Category Archives: Nursing

Life at brenthurst

Back to the Hawaiian theme of last time – drums beating and Hula girls swaying……..What is it about a beat and body-moving-music that gets one going?  The steady beat thrumming with our hearts anmusic stirring the senses in response?

So it is even with the elderly, at 9.am today in the frail Care – Unit, barely awake after a comfort –food brekkie, the music on and Carers and Residents armed with tambourines / shakers / tapping sticks & clapping.  The sparkof rhythms soon light up tired eyes & feet start tapping.

 

Then the singing starts and music therapy is in full swing as clapping starts to drown out the music. Who cares if it is in tune?  The blood is now pumping, eyes bright and cheeks flushed in “the history of now” joins in yesteryear when they were a whirl on the dance floor, memories in the making then and now being re-awakened.

 

 

 

The smiles are worth it all and for a while life on the Frail Care unit, known as “Brenton Lodge,” is alive with joy and new delights, where the music of the heart never fades

 

 

 

Sincerely

Matron Lizann Painter

Dementia Risks

Dementia related diseases. One of the silent and often overlooked risks for people living with Dementia is WEIGHT LOSS. The medial temporal cortex, which is involved in feeding behaviour and memory, is affected in the early stages of the disease. In today’s society weight loss is considered a good thing, something to aspire to, but as you become older that changes. Obesity carries its own risks, but for a person living with dementia, and even a healthy elderly person, there is a clear risk to losing weight. Often the weight being lost is muscle loss and not fat. The loss of muscle makes the person unable to carry their own weight and unsteady on their feet and the person becomes a fall risk. Falls can cause anything from skin flaps, broken hips to concussion. The consequence of repeated falls can become severe.

 

We do not have to accept the weight loss as a normal consequence of the illness. As caregivers, we have some simple tricks in our bag to combat dementia-associated weight loss:

 

  • Keep the person as active as possible, encourage them to exercise in any way that they are able. Swimming, dancing, walking, anything, and as much as what they are able to do. The more active they are the more enhanced their appetite will be. The increased movement will also help to improve their sleep.
  • Make sure that the meal with the highest caloric load is served at the time that they are the most alert. For most of Dementia patients this is at breakfast. There are some persons who are more alert later in the day, for them lunch can be the meal with the highest caloric load.
  • Don’t give them food they don’t like. This seems like an obvious, easy and silly point but people who live with dementia are often stubborn. If there is one thing on their plate that they do not like they can often discount the whole plate. The happier the person, the more likely they are to eat.
  • More herbs, more spices- over time and with age our taste buds ability decreases. This can be exacerbated by dementia. By using extra flavouring when cooking you can combat the problem of flavourless food and give the person more incentive to eat.
  • Make sure that the food is cooked to be tender and easily chewed and swallowed. Cutting the food into bite sized pieces before delivering it, will reduce the need to cut or handle the food which can frustrate or irritate the person.
  • Reduce the distractions in the dining room and over mealtimes. Turning off the television, making sure that your voice is kept low during meal times and ensuring that the table is clear of all unnecessary clutter will improve the focus on the meal and the eating process.
  • Make sure that the food is placed within the visual field of the person and that they are cued to start their meal. A person with a certain level of dementia will not initiate the eating process on their own, they will also stop and start eating and will need to be reminded to eat. Avoid interrupting the process or they might lose interest in the meal. Serve the pudding separately.
  • Frequently check the person’s mouth. Pain in their mouth or teeth can cause the person to lose their appetite and refuse to eat. Dentures that do not fit can cause frustration while eating and cause the person to stop eating.
  • Another obvious idea is to serve smaller more frequent meals with high calorie snacks in-between.
  • Champion independence. As the disease progresses the person will lose their ability to feed themselves little by little. The loss of independence can be devastating and depressing. Every scrap of independence that can be kept or regained will improve the person’s emotional wellbeing and, in turn, their appetite. There are many ways to offer the person’s independence back to them depending on their ability:
  • Make sure that the person can see the food i.e. do not put food on an overly patterned plate, this could cause the food to disappear into the pattern.
  • Make sure that the food colour contrasts with the colour of the plate.
  • Use cutlery crockery and glasses that are easy to lift and grip.
  • Give the person one item at a time with the appropriate utensil.
  • Make sure that the person is seated comfortably.
  • There are specific aids that can be bought to improve the person’s ability to eat on their own, plate guards to help scoop food on to the spoon or fork, utensils with plastic handles that are either molded to the person’s hand or that grip easier and will angle the spoon or fork into a better angle to easily fit into their mouth even with limited range of movement. Neck bibs that catch spills and. Hand wipes to reduce the tactile distraction if the person used their fingers to eat. Conversation may support distraction if they eat reluctantly.

