Care Journal
Medication
Body Mechanics
Hand Washing
Sitting Up in Bed
Bed Sore Precautions
Moving Up in Bed
Moving to the Side of the Bed
Sitting Up on the Bed Side
Turning to The Side Lying Position
Transferring to A Chair
Dressing
Undressing
Using a Bedpan
Diaper Changing
Shampooing Hair
Giving a Bed Bath
Giving a Partial Bath
Occupied Bed Making
Raised Bed Position
Lying on the Back
Lying on the Stomach
Lying on the Side
Sims' Position
30 Degrees Lateral Position
Tips on Care
Terminal Illness
Taking Care of the Caregiver
Be an Advocate
CARE JOURNAL
A care journal is a wonderful organizational and reference tool to record and track the care given to your loved one. On the first page list the person's doctor or doctors' phone numbers, the emergency medical service phone number, the pharmacy's phone number and his or her medical insurance policy number and phone number. Include relevant personal phone numbers. Record in the journal when meals, fluids, brushing and flossing of teeth and baths are given. Also, record bowel movements or any weight loss. If you are taking the person's temperature, record the time taken and degree, and any other vital signs taken. Record health observations and any other information that you may find useful.
MEDICATION
Check the medication to see if the pharmacy gave your loved one what was prescribed by the doctor. Check the expiration date and learn what the medication is used for in the treatment of your loved one. Learn the side effects of the medication. If multiple medications are prescribed, learn if it is safe to take the medications together including over the counter drugs, vitamins, or herbal supplements. Check for known allergic or negative reaction to a medication.
In the care journal, set up a table to record each day's medications. Across the top of a page, list the names of the medication and the dosage to be taken. On the left-hand side of the page, create a time line, list the time when each dose of medication should be taken. Start from the earliest time and work you way down the page to the latest time of the day. Draw horizontal lines across the page to separate the time periods when the medication should be taken. Draw vertical lines from the top of the page to the bottom to separate each individual medication. With the table formed, highlight the appropriate squares in the table to show when each medication should be taken.
Once you are finished, check the table you created, check the medication, the dosage and the time. Then have someone else check the table for you again. Taking medication properly is extremely important. Strictly follow the medication prescription and instruction. Write directions in the table's highlighted squares to remind you of instructions for taking a medication. Some medication should only be taken after eating. So in the medication's highlighted square write - eat first. As a helpful reminder, set an alarm clock for each time a medication should be taken. After the person takes the medication, write down in the proper highlighted square, the medication name, dosage and exact time ingested. Call the pharmacy if you have any questions in regard to the medication, dosage and time it should be taken. Inform the doctor if the person is having problems with a medication. Keep all medication in a safe and secure place.
If a person is unconscious or can not take pain medication or other needed medication orally, you may ask the doctor to administer the drugs through an IV or have the doctor or nurse administer medication in the rectum. If through the rectum place the person in the Sims' position or a comfortable left side lying position is preferred. Place a small amount of lubrication on the rubber glove for the patient's comfort and insert the medication no more than three inches.
BODY MECHANICS
The use of proper body mechanics by you and your loved one will reduce the risk of injury. You, the care giver, should never use your back to move your loved one. Always use your legs and keep your back straight. Bend your hips and knees to lift heavy objects from the floor. Straighten your back as the object reaches thigh level. Your leg and thigh muscles work to raise the item off the floor and to waist level.
Body support, like a back brace, may help keep your body well aligned.
When lifting, stand close, bend your knees, grasp firmly and then lift by straightening your legs keeping yourself vertical. Do not push yourself beyond your physical limits. If a movement is too challenging, ask someone for assistance. If your loved one is on a medical bed, use a raised bed when performing tasks and lower it when finished. To help prevent injury, make yourself and others fully aware and informed of any restrictions including moving and/or positioning restrictions your loved one may have. If there is a restriction, keep it strictly enforced. Post a helpful reminder above the bed. When moving your loved one, keep the person well aligned and protect the person's skin by making sure not to rub and cause friction to the skin. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
Move your rear leg back when pulling. Widen your base of support when pushing or pulling. Move your front leg forward when pushing. Move your rear leg back when pulling.
OtherTips:
Keep your body in good alignment with a wide base of support.
Use the stronger and larger muscles in your shoulders, upper arms, thighs, and hips. Keep objects close to your body when you lift, move or carry them. Avoid unnecessary bending and reaching. Raise the bed so it is close to your waist. Adjust the overbed table so it is at your waist level. Face your work area. This prevents unnecessary twisting. Push, slide or pull heavy objects whenever you can, rather than lifting them. Use both hands and arms to lift or carry heavy objects. Turn your whole body when changing the direction of your movement. Move your feet in the direction of the turn instead of twisting your body. Work with smooth and even movements. Avoid sudden or jerky motions. Get help to move a person.
HAND WASHING
Washing your hands is the easiest way you can help prevent the spread of infection. You, the care giver, should wash your hands for 30 seconds before and after giving care.
