an increase in mucus production and a decrease in the activity and number of cilia. The body becomes less efficient in monitoring and controlling breathing.

Coughing is less effective resulting in pooling in secretions and fluid in the lungs increasing the risk of infection and choking.

Shortness of breath on exertion

Gas exchange in the lungs is less effective, resulting in decrease oxygenation.

CAREGIVER INTERVENTION
1.

2.

3.

Promote exercise that would improve lung volume capacity Educate the elderly on the harmful effects of smoking and air pollution to the lungs Encourage the elderly to minimize if not avoid smoking and exposure to polluted air.

Major Gastrointestinal Changes with Aging

Reduced peristalsis of the colon can increase risk for constipation. Saliva production in the mouth is decreased, causing difficulty in swallowing and digestion of starches, increasing risk of tooth decay. Taste bud on the tongue is decreased beginning with sweet then salty. Food in the stomach is digested slower. Slower metabolism Increase incident of constipation

CAREGIVER INTERVENTION
1. 2.

3.

4.

5.

Educate elderly on dietary foods Prepare and provide foods that could easily be chewed and digested. Perform oral screening for sores and other signs of cancer specially on clients who are drinking and smoking. Increase the fluid intake of clients and ensure daily exercise in order to minimize constipation. Ensure regular toileting and provide privacy during toileting period.

Urinary System Changes with Aging

Kidney mass decreases by 25-30 percent and the number of glomeruli decrease by 30 to 40 percent. These changes reduce the ability to filter and concentrate urine and to clear drugs. With aging, there is a reduced hormonal response (vasopressin) and an impaired ability to conserve salt which may increase risk for dehydration. Bladder capacity decreases and there is an increase in residual urine and frequency. These changes increase the chances of urinary infections, incontinence, and urinary obstruction.

Age-Related Changes in the Endocrine System

Insulin resistance may prevent efficient conversion of glucose into energy. A decrease in aldosterone and cortisol may affect immune and cardiovascular function Decrease secretion of anti-diuretic hormones CAREGIVER INTERVENTION:

Higher levels of para-thyroid and thyroid hormones.

Ensure increase fluid intake specially in conditions like diarrhea, vomiting, excessive heat and taking diuretics.

Age-related Changes in the Musculoskeletal System

Height decreases an average of 2 inches. Weight increases until about age 60 and then declines. Body fat mass can double, lean muscle mass is lost Decline in bone density Slower movements Bones become brittle and break more easily Arthritis and osteoporosis become common

CAREGIVER ITERVENTION:

1. Provide a safe environment such as wide open areas for mobility 2. Plan individualized exercises that will improve the patients muscle strength 3. Provide special support when needed.

Age-related Changes in the Female Reproductive System

Ovulation ceases and estrogen levels drop by 95%. Vaginal walls become thinner and lose elasticity Most women experience a decrease in the production of vaginal lubrication.

 Menopause takes place as a normal physiologic process characterized by irregular menses, hot flashes, headaches, mood swings, fatigue, interruption of sleep.
Breast become flatter and sag Increase the risk of developing hypertension and osteoporosis due to absence of estrogen.

CAREGIVER INTERVENTION:

1.Inform elderly on the importance of hormonal replacement therapy

2.Increase fluid intake and wear comfortable clothing 3.Encourage to undergo Paps smear
4.Proper grooming

5.Discourage smoking and drinking

Age-related Changes in the Male Reproductive System

In some men, testosterone levels drop by up to 35%.
The size of the testes decreases. There is a decline in the rate of sperm production although the extent varies among individuals. Erectile dysfunction (impotence), in which an erection cannot be achieved is experienced by 15% of men by the age of 65 and increases to 50% by age 80.

CAREGIVER INTERVENTION:
1.Encourage older men to undergo digital rectal examination for early detection of prostate problems. 2.Assure older male on the importance of having quality relationships rather than physical attractions or sexual relationships.

MENTAL CHANGES IN ELDERLY

Decreased circulation to the brain can cause mental changes Some changes are temporary and some are permanent Obvious changes includes, forgetfulness, disorientation and irritability.

DEMENTIA
Is the gradual decrease in the persons ability to make judgments. This is not a normal part in the aging process. Two types of dementia, REVERSIBLE and IRREVERSIBLE.

CAREGIVER INTERVENTION
It may be necessary to remind the patient where they are, who they are and who you are. Safety is the care for these clients because they are unable to make judgment on their own.

SOCIAL CHANGES IN THE ELDERLY

Retirement Change in income Change in level of activity Fear of illness Isolation from friends and family Death of a spouse Change in housing Increase dependence on others

AGEISM- Is the discrimination of a person based on age.

MYTHS OF AGING
MYTH 1: AGE BRINGS ILLNESS AND DISABILITY MYTH 2: CHANGE OF HABITS WHEN ONE IS OLDER RESULTS IN NO PHYSICAL BENEFIT MYTH 3: AGING MEANS REDUCTION IN MENTAL SHARPNESS MYTH 4: BEING OLD EQUALS BEING SAD, LONELY, NONPRODUCTIVE MYTH 4: DEPRESSION AND SUICIDE IN ELDERLY MYTH 5: ELDERLY ARE NOT INTERESTED IN SEX AND COULD NOT PERFORM IF THEY WERE MYTH 6: RELIGIOUS BELIEFS INCREASE - FEAR OF DEATH DECREASES MYTH 7: ELDERLY ONLY WANT TO TALK ABOUT THE PAST

WHAT IS SUCCESSFUL AGING?

Basically, it is finding purpose and acceptance with life as it is - with little regret or remorse

FIVE FCTORS OF SUCCESSFUL AGING

LIFE SATISFACTION: rewarding, few regrets, positive attitude about past and future SOCIAL SUPPORT SYSTEM: network of family and friends GOOD PHYSICAL AND MENTAL HEALTH FINANCIAL SECURITY PERSONAL CONTROL OVER ONES LIFE: independence, dignity, and self-worth

CARE FOR THE DYING

1. 2. 3. 4.

