Alzheimer's Disease

Alzheimer's disease is a progressive and irreversible disorder. It causes issues with memory, thinking, behavior, and simple daily tasks. Nerve cells within the brain are damaged over time causing these neurological problems. This disease most commonly manifests itself in individuals age  60 or above, but can be seen in individuals as young as age 40 to 50 as well. 

Signs of Alzheimer's Disease

There is varying degrees of symptoms in an individual with Alzheimer's disease. The symptoms start off mild and continue to worsen until the individual can no longer perform daily tasks essential to independence.  The Alzheimer's Association lists 10 early signs and symptoms of Alzheimer's disease:

  • Memory loss that disrupts daily life.
  • Challenges in planning or solving problems.
  • Difficulty completing familiar tasks at home, at work, or at leisure. 
  • Confusion with time or place.
  • Trouble understanding visual images and spatial relationships.
  • New problem with words in speaking or writing.
  • Misplacing things and losing the ability to retrace steps.
  • Decreased or poor judgment. 
  • Withdrawal from work or social activities.
  • Changes in mood and personality.

Diagnosis

The diagnosis of Alzheimer's disease comes through medical investigation and multiple diagnostic tests. There is no one definitive test for diagnosis. Medical providers will talk with the patient and receive an in depth medical history from them.  Mental status testing will be performed on the patient including tasks involving memory, attention, language, common daily activities, and more. Blood tests and/or brain imaging (CT or MRI)  may be performed to rule out any other possible diagnosis. The only definitive diagnosis for Alzheimer's disease can be done after death with an examination of brain tissue.

Caring for Someone with Alzheimer's Disease

The level of care that you provide as a caregiver depends on the severity of the disease.  Initially, assume that the individual can still complete the tasks they perform on a regular basis. Be sure that the individual is safe to independently complete the activity. Provide encouragement to them and try to help them when they need help rather than providing complete assistance. Ask the individual what tasks they are struggling with and how you can best be of assistance.

As the disease progresses, the individual will require increasing assistance with simple tasks. The individual may experience changes in mood or behavior.  Give simple directions in a gentle tone to facilitate a calm environment. This can be especially helpful if individuals become frustrated with their declining health.

In the final stage of Alzheimer's, individuals will need help with all activities of daily living. Caregivers will help with feeding, bathing, toileting, dressing, and more. The individual may have issues with mobility and be confined to a wheelchair at this point. Try to provide good quality of life to the patient by playing their favorite music, taking them outside if possible, and facilitating them being involved or present during activities they enjoy. 

Is There A Cure?

Although there is not currently a cure for Alzheimer's disease, there is a great deal of ongoing research occurring. For more information on current research, look at articles from the Alzheimer's Association Research Center.

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Ways to Relieve Caregiver Stress

Being a caregiver can be such a rewarding career. People who are unable to care for themselves are relying  on you to assist them in or perform tasks that they cannot complete themselves. Despite the rewarding nature of assisting those in need, the stress of caregiving is very real and can take a toll on you if you do not care for yourself alongside the person you are caring for.

Tips for Caregivers

  • If you need help, do not wait to ask for it. If a person is becoming emotionally exhausting to you, it is easy to become frustrated or irritated. You want to provide the individual with excellent care! Take some time to yourself or see if there is another person who can help you with the individual as you work through this stress.
  • Be sure to rest and take time for yourself. Do not overwork yourself! Enjoy recreational activities and provide yourself with down time away from the caregiving environment and enhance your personal well-being.
  • Stay healthy through diet and exercise. 
  • Celebrate the little victories while working with someone. Maybe they have been unable to help with a certain task for weeks and now they are able to give some assistance. Enjoy these moments and try to have a positive attitude as situations arise.
  • Try to imagine how the person you are caring for would react if they were healthy. Illness and discomfort can cause a great deal of anxiety, depression, and stress for an individual. Even though it doesn't change the situation, it may change your outlook.
  • Try to find activities that both you and the person you are caring for can enjoy together.

"Caregiving can have many rewards. For most caregivers, being there when a loved one needs you is a core value and something you wish to provide. But a shift in roles and emotions is almost certain. It is natural to feel angry, frustrated, exhausted, alone or sad. Caregiver stress — the emotional and physical stress of caregiving — is common."    -Mayo Clinic

Caring for another person blesses their lives immensely. You provide them with the support that they need to accomplish daily activities that they would otherwise not be able to complete. You may be the help that is allowing them to continue living at home rather than in a nursing home. Remember to not only think of others and their needs, but think of yourself as well. Sometimes it is okay to be a little selfish and take some time for yourself to prevent yourself from burning out.

