6.3 Common Chronic Disease Processes & Emergencies
Key Takeaways
- Residents with Congestive Heart Failure (CHF) require daily weight monitoring at the same time on the same scale to detect fluid retention, reporting gains of 2-3 lbs/day or 5 lbs/week to the nurse.
- COPD care involves strict oxygen safety (CNAs never adjust flow rates) and orthopneic positioning (leaning forward over an overbed table) to ease dyspnea.
- Hypoglycemia presents with cold, clammy skin, sweating, and shakiness requiring immediate emergency action, while diabetic foot care requires daily inspection, thorough drying between toes, and never clipping toenails.
- Stroke recognition relies on the FAST protocol (Face, Arm, Speech, Time); CNAs must dress the weak side first when caring for hemiplegia and enforce 90-degree upright positioning with thickened liquids for dysphagia.
Chronic diseases are long-term medical conditions that progress over time and require continuous medical management and specialized nursing assistance. As a Certified Nursing Assistant (CNA) in Arkansas, you will provide daily care to residents living with cardiovascular, respiratory, endocrine, and neurological conditions. Recognizing acute complications and delivering disease-specific interventions are critical exam competencies.
Cardiovascular Disorders: Hypertension & Congestive Heart Failure
Cardiovascular diseases affect the heart and blood vessels, serving as a primary cause of disability among elderly nursing facility residents.
Hypertension (HTN)
Hypertension, or high blood pressure (persistently measuring 130/80 mmHg or higher), strains the heart and blood vessels. Often called the "silent killer" because it produces few obvious symptoms, uncontrolled hypertension increases the risk of stroke, heart attack, and kidney failure.
- CNA Care: Measure blood pressure accurately, support low-sodium dietary restrictions, and immediately report complaints of severe headache, dizziness, or visual disturbances to the nurse.
Congestive Heart Failure (CHF)
Congestive Heart Failure occurs when the heart muscle weakens and fails to pump blood efficiently. Blood backs up into the lungs and peripheral tissue, causing fluid retention, pulmonary congestion, and tissue swelling (edema).
- Daily Weights: The most sensitive measurement of fluid accumulation. Weigh the resident daily at the same time each morning, using the same scale, after voiding, and wearing similar clothing. Report a weight gain of 2 to 3 pounds in 24 hours or 5 pounds in one week to the nurse immediately.
- Fluid Restrictions & Intake/Output (I&O): Accurately measure and record all liquid intake and urine output. Help residents pacing their allowed fluids throughout the shift.
- Edema & Positioning: Monitor for swelling in feet, ankles, and legs. Elevate swollen extremities as ordered. Position residents in Fowlers or semi-Fowlers to relieve shortness of breath (dyspnea).
Respiratory Disorders: Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disorder—encompassing chronic bronchitis and emphysema—that obstructs airflow, making breathing difficult.
Oxygen Safety Guidelines
Many residents with COPD require supplemental oxygen therapy via nasal cannula or mask.
- CNA Limits: CNAs never adjust oxygen flow rates; flow rates are medical prescriptions set by the nurse.
- Fire Safety: Oxygen supports combustion. Post "No Smoking" signs, ensure no open flames, electrical sparks, or petroleum-based products (such as Vaseline) are used near oxygen equipment. Use water-soluble lubricants for dry nasal passages.
- Tubing & Skin Care: Check oxygen tubing for kinks. Inspect skin behind ears and under nostrils for pressure irritation.
Orthopneic Positioning
Residents experiencing acute dyspnea often instinctually adopt the orthopneic position—sitting upright and leaning forward over an overbed table supported by pillows. This position expands chest capacity and optimizes lung expansion.
Endocrine Disorders: Diabetes Mellitus
Diabetes Mellitus is an endocrine disorder in which the body cannot produce or properly use insulin, resulting in abnormal blood glucose levels.
- Type 1 Diabetes: An autoimmune disorder where the pancreas produces little or no insulin. Requires daily insulin injections.
- Type 2 Diabetes: The most common form in older adults, characterized by insulin resistance. Managed with diet, exercise, oral medications, or insulin.