5.

STEPS/STAGES IN THE DYING PROCESS Denial- Not me! Anger- Why me? Bargaining- Me, but Depression- Ah, me Acceptance- Yes, me..

Special emotional needs

Clients who are dying are still living people and have the same needs as you such as: 1. The need to be normal 2. The need for meaningful relationship 3. The need for love 4. The need for recreation 5. The need for safety and security

Guidelines when talking to a dying client

1.

2.

3. 4. 5.

HONESTY DO NOT OFFER FALSE HOPE OR REASSURANCE DO NOT SAY TOO MUCH LET THE CLIENT HAVE THE LEAD DO NOT DESTROY HOPE

HOSPICE PROGRAMS- program of care that allows a client who is expected to die within 6 months to remain at home and die at home while receiving professionally supervised care.
PALLIATIVE CARE- a multidisciplinary approach to managing care of people who are dying that includes curative medical intervention. Primary goal of palliative care is to give the client the best possible life during their illness through pain and symptom management and client and family support.

Physical care of the dying

1.
2. 3.

PHYSICAL NEEDS
Skin care Positioning Mouth care Bowel care Circulation Food/water Breathing

4.
5. 6. 7.

Post mortem care

Remove all pillows except one under the head Bathe the body, remove all secretions and reinforce dressing. Place dentures in the mouth if possible Close the eyes Keep the body flat on its back and straightening the arms and legs Move the body gently to avoid bruising Check with the family regarding any jewelry the client might be wearing remove any tubing, catheters, etc.

Common illness affecting elderly

Alzheimer's Disease
In simple terms, Alzheimer's Disease is the death of the mind before the body. Victims of the Alzheimer's Disease often suffer from a lack of a brain chemical called acetylcholine, which promotes brain activity. Alzheimer's Disease is typically diagnosed around the age of 75, with symptoms appearing approximately three years prior to the initial diagnosis. Alzheimer's Disease causes a person to lose their perceptions of reality until they become incoherent. This loss of perception is sometimes referred to as Dementia.

Signs and Symptoms

1. Loss of Abstract Thinking Someone with Alzheimer's disease may lose the ability to draw conclusions and solve problems. It may become difficult to balance a checkbook, for example, because the patient has forgotten what to do with the numbers. 2. Disorientation People with Alzheimer's disease can become lost on the street where they live, forget where they are and how they got there, and not know how to get back home. 3. Lack of Initiative A person with the disease may become passive or unmotivated, sitting in front of the television for hours, sleeping more than usual and not pursuing his or her usual activities. 4. Language Problems People with Alzheimer's disease often forget simple words or substitute words with inappropriate ones. An Alzheimer's patient who can't find his or her toothbrush may ask for "that thing for my mouth."

5. Misplacing Items We're all prone to misplacing a wallet or key from time to time, but a person with Alzheimer's will put things in unusual places, such as an iron in the freezer or a wristwatch in the sugar bowl. 6. Mood Swings Rapid mood swings from calm to tears to anger for no apparent reason is another common symptom. 7. Personality Changes Personalities tend to change with age, but a person with Alzheimer's disease may have a severe personality change, becoming extremely confused, suspicious, fearful or dependent on a family member. 8. Poor Judgment A loss of judgment is a common symptom. A patient may dress without regard to the weather, wearing several shirts or blouses on a warm day or very little clothing in cold weather. Others may give away large amounts of money to telemarketers or pay for home repairs or products they don't need.

MANAGEMENT FOR PATIENT WITH ALZHEIMERS DISEASE

1. Teach about the disease

2. Teach about the signs and symptoms.

3. Simplify the environment 4. Keep area safe and comfortable

5. Reduce clutter, reduce noise, organize things ahead of time

6. Safe transfer techniques. 7. Stick to a schedule

Angina
is a fairly common type of chest pain that results from less than adequate blood supply to the heart muscles. described as a pressure, heaviness, tightness, squeezing, burning, or choking sensation. Apart from chest discomfort, anginal pains may also be experienced in the epigastrium (upper central abdomen), back, neck area, jaw, or shoulders

RISK FACTORS: 1.Age ( 55 years for men, 65 for women) 2.Cigarette smoking 3.Diabetes mellitus (DM) 4.Dyslipidemia 5.Family History of premature Cardiovascular Disease (men <55 years, female <65 years old) 6.Hypertension (HTN) 7.Kidney disease 8.Obesity (BMI 30 kg/m2) 9.Physical inactivity

Treatment

When angina occurs: Stop what you are doing, sit or lie down immediately Take note of the time Use your nitroglycerine tablets as instructed (1 tab every after 5 minutes)

Bed sores Sitting or lying in one position for too long usually causes bed sores in the elderly or in immobile patients. Bed sores are easier to prevent than they are to treat. The first sign of a bed sore is a reddened area that does not go away within 30 minutes of pressure relief. Avoid rubbing or massaging red areas, which damages underlying tissues further.

Areas at risk for bed sores include the base of the spine, the shoulder blades, and the side of the knees, back of the head, heels and the hips.
Bed sores appear on the parts of the body that don't have fat to cushion them. Bed sores are also referred to as pressure sores, pressure ulcers and decubitus ulcers.

Stages of bed sores

Stage I is the most superficial, indicated by non blanchable redness that does not subside after pressure is relieved. The skin may be hotter or cooler than normal, have an odd texture, or perhaps be painful to the patient. Although easy to identify on a lightskinned patient, ulcers on darker-skinned individuals may show up as shades of purple or blue in comparison to lighter skin tones.

Stage II is damage to the epidermis extending into, but no deeper than, the dermis. In this stage, the ulcer may be referred to as a blister or abrasion. Stage III involves the full thickness of the skin and may extend into the subcutaneous tissue layer. This layer has a relatively poor blood supply and can be difficult to heal. At this stage, there may be undermining damage that makes the wound much larger than it may seem on the surface

Stage IV is the deepest, extending into the muscle, tendon or even bone. A graphic presentation of severe stage IV ulcers is visible here.

