copyright 2008 Cheryl K. Hosken, BSN, MS Psych.
Gas Pains
Gas pains are a common consequence of constipation. Gases in the digestive tract are unable to escape out of the anus in a normal manner. Diarrhea may also be accompanied by severe cramping as gas bubbles expand through the colon and lead to explosive escape of gas and diarrhea. Various foods are responsible for formation of gas in the colon. For those who are lactose intolerant, milk and milk products make the bowel react violently. Antibiotics and other common drugs disrupt the chemistry of the digestive tract and cause gas. Post-operatively, there are gas pains from the digestive tract being paralyzed by anesthetic and then revived and trying to function normally.
We can avoid feeding foods to our clients if we know which ones cause gas. Some drugs such as Mylanta help relieve gas, but these usually work only in the upper digestive tract. To ease gas to the anus to escape, help the person to walk or place a warm water bottle on the abdomen to stimulate the bowel to work the gas down the digestive tract.
Meditate Word By Word On These Verses:
Luke 10:25-37.
Diarrhea
The causes for diarrhea include medications, especially Coumadin, diatbetes, AIDS, radiation therapy to abdomen or pelvic region, infection and disease of the colon, and food sensitivities. Diarrhea can also be dangerous because vital nutrients and water speed through the digestive tract without being absorbed. Patients are left dehydrated, malnourished, and with imbalance of electrolytes such as sodium and potassium that can cause muscle cramps and abnormal heart beats. In AIDS, the intestinal infection cryptosporidosis often occurs and causes diarrhea that can make the body lose several liters of fluid a day and quickly cause death.
Question 1: What is the importance of monitoring the digestive tract of the person in your care?
When someone has diarrhea, we need to decrease the loss of fluids and electrolytes. Here is what we can do:
- Get anti-diarrheal drugs from the pharmacy. These are Imodium and Lomotil. Be sure not to give excessive doses, which can cause constipation.
- Change to a clear liquid diet when the diarrhea starts - apple juice, herbal tea, broth.
- Help them to drink as much liquids as they can tolerate.
- Avoid caffeine and regular tea because these are diuretics removing fluid from the body.
- Keep the person clean because diarrhea is highly acidic and can cause skin irritation.
Until the diarrhea improves, feed the person low-fiber foods such as rice, bread, well-cooked cream of wheat, and baby foods. Avoid raw vegetables and fruits, beans, milk and milk products, and whole grain. When someone has really severe diarrhea for days and nothing seems to help them, give them a diet of BRAH (bananas, rice, apples, and herbal tea) only. This combination seems to work to decrease the fluid in the bowel and form normal stool.
Question 2: What is lost from the body in diarrhea?
(Only one of the following answers is correct.)
liquids that fight fevers.
liquids and electrolytes that keep body fluids in the normal range for cell growth and repair.
electrolytes that can make fluids in the body acidic.
Urinary Tract Complications
Persons with neurologic disorders, spinal cord injury, surgeries of the prostate, rectum, or female reproductive tract can have incontinence. An enlarged prostate can also cause loss of bladder control. Urinary or urethral infections are irritating and cause incontinence.
Some loss of bladder control is inevitable as we age. Roughly one in five persons over the age of 65 has some degree of urinary incontinence. This is due to increasing relaxation of the muscles that control urination. Many other sick people suffer what is called functional incontinence. This means that they are too frail of too incapacitated to get to the toilet when they need to.
When the bladder is not regularly emptied, forcing urine to spill without warning, this is overflow incontinence. There are other types of incontinence as well. Stress incontinence occurs when one coughs, sneezes, laughs, or changes positions from getting out of bed or getting up from a chair. Urge incontinence occurs when the signal to urinate comes so quickly, there is no time to get to the toilet.
Question 3: Why are elderly persons more prone to incontinence?
For some people there are surgical procedures that can repair sagging muscles, or there are specific exercises to increase the strength and control of the muscles. For a small percentage of people, bladder training can be helpful. Bladder training can mean anything from a pre-scheduled daily toileting routine and exercises to careful timing of fluid intake. For most caregivers though, incontinence becomes a chronic problem that needs to be dealt with every day for the rest of the patient's life. The goals are to be sure that the person empties his bladder fully and to keep the skin exposed to urine as clean as possible. This is what we can do:
- Establish a toileting routine. Note when and how often the person urinates throughout the day and night. Then make sure he gets to the toilet or uses a badpan before wetting on himself. If accidents have happened during the night, wake him for prescheduled toileting.
- Coordinate the intake of fluids with the toileting routine. Decrease the amount of fluid intake 2-3 hours before bedtime and makes sure the bladder is emptied before going to bed. (Remember that ice cream and soups contain large amount of liquids.
