Advance Directives and Do Not Resuscitate Orders
What is an advance directive?
An
advance directive tells
your doctor what kind of
care you would like to
have if you become
unable to make medical
decisions (if you are in
a coma, for example). If
you are admitted to the
hospital, the hospital
staff will probably talk
to you about advance
directives.
A good advance directive describes the kind of treatment you would want depending on how sick you are. For example, the directives would describe what kind of care you want if you have an illness that you are unlikely to recover from, or if you are permanently unconscious. Advance directives usually tell your doctor that you don't want certain kinds of treatment. However, they can also say that you want a certain treatment no matter how ill you are.
Advance directives can take many forms. Laws about advance directives are different in each state. You should be aware of the laws in your state.
A good advance directive describes the kind of treatment you would want depending on how sick you are. For example, the directives would describe what kind of care you want if you have an illness that you are unlikely to recover from, or if you are permanently unconscious. Advance directives usually tell your doctor that you don't want certain kinds of treatment. However, they can also say that you want a certain treatment no matter how ill you are.
Advance directives can take many forms. Laws about advance directives are different in each state. You should be aware of the laws in your state.
What is a living will?
A
living will is one type
of advance directive. It
is a written, legal
document that describes
the kind of medical
treatments or
life-sustaining
treatments you would
want if you were
seriously or terminally
ill. A living will
doesn't let you select
someone to make
decisions for you.
What is a durable power of attorney for health care?
A
durable power of
attorney (DPA) for
health care is another
kind of advance
directive. A DPA states
whom you have chosen to
make health care
decisions for you. It
becomes active any time
you are unconscious or
unable to make medical
decisions. A DPA is
generally more useful
than a living will. But
a DPA may not be a good
choice if you don't have
another person you trust
to make these decisions
for you.
Living wills and DPAs are legal in most states. Even if they aren't officially recognized by the law in your state, they can still guide your loved ones and doctor if you are unable to make decisions about your medical care. Ask your doctor, lawyer or state representative about the law in your state.
Living wills and DPAs are legal in most states. Even if they aren't officially recognized by the law in your state, they can still guide your loved ones and doctor if you are unable to make decisions about your medical care. Ask your doctor, lawyer or state representative about the law in your state.
What is a do not resuscitate order?
A
do not resuscitate (DNR)
order is another kind of
advance directive. A DNR
is a request not to have
cardiopulmonary
resuscitation (CPR) if
your heart stops or if
you stop breathing.
(Unless given other
instructions, hospital
staff will try to help
all patients whose heart
has stopped or who have
stopped breathing.) You
can use an advance
directive form or tell
your doctor that you
don't want to be
resuscitated. In this
case, a DNR order is put
in your medical chart by
your doctor. DNR orders
are accepted by doctors
and hospitals in all
states.
Should I have an advance directive?
By
creating an advance
directive, you are
making your preferences
about medical care known
before you're faced with
a serious injury or
illness. This will spare
your loved ones the
stress of making
decisions about your
care while you are sick.
Any person 18 years of
age or older can prepare
an advance directive.
People who are seriously or terminally ill are more likely to have an advance directive. For example, someone with terminal cancer might write that she does not want to be put on a respirator if she stops breathing. This action can reduce her suffering, increase her peace of mind and increase her control over her death. However, even if you are in good health, you might want to consider writing an advance directive. An accident or serious illness can happen suddenly, and if you already have a signed advance directive, your wishes are more likely to be followed.
People who are seriously or terminally ill are more likely to have an advance directive. For example, someone with terminal cancer might write that she does not want to be put on a respirator if she stops breathing. This action can reduce her suffering, increase her peace of mind and increase her control over her death. However, even if you are in good health, you might want to consider writing an advance directive. An accident or serious illness can happen suddenly, and if you already have a signed advance directive, your wishes are more likely to be followed.
How can I write an advance directive?
You
can write an advance
directive in several
ways:
- Use a form provided by your doctor.
- Write your wishes down by yourself.
- Call your health department or state department on aging to get a form.
- Call a lawyer.
- Use a computer software package for legal documents.
Advance directives and
living wills do not have
to be complicated legal
documents. They can be
short, simple statements
about what you want done
or not done if you can't
speak for yourself.
Remember, anything you
write by yourself or
with a computer software
package should follow
your state laws. You may
also want to have what
you have written
reviewed by your doctor
or a lawyer to make sure
your directives are
understood exactly as
you intended. When you
are satisfied with your
directives, the orders
should be notarized if
possible, and copies
should be given to your
family and your doctor.
Can I change my advance directive?
You
may change or cancel
your advance directive
at any time, as long as
you are considered of
sound mind to do so.
