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Caregiving
tips
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"As
Dad got weaker, the nurse showed us some simple things
we could do. Those little tips really made a difference
in terms of his comfort level. It also helped us not to
feel so anxious and powerless!"
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Bathing
Everyone feels better after
a bath! Being clean enhances self esteem and reduces odors
and chances of infection. If the patient can still walk to
the bathroom, a stool in the tub and a handheld shower provide
helpful and safe ways to get clean and enjoy a change of pace.
As the patient’s skin becomes more delicate, you may
want to use only mild soaps or no soaps and after a bath apply
lotion to moisturize the skin. Fresh clean clothes and a bed
with new linens are a wonderful way to top off the experience.
If the patient can no longer
manage a trip to the bathtub or in the case of dementia finds
bathing a frightening experience, then a sponge bath in the
bed does just as well. The face, armpits, genitals, and rectal
area are the most important to bathe. Vigorous scrubbing is
not necessary, nor is a lot of soap and water. (Due to concerns
about pressure sores, it is especially important to reduce
the likelihood of getting the bedding wet.) If you really
want to use soap, consider using mild liquid soaps that do
not require rinsing. Be sure the room is warm and that the
patient is kept covered with dry towels; only expose those
areas you are cleaning at the moment. (Return
to list)
Bed sores
A patient may be in danger of
getting bedsores, also called "pressure ulcers,"
especially if he or she is confined to bed for most of the
day and night. They are red, painful, blister-like areas that
can crack and bleed. They tend to occur in bony places of
the body (hips, elbows, shoulders, head, heels, and tailbone)
where constant pressure against the bed can cut off the flow
of blood and cause the skin to break down. If the skin surface
is broken, call the doctor or nurse and learn how to best
protect the wound from infection. You can prevent bedsores
by following these routines:
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- Make sure the patient’s skin, bedding, and clothes
are clean and dry. Remove wet bedding or clothes immediately.
- Turn the patient to a new position every two hours to
alleviate pressure in any one spot. Encourage the patient
to get out of bed and sit up in a chair if he or she is
able to do so.
- Make sure the bottom sheet is pulled tight and that all
crumbs and wrinkles are removed from the bed.
- Consider using a foam rubber mattress pad with an "egg
carton" pattern developed especially to reduce the
incidence of pressure sores.
- Massage the patient gently with lotions, especially on
bony areas of the body. This not only increases circulation,
but also moisturizes the skin and helps comfort the patient
with the healing power of loving touch. (Return
to list)
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Bladder
care
At some point in a serious illness,
most patients will lose control of their bladders. It is sometimes
possible to avoid accidents by having the patient use the bathroom
frequently, before the bladder gets uncomfortably full. Setting
an alarm clock to ring every hour or two is a useful reminder.
If this strategy doesn’t work and the patient is generally
homebound, you might consider having a tube (called a "Foley
catheter" or "Foley") placed in the bladder by
a home care or hospice nurse. The catheter will drain into a
bag that is hooked to the bed or a chair and can be easily drained
several times a day. Some patients find it liberating to be
relieved of the anxiety of accidents. Others are uncomfortable
with this solution.
If preferred, an adult "diaper"
can be worn, or super-absorbent pads can be placed within regular
or specially fitted underwear. If you choose to use diapers
or pads, be sure the genital and rectal areas are kept clean
and dry so they do not become irritated and develop a rash.
To maintain the patient’s dignity, caregivers might refer
to the diaper as "protective panties or undergarments."
As the end of life approaches,
organs begin to shut down. This includes the kidneys, which
produce urine. Caregivers will notice a decrease in the amount
of the patient’s urine. It will be darker in color and
have a stronger odor. This change is a normal part of the process.
(Return to list)
Constipation
Constipation is a frequent side
effect of many medications, especially those that are used to
reduce pain. It can also be caused by decreased activity, not
drinking enough fluids, or not eating enough fiber. You should
call the doctor if the patient has been eating regularly but
goes for several days without a bowel movement or if the constipation
is accompanied by severe pain in the abdomen or by vomiting.
Simple ways to prevent or reduce constipation are: |
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- Provide a diet high in fiber, assuming the doctor has
not ordered otherwise. High-fiber foods include vegetables,
fruits, beans, whole grain breads and cereals, and dried
fruits and nuts.
- Be sure the patient drinks six to eight glasses of water
a day.
- Stimulate the bowels by taking the patient for walks or
by helping the patient jog in place or do sit-ups.
- Provide prune juice or black tea or coffee.
- Ask your doctor about laxatives and stool softeners. If
the dosage of pain medications has been increased, you may
also have to increase medications for constipation. (Return
to list)
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Diarrhea
The side effects of dehydration
caused by losing a lot of fluid (e.g., fatigue, confusion, bed
sores) are some of the more debilitating aspects of diarrhea.
You can prevent or reduce diarrhea and dehydration by doing
the following: |
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- Have the patient drink plenty of clear liquids (e.g.,
water, juice, and broth), especially between meals.
- Serve foods that are low in fiber and high in potassium
and protein (e.g., rice, bananas, eggs, toast, crackers,
applesauce, mashed potatoes).
- Avoid serving the patient spicy or fried foods and most
milk products (although some people respond well to yogurt).
