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Every surgery has risk — even short, “minor” surgeries. The wrong area of the body could be operated on accidentally. Sometimes surgery tools are left behind — especially in surgeries around and below the stomach. However, the greatest concern for your loved one’s doctors and nurses is preventing infection. Conditions that put patients at greater risk for infection include: Smoking Age 65 and older Poor nutrition/diet Surgeries on stomach area Low immune system Surgery on intestines Poor circulation Heavy use/abuse of alcohol Lack of exercise High blood sugar/diabetes

Support Safe Surgery

Support Safe Surgery

Facing surgery is stressful. You’ll offer peace of mind to your loved one if you prepare together and use the checklists on the next few pages. It’s a lot of information to take in, but every detail matters and you, dear Care Partner, will make a difference!

Remember to

Wash Hands!

13


Support Safe Surgery

Help Your Loved One Get Good Information

P Try to go to all doctor visits with your loved one. Bring a list of questions and concerns. Take good notes. ■ Ask: “What are some alternatives to surgery?” ■ For every diagnosis, ask: “What else could it be?”

P Urge your loved one to get an independent 2nd opinion — maybe even a 3rd opinion. (Not from the doctor’s friends or co-workers.) ■ Dig for more information on the Internet at reliable sites, sponsored by the government or leading health care associations. ■ Note: Internet information and other research — or advice from friends — does not take the place of seeing doctors!

P Urge your loved one to talk to surgeons who have done “thousands” of the planned surgery, not “hundreds.” (This may mean traveling to a different city if affordable.)

P If surgery is not an emergency, urge your loved one to schedule it on

Tuesday, Wednesday or Thursday. If possible, avoid July, August, and major holiday weeks. ■ Schedule surgery for when the surgeon will be working and available to your loved one for several days afterward. (It's OK to ask, "Planning a vacation?")

P Help make sure your loved one brings the surgery checklists in this book to doctor visits. Go over them together. (If the surgeon objects to these safety checklists, consider finding another.)

P If the surgeon works at different hospitals, help your loved one find out which one has the best record for infection. (See page 11.)

P Urge your loved one to talk to the surgeon about a screening MRSA test — a quick swab inside the nose. It's a helpful test so the hospital will know to take some special steps if your loved one happens to carry this germ.

P Ask the surgeon to explain the risks for surgery if your loved one

smokes or drinks heavily. (Maybe advice for stopping or cutting back too?)

P Ask for the doctor’s advice about diet and exercise to prepare for surgery.

14


P Read the surgeon’s pre-surgery instructions. Help make sure your loved one follows these instructions “to the T!”

P For 2 to 3 days before surgery, remind your loved one to shower with

antibacterial hair and body soap, with a final shower just before going to the hospital. (Chlorhexidine soap is available at most drugstores — it’s effective.)

P Help fill out a name tag (at right) for your loved one’s gown. Examples

Support Safe Surgery

Help Your Loved One Prepare for Surgery

of other details to include: hard of hearing, diabetic, low/high blood pressure, injured spinal cord, MRSA carrier, O negative blood type.

P If your loved one is having surgery on a "twin organ" (like kidneys and

lungs), or on an arm or leg, help avoid confusion over which side requires surgery. ■ Put a large piece of duct tape (or masking tape) over the side that should NOT be cut. Write a big, bold "NO!" on this tape for the side that should not be touched by the surgeon. ■ Note: Some suggest that this type of note should be written on the skin, but — for a lot of good reasons — that's not the safest thing to do.

P Keep your loved one warm. In cold weather, warm up the car first. Make sure hair is dry. Bring an extra sweater or other soft, warm clothing. (Hospitals have some very chilly areas.)

P Fill out a medication record with your loved one (pages 6 — 7). Bring it to the hospital with all of your loved one’s current medications.

P Prepare to stay with your loved one 24/7 while hospitalized. ■

It’s OK to ask for help — organize “shifts” with other family members and friends. Remember to

Wash Hands! 15


Support Safe Surgery

Use this Checklist to

Know What to Do at the Hospital the Day of Surgery

P The surgeon and nurses will find you to “touch base” before surgery starts. (If not, ask a nurse to help you find them.)

