Archive for the ‘Personal Care’ Category
Posted on July 19, 2010 - by Nurse Virginia
HOW TO TAKE CARE OF THE ELDERLY PERSON’S SKIN THE WAY THE NURSING HOME NURSE WOULD-AND PREVENT WOUNDS
Nurses know when the elderly person no longer moves independently, they will need to be extra vigilant in their skin care.
Nurses know:
- Preventing wounds is much easier than healing them
- An elderly person can develop a pressure wound in 2-6 hours of not changing position
- A pressure wound is painful
- Healing a pressure wound is costly
- Pressure wounds can develop anywhere there is a bone under the skin – elbows, heels, hips, buttocks and even the face if the elder has been lying in the same position for a very long time on their face
- Moisture makes the skin breakdown faster
- Chair positioning is as important as positioning an elder in bed – slouching in a chair can cause wounds on the spine and the elbow
- If the elder is sitting in a wheelchair for long periods of time, a well made cushion not only will provide better weight distribution, sitting balance and pressure redistribution but also provide a more stable surface for the elder to sit on and prevent the “sling-seat” so common in wheelchairs.
Things to look for in the products you choose:
- Is the fabric soft?
- Is the fabric one that will wick moisture away from the skin- such as cotton – and not an airtight fabric that will create moisture?
- Is the fabric or product washable (very important for infection control)?
- Does the product come with a gel insert?
- If preventing skin breakdown on the elder’s heel – does the product provide for an air cavity under the heel as if floating?
- If the elder is incontinent of urine or stool – choose an incontinent product that wicks away the moisture from the elder’s skin
An investment in pressure relieving products is an investment in pain prevention, saves time and money.
Virginia Garberding, R.N.
Director of Education, The Wilshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on July 6, 2010 - by Nurse Virginia
HOW TO BRUSH THE ELDERLY CONFUSED PERSON’S TEETH
As with all care issues for a person with Alzheimer’s disease or any confusion, the most important step is to have all of your equipment together before you begin.
Steps for brushing a confused elder’s teeth:
- Set out all supplies: toothpaste, glass, toothbrush and towel. (many times the best toothbrush for a person with dementia will be a children’s toothbrush, especially if they are not willing to open their mouth wide enough for an adult size brush – for the elder who is no longer able to rinse their mouth and spit out the toothpaste, the best toothpaste will be a children’s toothpaste – adult toothpaste is not made to be swallowed – and can be harmful)
- Have elder wash and dry hands.
- Have elder pick up toothbrush with the hand they normally use and hold the brush for a few seconds to get the feel of it.
- Instruct/guide elder to put toothpaste on brush, if necessary put your hand over their hand to assist them in doing this.
- Instruct/guide elder using same, your hand-over-their hand technique to bring brush to their mouth.
- Instruct/guide elder to brush gums and teeth, help the elder start brushing with your hand over theirs if needed.
- Encourage elder to spit out toothpaste. (if you need to sip some water yourself and demonstrate – this might be helpful)
- Instruct/guide elder to rinse toothbrush and replace in holder.
- Instruct/guide elder to pick up glass and bring to mouth.
- Instruct elder to rinse mouth and spit, as well as they are able – once again- if unable to rinse and spit out toothpaste a better alternative would be to use a children’s toothpaste.
- Instruct elder to pick up towel and wipe face as necessary
It is important for everyone to brush their teeth in the morning and evening. For the elderly with Alzheimer’s disease, an added benefit to brushing in the evening is that it can ensure the elder doesn’t go to bed with any food left in their mouth. This could present a choking hazard when lying down?
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on June 17, 2010 - by Nurse Virginia
HOW TO SHAVE AN ELDERLY MAN WHO IS BEDRIDDEN
Safety concerns before you begin – is the elderly man on any blood thinners? If so you will want to use an electric razor. When using an electric razor – it should not be shared with other men for infection control reasons.