- Reduce or eliminate caffeine from the patient’s diet
(e.g., coffee, black tea, chocolate, and many kinds of sodas).
- Talk to your doctor about medications that can help firm
the stool. (Return to list)
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Fatigue
All of us have experienced the
fatigue of inadequate rest, but fatigue that accompanies serious
illness is altogether different. Certainly getting enough rest
is important, but with this kind of fatigue no amount of sleep
will provide a complete resurgence of energy. In addition to
being tired as a result of fighting the disease, the person
you care for may be fatigued because of depression, inability
to eat, lack of movement/exercise, or side effects from treatments
or medications. Although restoring complete vigor may not be
possible, the following may help alleviate some of his or her
weariness: |
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- Appropriate physical activity (e.g., walking, stretching,
getting up out of bed and sitting in a chair). Depending
on the severity of the person’s condition, too much
bed rest can cause fatigue!
- Adjustments in medication/therapies, including the scheduling
of treatments such as chemotherapy or radiation.
- Blood transfusions or medications to offset anemia (appropriate
if the person has a low red blood cell count).
- Increased fluid intake, unless the doctor has ordered
otherwise. Dehydration and low blood pressure can contribute
to feelings of weariness and fatigue.
- Reducing noise and clutter. This strategy can help reduce
mental fatigue for a person who is already struggling with
many physical and emotional challenges.
- Antidepressants, stress-reduction techniques, and/or counseling.
These methods can relieve any emotional concerns that may
be contributing to lack of energy.
- Pacing activities appropriately. Restrict activities to
those that the patient absolutely must do and to those that
give the most pleasure. Don’t schedule too many in
a day, and try to schedule them at times when the patient
typically has the most energy.
- Adequate sleep at regular times. Unless the patient is
quite advanced in the illness, it might help if he or she
takes naps only in the morning and early afternoon rather
than late in the day when they could interfere with night
sleeping. (Return to list)
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Mouth
care
Keeping the mouth clean and fresh
does a lot to help the patient feel comfortable. If brushing
his or her teeth is difficult, you might try an electric toothbrush
or just wiping the teeth with a damp cloth if his or her mouth
is too tender. Pharmacies and medical supply houses carry a
product that is a small sponge mounted on a stick, rather like
a lollipop. To help with oral hygiene, you can dip one of these
in water and swish it around in the patient’s mouth. You
might choose to avoid toothpastes or alcohol-based mouthwashes
because they may be too strong and contribute to "dry mouth."
"Dry mouth" is a common
and uncomfortable side effect of many medications. If the patient
complains of this symptom, talk to your doctor about ways to
offset this condition. A change in medication or a reduction
in the dosage could help. Ice chips or sucking on a damp or
wet cloth can be soothing. Lip balms or olive oil can help keep
lips moisturized and prevent cracking. (Return
to list)
Nausea and vomiting
Nausea and vomiting, common side
effects of cancer treatments, can be distressing for both the
patient and caregiver. Keeping a bowl or basin within the patient’s
reach will alleviate distress caused by getting sick and soiling
the bed. Placing a towel over the pillow will also help catch
any fluids that miss the bowl.
Whether nausea and vomiting are
the result of treatments or the disease itself, you can reduce
the feelings of nausea and the frequency or likelihood of vomiting
by: |
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- asking the doctor to prescribe anti-nausea medicines.
These medications often come in suppository form, so you
do not run the risk of the patient throwing up the very
medicine needed to stop the vomiting.
- opening a window for fresh air or using a fan to keep
the air circulating.
- keeping the room free of strong or unpleasant odors.
- offering chewing gum or hard candy. Sometimes chewing
on ice chips will help.
- providing distractions such as music, television, reading
aloud, or other activities.
- having the patient slowly sip clear liquids to prevent
dehydration.
- serving frequent, light meals throughout the day. Don’t
force foods if he or she does not want to eat.
- avoiding offering fried foods, spicy foods, dairy products,
and acidic foods as well as high-fiber foods that are more
difficult to digest and may cause gas (e.g., vegetables,
beans).
- sticking with bland foods and foods high in potassium
and protein (e.g., rice, bananas, eggs, toast, crackers,
applesauce, mashed potatoes).
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When
a patient vomits up medicine, do not immediately re-administer
the medication. Call your physician and ask about the best policy
for the medicines in question. He or she can tell you what to
do in the moment and may be able to prescribe a liquid or suppository
form that will be better tolerated. (Return
to list)
Shortness of breath
Many people with serious illness
experience problems with breathing. First and foremost, consult
your physician to find out if there are medications that can
help. Or, the patient might benefit from the use of an oxygen
tank. You can do a few simple things in addition to the doctor’s
recommendations to help a person who is short of breath:
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- Open windows or use an electric fan.
- Change the patient’s position (from lying down to
sitting, or from one side to the other).
- Address the anxiety that comes with difficult breathing
(e.g., use relaxation techniques and guided visualizations).
(Return to list)
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This website was created by the Grand
Island Coalition for End of Life Care, a community organization dedicated
to improving end of life care through education, advocacy and support. We
gratefully acknowledge the generosity of KDSI for
their donation of webhosting services. Site design and layout created by Let's
Collaborate! |
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