Treatment
Preventative care

The most important care for a patient with bedsores is the relief of pressure. Once a bedsore is found, pressure should immediately be lifted from the area and the patient turned at least every two hours to avoid aggravating the wound

Debridement

The removal of necrotic tissue is an absolute must in the treatment of pressure sores. Because dead tissue is an ideal area for bacterial growth, it has the ability to greatly compromise wound healing.

Infection control In order to eliminate this problem, it is imperative to apply antiseptics at once. Hydrogen peroxide is not recommended for this task as it is difficult to balance the toxicity of the wound with this. New dressings have been developed that have cadexomer iodine and silver in them, and they are used to treat bad infections

Nutritional support
Have a consultation with a dietitian to determine the best diet to support healing, as a malnourished person does not have the ability to synthesize enough protein to repair tissue.

Other skin problems

Statis dermatitis
is commonly seen in women above 50 years of age due to decrease in the blood flowing through the veins. The condition is marked by symptoms such as swelling, redness and tenderness of skin; and dry, scaly skin.

Exfoliative dermatitis
is a scaly dermatitis involving most, if not all,of the skin. This generalized scaling eruption of the skin is drug induced, idiopathic, or secondary to underlying cutaneous or systemic disease.

General measures:
Withdraw implicated medications or treatment of identified underlying infection, disease, or both. Protect patient from development of hypothermia. Prescribe cool oatmeal baths. Advise local moisturizing ointments, lotions, or both. Advise a high-protein diet with folic acid supplementation, since protein losses may be increased as much as 30% above normal.

ARTHRITIS
Is inflammation of one or more joints. A joint is the area where two bones meet The most common type is osteoarthritis, and although it can occur in any joint, it most often affects the hands, knees, hips or spine.

 The exact cause is not known. Although it occurs after considerable wear and tear on the joints (in older people and athletes, for instance), heavy "wear and tear" alone cannot cause it to occur. It is believed the disease runs in families.

Joint inflammation may result from: 1.An autoimmune disease (the body's immune system mistakenly attacks healthy tissue) 2.Broken bone 3.General "wear and tear" on joints 4.Infection, usually by bacteria or virus

Symptoms:
Arthritis causes joint pain, swelling, stiffness, and limited movement. Symptoms can include: Joint pain Joint swelling Reduced ability to move the joint Redness of the skin around a joint Stiffness, especially in the morning Warmth around a joint

TREATMENT:

Lifestyle changes Physical therapy Eat a healthy diet full of fruits and vegetables, which contain important vitamins and minerals, especially vitamin E. Lose weight, if you are overweight. Weight loss can greatly improve joint pain in the legs and feet. MEDICATIONS e.g Tylenol, Aspirin, NSAIDS

FRACTURE A broken or cracked bone

Symptoms - Severe pain - Difficulty in movement - Swelling/ bruising / bleeding - Deformity / abnormal twist of limb - Tenderness on applying pressure

First-aid
-

Depends on type & location of fracture -Check the breathing - Calm the person - Examine for other injuries - Immobilize the broken wound - Apply ice to reduce pain / swelling -Consult a doctor

DO NOT! - Massage the affected area - Straighten the broken bone - Move without support to broken bone - Move joints above / below the fracture - Give oral liquids / food

CONSTIPATION Refers to bowel movements that are infrequent and/or hard to pass. Constipation is a common cause of painful defecation In the elderly, causes include: insufficient dietary fiber intake, inadequate fluid intake, decreased physical activity, side effects of medications, hypothyroidism, and obstruction by colorectal cancer.

Prevention: adequate exercise fluid intake, and high fiber diet is recommended

TREATMENT
The main treatment of constipation involves: 1. the increased intake of water, and fiber (either dietary or as supplements). 2.The routine use of laxatives is discouraged, as having bowel movements may come to be dependent upon their use.

Enemas can be used to provide a form of mechanical stimulation. However, enemas are generally useful only for stool in the rectum, not in the intestinal tract. If laxatives are used, milk of magnesia is recommended as a first-line agent due to its low cost and safety.

HYPERTENSION Hypertension is the term used to describe high blood pressure. The top number is called the systolic blood pressure, and the bottom number is called the diastolic blood pressure. Normal blood pressure is when your blood pressure is lower than 120/80 mmHg most of the time.

High blood pressure (hypertension) is when your blood pressure is 140/90 mmHg or above most of the time.

If your blood pressure numbers are 120/80 or higher, but below 140/90, it is called pre-hypertension.

Many factors can affect blood pressure, including: How much water and salt you have in your body The condition of your kidneys, nervous system, or blood vessels The levels of different body hormones High blood pressure increases your chance of having a stroke, heart attack, heart failure, kidney disease, and early death.

You have a higher risk of high blood pressure if you:

Are African American Are obese Are often stressed or anxious Drink too much alcohol (more than one drink per day for women and more than two drinks per day for men) Eat too much salt in your diet Have a family history of high blood pressure Have diabetes Smoke

TREATMENT
You can do many things to help control your blood pressure, including: Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water. See: High blood pressure and diet Exercise regularly -- at least 30 minutes of aerobic exercise a day. If you smoke, quit -- find a program that will help you stop. Limit how much alcohol you drink -- one drink a day for women, two a day for men.

Limit the amount of sodium (salt) you eat - aim for less than 1,500 mg per day. Reduce stress -- try to avoid things that cause you stress. You can also try meditation or yoga. Stay at a healthy body weight -- find a weight-loss program to help you, if you need it.

INCONTINENCE is any involuntary leakage of urine CAUSES Polyuria generally causes urinary urgency and frequency, but doesn't necessarily lead to incontinence. Caffeine or cola beverages also stimulate the bladder.

Enlarged prostate is the most common cause of incontinence in men after the age of 40; sometimes prostate cancer may also be associated with urinary incontinence. Moreover drugs or radiation used to treat prostate cancer can also cause incontinence.
Disorders like multiple sclerosis, spina bifida, Parkinson's disease, strokes and spinal cord injury can all interfere with nerve function of the bladder.

