Topic: 10

How to Help with Physical Needs?

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What You Need to Know

 

 

The Indigenous Wellness Framework identifies that physical wellness is expressed through a unique native way of being and doing and taking care of one’s physical body as the “home” of one’s spirit. It is how we behave and what we do that actualizes the intention and desire of the spirit world. As a result, physical wellness creates purpose.

(National Native Addictions Partnership Foundation, Honouring Our Strengths: Indigenous Culture as Intervention in Addictions Treatment Project - University of Saskatchewan. (2014). Reference Guide. Bothwell, Ontario: Author. Canadian Institutes of Health Research, Funding Reference Number AHI-120535.)

 

Physical needs can include:

  • Nausea and vomiting
  • Pain management (see Topic #12)
  • Trouble sleeping (Insomnia)
  • Loss of appetite and nutritional needs
  • Shortness of breath
  • Body odour
  • Skin breakdown or pressure sores
  • Changes in appearance (fluid retention, muscle waste, hair loss, skin discolouration)
  • Incontinence and Toileting
  • Constipation or Diarrhea
  • Helping people move around
  • Walking
  • Changing Positions in Bed
  • Mouth problems
  • Confusion
  • Inability to feed oneself
  • Increasing weakness

Information is provided below to help you with these physical needs.

Note: For more information on How to Give a Bed Bath and take care of a person’s personal hygiene issues See Topic 9.

Nausea and Vomiting

Nausea means feeling sick to the stomach and vomiting means throwing up. Nausea can happen even when a person is not thinking about food. Vomiting can occur even if nothing has been eaten or there has been no nausea. Many things can cause nausea and vomiting. These can include the illness, medications, irritation of the digestive system, certain foods, constipation, pain, bowel obstruction, infection, anxiety, movement, and some treatments.

You May Notice:

  • The person feels sick and is unable to eat.
  • They may vomit occasionally or often.
  • They may have trouble keeping down medication.
  • They are comfortable at rest, but feel sick with movement.
  • They may be sensitive to strong smells/tastes (i.e. cigarettes or cooking smells).

The cause can be discussed with the Community Care Team.

What to do:

  • Offer small amounts of food and fluids (broth, Jell-O, ginger ale, ice chips).
  • Try cold food as there is less odour.
  • Do not offer greasy or spicy foods. Try bland foods such as crackers, toast, angel food cake, soft fruits, and yogurt.
  • Cooking smells may trigger nausea.
  • Encourage them to take anti-nausea medication as required.
  • Freshen the mouth with a non-alcohol based mouthwash or club soda.
  • Always have basins close by and remove and replace immediately if vomiting does occur.
  • Fresh air from an open window or fan may help reduce nausea.
  • Help the person to rest sitting up, if appropriate, for a short while to aid digesting the meal.
  • Always work with the Community Care Team, regarding how often the person is experiencing nausea and/or vomiting.
  • Follow the Community Care Team advice on medications to manage the nausea and/or vomiting, and report frequently.

What to Report to the Community Care Team:

  • Increased vomiting despite medication.
  • Blood in vomit (may be red or coffee ground in appearance).
  • When medications are vomited.
  • Unusual weakness or dizziness, or the person is suddenly unresponsive.

Loss of appetite and nutritional needs

What you can expect?

It is understandably hard to watch those you and the family care for eat less than usual.

When a person is newly diagnosed with an advanced progressive illness, it is good to ask for early advice, information and direction on food and nutritional care. It also prepares you to know how an advanced illness can change and reduce appetite, taste, and weight as the end stage of life draws closer.

Depending on the person, and their illness, each situation will be different. Concerns about food and fluid need to be discussed and understood by the person, the caregiver, and the Community Care Team.

You may notice the person has no interest in foods, refuses solids, and will only drink liquids. There are commercial or homemade food supplements that may help at this time. These drinks and puddings can provide an easier source of calories and protein. Ask your Community Care Team for suggestions and what is available in your area.