SITTING UP IN BED
Learn if your loved one has any moving and/or positioning restrictions. Wash your hands. Explain to your loved one what you plan to do. Stand on the person's right-hand side, put your right arm underneath the person's right underarm and place your right hand on the person's right back shoulder. Tell the person to put his or her right hand underneath your right arm and place his or her right hand on your right back shoulder. With right arms locked, place your left arm across the person's far back shoulders supporting the neck and head with your left forearm. Tell the person on three you will slowly lift. On three, use your legs and not your back to slowly lift. If you have another care giver, the other care giver may assist you by doing the left arm on the left side. A simpler procedure may be done if the person is on a medical bed, just raise the head of the bed. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
If you have an assistant, both lock arms with the bed-bound loved one and support the person's head and neck.
BED SORE PRECAUTION
Bed sores are caused by pressure on or friction to the skin and/or poor skin conditions. To help prevent bed sores, make sure the linens are clean, wrinkle free and dry. If you are using plastic liners, keep the plastic liners covered by a cotton sheet. Keep heels off the bed by using pillows placed from the ankles up to the calves. Clean gently, do not rub the skin vigorously because this will irritate the skin. The skin must be clean and dry after bathing. Soap can dry and irritate the skin. The skin is kept free from urine, feces, perspiration, and wound drainage. Check diaper frequently. Use moisturizers on dry areas of the shin. Apply powder where skin touches skin. Use pillows and blankets to prevent skin from being in contact with skin and to reduce moisture and friction. When lifting a person, be careful not to rub and cause friction to the skin. When the person is resting, do not raise the head of the bed more than 30 degrees to help prevent shearing. Place the person in different position throughout the day to relieve pressure areas. If you notice any skin irritation or red areas, report this to the doctor. Take the appropriate safety precautions and make sure the person cannot fall and bruise the skin.
When the head of the bed is raised to a sitting position, skin on the buttocks stays in place. However, internal structures move forward as the person slides down in bed. Skin is pinched between the mattress and hip bones.
Reposition the person at least every 2 hours or as the doctor recommends. Use pillow for support . Some times the 30 degree lateral position is recommended.
Pillows are placed under the head, shoulder, and leg. This position inclines (lifts up) the hip to avoid pressure on the hip. The person does not lie on the hip as in the side-lying position.
Prevent shearing and friction during lifting and moving procedures. Avoid massaging over pressure points. Do not massage bony areas. Never rub or massage reddened areas. Report any signs of skin breakdown or pressure ulcers immediately to a doctor.
Remind person sitting in a chair to shift his or her positions every 15 minutes. This decreases pressure on bony points.
MOVING UP IN BED
Learn if your loved one has any moving and/or positioning restrictions. Wash your hands. Explain to your loved one what you plan to do. Be careful not to move up the person too quickly causing the head to hit the headboard. Place a pillow in front of the headboard as a precaution. The best way to move a person up is with the bed flat and a draw sheet. The draw sheet is an extra sheet that lies on top of the bed sheet and underneath the person. A draw sheet is a sheet folded long ways in half. It extends from the top of the person's shoulders and ends below the person's thighs. With the draw sheet procedure, you need the assistance of another care giver. You and the other care giver stand on opposite sides of the bed. On both sides, roll the draw sheet's sides in toward the person, then have one hand hold the draw sheet by the buttocks and the other hand holds the draw sheet by the shoulder. Count to three, lift and move the person up keeping your backs straight.
Here is an alternative way to move the person. You and the other care giver, place one arm underneath the person's upper thighs, lower buttocks. Lock your arms. Place the other arm under and around the person's back shoulders. Then move the person on three with straight backs using your legs.
If you are the only care giver present and if your loved one has leg strength, he or she may assist. Have the person raise his or her knees and place the feet flat on the bed. You then place one arm under the upper thighs, lower buttocks and one around the back shoulders. Tell the person, on three, to push down and away with his or her legs and you, using your legs, shift and move the person up in bed.
Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
MOVING TO THE SIDE OF THE BED
Learn if your loved one has any moving and/or positioning restrictions. Wash your hands. Explain to your loved one what you plan to do. The best way to move a person is with the bed flat and a draw sheet. With the draw sheet procedure, you need the assistance of another care giver. You and another care giver stand on opposite sides of the bed. On both sides, roll the draw sheet's sides in toward the person, then have one hand hold the draw sheet by the buttocks and the other hand holds the draw sheet by the shoulder. On three, lift and move the person in one motion across to the designated side with back straight. If you are the only care giver present, you may move the person to the side of the bed in segments. Have the person cross his or her arms over the chest. Start at the upper body. Place your arm under and around the back of the shoulders and the other arm under and around the middle of the back. On three, slowly pull the person toward you using your legs and not your back. Then move down to the midsection. Place one arm under and around the waist and the other arm under and around the thighs. On three, slowly pull using your legs. Then move your arms under and around the thigh and mid calves. On three, slowly pull using your legs. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
SET UP ON THE BED SIDE
Learn if your loved one has any moving and/or positioning restrictions. Wash your hands. Explain to your loved one what you plan to do. Use the procedure to help the person slowly sit up in bed. Once sitting up, support the person's back by putting your arm around the back shoulders of the person. Place your other hand on the person's far lower outer thigh above the knee. On three, pivot yourself and slowly pull the person's legs off the side of the bed still supporting the back. Have the person hold on to the end of the mattress. Let the person sit with your support until he or she feels comfortable without any sign of lightheaded or dizziness. Before, during, and after giving care, take the appropriate safety precautions and make sure the person is safe and secure from falling.
