Is There A Way Elderly Women can Feel Useful Again? I Need Suggestions.

This week one of my patients, an elderly woman in her 80’s, told me how useless she feels. This isn’t the first time I heard someone tell me that. Usually it is a woman used to a lifetime of being very busy around the house. Now they can’t walk without a walker, they need someone to clean their house, and they get their meals from Meals-on-Wheels. Arthritis, balance problems, general debility keeps them from being able to do the kinds of things that were always part of their life.

Some of these women live with their children. They see their daughters rushing around trying to balance work life with home life, a home that includes an aging parent. The patient I talked with this week said she used to help out by often cooking dinner for her daughter and son-in-law. Now she can’t.

I honestly don’t know what to tell these women. I encourage them to do things like folding laundry but that just doesn’t seem like enough to them. My heart breaks for them. Everyone wants to feel useful. I did get one woman to crochet squares that she gave to a charity organization. The squares would be joined, made into an afghan, and be given to someone in need.

Does anyone have any suggestions on how incapacitated elderly women can still feel useful? What can they do to help their families? I’d especially be interested in hearing from anyone who has lived with an elderly parent or grandparent. I’d love to be able to compose a list of suggestions that I can give to the women or their families of activities they can participate in. So please help me out if you can.

Back From Vacation

 I was back on the road today after a week-and-a-half vacation. One of the nice things about vacation was not having to drive thirty or forty miles everyday. I drove when I wanted and stayed home when I felt like it. Very nice.

Today was a beautiful day and I was feeling well-rested and ready to get back into the swing of things. I passed a thermometer on a bank as I drove to work. It read 64 degrees. I wore a short sleeve top and didn’t bother to bring a sweater knowing it would warm up as the day passed.

Is an Assistant Needed to Drain a PleurX Catheter?

Carefully I opened the package that contained the equipment I needed to drain a PleurX catheter.  A PleurX catheter goes into the pleural cavity and remains there where it can be used intermittently to drain fluid out of the pleural space. I was going to do this in the rather cluttered and small bedroom of my patient’s apartment. My patient was dying of lung cancer after years of heavy smoking. Now he lay in his bed with the ornate mahogany headboard. Oxygen ran through a soft green tubing into his nose. Before I began I left the room to scrub my hands at his bathroom sink. When I returned to his bedside, I picked up the drainage kit that was packaged in a blue wrapper. The inside of the wrapper was sterile and became my sterile field. That means anything that came in touch with it must be sterile. On the field was already gauze for the dressing I would put over the catheter when I finished. There were alcohol wipe that I would use to clean the tip of the catheter. A new cap to cover the tip of the catheter was also part of the kit. I touched nothing with my bare hands.  My patient waited expectantly for the draining to begin. The trouble he was having breathing was caused by the build-up of fluid in his pleural space. Once I was done, his breathing would be slower and easier. I expected that at least 200cc of amber fluid would be drained off today. He held his flannel shirt up so I could remove his old bandage which I did with non-sterile gloves. I threw the bandage and my gloves into a plastic bag I had set out for garbage. I now turned to put on the sterile gloves that lay across the blue sterile field. I gingerly picked up one and using sterile technique I put first one and then the other on. I was ready to begin. Just then a flash of black crossed in front of me and landed in the middle of the blue sterile field! It was Nicky, my patient’s devoted and very fluffy cat who now sat grooming himself  oblivious to the fact that he just contaminated something that I had been so careful about maintaining sterility. But I now had a cat in front of me, one who wasn’t about to move. Of course now I would have to #1 get Nicky out of the room and #2 start all over again. Later when I told my clinical supervisor about my feline helper, she laughed and said “Welcome to Home Care! You just never know who in the household will want to assist you!!”

Another Visit with Mr.R.