P During this pre-surgery conversation with the doctor, go over these

details to confirm: ■ Your loved one's name ■ Procedure ■ Location (ask for it to be marked) ■ Current medications ■ Allergies ■ Last time your loved one had anything to eat or drink ■ Any other information your loved one put on the gown label ■ Any other information the surgeon feels is important ■ How long the surgery will take ■ If you can expect updates during the surgery, or not Note: If you and your loved one used a "duct tape note" (see page 15), tell the surgeon to look for it!

P Go over the safe surgery steps below to confirm the surgical team will: ■ ■ ■ ■ ■ ■ ■

■ ■

Take a “Time Out” or “Huddle” just before the surgery Introduce team members to each other Share all the details confirmed above Use a surgical checklist Clip (not shave) hair that may need to be removed Give an antibiotic on time (Who is responsible? What time?) Review your loved one’s medications, allergies and any other special conditions (shown on your loved one’s name tag, too) Keep your loved one warm Provide additional oxygen

You may be wondering "What is a 'time-out'?”... "What's wrong with having surgery on a Friday — or a holiday?" This book wouldn't be quite so handy to use if we filled it full of all the "Why's" for these suggestions (and many more to come!) For more info, however, about the topics in this book go to www.SafeAndSoundBooks.com. 16


We Make a Great Team! TYPE OF SURGERY: ON MY:

LEFT

Thank You for Remembering to Double-Check... TYPE OF SURGERY:

RIGHT

MY SURGEON:

(if it applies, circle one) MY BLOOD TYPE:

ON MY:

LEFT

RIGHT

(if it applies, circle one)

MY SURGEON:

MY BLOOD TYPE:

MY ALLERGIES:

MY ALLERGIES:

MY CURRENT MEDICATIONS:

MY CURRENT MEDICATIONS:

OTHER SPECIAL INFO:

OTHER SPECIAL INFO:

P R I N T PAT I E N T ’ S N A M E A B O V E

P R I N T PAT I E N T ’ S N A M E A B O V E

PLEASE REMEMBER MY ANTIBIOTIC

PLEASE REMEMBER MY ANTIBIOTIC

© PartnerHealth www.partnerhealth.com

© PartnerHealth www.partnerhealth.com

I Know I’m in Good Hands,

Please Remember to Double-Check... TYPE OF SURGERY: ON MY:

LEFT

but I am still a little nervous...

TYPE OF SURGERY:

RIGHT

MY SURGEON:

(if it applies, circle one) MY BLOOD TYPE:

ON MY:

LEFT

RIGHT

MY SURGEON:

(if it applies, circle one) MY BLOOD TYPE:

MY ALLERGIES:

MY ALLERGIES:

MY CURRENT MEDICATIONS:

MY CURRENT MEDICATIONS:

OTHER SPECIAL INFO:

OTHER SPECIAL INFO:

P R I N T PAT I E N T ’ S N A M E A B O V E

P R I N T PAT I E N T ’ S N A M E A B O V E

PLEASE REMEMBER MY ANTIBIOTIC

PLEASE REMEMBER MY ANTIBIOTIC

© PartnerHealth www.partnerhealth.com

© PartnerHealth www.partnerhealth.com


Help Your Loved One Recover from Surgery

P Wait in the hospital during surgery and sit beside your loved one in the recovery area.

P Follow the checklists to help prevent infection, blood clots, bed sores and other conditions. (See next section, starting on page 20.)

P Make sure your loved one is warm. P Begin planning for care at home. (See pages 79-87.) P Follow up on whether post-surgery antibiotics are given. P Ask the surgeon: Were there complications during surgery? If so, what

Support Safe Surgery

Use this Checklist to

were they? Examples include unexpected blood loss or changes in the original surgery plan.

P Ask that a copy of the surgery notes be sent to your loved one’s home. During Your Loved One’s Recovery from Surgery,

Get a Nurse if: ■

A monitor alarm goes off

Your loved one shows signs of (or tells you about): Chills, shivering, body aches ■ Headaches, confusion ■ Unusual or extreme pain ■ Oozing, pus ■ Extreme redness where cuts were made for surgery ■

Remember to

Wash Hands!