Assemble all of your equipment before you start getting the elderly man ready for the shave. Equipment you will need:
Razor – electric or safety razor (use the best/safest razor possible)
Shaving lather for safety razor or pre-shave lotion for electric razor
Towels – 2 small hand towels
1 large towel -to go under the man’s head and cover the pillow
Basin of warm water
Washcloth
After shave lotion
Procedure for shaving a bedridden elderly man: (encourage elder to participate as much as he is able to do)
Place all the assembled equipment on a bedside table close to elder
Raise the head of the bed so the elder is sitting up as much as possible.
Place the large towel under the elder’s head covering the bed pillow.
Place one hand towel over the elder’s chest.
Moisten face with warm water from basin with washcloth to soften beard. (heat, moisture and lather help to reduce surface tension and soften the beard)
Apply shaving lather (or pre-shave lotion)
Starting in front of elder’s ear, hold skin taunt with one hand, (during any part of the procedure if you are able to make the skin taunt you will get a closer shave) take razor and shave from ear down cheek towards chin.
Use firm, short strokes.
Shave in the direction of the hair growth.
Rinse safety razor in warm water after every stroke.
Repeat shaving cheek until all the shaving lather is removed.
Continue shave with other cheek.
Using short strokes, shave from under nose to lip.
Shave from under lips in downward strokes to chin in short strokes.
On the neck area the strokes go from the base of the neck -upward towards the chin. If the elderly man is able to put his head back this will help considerably in tightening up the skin and making it easier to shave.
Remove all remaining shaving lather with moist washcloth.
Apply after shave lotion.
If the man is nicked during shaving, applying pressure with a small piece of tissue will stop the bleeding. Several nicks will mean that you are not using the correct razor. Maybe the razor you are using is too inexpensive, look for a higher quality razor.
For shaving the elderly man with Alzheimer’s disease or another disease with agitated behaviors, please see blog:
January 22, 2009 – Assisting the Confused Elder with Alzheimer’s Disease to Shave
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on January 22, 2009 - by Nurse Virginia
Caregiver Tips: Assisting the confused elder with Alzheimer’s Disease to Shave.
Elderly with Alzheimer’s disease are in the moment.
Anytime you are working with a person with Alzheimer’s disease you must provide enough time. People with Alzheimer’s disease are very aware of tone of voice and body language. If the caregiver shows impatience the person will know it. If the caregiver is talking to someone on a cell phone while providing care, the patient will think they are talking to them. Having the television on may also prove to be way too much distraction.
BE IN THE MOMENT – YOU ONLY HAVE THIS MOMENT – PERSONS WITH ALZHEIMER’S DISEASE ARE ALWAYS IN THE MOMENT – NO WHERE TO RUSH TO – JUST THE SUCCESS HOWEVER SMALL OF THE MOMENT
8 Steps for shaving the confused elder.
• Have all equipment ready – when someone has Alzheimer’s disease, it is difficult to leave the patient and have them wait till you come back. Remember when they are in the moment, they can and will quickly move on to something else if you leave.
• Have patient assist as much as he is able and to offer suggestions.
• Heat, moisture and lather help reduce surface tension and soften a beard.
• Shave sideburns with downward motion.
• Pull skin taunt when shaving around nose, mouth and neck areas
• Use short upward strokes on neck.
• Wash off lather.
• Apply lotion with palms of hands.
Any of the steps that a patient can do independently, they need to be able to continue to do to maintain their body memory. (See: Caregiver Tips: Working with Elderly with Alzheimer’s disease using Body Memory)
Hand over hand technique for assisting confused elderly with shaving.
When the patient no longer initiates shaving – putting your hand over the elder’s – whether it is with a safety razor or an electric and shaving “with them” can remind the body how to do the movement.
Caregiver mirroring technique for shaving confused elderly.
In order to prompt a person, who is able, to shave independently the caregiver can also shave their own face. Looking in the mirror at the patient or looking directly at the patient – to encourage them to shave also by imitating caregiver.
Including elderly in shaving activity.
Holding another Shaver – even if the patient is in the late stages of their disease and unable to participate. If they are being shaved with an electric razor and they are given to hold another electric razor that is on –so they feel the vibration – they can still experience the feeling of satisfaction in participating in their own care.
