CAREGIVING TECHNIQUES

Constipation

Patients are always put on a bowel regimen whenever opioid pain medications are prescribed.  Otherwise, they will quickly become constipated.  Constipation also frequently occurs as a consequence of the terminal illness, even if opioids are not used.  

The overall goal is for each patient to have a bowel movement at least every other day without inducing diarrhea.  Patients who are not eating well may have a bowel movement less frequently.   Because each patient’s response can vary, different protocols may have to be used to find the regimen that works best. Any time your pain medication is changed, you may also need to increase or decrease the daily dosage of laxative. 

Body Hygiene

It is good idea to provide the bed-bound patient with a bath each day.  This provides cleanliness, helps prevent skin breakdown and helps to refresh the patent in both body and spirit.  A large bowl filled with warm water may be used or we can provide a no-rinse shampoo and body wash that does not require rinsing.  To avoid chilling the patient, only a small area should be bathed at a time.  Gently soap the skin, the rinse and dry.  Begin washing at the face and work down towards the feet.  Don’t forget to wash the back. Apply a lotion containing lanolin.  After washing the feet, the water will need to be changed before doing the buttocks area. 

Daily washing of the genital area is especially important since bacteria tend to collect there.   Wash between the patient’s legs from the front toward the back.  Rinse well and dry gently with a towel. We can provide a soothing, moisture retarding ointment to apply to this area if control of stool or urine is a problem.

If waterproof underpads are used, ask the patient to turn on their side and change the underpads.  These should be changed daily, or more often if they become soiled.  Bed sheets should be changed at least once a week. This task usually requires two people.  Your nurse or home health aide can teach you the best way to do this.

Here are some tips about body cleaning:

  • If movement causes pain, wait about one hour after giving pain medication to bathe them

  • Ask the patient if you are rubbing too hard or too lightly. Everyone has a different sense of touch.

  • Provide privacy for the patient during the bath If the patient is in a hospital bed, raise or lower the bed to lessen the strain on your back

  • Do not use powders, except under the arms. Powders tent to cake in body creases. Instead sprinkle cornstarch lightly between the patient and the linens.

  • This is a good time to brush and style hair, shave the patient and do nail care.  For some patients, attention to their accustomed personal habits will help lighten their spirits and maintain their dignity.

Skin Care

Keeping the skin in good condition is one of the most difficult problems in caring for bed-bound patients.  Pressure sores (also called bed sores) often occur on patients who are confined to bed for a long time.  They typically develop on bony prominences: the coccyx, elbows, heels or hips. 

The following steps can be taken to help prevent pressure sores:

  • Explain to the patient the importance of turning frequently; at least once every two hours

  • You will have to turn patients who are unable to turn themselves. Your nurse or home health aide can teach you the best way to do this.

  • Provide pain medication as needed, so turning and positioning is more comfortable for the patient

  • Use pillows to help support the patient when lying on the sides

  • Keep the bed linens clean, tight and wrinkle free 

  • Gently massage and apply lotion around reddened areas at least twice a day

  • It is a good idea to check the skin for reddened areas each day while bathing.

Tell your nurse about any new areas or worsening of existing areas.  He/she will check them on the next visit.  There are devices such as eggcrate mattresses, air mattresses, heel protectors and elbow protectors to help reduce pressure.  Even with the best care, skin breakdown can occur.  Your nurse and physician will suggest ways to treat pressure sores to promote skin healing.