CONTINUE MEDICATIONS

CONTINUE MEDICATIONS

     They check the iron level also.  Iron is essential for adequate red blood cell formation.

     These blood tests are very meaningful to the doctor, so don’t complain when he wants to draw blood.

     There are many books on the market that give a complete list of side effects for all medications.  It is very helpful to have one when you are caregiving.  I use mine often.

     Giving medications at the proper time is very important in caregiving.  Certain medications must be given with meals, after meals, or on an empty stomach.  Ask questions about all medications to be sure that you are giving them properly.

     I found that a list of the medications and when they should be given is very helpful in organizing the daily intake of all medicines.  I bought a weekly dispenser that had four openings for medication each day.  By putting a week’s worth of medications in a dispenser, you can see if the medicine has been given each part of the day.  It is difficult to remember if you have given your patient their pills or not, especially when you have a dozen or more to give each day.  The dispenser is very helpful

     Another method many find helpful is to have a chart to tell you when to administer the medications.  Then as you give the pills to the patient, you can check off each medication.  This way you know that you have administered them at the proper time, and it helps the doctor as well.

     Don’t be afraid to ask a lot of questions when you see the doctor.  The more you know about your patient’s condition and the medications they are taking, the better you can care for your loved one.

     It is helpful to have a tray to hold your medicine, and a decanter of water and a glass beside the bed.  Be sure to have napkins close in case of a spill.  If you have liquid medication to give to your patient give a piece of fruit, a cracker, or some ice to help mask the unpleasant taste of the medicine.  When using liquid medication, it is helpful to have little plastic cups that you can measure your medicine in.  You can purchase them at the pharmacy.  They have measurements in ounces or cubic centimeters.  This way the patient does not have to worry about spilling the liquid; it is much easier to take.

     Always check the label on the medication to be sure you are giving it at the proper time and the proper dose.  Have the patient place the medicine on the back of their tongue, take a mouthful of water, tilt their head back, and swallow.  This will help the pill go down easily.  Stay with the patient until the medication is taken.

     Sometimes eye drops are prescribed for your patient, especially after cataract surgery.  Putting drops in the patient’s eye is a treatment ordered by the doctor that can safely be carried out at home.  The first things to do is wash your hands thoroughly.  You don’t want to contaminate your patient’s eye in any way.  Next, have the patient hold as still as possible.  Have the patient lean his head back and look up.  You should pull the lower lid down and drop the eye drops on the inside of the lower lid.  This is easy and fast.  Don’t let the tip of the bottle touch the eye itself.  Most people will probably flinch or squint a little.  Be sure that the patient doesn’t rub or use pressure on the eye after you administer the drug.  Simply pat the face if any medication runs down the cheek.

     Administering medication is simple if you follow the directions.  Be sure to check any medication given to your patient, to be sure it is the proper time and the proper dosage.  Before you begin always wash your hands to keep things as sterile as possible.  Have a routine that you always follow and you will do just fine.

MEDICATIONS

There may be times when you have to use adult diapers on your patient.  This is very disturbing to your patient, so be careful how you approach the subject, as it can have adverse psychological effects.  Before you resort to adult diapers, it may be wise to try bringing the bedpan to the patient at regular times each day, with the hope that it will train them to void at regular intervals.  About every two hours would be a good starting point.  This may help the patient accept his incontinence and work with you to avoid accidents.  The effect on his morale could be favorable.  No one likes to be embarrassed with incontinence.

     Check with your druggist for the adult diapers.  There are a variety of them on the market today.

THOUGHT FOR THE DAY

Help your patients hold on to their dignity.

It may be all they have left.

MEDICATIONS

     Medications have so many side effects.  It is important that you understand the medications given to your patient.  Knowing, how the medicine effects the body is important when you are watching for symptoms in your patient.  If you understand the side effects that each medication has, it is easier to catch problems before they begin.

     My mother-in-law had problems with overdosing on some of her medications.  She didn’t go to the doctor on a regular basis, so it was difficult for him to check the levels of her different medications in her blood.

     We often wonder why the doctor needs to take so much blood, but it is to check the chemical balance in the blood.  Complete blood analysis is important to the doctor, so that he can adjust medications to keep the proper balance in the body.

