CONTINUATION OF CHAPTER ON EATING

   If your patient can’t come to the dinner table and must eat in bed from a tray, be sure to brighten up the tray with a pretty place mat or a flower in a small vase.  Bright colors help to cheer the patient and soft music can also soothe them and make mealtime more pleasant.

     If they don’t eat much at mealtime, provide some nutritious snacks such as fruit, cheese, raw vegetables, juices, or just bread and butter, to help supply needed nutrition.  Sometimes smaller meals are more suitable for a poor appetite.  Four or five small portions each day will be handled better than three large ones.  A large portion is overwhelming to a person who doesn’t feel well and it’s also hard to gauge how much they’ve eaten.  Most likely their doctor will want to know how much the patient eats, in case there needs to be supplemental feeding.  If you do need supplements, there are many canned supplements on the market.

     Remember that if the patient had a small appetite before their illness, you can’t expect them to have a large appetite now.  They may be accustomed to only a cup of coffee in the morning.  If you feed them a big breakfast, you will be wasting a lot of food.  You can try adding a little more each day until they eat a more balanced meal.  But it takes time...don’t hurry.

     If the patient cannot chew easily, be sure to cut their food into bite-sized pieces.  If the patient is low on energy, you may have to serve soft foods for awhile.  If you need to thicken everything for easy swallowing, use gelatin to thicken cold drinks and potato flakes for hot foods.

     Sometimes the patient has a problem swallowing, or dysphagia.  This condition can cause all sorts of eating problems.  There are two types of dysphagia.

     Paralytic dysphagia results from damage to the lower motor system originating in the brain stem.  The swallowing reflex may be diminished or absent and the muscles for swallowing paralyzed, which leads to the high risk of aspiration.  Aspiration refers to breathing in food and drink.  People that have difficulty swallowing are at high risk of aspiration and consequent choking.

     The other type of dysphagia is pseudobulbar dysphagia.  This is a result of damage to the intellectual centers of the brain and the upper motor systems of the brain.  In this condition, the swallowing reflex is not paralyzed, but the supporting muscles may be weak or uncoordinated, which also can lead to aspiration.

     If the patient can swallow liquids, there are supplements available that can increase their caloric intake.  Ask their doctor about specific supplements before you use them.  He may have other methods of treating the condition.  He might also suggest diet restrictions.

     If your patient needs to increase their fluid intake and calories, mix a can of supplement with fruit, ice cream, or yogurt, then blend it for a delicious milkshake.  You can substitute frozen cola, fruit ice, popsicles, or slushy drinks for different flavors.  But, whatever products and foods you use, clear them with their doctor first.

     Keep track of how much food is eaten and how much liquid the patient drinks.  The doctor will ask, so keep good records.

         

REMEMBER

                  

                                            Watch for a poor appetite.

                                            Join the patient at mealtimes.

                                            Keep an antacid on hand for heartburn.

                                            Serve a balanced diet.

                                            Watch for trouble swallowing

                                            Keep good records for the doctor.

                                            Serve nutritious snacks in between meals.

FOR THE CAREGIVER

    

     Give someone a hug each day.  Personal contact makes us feel warm and comfortable.

LACK OF APPETITE

LACK OF APPETITE

My mother-in-law didn’t have a big appetite.  I believed that she needed to eat more to keep up her strength.  I learned that a lack of appetite, with a complete disinterest in food, can be a real challenge to any caregiver.  It will take patience, understanding and real persistence to see that your loved one gets a well-balanced diet.

     Your doctor will give you any dos and don’ts for the patient’s diet, so be sure to check with them before making any changes.

     A poor appetite can be caused by a number of things.  Sometimes difficulty swallowing or nausea causes a patient to push away the food tray.  Their sense of smell and taste can be altered by illness or medication.  Then there is depression or pain, causing the patient to leave their food uneaten.  Sometimes even a dry mouth makes it difficult to eat.  Of course, when your patient is weak and in poor physical condition, these obvious factors play a big part in how they will eat.  If the patient has dentures and loses weight, their mouth can shrink and the dentures won’t fit right anymore.  Ill-fitting dentures can cause pain and sometimes sores in the mouth.  It is reasonable that when your mouth is sore you lose interest in food because chewing hurts. It may take relining the dentures to make them more comfortable.  A visit to your dentist will help.

     Medications too can trigger a loss of appetite.  Some medications will give the patient a sour stomach or make the patient feel full.  Nobody wants to eat if their digestion is bad.  Medications can also trigger constipation, which also takes away the appetite.

     A hiatal hernia is common in elderly people and can cause gas or heartburn.  Your doctor can prescribe medication that will alleviate the excess gas and the heartburn.  A bland diet also helps.

     Be sure you check with your physician or dentist to treat any of these conditions.

     You can help the patient enjoy their meal a little more by joining them at mealtime with a little conversation, instead of just leaving the tray on the table.  If you make mealtime a social time, chances are they will eat more and feel better.  Bring them to the dinner table, if you can.  No one likes to eat alone and it helps keeps them in touch with the family.

MORE ALTERNATIVE MEDS

     St. John’s Wort is a strange name for an herb.  It is said to be an antidepressant and good for reducing stress.  Now this is something that we can all use.  As a caregiver, you know what stress can do.  This is an herb that might just help relieve nagging stress.  It is available as dried leaves and flowers,concentrated liquid, extract, oil, ointment, capsules and prepared tea.  Studies have found that St. John’s Wart might help relieve mild depression and anxiety.  Try a cup of tea made from one to two teaspoons of this dried herb in a cup of boiling water, steep for fifteen minutes.  If you are sensitive to the sun, be sure to check with your doctor before using this herb.  Also if you are taking a prescription antidepressant, be sure to get your doctor’s approval before using it.