TURNING TO THE SIDE LYING POSITION
Learn if your loved one has any moving and/or positioning restrictions. Wash your hands. Explain to your loved one what you plan to do. The best way to move a person is with the bed flat and a draw sheet. Move the person off from the center of the bed, toward the side the person will be turning away. You and another care giver stand on opposite sides of the bed. Cross the person's arms and place the outer leg over the inner leg. The care giver, standing on the far side of the person, reaches one hand over the far shoulder and grabs onto the draw sheet. The other hand, reaches over the far hip and grabs onto the draw sheet. The care giver, standing closer to the person, places a hand under the draw sheet at the person's near shoulder, and the other hand goes under the draw sheet at the near hip. On three, slowly, one care giver pulls the person with the draw sheet toward him or her and the other push the person onto the side. Make sure the care giver pulling, keeps his or her body tight to the edge of the bed to secure the person from falling. If you are the only care giver present, move the person off from the center of the bed to the side near you. Cross the person's arms and across the leg near you, over the far leg. Place one hand on the person's near side shoulder and the other hand on the person's near hip. On three, push the person slowly away from you onto his or her side, using your legs and not your back. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
Logrolling is turning the person as a unit, in alignment, with one motion. The spine is kept straight. The procedure is used to turn; Older persons witharthritic spines or knees, Persons recovering from hip fractures, Persons with spinal cord injuries (the spine is kept straight at all times following spinal cord injury). Two or three people are needed to logroll a person. Three if the person is tall or heavy.
TRANSFERRING TO A CHAIR
Learn if your loved one has any moving and/or positioning restrictions. Wash your hands. Explain to your loved one what you plan to do. Obtain a wide belt. Pick the person's strong side to exit the bed. Place the chair, on the strong side, up against the wall parallel with the bed. Have the person wear nonskid sole shoes to help prevent slipping. Follow the procedure to slowly sit the person up on the side of the bed. Let the person sit with your support until he or she feels comfortable without any sign of lightheaded or dizziness. Position yourself in front of the person. Place the wide belt over the person's clothing at the person's waist. Make sure the belt is not on the person's skin. Place the belt buckle off-center toward the person's side. The belt should fit snug but not too snug to impair breathing or is uncomfortable. Your fingers should be able to slide underneath the belt.
Make sure the person's feet are flat on the floor. Place your feet and knees to match up in front of the person's feet and knees. This helps prevent the person from slipping. Grab the belt at the person's waist sides. Ask the person to hold on to your upper arms. Tell the person on three to lean forward and push up to straighten his or her legs and you will help pull him or her up. Use your legs when lifting and not your back. On three, carefully pull the person up, then slowly pivot the person around. Keep your feet and his feet in front of each other. Back the person into the chair. Have the person grab the armrest and gently place the person in the chair. Remove the belt. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
When transferring a person without a transfer belt. The hands are placed under the person's arms and around the shoulder blades. Do not lift the persons by putting pressure under the arm but huge them around the back with equal pressure all the way around side and back. This will help prevent a shoulder injury .
Person positioned in a chair. The person's feet are flat on the floor, the calves do not touch the chair, and the back is straight and against the back of the chair.
DRESSING
Learn if your loved one has any moving and/or positioning restrictions. Wash your hands. Explain to your loved one what you plan to do. Respect the person's privacy and keep the person covered with a sheet. Have the person sit up and dress from the weak side first.
If the person cannot sit up, count to three, place the person lying on the strong side leaving the weak side up. If the garment is a button down, place the garment on the weak arm. Straighten and pull the garment down, then place the remaining garment rolled near the strong side. On three, turn the person over onto the weak side, leaving the strong side up, and place the strong side arm into the garment.
On three, lay the person on his or her back and button up the garment. If the garment is a pull over, place the garment gently over the person's head. On three, place the person on the strong side with the weak side up, put the weak arm in though the garment. On three, turn the person over to the weak side with the strong side up and put the strong arm though the garment. Pull the garment down. With pants, the pant legs are bundled up and placed over the feet carefully not to cause friction to the heels. On three, place the person lying on the strong side with the weak side up. The pants are pulled up over the weak side's buttocks and hip.
On three, turn the person on the weak side so the strong side is up, and then pull the pants up on the strong side. Zip or button up the pants.
