Disease Process and Common Conditions

The LNA Role in Disease Process (Excel Testing Focus)

On the New Hampshire Excel Testing written exam, disease process questions sit inside Basic Nursing Skills. The test does not expect LNAs to diagnose or treat. It expects you to recognize common condition patterns, protect safety, and report clear, factual observations to the charge nurse.

Think of yourself as the nurse's eyes and ears on the unit. Residents live with chronic illnesses every day. Your job is to notice what is new, worse, or different from baseline, then communicate those facts promptly. You do not:

• Tell a resident or family, "You have a stroke" or "Your blood sugar is high because you have diabetes" as a diagnosis
• Decide whether a resident needs insulin, inhalers, antibiotics, or pain pills
• Withhold or give medications (unless you hold a separate MNA credential and are practicing under MNA rules)

You do:

• Compare today's presentation to the care plan and the resident's usual status
• Use objective language ("Resident is diaphoretic and trembling"; "Left arm drifts downward when both arms are raised")
• Report urgent changes immediately—not at the end of shift

Diabetes: Hypoglycemia and Hyperglycemia

Diabetes mellitus affects how the body uses glucose. LNAs do not interpret glucometer results to diagnose, but many facilities train LNAs to assist with monitoring under nurse direction and always to report abnormal findings and symptoms.

Hypoglycemia (low blood sugar) — often urgent

Common signs LNAs should recognize and report immediately:

• Shakiness, trembling, or "jittery" feeling
• Sweating (diaphoresis), cool or clammy skin
• Sudden confusion, irritability, or personality change
• Hunger, dizziness, headache
• Weakness; in severe cases, loss of consciousness or seizures

Excel Testing logic: if a resident with diabetes becomes suddenly confused and sweaty, stay with the resident, ensure safety, and call the nurse at once. Do not leave them alone to "finish charting." Do not give juice or sugar on your own initiative unless the care plan and nurse specifically authorize that standing protocol for that resident.

Hyperglycemia (high blood sugar)

Common signs to observe and report:

• Excessive thirst (polydipsia) and frequent urination (polyuria)
• Dry mouth, flushed skin
• Fatigue, blurred vision
• Fruity or acetone odor on the breath (a late, concerning sign)
• Nausea, deep rapid breathing (report as emergency-level change)

LNAs also support diabetes care by ensuring meals and snacks arrive as ordered, reporting refused meals, documenting intake accurately, and watching skin integrity on the feet (never cut toenails if facility policy restricts this; report breaks in skin).

Stroke (CVA): FAST and Hemiplegia Care

A stroke (cerebrovascular accident) occurs when brain blood flow is interrupted. Time matters. Excel Testing and clinical practice both emphasize FAST:

• F — Face: Ask the person to smile. Look for droop on one side.
• A — Arms: Ask them to raise both arms. Look for drift or inability to lift one arm.
• S — Speech: Listen for slurred or strange speech.
• T — Time: Note the time symptoms started and get nursing help immediately.

New or sudden FAST signs are an emergency. Stay with the resident, keep them safe (do not leave them standing unattended), and summon the nurse. Do not give food or fluids if swallowing may be impaired.

Hemiplegia and hemiparesis care

Many residents live with lasting hemiplegia (paralysis of one side) or hemiparesis (weakness of one side) after stroke. Restorative nursing themes that appear on exams include:

• Approach and communicate from the stronger/unaffected side when possible, but always follow the care plan for positioning and feeding
• Dress the affected limb first; undress the affected limb last
• Support the weak arm during transfers; never pull on the affected arm or shoulder
• Place items within reach on the strong side while encouraging safe use of residual function
• Prevent contractures with proper positioning, pillows, and ordered ROM
• Watch for aspiration risk: report coughing during meals, pocketing food, or wet voice after swallowing

COPD and Dyspnea

COPD (chronic obstructive pulmonary disease) includes chronic bronchitis and emphysema. Residents often have chronic shortness of breath (dyspnea). Your role is to reduce oxygen demand and report worsening:

• Position for comfort—usually Fowler's or high Fowler's if ordered/tolerated
• Pace activities; allow rest between ADLs
• Keep the room calm; avoid crowding during bathing if dyspnea worsens
• Report increased respiratory rate, use of accessory muscles, cyanosis (bluish lips/nail beds), new confusion, or inability to speak in full sentences
• Report sputum color/amount changes (especially green/yellow or bloody sputum)

LNAs do not adjust oxygen liters without nurse/order authority. If an oxygen device is disconnected, follow facility procedure and notify the nurse.

Heart Failure and Edema

In congestive heart failure, the heart cannot pump effectively, so fluid backs up. Classic LNA observations:

• Edema in feet, ankles, or sacral area; shoes/socks suddenly tight
• Sudden weight gain (report per facility protocol—often 2–3 pounds overnight is concerning)
• Shortness of breath, especially when lying flat (orthopnea); residents may insist on sleeping upright
• Fatigue, reduced activity tolerance
• Cool, pale, or mottled extremities

Care themes: elevate edematous legs if ordered, encourage fluid restrictions only as care-planned, measure I&O accurately, and report crackling coughs or pink frothy sputum as urgent.

UTI and Sudden Confusion (Delirium Link)

In older adults, a urinary tract infection may present with sudden confusion or delirium rather than classic burning and frequency alone. Excel Testing loves this connection.

Report promptly:

• New or worsening confusion, agitation, or lethargy
• New incontinence or urgency
• Cloudy, foul-smelling, or bloody urine
• Lower abdominal discomfort or flank pain
• Fever or chills if present

Do not assume "that's just dementia." A sudden change from the resident's baseline mental status is a medical red flag until the nurse evaluates it.

Parkinson's Disease

Parkinson's disease involves tremor, rigidity, bradykinesia (slow movement), and postural instability. LNA priorities:

• Allow extra time for ADLs; never rush transfers
• Watch for freezing of gait—cue calmly, do not pull the resident forward forcefully
• Fall precautions and clear pathways
• Report swallowing difficulty, choking, or weight loss (aspiration/nutrition risk)
• Support independence with adaptive devices per care plan
• Report increasing rigidity, new falls, or medication side-effect observations to the nurse (you still do not adjust Parkinson's medications)

Arthritis: Pain, Stiffness, and Joint Protection

Osteoarthritis and rheumatoid arthritis cause pain, stiffness, and limited ROM. LNAs:

• Encourage warm-up and gentle movement as ordered—motion often reduces morning stiffness
• Never force a joint past the point of pain
• Use assistive devices (built-up utensils, raised toilet seats) to protect joints
• Report swollen, red, hot joints and sudden loss of function
• Schedule care to respect pain patterns when possible (e.g., allow rest after therapy)

Observation Language That Passes Exams and Protects Licenses

Write and speak in facts:

• Good: "Resident's right leg is more swollen than left; +2 pitting noted at ankle; resident states shoes will not fit."
• Poor: "Resident looks like heart failure is acting up."

Remember the scope boundary that Excel Testing repeatedly tests: observe → report → follow nurse direction. Diagnosis and medication decisions belong to licensed clinicians.