17


Support Safe Surgery 18

Doctors’/Nurses’ Suggestions to Support Safe Surgery and Care Afterward


A friend

hears the song in my heart

and sings it to me when my memory fails. — Anonymous

How to Help the Nurses

Checklists to Prevent Health Complications


Safe & Sound Checklists to Help You Prevent Common Hospital Complications ™

HOSPITAL LOGO HERE

The

least movement

is of importance to all nature.

The entire ocean is affected by a pebble. — Blaise Pascal


Use These Quick Checklists to Help Support Your Loved One’s Nurses

Nurses are truly great champions for quality care — but they are in charge of several patients at once and often pulled in different directions. That’s why you are important to your loved one’s care team. As your loved one’s Care Partner, you can be the extra pair of eyes, ears and hands to help prevent the most common potential problems nurses watch for. The simple checklists on the following pages will help you learn about complications patients can face during any hospital stay — and what you can do to help nurses safeguard your loved one’s care to avoid them. These checklists are very important. Please read them over a few times. Feel free to ask your loved one’s nurses any questions you have. They may have suggestions for other things you can do — or watch for — to help care for your loved one.

How to Support the Nurses in the Hospital

P

Please make the extra effort to follow the checklists for preventing infection — a top priority for everyone!

Remember, It’s OK to Speak Up 19


PLEASE

Use this Checklist to

Help Prevent “Superbug” Infections

P Always wash your hands with soap and warm water, or Wash Hands!

About “Superbug” Infections: Dangerous and difficult to fight infections such as MRSA (mersa), VRE, and CRKP are called “Superbugs.” The germs are invisible and they’re everywhere in every hospital — even on clothing.

alcohol gel or foam — this goes for all visitors, too: ■ Before you touch your loved one ■ Whenever you enter and leave your loved one’s room

P As needed, kindly remind others to wash their hands

before touching your loved one. It’s OK to speak up — in a rush, even nurses and doctors may forget this step, but it could be a life-saver! (Place the reminder cards at right in can’t-miss spots.)

P Help make sure your loved one washes hands and uses a soft-bristled brush to gently clean under nails, especially after using the bathroom and before eating.

P Use alcohol wipes to clean away germs from any surfaces your loved one and others may touch, such as…

Cell phone Telephone Doorknobs Faucets Call buttons Bed rails Bedside tables and chairs

Inhalers TV remote Toilet handle Grab rails IV pole Spirometer Wheelchair arms and backs

Who’s At Risk:

P Be sure to clean again after every touch/contact by

All patients are at risk for Superbug Infections.

P Ask for bottles of alcohol-based gel to put in easy reach

anyone.

for your loved one.

Note: It’s OK to ask for alcohol wipes and gel, and a nail brush. The hospital will likely have a supply. If not, buy them yourself. Choose well known brands for the wipes and gels.

P Make sure nurses and doctors use clean stethoscopes and thermometers.

20


T H E N F O L D T O F O R M T W O TA B L E S I G N S

P R I N T PAT I E N T ’ S N A M E A B O V E

Thank you for washing your hands... and using sterile instruments too!

P R I N T PAT I E N T ’ S N A M E A B O V E

Thank you for washing your hands... and using sterile instruments too!

For my safety.... Please wash your hands & use sterile instruments

T E A R O U T T H I S PA G E A L O N G P E R F O R AT I O N S ,

For my safety.... Please wash your hands and use sterile instruments.

P R I N T PAT I E N T ’ S N A M E A B O V E

© PartnerHealth www.partnerhealth.com

P R I N T PAT I E N T ’ S N A M E A B O V E © PartnerHealth www.partnerhealth.com


P

You see any changes in the skin (or your loved one tells you about): ■ Oozing, pus, extreme redness, tenderness ■ Bumps or spots that look like boils, pimples or bug bites ■ Breaks in the skin or a skin rash Your loved one shows signs of (or tells you about): Chills , shivering Headache Body aches Confusion Diarrhea Cramps Extreme pain Nausea No appetite Fast heartbeat Fast breathing Low blood pressure Check out www.hhs.gov/PartneringToHeal, a great video for Care Partners. In just a few minutes, it shows how you can help prevent infection — and why your help is so important!