TREATMENT
1.Bladder training 2.Scheduled toilet trips. 3.Fluid and diet management. 4. Pads and protective garments. 5.Catheter

STROKE Cere-brovascular Accident

A stroke happens when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack." Causes, incidence, and risk factors If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage. There are two major types of stroke: ischemic stroke and hemorrhagic stroke.

Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways: A clot may form in an artery that is already very narrow. This is called a thrombotic stroke. A clot may break off from another place in the blood vessels of the brain, or from some other part of the body, and travel up to the brain. This is called cerebral embolism, or an embolic stroke.

Ischemic strokes may be caused by clogged arteries. Fat, cholesterol, and other substances collect on the artery walls, forming a sticky substance called plaque. A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely.

STROKE RISK FACTORS High blood pressure is the number one risk factor for strokes. The other major risk factors are: Atrial fibrillation Diabetes Family history of stroke High cholesterol Increasing age, especially after age 55 Race (black people are more likely to die of a stroke)

The chance of stroke is higher in people who live an unhealthy lifestyle by: Being overweight or obese Drinking heavily Eating too much fat or salt Smoking Taking cocaine and other illegal drugs

Symptoms usually develop suddenly and without warning. Or, symptoms may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.

A headache may occur, especially if the stroke is caused by bleeding in the brain. The headache: Starts suddenly and may be severe Occurs when you are lying flat Wakes you up from sleep Gets worse when you change positions or when you bend, strain, or cough

Other symptoms depend on how severe the stroke is and what part of the brain is affected. Symptoms may include: Change in alertness (including sleepiness, unconsciousness, and coma) Changes in hearing Changes in taste Changes that affect touch and the ability to feel pain, pressure, or different temperatures Clumsiness Confusion or loss of memory Difficulty swallowing Difficulty writing or reading

Dizziness or abnormal feeling of movement (vertigo) Lack of control over the bladder or bowels Loss of balance Loss of coordination Muscle weakness in the face, arm, or leg (usually just on one side) Numbness or tingling on one side of the body Personality, mood, or emotional changes Problems with eyesight, including decreased vision, double vision, or total loss of vision Trouble speaking or understanding others who are speaking Trouble walking

TREATMENT

A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. Call 911 or your local emergency number or seek urgent medical care at the first signs of a stroke. It is very important for people who are having stroke symptoms to get to a hospital as quickly as possible. If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot.

 Most

of the time, patients must reach a hospital within 3 hours after symptoms begin. Some people may be able to receive these drugs for up to 4 - 5 hours after symptoms begin. Treatment depends on how severe the stroke was and what caused it. Most people who have a stroke need to stay in a hospital.

DIABETES
lifelong (chronic) disease in which there are high levels of sugar in the blood.

Diabetes can be caused by too little insulin, resistance to insulin, or both. People with diabetes have high blood sugar because their body cannot move sugar into fat, liver, and muscle cells to be stored for energy.

This is because either: Their pancreas does not make enough insulin Their cells do not respond to insulin normally Both of the above

There are three major types of diabetes. The causes and risk factors are different for each type: Type 1 diabetes can occur at any age, but it is most often diagnosed in children, teens, or young adults. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The exact cause is unknown. Type 2 diabetes makes up most of diabetes cases. It most often occurs in adulthood, but teens and young adults are now being diagnosed with it because of high obesity rates. Many people with type 2 diabetes do not know they have it. Gestational diabetes is high blood sugar that develops at any time during pregnancy in a woman who does not have diabetes.

Symptoms

High blood sugar levels can cause several symptoms, including: Blurry vision Excess thirst Fatigue Frequent urination Hunger Weight loss

Signs and tests A urine analysis may be used to look for high blood sugar. However, a urine test alone does not diagnose diabetes. Your health care provider may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL. To confirm the diagnosis, one or more of the following tests must be done.

Blood tests:
Fasting blood glucose level -- diabetes is diagnosed if it is higher than 126 mg/dL twice. Levels between 100 and 126 mg/dL are called impaired fasting glucose or pre-diabetes. These levels are risk factors for type 2 diabetes. Hemoglobin A1c test - Normal: Less than 5.7% Pre-diabetes: 5.7% - 6.4% Diabetes: 6.5% or higher Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours. (This test is used more often for type 2 diabetes.)

TREATMENT

There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms and problems.

OSTEOPOROSIS
is the thinning of bone tissue and loss of bone density over time. Osteoporosis is the most common type of bone disease. About half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebra (bones of the spine).

Calcium and phosphate are two minerals that are essential for normal bone formation. Throughout youth, your body uses these minerals to produce bones. If you do not get enough calcium, or if your body does not absorb enough calcium from the diet, bone production and bone tissues may suffer.

The leading causes of osteoporosis are a drop in estrogen in women at the time of menopause and a drop in testosterone in men. Women over age 50 and men over age 70 have a higher risk for osteoporosis.

Other causes include: Being confined to a bed Chronic rheumatoid arthritis, chronic kidney disease, eating disorders Taking corticosteroid medications (prednisone, methylprednisolone) every day for more than 3 months, or taking some antiseizure drugs Hyperparathyroidism Vitamin D deficiency

Absence of menstrual periods (amenorrhea) for long periods of time Drinking a large amount of alcohol Family history of osteoporosis History of hormone treatment for prostate cancer or breast cancer Low body weight Smoking Too little calcium in the diet

Symptoms
There are no symptoms in the early stages of the disease. Symptoms occurring late in the disease include: Bone pain or tenderness Fractures with little or no trauma Loss of height (as much as 6 inches) over time Low back pain due to fractures of the spinal bones Neck pain due to fractures of the spinal bones Stooped posture or kyphosis, also called a Dowager Hump"

Treatment

The goals of osteoporosis treatment are to: Control pain from the disease Slow down or stop bone loss Prevent bone fractures with medicines that strengthen bone Minimize the risk of falls that might cause fractures

PARKINSONS DISEASE

is a disorder of the brain that leads to shaking (tremors) and difficulty with walking, movement, and coordination. Nerve cells use a brain chemical called dopamine to help control muscle movement. Parkinson's disease occurs when the nerve cells in the brain that make dopamine are slowly destroyed. Without dopamine, the nerve cells in that part of the brain cannot properly send messages. This leads to the loss of muscle function. The damage gets worse with time. Exactly why these brain cells waste away is unknown.