The rain was pouring as I ran across the parking lot of the convalescent home. I headed into the lobby where several residents sat in wheelchairs watching me as I came through the door. Two young women behind the front desk were talking about the weather when I stopped to ask them to direct me to Mr. R.’s room. I did as they told me. I went down the hall, found the elevator on the right, and took it to the second floor, then another right and his room should be right in front of me. I didn’t see his room but I did see him. He was one of about ten elderly men and women in wheelchairs who lined the hall. The last time I saw Mr. R. he was in a short-term rehab facility. When I went to visit him there, I found him in the midst of having a stroke. Now he was here at this convalescent home sitting in a reclining chair with an untouched lunch tray next to him. A blanket was scrunched up on his left side. His pajama bottoms were ones I had seen on him so many times when I went to his apartment to make a home visit. Today they were pushed up and his scrawny legs dangled off  the edge of his wheelchair.

A Visiting Nurse Pays a Visit

One of my patients broke his leg a few weeks ago and ended up going to short-term rehab. He has been a favorite of mine. Each week I’ve checked his vital signs and blood sugar, listened to his heart and lungs, made sure he had no problems with his medications, and checked to make sure he is getting his Meals on Wheels. At 89, he was content to sit in his recliner all day. He looked forward to receiving communion each week from a volunteer that stopped at his apartment in a low-income senior housing building. Although he is nearly blind, he found comfort from having photos of his family on a wall near his chair. He’d tell me stories of his brother who was killed in WWII. There was a photo of his mother who raised seven children alone. He always talked of her with reverence. He liked our visits and told me that it always made him feel better when I came to see him. He always asked how my family was. I always asked about his family. He asked me if I thought I would be able to come to his 90th birthday party. No way would I miss it I told him.

Yesterday I decided to stop at the facility where he was recieving short-term rehab. Although it isn’t part of my job, I like to check in on my patients when they have gone into the hospital or rehab. When I walked into his room, I expected to see him sitting up in a wheelchair with his his leg elevated. I thought he would tell me how they never keep the room warm enough. Instead I found a man that looked much different from the one I knew. In fact, I walked back out of the room to check the name on the door to make sure I was in the right room. My patient was asleep. Mats were on the floor next to his bed which I assumed was to protect him in case he fell. As I stood next to his bed, I saw that his face was drooped on one side. I called to him but he was barely arousable. He’d try to open his eyes but couldn’t. His hands flailed randomly. I took hold of one hand and sat quietly next to him. His face was drawn. He had lost a lot of weight since I last saw him. Since I hadn’t had any reports about him, I thought perhaps that he had been heavily sedated or that he had stroke since I last saw him.

My Mother’s Rising BNP

My mother’s BNP is up to 301. Last year it was 201. She has had congestive heart failure for some time now so I’m not surprised that her cardiologist regularly checks her BNP. I am concerned that it is going up. That means her medication isn’t working the way it should or that her congestive heart failure is worsening.

The BNP (B-type natriutetic peptide) assists doctors in making a diagnosis of CHF in the context of shortness of breath. (See my January 4th post). It can also track the responsiveness of CHF to treatment. That’s why my mother gets tested.

I couldn’t remember the normal values for this test so I checked out the patient library at Quest Labs. Here is the breakdown:

Brain natriuretic peptide

Normal:	0–99 picograms per milliliter (pg/mL) or 0-99 nanograms per liter (ng/L) SI units. No heart failure is present.
Abnormal:	100–300 pg/mL or 100-300 ng/L (SI units) suggests heart failure may be present.
	300 pg/mL or 300 ng/L (SI units) or higher is considered mild heart failure.
	600 pg/mL or 600 ng/L (SI units) or higher is considered moderate heart failure.
	900 pg/mL or 900 ng/L (SI units) or higher is considered severe heart failure.

So my mother’s 301 reflects mild heart failure. As much as she won’t like it, she is going to need a change in her medication. Probably her doctor will increase her diuretic in order to pull fluid out of her system and relieve the burden on her heart. If it works, her BNP should go down the next time she is tested. Let’s keep our fingers crossed!