Noticeable weight loss may be caused by their illness, no matter how much they eat. A changing sense of taste may alter the enjoyment of food. If it is connected to a treatment or medication, this may be temporary. They may not be able to eat meat or certain textures and smells of food may bother them. Even when eating and drinking is reduced, regular bowel patterns should be monitored.

How can you help with changes in appetite?

  • You should not force the person to eat. Do not discuss how much they are, or are not, eating.
  • Make sure the person does not have sores in their mouth, or problems with their teeth (such as decay or broken teeth), which may contribute to a person not wanting to eat. Let the Community Care Team know so the problem can be looked in to. If dentures are loose, have them relined or try Poly Grip.
  • Freshen and clean the person’s mouth before and after eating.
  • Ask the person what they would like and offer what they can tolerate. Try to make a pleasant, quiet, and peaceful eating environment. For instance, remove bedpans or commodes from the area. Keep cooking smells and noises as far away as you can manage if the person finds them bothersome.
  • Serve small portions of favorite foods that are soft and easy to eat.
  • Avoid spicy or salty foods.
  • Eating protein in any form should be encouraged. Milk and milk products, such as macaroni and cheese, cottage cheese, yogurt, baked custard, ice cream, eggnog, and milkshakes are good sources of protein. If the person has diarrhea from lactose intolerance, a good nutritional supplement may be necessary. Meat, poultry, eggs, and fish are also very high in protein. They can be stewed, creamed, or poached to soften them into a more easily digested form.
  • Each person will have different tastes for fruits and vegetables. Prunes and other fruits and vegetables can relieve constipation. Cooked vegetables (i.e. in soups) are soft and may be easier to eat. Fruit or juice can be added to milkshakes, custards, ice cream, and puddings.
  • Gravy and sauces may be added to food to make drier foods easier to eat.
  • Bread and cereals, like Bran, are helpful in preventing constipation. Crackers and plain cookies may be helpful if nausea is a problem. Get advice from your Community Care Team who may give medication to help.
  • Fluid intake should be encouraged. Clear soups, ginger ale, soda, and fruit juice are recommended. Tea can also be served. Care should be used with citrus juices (i.e. orange, lemon, etc.) as they may bother a person with mouth sores.
  • Ask you Community Care Team for assistance with sore mouth, difficulty swallowing, and if it is safe to continue to try feeding.
  • When the person can no longer swallow it becomes important to continue to gently care for them with mouth care and spending quality time with them.
  • Just as with reduced appetite, reduced fluid intake needs to be discussed with your Community Care Team for advice and suggestions.
  • Most dying people do not demonstrate that they feel thirst or hunger as the end of their journey approaches.
  • Making sure the person is comfortable includes mouth care (such as ice chips) or other suggestions from the Community Care Team.

Giving Help with Eating

Eating for a person with a serious illness can be very tiring and often they have no appetite.

What to do:

  • Keep the head of the bed elevated to help digestion.
  • Soft foods or small bite-size portions of meat, softened with gravy, are ideal.
  • The person may not remember to eat, but can be offered small snacks throughout the day.
  • Assess the person’s ability to chew and swallow before you serve solid foods. For someone who can swallow but cannot chew, a puree or pudding would be most effective. For someone who can chew, keep food pieces small so less energy is needed to eat. Refer to your Community Care Team to assess if it is safe to continue feeding.
  • If nausea becomes a problem, be prepared. Report to the Community Care Team and have a small basin or bowl close by, as vomiting can happen very suddenly.
  • Keep your Community Care Team informed about issues with eating (nausea, dry sore mouth, trouble swallowing, etc.) so they can advise on care plan changes.
  • Encourage the person to rest after meals.
  • Never force a person to eat or drink.

Reduced Fluid Intake

Fluids usually help to flush out a healthy body of waste products and keep cells and skin well hydrated. As the person’s condition advances it is often more important to focus on trying to drink some liquids to keep the mouth moist. Just as with reduced appetite, reduced fluid intake needs to be addressed, assessed, discussed, and understood by the person, you, and your health care team. Gradually taking less food and fluid is a common, natural part of the dying process. Most dying people do not indicate they feel thirst or hunger as end of life approaches.