THE GOAL WITH ALL ACTIVITES OF DAILY LIVING IS TO PROVIDE FOR THE ELDER AN OPPORTUNITY FOR SUCCESS
Posted on January 11, 2009 - by Nurse Virginia
Caregiver Tips: Assisting Confused Elder with Alzheimer’s disease to Brush Their Teeth.
Caregiver needs to be in the moment with confused elder.
Anytime you are working with a person with Alzheimer’s disease you must provide enough time. People with Alzheimer’s disease are very aware of tone of voice and body language. If the caregiver shows impatience the person will know it. If the caregiver is talking to someone on a cell phone while providing care, the patient will think they are talking to them.
BE IN THE MOMENT – YOU ONLY HAVE THIS MOMENT – PERSONS WITH ALZHEIMER’S DISEASE ARE ALWAYS IN THE MOMENT – NO WHERE TO RUSH TO – JUST THE SUCCESS HOWEVER SMALL OF THE MOMENT
5 Techniques to assist confused elder brushing their teeth.
• Use a Children’s toothbrush – Sometimes when an individual is in the mid to late stages of the Alzheimer’s disease process, a toothbrush may feel like a large foreign object in their mouth. Using a child-size toothbrush with soft bristles is much more acceptable. This is also a good alternative when the individual no longer opens their mouth sufficiently for an adult toothbrush.
• Use Children’s toothpaste – When a person has forgotten how to rinse their mouth out and spit out the toothpaste a safe alternative is children’s toothpaste. Children’s toothpaste is made so that is can be swallowed.
• Hand over Hand – When the individual no longer initiates brushing their teeth independently – putting your hand over the elder’s hand and brushing with them can remind the body how to do the movement. See Blog: Working with Elderly with Alzheimer’s disease using Body Memory
• Caregiver Mirroring – In order to prompt an elder, who is able, to brush their teeth independently. The caregiver using another brush can demonstrate putting on the toothpaste – then putting the brush in their own mouth – then brushing their own teeth. The use of the word mirror, only indicates that two people are doing the same thing at the same time – does not have to be in a mirror.
• Brush Dangling – Putting toothpaste on a brush and then putting the brush in the individuals mouth – letting go and letting it dangle – through the taste of the toothpaste, and the feel of the brush – cause the individual to reach for that brush and start to brush their teeth.
Posted on January 11, 2009 - by Nurse Virginia
Caregiver Tips: Watch for Signs of Pain and Change In Skin Condition For Confused Elder with Alzheimer’s.
What does a change in the elder’s condition mean?
What should the caregiver be looking for? What is the most effective way to communicate? So many times, when asked the caregiver had all of the information, but didn’t know how to pass that information along. This isn’t an uncommon problem, in caregiving.
4 Things to look out for when caregiving for a confused elderly person.
• Be aware of the elder’s pain. Pain is the most under-reported problem with the elderly. This applies to the general population and even more so for those with Alzheimer’s disease. Sometimes the elder can’t express their pain in words, so those who know them need to be alert and able to read their body language. Signs of pain in elders with dementia may be increased restlessness, holding a body part or a sad facial expression.
• Chronic pain. Elders with chronic pain should have routine medication for pain. When pain medication is given as needed for someone with arthritis you have to rely on the caregiver to notice that the person’s knees are swollen or warm to touch and that the person has a pained expression when their knees bend. When a person suffers from chronic pain they don’t sleep well. Then they are always tired or may have behaviour problems. They may not eat well and may even start to withdraw.
• Observe the elder’s skin. The skin is a sign of the person’s health. The caregiver wants to be aware of any signs of warmth, redness, or swelling. As a person goes through the stages of Alzheimer’s disease they start to move less and less. When they move less, or are sitting in a wheelchair for long periods of time, they can be at risk for skin breakdown because of decreased circulation.
• Use pressure- relieving gel cushions and special mattresses. Money spent on prevention for skin problems is always money well spent. The pain involved with healing a wound and the cost involved can be avoided. When people start to move less they need the caregiver to move and reposition them, watch for skin breakdown and provide prevention.
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