Symptoms Symptoms may be mild at first. For instance, you may have a mild tremor or a slight feeling that one leg or foot is stiff and dragging. Symptoms may affect one or both sides of the body, and can include: Symptoms include: Slow blinking Constipation Difficulty swallowing Drooling Problems with balance and walking No expression in the face (like you are wearing a mask) Muscle aches and pains

Shaking, called tremors Usually occurs in the limbs at rest, or when the arm or leg is held out Goes away when you move Eventually may be seen in the head, lips, tongue, and feet May be worse when tired, excited, or stressed Finger-thumb rubbing (pill-rolling tremor) may be present

Treatment There is no known cure for Parkinson's disease. The goal of treatment is to control symptoms. Medications control symptoms, mostly by increasing the levels of dopamine in the brain. At certain points during the day, the helpful effects of the medication often wears off, and symptoms can return.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. It makes it difficult to breathe. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus Emphysema, which involves destruction of the lungs over time Most people with COPD have a combination of both conditions.

Causes, incidence, and risk factors Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD. However, some people smoke for years and never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema. Other risk factors for COPD are: Exposure to certain gases or fumes in the workplace Exposure to heavy amounts of secondhand smoke and pollution Frequent use of cooking fire without proper ventilation

Symptoms

Cough, with or without mucus Fatigue Many respiratory infections Shortness of breath (dyspnea) that gets worse with mild activity Trouble catching one's breath Wheezing

Treatment There is no cure for COPD. However, there are many things you can do to relieve symptoms and keep the disease from getting worse. Persons with COPD MUST stop smoking. This is the best way to slow down the lung damage. Medications used to treat COPD include: Inhalers (bronchodilators) to open the airways, such as ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent), formoterol (Foradil), or albuterol Inhaled steroids to reduce lung inflammation Anti-inflammatory medications such as montelukast (Singulair) and roflimulast are sometimes used

In severe cases or during flare-ups, you may need to receive: Steroids by mouth or through a vein (intravenously) Bronchodilators through a nebulizer Oxygen therapy Assistance during breathing from a machine (through a mask, BiPAP, or endotracheal tube)

PEPTIC ULCER DISEASE

A peptic ulcer is a defect in the lining of the stomach or the first part of the small intestine, an area called the duodenum. A peptic ulcer in the stomach is called a gastric ulcer. An ulcer in the duodenum is called a duodenal ulcer.

Causes, incidence, and risk factors

Normally, the lining of the stomach and small intestines is protected against the irritating acids produced in your stomach. If this protective lining stops working correctly and the lining breaks down, it results in inflammation (gastritis) or an ulcer.

The most common cause of such damage is infection of the stomach by bacteria called Helicobacter pylori (H.pylori).
Most people with peptic ulcers have these bacteria living in their gastrointestinal (GI) tract. Yet, many people who have these bacteria in their stomach do not develop an ulcer.

The following also raise your risk for peptic ulcers: Drinking too much alcohol Regular use of aspirin, ibuprofen, naproxen, or other non-steroidal antiinflammatory drugs (NSAIDs). Taking aspirin or NSAIDs once in a while is safe for most people. Smoking cigarettes or chewing tobacco Being very ill, such as being on a breathing machine Having radiation treatments

Symptoms Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding. Abdominal pain is a common symptom, but it doesn't always occur. The pain can differ from person to person. Other symptoms include: Feeling of fullness -- unable to drink as much fluid Hunger and an empty feeling in the stomach, often 1 - 3 hours after a meal Mild nausea (vomiting may relieve this symptom) Pain or discomfort in the upper abdomen Upper abdominal pain that wakes you up at night

Other possible symptoms include: Bloody or dark tarry stools Chest pain Fatigue Vomiting, possibly bloody Weight loss

Prevention Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your doctor first. Your doctor may: Test you for H. pylori first Have you take proton pump inhibitors (PPIs) or an acid blocker Have you take a drug called misoprostol The following lifestyle changes may help prevent peptic ulcers: Do not smoke or chew tobacco. Limit alcohol to no more than two drinks per day.

HEMORRHOIDS
are painful, swollen veins in the lower portion of the rectum or anus. They result from increased pressure in the veins of the anus. The pressure causes the veins to swell, making them painful, particularly when you are sitting.

Hemorrhoids may be caused by: Straining during bowel movements Constipation Sitting for long periods of time Anal infections Certain diseases, such as liver cirrhosis

Hemorrhoids may be inside or outside the body. Internal hemorrhoids occur just inside the anus, at the beginning of the rectum. External hemorrhoids occur at the anal opening and may hang outside the anus.

EXTERNAL HEMORRHOID

Symptoms of hemorrhoids include: Anal itching Anal ache or pain, especially while sitting Bright red blood on toilet tissue, stool, or in the toilet bowl Pain during bowel movements One or more hard tender lumps near the anus

Treatments for hemorrhoids include: Over-the-counter corticosteroid creams to help reduce pain and swelling Hemorrhoid creams with lidocaine to help reduce pain Stool softeners help reduce straining and constipation

Prevention Constipation and straining during bowel movements raise your risk for hemorrhoids. To prevent constipation and hemorrhoids, you should: Drink plenty of fluids, at least eight glasses per day. Eat a high-fiber diet of fruits, vegetables, and whole grains. Consider fiber supplements. Use stool softeners to prevent straining.