How you can help with fluid intake:

  • Have drinks like water, juice, etc. available
  • Ice chips or popsicles are excellent ways to give fluids. Also, they help to keep the mouth moist and feeling fresh.
  • Raise the person’s head when helping to drink. Use a few pillows or gently support the base of the head with your hand. It is almost impossible to drink when lying flat.
  • Ask your loved one to take small sips and not big gulps to help prevent choking.
  • Use a short straw that bends if the person is strong enough to draw up the liquid through it.

Watch the video on How to Feed Someone Else
Sometimes a person will need assistance with feeding.

Trouble Sleeping (Insomnia)

Insomnia may range from trouble sleeping to being fully awake. At one time or another, most people who are seriously ill have difficulty falling asleep or staying asleep. This can be caused by anxiety, fear, sadness, or other psychological or spiritual concerns.

Physical problems such as pain, nausea, vomiting, and coughing may cause insomnia, therefore it is important to give any medication prescribed for these things as directed. Advise the Community Care Team if the person becomes confused at night, and if the caregiver is not able to sleep at night and is becoming tired.

How to help with insomnia

  • Allow the person to sleep whenever, and as much as needed, without staying to a schedule.
  • Provide warm, non-caffeinated drinks such as warm milk with honey before sleep.
  • Spend quiet times with the person, listening and talking.
  • Try to make the person comfortable. Close contact such as holding a hand, sitting or lying nearby on the bed may give comfort and allow the caregiver to rest as well.
  • Offer backrubs or massage the feet to help with relaxation.
  • As much as possible, provide a quiet, peaceful area.
  • Some people find various types of music helps.
  • Ask your Community Care Team for advice.

Shortness of breath, breathing difficulties

Breathing problems can be very frightening for caregivers. Anxiety can cause shortness of breath; shortness of breath can cause anxiety. Shortness of breath has many causes, including the illness itself. It can also occur when someone is not getting enough air/oxygen. This may be caused by anxiety, smoke from cigarettes, a smudge or from a fire. Call the doctor when a sudden onset of breathing difficulties occurs. Signs that a person is experiencing breathing difficulties:

  • Shortness of breath from whatever cause can be very frightening.
  • There may be large amounts of thick mucus that the person can or cannot cough up. Tell the Community Care Team if the mucus is yellow, green, or blood.
  • Respirations may sound moist and gurgling.
  • Breathing may be difficult when moving, talking, or even resting.
  • The nail beds, and the skin around the mouth, may look blueish.

Note: Not all of these signs have to be present for a person to be having breathing difficulties.

How to help with breathing difficulties

  • The goal is to make the person comfortable and minimize their feeling of distress. Whatever helps the person relax (i.e. relaxation exercises, music, etc.) may help ease tension and breathlessness.
  • Plan for frequent rest periods between events where some exertion is needed.
  • Remain close by, be calm, and coach the person into relaxing and breathing more slowly.
  • Create a breeze by opening a window or using a fan.
  • Avoid fragrances or scented products which can trigger a coughing or sneezing attack or cause shortness of breath.
  • Use a humidifier to moisten the air and loosen secretions so a person can cough them up.
  • Serve warm drinks with lemon and honey to reduce mucous.
  • Reposition the person by having them sit up with arms over a pillow or bed table or elevate the head of the bed to raise the upper body. Try a recliner chair for sleep as it keeps the body in a semi-upright position.
  • Loosen clothing and bedding.
  • If secretions cannot be cleared with a mouth swab, then ask the doctor for a medication that will dry up the secretions.
  • A cold compress placed on the forehead or cheeks will help to lessen the feeling of breathlessness.

Note: if the person describes the breathlessness as chest pain, always report this to the Community Care Team.

Managing Oxygen Therapy

Be careful! Any spark could ignite a flame or explosion. Do not use Vaseline as it contains petroleum which is flammable.

  • Be sure that the face mask is properly adjusted and in the correct position.
  • Turn oxygen off when not in use.
  • If the tubing is reddening the skin use a self-adhesive padding under the tubing.
  • Oxygen is not recommended at end of life unless the person has used it throughout their illness. If so, it can provide comfort.
  • If the tubing is irritating the back of the ears, talk to your oxygen provider about ear protectors.