Help Prevent “Superbug” Infections

Get a Nurse if:

Notes:

Remember, It’s OK to Speak Up 21


PLEASE

Use this Checklist to

Help Prevent C. diff Infection

P If your loved one has been on antibiotics in the past Wash Hands!

About C. diff Infections: C. diff is another type of infection from germs in hospitals. It causes diarrhea and dehydration that can lead to heart failure.

Who’s At Risk: All patients are at risk of D diff, especially those age 65+, recent use of antibiotic medicines, prior history of C. diff, long bouts of diarrhea, weak immune system, live in a nursing home or other long-term care facility 22

year, or lives in a nursing home or long-term care facility, make sure these facts are part of the medical record. To be on the safe side, tell your loved one’s nurses yourself.

P Follow the checklist for preventing Superbug infections. P Alcohol wipes won't kill C diff germs. In addition to

alcohol wipes, help keep your loved one’s surroundings extremely clean with bleach wipes. Wipe down these surfaces when your loved one first arrives and after every touch/contact by anyone: (Pay special attention to toilet levers and faucets.) TV remote telephone call buttons door knobs bedside tables bedside chair bed rails faucets toilet handle wheelchairs (especially backs & arms) IV pole personal items, such as: cell phone, iPod, laptop, pens, glasses and case Note: It’s OK to ask for bleach wipes. If the hospital doesn’t have a supply, buy them yourself and choose a trusted brand of bleach wipes from a well-known store.

P Make sure you and your loved one wash hands with

warm soap and water before eating and after using the bathroom. A soft soapy nail brush helps clean under nails where C. diff spores can hide.

P Bring clean clothes to the hospital for your loved one to

wear home. Store until needed in a suitcase or plastic bag to keep germ-free. ■ As soon as you get home, wash all clothing you and your loved one wore in the hospital with warm soapy detergent and bleach. Use a clothes dryer, which helps kill germs. ■ Share this tip with visitors, too!


P Help Prevent C. Diff Infections

Get a Nurse if: Your loved one shows signs of (or tells you about): ■ Diarrhea (may be bloody) ■ Stomach pains, cramps ■ Loss of appetite ■ Nausea ■ Chills ■ Fast/racing heartbeat

Notes:

Remember, It’s OK to Speak Up 23


PLEASE

Use this Checklist to

Help Prevent Bloodstream Infection

P When a central line is inserted, ask: “Are you using a central line bundle?"

Wash Hands!

About Bloodstream Infections: Germs can invade the body through cuts or breaks in the skin, resulting in serious infection that’s carried through the body in the bloodstream.

P Watch to make sure that nurses and doctors always: ■

■ ■ ■

■ ■ ■

Wash their hands thoroughly before touching your loved one Use sterile instruments and supplies Sterilize the skin Choose the safest spot Ask, “Why?” if groin is chosen Use a clean sheet to drape your loved one's body Wear a mask Cover the area with a sterile pad

P Make sure any openings in the skin are kept covered at all times.

Central line xxx

IV lines often go here (but not always)

Risk Factors: Use of a tube and bag system called an “IV” or a “central line” to deliver fluids because the skin has to be broken for these lines to be inserted.

24

Central line can go in the groin, but it’s not the safest place xxx shows example surgery sites

x x x

xxx


P

Your loved one shows signs of (or tells you about): Chills , shivering Headache Body aches Confusion Diarrhea Cramps Extreme pain Nausea No appetite Fast heartbeat Fast breathing Low blood pressure Check out www.hhs.gov/PartneringToHeal – a great video for Care Partners. In just a few minutes, it shows how you can help prevent infection — and why your help is so important!

Notes:

Help Prevent Bloodstream Infections

Get a Nurse if:

Remember, It’s OK to Speak Up 25


PLEASE

Use this Checklist to

Help Prevent Blood Clots

P Tell doctors and nurses you’re concerned about blood clots.

