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Caring for the Patient With Limited Mobility

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

Page Two of Two Pages

Care For Elimination Needs (Urination and Bowel Movements)

There are several things you can do to promote regular and comfortable elimination for the person who is not ambulatory (as well as for someone who can still get around fairly well). For example, appropriate food and fluid intake, adequate intake of dietary fiber (such as fresh fruit and vegetables and whole grain products), rest and stress relief will all help. Other things to consider are:

Doctors frequently forget to inform patients and caregivers that the use of narcotic pain relievers, such as codeine and morphine, frequently causes constipation. Daily stool softeners can help to prevent this. Do not use strong laxatives or give enemas without medical advice, however, and never give them if your loved one is having bleeding or pain, unless a doctor specifically instructs you to.

Afford your loved one as much privacy as possible, even when assistance is required, to protect his dignity.

Observe and report any time he has not urinated or a catheter bag remains empty for 12 or more hours, and report the absence of bowel movements for more than 3 days in a row.

Provide careful skin care to genital areas and try to eliminate as many odors as possible.

Care For Unpleasant Symptoms and the Promotion of Comfort

Monitor the patient's comfort level and report any new or worsening symptoms to the doctor or home care nurse. Also observe whether the currently prescribed treatments are keeping the patient comfortable or are working as well as they have in the past. Signs that current pain medication orders are not adequate are (1) any period of time when pain is not well controlled and (2) the need for pain medication a long time before or consistently before the next dose is due.

There are several things to remember concerning promotion of comfort:

Only the person experiencing discomfort or pain can define her own symptoms and tell you how much is tolerable or is too much. She may have learned how to "look" comfortable in order to protect family and loved ones and yet be in severe distress, so you cannot tell from the outside what she is actually feeling inside. Encourage her to openly tell you, the nurse or someone else she trusts about her discomfort and emotional feelings. Relief is frequently possible, but only if you are aware of the problem.

Emotional concerns can affect and worsen her physical symptoms, so provide for open communication and support as many emotional outlets as possible. Also, remember that you, as caregiver, are under physical and emotional stress and need to monitor your own symptoms and level of well-being and to seek relief and support when it is needed. If you are ashamed of your own needs and feelings -- and are unwilling to express and share them, it is unlikely that you will be very helpful in supporting her to do the same for herself. Modeling behavior is often a far more powerful and effective teacher than any amount of words or lectures.

Care of the Environment

Sensory deprivation can result in extreme confusion for a bed-bound person. Here are some things you can do to control the environmental stimuli, an important but frequently overlooked type of care giving.

Keep a clock and calendar within the view of your loved one and remind him of the day, date and time on a regular basis.

Open the curtains so that day and night are apparent and allow fresh air into the room if possible

Always inform him of anything you plan to do with or for him and explain just what you are doing as you go along.

Offer to read to him, provide music and keep him updated on the news, family and community events, if he wishes to hear about these things.

Promote stimulating activities that he can easily manage.

Sensory overload, though, can also lead to confusion, irritation or exhaustion. Turn off the TV if you are going to talk to him and protect him from excessive noise and emotion, especially when he is unable to control these things independently. Hiding emotions is not the idea, but shouting disagreements in front of him between family members can only cause unnecessary distress.

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