A simpler procedure may be done if the person can arch the back. Bundle the pant legs and carefully put the pant legs on over the feet. On three, as the person arches his or her back, pull the pants past the buttocks. Zip or button up the pants.
Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
UNDRESSING
Learn if your loved one has any moving and/or positioning restrictions. Wash your hands. Explain to your loved one what you plan to do. Respect the person's privacy and keep the person covered with a sheet. Have the person sit up in bed and undress starting from the person's strong side first.
If the person is limited in movement and cannot sit up in bed, use the turning approach. On three, place the person lying on his or her weak side, leaving the strong side up. If the garment is a button down, unbutton and slide the garment off the strong arm. Roll the removed garment to the bed, near the person's weak side. On three, turn the person over to the strong side leaving the weak side up. Remove the garment from the weak side.
If the garment is a pullover, on three, place the person lying on his or her weak side with the strong side up. Pull the garment up along the strong side. Pull the strong arm out, placing the removed garment on top of the strong shoulder. On three, turn the person over onto his or her strong side, with the weak side up, and moves the weak arm out.
Then remove the garment gently over the head. Pants are removed the same way from the side lying position. With the strong side up, unbutton or unzip, then pull the top pant's side down past the hip and buttocks.
On three, turn the person, with the weak side up, and the pull top pants side down on the weak side.
Pull the pant legs down, bundling them up as you go. Lift one foot up at a time and pull the pants over the foot, making sure not to cause friction to the heel. A simpler procedure may be done if the person is able to arch his or her back. On three, as the person arches, pull the pants down below the buttocks. Then bundle the pant legs down and over the feet, careful not to cause friction to the shin.
Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
USING A BEDPAN
Learn if your loved one has any moving and/or positioning restrictions. Wash your hands. Explain to your loved one what you plan to do. If the person is continent, has control, but cannot get out of bed, or it is too hard to get out of bed to use a toilet, a bedpan is used. You need a clean warm bedpan, gloves, wipes, toilet paper and a changing pad or a bath towel. Put on gloves. On three, place the person in the side lying position. Place a changing pad or towel on the back side of the person so the top lies at the waist and the bottom lies at the thighs. Leave some excess changing pad or towel, fan folded or rolled, near the edge of the buttocks. On three, turn and roll the person over onto other side. From the other side of the bed, pull the excess changing pad or towel straight. Have the person lie on the back and place her or her knees up and feet flat on the bed. Place your hand underneath the person's lower back and have the bedpan ready to slide under. On three, have the person push his or her feet down on the mattress, arching the back and pushing up the buttocks. Help the person by lifting up on the lower back. Slide the bedpan under the buttocks making sure the anus and urethra are centered over the bedpan.
Give the person privacy. If the person can wipe him or herself, leave toilet paper. When you are called for, come back. Have the person arch and raise the buttocks, then carefully slide out the bedpan.
There is another approach if the person cannot lift up the buttocks. On three, place the person on his or her side. Place the bedpan on the center of the buttocks. On three, have the person lean back as you push down on the bedpan, push the pan between the bed and the person.
Once the person is completely on his or her back, make sure the bedpan is centered.
To remove the used bedpan, securely hold the bedpan and carefully, on three, turn the person on his or her side away from you. Remove the pan. If the person cannot clean him or herself, keep or on three, turn the person on his or her side away from you. Wipe the genital and buttock area from front to back with toilet paper. For each wipe, use a new tissue. Once finished wiping, the changing pad or bath towel is rolled up or fan folded near the edge of the buttocks. Turn and roll the person over to the other side and remove changing pad or towel. Empty the bedpan in the toilet, wash out the pan with a pitcher of water and disinfectant soap pouring out the wash water into the toilet. Clean the bedpan with a disinfectant. Take off the gloves and wash your hands. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
DIAPER CHANGING
Learn if your loved one has any moving and/or positioning restrictions. Wash your hands. Explain to your loved one what you plan to do. If the person has no control over the bowel and bladder, he or she is incontinent, and a diaper is used. Gather a clean diaper, gloves, washcloth, wipes, a basin of warm water, and a changing pad or a bath towel. Put on gloves. On three, place the person in the side lying position. Place a changing pad or towel on the back side of the person so the top lies at the waist and the bottom lies at the thighs. Leave some excess changing pad or towel, fan folded or rolled, near the edge of the buttocks. On three, turn and roll the person over onto the person's other side. From the other side of the bed, pull the excess changing pad or towel straight. Place the person on his or her back with knees up and feet flat on the bed. If the person cannot bend his or her knees, spread the person's legs. On both sides, undo the fastener. If pinned, remove the pins. If taped, unfasten the tape then refasten the tape onto itself. This will prevent the tape from wrongly sticking to the person's skin. Lay the front of the diaper down past