UTI’s in the Elderly

As we grow older we find that normal tasks, usually quite simple and easy become more complex and problematic. Bending down all the way to tie your shoes or remembering where you put your car keys. It is a normal part of progressing in age. Part and parcel of this change is the myriad of health changes that we go through. Our immune system becomes weaker so the healing process takes longer. Because of this change elderly persons are more susceptible to infections like UTI’s.

What is a UTI?

UTI stands for a urinary tract infection. It is an infection involving the kidneys, ureters, bladder, or urethra, the structures that urine passes through before being eliminated by the body. Any part of this system can become infected. As a rule the farther up the tract the infection is located the more serious it is. Urine is normally sterile and infection occurs when bacteria get into the urine and begin to grow. The infection usually starts at the opening of the urethra where the urine leaves the body and moves upward to the urinary tract.

What are the symptoms?

The classic symptoms of UTIs are mild fever, chills or just not feeling well, cloudy, bad smelling or bloody urine, burning during urination, and frequent urination or leaking. In elderly people the classic symptoms of a UTI may not be present due to the poor immune system’s ability to fight the infection or an inability to express discomfort. Common symptoms to look out for are poor appetite, lethargy or a change in mental status – confusion, agitation or withdrawal.  If there is mild dementia present, days and nights can get mixed up and normal levels of confusion and other behaviours will be exacerbated.

Are UTIs dangerous?

The threat posed to an elderly person varies, some are very mild while others can be life threatening but typically, ordinary UITs are not especially dangerous to older people. For people who have dementia the symptoms can be misdiagnosed as part of the dementia condition. If the underlying UTI goes unrecognised and untreated for too long it can spread to the blood stream and become life threatening. Thus confusion in the elderly is often attributed to UTIs. Many infections are asymptomatic causing little or no symptoms at all. Often attempts to get to the toilet can quickly result in slipping or falling, thus increasing the risk of broken bones, surgery, death or disability.

How do you reduce the risk of UTIs?

People with incontinence are more at risk for UITs because of the close contact that adult briefs have with their skin which can reintroduce bacteria into the bladder. For these individuals encourage the frequent change of adult briefs, keep the genital area clean, encourage front to back cleansing and for memory impaired people set regular reminders to use the bathroom to avoid the need for adult briefs. Other ways to reduce the UTI risk are drinking enough liquids. Cranberry juice or cranberry tablets are known to reduce the risk of UTI but not in people prone to kidney stones. Avoid caffeine and alcohol as these irritate the bladder. Wear cotton-cloth underwear and practice emptying the bladder completely when going to the toilet.

If you notice any of the above symptoms please seek medical help.

 

The changing face of Nursing

 

A large part of the charm and success of Brenthurst residence is in the people who have chosen to work here. One such person is Sr. Lynette Unser our Nurse Manager –

I trained at Addington Hospital in Durban. These were the golden years of nursing training. An entire new hospital was built on the seafront in Durban’s’ Addington Beach and our group 2/66 ( March intake 1966) was involved in actually moving into and setting up the new wards and units. We also took occupancy of the brand new nursing home.

The nursing intakes for new recruits were large in those days. Our group was over hundred trainee nurses and we all lived in the Nurses Home so developed a strong relationship with our colleagues over the years. We had excellent tuition and exposure to all disciplines. Training was tough then and the senior Charge Sisters were absolute tyrants! As students one was terrified of them but they did instil a great work ethic which has remained ingrained in me throughout a very long career.

Our lives were quite regimented dividing the year into practical work in the wards alternating with periods or blocks in the Nursing College. As a Junior Nurse we wore green buttons on our uniforms and we all envied the Pale blue buttons of the senior nurses who were actually finished their training and waiting for their Epaulettes. But our time did come and eventually we could proudly display those epauletts and place a veil on our heads. What a sense of achievement! Today some of the traditional decorative insignia has gone, along with the nursing capes that we treasured on night duty as it kept you warm during the wee early hours of the morning. Gone too the veils and other frivolous head gear that was totally impractical as it caught on the patients curtains between the beds and was difficult to secure on one’s head.

lynette

I finally left Addington after completing my Midwifery course which was a year in those days. I had a desire to work at GSH the home of heart transplants and Dr Christian Barnard who had been the guest speaker at our inauguration ceremony. I think I had a sort of romantic impression of this great surgeon and the world wide recognition that he received after Louis Washkansky’s heart transplant. Delusion quickly set in in this regard but I won’t dwell on that. I did work in the Emergency department and gained a great deal of experience treating large trauma and distinctly remember suturing multiple wounds on night duty because the doctors were just inundated by patients. It was exciting and stimulating never routine and I looked forward to going to work everyday.