Being of sound mind
means that you are still
able to think rationally
and communicate your
wishes in a clear
manner. Again, your
changes must be made,
signed and notarized
according to the laws in
your state. Make sure
that your doctor and any
family members who knew
about your directives
are also aware that you
have changed them.
If you do not have time to put your changes in writing, you can make them known while you are in the hospital. Tell your doctor and any family or friends present exactly what you want to happen. Usually, wishes that are made in person will be followed in place of the ones made earlier in writing. Be sure your instructions are clearly understood by everyone you have told.
If you do not have time to put your changes in writing, you can make them known while you are in the hospital. Tell your doctor and any family or friends present exactly what you want to happen. Usually, wishes that are made in person will be followed in place of the ones made earlier in writing. Be sure your instructions are clearly understood by everyone you have told.
Artificial Hydration and Nutrition
When do people need artificial hydration and nutrition?
If
a patient isn't able to
swallow because of a
medical problem, he or
she can be given fluids
and nutrition in ways
other than by mouth.
This is referred to as
artificial hydration and
nutrition. This is
sometimes done when
someone is recovering
from a temporary
problem. It may also be
done when someone has an
advanced,
life-threatening illness
and is dying.
What is involved in artificial nutrition and hydration?
An
intravenous (IV)
catheter (a thin plastic
tube that slides in over
a needle) may be placed
in the vein under the
patient's skin. Fluids
and sometimes nutrition
are given through the
catheter.
Another method of artificial nutrition and hydration is through a plastic tube called a nasogastric tube (also called an NG tube). This tube is put through the nose, down the throat and into the stomach. It can only be left in for a short time, usually 1 to 4 weeks. If the tube has to be in longer, a different kind of feeding tube may be used. It's placed into the wall of the stomach (also called a PEG tube or g-tube).
Another method of artificial nutrition and hydration is through a plastic tube called a nasogastric tube (also called an NG tube). This tube is put through the nose, down the throat and into the stomach. It can only be left in for a short time, usually 1 to 4 weeks. If the tube has to be in longer, a different kind of feeding tube may be used. It's placed into the wall of the stomach (also called a PEG tube or g-tube).
What happens if artificial hydration or nutrition are not given?
Persons who don't
receive any food or
fluids will eventually
fall into a deep sleep
(coma) and usually die
in 1 to 3 weeks.
What are the benefits?
A
person with a temporary
illness who can't
swallow needs nutrients
and water. A feeding
tube can help. Sometimes
a person may become
confused because of
dehydration. Dehydration
is when the body doesn't
get enough fluids.
Giving a patient fluids
through a tube help
dehydration and may
lessen his or her
confusion. Giving fluids
and nutrition helps the
patient as he or she is
recovering.
For a patient with an advanced life-threatening illness who is dying, artificial hydration and nutrition may not provide many benefits. Artificial hydration and nutrition in these patients may make the patient live a little longer, but not always.
For a patient with an advanced life-threatening illness who is dying, artificial hydration and nutrition may not provide many benefits. Artificial hydration and nutrition in these patients may make the patient live a little longer, but not always.
What are the risks?
There's always a risk
when someone is fed
through a tube. Liquid
might enter the lungs.
This can cause coughing
and pneumonia. Feeding
tubes may feel
uncomfortable. They can
become plugged up,
causing pain, nausea and
vomiting. Feeding tubes
may also cause
infections. Sometimes,
patients may need to be
physically restrained or
sedated to keep them
from pulling out the
feeding tube.
How do we decide whether to use artificial hydration and nutrition?
The
patient and his or her
family should talk with
the doctor about the
patient's medical
condition and risks and
benefits of giving
artificial hydration and
nutrition. Each
situation is different.
Your doctor can help you
make the decision that
is right for the patient
and family
Artificial Hydration
What is artificial hydration?
Artificial hydration is
a way to replace fluids
that have been lost
through vomiting,
sweating or diarrhea. It
may be necessary when a
person is too sick to
drink enough water or
eat enough food.
Why do our bodies need fluid?
Our
bodies are made mostly
of water. Almost 60
percent of our body
weight comes from water.
In order to be healthy,
the body needs water
just as it needs food.
We lose water everyday
in two ways: by going to
the bathroom (about 45
ounces a day) and by
sweating and breathing
(at least 21 ounces a
day). We have to eat
food and drink fluids
every day to get the
amount of water our
bodies need.
How are fluids replaced?
There are two ways to
replace fluids in
someone who needs them.
The first way is to put
the fluid right into a
vein. This is called
intravenous (IV) fluid
replacement. The other
way is to put the fluid
under the skin. This is
called hypodermoclysis,
or subcutaneous fluid
replacement.