Wash Hands!

About Blood Clots Blood clots can form in the deep veins of legs and arms. Sometimes, a piece of the clot breaks off and travels to the lung, which is called an embolism. Blood clots and embolisms are serious.

P Make sure your loved one has: ■ ■

Special stockings, boots or arm bands that pulse Regular and frequent walks — if able and allowed by your loved one’s doctor A prescription for a blood thinner*

P Watch for signs of blood clots for at least one month after your loved one leaves the hospital. (See list under “Call a Nurse,” page 27.)

Remember that blood clots can form even if your loved one feels 100% “back-to-normal” in other ways.

P Encourage walks and exercise after your loved one leaves the hospital (if OK’d by doctor).

* To be on the safe side, be sure the doctor is aware of other Risk Factors: Surgery (stomach, hip, and knee, especially), family history of clotting, diabetes, smoking, birth control and other hormone pills, obesity, spinal cord injury, multiple injuries, lack of exercise 26

medications, vitamins and herbs your loved one is taking— plus any prior bad reactions to medications. If you are not sure, it’s OK to ask “Before you give the blood thinner, can we make sure nothing else will interfere with it?” A review of your loved one’s diet is a good idea, too.


P

Your loved one shows signs of (or tells you about): ■ Swelling in a leg or arm ■ Pain or a burning feeling in a leg or arm ■ Shortness of breath, difficulty breathing Special Note: If your loved one is on pain medication or on a breathing machine, you need to be especially watchful because the senses are dulled.

Help Prevent Blood Clots

Get a Nurse if:

Notes:

Remember, It’s OK to Speak Up 27


PLEASE

Use this Checklist to

Help Prevent Medication Mix-Ups

P Make sure that your loved one's allergies and any bad Wash Hands!

About Medication Mix-Ups Over a dozen steps are followed each time a patient gets a medicine in the hospital. Several safety checks are part of the process, but it’s important for you to help, too — there is no such thing as “too safe” for your loved one!

Risk Factors: Patients tend to get several medications in the hospital. Many look alike and their names sound alike. Nurses can be distracted, especially when others talk or interrupt them while giving a medication.

28

experiences with medicines in the past are included on the medical record — and highlighted in a bold way.

P Before a nurse ever gives a medicine, ask: ■

■ ■ ■ ■ ■

What is the medicine you're planning to give? (If an IV bag is used, read the label to double check it's the right medicine.) What is it for? What is the dose? Who prescribed it? (your loved one’s name) Say: “Let’s confirm that it's for_____________________.“ For medicines in an IV bag, ask: “What time do you think this bag will run out?” If the bag empties completely, get a nurse, especially if you see blood creeping up the IV tube.

P Don't talk to nurses when they give medicines — or

distract them. ■ However, speak up immediately if you sense a mistake is being made. (For example, wrong patient, wrong medicine, wrong time, wrong dose, wrong way.)

P Research the pros and cons of every drug prescribed for your loved one. Make notes about the potential side effects and interactions. Buy a drug guide or look on the Internet. If you have any concerns, bring them up immediately with the attending doctor.

P Record every time your loved one gets a medicine. See Daily Care Section beginning on page 39.


P You see — or your loved one tells you about — signs of bad reactions to medications: Diarrhea Stomach cramps Coughing Wheezing Swelling in neck Difficulty breathing Difficulty swallowing Swelling face Swelling/itchy eyes Rash or hives

Confusion, anxiety, restlessness Light-headedness, dizziness Fainting High blood pressure Drop in blood pressure Bluish lips Cool, clammy skin Chest pain Unusual sweating

Help Prevent Medication Mix-Ups

Get a Nurse if:

Note: It’s OK to simply trust your gut. You know your loved one best. Every medication — or combination — could affect your loved one in a way that’s not expected. Always get a nurse if you have any worries about anything that “just doesn’t seem right.”

Notes:

Remember, It’s OK to Speak Up 29


PLEASE

Use this Checklist to

Help Prevent Your Loved One from Falling

P Tell nurses you are concerned about your loved one Wash Hands!