the thighs and roll the high waist side in on the side you will be turning too. On three, turn the person back to the side lying position, facing away from you. Remove the diaper completely. From the side lying position, with wipes, wipe the buttocks from the genital area back. For each wipe, use a new wipe or tissue. If the person needs to be cleaned further, use a warm wet washcloth to clean. Lift the top leg and clean the genital area wiping from the front to the back. Clean the buttocks from front to back. If the genital area needs further cleaning, place the person on the back with knees up and feet flat on the bed. If the person can wash the genital area, have him or her wash this area. This is a very private area. If the person cannot wash, wash from the front down toward the buttocks. Clean all folds well using a clean part of the washcloth with each wipe. With a dry washcloth pat dry all areas thoroughly. Place on a clean diaper from the side lying position. Tuck the top far corner of the diaper under the high waist and work your way down, tucking the side under the buttocks. Leave the majority of the diaper to lie flat behind the buttocks. On three, turn the person over to the back, placing the knees in the up position. Pull the front of the diaper in between the thighs and fasten both sides. It is easier to reposition the diaper by pulling it down from the buttocks, compared to pulling it up. So make sure you start with the diaper high up on the back waist, instead of too low. On three, place the person in the side lying position again to remove the changing pad or bath towel. The changing pad or bath towel is rolled up or fan folded near the edge of the buttocks. On three, turn and roll the person over to the other side and remove changing pad or towel. Take off the gloves and wash your hand thoroughly. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
SHAMPOOING HAIR
Learn if your loved one has any moving and/or positioning restrictions. Wash your hands. Explain to your loved one what you plan to do. Gather a gentle shampoo, conditioner, bucket, pitcher, plastic shower curtain or tablecloth, towels, brush or comb and a hair dryer if preferred by the person. Ask if the person needs to use the toilet before starting. Create a trough by place a plastic shower curtain or tablecloth underneath the person's head and shoulders. Roll a towel up and place the towel underneath the plastic and the person's neck. Be very careful not to extend the neck, keep the neck and head straight and well supported. Make sure there are no neck, spine, head, or other injury or medical reason why this position would not be allowed. Place another rolled towel under the plastic and curve it around the person's head. Keep placing rolled towels under the plastic to curving around the head creating the trough. Leave one narrow side of the trough open along the edge of the bed, so water may drain out. Where the opening is, make sure the plastic lays down along the side of the bed. Direct the open end of the trough so the water will drain into a bucket placed on the floor or on a chair. Now place a towel over the person's shoulders and chest. Place a face towel over the eyes making sure not to cover the person's nose or mouth. Obtain a warm pitcher of water with temperature around 105 F (40.5 C). With your elbow or inner wrist, test the warmth of the water. Pour the warm water in small amounts over the hair until completely wet. Then apply small amounts of shampoo to the hair starting at the scalp. Do not scratch the scalp, but massage gently with your fingertips. Work though the hair to the ends. Rinse the hair and remember to check the receptacle bucket to make sure it does not overflow. Depending on the hair, you may want to rinse and repeat the shampooing. You may apply a conditioner. A conditioner is applied the same way as the shampoo and rinse. Dry the hair with a towel or hair dryer. Make sure the hair and scalp are completely dry to prevent pressure sores from forming. Gently comb or brush the hair to remove tangles. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
GIVING A BED BATH
Learn if your loved one has any moving and/or positioning restrictions. Wash your hands. Explain to your loved one what you plan to do. What you need to gather is a wash basin or pail, gloves, paper towels, bath towels, washcloths, face towels, and soap. Ask if the person needs to use the toilet before starting. Put on gloves. Respect the person's privacy when giving a bath and keep the person covered with a sheet. Remove the clothing from under the sheet and make sure the person is warm and stays comfortable. Add a sheet or blanket if needed. Obtain warm water at 113 F (45 C) and fill the wash basin or pail two thirds of the way fill. With your elbow or inner wrist, test the warmth of the water. Let the person wash what he or she can wash. If he or she needs your assistance, place a bath towel under the person's head. Fold a washcloth around your hand creating a mitt.
Without soap using only water, gently wash the skin around the person's eyes starting with the corner and moving outwards. Use a clean part of the washcloth to wash around the other eye. Wash the face, neck and ears then rinse off and pat dry.
Check the water temperature. Place a bath towel stretching under the arm and hand. Wash with soap and water the arm, shoulder and underarm. Rinse off, and gently pat dry. Place the basin on top of the towel near the hand. Place the person's hand into the water basin and wash the hand. Rinse off, and gently pat dry. Remove the basin. Do the same for the opposite arm and hand. Replace the water if it is cool or too soapy. Again, lift the sheet slightly and place a towel along both sides of the chest and stomach area. Lift the sheet slightly and wash the chest with the sheet still covering the area. Wash well under the skin folds. Rinse and dry especially well under the skin folds including under the breasts.