With IV fluid replacement, doctors and nurses need to watch the person very closely in a hospital. But a family member or other caregiver can do hypodermoclysis at home after a doctor or nurse shows him or her how to do it.
With IV fluid replacement, doctors and nurses need to watch the person very closely in a hospital. But a family member or other caregiver can do hypodermoclysis at home after a doctor or nurse shows him or her how to do it.
How safe is hypodermoclysis?
This way of replacing
fluid has been used
safely for many years.
It is used most often on
older people and in
people who have cancer.
How does hypodermoclysis work?
A
bag of fluid is
connected to a plastic
tube and to a long
needle. The needle is
put under the skin and
taped in place, usually
on the chest, abdomen or
thighs.
A "drip chamber," or small window, in the tube shows how fast the fluid is dripping. The speed of the drip can be controlled by using a roller clamp. A nurse or doctor should replace the needle every 4 to 7 days so the flesh around the needle does not become infected.
Your doctor will decide how fast the fluid should drip. Your doctor will show you how to control the drip and tell you when to check it at home. You can ask your doctor for help if you have questions or problems.
A "drip chamber," or small window, in the tube shows how fast the fluid is dripping. The speed of the drip can be controlled by using a roller clamp. A nurse or doctor should replace the needle every 4 to 7 days so the flesh around the needle does not become infected.
Your doctor will decide how fast the fluid should drip. Your doctor will show you how to control the drip and tell you when to check it at home. You can ask your doctor for help if you have questions or problems.
What are the common problems with hypodermoclysis and what should I do?
Most of the time,
hypodermoclysis is safe.
Sometimes though, there
can be problems. Here
are a few things that
might happen during
hypodermoclysis:
- The speed of the drip changes or the drip stops. Your doctor will show you how to control the flow rate by rolling the roller clamp.
- The site where the needle is inserted will swell. If you gently rub the skin there, the fluid will soak in better. Your doctor will show you how. Call your doctor for help if the swelling continues or does not get better.
- The site where the needle is inserted becomes painful. Check the skin for redness. Tell your doctor if the skin is red. It may be time to find a different place to insert the needle.
- Blood collects in the tube. This means the needle has gone into a vein. Call your doctor if this happens.
- The person has trouble breathing or is feeling much worse. If this is the case, call your doctor.
End-of-Life Care: Cardiopulmonary Resuscitation (CPR)
When is CPR important?
CPR
may be done when a
person stops breathing
or the heart stops
beating (like when a
person has a heart
attack). When it's
possible that the person
may get better, CPR is
important.
However, when a patient has an advanced life-threatening illness (such as cancer) and is dying, CPR may not be the option to choose. It's important for the patient, family members and doctor to talk about this issue before the need arises.
However, when a patient has an advanced life-threatening illness (such as cancer) and is dying, CPR may not be the option to choose. It's important for the patient, family members and doctor to talk about this issue before the need arises.
What happens during CPR?
During CPR, the chest is
pressed on forcefully.
Electric stimulation to
the chest and special
medicines are sometimes
used. This is usually
done for 15 to 30
minutes. A tube may also
be put through the mouth
or nose into the lung.
This tube is then
connected to a breathing
machine.
What happens if CPR isn't done?
A
person will become
unconscious almost
immediately and will die
in 5 to 10 minutes.
What are the benefits of CPR?
For
a patient with an
advanced
life-threatening illness
who is dying, there are
really no benefits.
CPR may prolong life for patients with a better health status or who are younger. CPR may also prolong life if it's done within 5 to 10 minutes of when the person's heart stopped beating or breathing stopped.
CPR may prolong life for patients with a better health status or who are younger. CPR may also prolong life if it's done within 5 to 10 minutes of when the person's heart stopped beating or breathing stopped.
What are the risks of CPR?
Pressing on the chest
can cause a sore chest,
broken ribs or a
collapsed lung. Patients
with breathing tubes
usually need medicine to
keep them comfortable.
Most patients who
survive will need to be
on a breathing machine
in the intensive care
unit to help them
breathe for a while.
Few patients (less than 10 percent) in the hospital who have had CPR survive and are able to function the way they used to. Many patients live for a short time after CPR, but still die in the hospital. CPR may also prolong the dying process.
Patients who have more than one illness usually don't survive after CPR. Almost no one with advanced cancer survives CPR and lives long enough to leave the hospital. Of the few patients who do, many get weaker or have brain damage. Some patients may need to live on a breathing machine for the rest of their lives.
Few patients (less than 10 percent) in the hospital who have had CPR survive and are able to function the way they used to. Many patients live for a short time after CPR, but still die in the hospital. CPR may also prolong the dying process.
