Selecting & Using a Cane

When a resident has limitations in balance, joint motion, coordination or strength, a cane can sometimes be a useful tool in restoring mobility.  The first key is having the right ambulation aid for the user’s needs and abilities.  The second is gait training to achieve the safest walking pattern.

Considerations

The resident’s vision, balance and stability need to be considered, as well as his or her ability to learn new things and use good judgment.  If a cane is the right aid for the resident, it can provide support, balance, stability, safety, independence and relieve stress on the legs and feet.

A quad cane with four feet is the appropriate choice for a resident who is weaker on one side than another, such as after a stroke.

Measuring

Here’s one way to determine the right height for the cane:  Turn it upside down with the handle on the floor.  With the resident’s arms at his side the tip of the can should be level with the wrist.  Wooden canes can be shortened by removing the rubber tip and cutting with a saw.  Aluminum canes have holes and pins to adjust height by the inch; there are extenders for very tall people. 

Using a Cane

To use a cane, the resident should hold it on his or her stronger side.  When walking, the resident should move the cane and the weaker leg together.  When climbing up stairs, the resident should first step up with the stronger leg, then push to move the cane and the weaker leg up.  To go down stairs, the resident should first step down with the weaker leg and the cane.  Then, using the cane for support, he or she can lower the stronger leg down.

Great Catheter Care: Preventing Infections

Good catheter care is the biggest factor in preventing catheter-associated urinary tract infections.  Here are some tips for great catheter care.

• Wash your hands.  It sounds simple, but this is the single most important step in preventing infections.  Wash your hands BEFORE and AFTER putting on gloves.
• Use catheters sparingly—only when necessary.
• Use the smallest catheter that will do the job.
• When inserting the catheter, lay out a sterile field and maintain it.  If a person is obese or has contractures you may need two people to insert the catheter while maintaining a sterile field.
• Lubricate the tip of the catheter to prevent damage to the urethra during insertion.
• Use good lighting.  If you accidentally insert the catheter in the vagina, leave it there as a marker until you have placed a second, sterile catheter.
• Keep the system (catheter, tubing and bag) closed if possible.  The system should never be opened simply for convenience.
• Keep the drainage bag below the level of the bladder (but not lying on the floor).  Use clean technique when emptying the bag.
• Secure the catheter to prevent bleeding, trauma, tissue damage or bladder spasms that can be triggered by the catheter or balloon.  Tape can be hard on the skin; use a commercial device when possible.
• Keep the perineum clean.  Treat the catheter area like any other part of the body, washing as you would any other body part.
• If the resident is also incontinent of stool, check frequently to prevent stool from contaminating the catheter.
• Keep residents with catheters away from residents with infections.

Suspected infection:

If you suspect a urinary tract infection, remove the catheter and replace it with a new one.  Get a urine sample for culture and sensitivity from the new catheter.  Antibiotics should only be used for infections that are symptomatic.

Leakage

If catheter leakage occurs, check that the balloon is inflated and that the catheter is in the right place.  Make sure the balloon is inflated completely.  It is never acceptable to use a 30 cc balloon partially inflated.  Before changing to a larger catheter, keep in mind that constipation and fecal impaction may also contribute to leakage.  Larger catheters with larger balloons can damage the neck of the bladder.

YOU are the key to good catheter care that can prevent infections and discomfort, and save time and money.

Meds That Cause ER Visits

Four Culprits

Just four drugs and drug classes cause two thirds of the 100,000 annual emergency room visits for drug reactions in the elderly, according to recent research.  At the top of the list is warfarin (also known as Coumadin); it alone accounted for one third of the visits.  The other categories are insulins, oral hypoglycemic agents and oral antiplatelet medications.

With antiplatelet or blood thinning drugs, bleeding was the main problem. For insulin and other diabetes medications, about two-thirds of cases involved changes in mental status such as confusion, loss of consciousness or seizures.

Some of the common denominators in these drugs are that: they are commonly prescribed; there is a fine line between the therapeutic dose and a dangerous one; and they can all be difficult to use.  The researchers made note that none of the medications that were culprits were drugs that were labeled “high risk” for older adults, although some over-the-counter drugs like Benedryl are.

“Of the thousands of medications available to older patients, a small group of blood thinners and diabetes medications caused a high proportion of emergency hospitalizations for adverse drug events among elderly Americans,” said lead study author Dr. Daniel Budnitz of the Centers for Disease Control and Prevention (CDC). 

“We weren’t so surprised at the particular drugs that were involved,” Budnitz said. “But we were surprised how many of the emergency hospitalizations were due to such a relatively small number of these drugs.”

It is estimated that hospitalizations for accidental overdoses and adverse side effects are likely to increase as Americans live longer and the senior population grows.  Currently 40% of people older than 65 take five to nine medications; 18% take 10 or more.

Researchers at CDC published the study in the Nov. 24, 2011 New England Journal of Medicine.