Wash the stomach or abdomen. Rinse off, and gently pat dry. Replace the water if it is cool or too soapy. Move to the person's leg. Pull up the sheet making sure not to expose the genital area. Place bath towels stretching under the leg and foot. Wash the leg, then rinse, and pat dry. Place the basin near the calf on the towel. Bend the knee and place the foot in the basin. Wash the foot, rinse, and pat dry. Remove the basin from the bed. Do the same for the other leg and foot.
Replace the water if it is cool or too soapy. On three, turn the person to the side lying position and place towels lengthwise next to the neck and back. Wash the neck and back, rinse, and pat dry.
Place a towel next to the buttocks, be careful not to expose the person, and wash the buttocks from the genital area back, rinse, and pat dry.
Replace the water. Last is the genital area. If the person can wash the genital area, have him or her wash this area. This is a very private area. Place a towel under the buttocks and thighs. If the person cannot wash, have the person raise his or her knees. If the person cannot raise the knees, spread the legs. Wash from the front down. Clean all folds well using a clean part of the washcloth with each wipe. Rinse well and pat dry. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
GIVING A PARTIAL BATH
Learn if your loved one has any moving and/or positioning restrictions. Wash your hands. Explain to your loved one what you plan to do. The partial bath focuses only on the higher maintenance areas of the body, the face, underarms, hands, back, buttocks and genital area. What you need to gather is a wash basin or pal, gloves, paper towels, bath towels, washcloths, face towels, and soap. Ask if the person needs to use the toilet before starting. Put on gloves. Respect the person's privacy when giving a bath and keep the person covered with a sheet. Remove the clothing from under the sheet and make sure the person is warm and stays comfortable. Add a sheet or a blanket if needed. Obtain warm water at 113 F (45 C) and fill the wash basin or pal two thirds of the way fill. With your inner wrist or elbow, test the warmth of the water. Let the person wash what he or she can wash. If he or she needs your assistance, place a bath towel under the person's head. Fold a washcloth around your hand creating a mitt. Without soap using only water, gently wash the skin around the person's eyes, starting with the corner and moving outwards. Use a clean part of the washcloth to wash around the other eye. Wash the face, neck and ears, then rinse, and pat dry. Check the water temperature. Wash the underarm with soap and water. Rinse off, and gently pat dry. Place the basin on top of a towel near the hand. Place the person's hand into the water basin and wash the hand. Rinse off, and gently pat dry. Remove the basin. Do the same for the other underarm and hand.
Replace the water if it is cool or too soapy. On three, turn the person to the side lying position and place towels lengthwise next to the neck and back. Wash the neck and back, rinse, and pat dry.
Place a towel next to the buttocks, be careful not to expose the person, and wash the buttocks from the genital area back, rinse, and pat dry.
Replace the water. Last is the genital area. If the person can wash the genital area, have him or her wash this area. This is a very private area. Place a towel under the buttocks and thighs. If the person cannot wash, have the person raise his or her knees. If the person cannot raise the knees, spread the legs. Wash from the front down. Clean all folds well using a clean part of the washcloth with each wipe. Rinse well and pat dry. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
OCCUPIED BED MAKING
Learn if your loved one has any moving and/or positioning restrictions. Wash your hands. Explain to your loved one what you plan to do. Gather a mattress pad, bottom sheet or fitted sheet, plastic liner, if you use one, cotton draw sheet, which is a top sheet folded in half, top sheet, blanket, bedspread, and pillowcases. On three, move the person to one side of the bed, placed in the side lying position face outwards. Take the appropriate precautions to insure the person won't fall off the edge of the bed. Keep the person warm and comfortable. If the person needs a bath blanket, tuck it under so it is out of the way. On the back side of the person, work your way down through the bedding. Start with the top draw sheet, and fan fold or roll it as close as you can to the back of the person. Then fan fold or roll the plastic liner as close as you can to the back of the person.
Continue with the bottom sheet or fitted sheet, fan fold or roll as close as you can to the person's back. Then if you are doing the mattress pad, do the same as the others.
Now, work from the same side of the bed and apply the new linens to the empty side of the mattress, working your way up. If you are changing the mattress pad, start with a clean mattress pad and unfold it over the empty half of the bed. Tuck the two corners of the mattress pad in under the mattress on the back side of the person. Pull the mattress pad tight across the empty side to the back of the person. Fan fold or roll the end of the clean mattress pad and tuck the end portion underneath all the old bedding. Take a clean bottom sheet or fitted sheet, and unfold it over the clean mattress pad, tuck two corners in under the mattress. Pull the bottom sheet or fitted sheet tight to the back of the person. Then fan fold or roll the end of the clean sheet and tuck the end portion under all the old bedding. Next is the plastic liner, if you use one. Lay the plastic liner over the bottom or fitted sheet. Line up the top with the top of the person's abdomen and the bottom lines up below the thighs. Fan fold or roll the end of the plastic liner to the person's back. Tuck the end portion of the plastic liner under all the old bedding. Then add a cotton draw sheet. Have the top line up with the person's shoulders and the bottom line up below the thigh. Fan fold or roll the end of the clean cotton draw sheet and tuck the end portion under all the old bedding. Do not tuck the draw sheets under the mattress.
