8.3 Common Chronic Diseases & Age-Related Changes

Chronic diseases are long-term medical conditions that can be managed and controlled but not fully cured. As the human body ages, organs and physiological systems undergo age-related changes that reduce reserve capacity and increase susceptibility to illness. For instance, blood vessels stiffen, lung elasticity decreases, and glucose metabolism slows. Certified Nursing Assistants (CNAs) in Oregon spend a significant portion of their clinical hours caring for residents with chronic conditions. Under Oregon State Board of Nursing (OSBN) standards, a CNA must understand the basic pathology of these diseases, recognize critical changes in a resident's baseline status, and implement safe care interventions as specified in the care plan.

Diabetes Mellitus: Complications and Foot Care Rules

Diabetes is a chronic metabolic disorder characterized by the body's inability to produce sufficient insulin (Type 1) or to properly utilize the insulin it does produce (Type 2). This results in abnormal blood glucose (sugar) regulation.

• Hypoglycemia (Low Blood Sugar): Occurs when blood glucose falls below normal levels, typically defined as under 70 mg/dL. This is an acute, life-threatening emergency. Signs and symptoms include cool, clammy skin, shakiness, sweating, confusion, rapid pulse, irritability, and headache. If left untreated, it can lead to seizures and loss of consciousness. CNAs must recognize these signs ('cold and clammy, need some candy') and report them to the nurse immediately.
• Hyperglycemia (High Blood Sugar): Occurs when blood glucose is chronically elevated. Signs and symptoms include increased thirst (polydipsia), frequent urination (polyuria), extreme hunger (polyphagia), dry mouth, drowsy behavior, and a sweet, fruity breath odor. While less immediately acute than hypoglycemia, chronic hyperglycemia damages blood vessels and nerves over time.
• CNA Care and OSBN Foot Care Restriction: CNAs must carefully monitor and document a diabetic resident's dietary intake, as insulin doses are strictly calculated based on carbohydrate consumption. Foot care is a high-risk area because diabetes causes peripheral neuropathy (loss of sensation in the feet) and poor circulation, making residents prone to severe wounds and infections that heal very slowly. OSBN Rule: Under Oregon administrative rules, CNAs are strictly prohibited from cutting or trimming the fingernails or toenails of any resident who has diabetes, peripheral vascular disease, or poor circulation. This task must be performed by a licensed nurse or a podiatrist. CNA foot care is strictly limited to washing the feet, drying them thoroughly (especially between the toes to prevent fungal growth), inspecting the skin daily for redness, blisters, or cuts, and reporting any abnormalities to the nurse immediately. CNAs must never apply lotion between the resident's toes.

Cardiovascular Conditions: Hypertension, MI, and CHF

Cardiovascular diseases affect the heart and blood vessels, representing a leading cause of disability and death in long-term care populations.

• Hypertension (High Blood Pressure): Defined as a chronic reading of systolic pressure ≥ 130 mmHg or diastolic pressure ≥ 80 mmHg. CNAs must measure blood pressure accurately, ensuring proper cuff size and positioning, and report any readings that deviate from the resident's normal baseline.
• Myocardial Infarction (MI / Heart Attack): Occurs when a coronary artery is blocked, depriving the heart muscle of oxygen. Signs include crushing chest pain or pressure that may radiate to the left arm, shoulder, neck, or jaw; shortness of breath; sweating; nausea; and extreme anxiety. Crucial Action: If a resident shows signs of an MI, the CNA must notify the nurse immediately, help the resident into a comfortable semi-Fowler's position, encourage them to stay calm and still, and monitor vital signs.
• Congestive Heart Failure (CHF): A chronic condition where the heart muscle is weakened and cannot pump blood efficiently, causing fluid to accumulate in the body.
  • Left-sided failure: Causes fluid to back up into the lungs, leading to shortness of breath (dyspnea), coughing, and a wet breathing sound.
  • Right-sided failure: Causes fluid to pool in the body's tissues, resulting in peripheral edema (swelling) in the feet, ankles, legs, and abdomen.
• CNA Care for CHF: CNAs must weigh CHF residents daily using the same scale, at the same time each morning (usually after the first void and before breakfast), wearing similar clothing. A sudden weight gain of 2 to 3 pounds in 24 hours, or 5 pounds in a week, is a sign of fluid retention and must be reported immediately. CNAs must also measure fluid Intake & Output (I&O) accurately, encourage fluid restrictions if ordered, and elevate the resident's swollen limbs.

Respiratory Conditions: COPD and Oxygen Safety

Respiratory conditions limit the body's ability to exchange oxygen and carbon dioxide, leading to chronic fatigue and breathing difficulties.

• Chronic Obstructive Pulmonary Disease (COPD): An umbrella term for progressive lung diseases, including emphysema and chronic bronchitis, characterized by chronic airflow blockage. Symptoms include chronic cough, sputum production, dyspnea on exertion, wheezing, and a barrel-chested appearance.
• CNA Care and OSBN Oxygen Safety Scope: CNAs assist residents with COPD by placing them in positions that facilitate chest expansion, such as Fowler's or High Fowler's, and pacing ADLs to prevent fatigue and shortness of breath. OSBN Rule: Under OSBN rules, oxygen is considered a medication. A CNA is strictly prohibited from adjusting the oxygen flow rate (liters per minute) on a resident's oxygen tank, wall unit, or concentrator. The CNA's role is limited to verifying that the oxygen equipment is running at the prescribed rate, checking the skin around the ears and nose for breakdown caused by the cannula tubing, and reporting any breathing difficulties or cyanosis to the nurse immediately.

Nervous System Conditions: Stroke (CVA) and Parkinson's Disease

Nervous system disorders impair the brain's control over voluntary movement, communication, and basic functions.

• Cerebrovascular Accident (CVA / Stroke): Occurs when blood flow to a part of the brain is blocked or a blood vessel ruptures, causing brain tissue damage. CNAs must recognize stroke symptoms using the FAST acronym: Face drooping, Arm weakness, Speech difficulty, and Time to report immediately.
• CNA Care for Post-Stroke Hemiparesis (One-Sided Weakness):
  • Transfers: Position the wheelchair on the resident's stronger (unaffected) side when transferring out of bed so they can lead with their strong leg.
  • Dressing: Follow the rule of Dress Affected First (DAF) and Remove Unaffected First (RUF). Apply clothing to the weak side first, and remove clothing from the strong side first.
  • Eating: Place food on the stronger side of the mouth to prevent 'pocketing' (food accumulating in the weak cheek). Monitor closely for dysphagia (difficulty swallowing) and coughing, which are high-risk signs of aspiration.
• Parkinson's Disease: A progressive neurological disorder affecting movement due to a lack of dopamine. Symptoms include a shuffling gait, pill-rolling tremors of the hands, muscle rigidity, mask-like facial expressions, and difficulty initiating movement. Parkinson's residents are at an extremely high risk for falls. CNAs must ensure a clear pathway, assist with mobility devices, encourage the resident to stand upright, and allow ample time to complete tasks without rushing.