- The person should dress in easily removable clothing for ease in toileting and changing if an accident occurs.
- Place a portable commode or urinal at the bedside for people who have trouble getting to the toilet.
- If the person is taking diuretics, be sure that the peak effect of the medication occurs during the day.
- Place absorbent pads under the person to absorb moisture of urine away from the skin and prevent sheets from getting wet.
- Wash the skin as quickly as possible. Dry it and put a thin layer of moisture on it. Even regular bath soap may be too harsh for the skin. Diaper rash from laying on urine-soaked pads or sheets can set the stage for bed sores and infections.
Question 4: How do you establish a toileting routine?
(Select the best answer.)
Have the person go to the toilet three times a day.
Note when and how often the person urinates throughout the day and night. Decrease the amount of fluid intake before bedtime.
Always be prepared to change the person's clothing if it gets wet or soiled.
If there is an infection of the urinary tract, be sure that the person drinks many fluids. The emphasis is on cleaning the urinary system. Don't be overly concerned about incontinence at this time.
5. If you have a client with urinary incontinence, what time of day do you feed him soup?
(Only one of the following answers is correct.)
before bed.
for dinner at the mid-day.
for breakfast.
Insomnia
The causes for insomnia are the effects of medications, cancer and cancer treatments, Alzheimer's disease, anxiety, depression, Parkinson's disease, difficulty breathing due to lung diseases, congestive heart failure, pain, and indigestion. The problem of sleeplessness is two-fold: The person gets progressively weaker and the caregiver loses sleep too. The lack of sleep can make the sick person and the caregiver irritable, depressed, and less alert. It is well documented that persons deprived of sleep have weakened immunity.
Question 6: Why is rest important for the elderly or sick?
Here is what may help:
- Try to get to bed and get up at approximately the same time every day. If the person likes to doze in the morning, plan activities for him in the afternoon and conversely, if he likes to get to bed early in the evening, activities should be planned for the morning. Usually, every person has some biorhythmic sleep patterns that are part of his routine.
- Establish a bedtime ritual - this is not just for children! Perhaps it is watching the news before sleep or having a cup of tea. The same activities in the same order each night train the body and mind to prepare for sleep.
- Avoid caffeine and large meals before sleep. The activity of the digestive system can disturb rest.
- Make the most of the sleep that the person does get. Perhaps turning off the phone ringer in the room, drawing the curtains, and decreasing fluids will give the person a better rest.
- Get as much exercise during the day as possible.
- Schedule medications that cause drowsiness about one half hour before bedtime. Nonprescription pain relievers may help a person sleep more soundly by relieving muscle aches and tension. Some nonprescription sleeping aids may also help for insomnia.
There will be times when nothing helps a person to get rest, then the caregiver needs to sleep when the sick person sleeps or get help from others so that the caregiver does not become ill from lack of sleep himself.
Question 7: Why is daily exercise important for sleep?
Respiratory Complications
Respiratory problems may be caused by pain and weakness following surgery, respiratory infections, chronic pulmonary disease, impaired ability to expand the lungs due to spinal cord injury or Parkinson's disease, edema of the lungs due to congestive heart failure, asthma, and radiation therapy.
Not being able to breathe is one of the most frightening experiences and the panic that occurs with lack of breath only makes the problem worse. There is a real need to provide vital organs with oxygen. The caregiver can help a person keep airways open with positioning the patient's body and giving him oxygen. This is what you can do:
- Elevate the head of the bed or have the person sit upright in soft, easy chair. By sitting up, gravity assists in the work of breathing.
- Give medications for anxiety if possible and do whatever seems to make him calm. One woman rested her husband's head on her chest and massaged his back. This calmed his anxious breathing.
- Have the person breathe deeply if possible and cough to release secretions.
- Ask the doctor for a bronchodilator medication to open up air passages.
- Help him to drink enough fluids to keep secretions thin.
Question 8: What can you do to keep secretions thin so a person can cough and get rid of them?
(Only one of the following answers is correct.)
Elevate the head of the bed or have the person sit up.
Have the person breathe as deeply as possible.
Help the person drink plenty of fluids.
For persons who drool or have copious secretions while sleeping, position them on their sides to take drainage away from the airway to the lungs. Tuck a towel under the person's chin to catch secretions.
Chronic coughing
Coughing is necessary to clear the airway for breathing. An unrelenting cough can lead to loss of sleep, collapsed lung, stress incontinence, and weakness. Heart rates also increase causing strain on the heart muscle. The causes of chronic coughing are infections of the lung (pneumonia and tuberculosis), emphysema, excess fluid on the lungs, radiation to the lung, chest, throat, or breast. To help your patient, do the following:
- Make sure the airway is clear by coughing up accumulated drainage or mucus.