About Falling: Falls can happen to anyone in an unfamiliar place. Most patients are tired, weak or sleepy from medications, or suffering from conditions affecting balance.

taking a fall or falling out of bed. ■ Ask about getting a cane or walker, and using bed rails. ■ Ask about the hospital's fall protection equipment such as low beds and floor padding.

P Look for things in your loved one’s room that might

cause a trip and fall. ■ Point out all furniture and equipment on wheels. ■ Discuss ways to move around the room without leaning on wheeled items for support.

P Ask for a bed alarm and a room close to the nurses' station.

P Make sure someone helps your loved one go back and

forth to the bathroom or commode, and that someone is on standby in your loved one's room for every trip.

P Hang the “CAUTION!” signs (at right) in can’t-miss

spots in your loved one’s room, such as on doors or over the head of the bed.

Who’s At Risk:

P Bring non-skid socks or slippers for your loved one to

All patients are at risk for Falling

P If you are able, lend your arm for support when your

wear when out of bed.

loved one walks. ■ Please don’t take a risk you might injure yourself — it’s OK to ask for help.

P Watch to make sure the hospital gown and any IV tubes won’t trip your loved one.

30


CAUTION!

FALL RISK

CAUTION!

FALL RISK

P R I N T PAT I E N T ’ S N A M E A B O V E © PartnerHealth www.partnerhealth.com

P R I N T PAT I E N T ’ S N A M E A B O V E © PartnerHealth www.partnerhealth.com

CAUTION!

CAUTION!

FALL RISK

P R I N T PAT I E N T ’ S N A M E A B O V E © PartnerHealth www.partnerhealth.com

FALL RISK

P R I N T PAT I E N T ’ S N A M E A B O V E © PartnerHealth www.partnerhealth.com


P

Hit a call button immediately.

Go in the hall and call for help.

Make sure someone hears you and comes right away.

Do not move your loved one.

Put a blanket over her/him.

Note: If your loved one falls, or falls out of bed, ask to be part of the hospital's post-fall huddle to find out: ■ ■

How the fall happened What will be done to help make sure your loved one doesn't fall again.

Notes:

Help Prevent Your Loved One from Falling

Get a Nurse if Your Loved One Falls

Remember, It’s OK to Speak Up 31


PLEASE

Use this Checklist to

Help Prevent Painful Bed Sores

P Help make sure your loved one changes positions every Wash Hands!

About Bed Sores: Bed sores are pits or breaks in the skin in areas that don’t get much blood flow (bony areas) or where sweat collects (folds of skin). Bed sores are much easier to prevent than to heal. They can also be a dangerous tunnel for infection.

two hours — even more often if your loved one can manage it. (It helps to set a timer.)

P Ask for an alternating air pressure mattress and some type of pad to absorb moisture.

P Make sure your loved one has foam cushions between ankles and knees, for elbows, and back of head.

P If the hospital gown or sheets become wet, get help to

change them as soon as possible. If you are able-bodied, help change the sheets.

P Help make sure that nothing rubs or scratches your

loved one’s skin — ask nurses about barrier cream for fragile skin areas.

P When your loved one gets out of bed, either alone or with help, make sure it’s done very gently to avoid scraping any skin.

Risk Factors: Thin skin, stroke, lung conditions, cancer treatment, diabetes, spinal cord injury, bed/chair-bound, poor circulation, very thin/overweight, age 65 and older

32

P Ask the attending doctor about “upping” the protein in

your loved one’s diet. Ask if it’s OK for you to bring highprotein snacks, drinks or food.

P It’s OK to ask for the hospital wound care specialist if you have any concerns. Remember, bed sores are much easier to prevent than to heal!


P Nurses Check Your Loved One’s Skin Every Day If OK with your loved one, check his or her skin daily — or even more often.

..

This is Where Nurses Look: ■

The bony areas (see blue dots): Back of head Behind ears Elbows Hipbones “Sit” bones Tailbone Knees Heels Areas where sweat collects: Between buttocks Between folds of fat Under breasts

.

. . ..

Help Prevent Painful Bed Sores

Help Make Sure

..