Body Odour Problems

If the body is dealing with a serious health condition and the body’s liver and/or kidneys are struggling to process toxins then a body odour may result. In those cases, no amount of personal hygiene will take away the smell. Similarly, diabetes creates a condition called ketoacidosis which gives the breath a fruity smell and can cause a distinct body odour. IF the person is diabetic, consider it a medical emergency and call for help immediately. However, if someone is dying naturally there is no need to call 911.

Caregivers may need to wear a mask to help cope with the strong smells. However, doing so may upset the person.

Instead try one of these easy ways to mask odours:

  • Place coffee grounds in the room
  • Place a bowl of baking soda in the room
  • Use an essential oil diffuser
  • Open the window and let in some fresh air

Ensure the person receives frequent skin and oral care and clean bedding as often as needed.

Watch the video to learn how to change the bedding when a person is unable to get out of bed.

Aromatherapy

Aromatherapy is the use of essential oils of plants by inhalation using a diffuser or by applying to the skin. It may be helpful:

  • To promote relaxation
  • To alleviate anxiety
  • To reduce depression
  • To reduce pain
  • To reduce nausea
  • To alleviate physical symptoms
  • To alleviate side effects of chemotherapy
  • To improve sleep patterns
  • To reduce stress and tension
  • To alleviate psychological distress/provide emotional support
  • To improve well-being and quality of life
  • To live with altered body image

Ask at your local pharmacy where you could purchase essential oils and a diffuser.

Skin breakdown or pressure sores

When a person is seriously ill there may be changes in the skin that can be very uncomfortable, and lead to restlessness, anxiety, skin sores and infection. When you see red, tender skin over pressure points or in skin folds, dry itchy skin, rashes, open weeping sores or tears in the skin then you know that skin is breaking down.

Skin problems and skin breakdown can occur for a number of reasons including:

  • Immobility
  • Decreased nutritional intake
  • Changes in metabolism and a lack of repositioning
  • Sliding on the sheets which can cause tiny skin tears making people predisposed to infection
  • Old age which can lead to thin, fragile skin that is easily torn
  • Lack of oxygen to the tissue at pressure points leading to pressure sores
  • Yeast infections such as thrush in the groin area or under the breasts

Itching

Itching is an unpleasant sensation that causes a desire to scratch or rub the skin. Scratching can cause bleeding and skin sores. Common causes of itching may be things like: dry skin, allergies, side effects of medications, some treatments, etc.

What to do:

Check for areas that are red, rough, and flaky, especially at pressure areas (for example: tailbone, heels, and elbows). Observe for any widespread rashes.

Report to your Community Care Team any itchiness that does not stop after two days; any change in the person’s skin colour (i.e. yellow, grey), any areas that have been scratched and look raw; and/or any changes in the skin after treatments.

If there is a sore that is getting larger or has any liquid draining or smells foul, report to your Community Care Team.

Hints to calm itching skin:

Apply skin creams with a water-soluble base two to three times a day, especially after a bath when the skin is damp.

Use warm water instead of hot for bathing, as hot water dries the skin.

Add baking soda or bath oil to the bath water.

Wash skin gently using a mild soap. Do not scrub.

Use baking soda instead of deodorant under the arms.

Keep nails clean and short.

Choose loose clothing made of a soft fabric.

Avoid scented and alcohol-based products on the skin.

Use gentle laundry detergents.

How to help with skin difficulties

  • Establish a schedule so you can remember to reposition the person every 1 to 2 hours by lifting them with a turn sheet or slider sheet.
  • Add a foam pad on top of the mattress.
  • Use pillows or sheets to pad bony prominences. Put a pillow between the knees and ankles when the person is lying on their side.
  • Gently massage hips, heels, and the person’s tailbone with a moisturizing lotion.
  • Keep all linen wrinkle-free and dry.
  • Give a gentle bed bath. (See Topic# 9)
  • Use flannel towels as they are softer than terrycloth towels.
  • Wear gloves so your own rough skin isn’t hurting the person.
  • Report skin changes to health care providers.