Patients who have more than one illness usually don't survive after CPR. Almost no one with advanced cancer survives CPR and lives long enough to leave the hospital. Of the few patients who do, many get weaker or have brain damage. Some patients may need to live on a breathing machine for the rest of their lives.
Cancer: End-of-Life Issues for the Caregiver
Not
everyone who has cancer
succumbs to the disease.
In fact, there are
nearly 9 million cancer
survivors living in the
United States today.
However, if your loved
one's cancer cannot be
cured or controlled with
treatment, then planning
for how you and your
loved one will handle
the last stages of the
disease can ease the
burden for both of you.
Ideally, you should make
these decisions
together, while your
loved one is well enough
to participate. Doing so
can help give your loved
one a sense of control
over his or her future
and relieve you from
having to make difficult
decisions on your own.
What kinds of things should we plan for?
Hospice care: Talk
with your loved one
about hospice care and
advanced directives.
Hospice care focuses on
providing people whose
illness can't be cured
or controlled with
treatment with the most
dignified, pain-free
existence possible in
their last stage of
life. Advance directives
are instructions on what
kind of care your loved
one wishes to receive
when he or she becomes
unable to make medical
decisions.
Financial and legal issues: You and your loved one may wish to have an accountant or lawyer help you sort through financial and legal issues. You can review things such as your loved one's insurance policy, finances and his or her will.
Funeral arrangements: Perhaps the most difficult part of this process is planning your loved one's funeral. Talk with your loved one about his or her preferences (for example, burial vs. cremation) in relation to your budget. Ask your loved one how he or she wants the service to be conducted. For example, you may want to discuss things such as what hymns or readings to include in the ceremony and whom your loved one wants to have as his or her pallbearers. Don't feel that any detail is too small to discuss. When selecting a funeral provider, be sure to compare prices, services and payment options. It will be easier to do this sooner rather than later.
Financial and legal issues: You and your loved one may wish to have an accountant or lawyer help you sort through financial and legal issues. You can review things such as your loved one's insurance policy, finances and his or her will.
Funeral arrangements: Perhaps the most difficult part of this process is planning your loved one's funeral. Talk with your loved one about his or her preferences (for example, burial vs. cremation) in relation to your budget. Ask your loved one how he or she wants the service to be conducted. For example, you may want to discuss things such as what hymns or readings to include in the ceremony and whom your loved one wants to have as his or her pallbearers. Don't feel that any detail is too small to discuss. When selecting a funeral provider, be sure to compare prices, services and payment options. It will be easier to do this sooner rather than later.
Hospice Care
What is hospice care, and what are its purposes?
Hospice is the term for
a special program of
care for terminally ill
(dying) patients and
their families. Rather
than trying to cure an
illness, hospice efforts
aim to make the patient
comfortable, ease pain
and other troublesome
symptoms and support the
family through a sad and
difficult time.
A hospice care program tries to provide the best quality of life for dying patients by providing a holistic approach. That means giving spiritual, mental, emotional and physical comfort to the patients, their families and their other caregivers.
A hospice care program tries to provide the best quality of life for dying patients by providing a holistic approach. That means giving spiritual, mental, emotional and physical comfort to the patients, their families and their other caregivers.
What is a hospice team?
A
hospice team is a group
of people who understand
the special goals of
hospice care. The team
includes doctors,
nurses, social workers,
spiritual counselors,
home health aides,
bereavement counselors
and volunteers. The
hospice team helps
patients live out their
final days with dignity
and with as much
physical comfort as
possible.
Is hospice care available to nursing home residents?
Yes. The services of
hospice care programs
are provided wherever
patients are spending
their final days. This
includes their own home,
a family member's home,
a hospital, a nursing
home or a hospice
facility.
The members of the hospice team try to help nursing home patients be as free of pain as possible. They also try to help them be at peace with themselves and their illness. At the same time, the hospice team provides support, education and counseling to family members, nursing home staff and other nursing home residents who know the patient.
The members of the hospice team try to help nursing home patients be as free of pain as possible. They also try to help them be at peace with themselves and their illness. At the same time, the hospice team provides support, education and counseling to family members, nursing home staff and other nursing home residents who know the patient.
What specific services does a hospice program provide?
Hospice care programs
can provide the
following services:
- Around-the-clock nursing care.
- Training of family members in patient care, as appropriate.
- Spiritual and emotional support for both the patient and the family.
- Help with practical matters associated with terminal illness.
- Speech, occupational and physical therapies (when these services are considered useful by the hospice team).
- Coordination of services and care with the patient's family doctor.
- Expert management of physical symptoms.
- Bereavement and support groups for families.
What is bereavement support?
