From the Survival Blog
The time may come when normal medical
facilities are not available for any number of reasons. If a family member were
sick or injured, would you have the supplies and skills to care for them in
your home? After 26 years as a registered nurse (RN) working in a hospital
setting with a multitude of different types of patients, I have learned the
procedures, tips, and tricks for making patient care easier. I will not attempt
to teach you about specific injuries and diseases or their treatments. There
are many resources for learning these skills, and I suggest that you take
advantage of them while they are available. What I can teach you is how to set
up a sick room in your home to care for a sick, injured, or quarantined
patient. The first thing on the list of things to know is that organization--
both before and during care-- is very important in making a caregiver's job
both possible and easy. If you stock the supplies that I have listed below and
made a plan, then you will be able to make a challenging situation doable.
Let's discuss choosing a room in your
home that can function as a sick room. A bedroom furthest from the rest of the
home's rooms and occupants would be best. If it has an attached bathroom, your
job will be much easier. It is always best not to have to transport
contaminated body fluids (urine, feces, vomit, and blood) thru an
uncontaminated area in order to dispose of them. If an attached bathroom is not
available, then one as close as possible will do. I suggest removing all
furniture except the bed, rolling table, shelves, or bureau, and a chair from
the room in order to increase your working area and decrease the number of
items that can be contaminated. It makes sense to also remove all rugs from the
room for the same reason--less to contaminate. I believe that a single/twin bed
is easier to work with because you can reach over it in order to move your
patient without constantly having to walk around to the other side. It would
also be back-saving for you to elevate the bed to a comfortable working level.
There are bed raisers available or you can improvise with anything you have as
long as it results in a stable bed. There are easily detachable side rails
available which will protect a confused patient from falling out of bed. I am a
big fan of side rails and suggest their use even with a patient who seems
unlikely to fall. A rolling table will provide both a surface on which to place
clean items that you are using to give care and the usual function of providing
a dining surface for a patient who is taking food by mouth. A bureau or set of
shelves can serve as a place to store all those things that you will need in
order to care for the patient--linens, clothing, bath supplies, gloves, etc. It
will be so much easier if you gather all these supplies and place them in the
room in an organized manner before you try taking care of your patient. You
will wear yourself out if you have to leave the room every time you need to go
get something you forgot. You will also risk carrying germs to the healthy
members of your family if you make frequent trips from the sickroom to the
clean parts of your home. You will need a light source in the room-- electric
lights, if they are still working or another light source if necessary. Windows
for light and fresh air (if the patient is not under quarantine) are nice to
have for both the patient and the caregiver.
All of these things will make your
job possible and easier, but what else is needed if the problem is one of
infectious disease? I suggest setting up a vestibule outside the sick room
door. This can be a simple frame made of PVC pipe-- the height of the door and
two feet wider on each side. This will give you enough room to prepare to enter
the sick room or exit into your "clean" home. If you hang heavy, clear
plastic sheeting on the sides, top and the front (nearest your clean hallway)
you can produce an area that can hold you and supplies, which you don't wish to
leave in the sick room. The entry plastic sheet can be split down the middle,
from top to bottom so you can pass through it easily. If you fold up the bottom
edge of all the plastic walls of the vestibule, you can place heavy washers or
drapery weights in this edge in order to keep the sheet hanging down. Place
heavy plastic sheeting, which can be cleaned with antibacterial solution on a
regular basis to decrease possibility of tracking contaminants thru your home,
on the floor of the vestibule. If you duct tape the long edges of the sides of
the vestibule to the walls on either side of the sick room door you will have
one more barrier to escaping contaminants. In the vestibule you should have a
box of plastic garbage bags because all bagged trash, laundry, and body waste,
which you have to transport for cleaning or disposal, should be bagged in a clean
trash bag. Before you leave the sick room, the following sequence of actions
can help reduce the chance of spreading germs: 1) gather all your plastic
bagged items, 2) set them near the door, 3) remove your dirty gloves, 4) put on
clean gloves, 5) open the door, 6) go into the vestibule, 7) open and place on
the floor a clean plastic bag 8) place a filled plastic bag into the clean bag
9) remove your gloves and dispose of them 10) gather the top and close the
clean bag that contains your contaminated items, without touching the dirty
bag. Just a note to explain how to best remove dirty gloves without touching
them with your clean hands--grasp your left glove near the wrist with your
right thumb and forefinger and peel the left glove off, turning it inside out
as you do so. Then you can slip the now bare fingers of your left hand under
the cuff of the right glove and peel it off, also turning it inside out. This
keeps the contaminated surface of the gloves away from your skin. You might
want to consider having a large garbage can with lid and wheels outside the
vestibule into which you can place bags for transport. This would be easier
