9.4 Common Disease Processes in LTC
Key Takeaways
- The CNA never diagnoses — the role is to observe accurately, support the care plan, and report changes to the nurse.
- Stroke (CVA): use FAST — Face drooping, Arm weakness, Speech difficulty, Time to call for help immediately.
- Diabetes: report shakiness, sweating, confusion (low sugar) or extreme thirst, frequent urination, fruity breath (high sugar); never give insulin.
- CHF and COPD show shortness of breath, fatigue, swelling, or weight gain; never adjust or remove oxygen without a nurse's direction.
- Report chest pain, trouble breathing, sudden weakness, seizures, blood in urine/stool, and sudden confusion immediately.
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."
Stroke (CVA — Cerebrovascular Accident)
A stroke is interrupted blood flow to the brain. It is an emergency. Use FAST:
| Letter | Sign |
|---|---|
| F | Face drooping (one side) |
| A | Arm weakness (one side, drifts down) |
| S | Speech difficulty (slurred, garbled, or absent) |
| T | Time — call for help immediately |
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, place items on the strong side, supervise swallowing per care plan to prevent aspiration, and prevent 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 decides on food independently — that is outside CNA scope.
| Low Blood Sugar (hypoglycemia) | High Blood Sugar (hyperglycemia) |
|---|---|
| Sudden onset | Gradual onset |
| Shakiness, sweating, cold/clammy skin | Hot, dry, flushed skin |
| Confusion, irritability, dizziness | Extreme thirst, frequent urination |
| Weakness, hunger | Fruity-smelling breath, nausea |
| Rapid pulse | Drowsiness, deep breathing |
Both are reported to the nurse promptly; low blood sugar can become an emergency very quickly. Supportive CNA care includes serving meals on time, reporting how much was eaten, doing careful foot and skin checks (diabetics heal slowly and are prone to wounds and infection), and protecting the feet from injury. Never cut a diabetic resident's toenails — report the need.
Heart Failure, COPD, and Arthritis
Congestive Heart Failure (CHF)
The heart pumps inefficiently and fluid backs up. Observe and report:
- Shortness of breath, especially when lying flat (resident wants extra pillows)
- Swelling (edema) of ankles, feet, or legs
- Sudden weight gain (a key reportable sign — fluid retention)
- Fatigue and decreased activity tolerance
Support: report daily weights accurately, follow fluid/sodium restrictions in the care plan, position with the head of bed elevated for easier breathing, and report worsening breathlessness immediately.
COPD (Chronic Obstructive Pulmonary Disease)
Chronic lung disease causing trapped air and difficulty breathing. Signs: chronic cough, shortness of breath, fatigue, barrel chest, pursed-lip breathing, low activity tolerance. Never remove oxygen or change the flow rate without a nurse's direction. Keep the resident calm, position upright (orthopneic/tripod 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. Support: allow extra time, do not rush, encourage prescribed range-of-motion as ordered (stop at the point of pain, never force a joint), apply heat/cold only per care plan, use assistive devices, and report increased pain, swelling, or new loss of function.
A CNA notices a resident's face is drooping on one side, one arm drifts down when raised, and speech is slurred. What is the priority action?
A resident with COPD becomes short of breath and anxious. The oxygen is set at the prescribed rate. What should the CNA do?