     For instance, he looks at the potassium level in the blood.  Potassium is an important electrolyte in the body, which regulates nerve heart and muscle function.  It comes from the food we eat; fruit, vegetables, meat, milk and coffee.  If the potassium level is too high, the heart slows and occasionally patients may pass out.  Prior to this, you will notice a sudden loss of strength in the legs and body.  If potassium is too low it may cause weakness, irregular heartbeat, confusion and irritability.

     The doctor will also look at the sodium content of the blood.  Sodium is another electrolyte.  It regulates body fluid levels.  If you use too much sodium in your diet, you will drink a lot of water and you will retain fluid in your tissues.  People with heart conditions must watch their intake of sodium so they don’t retain too much fluid and put a strain on their heart.  If your patient has a heart condition, watch their ankles for any swelling or rapid weight gain.  That may be a sign that they are retaining too much fluid.  You should question this condition with your doctor.  The doctor may increase your patients diuretic.

INCONTINENCE

     During the aging process, the muscles become weak and there is a chance of the patient becoming incontinent.  When this happens they have very little control over their elimination process. They may wet the bed or become fecal incontinent.  Precautions should be taken when this difficulty becomes apparent.  You can also use a mattress cover to eliminate the possibility of ruining your mattress.  Hospitals use a draw sheet, a sheet that has been folded in half and placed over the main sheet.  They also put a plastic covered pad under the draw sheet to absorb any liquid, in case the patient voids.

     If the patient is a man, be sure to keep a urinal close to the bed.  With incontinent patients, the urge to urinate is great and immediate.  Often there is no time to call the caregiver, so place the urinal where the patient can reach it.

     When your patient is in a hospital bed and you have the head of the bed raised your patient will sometimes slide toward the foot of the bed.  If the patient can’t back up to the proper position, the draw sheet can be used to scoot the patient toward the head of the bed.  When you want to reposition the patient in the bed, have someone help you.  Let the head down flat and each of you grab the draw sheet, put one knee on the bed for leverage, and to save your back, and on the count of three pull the draw sheet toward the head of the bed.  The patient will be repositioned, with little strain on either of you.

     It is important for you, the caregiver, to take care not to injure your back.  You have to stay in good shape to be able to give good care to the patient.  If you hurt yourself, someone else has to take your place while you are getting well and it might get pretty expensive.

     When your patient has had a stroke, their brain may forget to send messages to the parts of their body that let them know they have to have an elimination.  Consequently, it will sneak up on them and they sometimes will have a stain in their undergarment.  If this gets too bad, there are undergarments made for this on the market today.  Ask your druggist about them.  Be sure that you always carry an extra undergarment with you in case of an accident.  It is also good to carry a wet washrag in a plastic bag.  It can save a lot of embarrassment to the patient.

     There is an incontinence cleanser called Proshield Foam and Spray, put out by Healthpoint Medical in San Antonio, Texas.  it is a gentle non-aerosol. no-rinse moisturizing foam and spray cleanser that is ideal for incontinent care.  Since you don’t have to rinse it off, it is perfect for use when you are away from home.  Check with your medical supply store or druggist to see if they carry it.  It is wonderful.

DIARRHEA

AND INCONTINENCE

DIARRHEA

     With elderly people, sometimes you may run into a problem with digestion and diarrhea.  It’s not something we like to talk about, but sometimes we have to deal with it.  When a person suffers from diarrhea there are certain changes that need to be made.  Take this condition seriously.  If the diarrhea lasts for an extended period of time or there is blood in the stools, be sure to contact your doctor immediately.

      There are a few things you can do to help the patient overcome this condition.  Be sure to serve foods that are high in protein, calories and potassium, but make sure they are low in bran or roughage.  Some of the foods that are acceptable are cottage cheese, eggs, baked potato, white rice, cooked cereals, bananas, macaroni, white toast, and smooth peanut butter.  Be sure that all fruits and vegetables are cooked and stay away from foods with seeds or rough skins, like beans, corn, or onions.

     The patient should consume lots of water or clear liquids each day, about three quarts, and be sure to drink them slowly---sip them.

     The body loses potassium when diarrhea appears, so you must supplement with foods high in potassium, such as bananas, potatoes, meat, fish, and apricot nectar.

     I learned that by adding nutmeg to your food, you will slow down the movement of the intestines, helping the intestines form a more solid stool.