than juggling multiple bags. Make sure that you have gloves in any place you
will need to remove contaminated items in order to clean or dump them. Try to
remember that anything coming out of the contaminated sick room is a hazard to
you and your family. Place as many barriers as possible between the sick and
the healthy. You, as caregiver, are one of the healthy ones, so you should also
protect yourself with gowns, hair covers, shoe covers, masks, and gloves as
well as constant awareness of your risk. Plan all your actions beforehand and
move carefully and deliberately in order to minimize those risks. Now that we
have set up the sick room and all our supplies are installed and ready to use,
what should we do next? Let's talk about the linens needed to make the bed and
how we go about putting them to best use. I think the first thing to do is to
encase the mattress in a zippered plastic mattress cover. This will protect it
from being ruined by body fluids. A replacement mattress may be hard to come by
in challenging times. The bed can then be made with the following layers of
linens: a fitted sheet, a "draw" sheet (one folded to cover the area
from the patient's upper back to thigh area for lifting the patient), a
fluid-proof pad positioned in the center, a top flat sheet, and a blanket. The
fluid-proof pads can be commercial disposable ones or home-made ones. I have
made them from inexpensive flannel-backed plastic table cloths and a fabric
topping, such as old, soft toweling or heavy flannel. If you decide to make
them, cut them out in a size large enough to cover the bed from side to side
and about 24 inches wide. Sew them together like a pillowcase with the toweling
facing the plastic, then turn them right-side out so that the plastic is on one
side (the bottom) and the toweling is on the other side (next to the patient's
skin). Then sew the open end closed. These pads wash well but I would hang them
to dry, as the plastic may melt in a dryer. A "draw" sheet may be
made from cutting a flat twin sheet in half crossways then hemming the raw
edges. This sheet is placed across the center of the bed with its ends tucked in
on each side. This is a very useful piece of bed linen as it can be used to
pull your patient up in bed or to roll them from side to side by untucking the
ends and grasping them for the movement instead of grabbing the patient to move
them. It becomes more comfortable for the patient and provides better body
mechanics for the caregiver. The flat top sheet and blanket are placed on the
bed next, just as you would do normally. The only thing I would suggest that
you change from your usual bed-making is forgoing tucking the sheet and blanket
under the end of the mattress. A tightly tucked covering is uncomfortable for
the patient and can cause a problem called "foot drop" in patients
who are unable to reposition their feet themselves. As far as pillows are concerned,
you need lots of them and they should be encased in plastic protectors for the
same reason as you protected the mattress. Multiple pillows have a lot of uses
in the sick room. They can be used to raise the patient's head and upper body
for easier breathing. They can be used to elevate injured extremities, placed
under knees or feet, and tucked behind the patient to keep them in a side-lying
position. It was a rule when I worked in the hospital that the nurse with the
most pillows "won".
Let's discuss those wonderful
disposable plastic basins and "body fluid catchers" that will make
your job so much easier. We all have friends and family who have been
hospitalized (unfortunately) and return home with a collection of pink plastic
"stuff". Don't let them throw them away. Offer to take them off their
hands. A collection of rectangular bath basins, emesis basins, urinals, regular
bedpans, and flat fracture bedpans will be treasures if you have to care for a
sick family member. Just give them a good cleaning and disinfecting and pack
them away with all your other sickroom preps. If you can't get them for free,
they are available fairly reasonably in medical supply stores. What purpose do
these plastic wonders serve? The rectangular basins can be filled with warm soapy
water for a bath. The kidney shaped small emesis basins are easy to position
under the chin of a vomiting patient. The urinal is fairly self-explanatory as
it is positioned to catch the urine flow of a male patient. I would just warn
you to make sure that it is tilted with the opening up slightly or you will be
changing the sheets. Also be careful to place it gently between your patient's
legs to avoid injuring "delicate" parts. The regular bedpan is used
for bowel movements for both sexes and urination for female patients. It can be
positioned in two ways. If the patient is awake and able to move, they can bend
their knees and lift their bottom to allow you to place the bedpan underneath
them. If you dust the top edges of the pan with talc first it will slide into
place easier. Removal should be done the same way, except carefully so as not
to soil the sheets. If the patient is unable to move, you can use the draw
sheet to roll them onto their side and place the pan in position before rolling
them onto their back again. Obviously the laws of fluid mechanics won't allow
you to roll patient and pan for removal; just roll the patient while holding
the pan flat. The pan can then be set aside on that handy rolling table while
you clean the patient's bottom, straighten the sheets, and reposition them for
comfort. Baby wipes are wonderful for the cleaning chores and diaper cream
applied to the bottom will help avoid skin irritation. Diaper cream is
especially important for those patients who are incontinent and unable to use
bedpans or urinals. The fracture bedpan being flatter and smaller is useful
with those patients who have lower extremity, back, or pelvis injuries and for
whom movement causes pain. This pan can be powdered and gently worked under
their bottoms with less pain than the full-size bedpan.