Bereavement support is
help in coping with the
loss of a loved one.
Grieving is a normal
psychological process
that nursing home staff
members, family members
and friends go through
when a person they love
or take care of passes
away.
Normal grief has no timetable or calendar. People experience grief in many different ways. Many people feel anger, loneliness, guilt, confusion and fear after a loved one dies. It helps to be able to talk about these feelings and about the person who has passed away.
Hospice is committed to helping people who are grieving. Hospice staff members and volunteers offer warm professional support to help family members with emotional healing and readjustment. Hospice respects the natural dying process. It provides patients and family members with an opportunity for spiritual growth during this final phase of life.
Normal grief has no timetable or calendar. People experience grief in many different ways. Many people feel anger, loneliness, guilt, confusion and fear after a loved one dies. It helps to be able to talk about these feelings and about the person who has passed away.
Hospice is committed to helping people who are grieving. Hospice staff members and volunteers offer warm professional support to help family members with emotional healing and readjustment. Hospice respects the natural dying process. It provides patients and family members with an opportunity for spiritual growth during this final phase of life.
Pressure Sores
What are pressure sores?
Pressure sores are areas
of injured skin and
tissue. They are usually
caused by sitting or
lying in one position
for too long. This puts
pressure on certain
areas of the body. The
pressure can reduce the
blood supply to the skin
and the tissues under
the skin. When a change
in position doesn't
occur often enough and
the blood supply gets
too low, a sore may
form. Pressure sores are
also called bedsores,
pressure ulcers and
decubitus ulcers.
Are pressure sores serious?
Pressure sores can be
serious, depending on
how much the skin and
tissues have been
damaged. You should call
your doctor if you think
a sore is forming.
Mild damage causes the skin to be discolored, but a sore doesn't form. In light-skinned people, the damaged skin may turn dark purple or red. In dark-skinned people, the area may become darker than normal. The area of damaged skin may also feel warmer than the surrounding skin.
Deep sores can go down into the muscle, or even to the bone. If pressure sores are not treated properly, they can become infected. An infection in a pressure sore can be serious. Pressure sores also hurt a lot and make it hard for a person to move around.
Mild damage causes the skin to be discolored, but a sore doesn't form. In light-skinned people, the damaged skin may turn dark purple or red. In dark-skinned people, the area may become darker than normal. The area of damaged skin may also feel warmer than the surrounding skin.
Deep sores can go down into the muscle, or even to the bone. If pressure sores are not treated properly, they can become infected. An infection in a pressure sore can be serious. Pressure sores also hurt a lot and make it hard for a person to move around.
Who gets pressure sores?
Anyone who sits or lies
in one position for a
long time might get
pressure sores. You are
more likely to get
pressure sores if you
use a wheelchair or
spend most of your time
in bed. However, even
people who are able to
walk can get pressure
sores when they must
stay in bed because of
an illness or injury.
Some chronic diseases,
such as diabetes and
hardening of the
arteries, make it hard
for pressure sores to
heal because of a poor
blood supply to the
area.
Where on the body can you get pressure sores?
Pressure sores usually
develop over bony parts
of the body that don't
have much fat to pad
them. Pressure sores are
most common on the heels
and on the hips. Other
areas at risk for
pressure sores include
the base of the spine,
the shoulder blades, the
backs and sides of the
knees, and the back of
the head.
How are pressure sores treated?
Three things help
pressure sores heal:
- Relieving the pressure that caused the sore
- Treating the sore itself
- Improving nutrition and other conditions to help the sore heal
What can be done to reduce pressure on the sore?
Don't lie on pressure
sores. Use foam pads or
pillows to take pressure
off the sore. Special
mattresses, mattress
covers, foam wedges or
seat cushions can help
support you in bed or in
a chair to reduce or
relieve pressure. Try to
avoid resting directly
on your hip bone when
you're lying on your
side. Use pillows under
one side so that your
weight rests on the
fleshy part of your
buttock instead of on
your hip bone. Also, use
pillows to keep your
knees and ankles apart.
When lying on your back,
place a pillow under
your lower calves to
lift your ankles
slightly off the bed.
Change your position at
least every 2 hours.
When sitting in a chair or wheelchair, sit upright and straight. An upright, straight position will allow you to move more easily and help prevent new sores. If you cannot move by yourself, have your caregiver shift your position at least every hour, or more often if possible.
When sitting in a chair or wheelchair, sit upright and straight. An upright, straight position will allow you to move more easily and help prevent new sores. If you cannot move by yourself, have your caregiver shift your position at least every hour, or more often if possible.
How should the pressure sore be kept clean?
In
order to heal, pressure
sores must be kept clean
and free of dead tissue.