     It also helps them to drink liquids in between meals, instead of with the meal.

     If your patient is bedridden, be sure to keep a bedpan handy.  Your doctor will want to know the frequency and amount of the bowel movements, so keep good records.

     Be sure that they avoid milk products, creamed soups, puddings, and milk shakes.  Don’t serve very hot or very cold foods, to avoid cramps.  This also goes for gassy foods, sweets, and chewing gum, which lets your swallow air.

     At times your patient may not be able to swallow normally.  It may be due to medications being too large to swallow, or the muscles in the throat simply not working too well, while they are recovering from a stroke or other illness.  When there is a problem with the patient swallowing their medication, crush the pill thoroughly and add a teaspoon of gelatin, juice, applesauce, or pudding.  Then feed it to the patient.  This makes is easier to swallow and will mask the taste of the pill.  You know, “a spoonful of sugar makes the medicine go down.”  It is much better than causing discomfort to your patient.

     If you have concerns or questions, don’t forget to call your doctor with them.  He will give you suggestions that will make your life easier, as far as the patient is  concerned.

BEDSORES

(DECUBITI)

Bedsores (decubiti) may occur when your patient is confined to bed for long periods of time.  These are caused by the blood supply being interrupted to part of the body, such as sleeping on one side all the time with the elbow on the sheets.  Usually the sores will appear in the skin areas over the body prominences of the body that come in contact with the bedclothes.  First the skin breaks down and a red spot will appear.  You must take care of these red spots before they become bedsores, which are very difficult to heal.

     Many factors can contribute to bedsores, including moisture, especially urine.  Even wrinkles in the bedclothes can irritate the skin sufficiently to create sores.  The skin is very delicate and care should be taken not to pull or tug on the skin, such as by removing the bedpan too fast.

     When you bathe your patient, you should watch for red spots that could turn into bedsores.  When you press on a red spot or pressure point, it will turn white and as you release your pressure it will return to red.  As it progresses to a bedsore, the skin turns a purplish red color and becomes rough, like a chapped area.  If not treated, the skin will break and become a sore.

     To prevent this from happening, a bedridden patient should be turned every two hours to a new position, so the pressure is changed to a different part of the body.  Gently rubbing the affected area with alcohol or lotion will help to stimulate circulation, thereby bringing needed nutrients to the affected area.  If your patient is large or obese, especially a woman with large breasts, special care should be given to these portions of the body.  When bathing the patient, be sure to get between the folds of skin and dry them carefully, then apply powder to relieve friction.

     It also helps to have an “egg-crate” mattress placed on the patient’s bed in ease pressure.  This is a piece of sponge rubber formed like an egg carton.  It keeps air in spots and doesn’t let the body settle completely onto the mattress.

     Sheepskin placed on the mattress also makes the patient more comfortable.  Anything soft and cushioned under the sore areas will relieve the pressure and assist the body to repair the damaged areas.

     A good back massage before retiring will also help with the circulation and relax the patient for a more comfortable sleep.  Be sure to report any red areas to the doctor, so  he can check them before they go too far.

DEPRESSION CONTINUED

     Other things also contribute to depression: the winter blues, low self-esteem, being too passive and dependent on others, moving away from your family members, dissatisfaction with your lot in life.  So you see, there are a great many things that can cause, trigger, or contribute to a depressed state of mind.  If you know what the cause is you can deal with it a little better.

     With health problems and the normal aging process, it is difficult to recognize depression in older people.  Then, some older people just can’t seem to talk about their feelings or discuss the pain they feel.  They will go to great lengths to hide it, putting up a facade of happiness when they are really very depressed.

     These are some of the things to look for to recognize depression:

• Difficulty falling asleep or staying asleep
• Waking up too early in the morning and not getting back to sleep
• Sleeping too long in the morning
• Nightmares or crazy dreams
• Loss of appetite
• Heartburn, nausea, vomiting, or indigestion
• Negative thinking, as if nothing matters anymore
• Loss of self-esteem
• Difficulty concentrating or paying attention when talking with someone
• Always feeling sad
• Tiredness all the time
• Mood swings

     Emotions play a large part in physical complaints.  When an older person cannot express their emotions, they manifest them in physical complaints.  They may complain of headaches, shortness of breath or chest pains--nothing specific, but vague aches and pains.  Of course, you want to check with the doctor about any complaints, but keep in mind the possibility that these complaints are connected with a depressed state of mind.