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What Is COPD?

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a category of progressive lung diseases including emphysema, chronic bronchitis, and some forms of bronchiectasis. 

Symptoms

The most common symptom exhibited by people with COPD is increased shortness of breath. Some may think this commonly happens as people age, but this is not the case. Other symptoms include the following:

  • Cough
  • Excessive mucus production
  • Wheezing
  • Chest tightness
  • Frequent respiratory infections
  • Unintended weight loss
“COPD affects an estimated 24 million individuals in the U.S., and over half of them have symptoms of COPD and do not know it. Early screening can identify COPD before major loss of lung function occurs.”

— COPD Foundation

Common Causes Of COPD

There are multiple causes of COPD, but the most prominent cause is cigarette smoking.  According to the Mayo Clinic, only about 25% of smokers develop the disease.  Other populations of people with COPD include those exposed to "other inhaled irritants including second hand smoke, cigar smoke, air pollution, and workplace exposure to dust, smoke, or fumes." There is a very small percentage of COPD patients who have developed the disease because of a genetic condition called alpha-1-antitrypsin.  This is a condition in which the body does not make a certain protein necessary for adequate lung function.

Diseases That Contribute To COPD

Emphysema: A condition where the alveoli (air sacs) in a person's lungs are damaged. This is usually due to smoking.

Chronic Bronchitis: This is the inflammation of the bronchial tubes (the airway that carries air from your wind pipe to your lungs). The inflamed bronchials cause people to have a chronic cough as well as increased mucus production. This makes it difficult for air to move in and out of the lungs. This is also usually due to smoking.

Bronchiectasis: The bronchial tubes become widened and scarred due to infection or damage to the bronchial wall. This is most commonly caused by severe or repeated respiratory infections.

Tests To Determine Diagnosis

  • A chest x-ray or a chest CT scan can determine whether a person has emphysema.  This can also provide necessary information about other lung or heart issues.
  • A doctor may have a patient perform pulmonary function tests.  This will measure the amount of volume a person breathes in and out with each breath.  There are certain criteria that patients must meet in order to be diagnosed with COPD.
  • A venous blood gas may be performed to see how effectively a person is breathing.  This test shows how well a person is bringing in oxygen and  removing carbon dioxide from their bodies.

Treatment

There are a variety of treatments for COPD depending on the severity of the disease.  Many people will be prescribed medications to manage their symptoms.  These may include bronchodilators (to open up the tubes leading to the lungs), inhaled steroids (to reduce inflammation in the lungs), antibiotics (if a respiratory illness is present), amongst other medications to manage the disease. 

Patients who have low oxygen saturation as a result of lung damage may also need to be on supplemental oxygen. A list of different administration methods of oxygen can be found under oxygen administration.  Most people require a nasal cannula for their oxygen delivery.  

In some cases, patients with severe COPD may qualify for surgery to increase lung function.  Some may even qualify for a lung transplant.

Resources For Help

COPD is the third leading cause of death, according to the American Lung Association.  If you or a person you know is suffering from the symptoms above, encourage them to seek the care of a doctor.  COPD is manageable when the right treatment is in place.  Improve your life today and get the help that you need!  

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Respite Care

Foley Catheter

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Activities of Daily Living

Are you thinking about home care for your loved one? Oftentimes this is because they need help with one or more activities they. The functional activities that we perform are divided into two different categories: activities of daily living (ADLs) and instrumental activities of daily living (IADLs). These are common self-care activities that involve caring for and moving the body.  Examples include the following:

  • Bathing
  • Toileting
  • Grooming
  • Dressing
  • Walking
  • Eating  

Instrumental activities of daily living (IADLs) are complex skills that are necessary for a person to live independently. They are not necessary for a person's basic health, but are necessary if they would like to function independently in a community. These include the following:

  • Preparing meals
  • Performing housework
  • Managing money
  • Taking medications as prescribed
  • Shopping
  • Using the telephone
  • Managing transportation 

Difficulties with IADLs are commonly seen in patients with early onset dementia or Alzheimer's disease. This can often become a dangerous situation for the individual and those around them. For example, someone may forget to turn off the stove when cooking or become forgetful of the rules of the road when driving.

Having conversations with your loved one about these tasks may prove to be very difficult especially when it is a child speaking to their parent. If needed, include your loved one's primary healthcare provider in these conversations to speak about available resources to help the situation. Caregivers are often contacted to help with safely preparing meals, performing routine housework, and even taking the person shopping for household items or groceries. This allows the individual to maintain their independence while also ensuring safety as well.