- Eliminate dust, pollens or other respiratory irritants from the sick person's room. Use a vacuum cleaner.
- Ask about getting a cough suppressant for bedtime.
- Coughing can be painful and ribs can be broken during coughing. Have the person hold a pillow up to his chest when he coughs to cushion the pain and irritation of the ribs.
Question 9: What are the effects of constant coughing?
Circulation Problems
Lying in bed for extended periods of time can cause fluid to build up in body tissue, especially the legs and feet. This is called dependent edema. It can lead to breakdown of blood vessels in the swollen area. This causes phlebitis. Thrombophlebitis is also a serious problem because the clots that form in the vein can move on to the lungs causing death.
Congestive heart failure and poor kidney function can also cause fluid to accumulate in the blood stream and in the spaces between tissue cells. In the lungs, this is called pleural effusion. It is very hard to eliminate this fluid between the tissues. It usually requires a diuretic. Immobility and weakness can cause the blood to flow slowly in the legs and the heart becomes slow to respond to changes in activity.
For example, orthostatic hypotension is a drop in blood pressure that occurs when a person gets up quickly from a sitting to a standing position or from a lying to a sitting position. The blood and fluids stay in the legs instead of going back to the heart. This makes the person feel dizzy, light-headed, and vision. is blurred. This can cause a serious fall.
Question 10: What is the difference between phlebitis and thrombophlebitis? Which is more dangerous?
Medications that treat circulatory problems are diuretics and anticoagulants to thin the blood and prevent clots from forming.
To prevent circulation problems, you can:
- Keep your client's legs elevated whenever he is sitting or lying down. This means putting his feet about 10cm. above the level of his heart.
- For those who are prone to orthostatic hypotension, keep the their heads elevated when in bed. They must be careful to get up slowly and sit down if they are dizzy.
- Repositioning the person in bed helps circulation. Do the passive range of motion exercises for your patient.
- Use elastic supportive stockings to prevent clot formation in the lower legs.
- Restrict the intake of dietary salt that makes the body retain fluid.
Question 11: What helps circulation when a person stays in bed a few days?
(Only one of the following answers is correct.)
Keeping the person's legs elevated while he is in bed.
Repositioning the person in bed and doing passive range of motion exercises.
Restricting the intake of dietary salt.
Bleeding and Bruising
Anticoagulants and other common drugs inhibit blood from clotting normally. This causes bruising and bleeding. Chemotherapy is another cause for bruising since the drugs usually diminish the number of platelets that initiate the clotting process. Symptoms of clotting disorders include frequent nosebleeds, vomiting blood; pink or red streaks in the urine, sputum, or stools; and tiny red and purple spots on the skin or in the mouth.
To control the problems associated with bleeding, you can:
- Control bleeding by gently pressing a clean cloth against the site until the bleeding stops. To stop a nosebleed, pinch the nose and tilt the head back.
- Reduce bleeding and slow bruising by using ice packs. You can use a package of frozen food from your freezer if you do not have ice packs available. Or you can freeze water in a small plastic bag for this purpose. Be careful when putting ice on swollen legs. If circulation is poor, ice packs increase circulation problems.
- Consult with the doctor about giving aspirin and if any of the above symptoms appear.
- The person should use a soft toothbrush to clean teeth and rinse the mouth with a solution of hydrogen peroxide and water in equal parts.
Question 12: What is the blood component that helps with clot formation and why is it sometimes low?
Seizures
Seizures occur when disease or injury scrambles the electrical signals from the brain causing the muscles to contract throughout the body. Seizures can be small causing twitching of hands, face, or extremity. They can be large meaning a full convulsion and failing of the extremities risking injury to the person.
Usually a seizure is more frightening to the person who is watching than to the person who is experiencing it. There is little to be done to control a seizure when it occurs, but medical investigation and correction is necessary following a seizure.
Fevers of greater than 38 degrees can cause convulsions. You can try to bring the temperature down by wiping down the person's body with alcohol or a cool cloth. Do not try to stop the person from falling, ease him to the floor or ground and protect his head. Do not try to restrain the seizure. You cannot stop it. Gently steer hands, elbows, feet, and knees away from solid objects that might cause injury.
When someone is having a seizure, roll him to his side if possible. If secretions and vomiting occur, they can be removed. Loosen ties, belts, and other clothing so that the airway is not obstructed. Do not attempt to place anything in the mouth. Sometimes putting something in the mouth cause the tongue to drop backward and cuts off the airway.
Question 13: You are in the market and you see a young man beginning to seizure. What do you do for him?
(Only one of the following answers is correct.)
Shout, "Help!"
Help him to the ground and try to make his head comfortable.
Don't try to keep his hands from hitting objects around him.