Inform the person that he or she will need to roll over the hump of bedding. On three, assist the person in rolling onto the other side of the bedding. Remove all the old bedding then work your way up starting with the clean bottom mattress pad. Pull tight and tuck the two corners of the mattress pad under the mattress. Moving to the bottom or fitted sheet, pull tight and tuck two corners under the mattress. The plastic liner is pulled tight and left untucked from the mattress. If you use a plastic draw sheet, or plastic liner, make sure there is a cotton sheet covering over the plastic. Next, pull the cotton draw sheet tight and leave untucked. Make sure the bed is smooth and wrinkles free, this helps to prevent skin problems. Position the person in the center of the bed. Place a clean top sheet on the person. Do not tuck the top sheet tight because the pressure may cause sores on the feet and heels. Lay a blanket on top of the top sheet leaving the ends untucked. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
RAISED BED POSITION
Learn if your loved one has any moving and/or positioning restrictions. The person is lying on the back with the back straight. A pillow is placed under the head, and the forearms. The head of the bed is raised 45 to 60 degrees. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
LYING ON THE BACK
Learn if your loved one has any moving and/or positioning restrictions. The bed is flat. The person is lying straight with arms to the side and back to the mattress. A pillow is placed under the head. You may place a small pillow or towel under the lower back and under the hands. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
Not all positions are meant for every person. Keep the person in body alignment with the back and spine straight.
LYING ON YOUR STOMACH
Learn if your loved one has any moving and/or positioning restrictions. This may be an uncomfortable position for some persons. The bed is flat. The person is lying on the stomach with flexed elbows with the hands up by the head that is turned to the side. A pillow is placed under the head, the stomach, and the legs below the knee and above the toes. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
Feet supported by a pillow
Feet hanging over the edge of the mattress.
Not all positions are meant for every person. Keep the person in body alignment with the back and spine straight.
LYING ON THE SIDE
Learn if your loved one has any moving and/or positioning restrictions. The bed is flat. The person is lying on either side and the top leg is slightly flexed at the knee and is extended forward. The arms are in front of the person. A pillow is placed under the head, between the top leg's thigh the lower leg, and under the top arm and hand. Fold a pillow in half creating a square shape and wedge the two folded edges against the person's back. This helps to support the person's back. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
Not all positions are meant for every person. Keep the person in body alignment with the back and spine straight.
SIMS' POSITION
Learn if your loved one has any moving and/or positioning restrictions. The bed is flat. This is a semi stomach and side lying position. The person is facing left with the front right corner of the shoulder turned into the mattress. The right arm extends behind the back side and the left arm is flexed with the hand near the face. The left knee is sharply flexed so it does not touch the right leg. A pillow is placed under the head, the left leg and left arm and hand. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
The Sims' position usually is not comfortable for older persons. Check with a doctor before positioning an older person in the Sims' position.
Not all positions are meant for every person. Keep the person in body alignment with the back and spine straight.
30 DEGREE LATERAL POSITION
Learn if your loved one has any moving and/or positioning restrictions. The bed is flat. The person is lying on the right side of the back and the right buttocks with the lift buttocks raised. The legs are flexed toward the right. The right leg is raised a little more than the left leg. A pillow is placed under the head, along the left shoulder and back and in between the legs. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
Not all positions are meant for every person. Keep the person in body alignment with the back and spine straight..
TIPS ON CARE
Tips on Feeding
If the person cannot feed him or herself, use a spoon to feed the person because a spoon most likely will not cause injury. Fill the spoon only one-third of the way and offer liquids throughout the meal. This will help make the food easier to chew. Feed your loved one at a comfortable relaxed pace. Make sure the food is swallowed before offering the person more food. Before, during, and after giving care, take the appropriate safety precautions, and make sure the person is safe and secure from falling.
Tips on Hygiene
All hygiene performed made the loved one feel better and keeps them healthier. Remember to keep the mouth and teeth clean. This prevents mouth odors and infections. It also increases comfort and makes food taste better.
Brushing hair make them look better and is relaxing to the person. All forms of grooming help physically and mentally.
Tip on Exercise
Exercise increases venous blood flow. Therefore they help prevent thrombi, blood clots, especially in the legs. Ask your doctor what, if any, exercises may be helpful to your love one.
TERMINAL ILLNESS
Terminal Illness Terminal illness is an injury or sickness for which there is no reasonable expectation of recovery. People that are expected to pass away soon can live for a very long time and people who are expected to live longer can pass away in a short period of time. Predictions can be wrong and cures may or may not be found.
Respect your loved one's wishes and make them feel as comfortable as possible with care, listening, and touch. Listening and touch are very important aspects of communication when caring for a loved one who may be dying.
The loved one's room should be well lit, well ventilated, and kept as pleasant and clean as possible. Unnecessary equipment should be removed. Your loved one may like pictures, mementos, flowers, or other personal items to be in their room.