PROSTATE CANCER
Prostate cancer is cancer that starts in the prostate gland. The prostate is a small, walnut-sized structure that makes up part of a man's reproductive system. It wraps around the urethra, the tube that carries urine out of the body.

Prostate cancer is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40. People who are at higher risk include: African-American men, who are also likely to develop cancer at every age Men who are older than 60 Men who have a father or brother with prostate cancer

Other people at risk include:

Men who have been around agent orange Men who use too much alcohol Farmers Men who eat a diet high in fat, especially animal fat Tire plant workers Painters Men who have been around cadmium Prostate cancer is less common in people who do not eat meat (vegetarians

TREATMENT

For early-stage prostate cancer, this may include: Surgery (radical prostatectomy) Radiation therapy If the prostate cancer has spread, treatment may include: Hormone therapy (medicines to reduce testosterone levels) Surgery Chemotherapy

BREAST CANCER
Breast cancer is a cancer that starts in the tissues of the breast Breast cancer may be invasive or noninvasive. Invasive means it has spread from the milk duct or lobule to other tissues in the breast. Noninvasive means it has not yet invaded other breast tissue. Noninvasive breast cancer is called "in situ."

Risk factors you cannot change include: Age and gender -- Your risk of developing breast cancer increases as you get older. Most advanced breast cancer cases are found in women over age 50. Women are 100 times more likely to get breast cancer than men. Family history of breast cancer -- You may also have a higher risk for breast cancer if you have a close relative who has had breast, uterine, ovarian, or colon cancer. About 20 - 30% of women with breast cancer have a family history of the disease.

Genes -- If a parent passes you a defective gene, you have an increased risk for breast cancer. Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life. Menstrual cycle -- Women who got their periods early (before age 12) or went through menopause late (after age 55) have an increased risk for breast cancer.

SYMPTOMS

Early breast cancer usually does not cause symptoms. This is why regular breast exams are important. As the cancer grows, symptoms may include: Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt Change in the size, shape, or feel of the breast or nipple -- for example, you may have redness, dimpling, or puckering that looks like the skin of an orange Fluid coming from the nipple -- may be bloody, clear to yellow, green, and look like pus

Men can get breast cancer, too. Symptoms include breast lump and breast pain and tenderness. Symptoms of advanced breast cancer may include: Bone pain Breast pain or discomfort Skin ulcers Swelling of one arm (next to the breast with cancer) Weight loss

Tests used to diagnose and monitor patients with breast cancer may include: Breast MRI to help better identify the breast lump or evaluate an abnormal change on a mammogram Breast ultrasound to show whether the lump is solid or fluid-filled Breast biopsy, using methods such as needle aspiration, ultrasound-guided, stereotactic, or open CT scan to see if the cancer has spread Mammography to screen for breast cancer or help identify the breast lump PET scan (positron emission tomography ) Sentinal lymph node biopsy to see if the cancer has spread

Treatment is based on many factors, including: Type and stage of the cancer Whether the cancer is sensitive to certain hormones Whether the cancer overproduces (overexpresses) a gene called HER2/neu In general, cancer treatments may include: Chemotherapy medicines to kill cancer cells Radiation therapy to destroy cancerous tissue Surgery to remove cancerous tissue -- a lumpectomy removes the breast lump; mastectomy removes all or part of the breast and possible nearby structures

CERVICAL CANCER
cancer that starts in the cervix, the lower part of the uterus (womb) that opens at the top of the vagina. There are two types of cells on the cervix's surface: squamous and columnar. Most cervical cancers are from squamous cells.

Cervical cancer usually develops very slowly. It starts as a precancerous condition called dysplasia. (abnormal changes in the cells on the surface of the cervix) This precancerous condition can be detected by a Pap smear and is 100% treatable. Almost all cervical cancers are caused by HPV (human papilloma virus).

A woman's sexual habits and patterns can increase her risk for cervical cancer. Risky sexual practices include: having sex at an early age having multiple sexual partners and having multiple partners or partners who participate in high-risk sexual activities.

Risk factors for cervical cancer include: Not getting the HPV vaccine Poor economic status Women whose mothers took the drug DES (diethylstilbestrol) during pregnancy in the early 1960s to prevent miscarriage Weakened immune system

Most of the time, early cervical cancer has no symptoms. Symptoms that may occur can include: Abnormal vaginal bleeding between periods, after intercourse, or after menopause Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody, or foulsmelling Periods become heavier and last longer than usual

Symptoms of advanced cervical cancer may include: Back pain Bone pain or fractures Fatigue Leaking of urine or feces from the vagina Leg pain Loss of appetite Pelvic pain Single swollen leg Weight loss

Treatment of cervical cancer depends on: The stage of the cancer The size and shape of the tumor The woman's age and general health Her desire to have children in the future Types of surgery for early cervical cancer include: Loop electrosurgical excision procedure (LEEP) -- uses electricity to remove abnormal tissue Cryotherapy -- freezes abnormal cells Laser therapy -- uses light to burn abnormal tissue A hysterectomy (removal of the uterus but not the ovaries) is not often performed for cervical cancer that has not spread. It may be done in women who have repeated LEEP procedures.

ELDERLY DISABILITIES

A disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these. covering impairments, activity limitations, and participation restrictions An impairment is a problem in body function or structure

Types of disability
Physical disability- Any impairment which limits the physical function of limbs or fine or gross motor ability is a physical disability Sensory disability- is impairment of one of the senses

Visual impairment
Visual impairment (or vision impairment) is vision loss (of a person) resulting from either disease, trauma, or congenital or degenerative conditions that cannot be corrected by conventional means such as refractive correction, medication, or surgery.

Myopia; Shortsightedness; Refractive error - nearsightedness

Nearsightedness is when light entering the eye is focused incorrectly, making distant objects appear blurred. Nearsightedness is a type of refractive error of the eye. Symptoms A nearsighted person sees close up objects clearly, but objects in the distance are blurred. Squinting will tend to make far away objects seem clearer.