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Could My Loved One Benefit From Hospice Care?

What is Hospice?

Hospice care is focused on caring for, but not treating, a person with a terminal illness. All aggressive treatments that may inflict pain or discomfort are discontinued. The primary focus is on the person's spiritual and emotional well being. There is a medical team involved to discuss and implement the wishes of the person and their family during this difficult time. Most of the time this care is delivered in the comfort of the person's home but can also be given in the hospital or long-term care setting.

"At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so. " -National Hospice and Palliative Care Organization

Services Provided

  • Provides basic medical care focusing on pain and symptom management.
  • Ongoing access to the interdisciplinary hospice team.
  • Helps the patient with the emotional and spiritual aspects of dying.
  • Provides needed drugs, medical supplies, and other necessary equipment.
  • Coaches the family on how to care for the patient including psychological, spiritual, and emotional issues.
  • Delivers services like speech therapy, occupational therapy, and physical therapy if needed.
  • Makes short-term inpatient care available if needed.
  • Can deliver respite care for caregivers or family if needed.
  • Provides guidance with end of life questions and closure.
  • Provides bereavement care and counseling to surviving family and friends.
  • Counseling and support for your loved ones after a person dies.

"My grandmother suffered a massive stroke a few years ago. This left her with little quality of life. In the last months of her life she was diagnosed with pneumonia. Rather than pursue aggressive treatment, we decided to involve hospice care. She was given the care that she needed to have little pain and discomfort when she passed away." -Courtney T.

How Does It Work?

Usually family acts as the primary caregivers for their loved ones. The person's care team usually consists of their personal doctor, a hospice doctor, nurses, social workers, chaplains, and home health aides. Members of the care team make routine visits and help to provide any additional resources that may be needed. During this difficult time, many people feel they have lost control of their lives. Hospice care can provide them with the options they have available to help them feel empowered during the last months of their lives.

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Do I Have Type 2 Diabetes?

Type 2 Diabetes: Causes, Symptoms, And Management

Type two diabetes is a condition that causes a person's blood sugar to rise to a higher level than normal. The process of using your blood sugar for energy is facilitated by insulin.  With type two diabetes, a person's body does not use insulin properly. Let's learn more about the causes, symptoms, and management of this condition.

Causes

Insulin is a hormone used to bring sugar into a person's cells to be used for energy. With type two diabetes, a person's body becomes resistant to insulin. At first their pancreas will make more insulin to try and lower their blood sugar. After a period of time, the pancreas cannot sustain this and blood sugars start to rise. Type two diabetes often develops in adulthood in individuals who are overweight  and physically inactive.

Symptoms

 

How do you know if you are suffering from diabetes? Common symptoms of diabetes include the following: 

  • Urinating often
  • Feeling increasingly hungry or thirsty
  • Weight loss
  • Blurry vision
  • Extreme fatigue
  • Slow wound healing
  • Tingling in hands or feet

In rare cases, individuals can experience dangerous complications from uncontrolled blood sugars. This life threatening condition is calleddiabetic ketoacidosis (DKA). Individuals with extreme symptoms consistent with DKA should seek emergency care immediately.

 

Management

If not controlled with diet and exercise, diabetes almost inevitably gets worse over time.  High blood sugar levels can damage blood vessels leading to a variety of complications including damage to the eyes, nerves, heart, and kidneys. It also can increase the chance of developing high blood pressure or stroke.  

Some people with type two diabetes can manage their condition by exercising and eating a healthier diet. Overweight individuals are at a much higher risk for diabetes. Doctors may also prescribe medications to be taken to help control blood sugars. Patients may be required to check their blood sugar levels daily or more frequently depending on the severity of their diabetes. Insulin injections may also be required if blood sugar levels cannot be controlled with oral medications. 

““Diabetes is a common disease, yet every individual needs unique care. We encourage people with diabetes and their families to learn as much as possible about the latest medical therapies and approaches, as well as healthy lifestyle choices. Good communication with a team of experts can help you feel in control and respond to changing needs. ””

— American Diabetes Association

Diabetes is a very manageable disease with the help of doctors and nurses. Learn more about diabetes from the American Diabetes Association. Make sure to eat a healthy diet and exercise regularly to enjoy a long and healthy life!

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Working nights can be a daunting task for a caregiver. How do you stay awake and alert during your shift?  Everyone is different in how their bodies react to being turned upside down from a sleeping perspective.

