Topic 13: How to Help with physical Needs?

WHaT You Need To KNoWPhysical needs can include: • Lossofappetiteandnutritionalneeds • Shortnessofbreath • Bodyodour • Skinbreakdownorpressuresores • Changesinappearance(fluidretention,musclewaste,hairloss,skindiscolouration) • Incontinence • Constipation • Unabletogetoutofbedtomakethebed • Movingfrombedtochair • Mouthproblems • Confusion • Inabilitytofeedoneself

Informationisprovidedbelowtohelpyouwiththesephysicalneeds.Note:FormoreinformationonHowtoGiveaBedBathandtakecareofaperson’spersonalhygieneissuesSeeTopic9.

Loss of appetite and Nutritional needsWhatyoucanexpect?Thebodyisn’tdigestingfoodasitoncedid.Theperson’smetabolismmaybeslowingdownandadecreasedappetitewillthereforebenormal.Thepersonmayrefusesolidsaltogetherandpreferonlyliquids.Weightlossmayoccurnomatterhowmuchiseaten.Achangingsenseoftaste,includingmakingsomefoodstastetoobitterortoosweet,willalsoalteraperson’sappetite.Certainfoodtexturesandcertainfoodsmellsmaycausenausea.Theneedforliquidswillalsodecreasetowardsendoflife.Thisisnormal.Forcingfoodsorfluidscanleadtodistress,chokingoraspirationwhichmeansinhalingfoodorfluidintothelungs.

Howcanyouhelpwithchangesinappetite? • Itisperfectlyfineifthepersondoesn’twanttoeataslongastheycontinuetodrinkfluids(althoughat somepointswallowingliquidsmaybecomedifficult).Tryaddingfruitandjuicetomilkshakesorsmoothies. Avoidgivingorange,pineappleortomatojuiceonitsownasthesejuicescanaggravatemouthulcersor causeindigestion. • Tryservingwater,teaorsoftdrinkstotakeastrangetasteaway.Sometimesaddinglemonjuicetofoods canmakefoodtastemorenormal. • Trynewspicesandflavouringsforfoodavoidingtoosaltyortooseasonedfoods. • Addsaucesorgraviesandexperimentwithaddingalittlesugar,basil,lemonjuiceormint. • Marinatemeatinsoyasauce,sweetjuicesorsweetwines. • Forpeoplewhodonotwantmeattryhighproteinfoodslikeeggs,chickenorfish. • Choosefoodsthataresoftandeasytoeat. • Smallerportionsservedfiveorsixtimesadayorwhenthepersonrequestsmaybemorepalatable thanafullmeal.Onlyofferwhatapersonfeelslikeeating. • Sometimesaglassofbeerorwine(ifpermittedbythedoctor)willstimulateappetite. • Offercoldplatesofcottagecheeseandfruitifthesmelloffoodisaproblem. • Nutritionalsupplementscanbefoundatthepharmacy. • Don’tworrythatapersonisstarvingorthirsty.Thebodyhaslearnedtoshutdownandpreparefor theendandeliminatestheneedforfluidsandfoodnaturally.

WatchthevideoonHowtoFeedSomeoneElse Sometimesapersonwillneedassistancewithfeeding.

Shortness of breath, breathing difficultiesBreathingproblemscanbeveryfrighteningforcaregivers.Anxietycancauseshortnessofbreath;shortnessofbreathcancauseanxiety.Callthedoctorwhenasuddenonsetofbreathingdifficultiesoccurs.Signsthatapersonisexperiencingbreathingdifficulties:

• Depthofbreathingchanges • Rateofbreathingchanges • Breathingbecomesmoreirregular

• Abluetingeappearsaroundthemouthandnailbeds • Thickmucuscan’tbecoughedup • BreathingsoundsmoistandgurglingNote:Notallofthesesignshavetobepresentforapersontobehavingbreathingdifficulties.