Bed Sores (Pressure Sores)

A bed sore develops when blood flow to an area is stopped and the tissue in the area dies. Sores are made worse when a person is spending more time in bed causing pressure to certain areas, or when the person rubs against the sheets, or is pulled against the sheets, causing friction. Skin that is irritated because of contact with urine or bowel movements is at risk for breakdown. They are very difficult to heal in the seriously ill once they start. Pressure sores usually happen over bony areas. A regular back rub promotes blood supply to bony areas and can be relaxing as well.

Things to watch for:

  • Red areas on the skin that do not go away.
  • Cracked, blistered, scaly, or broken skin.
  • Pain at the pressure points.
  • Any staining on clothing or sheets that may indicate oozing from a sore.

What to do:

  • Encourage the person to move about and help them change position in bed often.
  • Protect pressure points with pillows.
  • Ask advice from your Community Care Team about such things has heel pads and elbow pads.
  • Check in your area with your Community Care Team about the availability of special mattresses that reduce pressure areas.
  • Lift, rather than pull, the person when changing positions.
  • Check the skin for any reddened areas. Keep the skin clean and dry.
  • Massage the back and areas of pressure with lotion after each turn using soft pressure and moving your hands in a circular motion.
  • Use pillows to support the person in different positions.
  • As much as possible, keep the bed sheets dry and free of wrinkles.
  • Change the bed immediately and clean the skin if the person has urine or a bowel movement on the skin.
  • If the seriously ill person is still eating, high protein foods will help nourish the skin.

Watch the video to learn how to turn a person safely in bed.

Traditional Comfort Measures:

  • Bear grease can be applied to skin
  • Milkweed (sesab)
  • White Spruce – used for skin eczema (no need to boil)
  • Singe the rabbit skin and rub on skin to get rid of itchiness

Always offer tobacco before picking and when the picking starts, go from the EAST and pick clockwise. Use the bark of the trees – ash, choke cherry, Saskatoon, pin cherry, thorn bush and alder. Boil about a gallon. The lotion turns into a jelly.

Changes in Appearance

Swelling is caused by extra fluid in the tissues or abdomen which will cause feet, lower legs and hands to swell. Swelling happens often in seriously ill people with advanced cancer, and end stage heart, lung, liver, and renal diseases. There are a number of reasons why this happens and the Community Care Team will decide the treatment depending on the cause.

Things to watch for:

  • Feet and lower legs swell when the person sits, stands, or walks.
  • Rings too tight for fingers or a tightness in the hands when making a fist.
  • The abdomen looks distended or blown up. Pants feel tighter.
  • Shortness of breath.
  • Your fingers leave marks in the swollen area.
  • Report to the Community Care Team if any of the above are present.

How to help with swelling

  • Elevate the feet when the person is sitting in a chair or lying in bed.
  • Massage the swollen areas to help fluid to be absorbed.
  • Follow any advice from the Community Care Team.
  • Encourage bed rest

How to help with muscle loss

Loss of muscle strength can occur as a result of illness and/or from prolonged time spent in bed which will require that you provide extra help with walking, dressing, and getting in and out of bed.

  • Reassure the person that you don’t mind helping them
  • Recognize that the person may feel frustrated at how weak and tired they feel
  • Use a bell or baby monitor so you can come quickly if needed
  • Rent a walker or wheelchair if needed

Incontinence

Loss of control of the bowel and bladder is so common that there are several products on the market now that can help.

Considerations:

Skin breakdown is a risk with contact with urine or bowel movement. Clean and dry skin is very important in preventing this breakdown. Use of incontinent supplies will help keep the bed dry and assist in preventing pressure area breakdown. Ask your Community Care Team for advice.

Water-repellent creams such as zinc oxide can be applied to help as well. Ask advice from your Community Care Team.

If a person who is seriously ill is often incontinent of urine, a catheter may be helpful in preventing skin breakdown. A catheter is a tube put in the bladder so the urine can drain into a bag.

When the person has a catheter, be sure to wash the area where the catheter enters the body with soap and water and pat dry. Your Community Care Team will show you how to care for the catheter bag, tubing, and how to empty the drainage bag.