     What can we do as caregivers to help our patient overcome this depression?  We can use touch as a beginning.  Everyone enjoys and needs human touch.  We all need to feel loved and needed.  A bit hug will go a long way toward helping our patient feel loved.  The human body needs a gentle, caring touch often.  It has been proven in studies that the lack of touch and warm support can lead to forgetfulness, confusion and dullness in the elderly.  Remember that your touch, as a caregiver, can help your patient manage the depression they feel.  Show affection by touching and hugs, show your acceptance and your love.  It can reassure your patient and reduce those feelings of loneliness.

     In some cases of depression, professional treatment is necessary.  If your patient is depressed for ore than two weeks, they may need more help than you can give.  If they have problems functioning in their daily routine, if their health is being threatened by the depression, or if they begin talking about dying, those are signs they may need professional help.  Discuss this with their doctor and he will provide you with the names of professional that can help.

     There are two ways to treat depression psychotherapy and medications.  They are often used together.

     Counseling with a psychiatrist or social worker is effective with patients who are moderately depressed.  It can help elderly people adjust to their condition.

     Drugs are effective with patients who are severely depressed.  They can help to improve their appetite, help them to sleep, and ease the brain chemical balance causing the  the depression.  Your doctor may prescribe medication such as Elavil, Prozac, Zoloft, or one of many others.  If these drugs are prescribed, be sure to watch out for side effect.  Ask your pharmacist about the side effects for any of these drugs; they will give you a printout listing all of them.

THREE BASIC TYPES OF DEPRESSION

     There are three basic types of clinical depression, according to the mental health community: major or severe depression, chronic or dysthymic depression, and bipolar disorder or manic depression.  

     Major Depression---This depressed state will last for two weeks or more, bringing on sadness, frustration, plus intense pessimistic feelings.  The person is so down that they feel that things are hopeless and this feeling will last forever.

     Chronic Depression---With chronic depression the down feeling will come and go.  If your patient is depressed more than half the time, it is considered chronic depression.  If your patient is severely depressed and that depression goes untreated, it can become chronic depression.

     Manic Depression---In this type of depression the patient’s mood swings from one extreme to the other.  They will have periods of high energy and excitability, then swing to periods of depression and low energy.

     Sometimes depression follows a loss of a loved one or some crisis in your life.  It is a normal reaction to be depressed when a crisis befalls you.  It will pass.  Usually, it will last a couple of weeks or even a month, but not much longer.  It might incapacitate you for a while, but you will snap out of it.  This depression is called reactive depression.  You are reacting to a personal crisis or loss, even the loss of a job.  This type of depression is common with older people as they lose their health, their spouse, or their home when they have to move.  But this type of depression is not likely to cause a person to lose weight, concentration, memory, or attention.

     Depression can also well up from within. Again the person will lose his appetite, have problems concentrating or remembering, may have heart palpitations, and may have trouble making decisions.  Personal grooming will suffer and the person may feel guilt and be full of self-doubt about everything.  Mood swings are common.  The person may feel worse in the morning and then as the day goes on, feel a little better.  It is hard to distinguish between this depression (endogenous) and the other type of depression (reactive).  Both make the patient feel terrible.

     It is hard to say what causes depression.  If there is a family history of depression, chances are greater that it will continue with other family members.  Some families keep this a deep, dark secret because they feel ashamed.  Therefore, it can be difficult to gather this information.

     With the many changes that occur as we get older, including the loss of loved ones, moving from the old neighborhood, and retirement, many older people feel unneeded, unwanted, and useless.  This can certainly make them depressed.  Sometimes they wonder if this is all there is to life or if their being on Earth has really made a difference in the world.  These questions are asked by many elderly people.

     Depression can be triggered by medications as well.  One side effect of many medications is depression.  That is why it is so important to know the side effects of all the medications that your patient is taking.

     As we get older our bodies change, we get illnesses that are related to age, we slow down and the simplest task seems to be a chore.  Our bodies are changing, and the brain chemicals are also changing.  There is a delicate balance of chemicals in the brain that can be thrown off by certain illnesses.  These changes can cause depression.