Howtohelpwithbreathingdifficulties • Thegoalistomakethepersoncomfortableandminimizetheirfeelingofdistress. • Planforfrequentrestperiodsbetweeneventswheresomeexertionisneeded. • Remaincloseby,becalm,andcoachthepersonintorelaxingandbreathingmoreslowly. • Createabreezebyopeningawindoworusingafan. • Avoidfragrancesorscentedproductswhichcantriggeracoughingorsneezingattackorcause shortnessofbreath. • Useahumidifiertomoistentheairandloosensecretionssoapersoncancoughthemup. • Servewarmdrinkswithlemonandhoneytoreducemucous. • Repositionthepersonbyhavingthemsitupwitharmsoverapilloworbedtableorelevatethehead ofthebedtoraisetheupperbody. • Loosenclothingandbedding. • Ifsecretionscannotbeclearedwithamouthswab,thenaskthedoctorforamedicationthatwilldry upthesecretions. • Acoldcompressplacedontheforeheadorcheekswillhelptolessenthefeelingofbreathlessness.

ManagingOxygenTherapyBecareful!Anysparkcouldigniteaflameorexplosion.DonotuseVaselineasitcontainspetroleumwhichisflammable. • Besurethatthefacemaskisproperlyadjustedandinthecorrectposition. • Turnoxygenoffwhennotinuse. • Ifthetubingisreddeningtheskinuseaself-adhesivepaddingunderthetubing. • Oxygenisnotrecommendedatendoflifeunlessthepersonhasuseditthroughouttheirillness. Ifso,itcanprovidecomfort. • Ifthetubingisirritatingthebackoftheears,talktoyouroxygenprovideraboutearprotectors.

Body odour problemsIfthebodyisdealingwithaserioushealthconditionandthebody’sliverand/orkidneysarestrugglingtoprocesstoxinsthenabodyodourmayresult.Inthosecases,noamountofpersonalhygienewilltakeawaythesmell.Similarly,diabetescreatesaconditioncalledketoacidosiswhichgivesthebreathafruitysmellandcancauseadistinctbodyodour.IFthepersonisdiabetic,consideritamedicalemergencyandcallforhelpimmediately.However,ifsomeoneisdyingnaturallythereisnoneedtocall911.

Caregiversmayneedtowearamasktohelpcopewiththestrongsmells.However,doingsomayupsettheperson.Insteadtryoneoftheseeasywaystomaskodours: • Placecoffeegroundsintheroom

• Placeabowlofbakingsodaintheroom • Useanessentialoildiffuser • Openthewindowandletinsomefreshair

Ensurethepersonreceivesfrequentskinandoralcareandcleanbeddingasoftenasneeded.

Watchthevideotolearnhowtochangethebedding whenapersonisunabletogetoutofbed.

aromatherapyAromatherapyistheuseofessentialoilsofplantsbyinhalationusingadiffuserorbyapplyingtotheskin.Itmaybehelpful: • Topromoterelaxation • Toalleviateanxiety • Toreducedepression • Toreducepain • Toreducenausea • Toalleviatephysicalsymptoms • Toalleviatesideeffectsofchemotherapy • Toimprovesleeppatterns • Toreducestressandtension • Toalleviatepsychologicaldistress/provideemotionalsupport • Toimprovewell-beingandqualityoflife • Tolivewithalteredbodyimage

Askatyourlocalpharmacywhereyoucouldpurchaseessentialoilsandadiffuser.

Skin breakdown or pressure soresWhenyouseered,tenderskinoverpressurepointsorinskinfolds,dryitchyskin,rashes,openweepingsoresortearsintheskinthenyouknowthatskinisbreakingdown.

Skinproblemsandskinbreakdowncanoccurforanumberofreasonsincluding: • Immobility • Decreasednutritionalintake • Changesinmetabolismandalackofrepositioning • Slidingonthesheetswhichcancausetinyskintearsmakingpeoplepredisposedtoinfection • Oldagewhichcanleadtothin,fragileskinthatiseasilytorn • Lackofoxygentothetissueatpressurepointsleadingtopressuresores • Yeastinfectionssuchasthrushinthegroinareaorunderthebreasts

Howtohelpwithskindifficulties • Establishaschedulesoyoucanremembertorepositionthepersonevery1to2hoursbyliftingthemwithaturnsheetorslidersheet. • Addafoampadontopofthemattress. • Usepillowsorsheetstopadbonyprominences.Putapillowbetweenthekneesandankleswhenthepersonislyingontheirside. • Gentlymassagehips,heels,andtheperson’stailbonewithamoisturizinglotion. • Keepalllinenwrinkle-freeanddry. • Giveagentlebedbath.(SeeTopic#9) • Useflanneltowelsastheyaresofterthanterryclothtowels. • Wearglovessoyourownroughskinisn’thurtingtheperson. • Reportskinchangestohealthcareproviders.