After getting married and having 3 children I returned to nursing and besides this gap of 8 years I have been nursing my entire life. I have worked overseas in the Middle East in Saudi Arabia and also the UAE for a period of 10 years so gained invaluable experience by being exposed to an entirely different culture and nursing philosophy. The Middle East is a university of life and if you can succeed there then you can succeed anywhere.

Now, when I really should be retiring, I find that I still enjoy this profession and continue to have a passion for my work, hence the reason that I am working at Brenthurst Residence in an entirely different field of nursing. Caring for people living with Dementia gives one a completely different perspective of nursing. No longer am I working in a tertiary institution where aggressive medicine is practiced. Now the accent is on providing a safe environment and maximizing care practices to promote independence. This has been an invaluable learning curve for me. It has indeed been a privilege to work here as this will certainly be my swansong.

Sr. Lynette Unser – Nurse Manager

Brenthurst Residence

World Diabetes Day 14 November 2015

With World Diabetes Day coming up on the 14th of November here is some interesting information pertaining to the least remembered part of diabetic care, FEET.

DIABETIC FOOT CARE

Why do people with diabetes get “Diabetic feet”?

If you have diabetes, your blood glucose, or blood sugar levels are too high. Over time, this can damage your nerves and/or blood vessels.

Nerve damage from diabetes can cause you to lose feeling in your feet. You may not feel a cut, blister or sore. Foot injuries such as these can cause ulcers and infections.

Inadequate blood flow increases the healing time for cuts and sores. Poor blood flow increases the risk that infections will not heal. This, in turn, increases the risk of ulcers and gangrene, which is tissue death that occurs in a localized area when there is an inadequate blood supply.

Can ‘diabetic feet” be prevented?

Taking good care of your feet can prevent problems before they start! Use the following tips to reduce your risk of common foot problems and serious complications associated with them.

Prevention:

  • Living with diabetes requires you to pay special attention to your overall health and your condition. Follow your doctors, dietician and physiotherapists instructions regarding diet, exercise and medication. Keeping your blood sugar levels within the recommended range is one of the best things you can do to control your condition and protect your feet.
  • Carefully inspect your feet daily for redness, blisters, sores, calluses and other signs of irritation. Daily foot checks are especially important if you have inadequate blood flow.
  • Follow these foot care tips to properly care for your feet:
    • Wash your feet daily with soap and warm water
    • Avoid soaking your feet
    • Dry your feet completely after bathing, paying special attention to the areas between the toes
    • Avoid applying lotion to the areas between the toes
    • Ask your doctor or a nurse which lotion is best for your skin type and health condition
  • Use the following toenail care tips to help prevent ingrown toenails:
    • Once a week, examine your toenails.
    • Trim toenails straight across using a nail clipper
    • Avoid rounding or trimming down the sides of the toenails
    • Smooth rough nail edges after trimming
  • Proper footwear, socks and stockings can go a long way to help protect your feet. Follow these tips:
    • Choose well fitted socks or stockings.
    • Wear socks to bed if your feet get chilly.
    • Avoid sandals and walking barefoot at home
    • Wear properly fitting shoes
    • Wear shoes made of soft material
    • Protect your feet by always wearing slippers or closed-toed shoes
  • Follow these tips to keep blood flowing to your feet:
    • If you can, prop your feet up when sitting down.
    • Wiggle your toes frequently.
    • Take frequent breaks to flex and point your toes
    • Circle your feet in both directions
    • Avoid crossing your legs
  • Avoid smoking, and if you do smoke, quit. Smoking aggravates blood flow problems
  • People who have diabetes should see a foot doctor every 2 to 3 months, even when not experiencing foot problems. At each check-up, ask the doctor to thoroughly examine your feet.

When should you contact a doctor?

  • Changes in skin colour or temperature
  • Foot or ankle swelling
  • The appearance of calluses, ingrown toenails, infected toenails, dry or cracked skin
  • Leg pain
  • Oozing, open sores that appear to be draining and are slow to heal