By Emile Franssen, Liduin Souren
A handbook to supplying nursing care through the sensible decline of Alzheimer's sufferers, emphasizing tips on how to overview the sufferers' competence at every one level and make allowance them to take as a lot care of themselves as attainable
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Extra resources for Broken connections : Alzheimer's disease. Part II, Practical guidelines for caring for the Alzheimer patient
G. g. with regard to length of nails or polishing nails √ put on and take off shoes √ wash and dry his feet √ mention pain and indicate the painful spot if requested √ wash feet daily and dry well, particularly between the toes √ put on clean stockings, panty hose or socks every day √ smooth out wrinkles when pulling stockings, panty hose or socks over foot √ difficulties with walking √ swollen ankles (edema); chilblains, cold feet; cramp √ too long or blue nails; ‘chalk’ nails; ingrowing nails √ unequal wearing down of heels of shoes √ holes in shoes, tights, socks SUPERVISION AND STIMULATION Partial take-over Total take-over Attitude What the patient can do himself √ blisters; sore places between the toes; bunions under big toe, ball of the foot or edge of heel; corns; eczema √ put out items for foot care such as foot-bath with water; if necessary an appliance for foot massage √ if necessary dry between the toes √ daily manual check of inside of shoes for unevenness √ keep toenails short, cut off straight, round off corners √ if necessary arrange for visit to podiatrist for foot care √ where necessary apply ointment, powder and bandaids √ regularly massage the feet and toes with moisturizing cream on top and underneath for at least five minutes (stimulates blood circulation) √ buy comfortable shoes in good time; lightweight, leather, with anti-slip sole and heel √ consult doctor or podiatrist in the event of serious pain or foot injuries √ realize the importance of and see to painless feet and suitable footwear to prevent problems √ be aware that being able to move about independently is of great importance for the patient √ use his own toothbrush √ put toothpaste onto toothbrush √ clean his teeth in the familiar way √ rinse his mouth √ rinse off the brush √ put his dentures into his mouth and take them out √ clean his dentures and mouth √ indicate toothache or other oral discomfort √ on request: show what or where the discomfort is; breathe deeply in and out; open and shut mouth; keep mouth 41 42 CHAPTER 2 Remind and encourage patient to if necessary explain Intervene observe for and if necessary prevent Partial take-over Total take-over open; stick out tongue; swallow; bite hard; chew; suck; spit out; blow √ brush teeth or clean dentures (twice a day) √ rinse mouth with mouthwash if breath is bad √ carefully rinse off toothbrush and put it back in the right place √ if patient has dentures to take them out before going to sleep and put into glass or container √ use moisturizing cream on the lips √ spit out mucus into receptacle √ remains of food between the teeth √ dirty corners of the mouth √ dry or scabbed lips √ badly fitting dentures √ grinding teeth; this causes earache and damaged molars; certain drugs may increase tooth grinding √ inflamed gums or mucous membrane √ put out requisites for oral and dental care √ prevent drying out of mucous membrane by: .
It is now obvious even to an outsider that he has dementia. His intellectual abilities now fail him to such an extent that it interferes with maintaining himself as an independent person in the community. In terms of decline in functions of self care, this stage is characterized by the inability to choose proper clothing to wear in the way he used to. Factors such as lack of initiative and self neglect play a role. The patient lacks the ability to survey possible alternatives, to discriminate between alternatives, and to appraise the actual situation on which his choice must be based.
Mikado: 26 colored sticks are mixed up in a pile or in a row packed closely together; the players have to pick up a stick each time with a hook without moving the others √ join with the patient in singing, making music, dancing, swimming etc. √ planning vacations √ find out which of his senses and which functions are the best developed and make use of this, eg: counting up, conversation, humor, manual skill, music and dance, sports & games √ do not urge the patient to undertake activities if he is not familiar with them or does not enjoy them √ regularly do recreational activities with him; realize that he himself lacks the initiative, the concentration or the motivation to perform structurized activities SUPERVISION AND STIMULATION What the patient can do himself Remind and encourage patient to Intervene observe and if necessary prevent √ emphasize doing things together and experiencing activities together, being involved in something, not having to be on his own in an increasingly confusing world √ use the shared experiences as a topic of conversation √ the patient must be given every opportunity to express his experiences in words or gestures √ if people listen to him attentively, he feels important and safe again √ if he has difficulty in expressing what he is experiencing, he must be helped √ experiences which cannot be shared make for a lonely world; this applies both to the patient and to the caregiver √ use most words in the daily spoken language √ put the emphasis correctly on the right part of the word (through difference in pitch, strength, duration) √ be guided by concrete causal thinking √ follow his own train of thought √ follow someone else’s train of thought if it is sufficiently concrete √ play the broken word connection game.