When I was in nursing school I was terrified of the prospect of working nights. How on earth are people able to stay up until 8:00 AM? Holy cow. I would see the night nurses when I started my shift at 7:00 AM and they all looked exhausted! Little did I know at the time that I would work nights for a very long time (five years and counting!). 

Disadvantages

No sleep: Definitely a disadvantage. People have asked me how I switch my sleeping schedule. My personal preference when I was working full-time was to sleep a couple hours in the afternoon before my first shift and then sleep until 1:00 PM after my last shift. I'm pretty beat up waking up at 1:00 PM (think if you were waking up at 1:00 AM!), but it's what I've got to do to flip back to normalcy. Everyone is different though. Some people sleep for 4-5 hours before their first shift. Some are perpetual night owls and stay up until 1:00 AM or 2:00 AM each night when they aren't working (obviously they don't have kids that wake up at 7:30 AM :) ). Just try out different sleeping schedules to find out what works best for you. You'll still feel pretty exhausted (from my experience), but you bounce back quicker once you figure out a good sleeping schedule.

Not As Much Staff: If you have clients that are a two-person transfer and you are the only one there (because it is nighttime), what do you do? First off, try to be proactive at the beginning of your shift. If you know that someone is in need of additional assistance for getting dressed for bed or getting to the bathroom for bedtime hygiene, help them first with the caregiver that is finishing their shift. You can always use a bedpan if a patient cannot be transferred safely at night for toileting. Be sure to pay close attention and not forget about the bedpan. This can cause serious skin breakdown and pressure ulcers. 

Benefits

Family Friendly: Working nights has been amazing for my little family. I have a six-year-old stepson and a two-year-old daughter. I work one to two nights a week now (I've decreased my shifts as our family as grown) and don't need to get babysitters. If I work a Friday night, my husband picks up the slack that night and then watches the kids on Saturday. I know a lot of single mom nurses and caregivers that drop their kids off at school, they go sleep, and then they pick them up and don't miss a beat. 

Night Owls Are Happy: Some people function much better at nighttime than others.  I've found that I function much better at night than I do at 7:00 AM.  Everyone is different in their sleep cycles and what they can tolerate. It takes a few months to get used to switching days and nights. 

 

Overall, I am grateful to be able to work nights. It is tricky with getting adequate sleep, but I feel like it has worked well for my family and me. Give it a try! You just might like it!

-Courtney, RN

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Where Can I Work As A Caregiver?

As a caregiver there are multiple settings that you can work in.  The two main areas that have needs for caregivers are clients in their homes and clients in assisted living communities. 

Clients at Home

Clients who are in need of care at home can either hire caregivers privately or through a home healthcare agency.  If you are hired privately, you and the client work together to establish your pay rate, schedule, and what is to be expected. Your pay rate may be hired if you are hired privately because there is not the overhead costs of the home healthcare agency. 

If you are hired through an agency, your schedule and pay is negotiated with the agency rather than with the client. You may be traveling from client to client during your shift to help them with their activities of daily living (ADL) rather than staying at one client's home like you would if you were hired privately.

Clients in Assisted Living Communities

An assisted living community is a place where individuals needing additional help with their ADLs In an assisted living community, caregivers are hired to come and care for a variety of clients all within the same home or community. Caregivers negotiate their pay and schedule with the owner of the assisted living home or the administrator of the community.  Caregivers are scheduled for a specific time period and help multiple clients in need during this time period.

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Suprapubic Catheter 

A suprapubic catheter is a thin, hollow tube (similar to a urinary catheter) that helps to drain urine from the bladder. Unlike a urethral catheter, this catheter drains the urine through a hole created in the lower abdomen directly into the bladder. There is a balloon on the end of the tubing (similar to a urinary catheter) that holds the tubing inside the bladder. Suprapubic catheters can be much more comfortable for clients who are in need of long-term help with draining their urine.

As a caregiver, be sure that the site where the tubing enters the lower abdomen is always clean and dry. If there is oozing, redness, pus, or anything abnormal surrounding the site, contact the family or necessary personnel for the client to get a doctor's appointment.

Empty the catheter bag before it fills completely. It is best to empty it at the end of your shift as a courtesy to the next caregiver (if working for an agency).  When emptying the catheter bag, look at the urine. Is it cloudy?  Does it have sediment in it?  Does it have a foul smell?  These are all signs of urinary tract infection (UTI) and are very common in clients with long-term catheters. If you notice any of these, contact the necessary personnel for the client to get a doctor's appointment. 

 

When Is It Time To Get Help?

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Colostomies

Helping with Insomnia