Providing for Basic Needs

Looking after a sick or severely disabled family member can put a lot of stress on the caregiver, who has generally had little or no training in home-care.

The person needing the care generally has a range of needs — physical, emotional, social and spiritual. Sometimes the complexity of the demands is so overwhelming that caregivers don’t take time to establish any sort of system which in turn leads to an even more burdensome role. They keep on, on an ad hoc basis, becoming increasingly exhausted.

A knowledge of basic home-caring procedures can be reassuring and relieve a lot of the strain.

Organizing the Nursing Environment

• Ideally, the furniture in the patient’s room should be arranged to have easy access to the bed. The furniture should include a bedside table, a comfortable chair for when he is sitting out of bed and the floor should be non-slip; preferably covered for coziness.

• The room should always be adequately heated or cooled and fresh.

• If there is not sufficient cupboard space, build a shelf to contain nursing paraphernalia — plastic bags for refuse; personal care
equipment — brush, comb, toothbrush and cup, and fresh face-cloths and towels, soap, extra glasses (that cupboard or shelf will save you many trips in and out).

• Keep all medications out of the reach of the patient who has any memory impairment or confusion.

Bathing

• If the person is afraid of getting into the bath, a bath chair may help. If he prefers showering, a shower stool may be used. Always run the cold water before the hot water and mix well. A rail beside the bath or shower may help him to get back into a standing position.

• A roller-towel fastened to a secure bar can enable him to dry himself in privacy.

• If he cannot get out of bed, then he will have to be given a bed-bath. This is better managed by someone who has had training or by
two people. If you do not have the help of a bath aide, ask the nurse to demonstrate how to give a bed-bath.

• Wash his hands and face several times a day to freshen the patient and wash the genital areas after toileting.

• Attend to nails immediately after bathing as they will be more
pliable.

• If you notice any changes in the patient’s skin, report them immediately to the nurse or doctor.

• Hair-care for a bed-bound person can be a problem. Molded plastic vinyl shampoo basins, with attached hoses which drain into a bucket, are available at drugstores and through mail-order catalogs. The equipment provides support for the neck while the hair is being washed. After thorough rinsing, to avoid scurf build-up, see that the hair is properly brushed and dried. Dry shampoo powders may also be used; but watch for scurf build-up, if it is not completely removed.

Medication Management

Enclosed with your Caregiver’s Support Kit® you’ll find a complimentary pill box dispenser. Note, however, that many elderly take multiple medications at various times each day. The responsibility to administer the correct medications at the proper time is perhaps the most important part of your caregiving tasks.

To help remember the proper procedure for administering medications you can refer to the following six rights!

This procedure will ensure that:

1. the RIGHT PERSON

2. receives the RIGHT MEDICATION

3. in the RIGHT DOSE

4. at the RIGHT TIME

5. via the RIGHT METHOD/ROUTE

6. followed by the RIGHT CHARTING procedures.

You don’t need to worry about the right person if you only care for one person, but many caregivers have more than one person getting medications in the household. Be sure you have the right person and the right medication for that person.

Double check, even triple check, that you have the right dose prepared. This is especially important if the patient has recently seen the doctor where changes may have been prescribed. Take time to read the pharmacy label frequently. Always check the expiration date for the medications. If the medication has expired – stop – do not give expired medications. Call your health care professional for instructions.

The right time for medications is the time specified or prescribed on the medication label. In general, medications can be given within one hour before or after the prescribed time. For example, a medication prescribed for 4:00 p.m. can be given any where from 3:00 p.m. to 5:00 p.m. Be sure to remember any special instructions such as “must be taken with food”

The right method/route is indicated when a health professional
prescribes a medication. The method is usually orally, or by mouth,
but occasionally it could be in the form of a topical skin cream, patch, eye drops etc.

Finally, keep a chart record of the medications given and note any reactions or problems encountered. Tell your health care professional if you observe any negative reactions to medications as soon as possible. You can use a calendar kept for chart purposes only. There is usually enough room to write notes and reminders and it will save you having to remember everything.

How to Avoid Medication Error

Taking the wrong medications or taking medications incorrectly can have serious consequences or even be fatal. Here are some suggestions to
help you and your loved one avoid harmful drug interactions, problems with dosages and other potential adverse actions.

At Home:

• Make a list of all your loved one’s medications, including dosage, frequency of use, condition it is for, name of pharmacy and prescribing physician.

• Any time your loved one’s medication changes, change your list.

• Keep all medications in their original containers.

• Don’t chew, crush, or break capsules or tablets unless so advised. You may make the medication unsafe or ineffective.

At the Hospital:

• Take your loved one’s own medication list with you.

• Ask the physician the names of any new medications to be used and the reasons they are prescribed.

• Look at all medications before your loved one takes anything, if they appear different from what he/she usually takes, question why.

• Ask hospital staff to check your loved one’s hospital ID bracelet before administrating medication to prevent receiving another
person’s medication.

• When your loved one is ready to go home, have a knowledgable person review each medication with you. Find out what condition it treats and whether it is to be taken in addition to what you have at home for the condition or in lieu of it. Ask about possible side effects.