Hypoglycemia vs. Hyperglycemia
CNAs must instantly recognize the clinical signs of acute blood sugar imbalances:
| Condition | Cause | Clinical Signs & Symptoms | CNA Action |
|---|---|---|---|
| Hypoglycemia<br>(Low Blood Glucose) | Too much insulin, missed meals, or excessive exercise | Cold, clammy, shaky skin, sweating, confusion, dizziness, fast pulse ("Cold and clammy, need some candy") | Medical Emergency: Report to nurse immediately; prepare rapid sugar (juice, glucose tablets) as directed |
| Hyperglycemia<br>(High Blood Glucose) | Insufficient insulin, overeating, stress, or infection | Hot, dry, flushed skin, extreme thirst (polydipsia), frequent urination (polyuria), fruity breath odor ("Hot and dry, sugar high") | Report to nurse immediately; encourage water if ordered |
Strict Diabetic Foot Care Protocol
Diabetic residents suffer from poor circulation and reduced peripheral nerve sensation (neuropathy), making them vulnerable to severe foot ulcers and amputations.
- Daily Inspection: Inspect feet daily for redness, blisters, breaks in skin, or swelling.
- Washing & Drying: Wash feet daily with mild soap and warm water (check water temperature with a thermometer, 100°F–105°F). Dry thoroughly between the toes to prevent fungal infection.
- Lotion Application: Apply moisturizing lotion to tops and soles of feet, but NEVER apply lotion between the toes (traps moisture and causes tissue breakdown).
- Toenail Trimming Warning: CNAs must NEVER clip or trim the toenails of a diabetic resident. Toenail care for diabetic residents must be performed strictly by a podiatrist or Licensed Nurse.
Neurological Disorders: Cerebrovascular Accident (CVA / Stroke)
A Cerebrovascular Accident (CVA), or stroke, occurs when blood supply to a portion of the brain is interrupted by a blood clot (ischemic stroke) or a ruptured blood vessel (hemorrhagic stroke).
The FAST Emergency Acronym
When evaluating a suspected stroke, every minute counts:
- F — Face: Ask the resident to smile. Check for facial drooping on one side.
- A — Arm: Ask the resident to raise both arms. Check if one arm drifts downward due to weakness.
- S — Speech: Ask the resident to repeat a simple phrase. Check for slurred, garbled, or strange speech.
- T — Time: Time is critical. Immediately alert the nurse or call emergency medical services (911).
Caring for Hemiplegia
Stroke often leaves residents with hemiplegia (paralysis on one side of the body).
- Dressing Rule: When dressing a resident with hemiplegia, dress the weak (affected) side first, and undress the strong (unaffected) side first ("Dress the weak, undress the strong").
- Transfers: Position the wheelchair on the resident's strong side during transfers so they can lead with their non-paralyzed arm and leg.
Dysphagia Management & Thickened Liquids
Stroke frequently causes dysphagia (difficulty swallowing), posing a high risk of choking and aspiration pneumonia.
- Positioning: Keep the resident sitting upright at 90 degrees (High Fowler's) during meals and for at least 30 to 60 minutes after eating.
- Thickened Liquids: Serve liquids thickened to the prescribed consistency (nectar-thick, honey-thick, or pudding-thick). Never offer plain water or unthickened liquids to a resident prescribed thickened liquids.
- Feeding: Offer small bites, allow ample time between swallows, and check for food pouching in the cheek on the paralyzed side.
A Nursing Assistant is assigned to care for a resident with Congestive Heart Failure (CHF). Which daily monitoring procedure is most critical for detecting fluid retention in this resident?
While assisting a diabetic resident with afternoon activities, the CNA observes that the resident is sweating profusely, has cold and clammy skin, and appears shaky and confused. What condition should the CNA suspect, and what is the immediate action?
During breakfast, a Nursing Assistant notices that a resident suddenly drops their fork, has noticeable weakness on the right side of their mouth, and speaks with slurred words. Using the FAST protocol for stroke assessment, what does the 'T' stand for, and what should the CNA do?
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