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The
Taking Charge Stage of Incontinence Care.
This
stage of care gradually gets more involved. As stated in the section
entitled The Taking Charge Stage of Incontinence
Care, behaviors, loss of physical abilities, and profound loss of
cognitive skills will impact the caregiver's tasks
dramatically. The good news is that the further along this
stage goes the easier incontinence care becomes. The more in charge
you are of your emotions the more successful you'll be dealing with theirs.
By
now your person has become accustom to your hovering over them.
During this stage your care will become more involved and they need total
supervision. They can't be expected to complete any function of
their hygiene care without someone there to do all the things you do when
you began poddy training your child. They are entering the phase
where they lose the ability to toilet themselves and none of the handy
reminders are going to work anymore.
The
behaviors and hallucinations that develop in varying degrees will
complicate your tasks.
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Your
person will have difficult finding the bathroom, handling the
logistics of the toilet, toilet paper, faucets, bath tubs/showers.
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They
can't use public rest rooms alone anymore.
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They
can't bathe themselves alone any more.
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They
can't dress themselves alone any more
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Bowel
incontinence will become a reality
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You
will be using briefs for overnight but I don't recommend them for
daytime wear. They are too unwieldy, your person can still use
the facilities in a rest room to a large degree and the belted
products with sturdy underpants to hold them in place will work as
long as they are standing and walking.
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You
want to check the diapers for discoloration in urine.
This is a symptom of urinary track infections and the doctor should be
called immediately
Tools:
The Taking Charge Stage of Incontinence Care
The
tools and products are as follows:
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Handi
Wipes. Most brands are not flushable. .....
is. The problem with everyday use is that they are unwieldy.
They stick together, are difficult to get out of the container, and don't have a good grab when you're cleaning up
a messy bowel movement. Unlike a baby's bottom, the bottom of a
grown person is not hairless. You need something that is going
to catch it all with as little effort as possible. But in a pinch and on the road they are they
only act in town.
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100%
cotton wash cloths.
Purchase the ones sold in packs of 6 or
12. I see them in supermarkets, drug stores, home furnishing
stores, department stores. These are thinner than the regular wash cloths and you have
more control with your hand while reaching under to clean your person
when changing their pads. They are inexpensive and always have a couple of
packages on
hand because you will discard them as they wear out from repeated
washings. I recommend darker colors because no matter how well
they are washed they will stain. Bleaching might whiten them but
bleach also leaves chemicals in the fabric, which is not good on
skin. Do
not use heavy velour or terry towel cloths. They are heavy and
unwieldy and a pain in the butt to get clean.
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Pail,
or
receptacle of some sort to hold warm soapy water into which soiled
wash cloths will be left soak before rinsing and washing.
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Pop
top plastic bottles that fit comfortably in one hand.
Fill these
with half water and half liquid soap. Flip tops are unwieldy as
the flapping top tends to get in the way when you're trying to squeeze
the liquid out. You will use these in the shower as well as at
the sink when you're cleaning up a bowel movement.
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Liquid
soap.
Whatever type you want antibacterial or floral scent,
dilute them with water. You want an easy flow of soap and when
it isn't diluted it's too thick, and makes so much lather it's
difficult to get it all rinsed off.
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Hand
held shower nozzle with 7-8 feet of hose.
You
need to be able to reach over, under and around your person in the
shower. By this stage of care they will have great difficulty
getting under the shower while it's running. It is kinder and
easier to bring the water to them. With a hand held nozzle,
preferably one with a trigger so that you can control the water flow,
you can bathe them without frightening them.
My
hose was long enough to reach the toilet. I used it to spray bowel
movement off the wash cloths directly into the bowl thus speeding up
clean up time dramatically. If you can't find a commercial nozzle
with the length of hose you need in the stores, any plumbing supply
place will put one together for you. The fittings are all
standard. For details on adapting the bathroom click
here
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Latex
Gloves. Even
if you don't feel you need to use these it is a good idea to have them
on hand for helpers, volunteers, and family members who might be faced
with having to change an adult diaper in an emergency. They are
available in medical supply places, drug stores, department stores,
beauty parlor supply stores and the best buy I found was in Cosco and
Sam's warehouse stores. I haven't checked, but B J's probably
carries them also.
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Travel
bag.
This is the adult version of a diaper bag. Get a
simple tote with a snap on top and handles long enough to fit
comfortably over your shoulder. Keep the essentials in it
including extra underpants and possibly a change of clothing for
emergencies.
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Bed
pads. Please
check out Organizing the
Bedroom here for details about bedding. I bought baby crib
pads, double sided flannel instead of the more expensive pads offered
in home health care departments of drug stores and med. supply
places. The crib pads worked just as well and will a terry bath
towel on top were totally comfortable on Tom's body. The
disposable bed pads are a waste of money.
They slip, they bunch, they were more trouble than they were worth.
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Shower
Chair or Tub Bench.
Get one with a back rest and preferably a hole in the seat area so
that you can reach under them to clean with the shower nozzle without
having to shift their weight. They might very well topple over
because their lose their sense of a central balance in this stage of
care.
Beltless
pads, belted pads... same
process as The Assisting and Supervision Stage.
Briefs:
Briefs
mimic underpants. They come in medium and large, have elastic
gathering around waist and legs. They are designed to hold liquid
and solid waste and are held on with adhesive tabs. They come in two and
three tab varieties, the tabs connecting on the front panels. They are
designed for use for both bed-ridden and ambulatory patients.
Some
of the brand names to look for are:
Reassure, Surety, Attends, and
Depends.