You can clean the sore
by rinsing the area with
a salt-water solution.
The salt water removes
extra fluid and loose
material. Your doctor or
nurse can show you how
to clean your pressure
sore.
Pressure sores should be kept covered with a bandage or dressing. Sometimes gauze is used. The gauze is kept moist and must be changed at least once a day. Newer kinds of dressings include a see-through film and a hydrocolloid dressing. A hydrocolloid dressing is a bandage made of a gel that molds to the pressure sore. These dressings can stay on for several days at a time.
Dead tissue (which may look like a scab) in the sore can interfere with healing and lead to infection. There are many ways to remove dead tissue from the pressure sore. Rinsing the sore every time you change the bandage is helpful. Special dressings that help your body dissolve the dead tissue can also be used. They are left in place for several days.
Another way to remove dead tissue is to put wet gauze bandages on the sore and allow them to dry. The dead tissue sticks to the gauze and is removed when the gauze is pulled off. Sometimes dead tissue must be removed surgically.
Removing dead tissue and cleaning the sore can hurt. Your doctor can suggest a pain reliever for you to take 30 to 60 minutes before your dressing is changed.
Why is good nutrition important for healing sores?
Pressure sores should be kept covered with a bandage or dressing. Sometimes gauze is used. The gauze is kept moist and must be changed at least once a day. Newer kinds of dressings include a see-through film and a hydrocolloid dressing. A hydrocolloid dressing is a bandage made of a gel that molds to the pressure sore. These dressings can stay on for several days at a time.
Dead tissue (which may look like a scab) in the sore can interfere with healing and lead to infection. There are many ways to remove dead tissue from the pressure sore. Rinsing the sore every time you change the bandage is helpful. Special dressings that help your body dissolve the dead tissue can also be used. They are left in place for several days.
Another way to remove dead tissue is to put wet gauze bandages on the sore and allow them to dry. The dead tissue sticks to the gauze and is removed when the gauze is pulled off. Sometimes dead tissue must be removed surgically.
Removing dead tissue and cleaning the sore can hurt. Your doctor can suggest a pain reliever for you to take 30 to 60 minutes before your dressing is changed.
Why is good nutrition important for healing sores?
Good nutrition is
important because it
helps your body heal the
sore. If you don't get
enough calories, protein
and other nutrients,
your body won't be able
to heal, no matter how
well you care for the
pressure sore. Your
doctor or nurse or a
dietitian can give you
advice about a healthy
diet. Be sure to tell
your doctor if you have
lost or gained weight
recently.
What if the sore gets infected?
Pressure sores that
become infected heal
more slowly and can
spread a dangerous
infection to the rest of
your body. If you notice
any of the signs of
infection listed below,
call your doctor right
away.
Signs of an infected pressure sore include the following:
Signs of an infected pressure sore include the following:
- Thick yellow or green pus
- A bad smell from the sore
- Redness or warmth around the sore
- Swelling around the sore
- Tenderness around the sore
Signs that the infection
may have spread include
the following:
- Fever or chills
- Mental confusion or difficulty concentrating
- Rapid heartbeat
- Weakness
How are infected pressure sores treated?
The
treatment of an infected
pressure sore depends on
how bad the infection
is. If only the sore
itself is infected, an
antibiotic ointment can
be put on the sore. When
bone or deeper tissue is
infected, intravenous
antibiotics (given
through a needle put in
a vein) are often
required.
How can I tell if the sore is getting better?
As
a pressure sore heals,
it slowly gets smaller.
Less fluid drains from
it. New, healthy tissue
starts growing at the
bottom of the sore. This
new tissue is light red
or pink and looks lumpy
and shiny. It may take 2
to 4 weeks of treatment
before you see these
signs of healing.
How can pressure sores be prevented?
The
most important step to
prevent pressure sores
is to avoid prolonged
pressure on one part of
your body, especially
the pressure points
mentioned previously.
It's also important to keep your skin healthy. Keep your skin clean and dry. Use a mild soap (like Dove, Basis or Oil of Olay) and warm (not hot) water. Apply moisturizers so your skin doesn't get too dry. If you must spend a lot of time in bed or in a wheelchair, check your whole body every day for spots, color changes or other signs of sores. Pay special attention to the pressure points where sores are most likely to occur.
It's also important to keep your skin healthy. Keep your skin clean and dry. Use a mild soap (like Dove, Basis or Oil of Olay) and warm (not hot) water. Apply moisturizers so your skin doesn't get too dry. If you must spend a lot of time in bed or in a wheelchair, check your whole body every day for spots, color changes or other signs of sores. Pay special attention to the pressure points where sores are most likely to occur.
Autopsy
What is an autopsy?