• Update your medication list from home as needed.

At the Doctor’s Office:

• Bring a copy of your loved one’s medication list on every visit.

• If your doctor offers samples, ask if the medications will interfere with any medications your loved one is using.

• Ask the drug name, how the prescription should be filled, and how often the medication should be taken.

• Ask the doctor to write the purpose for the medication on the prescription. Drug names can be “look-a-likes” when written in longhand. Having the purpose noted will help the pharmacist to double check the prescription.

• Encourage the doctor to institute electronic prescribing as a way of enhancing patient safety.

Take it to the Doctor

Better safe than sorry. Before you leave the pharmacy, compare your doctor’s prescription to the label on the bottle. You might catch a deadly mistake.

Is your NAME correct on both the prescription and the medicine bottle? If you have a name such as Bob Jones or Mary Smith, ask the pharmacist to include your middle initial.

Is your NAME on the medication correct? Look carefully. Some drug names are similar.

Is the DOSAGE the same as what your doctor told you.

Are the Instructions understandable? Doctors and pharmacies often communicate in LATIN. For example:

Latin Abbreviation Meaning

ante cibum ac before meals

bis in die bid twice a day

gutta gt drop

hora sommi hs at bedtime

oculus dexter od right eye

oculus sinister os left eye

per os po by mouth

post cibum pc after meals

pro re nata prn as needed

quaque 3 hora q3h every 3 hours

quaque die qd every day

quater in die qid 4 times a day

ter in die tid 3 times a day

When traveling KEEP your medicine with you — not checked in your luggage. BRING more than enough medicine for your trip. REVIEW your dosage schedule with your doctor or pharmacist before you leave and DISCUSS whether you should make allowances for changes in time zones.

Keep a list of all your medicines and dietary supplements with you.

Prescriptions

• Do not run out.

• Know the pharmacy hours; including emergency arrangements.

• Always check with the pharmacist about drug mixes.

• Be very vigilant that correct doses are taken at prescribed times.

• If any unusual symptoms show up, call the doctor immediately as they may be due to a sudden allergic reaction to some drug or due to the drug reacting negatively with some food.

Diet

• It is important to maintain a good nutritional diet.

• Present food in as attractive a manner as time and energy permit.

• For some patients, several small meals may be better than three larger meals (check with the doctor before making any changes).

Exercise

• There are exercises suitable for even chairbound and bedbound people. Do not introduce an exercise regimen without first consulting the doctor or physical therapist.

Entertainment

You may not only be responsible for meeting physical needs but additionally for meeting emotional needs. Part of this can be met by introducing some form of entertainment. Among possible options may be:

• encouraging more visiting by friends and family, whether other adult children, siblings, remote cousins or old friends,

• music; especially where there has been a lifelong interest in music

• reading (large print books are available for those with vision problems)

• television (especially for many elderly women the “soap operas” become a surrogate family; and “game” shows maintain a competitive interest)

• talk shows which discuss “human interest” topics

• crosswords

• hobbies that are still manageable

• crafts

• talking to grandchildren or old cronies about “the past”

• card games or other games such as monopoly

Whether we are sick or well, we do need peer company; peers act not only as someone to talk to but they can be confidants. Even as the caregiver needs to vent frustrations and perhaps discontent with the status quo, so do their bedbound or housebound care-recipients.

Sleeping

Proper rest is essential for us all. There are several needs that must be met to ensure that the person gets proper rest.

• The room should be comfortably either warm or cool, depending on the season.

• Enough pillows for comfort should be provided.

• Several layers of bed-clothes, instead of one very heavy layer, is usually more comfortable.

• The room should be comfortably darkened.

• A dim, but functional night-light may help if bathroom visits are necessary.

• Reading until sleep-time or soft radio talk or music shows can be soporific.

• Constipation, pain or leg cramps are among conditions which may affect sleep patterns. If there is a problem, consult the doctor.

Lifting

Improper lifting techniques may not only damage the caregiver’s physical health, they will make the care-recipient feel insecure and may lead to injury.

• Ask the nurse or physical therapist to demonstrate proper lifting techniques. Learn the appropriate action to move the patient in the bed; from the bed to the chair; from the chair to a standing position; how to make the bed with her in it; how to get up and down stairs; in and out of a car — whichever lift is required.

• The handicapped person should be encouraged to participate in the lift to the extent that his residual abilities will allow.

• A mechanical hoist may help with some lifts.

• Lifting techniques should be practiced under supervision of a relevant professional.

Avoiding Pressure Sores

Pressure sores can cause untold misery to an already debilitated person. Therefore it is essential for every measure to be taken to prevent them from developing.

• Change his position in the bed at regular intervals (ask the nurse or doctor what they recommend).

• Keep the vulnerable areas clean and dry.

• Do not drag a patient in the bed as the skin may tear.

• Make sure the bed is crease-free and crumb-free.

• Be careful when either giving or removing a bedpan; always roll or lift the patient; never drag him.

• A water-cushion or water-bed may help someone who is practically immobile.

If pressure sores do develop, consult the doctor or nurse immediately. Follow any care-plan they recommend. Usually a nurse will monitor the bedsores and provide treatment.