One of the biggest morale problems among caregivers is the problem of incontinence.
In most cases, incontinence can be reduced or eliminated.
My little sweetheart is now 103 and seven months. She was incontinent at age 100 and I ended that in five months. Six months ago she went into the hospital and was briefly in the hands of "professionals" and the incontinence started again. Right now she is no longer incontinent. She uses the toilet.
The basic protocols are simple:
(1) The patient must have the toilet in visual sight at all times. It should stay in the same place in the room and not be moved around.
(2) If there is a chair they watch TV on, the toilet must be in view, so they can point to it. Failure to sit next to the patient should be a dismissable offense.
(3) The aide MUST sit in sight of the patient 24/7. This way they can see them point to the toilet.
(4) Toilet times are at exactly the saeme time every day. These times should be exactly THREE. No more and no less.
(5) Suggested times are 9 A.M. 4 P.M. and 10 P.M., however these can be varied. The important thing is to be on the toilet at EXACTLY the same time. This rule can be altered when the patient is in deep sleep.
(6) Before going to the toilet the patient is INFORMED of the time, verbally or with a dry-erase board. This sets the internal circadian clock.
(7) Morning toilet is after getting up. Mid-day toilet is thirty minutes after a snack or small meal. Evening toilet is thirty minutes after a snack or small meal. Eating induces peristalic action approximately thirty minutes later.
(8) Daily beverage should include four ounces or prune juice and two ounces of apple juice as stool softeners.
A few other things that help include EXERCISE. Without exercise normal paristaltic movement diminishes. I have a dislike for Hoyer Lifts and the readiness with which they are utilized. In order to exercise the patient must be dressed properly and not be in a night gown and a diaper. Thus my rule is normal dress upon awakening and no nightgown until night. I also recommend a small amount of Metamucil every day. Not much. Too much causes constipation.
Defecation is conditionable. Ideally, if the patient is ambulatory, the bathroom should be used. If an in-room toilet is used it should be in a corner of the room with a curtain or shield. With my little one I told the aides it is a dismissable offense for toilet to be performed with the door open. I installed a large "knocker" on the door for people to use. The human mind has the ability to measure time quite precisely. This internal clock needs to be reset, which is why you show the patient the time after each toilet. Excercise as much as possible is also important. I give my little camper Aptiva yogurt, which seems to help, but this is only an anecdotal observation.
Avoidance of constipation and straining is important. There should be a soft rug around the tolet in the event of a period of unconsciousness and the aide should be in physical contact with the patient at all times. Do not have the aides encourage the patient to "push".
Gentle massage of the tummy before a bowel movement and as much physical exercise as possible helps break up the feces. Soy products tend to produce constipation.
A teaspoon a day of cod-liver oil and a teaspoon of extra-virgin oilive oil are helpful. The cod-liver oil now comes in flavored varieties.
Straining causes activation of the vagus nerve near the rectal muscle, which drops the blood pressure and heart rate. That is why many people die on the toilet.
This is termed a vasovagal fainting episode.
The drill is to IMMEDIATELY lie the patient flat on his/her back, put a pillow under the shoulders to make sure the tongue does not occlude the trachea, open a window, and raise the legs seven to ten inches. If anything a simple pillow under them is better that nothing. Hold the patient's hand and provide reassurance until the condition stabilizes. It will take twenty-thirty minutes for the heart rate to recover, but the patient should not stand up for an hour. Do not worry about feces on the floor.
I am not going to tell you NOT to call 911, but this is generally unnecessary. The problem is the patient needs rest and you will end up with a siren run, blood draws, and probably seventeen hours in an emergency room. The exception is when the patient has a significant cardiac condition.
Reduce this problem by a daily teaspoon of metamucil (not more), three-four ounces of prune juice, Ativa Yogurt, three-four ounces of apple juice. And of course ADEQUATE HYDRATION.
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