Watchthevideotolearnhowtoturnapersonsafelyinbed.

changes in appearanceSwellingiscausedbyextrafluidinthetissuesorabdomenwhichwillcausefeet,lowerlegsandhandstoswell.Howtohelpwithswelling • Elevatethefeetwhenthepersonissittinginachairorlyinginbed. • Massagetheswollenareastohelpfluidtobeabsorbed.

HowtohelpwithmusclelossLossofmusclestrengthcanoccurasaresultofillnessand/orfromprolongedtimespentinbedwhichwillrequirethatyouprovideextrahelpwithwalking,dressing,andgettinginandoutofbed. • Reassurethepersonthatyoudon’tmindhelpingthem • Recognizethatthepersonmayfeelfrustratedathowweakandtiredtheyfeel • Useabellorbabymonitorsoyoucancomequicklyifneeded • Rentawalkerorwheelchairifneeded

incontinenceLossofcontrolofthebowelandbladderissocommonthatthereareseveralproductsonthemarketnowthatcanhelp.

HowtohelpwithincontinenceIncontinencegarmentslikeStayfree™,DryPlus™,Attends™,Poise™,willhelpkeepsheetscleananddry.Changethegarmentoften.Useazincoxidecreamtohelppreventsoreskin.

Note:Besuretowearglovesorwashyourhandswithwarmsoapywatereachtimeyouassistwithincontinencegarments.

Watchthevideotolearnhowtousechangeincontinencegarments.

constipationConstipationiscausedbynotdrinkingenough,noteatingenough,noteatingenoughfibre,notgettingenoughphysicalexercise,andgutslow-downduetoopioid-basedpainmedication.

Howtohelpwithconstipationdifficulties:Notethatmostofthesesuggestionsareinappropriateinthefinaldaysofaperson’slife. • Havethepersondrinkseveral(8-10)glassesofwatereachday.However,atendoflifethisintake becomesunrealisticandcouldcausedistress.Oftenpeopletakeonly½cupperdayinthefinaldaysoflife. • Graduallyaddmorewholegrainstothediet • Offerahotdrinkinthemorning • Encouragewalking,exercisinginbed • Avoidchocolate,cheese,eggs • Monitorbowelmovementsandobserveforabdominalswellingandpainduetoconstipation.Havea nursegiveasuppository.

Mouth problemsMouthproblemscanhaveseveralcausesincluding: • Dehydration • Fungalinfectionssuchasthrush(badbreath,whitepatchesonthetongue,soremouthandthroat)Note:Thrushcanspreadtoothers.Avoidkissingthepersononthelipsorsharingutensilsifyoususpectthrush. • Opensores • Crackedlips • Poor-fittingdentures(refusaltoweardentures) • Decayingteeth(toothpain)

Howtohelpwithmouthdifficulties • Keepthemouthcleanandmoist • Removedenturesbeforecleaningthemouthandcleanthedenturesusingadenturecleaningproduct;thedoctormayprescribeamedicatedcreamtorubonthegumsunderdentures • Treatcrackeddrylips • Providefrequentsipsofwaterastoleratedoruseaspraybottle • Provideoralcareasfrequentlyaseverytwohoursandcertainlyafterwaking,aftereachmeal,atbedtime • Havethedoctorprescribeamedicationthatisswishedinthemouththenswallowedifneededforthrush • Useanalcoholfree,gentlemouthwash

ComfortMeasuresforThrushInfections • Medicationobtainedfromahealthcareprovider,i.e.Mycostatin

• Cleanthemouthbyrinsingwithmouthwashorplainwateraftereating • Whitepatchescanbegentlyremovedwithasofttoothbrushwhentheybecomeloose • SoakdenturesovernightinfullstrengthListerine,rinsingbeforetheyareputbackinthemouth.

