Showing posts with label ADLs. Show all posts
Showing posts with label ADLs. Show all posts

Thursday, May 24, 2012

Embracing Those Who are Different Than Us

Back to my blog home page: http://travelingotr.blogspot.com

I pull the chart to do a review prior to the evaluation. Embedded way back near the last page of the records sent by the hospital in the middle of the PMH (past medical history) is a diagnosis of mental retardation.


Hank has been in the building twice before  and has rehabbed home both times. I ask a coworker, "Do you know Hank? There is one little diagnosis mentioned once, but nowhere else!"

"Yep." He confirms the diagnosis. "He is married and they live in a community with a group of folks who are mentally retarded...but they get married, have kids, work and get support from the community."

My memory immediately reverses to 1993 when I was working with adults with developmental disabilities in group home and community settings while I was in OT school.

I absolutely loved working with these joyful people!

I also remember the discrimination they received. I remember the uncomfortable stares when I would lead a group of five or six adults with mental retardation to the movie theatre or even through the airport to pick up a fellow client who had spent the holiday with family outside of town.

There was not always a lot of this:


Why do people
have difficulty
embracing those
who are
different from them?

There are philosophical and ethical discussions all over classrooms and the internet discussing whether people with mental retardation should be able to marry and have children. When I was working with this group, there would occasionally be discussions on the rights of clients within our organization and about how to handle sticky situations related to dating, sex and marriage. There was not cut and dry answer. Every situation had its own set of complexities.

Anyway, in I go to Hank's room after lunch. I knock on the open door. He is sitting with his back facing me, a frail, thin man with sagging shoulders and a bony face, but I can tell he is absolutely precious the moment I lay eyes on him.

I hear rustling in the bathroom. The bathroom door is wide open. Someone is peeing! I don't have to ask who. I stand at the doorway so I give his wife privacy. I hear the toilet flush, but no water running in the sink. Out walks the sweetest little lady with a head full of messy gray hair and a cane.

"Hi, there!" After introductions, " Did you by chance wash your hands?"

"Sure did."

A few minutes later when I go in to set up Hank up for ADLs, the sink is dry. Oh, well...on come the gloves.

I spend the next hour learning about Hank and Marta. They have been married for 59 years, have three adult children all working jobs and contributing to society. They respect each other in their communication. They demonstrate the nuances of a couple who have taken care of each other for many years. They reach out with familiarity to finish what the other could not, like Marta instinctively buttoning Hank's sleeves.

We are talking about his medical history when Hank reveals, "...and they put in a spacemaker."  He is patting his collarbone area on the left side.

On my paper, I note, "pacemaker," all the while thinking, "I am going to love working with this man." He is so earnest.

Their daughter comes in before the treatment is done. Many years ago, people would have said that she is "not quite right."

You know what? She is just right. She is outgoing, funny, loving to her parents and contributing to a better society.

I have to admit something. When I was a senior in high school, our National Honor Society hosted a Valentine's Party for the state school students, students with severe retardation and physical disabilities.

I was terrified.

I had not yet come to understand they they are beautiful souls, just in a different body and mind than in what we arrived onto this Earth.

What I know now is how deeply we are all connected. We are all here to take care of each other. It doesn't matter what color, creed, religion, socioeconomic status or intellectual level.

Let me say it again!  We are all here to take care of each other. And that means encouraging every person to shine their own individual light, their I Am essence, as brightly as they can.

Tuesday, April 24, 2012

Bathing Whimsy

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The patient I wrote about yesterday?

Eva looked like a different person today. Honestly, I was dumbfounded at how much she had improved since yesterday. I have to give credit where credit is due - I have to believe divine intervention played a part. It was too much of a turnaround to be chance or meds or anything other than what it was.

Anyway, this morning I introduced Eva to a leg lifter. It's used primarily following hip surgeries to help lift the leg when you're getting in and out of bed.


Eva sat on the edge of the bed without assistance and began a bed bath with a pan of soapy warm water. She did great! Of course, she couldn't reach her feet (gotta be careful about bending!). I assisted, and she did the rest.

As she worked her way toward the middle of her body, she started to tell me a story.

"When I was a little girl, my mom used to say,

Wash down as far as possible,

then wash possible."

I paused a second before it sunk in. Then I began to laugh.

I had never heard that before! What a kick! That was my whimsy for the day. I learn something new every day, and today that was it. A new description for that part of the body.

When I told Stacie, the COTA, she had heard it before. In fact, she could add to the story. One of her patients (this must be a Kansas thing) had told her that Loretta Lynn had sung about this....

Of course, I tried in vain to find the song to include it in the post, but no luck.

Do any of you know more of the story? Send it if you do!