An
autopsy is a medical
exam of the body of a
person who has died. The
purpose of an autopsy is
to answer questions
about the person's
illness or the cause of
death. In addition,
autopsies provide
valuable information
that helps doctors save
the lives of others.
Autopsies are performed
by specially trained
doctors, called
pathologists.
Who may request an autopsy?
You
can request an autopsy
if you are the person's
next of kin or the
legally responsible
party. Your doctor will
ask you to sign a
consent form to give
permission for the
autopsy. You may limit
the autopsy in any
manner you wish.
However, if the cause of death is unclear, the pathologist may perform an autopsy without the family's permission.
However, if the cause of death is unclear, the pathologist may perform an autopsy without the family's permission.
What is the procedure for an autopsy?
First, the pathologist
looks at the body for
clues about the cause of
death. Next, he or she
examines the internal
organs, taking samples
as needed to look at
under a microscope. The
autopsy takes from 2 to
4 hours. The autopsy
room looks similar to an
operating room. An
atmosphere of dignity
and respect for the
deceased is maintained
at all times.
What does an autopsy cost?
If
the autopsy is performed
by family request, the
cost is between $5000 &
$8000 and is paid prior
to the procedure.
Will an autopsy interfere with funeral arrangements?
No.
Pathologists perform
autopsies in a way that
doesn't interfere with
burial or cremation.
Once the autopsy is
completed, the hospital
tells the funeral home.
An autopsy won't delay
funeral services.
When will the results of an autopsy be known?
The
first findings from an
autopsy are usually
ready in 2 to 3 days.
The doctor can review
these results with you.
A final report may take
many weeks because of
the detailed studies
performed on tissue
samples. The doctor will
also review the final
report with you.
Caregiver Stress
Who is a caregiver?
You're a caregiver if
you give basic care to a
person who has a chronic
medical condition. A
chronic condition is an
illness that lasts for a
long period of time or
doesn't go away. Some
examples of chronic
conditions are cancer,
stroke, multiple
sclerosis, dementia,
diabetes and Alzheimer's
disease.
If you're a caregiver, you may be doing the following things for another person:
If you're a caregiver, you may be doing the following things for another person:
- Lifting
- Turning him or her in bed
- Bathing
- Dressing
- Feeding
- Cooking
- Shopping
- Paying bills
- Running errands
- Giving medicine
- Keeping him or her company
- Providing emotional support
Why is caregiving so hard?
The
person you're caring for
may not know you
anymore. He or she may
be too ill to talk or
follow simple plans.
This may make it hard
for you to think of that
person in the same way
that you did before he
or she became ill. This
may be especially true
if the person you're
caring for suffers from
dementia.
The person you're caring for may also have behavior problems, like yelling, hitting or wandering away from home. This behavior may make you feel angry and frustrated.
The person you're caring for may also have behavior problems, like yelling, hitting or wandering away from home. This behavior may make you feel angry and frustrated.
How can I tell if caregiving is putting too much stress on me?
Common signs of
caregiver stress include
the following:
- Feeling sad or moody
- Crying more often than you used to
- Having low energy level
- Feeling like you don't have any time to yourself
- Having trouble sleeping, or not wanting to get out of bed in the morning
- Having trouble eating, or eating too much
- Seeing friends or relatives less often than you used to
- Losing interest in your hobbies or the things you used to do with friends or family
- Feeling angry at the person you are caring for or at other people or situations
In
addition, you may not
get any thanks from the
person you are caring
for. This may add to
your feelings of stress
and frustration.
What should I do if I'm feeling overwhelmed and stressed?
These feelings are not
wrong or strange.
Caregiving can be very
stressful. Because being
a caregiver is so hard,
some doctors think of
caregivers as "hidden
patients." If you don't
take care of yourself
and stay well, you won't
be able to help anyone
else.
Talk with your family doctor about your feelings. Stay in touch with your friends and family members. Ask them for help in giving care. Asking for help doesn't make you a failure.
Look for help in your community. You may start by asking your church or synagogue if they have services or volunteers who can help you. You can also ask for help from support organizations (see "Other Organizations").
Talk with your family doctor about your feelings. Stay in touch with your friends and family members. Ask them for help in giving care. Asking for help doesn't make you a failure.
Look for help in your community. You may start by asking your church or synagogue if they have services or volunteers who can help you. You can also ask for help from support organizations (see "Other Organizations").
Grieving: Facing Illness, Death and Other Losses
What is grief?
Grief is a normal,
healthy response to
loss. One of the
greatest losses that can
occur is the death of
someone you love. Other
losses include the loss
of your health or the
health of someone you
care about, or the end
of an important
relationship, such as a
marriage. Healing from a
loss involves coming to
terms with the loss and
the meaning of the loss
in your life.
