Home > Stages of Life > Facing the End of Life Together

Caring for the Patient With Limited Mobility

By Barbara Barbero, M.A., R.N.

Page One of Two

As the need for care at home grows, care will become more complex. In addition to physician ordered care, however, there are other care needs which physicians sometimes forget to inform you about. Fortunately, a hospital, home health or hospice nurse can teach you precisely how to do each of these things in ways that will be most comfortable for the patient and safest for you. Also, it is necessary to learn skills, such as proper body mechanics, in order to protect your loved one from injury and yourself from damage to your back or other joints.

As you take on the role of caregiver for someone whose movement is very limited, the following are some important things you can to learn to do:

Skin Care

Often overlooked until a serious problem occurs, proper care of the skin is critical. Anyone who is chronically ill is at increased risk for skin breakdown. This can be due to decreased nutritional intake, mobility and activity, impaired circulation, impaired functioning of the immune system, decreased blood cell and platelet counts resulting from chemotherapy and radiation therapies, and the disease itself. Intact skin is one of our body's major defenses against infection, so when skin breaks open, if the wounds are neglected, severe and even deadly infections can develop more rapidly than you might imagine. Here are several things you can do to protect the skin:

Keep the skin clean and dry. In addition to daily bathing (if necessary, given in bed with a sponge bath) carefully observe and cleanse with special care all entry sites for tubes, catheters and ostomies according to the doctor's or nurse's instructions. You also need to pay extra attention to what are called "bony prominences"; these are the unpadded areas of the skin and are found at the back of the head, the shoulder blades, elbows, wrists, pelvic and hip bones, tailbone, sides of the knees, ankles and heels.

Protect all the skin areas which don't have much fat padding under them from pressure, rubbing and scraping. Assist your loved one to change positions in order to transfer pressure from one site to another at least every two hours. A totally bed-bound patient also needs to be turned from side to side every two hours as much as possible. Whenever positions are changed, inspect the pressure areas. If they are pink, massage gently around the outside of the pinkness to increase the blood circulation to that area. If any of these areas become permanently dark pink or red and do not return to a normal color within an hour or so after the position changes, notify your doctor or home health nurse. Also report any areas where the outer skin layer has opened.

Home health nurses can provide you with sheepskin protectors for areas at risk and show you how to use them. Preventing skin breakdown is always easier than treating it and treating early skin breakdown is more effective than trying to heal a deep and infected wound.

Even with the very best care, however, some people will develop pressure sores ("bedsores"). When this happens, report it and follow instructions for treating the area. Don't allow yourself to feel guilty.

Promoting Deep Breathing

Good breathing brings necessary oxygen into our lungs and cells and allows us to get rid of carbon dioxide and other wastes from our cells and lungs. Unfortunately, the respiratory system can be impaired by all the same things that can cause skin breakdown. In addition, severe pain and other symptoms can prevent a person from breathing deeply and fully. Nurses in hospitals are taught how to assist a patient to turn, cough and deep breathe (TCDB) approximately every two hours. You can learn to do this the same way at home.

Here are some simple things you can do to help your loved one breathe more easily and greatly decrease, or even prevent, the chance of pneumonia developing, which can happen if the lungs become sticky and stiff.

Being turned, changing positions, getting out of bed, walking and exercising (whatever level of movement your loved one can tolerate) increases blood circulation, which in turn carries oxygen through his body and helps to loosen any fluids or secretions which might be stuck in his lungs.

To help him get secretions out of his lungs, make sure he gets adequate fluid intake and encourage him to cough and to breathe deeply to expand and empty his lungs completely. This will allow him to take in the greatest amount of oxygen, exhale the greatest amount of waste and lessen the chance that his lungs will become sticky and stiff.

When he has difficulty breathing or becomes fatigued with the effort, raising the head of the bed or propping him up on extra pillows may help. If you have a table that extends over the bed, put pillows on it and place it in front of him when he is sitting in bed or in a chair and allow her to lean forward and rest on the pillows. This will help her breathe more comfortably and with less effort.

Always report significant changes in breathing ability to your nurse or doctor.

Nutritional Care

Sufficient nutrients help us maintain weight and promote optimum health. Cancer patients, however, often have difficulty eating due to pain, nausea and vomiting, weakness, emotional factors, loss of appetite and other symptoms of the disease or its treatment. You may not be able to solve this problem entirely, but there is much you can do to help.

Promote comfort as much as possible, including giving pain or nausea medication (if it has been ordered by the doctor) approximately 30 minutes before mealtimes.

Eliminate odors and distractions, making the environment as pleasant as possible (perhaps by adding a flower to a tray, opening the curtains, or putting on soft music).

Prepare small, appealing meals which are easy to chew, swallow and digest (if she has difficulty with this). Large meals can be exhausting, but small meals require that you pack as much protein, calories and other quality nutrients into them as possible at each serving. For example, a teaspoon of peanut butter or adding Instant Breakfast mix and ice cream to milk can pack a lot of nutrients into a small amount of food.

Prepare to serve feedings when she is rested.

Vary textures and colors of foods when possible and serve them at the temperature she prefers.

Many people prefer company when they eat, so sit or eat with her or try to arrange for someone else to do so whenever possible. Don't, however, engage her in much conversation when he or she is trying to eat. Attempting to breathe, eat and talk all at the same time can be very fatiguing, or even impossible for a very ill person. You may also find it restful for you to become a quiet, rather than a talking, presence.

Remember, though, that despite your best efforts, she may be unable or unwilling to eat adequately. Never try to force her to eat against her will. This infringes on her rights and offends her dignity.

CONTINUED on Page Two

© Copyright 1997, CancerOnline