9.4 Common Disease Processes in LTC

CNA-Level Disease Knowledge

Disease-process questions on the Florida written test do not ask the CNA to diagnose or treat. They test whether you can observe accurately, support the care plan, recognize an emergency, and report. The reward answer for a new or serious symptom is almost always "report to the nurse." The CNA works within scope: measuring and reporting, providing ADL and comfort care, and never administering medications, oxygen changes, or treatments.

Stroke (CVA — Cerebrovascular Accident)

A stroke is interrupted blood flow to the brain — a medical emergency where minutes matter. Use FAST:

Also report sudden severe headache, vision loss, confusion, or one-sided numbness. For a resident with stroke history, support the weak (affected) side: dress the weak arm first and undress it last, place the call light and items on the strong side, supervise swallowing per the care plan to prevent aspiration, and guard against falls toward the weak side.

Diabetes

In diabetes, the body cannot regulate blood sugar. The CNA watches for both extremes and never administers insulin or independently decides on food — that is outside CNA scope.

Both are reported to the nurse promptly; low blood sugar can become an emergency very quickly because the brain depends on a steady glucose supply. A memory aid: low sugar is cold and clammy — needs candy; high sugar is hot and dry — sugar high. Supportive CNA care includes serving meals on time and not skipping or delaying a diabetic resident's meal, reporting exactly how much was eaten (intake affects the insulin the nurse gives), and doing careful foot and skin checks.

Diabetics heal slowly and are prone to wounds and infection, and reduced sensation means a resident may not feel a sore developing. Foot-care rules the exam tests:

• Inspect the feet daily for redness, blisters, cracks, or sores and report any finding.
• Wash and dry thoroughly, especially between the toes; apply lotion to the tops and bottoms but not between the toes (moisture there breeds infection).
• Keep feet protected with clean socks and well-fitting shoes; never let the resident go barefoot.
• Never cut a diabetic resident's toenails — report the need so a nurse or podiatrist can do it. A single nick can become a serious, slow-healing wound.

Heart Failure, COPD, Arthritis, and Parkinson's

Congestive Heart Failure (CHF)

The heart pumps inefficiently and fluid backs up. Observe and report shortness of breath (especially lying flat — the resident wants extra pillows), swelling (edema) of ankles, feet, or legs, sudden weight gain (a key reportable fluid-retention sign), and fatigue. Support: record daily weights accurately, follow fluid/sodium limits in the care plan, elevate the head of the bed, and report worsening breathlessness immediately.

COPD (Chronic Obstructive Pulmonary Disease)

Chronic lung disease with trapped air and difficulty breathing. Signs: chronic cough, shortness of breath, fatigue, barrel chest, pursed-lip breathing. Never remove oxygen or change the flow rate without nurse direction. Keep the resident calm, position upright (the tripod/orthopneic position helps), pace activities with rest, and report increased breathlessness, blue lips, or confusion.

Arthritis

Joint inflammation causing pain, stiffness, and reduced range of motion — worst in the morning. Allow extra time, do not rush, encourage prescribed range-of-motion (stop at the point of pain, never force a joint), apply heat or cold only per care plan, and report increased pain or swelling.

Parkinson's Disease

A progressive brain disorder with tremor (resting, often "pill-rolling"), muscle rigidity, bradykinesia (slow movement), a stooped posture, a shuffling gait, a mask-like face, and small handwriting. Fall risk is high — remind the resident to pick up the feet, keep paths clear, and use ordered assistive devices. Aspiration risk is high from swallowing trouble — supervise meals, offer soft foods or thickened liquids per care plan, and sit the resident fully upright. Allow extra time for slow movement and unclear speech.

Cancer and the Observe-and-Report Rule

Cancer care at the CNA level centers on comfort, dignity, and observation, since residents may be undergoing chemotherapy or radiation or receiving end-of-life/hospice care. Watch for and report new pain, poor appetite and weight loss, nausea or vomiting, extreme fatigue, mouth sores, skin breakdown, and signs of infection (chemotherapy lowers immunity, so even a low-grade fever matters). Provide gentle skin and mouth care, offer small frequent meals and preferred foods, handle the resident gently, manage fatigue with rest, and respect privacy and emotional needs. Always follow standard precautions and any isolation orders.

The Universal CNA Rule

No matter the disease, the CNA observes objectively, supports the care plan, and reports. Report immediately: chest pain, trouble breathing, FAST stroke signs, a seizure, sudden weakness, sudden confusion, blood in urine or stool, a fall, or any sharp change from the resident's baseline.