Nursing home Bedsores? I'm so MAD! A yr later... I'm STILL MAD!

It has been a year and a month since my mom went to Heaven. I was so mad over her received treatment in a nursing home back then. I had to put the anger away at that time, and I did. I brought her home and became her full time caregiver again. I thought maybe the anger would disappear but even now, it hasn't. Why all the anger? Why am I mad still? I will share this with you. My mom was not given the treatment she had the right to receive in that nursing home. I guarded over her, I took notes, and I tried my best to make sure she did, but during all of that one and a half month period, my mama was developing stage 4 bedsores right under my watchful eyes and I did NOT KNOW! I was NOT ALLOWED to KNOW even though I was her Health Care Power of Attorney! I was ordered OUT of her room at each changing, each bath, each ANYTHING! How did the nursing home get away with this? They recited the Privacy Act to me! Finally, the bedsores were so bad that the director of nursing decided that I should be informed. I was informed of one bedsore, and told that it seemed to be getting a little worse. I asked to see this sore. My heart was broken when I looked and saw not ONE sore but TWO that were almost the same size and only about a half inch apart. I felt so responsible although I did not know how I could have avoided it happening. In the days to come, I made sure that all that could be done for her was being done. It was a constant battle. Writing down the repositioning times, having someone else come sit with her when I had to leave, and even returning 4 hrs later to find that she had not been repositioned at all since my departure. I would go to the desk, just to be told that the CNA on duty, reported that she had repositioned her, and that was the final word. No action taken. This happened repeatedly. I read physician orders for her that stated that she was never to be positioned on her back, where it would bring pressure to the bedsores. Repeatedly, the CNA staff would ignore the charted sign over her bed and place her on her back regardless. When I would go to the desk, I would be told that our family members must be responsible for her being in that position because the CNA said... you get the idea, right? I could tell you lots more but this blog is on caregiving and I will refrain. When the bedsores were staged at 4's and it had became a must for me to stay present in order for her to receive proper treatment, I decided we would just go home and take her with us. Talk about scared. I was terrified of my own decision. My entire being told me that I was taking on the impossible but I felt that it was not an option to not take her home. We made it thru it all and if you are a caregiver, you will make it too. I've spent quite some time since mom's passing, just trying to decide what to do to help the others left behind in those nursing homes. I want to deal with my anger. I want to change things for the better. This morning I came up with a brainstormer idea that I think might be an answer. Stay tuned for I will be blogging soon to tell you all about it! You can also watch for my blogging on bedsores and alternative treatments, and more!

New at Caregiving?

If you have newly found yourself in a caregiving position, these tips are for you! First of all, remember that caregivers are most always just like you - inexperienced! That said, start learning! From my experience with being a caregiver, and then later on, having to hire caregivers; I learned what was most important to me. Top priority was being attentive, detail oriented, prompt, and trustworthy. A pleasant personality goes a long way to ease stress, not only for your loved one, but the rest of the family and yourself also. We already know how hard your job is, please refrain from reminding everyone of it! Take short and as many frequent breaks as possible in order to keep your stamina going. Read a book that you enjoy, but consider reading it outloud and sharing it with your client or loved one. Sometimes, just the simplest thing can be a very powerful stress reliever!

ROM Exercises

Never underestimate the importance of faithfully doing the range of motion exercises with your loved one! Sometimes these are just called ROM for short. These exercises will be selected by your loved ones therapist and they can show you how to do each one with your loved one. If your loved one is bedfast, paralyzed, or in some way unable to participate, then you will have to takeover these exercises. The exercises are important to keep your loved one's limbs, muscles and joints in as good a shape as possible. If you do not perform these exercises loyally, your loved one's limbs, muscles and joints can really suffer, even to the point of locking up and becoming unmovable. Be careful not to over stretch or overflex the joints and muscles. The exercises are meant to rotate or bend slowly and carefully without extra force, in order to keep them all working smoothly. They also will help your loved one to regain or to keep whatever strength is possible if you work the exercises faithfully. More on this subject coming soon.