This is What Nurses Look For: ■ ■ ■

Any breaks or scrapes in the skin Abnormally white patches of skin (especially on bony areas) Pinkness, redness or swelling in the skin that doesn’t go away in minutes Areas of skin that are extra-warm

If Skin Problems Appear: Make sure no pressure is put on the abnormal areas of skin for the next 24-48 hours, or until the skin is back to normal. Ask nurses for their attention and help.

Remember, It’s OK to Speak Up 33


PLEASE

Wash Hands!

About Pneumonia from a Ventilator Patients who need a machine to help them breathe can get a lung infection (pneumonia) if germs get into the breathing tube. This infection is also called VAP, for Ventilator Associated Pneumonia.

Use this Checklist to

Help Prevent from a Pneumonia from a Ventilator (VAP)

P Ask about the sterile steps used to put the breathing tube into your loved one.

P Ask for a daily check of your loved one’s ability to breathe without machine help.

P Use the angle guide (at right) to help make sure your

loved one’s back and head are always at least at a 30 degree angle by raising the mattress. ■ If your loved one slumps, tell a nurse right away. ■ If you are able-bodied, ask if you can help position your loved one to sit up straighter. ■ Be on the lookout for bed sores on your loved one's tailbone and "sit bones." Follow the checklist on page 32 to prevent bed sores.

P Ask about medicines to help prevent your loved one

from getting stomach ulcers (sometimes caused from the breathing tube).

P Ask about care for your loved one’s teeth, gums and Risk Factors: Use of ventilator for breathing, lung disease, age 65 and older

tongue every four hours to kill germs that could go from mouth to lungs. Make sure these are used every time: ■ A toothbrush with soft bristles and 1.5% peroxide toothpaste ■ A vacuum tool to pull germs and waste from the mouth ■ A chlorhexidine rinse (It tastes bad — but it works!)

Note: Sometimes patients on ventilators have their hands bound to keep them from pulling out the tubes by accident. This may be scary for your loved one, and may even cause a panic attack. Get a nurse to help ease your loved one’s fears.

34


30 Degree Angle Guide This can help you check that your loved one’s head and back are supported at an angle of 30 degrees or more. Š PartnerHealth www.partnerhealth.com


P

You see signs of (or your loved one tells you about): ■ Fever, chills, shivering, body aches, headaches, confusion ■ White patches or sores in your loved one’s mouth or on the lips ■ Cough with phlegm (can be yellow or green) ■ Your loved one needs suctioning more and more often ■ Need for higher settings on the breathing machine You see: ■ The tube coming loose ■ Water drops inside the tube

Help Prevent Pneumonia

Get a Nurse if:

Notes:

Remember, It’s OK to Speak Up 35


PLEASE

Wash Hands!

About Urinary Tract Infections A urinary tract infection (UTI) can develop when germs enter the body through a plastic tube used to drain urine. The bladder, kidneys and urethra can all be infected. (*This infection is also called a CAUTI for Catheter Associated Urinary Tract Infection.)

Risk Factors:: Use of plastic tube and bag system for urine collection (called a “Foley” catheter)

36

Use this Checklist to

Help Prevent a Urinary Tract Infection (UTI)*

P Every day, ask if the Foley catheter can be removed. P When no longer needed, ask the doctor for a written

order to take it out. ■ If not taken out as ordered, politely remind at every shift change until the tube and bag are removed from your loved one’s body.

P Ask about the cleaning plan (daily is ideal). P To prevent urine from going back into your loved one’s

body, keep an eye on the tube for kinks and tangles, and straighten them. ■ Make sure the bag hangs below your loved one’s stomach area so urine can’t back up the tube.

P Make sure the bag is replaced when full.


P Help Prevent Urinary Tract Infections

Get a Nurse if: You see signs of (or your loved one tells you about): ■ Chills, shivering, body aches, headaches, confusion ■ Pain or a burning feeling in the lower stomach area ■ Lower back pain ■ Blood in urine bag (You may see a slightly pink color.)

Notes:

Remember, It’s OK to Speak Up 37


38

How to Support the Nurses in the Hospital Additional Notes


Prepare for surgery e book