Monday, February 27, 2012

What Can Come Out of Your Mouth

Back to my blog home page: http://travelingotr.blogspot.com

WARNING:
IF ANY OF YOU HAVE SENSITIVE STOMACHS, DO NOT LOOK AT THE PHOTO IN THIS BLOG ENTRY...

We received a new, quite debilitated patient who was transported four hours from the nearest "big" city. Whitey had been in a top rated nursing facility, the kind that looks like a five-star hotel.

The rehab staff had given up on making progress with him, as evidenced by their therapy notes.

I completed Whitey's chart review and asked myself what I could do to start the process with this guy. What could I do to help him progress steadily so that he could go home with his family?

I went to Whitey's room and immediately heard the sound of a feeding tube at work. The bag of enteral nutrition hung on a pole at his bedside, and I could hear the hum of the machine delivering it to his stomach.



I introduced myself. Whitey opened his eyes. He was "there," but I couldn't understand a word he was trying to tell me. His voice was muffled. His lips were dry.

I immediately realized I needed to check out his mouth. After all,

O.T.s = ADLs
(Occupational therapists = Activities of Daily Living = brushing teeth)

"Let's start with your mouth. I need to moisten your mouth and while we're at it, it would be good brush your teeth. I'll help."

I got the supplies together and put them on his tray.

"Whitey, please open your mouth."

Crooked, brown teeth. Many were missing on the sides, but there were teeth intact in the front and back. I handed him the brush mixed with water and mouthwash. He had been cleared during a swallow study to drink water in the presence of the nurse or the therapist.

He was able only to do a little. My focus shifted from attempting to have him do the whole task to having him hold up his head in neutral. He was so weak that he had difficulty holding his head in neutral and brushing his teeth at the same time. His head kept lilting to the left.

This was an opportunity to strengthen the neck and trunk.

I began flicking at those teeth with the brush. I really should have worn a pair of goggles.


What I had thought were brown teeth were really shiny white teeth covered with a slime of (don't gag) tube feeding and yellow/brown/green phlegm.

I methodically flicked the brush into the crevices of Whitey's teeth until the front teeth were pretty clean. Not bad!

Then...

I started on the sides. By this time, I was pulling out solid yellow green clumps. (I know, this is really gross.)

When I got to the inside of the roof of the mouth, I found brownish buildup all around the base of the teeth...

What the heck??

I kept flecking the buildup with the brush, alternating with brushing until a small section peeled away from the tooth. "Oh, my gosh, I thought! I am going to have to reach in and pull it."

That is what I did.

I nearly gagged.
I kept pulling.
He began to gag.
I just kept pulling.

And finally...off the roof of Whitey's mouth came a thick, hard, brownish yellow shell of old snot and feeding tube that had not only covered the whole roof of his mouth, but that had been growing down into his throat.




I almost came undone.

No wonder no one could understand him!

The moment that whatever-it-was (a plug??) was pulled out, Whitey's speech could be clearly understood.

In 16 years I have seen nothing like it. I can do blood, wounds and most bodily fluids, but I cannot do phlegm. I felt weak. I can only imagine how he felt!

What do I think about this?

 Even the "best" nursing facilities don't always give the best care. Every person on a G tube needs oral care throughout the day, not just twice a day.

If you have a family member on a tube, check your loved one's mouth.
If you are a caregiver, check your patient's mouth.

You never know what can come out of the mouth...

Thursday, January 12, 2012

Grand!

Back to my blog home page: http://travelingotr.blogspot.com

My assignment should have ended tomorrow. 18 weeks. I can't believe I have been here 18 weeks. (I've extended until the end of March!)

I remember my first week here.

The noise from the residents with dementia was overstimulating. The well-meaning staff had not been trained how to deal effectively with behaviors.

Remember this little chicklet at the Royal Wedding?  This was how I felt, too, for the first few weeks of this assignment!




I'm happy to report that it's gotten much better.


In fact, if you review the blog I linked to above, you'll remember the tiny  lady, Lizzie, who cruises her wheelchair down the hall singing, "Dum dum dum dum dum" and "By by by by byyyyy."

Nonstop!

The most curious thing happened with her. I sat at her table the other evening when I was working with her tablemate on another ADL (activity of daily living), feeding. I started talking with her, and she could hold quite a conversation.

I realized something...I had not given her the benefit of the doubt!

I had simply resented her for making noise.  I had not made the attempt to figure out what made her tick. I had made no connection with her until now.

After that dinner, she recognized me when I passed in the hall. I stopped and greeted her, held her hand for a moment several times this week. I realized yesterday that her behaviors have curbed quite a bit over the last month or so.

Until tonight.

I was trying to get the heck out out of the building in 8 hours! (Isn't every SNF like a black hole?!) I was banging out my billing and daily docs on Casamba when I heard her singing down the hall. The sound was getting closer and closer. I knew she was headed to the exit door, and I prayed to God she wasn't going to set off the alarm!