The Five Stages of Dying
Five Stages of Dying Respected researcher, Dr. Elisabeth Kubler-Ross, identified "The Five Stages of Dying". Your loved one may emotionally go through the following stages. They may go back and forth between them. Not all patients go through each stage, but they are common.
The stages are: Denial, when a patient refuses to believe they are dying. Anger, when the patient may ask "Why me? Bargaining, when the patient makes "deals", often with God. Depression and Acceptance
Hospice Care
Hospice Care Hospice care is an option for your loved one. Hospice may be a part of a healthcare agency or can be in-home professional assistance provided by a person or staff trained in treating terminally ill patients. They focus on your loved one's emotional, physical, social, and spiritual needs. Pain relief is typically provided through medication and measures are taken to ensure the person in their care is as comfortable as possible.
Spiritual Needs
Spiritual needs are important. Your loved one may wish to speak with a rabbi, priest, or other cleric. You can assist them in making those arrangements if that is their wish.
Legal Issues
Your loved one must make his or her own decisions about their preferred care when they are of sound mind and body. Where possible all people should create a Living Will or have given Durable Power of Attorney to a specific person, so that when the time comes, a competent person can make healthcare decisions for the terminally ill patient in their time of need.
Signs of Approaching Death
The signs of approaching death may come rapidly or slowly. Starting with the lose of appetite and bowel elimination. There may be abdominal distention, incontinence, vomiting and nausea. Movement may be lost usually starting in the feet and legs then moving up. The mouth may stay open. Circulation fails and body temperature rises. The person's skin may feel cool, look pale, and perspire. Pulse rate is fast, weak, and irregular and the blood pressure starts to fall. The respiratory system fails with slow or rapid shallow respirations. Mucus may collect in the respiratory tract causing a rattling sound. Pain decreases as the person loses consciousness, however, some are conscious until the last moment of death.
With the lowering amounts of oxygen feeding the brain and being on medications, some people may become delusional and agitated. With this they may have a burst of energy even after being in a semiconscious state.
When they are unconscious or even at their last seconds before dying, they can still hear you, so express you love and support and let the know it's okay to pass and move on.
The terminally ill patient may show common signs that they are approaching death; those signs may surface rapidly or develop slowly. One such sign is the loss of appetite and the inability to control one's bowels, eliminate waste. The patient may experience abdominal distention, incontinence, vomiting, and/or nausea. The ability to move various body parts may be lost. This usually starts in the feet and legs then moves up the body progressively. The mouth may stay open. Circulation will fail and body temperature will rise. The person's skin may feel cool and look pale; they may perspire. Pulse rate will be fast, weak, and irregular, and the blood pressure will fall below normal levels. The respiratory system will fail and the person will experience shallow breathing. It is possible for mucus to collect in the respiratory tract causing a rattling sound. Pain decreases as the person loses consciousness, however, some will remain conscious until the last moment before death.
Lower amounts of oxygen than usual will be available to feed the brain. Additionally, the patient is typically prescribed medication. For these reasons terminally ill patients can become delusional and agitated. They may have a burst of energy even after being in a semi-conscious state.
When your loved one is unconscious they can still hear you, so express you love and support always. Communicate with them even during their last seconds before dying, letting them know it is alright to pass and move on. This should provide them some comfort.
After the Death
Your State regulations will require an authority, medical or otherwise, to pronounce the death.
After the Death State regulations will require an authority, medical or otherwise, to pronounce your loved one's time of death.
After a loved one passes, the caregiver is encouraged to talk with family and friends about what they experienced and to express their deepest sentiments. Share your love and emotions always. Take time out for yourself. Know not everything was within your control. Be assured, you did the best you could have done, and feel proud of the care you have provided. Your loved one was blessed to have your support.
TAKING CARE OF THE CAREGIVER
You, the caregiver, are commended for your loving and nurturing support. Each time you give care it makes the person feel better physically as well as emotionally. This may be a stressful time for your loved one, and in turn, for you. So, think of your needs as it relates to sleep, nutrition, health, and your overall well-being. You may need to talk to a friend or another person about your situation and feelings. You may need to take a break and/or ask for help.
Know not everything is in your control. Ask questions to relieve any doubts or concerns you may have. Be assured, you are doing the best you can do, and be and feel proud of yourself for the care you are giving. Your loved one is blessed to have your support.
A reporter, speaking to one of Mother Teresa's caregivers with Mother Teresa at her side, ask the caregiver, what formal training did the caregiver have? Mother Teresa quickly replied, "She is trained in love".
On behalf of the GivingCare organization, thank you for caring.
BE AN ADVOCATE
Be an advocate for your loved one. Be well informed so that you can optimize the patient's care. Do not be afraid to ask any questions or express any concerns as it relates to their well-being. On a personal level, when you are interacting or helping your loved one, remember to focus on the individual and not just the illness and make the person feel comfortable by providing a relaxed atmosphere.