What are the normal feelings of grief?
Symptoms of grief
- Anger
- Blaming yourself
- Crying spells
- Diarrhea
- Dizziness
- Fast heartbeat
- Feeling like there's a lump in your throat
- Feeling like what's happening around you isn't real
- Headaches
- Hyperventilating -- sighing and yawning
- Nausea
- Not being able to get organized
- Not feeling hungry or losing weight
- Restlessness and irritability
- Sadness or depression
- Seeing images of the dead person
- Shortness of breath
- Tightness in your chest
- Tiredness
- Trouble concentrating
- Trouble sleeping
As
you face a loss, you may
have different feelings
at different times.
These feelings include
shock, denial, anger,
guilt, sadness and
acceptance. You may find
yourself going back and
forth from one feeling
to another. For example,
right when it seems that
you're starting to
accept your loss, you
may find yourself
feeling sad or guilty
again. Your grief may
never completely go
away. But the pain you
feel will lessen with
time as you work through
these feelings.
What usually happens first?
In
the first hours or days
after the loss, you may
feel shocked, numb and
confused. You may not
remember what people
have said to you. You
may think and act as
though the loss hasn't
occurred. This is called
denial.
As the shock wears off, reality will slowly break through. You'll begin to realize that the loss has happened. It's normal to feel abandoned and angry. You may direct your anger toward God, religion, doctors and nurses, the one who has died or other loved ones, or even yourself.
As the shock wears off, reality will slowly break through. You'll begin to realize that the loss has happened. It's normal to feel abandoned and angry. You may direct your anger toward God, religion, doctors and nurses, the one who has died or other loved ones, or even yourself.
What happens after the anger wears off?
After you get through
some of the anger and
denial, it's normal to
pretend things are like
they used to be. If
someone you love has
died, you may play
memories over and over
in your mind. You may
also feel the presence
of your loved one, think
you see him or her, or
think you hear his or
her voice.
You may also find yourself talking to your loved one as though he or she were in the room with you. As you begin to realize that your loved one is gone and won't be back, you'll begin to feel the full impact of your loss. These feelings may be scary because they're so strange and so strong. They may make you feel like you're losing control.
You may also find yourself talking to your loved one as though he or she were in the room with you. As you begin to realize that your loved one is gone and won't be back, you'll begin to feel the full impact of your loss. These feelings may be scary because they're so strange and so strong. They may make you feel like you're losing control.
What happens then?
When you begin to
realize the full impact
of the loss on your
life, you may feel
depressed and hopeless.
You may also feel
guilty. You may find
yourself thinking things
like "if only" or "why
me?" You may cry for no
apparent reason. This is
the most painful stage
of healing, but it won't
last forever. In normal
grief, the depression
will begin to lift with
time.
What is the first sign of relief?
You
may start to feel better
in small ways. For
example, you may find
it's a little easier to
get up in the morning,
or you may have small
bursts of energy. This
is the time when you'll
begin to reorganize your
life around your loss or
without your loved one.
What is the final stage?
Tips on dealing with a loss
- Talk about how you're feeling with others.
- Try to keep up with your daily tasks so you don't feel overwhelmed.
- Get enough sleep, eat a well-balanced diet and exercise regularly.
- Avoid alcohol. Alcohol can make you feel more depressed.
- Get back into your normal routine as soon as you can.
- Avoid making major decisions right away.
- Allow yourself to grieve--to cry, to feel numb, to be angry or to feel however you're feeling.
- Ask for help if you need it.
The
last stage of accepting
a loss is when you begin
to reinvest in other
relationships and
activities. During this
time, it's normal to
feel guilty or disloyal
to your loved one
because you're moving on
to new relationships.
It's also normal to
relive some of your
feelings of grief on
birthdays,
anniversaries, holidays
and during other special
times.
How long does grief last?
You'll probably start to
feel better in 6 to 8
weeks. The whole process
can last anywhere from 6
months to 4 years.
If you feel like you're having trouble at any point, ask for help. People who can help include friends, family, clergy, a counselor or therapist, support groups and your family doctor.
Be sure to talk with your family doctor if you have a lot of trouble eating, sleeping or concentrating for more than the first couple of weeks. These can be signs of depression. Your family doctor can help you with depression so you can start to feel better.
If you feel like you're having trouble at any point, ask for help. People who can help include friends, family, clergy, a counselor or therapist, support groups and your family doctor.
Be sure to talk with your family doctor if you have a lot of trouble eating, sleeping or concentrating for more than the first couple of weeks. These can be signs of depression. Your family doctor can help you with depression so you can start to feel better.