 

Instead of heading straight toward the alarmed door, she wheeled right into the rehab department toward me.

"Well, Lizzie! How are you?"

I gave up all hope of leaving quickly. She had the sweetest smile on her face. I asked her about dinner. She told me she had a lovely dinner with her family even though I know she had been in the dining room with all the other residents. She talked about her son and the rest of her family.

Finally, I told her I needed to get the paperwork done so I could leave. "It's been so nice to see you!"

I really meant it.

She took my hand and stroked it. (I just love those tactile little old ladies.)

"You're a grand person..." and she lifted my hand and kissed it.

I've had people compliment me, but I've never had anyone tell me that I am grand.

She melted my heart.  Really.

She made my day.

Wednesday, January 4, 2012

Unexpected Admiration

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Happy is a WWII vet, long, lean, with usually sad eyes and a gray five-o'clock shadow. He gets around with one foot pushing his high back reclining wheelchair and makes his way from one end of the building to the other several times a day.

He stops in regularly to find out when "he is going to walk again."

I wish I had known him after his stroke; maybe we could have done some good neuromuscular re-education (layman-speak: making his muscle tone normal to retrain movement after a person loses movement in their limbs).

Now, it's been too long;  this lovely place did not have a therapy team in place when he moved here years ago. His knees have contractures, and he can't straighten his legs.

I am in the building late tonight, working on evening ADLs (activities of daily living) which include the residents' regimens for getting ready for bed after dinner.

Happy wheels down Station One and holds out his hand. I take his hand and lean down. He is hard of hearing. He looks up and starts to speak.

Out comes his sweet, soft Southern accent, foreign on the northern California coastline:

"Did you ever see someone
and get a passion for 'em?
There's no law against that,
is there?"

Then, I realize he means me. And I smile back at him,

"No, Happy, there's no law against that."

Friday, December 23, 2011

Yogi Tea's Advice of the Day

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I had intended to work today; my body instead imposed a sick day.

Really! I did a lot of one particular ADL (activity of daily living) this week with my patients....ask any OT, and they will tell you that "toileting" is the least favorite part of their job!

So, guess what problem I may be having? Suffice to say, during this first week of winter season, that I am having symptoms of the flu...

To aid in the calming of my nausea and other less than delightful symptom, I reach for my Yogi Tea.

Thought it very fitting today to see this on the tab:


I assume that Yogi Tea may have been referring to the practice of meditation here, but I was thinking about something else...

Last night, I had read a post on a website for travel healthcare professionals that a particular traveler was having a difficult assignment. She was working in a facility with a lot of dementia patients. Like me. She felt as if she could not make it through the 13 weeks there.

When I read the tab, I thought about her, "Yes, you can  -  you can do it! Just follow these directions...."

Actually, I think if we follow these directions for everything in life, we'll be quite okay.

Don't you?




Sunday, October 9, 2011

The Many Ways Men Shave

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I am standing at the sink with an 82 year old gentleman this morning working on ADLs (activities of daily living) , specifically grooming (brushing teeth, combing hair, shaving). Albert starts applying shaving cream to his face with slow, deliberate movements using his right fingertips. During the wait, I watch him as he smears his cheeks, moustache, and chin. Then I notice him turn his right hand over, squeezing Barbasol onto the outer center of his index and middle fingers before bending them to wipe up his neck. Pretty adaptive, since he has trouble bending his head back!

So, this shaving thing....in almost 16 years of practice, I have come to find it pretty interesting! Shaving is one of my favorite ADLs. I love to do touch up! I have a firm but gentle hand and know how to pull the neck skin up over the jawline perfectly to get a close shave. Remember, these older gentlemen have loose skin.


'Shaving Cream' (1946) by Singer-Songwriter Benny Bell
(There are over 14,700 YouTube videos on shaving!)

Did you know every man has his own individual method of shaving? Some start with long, strong strokes from the temple to the jawline. Some start the razor blade just under the nose and take short swipes down to the top lip.

Some shave vertically from the lower lip to the chin, using the tongue pushed out to tighten the skin, while others pull their lips into a wide "long e" (as in a,e,i,o,u) and slide the razor horizontally and slightly curved along the lower lip line.

Some shave up the neck; others, down. Some keep the water running; others turn it on and off to tap the razor in the base of the sink.

Albert does something this morning I have never seen. He runs a thin line of water out of the tap, turns the razor sideways under it, then click, click, clicks the end of the razor blade against the top of the faucet...

I realize that I am smiling broadly as I look at him through the mirror.

He looks up into my reflection. "What is it?" he asks.

"I'm just learning from you, Albert. I never realized until this moment that men have so many different ways of shaving..."