Home Care with a Catheter

What is this and how does it work? How do I clean it? Those were my first thoughts when mom came home with her Foley catheter. You may think it will not require much of your time. You may be wrong! Actually, you may find yourself very surprised at how much time and tasking that taking of a catheter can require! I sure was!
The first thing you will learn is how to empty the drainage bag. Always remember to never raise the bag over the bladder which can allow the urine to back flush into the bladder. Using gloved hands, lay a paper towel under the urinal, pick up the tubing on the drainage bag, open the clamp and empty into the urinal, wipe the tubing end off with an alcohol prep and reclose the clamp. Be sure to reattach the drainage bag securely in order to avoid pulling out the catheter by mistake. Make sure there are no kinks in the catheter tubing and that it can drain easily. The catheter and it's tubing should be wiped from the entrance to the end at the drainage bag on a daily basis.
Soap and water will be fine to use for the cleaning. After a week goes by, you will began wondering how to clean that drainage bag. You will need to have an extra drainage bag for this weekly cleaning so that you can swap them out. Before you do this, do consult with your Home Health nurse to be sure it is appropriate for your loved one's catheter. Some catheter systems are self cleaning and are designed to stay closed. If your loved one has this type of catheter, it cannot be cleaned and should just be replaced when necessary. If you are allowed to clean your loved one's catheter bag, here are some tips. With clean hands and gloves on, twist gently and pull the tubing apart. Be sure to hold it over a container so that it will not leak onto your bedding or floor. Wipe the tubing on the catheter and also wipe the tubing from the drainage bag that you are using for the replacement bag, then just push these ends together to connect. Alcohol preps are good to use for wiping these ends. The removed drainage bag can now be taken and cleaned. Use soap and warm water with a teaspoon of vinegar for cleaning the bag. Shake the cleaning mixture around and empty, following with a clean rinse. Hang upside down to air dry.
If you are lucky, this may be the only catheter care you will need to learn, other than the daily washing including in bathing your loved one. If you are not so lucky, you may find yourself with a blocked catheter or a leaking catheter at some time. Make sure that there are no kinks in the tubing. You can try to gently maneuver the catheter around with a gentle twist, and a few very gentle slight push in and pull back maneuvers may help. Remember, do NOT move the catheter with any force at all. If it does not move then you should leave it alone and call your health nurse who will be better equipped to deal with the problem. You can also massage the bladder area gently and see if that helps to unclog the catheter, if clogging is the problem. If none of these efforts solve the problem, you may need to irrigate the catheter. Your health nurse will instruct you on this method if it is needed. I irrigated mom's catheter once in the morning and once again at night on a daily basis. Her catheter blocked at least once a month and the irrigation with a vinegar-saline water solution really did help to slow the blockages. If you do use the irrigation method, be sure to measure properly for the solution that you can make at home. If it is not mixed properly, it can burn your loved one's bladder tissue. If your loved one's catheter comes out or if there is no urine in the drainage bag after an hour, please call the health nurse or see a doctor. There should be at least 30 cc's of urine for every hour as an estimate. A blocked catheter is an emergency. Do not hesitate to call your medical authorities in such cases.

What does DNR Mean? Do not Resuscitate or Do not Treat?

When many of us make preparations ahead in order to prepare for catastrophic events or dying, one of the decisions we must make is usually whether to sign a DNR order or not. There appears to be confusion about the meaning of a DNR order. During our ordeal with our loved one’s illness, we were dismayed at the assumptions of the medical teams, physicians and nursing home staff as to what type of treatment would or would not be given to a patient who had a DNR order. If you look up the meaning of an actual DNR order, you will find that a do-not-resuscitate (DNR) order tells medical professionals not to perform CPR. This means that doctors, nurses and emergency medical personnel will not attempt emergency CPR if the patent's breathing or heartbeat stops. DNR orders may be written for patients in a hospital or nursing home, or for patients at home. Hospital DNR orders tell the medical staff not to revive the patient if cardiac arrest occurs. If the patient is in a nursing home or at home, a DNR order tells the staff and emergency medical personnel not to perform emergency resuscitation and not to transfer the patient to a hospital for CPR. Sounds simple enough, and easy to understand also, so why all the confusion? A DNR means that a person is not to be revived IF they stop breathing. A DNR order does not mean that a patient is not offered or provided other medical treatment and/or comfort care. It does not mean “do not treat.” A DNR order is only applicable when there is no pulse. That would mean that a DNR order is meant to only be referred to at THAT point and not to be referred to in any other situation, right? Not necessarily. There may be very important implications for the type of care an individual who receive a DNR status obtains. There are wide variations in its use among patients, with the elderly more frequently receiving such orders. What I've found is that people are treating DNRs as if they're for giving a lower standard of care.

Catheter Blockage Blocker or NonBlocker?