What to report:

  • If there is leaking around where the catheter enters the body.
  • If the urine becomes cloudy, has an offensive smell, or the person develops a sudden fever. These could indicate a bladder infection.
  • If there is blood in the urine.

How to help with incontinence

Incontinence garments like StayfreeTM, DryPlus, TM AttendsTM, PoiseTM, will help keep sheets clean and dry. Change the garment often. Use a zinc oxide cream to help prevent sore skin.

Note: Be sure to wear gloves or wash your hands with warm soapy water each time you assist with incontinence garments.

Watch the video to learn how to use change incontinence garments.

Constipation

Constipation means infrequent stools or stool that is difficult to pass. Constipation is caused by not drinking enough, not eating enough, not eating enough fibre, not getting enough physical exercise, and gut slow-down due to opioid-based pain medication. Bowel changes, such as constipation, must be reported to, and assessed by, the Community Care Team who will make sure there is no obstruction in passing of stool. Tell your Community Care Team if there is blood in or around the stool, no bowel movement for three days (or within one day of taking a laxative), and if there is persistent cramping or vomiting.

Stool is still produced even when the person is not eating. Constipation is uncomfortable and may cause serious problems. Keeping ahead of it through prevention is very important. Stool may be dry and painful to pass. The person may have large amounts of gas, burping, or feel sick to the stomach. There may be pain in the abdomen. What may appear to be diarrhea, may in fact be small amounts of runny stool escaping around the hard, constipated stool. The person may have small hard bowel movements, but not enough stool to correct the constipation. Headaches and possibly confusion may accompany constipation. The person’s abdomen may look blown-up or bloated. If there is no bowel movement in three days, it is important to tell your health care provider so they can adjust the medication, order a suppository or an enema. Follow the Community Care Team’s direction regarding enemas.

How to help with constipation difficulties: Note that most of these suggestions are inappropriate in the final days of a person’s life.

  • Have the person drink several (8-10) glasses of water each day. However, at end of life this intake becomes unrealistic and could cause distress. Often people take only ó cup per day in the final days of life.
  • Gradually add more whole grains to the diet (Natural fibre recipe: 1 cup All Bran; 1 cup apple sauce; ½ cup prune juice. Mix together to soften the All Bran. Eat by the spoonful and drink lots of water. Could be spread on crackers or toast if the person is able to eat it.)
  • Offer a hot drink in the morning and drinking vegetable juiced may be helpful
  • Encourage walking, exercising in bed
  • Avoid chocolate, cheese, eggs
  • Monitor bowel movements and observe for abdominal swelling and pain due to constipation. Have a nurse give a suppository.

Diarrhea

Diarrhea is the passage of loose or watery bowel movements three or more times a day. There may or may not be discomfort. Causes of diarrhea include infections, some medications, treatments, etc. and sometimes the disease itself.

Considerations:

  • Certain foods may make diarrhea worse while others may slow it.
  • Diarrhea may cause dehydration and upset the body’s balance of electrolytes.
  • Report to the Community Care Team if there are six or more loose bowel movements more than two days in a row.
  • If you notice blood in or around the stool, tell the Community Care Team.

How to help with diarrhea

  • Avoid foods that irritate the person’s stomach.
  • Very hot and very cold foods can trigger diarrhea.
  • If the person is eating, choose foods that are high in protein, calories and potassium. Ask for advice.
  • If they are able to drink, increase fluids and aim for eight to 10 glasses of fluid a day.
  • Serve a variety of drinks, as well as water.
  • Try frequent small meals.
  • Make sure to protect their skin to prevent breakdown.
  • Use protective pads on the bed.

Mouth problems

Mouth problems can have several causes including:

  • Dehydration
  • Fungal infections such as thrush (Thrush commonly occurs in people who are seriously ill. It can be caused by medications or treatments such as radiation.)

What to watch for:

  • Complaints of sore mouth, scratchy sore throat.
  • Hoarseness and problems swallowing.
  • White, curd-like patches on the tongue, roof of mouth, inside cheeks, lips and back of throat.
  • The tongue may look swollen and red.