     If you need a boost in the afternoon, try yogurt and fruit to give you a spurt of energy.  This snack contains just the right balance of carbohydrates, protein and fat to provide the energy you need to get through the day.  About eight ounces of yogurt and fruit should do the trick.

     If you are feeling blue, take a leaf out of Popeye’s book and eat your spinach.  It is thought that a deficiency of folic acid may cause depression.  Eat one cup of spinach a day to get your folic acid.  You need about 180 micrograms a day.  You can get additional folic acid from munching on leafy green vegetables, whole wheat foods, peas and beans.

     How about a cup of dandelion tea?  It is said that it will help you lose weight.  It may not be good for the lawn, but it’s good for you.  It is high in natural potassium, vitamin A. calcium and iron. The root and leaf are both known to build and restore energy and aid digestion.  In tea form, it serves as a mild diuretic and helps the body flush out the kidneys, eliminating excess fluid and, of course, weight.

     For a simple upset stomach, try a handful of dried blueberries.  They contain both an antibacterial compound and a sticky substance that soothes your tummy.  Take about two teaspoons of dried berries and wash them down with a little water.  Be sure to use dried blueberries they are the best.

     Of course, everyone has heard that chicken soup is good for colds, but have you tried spicy food for nasal stuffiness?  It works.  They say that bananas help heartburn and cranberry juice is good for a urinary tract infection.  Did you know that chocolate is good for the blues?  Sounds good to me.

     There are some combinations of herbs that could take the place of prescription drugs.  When I was researching herbs for my husband, I found that a combination of valerian, skullcap and hops helps with insomnia.  Valerian is said to be a tranquilizer, while skullcap relaxes the mind.  Hops help with restlessness and act as a nervine for insomnia.  Of course, always check with your physician first.

     Papaya, ginger, peppermint and wild yam are good for the digestive system.  I have tried chewing papaya pills to help with heartburn.  It works like a charm and it won’t hurt you---besides it tastes good.

     There are natural foods that can be eaten to help some complaints.  Apricots are rich in minerals, especially iron, and so are raisins.  They are also good for constipation.  They are high vitamin A and they are good for the blood and skin.

     Blackberries are good for diarrhea and help cleanse the colon.

     Grapes are a good blood builder, very good for anemia and are said to be an anti-tumor food.

     Try some of these.  They may make a difference in your life.  These are all nutritious snacks for your patients too.  They’re worth a try, but check with your doctor before beginning to take any herbs or vitamins or giving them to your patient.

ALTERNATIVE MEDICATIONS

     We are all coming to the realization that there must be a better way to good health than always taking prescription medicines.  There are so many side effects to some prescription medicines that our quality of life is suffering.  More and more people are looking for alternative care.  Mother Nature has given us herbs that can do what prescription drugs do, without harming us or building up a resistance to a drug we will need in the future.

    I’m not saying that you shouldn’t go to the doctor---you should.  But for the small things, like sinus, menopause, achy joints, headaches, Mother Nature has some remedies you could try.  It sure beats medication that makes you go through your day in a fog.

     It is worth a try.  In looking for something that could help my husband with some of the aches and pains of a dialysis patient, I read a reference guide called Herbal Health by Louise Tenney, M.H.  She gives a complete guide to the use of natural remedies.  I found it very enlightening.

     There are many natural remedies that really work.  A few years ago I wouldn’t have known what you were talking about, if you asked me about echinacea.  Now I know that taking it when I feel a cold coming on is helpful in warding off a cold.  In fact, I take it every day.  A growing number of physicians are now open to trying some of these natural remedies.

     Of course, you shouldn’t replace a doctor’s care by self-treating with natural remedies.  In fact, you should never begin any herbal or vitamin therapy without the approval of your doctor.

     Remember that you should be a little skeptical about the claims made by the herbalist.  Not everyone has the same results from these herbs, but it is definitely worth a try.  The Food and Drug administration looks at all drugs, but they don’t check out herbal and vitamin products with the same eye.  I did find a few home remedies that caught my eye.

     Hot peppers are good for the heart.  Capsaicin, the ingredient in hot red peppers, has been used in Eastern medicine to soothe ulcers, improve circulation and speed up sluggish bowels.  German researchers have found that capsaicin goes to work in the bloodstream, forming clot-dissolving stimulant that prevents clots that can cause heart attacks or strokes.  Capsaicin is also helpful in protecting the heart by suppressing the liver’s production of cholesterol.  You know that we are all trying to keep our cholesterol lower.

     Onions can help prevent cancer.  According to a study in the journal Gastroenterology, half an onion a day can lower the risk of stomach cancer.  In a study, those who ate half an onion daily had a lower risk of stomach cancer than those who ate no onions at all.  Onion contains vitamin C, fiber and the phytochemical allium, which are thought to protect the body against carcinogens.

     Tension headaches can be relieved by moistening the fingers with a few drops of lavender oil and massaging your temples with a circular motion.  Use the same motion behind your ears and then up and down the back of your neck.  It will relax your muscles and ease the tension in these areas.

     If you are prone to migraine headaches, you may want to try feverfew.  Feverfew is said to reduce headache and migraine pain because it prevents blood vessels from dilating.  There have been several studies that have shown it to be effective in reducing the number of migraines as well.  It is suggested that you take three 125 mg capsules three times daily.

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.