In the Care of a Sister

Today I saw a patient of mine who has been through a difficult illness requiring much help. Her sister rose to the occasion. She left her grown family and moved in with her sister for the duration of the illness which lasted for several months. It was just the two of them. The sister became a caregiver as she bathed and dressed her sister, washed her clothes, and cooked her meals. She became a nurturing presence in this household.

These sisters are in their seventies. It’s been more than half a century since they lived together. Illness gave them the incredible opportunity to be with each other in ways they haven’t been since they were children. As my patient gained her strength, the two of them took time to look through old photo albums and spend quiet moments talking about bygone days. They learned new things about each other. They had moments when they got on each others nerves but later laughed about it. When my patient was almost at the point of full recovery, these sisters had a hard time saying good-bye.

I learn something from every patient I take care of. These two sisters taught me about the unique opportunities we have in life that are hidden like treasures within a sometimes tragic or challenging health experience.

Give the Elderly More than Photos

What really gets to me in my job as visiting nurse is the raw loneliness that many of my patients face every day. Last week I went to see a eighty year old woman who had a small but pleasant apartment. There were family photos on the walls and every flat surface. She knew the name of each of her fourteen grandchildren and seven great-grandchildren. We talked about her family for a little while before I took her blood pressure and give her an injection of Vitamin B12. She told me that her large family all lived locally but no one visited her. That used to bother her alot but now she is resigned to it. They are all so busy she adds with tears in her eyes.

When I was young, we often went to see my grandparents on Sunday. There was no choice. We just did it. In today’s complex world, children are over-scheduled and parents are over-worked and the elderly are left out of the equation. As I drove away from this woman’s home, I thought about the photos in her home. There were school photos, studio portraits, wedding and graduation photos. Lots of my elderly patients have the same kind of family photos. It is almost like the family is saying ” I can’t visit you but here’s my picture so you know I care”. But photos are no substitution for the real thing. And the elderly know it.

The elderly speak of the world that they grew up in where  mothers cared for elderly relatives and visits to grandparents were often and expected. They are puzzled by today’s world now that they are the senior member of the family. I see them alone and sad. They fill their days watching game shows on TV and doing search-a-word puzzles. Women, like my eighty-year old patient, just want what we all want: the love and support of their family. I truly believe their families love them but it almost seems as if they have forgotten them. We need to assure that our family life  includes time for our elderly members.

Take my Blood Pressure Right Please!

Since May is Blood Pressure Awareness Month I have to tell you about my pet peeve: blood pressures that aren’t taken right.  How often have you had the experience of rushing to keep a  doctor’s appointment during a busy day in your life, be brought into the exam room, directed to jump onto the table, and immediately have your blood pressure taken by the medical assistant? You figure the person taking your blood pressure knows what they are doing. You think she didn’t make the cuff tight enough but you don’t want to say anything. You are nervous about being at the doctor’s office where your blood pressure is always higher than when you take it at home but the office routine is the office routine. No one ever comes back to repeat a reading. You notice that the medical assistant takes your blood pressure over the sleeve of your sweater even after you offer to push your sleeve up but you aren’t sure if that is right or not.

Now please don’t think I’m singling out medical assistants as being incompetent in blood pressure taking.  I have seen doctors and nurses take blood pressures wrong. My own doctor would often take my blood pressure with my arm way above my heart….wrong, wrong, wrong!

Hear the Lung Sounds

Mr. Donovan was a 76 year old man who was just in the hospital for congestive heart failure. When I listened to his lungs, I could still hear some fine crackles at the bottom of his lungs. Peggy Rowley was a 52 years old recovering from pneumonia. Except for a little congestion in her upper airways, the rest of her lungs were clear. John Shaffer, age 61, has emphysema. I struggle to hear breath sounds when I listen to his lungs. The sounds are very diminished. He asks me what I’m listening for when I listen to his lungs. Good question, I tell him.