SignsthatMouthCareisHelping • Mucousmembranesarepinkandmoist • Mouthisclean • Thrushpatchesdecreaseinsizeandnumber • Mouthdiscomfortsubsides

CAUTION: •Alwaysuseanultra-softtoothbrushashardbrushescandamagegumtissue •Avoidcommercialmouthwashesthatcontainalcoholastheycancausefurtherdryness. •Donotusedentalflossasitcancausegumtissuedamage. •Avoidhardfoodslikerawcarrots,citrusjuicessuchasoranges,lemons,limes,tomatoes. •Beverycarefulwithtoothettesinpeoplewithdementiaorconfusionastheycanbebittenoff andcausechoking.Useasofttoothbrushinstead.

Watchthevideotolearnhowtodomouthcare.

ThreeEasyRecipesforMouthwashtoMakeatHome

“CaringfortheTerminally

Ill:HonouringtheChoicesof

thePeoplePerson/Family/

Community”3rdEdition

August2014

confusionConfusionmaystartslowlyandprogressivelyworsenleadingtoshorttermmemoryloss,poorconcentration,decision-makingdifficulties,seeingandhearingthingsatnightthataren’thappening.Similarly,thepersonmaydemonstrateangerandbecomefearfulfornoobviousreason.

Howtodealwithconfusion • Startwiththemandwheretheyareat. • Remindthepersonwhoyouarefrequently. • Whiletalkingtothepersonpositionyourselfsothatyouarefacetofaceturningoffthebackground noisefromthetelevisionorradio. • Keepthecalendarandclockinviewofthepersonsotheycanfeeloriented. • Donotleavethepersonaloneforprolongedperiodsoftime. • Talkslowlyandquietlyusingshortstatements. • Besuretokeepthemedicationoutofreachandbringittothepersonyourselfratherthanhavingthe personself-administertheirownmedication.

Askforhelpif: • Confusionoccursverysuddenlyorbecomesworse. • Thepersonbecomesviolentoragitated. • Youorthepersonthemselvesarehurtphysicallybecauseoftheconfusion. • Youaretiredandneedrelief.

Watchthevideoonhowtomakeabedwithsomeoneinit.

Watchthevideoonhowtotransferapersonfromabedtoachair andchairtoabedsafely.

WaLK iN THeSe SHoeS 1. Readthisscenario. Joeisan85yearoldmanwhoisrecoveringfromheartsurgery.Priortothesurgeryandtothefewmonthsleadinguptothesurgery,hewasextremelyactiveandsocial.Hisrecoveryistaxingtohimandhiscaregiverbecauseheisn’tsleepingwellatall.Joeisanavidreaderandhasafewbooksonthegoatonetime.Heishavingdifficultyconcentratingonhisreadingwhichhethoughtgoingintothesurgerywouldbetheonethingthathecouldmanagetomakethetimepass.WhenJoeawakensatnightheoftenfeelsdisorientedwhichcausesanxiety.

2. YouwouldliketochangeupthebedtimeroutinetoseeifJoecangetabetternight’srest.Whatwouldyousuggest?Thinkaboutsomestrategiesbeforecheckingthesampleresponse.

Sampleanswer:TryreadingtoJoeintheeveningbeforehefallsasleep.TrysuggestingtoJoethattherebethreesleepbreaksina24hr.periodratherthanjustonelongone.Establishtimesforthosesleepbreaks.KeepalightonatnightnearbyifJoedoesweeksoanxietyanddisorientationmaybelessened.

addiTioNaL ReSouRceS

use these additional resources to learn more.

TheRelationshipbetweenMentalHealth,MentalIllnessandChronicPhysicalConditionsontario.cmha.ca/documents/the-relationship-between-mental-health-mental-illness-and-chronic-physical-conditions

BackPainExercisesandStretchesforCaregiverswww.spineuniverse.com/conditions/back-pain/back-pain-exercises-stretches