Farsightedness Hyperopia
Farsightedness is greater difficulty seeing near objects than distant objects. Symptoms Aching eyes Blurred vision of close objects Crossed eyes (strabismus) in children Eye strain Headache while reading

Glaucoma
Glaucoma refers to a group of eye conditions that lead to damage to the optic nerve. This nerve carries visual information from the eye to the brain.

OPEN-ANGLE GLAUCOMA Most people have no symptoms Once vision loss occurs, the damage is already severe There is a slow loss of side (peripheral) vision (also called tunnel vision) Advanced glaucoma can lead to blindness

Cataract
A cataract is a clouding of the lens Blurred or vision distortion Can be from trauma or medication Common in old age

Hearing impairment
Hearing impairment or hard of hearing or deafness refers to conditions in which individuals are fully or partially unable to detect or perceive at least some frequencies of sound which can typically be heard by most people. Mild hearing loss may sometimes not be considered a disability.

Olfactory and gustatory impairment

Impairment of the sense of smell and taste are commonly associated with aging but can also occur in younger people due to a wide variety of causes.

BASIC NUTRITION for Elderly

NUTRITION- That which that nourishes; food NUTRIENTS- Food substances required by the body to repair, maintain and grow new cells FOOD GROUPS- the division of nutrients into four categories. E.g dairy products, fruits and veggies, meat and fish, bread and cereals.

Macronutrients are nutrients we need in relatively large quantities Micronutrients are nutrients we need in relatively small quantities.

Eating properly is important to all people. Good nutrition is especially important for a person whose body is in a weakened condition. Food gives us energy to carry out the days activity and is necessary to rebuild body tissues.

PERSONAL PREFERENCES
Sometimes a client will not eat a food for cultural reason, or unexplainable reason You must respect this preferences and plan meals and diets taking these personal preferences into consideration. Your goal is to understand the clients habits so that you can honor them in planning meals.

Be observant as to what your client eats. Also note when he eats which foods.

The human body requires seven major types of nutrients

Carbohydrates- are an ideal source of energy for the body. This is because they can be converted more readily into glucose the form of sugar that's transported and used by the body, than proteins or fats can.

There are two types of carbohydrate: complex and simple. Complex carbohydrates are often referred to as starch or starchy foods. They are found naturally in foods and also refined in processed foods. Bananas,nuts,oats,sweet corn, wholegrain cereals ,whole meal breads, whole meal cereals, whole meal flour, whole meal pasta yams.

Simple carbohydrates are also known as sugars. They also exist in either a natural or refined form. Natural sugars are found in fruit and vegetables. Refined sugars are found in: biscuits, cakes and pastries, Chocolates, honey and jams brown and white cane sugar soft drinks

Proteins
Proteins are the building blocks of life. The body needs protein to repair and maintain itself You need protein in your diet to help your body repair cells and make new ones. Protein is also important for growth and development during childhood, adolescence, and pregnancy.

Fats
Fats provide a source of concentrated energy as well as the fat-soluble vitamins A, D, E and K. Fat transports these vital nutrients around the body. We also need fat for hormone metabolism, healthy skin and hair, tissue repair, protecting the internal organs and to prevent excessive loss of body heat.

There are two main types of fat: saturated and unsaturated.

Saturated fat Excessive amounts of fat are found in saturated animal fats and trans-fatty acids. These types of fat raise cholesterol levels and increase your risk of many chronic diseases, such as heart disease, stroke and certain cancers.

Unsaturated fat They come from vegetable sources and are also found in oily fish and in soft margarines Unsaturated fats contain essential fatty acids that cannot be manufactured by the body. This means you need to get them from food.

Other macronutrients. These do not provide energy

Fiber- is a substance found in plants. Dietary fiber -- the kind you eat -- is found in fruits, vegetables, and grains. It is an important part of a healthy diet. Dietary fiber adds bulk to your diet. Because it makes you feel full faster

it can be helpful in controlling weight. Fiber aids digestion helps prevent constipation, and is sometimes used for the treatment of diabetes, and heart disease.

Water- to prevent dehydration. Micronutrients Minerals- Your body uses minerals for many different jobs, including building bones, making hormones and regulating your heartbeat.

Potassium Chloride Sodium Calcium Phosphorus Magnesium Zinc Iron

Vitamins- are substances that your body needs to grow and develop normally. There are 13 vitamins your body needs They are vitamins A, C, D, E, K and the B vitamins (thiamine, riboflavin, niacin, pantothenic acid, biotin, vitamin B-6, vitamin B-12 and folate)

PLANNING A MENU
As the home health aide, you may find it necessary to purchase food for the client. Be sure that the menu is planned from the clients diet and preferences. It is important to keep in mind the clients ability to chew and swallow food. Check the recommended servings from the food pyramid.

WHEN PLANNING A MEAL..

VARIETY- A WELL BALANCED DIET CONSISTS OF NUTRIENTS FROM MANY DIFFERENT KINDS OF FOOD. TEXTURE- COMBINING CRISPY FOOD WITH SOFT FOODS TO MAKE IT INTERESTING. FLAVORS- SEASON FOODS AS THE CLIENT PREFERS AND HIS DIET PERMITS.

TEMPERATURE- COOK FOOD AT THE RIGHT TEMPERATURE. TASTE- COOK MEALS TO THE CLIENTS TASTE. SHAPE- PREPARE FOODS WITH FAMILIAR SHAPES. ASK HOW FOOD IS PREPARED IN THE HOUSEHOLD. COLOR- GIVE EACH MEAL EYE APPEAL BY KEEPING COLORS COMPATIBLE.

COST- PLAN MEALS WITH THEIR BUDGET AND DO NOT CAUSE WASTE.