Note: Thrush can spread to others. Avoid kissing the person on the lips or sharing utensils if you suspect thrush.

  • Open sores (Mouth sores are like little cuts or ulcers in the mouth. Chemotherapy, radiation, therapy, infection, limited fluid intake, poor mouth care, oxygen therapy, too much alcohol or tobacco use, and some medications can cause them.)

What to know:

  • Mouth sores can be very painful and interfere with eating and drinking.
  • The inside of the mouth, gums, and tongue may look red, shiny, or swollen with sores that may bleed.
  • There may be blood or pus in the mouth.
  • The mouth may be coated and look white or yellow.
  • Eating food may cause dryness or mild burning and sensitivity to hot or cold.
  • There may be difficulty swallowing.

 

  • Cracked lips
  • Poor-fitting dentures (refusal to wear dentures)
  • Decaying teeth (tooth pain)

How to help with mouth difficulties

• Keep the mouth clean and moist (Dry mouth may occur in a person who is seriously ill if they are not able to drink their normal amount. This may happen with nausea and/or vomiting or because of some medications. Because they are not able to eat or drink their regular amount, saliva may dry up. Mouth breathing is common in a person who is seriously ill and can cause dry mouth. Dry mouth can be a source of discomfort for a person and may be described as a dry mouth or a bad taste in the mouth. The tongue may be red and coated and the lips may be dry and cracked.)

Some suggestions:

  • The most helpful thing you can do is keep your loved one’s mouth clean and moist, to help it feel fresh.
  • Try to keep a bowl of ice chips by the bed. Even if the person does not want or is unable to drink, suggest sucking ice cubes to moisten the mouth. Remember: Use a very soft toothbrush. Do not use mouth wash containing alcohol. Do not use dental floss. Tobacco and alcohol can make mouth sores worse. Avoid hard foods like crackers or potato chips.)

 

  • Remove dentures before cleaning the mouth and clean the dentures using a denture cleaning product; the doctor may prescribe a medicated cream to rub on the gums under dentures
  • Treat cracked dry lips
  • Provide frequent sips of water as tolerated or use a spray bottle
  • Provide oral care as frequently as every two hours and certainly after waking, after each meal, at bedtime
  • Have the doctor prescribe a medication that is swished in the mouth then swallowed if needed for thrush
  • Use an alcohol free, gentle mouthwash
  • Check for advice from your Community Care Team. Report if the person’s mouth looks different or there is a change in taste or sensation.
  • Do mouth care after eating and frequently through the day, as tolerated.
  • Check mouth often with dentures (if present) out.
  • Rinse with any of the solutions suggested in the section on mouth care.
  • Offer small, frequent, cold, non-spicy, bland meals as the person tolerates.
  • Try chilled foods and fluids (popsicles, ice cubes, frozen yogurt, sherbet, or ice cream, if available).
  • Avoid citrus fruits and juices such as oranges, lemons, limes, and tomatoes. Although they may seem to moisten the mouth, they actually have a drying effect.
  • If mouth sores are severe, and dentures are present, leave them out except when eating.

Comfort Measures for Thrush Infections

  • Medication obtained from a health care provider, i.e. Mycostatin
  • Clean the mouth by rinsing with mouth wash or plain water after eating
  • White patches can be gently removed with a soft toothbrush when they become loose
  • Soak dentures overnight in full strength Listerine, rinsing before they are put back in the mouth.

Signs that Mouth Care is Helping

  • Mucous membranes are pink and moist
  • Mouth is clean
  • Thrush patches decrease in size and number
  • Mouth discomfort subsides

 

 

CAUTION:

  • Always use an ultra-soft toothbrush as hard brushes can damage gum tissue
  • Avoid commercial mouthwashes that contain alcohol as they can cause further dryness.
  • Do not use dental floss as it can cause gum tissue damage.
  • Avoid hard foods like raw carrots, citrus juices such as oranges, lemons, limes, tomatoes.
  • Be very careful with toothettes in people with dementia or confusion as they can be bitten off and cause choking. Use a soft toothbrush instead.