One of the other procedures that can
seem daunting to a novice care giver but brings so much comfort to the patient
is bathing. If you gather all your equipment first and proceed logically, it
can be a pleasant experience for both of you. You will need to assemble: a
basin with hot, lightly soapy water, wash cloths, towels, talc, lotion, diaper
cream, and a light-weight flannel blanket. If you proceed from one part of the
body to the next while keeping everything else covered with the thin blanket,
the patient will not get too chilled. I usually start with the head, face, and
neck, then the chest, abdomen, and arms. When these areas are washed, dried,
and powdered, you can cover then with the blanket and do the lower front part
of the body. Use a separate wash cloth for the genitals. After the front of the
body is done, you can turn the patient on their side and do the back half. I
like to gently rub lotion onto their back before I reposition them again. This
relaxes tired muscles as well as stimulates blood flow to the skin, helping to
avoid pressure issues. A reminder--every time you have access to any part of
your patient's skin, you should make sure it is clean, dry, and either powdered
or lotioned. Look for any signs of impending pressure sores--especially over
bony areas like shoulder blades, hips, tailbone, elbows, and heels. If you see
any redness or whitening of skin, as well as any blistering or skin breakdown,
you need to address it immediately and frequently. Make sure the area is clean
and dry. If the skin is intact you can apply cushioning pads (available in
medical supply stores) and position the area to take pressure off of it.
Patients who are unable to move and roll in bed on their own should be repositioned
every two hours around the clock. It is much easier to prevent skin breakdown
than it is to heal it.
If you plan to change the linen on
the bed, it is easy to do after the patient's bath. After finishing bathing the
back of the patient and while they are still lying on their side, you can
loosen all the linen under the patient and roll it in a long roll toward the
patient's back. Then remake that side of the bed with fresh linen--rolling the
extra again into a long roll close to the patient's back. Reposition the
patient onto their back (they will be lying in a long lump of old and new linen
for a few seconds) and then onto their other side. Remove all soiled
linen--place it in dirty linen bag--then pull the clean linen through and tuck
as needed. Try not to leave folds and creases of linen under the patient; it is
uncomfortable and damaging to skin.
Something I have not addressed is
talking to your patient. It is a good thing to talk with and listen to your
patient during the times you are providing care. They are probably frightened
and need to express their fears, be reassured, and be updated on the situation
outside their sickroom, especially if they have a contagious disease and have
been isolated from family and friends. Being sick brings a strong sense of
helplessness and you will be doing a service to your patient if you let them
make choices and decisions where it is possible. Even if the patient is
unconscious and unresponsive, talk to them; they just may be able to hear you.
Another item of caregiving that
should be mentioned is record keeping. I am not talking about a detailed chart
such as is seen in hospitals. I am referring to a simple record that lists
pertinent information such as name, age, medical history, onset of illness,
symptoms, treatment given, and results observed. This information will allow
another caregiver to step in and take over care if you must leave the bedside.
The last, and possibly least planned for, but most important part of the home
sick room is taking care of the caregiver. Nursing a very ill or injured
person, especially if it is a friend or family member, is physically, mentally,
and emotionally draining. Make sure that you, as the caregiver, get enough
food, liquid, rest, and time away from the sick room to maintain your strength
and health.
This article contains the basics that
you need to know in order to care for a patient in your home. It certainly is
not a comprehensive nursing course. Please use the extensive online resources
available to extend you knowledge in this area. I hope that this information
has been useful and would welcome questions and comments.
Things to Stock For
Setting Up A Home Sick Room
·
Single bed (possibly hospital bed or raised bed)
·
Plastic mattress cover
·
Pillows (6)
·
Plastic pillow covers
·
Fitted sheets, flat sheets, blankets, pillow cases, draw sheets,
waterproof pads
·
Side rails
·
Towels/washcloths
·
Plastic basin, emesis basin bedpan, fracture bedpan, urinal
·
Hospital gowns
·
Rolling table
·
Chair
·
Bureau or shelves
·
Bedside commode
·
Walker, cane, crutches
·
Plastic garbage bags--large & small
·
Plastic garbage cans (2)
·
Toilet tissue and paper towels
·
Tissues
·
Baby wipes
·
Body wash, talcum powder, lotion, diaper cream, waterless
·
Cotton swabs
·
Disposable exam gloves
·
Thermometer with holder
·
Clipboard, paper, pens
·
Bleach, hand sanitizer, air freshener, surface cleaner
·
Tape
ADDITIONAL SUPPLIES
FOR CONTAGIOUS DISEASE
·
Several large, heavy sheets of clear plastic (for vestibule)
·
Heavy washers or drapery weights
·
Duct tape
·
Heavy duty stapler
·
PVC pipe
·
Shelves or table for vestibule
·
Disposable paper gowns, hair covers, shoe covers, masks
·
Large tub for soaking contaminated linens
·
Tarps for wrapping bodies