FOOD ALLERGIES CLIENTS MAY HAVE FOOD ALLERGIES THAT CAN CAUSE MILD SKIN IRRITATION OR CAN AFFECT THEIR ABILITY TO BREATHE. DO NOT ATTEMPT TO INTRODUCE ANY FOOD EVEN IN SMALL AMOUNTS

PREPARING A CLIENT FOR A MEAL

SERVE THE CLIENT IN AN ORDERLY AND FRIENDLY MANNER. PREPARE SMALL PORTION IF THE CLIENT HAS A POOR APPETITE. SERVE THE MEAL AS THE CLIENT WANTS IT THE PLACE PEOPLE EAT IS IMPORTANT.

AN IMPORTANT PART OF SERVING A CLIENTS MEAL ARE YOUR OBSERVATIONS

1.

2.
3. 4.

5. 6.

7.

HOW IS THE CLIENTS APPETITE? DOES HE EAT FOODS ON HIS DIET? WHAT FOOD DOES THE CLIENT AVOID? IS THERE DISCOMFORT ASSOCIATED WITH EATING? DOES THE CLIENT DRINKS FLUID? DOES THE CLIENT EAT SEVERAL BIG MEALS OR DOES HE EAT EVERYDAY? WHO SERVES THE CLIENT WHEN YOU ARE NOT THERE?

THERAPUETIC DIETS
Diet therapy is a personalized eating program designed to address a particular medical problem or to help you lose weight for health reasons. The therapy might include reducing or adding certain nutrients in your diet to prevent ill health effects or to treat one or more which already exist.

TYPES OF PATIENT DIET

NORMAL/REGULAR- PROVIDES ALL ESSENTIALS OF GOOD NOURISHMENT IN NORMAL FORMS. FOR CLIENTS WHO DO NOT NEED SPECIAL DIETS. SOFT (MECHANICAL)- SAME FOODS AS NORMAL DIET BUT CHOPPED OR STRAINED.

FOR CLIENTS HAVING DIFFICULTY IN CHEWING OR SWALLOWING. BLAND- FOODS MILD IN FLAVOR AND EASY TO DIGEST; OMITS SPICY FOOD. AVOIDS IRRITATION OF THE DIGESTIVE TRACT, AS WITH ULCERS AND COLITIS CLIENTS. EX: PUDDINGS, CREAMED DISHES, MILK, EGGS, PLAIN POTATOES. TO BE AVOIDED: FRIED FOODS, RAW VEGETABLES, FRUITS WHOLE GRAIN PRODUCTS.

LOW-RESIDUE- FOODS LOW IN BULK; OMITS FOOD DIFFICULT TO DIGEST FOR CLIENTS WITH RECTAL DISEASE. AVOID: WHOLE GRAIN PRODUCTS, UNCOOKED VEGGIES AND FRUITS. HIGH CALORIE- FOODS HIGH IN PROTEIN, VIT. AND MINERALS FOR UNDERWEIGHT AND MALNOURISHED CLIENTS.

ICE CREAM, FREQUENT SNACKS, PEANUT BUTTER, MILK. LOW CALORIE- FOODS LOW IN CREAM AND FATS, CEREALS, LOW FAT DESSERTS. FOR CLIENTS WHO HAVE DIFFICULTY IN DIGESTING FATS AND MAY HAVE GALL BLADDER, CARDIO OR LIVER PROBLEMS. EX: VEAL, POULTRY, FISH, SKIM MILK, FRESH FRUITS AND VEGGIES

DIABETIC DIET- BALANCE OF CARBOHYDRATES, PROTEINS AND FATS DEVISED ACCORDING TO THE NEEDS OF CLIENTS MATCHES FOOD INTAKES WITH INSULIN AND NUTRITIONAL REQS. FRESH FRUITS AND VEGGIES, LOW SUGAR PRODUCT. AVOID: HIGH SUGAR FOODS, ALCOHOL, CARBONATED DRINKS.

HIGH PROTEIN- MEALS HIGH IN PROTEIN. ASSISTS IN THE GROWTH AND REPAIR OF TISSUES WASTED BY DISEASE. MILK, MEAT, EGGS, CHEESE, FISH LOW SODIUM- LIMITED AMOUNT OF FOODS CONTAINING SODIUM; NO SALT ALLOWED ON THE TABLE.

FOR CLIENTS WHOSE CIRCULATION WOULD BE IMPAIRED BY FLUID RETENTION; FOR CLIENTS WITH HEART CONDITIONS AND KIDNEY CONDITIONS WHEAT/ RICE. FRUITS AND FRUIT JUICES. AVOID: CANNED VEGGIES, HAM, LUNCHEON MEATS, MOST CHEESES. SALT FREE- COMPLETELY NO SALT MOST FRESH OR FROZEN VEGGIES

FEEDING A CLIENT
SOME CLIENTS CANNOT FEED THEMSELVES AND THEREFORE NEED TO BE FED. THE REASON MIGHT BE: THE CLIENT CANNOT USE HIS HANDS. CLIENT IS ON CBR. TOO WEAK TO FEED HIMSELF.

WHEN YOU FEED A CLIENT

ALLOW CLIENT TO FEED THEMSELVES AS MUCH AS POSSIBLE; ASSIST ONLY WHEN NEEDED. DO NOT RUSH FEEDING BE GENTLE WITH FORK AND SPOONS; STRAWS MAY HELP IN FEEDING LIQUIDS. KEEP THE CONVERSATION PLEASANT AND MAKE THE MEAL THE HIGHLIGHT OF THE DAY

FEED FOOD SEPARATE RATHER THAN MIXED TOGETHER WHEN OFFERING A CUP/GLASS FIRST TOUCH IT TO THE LIPS RECORD INTAKE AND OUTPUT RECORD YOUR OBSERVATIONS ABOUT THE CLIENT WHEN YOU WERE FEEDING HIM.

SAFETY FACTORS
1.

2. 3.

4.

BE SURE YOUR CLIENT CAN SWALLOW THE FOOD BEFORE PUTTING IN THE MOUTH PAY ATTENTION TO FOOD TEMP. KEEP FOOD ON TABLE AWAY FROM BED TO PREVENT SPILLING IF CLIENT IS BLIND, NAME EACH MOUTHFUL BEFORE YOU OFFER IT TO HIM.