Catheter Blockage Are you a Blocker or NonBlocker?
An indwelling urethral catheter, often called a "Foley" catheter, is a closed, sterile system inserted into the urethra to allow the bladder to drain. If you or your loved one is a "Blocker", then you already know what the title refers to. If you or the loved one is not a "Blocker", then chances are that you or that person is a "NonBlocker". Persons who require long term catheterization sometimes have problems with their catheters blocking, thus the term "Blocker". This article will address various possible reasons for this blockage problem. After fourteen days, most catheters are already colonized with bacteria, regardless of the critical care that we take to keep them bacteria free. Catheter blockage sometimes results from encrustations. This is caused by buildup of bacteria, crystallized protein, or even mucus plugs. It can also be obstructed by calcium deposits, phosphorus, magnesium, uric acid and protein debris. Alkaline urine which is urine with a high pH level is usually present and part of the problem. Under alkaline conditions minerals precipitate on the outside of the inserted portion of the catheter, especially the tip, causing recurrent blockage in around 40-50% of long-term catheterized patients. How does bacteria enter the bladder? A few of the most common ways that bacteria travels to the bladder is by traveling up from the inside of the catheter although it can also travel by way of the outside of the catheter also. Sometimes the bacteria just comes from a person's skin.
What can be done to reduce the number of blockages? Drinking more fluids will help. Urine can be made to become more acid by taking ascorbic acid 500-1000mg daily. Daily bag decontamination with a diluted (1:10) bleach solution has been found effective in reducing bacterial colony forming units to a negligible number. Catheterized persons who take in excess calcium such as found in protein supplements and antacids are at higher risk of blocking. Also it has been found that the magnesium from certain beverages and antacids in excess can lead to a higher risk of blockage also. Also found on this higher risk list is excess alkali from denture tablets, citrate from fruit juices and also dehydration. One certain organism called crystalline Proteus mirabilis frequently causes a bio film to form over the tips and eyes of the catheters and can cause blockage. Using a Silicone, antibiotic impregnated catheter will reduce blockage and so will mandatory hand washing procedures.

Drawsheets Pads Bedpads Cloth Plastic or NOT?

This is what you call, starting from the bottom up! This subject will be on the discussion of bedpads. Sounds simple, doesn't it? Not quite. Many people will have many various opinions on what type of bedpads to use and I would like to offer my own here. Beginning with the drawsheet and it's uses, I will begin. I have read that folding a sheet and using it under a person in bed will help with turning and repositioning a person. The drawsheet is to be used by holding it by the edges and doing all lifts and turns with it, instead of pulling or grabbing onto the person being moved. A strong and firm material is needed and I found that a sheet was not of much help for us. I found it to be too flimsy and that it made it harder to work with. It also tended to wrinkle which caused more work in getting those wrinkles out before your job was completed. The material was too slippery also, having nothing to grip onto. I tried using a thick towel next. More wrinkling, not stiff enough either. I went right back to using the flannel quilted cloth bedpads. Less wrinkling, more grip, and more leverage when repositioning the person. These are also wonderful for protecting the bed and keeping your loved one drier. They are expensive, true, but can be made at home if you are thrifty with a sewing machine. You will need at least five of these. Some days you may go thru a lot of them before you can get the others washed and dried. This will not happen often, but when it does, it is best to be prepared!
I will move on to the plastic bedpads now. To use or not to use? That is a big question, asked often by many caregivers who have only the best for their loved one in mind. Like myself, I only wanted the best for my mom also. I took away the blue plastic bedpad right away, hoping to make do with only the cloth quilted ones. I soon found out that I could not keep up with the extra laundry that came with that decision. You should note that we did not use briefs or any other type of underwear for mom and that only the bedpads were used. This fact being another reason to continue using the plastic bedpads. We found that adding plastic briefs or pads just put more bulk and pressure under mom's sensitive skin and we chose to not use those. I also found that the blue disposable pads were a big help with keeping mom drier and less likely to have skin breakdown. They absorbed much better than the cloth ones. The absorbent padding allowed the urine to spread out into the pad and to help keep it from puddling up under her. None of us want to have to use plastic on the skin of our loved ones and here is what I did to avoid that. I folded all of the plastic ends of the pad under and away from my mom's skin. That helped to avoid having plastic against her skin during most of the time and also made the cloth pads a lot easier to wash.
There were times that we did have to use the disposable briefs for mom. At these times, I found that the pull up type were a waste of money because we had to tear them in order to use them anyway. I found that the elastic type pads were not a good choice because the elastic cupped and would hold the moisture to her body instead of allowing it to spread out and be absorbed. My choice, after trying all of these, was to use the large, flat brief pads that just fold open and are actually made to be worn inside of a person's underwear. These worked very well in absorbing the moisture evenly and make it also easier to avoid having the plastic touching the skin areas. I folded all of the plastic ends on these back and underneath in the same way I did the bedpads. I will also mention here that I also tried using cloth padding instead of pads but they were not absorbent enough and left the moisture right next to mom's skin. There are lots of diapering creams and lotions available for taking care of sensitive skin and I intend to cover that subject very soon on here.