Watch the video to learn how to do mouth care.

Three Easy Recipes for Mouthwash to Make at Home

 

Confusion

A person who has trouble thinking and acting appropriately or has disturbed thoughts is said to be confused. A person who is seriously ill may become confused due to the illness, infection, a side effect of  edications, decreased fluids, or during the final days. Confusion may start slowly and progressively worsen leading to short term memory loss, poor concentration, decision-making difficulties, seeing and hearing things at night that aren’t happening. Similarly, the person may demonstrate anger and become fearful for no obvious reason.

Tell your Community Care Team if you notice the start of confusion and ask if anything can be tried to help.

What to know:

  • Understanding how a confused person might act may help you to feel less anxious.
  • Confusion starts very slowly and can look like poor concentration, being unable to make decisions, loss of memory, etc.
  • The person may feel like they are losing their mind.
  • A confused person may become restless and move about in a random fashion.
  • Confusion and restlessness is sometimes thought to be pain.
  • The person may hallucinate (see or hear things that are not real), particularly at night.
  • The person may or may not be aware and disturbed by the confusion.
  • Confusion may be expressed as fear or anger.
  • Confusion may move slowly or very quickly.
  • Seek guidance from the Community Care Team.

How to deal with confusion

  • Start with them and where they are at.
  • Watch the person carefully and protect the person from harm. Be aware that trying to correct the confusion or hallucinations may cause more agitation.
  • Remind the person who you are frequently.
  • While talking to the person position yourself so that you are face to face turning off the background noise from the television or radio.
  • Keep the calendar and clock in view of the person so they can feel oriented.
  • Do not leave the person alone for prolonged periods of time.
  • Talk slowly and quietly using short statements.
  • Be sure to keep the medication out of reach and bring it to the person yourself rather than having the person self-administer their own medication.

Ask for help if:

  • Confusion occurs very suddenly or becomes worse.
  • The person becomes violent or agitated.
  • You or the person themselves are hurt physically because of the confusion.
  • You are tired and need relief.

Watch the video on how to make a bed with someone in it.

Watch the video on how to transfer a person from a bed to a chair and chair to a bed safely.

Increasing Weakness

Changes in energy level and strength usually happens over weeks and months, but it can also happen fairly quickly over a matter of days. As the person gets weaker, you will need to change the way you do things. For example, using equipment such as a walker or wheelchair can provide safety and make care in the home easier.

You may notice the person tires more easily, needs to nap more often, and may need more help to walk, bathe, or dress. The person may tire more easily with activity and may have shortness of breath when moving or talking. They may become anxious and frustrated about these changes.

What to do:

  • Give reassurance.
  • Alert the Community Care Team about the changes.
  • Ask the Community Care Team for help with easier ways of doing things for the person.
  • Provide time for rest before and after activities.
  • Make sure the person has a way of calling for help (a bell to jingle).

 

 

1. Read this scenario.

Joe is an 85 year old man who is recovering from heart surgery. Prior to the surgery and to the few months leading up to the surgery, he was extremely active and social. His recovery is taxing to him and his caregiver because he isn’t sleeping well at all. Joe is an avid reader and has a few books on the go at one time. He is having difficulty concentrating on his reading which he thought going into the surgery would be the one thing that he could manage to make the time pass. When Joe awakens at night he often feels disoriented which causes anxiety.

2. You would like to change up the bedtime routine to see if Joe can get a better night’s rest. What would you suggest? Jot down some strategies before checking the sample response.

Sample answer:

Try reading to Joe in the evening before he falls asleep. Try suggesting to Joe that there be three sleep breaks in a 24 hr. period rather than just one long one. Establish times for those sleep breaks. Keep a light on at night nearby if Joe does week so anxiety and disorientation may be lessened.  

 

ADDITIONAL RESOURCES

Use these additional resources to learn more about the topic of helping someone with their physical needs.

The Relationship between Mental Health, Mental Illness and Chronic Physical Conditions
https://ontario.cmha.ca/documents/the-relationship-between-mental-health-mental-illness-and-chronic-physical-conditions/