Important
Recommendation:
Don't buy the two tab briefs. You are better off with the three tab brief over the two tab. The three tab briefs have ample material
to wrap around the body and offer a much snugger and leak proof
fit. There is less gapping and some of the products have a wetness indicator
that changes color when the brief needs changing. The three tab products are
slightly more expensive than the two-tab variety, but I think they are worth the
extra cost.
Using
briefs on someone who can stand unassisted
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Stand
behind them and arrange their clothing.
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Slip
the front of the brief through the legs
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Attach
the top tab to one side to hold the brief on.
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Attach
the top tab on the other side and finish the fit by pulling the
remaining tabs into position.
Using
belt-less pads with briefs For
extra over night and extra urine control use a belted pad inside the
brief.
Changing
briefs/pads on someone who cannot stand unassisted but who can hold their
own weight. With a helper... This
will be possible through the end of this stage of care and into the last
stage of Alzheimer's.
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You
or the helper stands behind them and grasps them under the arms. Lock
your arms around their chest at your wrists and rest their body
against yours. You might want to also hold their wrists in your
hands to keep them from flashing out at who ever is changing the pads.
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Have
your helper undo the clothing and remove the pad.
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Wash
and dry the under area.
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Slip
new pad through legs and adjust position of pad.
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Bring
tabs/elastic strips around the front and attach for fit.
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Rearrange
clothing and assist back into chair.
Dealing
with Bowel Incontinence
Normal
Stool:
Prepare
all tools before you bring your family member into the
bathroom.
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Have
new diaper set up and ready for use and a pail of warm soapy water within
easy reach of the sink.
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Lay
out clean clothes if needed.
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Prepare
the washcloths with liquid soap/water combo. Pile those with
soap on one side of the sink so that you don't have to soap each one while you are cleaning
your family member. Wet other washcloths with hot - warm water,
(they will cool off rapidly) and set them on the other side of the sink. Make sure they are
warm to the touch or you will have a very unhappy person on your
hands.
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Now
bring your family member into the bathroom and place them facing away from
the sink, the mirror (if it's still there). You stand so that
you have easy access to the cleaning implements.
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Undo
their garments and lower the underpants. Undo the diaper and discard
out of reach of the family member. Do not bother with disposing of
it at this time.
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Use
your soaped washcloths to grab the soil, toss the cloth in a pail of warm
soapy water or the toilet bowl. Continue using the cloths in this
manner until there is no more soil between the legs. Keep
in mind that women are susceptible to yeast infections and it is very
important to make sure that area is clean. While
cleanliness is also important to men, their equipment is more accessible
and contained is that of women..
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Use the soaked
clothes to rinse and wipe dry. Put powder or lotion on the area and
placer new diaper in place.
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Redress
the family member, take them out of the bathroom, settle them elsewhere in
the living quarters and then return to take care of the clean
up.
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Rinse
the major part of the poop in the toilet and be careful not to flush the washcloths down the flue.
Those of us old enough to remember life before disposable baby diapers
remember doing just that with cloth diapers. The diapers then
went into a soaking solution of water and soap, rinsed and then
laundered. The principle is the same for the wash cloths.
My
shower nozzle had a hose long enough to reach the toilet. This was
the easiest way to get the lion's share of the poop off the wash
cloths. Rinse in soapy water and flush the water down the flu as
well. Launder later. This is why you want a supply of these
wash cloths. There are always some being washed, some being soaked
and some being needed.
Soft
Stool
If
it's contained and not sliding down the legs you treat this diaper change
exactly the same way as you would for a regular bowel movement. You
have to be careful not to spill the contents of the diaper in the clothing
but other than that, the clean up and washing part is actually
easier. The soft stool is easier to grab with the wash cloths and
the wipe up is quicker. Rinsing out the wash cloths is a little more
involved but if you have the use of the shower nozzle with a long hose
even that is done rather quickly.
Diarrhea
If
you're facing an intestinal but of some sort you might as well keep the
bathroom set up for the inevitable, because there will be more than one
episode to deal with over the next hours.
Diarrhea
is very traumatic for people with Alzheimer's and potentially volatile for
the caregiver. They suffer stomach cramps, they are trying to
control the flow and they can't, and they also have trouble letting
anyone know they are about to lose control. They are going to be
agitated, embarrassed and possibly even angry because they couldn't get to
the bathroom in time. They will be bothered by the smell and they
might even be frightened.
The
biggest problem facing you is getting your loved one out of the soiled
clothes without increasing the 'fall out,' or bringing on a full scale
war.
The
most important first thing to do is remain calm.
Keep your voice low, your body language under control and speak to your
person in only loving accepting terms, or you may very well increase their
anxiety, bring on a catastrophic reaction and end up with a nightmare on
your hands. Keep
the noise level down as much as possible. That includes
television, other's conversations, running water and your voice raising in
volume as your own panic begins to surface.
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Set
up the new diaper and get out clean clothes.
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Have
wash cloths, bottle of soap/water mixture in shower
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Undress
them in the shower or tub if possible. Do it calmly and slowly
so as not to provoke anxiety in them.
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Pile
the soiled clothes in the sink, a pail, or on a plastic table cloth
away from where you are working.
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It
is easier to give them a shower than to try the section-by-section
clean up if 'it' has gone
down the legs. The warm shower, a soft kindly manner and a
matter-of-fact attitude towards helping them can turn this episode
into a comforting moment for them and for you.
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Dress
them as you would after a shower, remove them back to their living
area and then return to deal with the clothing, the floor and what
ever else has caught the debris.
As
long as you are purposeful, tender, kindly and the water and soap are warm it
might be less than traumatic for everyone than imagined.
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