|Making the Transition From Hospital to Home: Basic Physical Care|
Making the transition from hospital to home, although likely more comfortable for the patient, can present challenges for both patients and caregivers. Before leaving the hospital, patients can often work with a social worker or case worker to get a system in place to allow a smooth transition. Often visiting nurses and other health care workers are often needed for assistance, at least in the beginning. Family members or caregivers can also be a good source of support for patients.
Avoiding Bed Sores
Bed sores are a common uncomfortable occurrence in patients who are confined to their bed for long periods of time. Patients and caregivers need to pay special attention to recognizing and preventing bed sores, also called pressure ulcers, while at home. Bed sores form through friction and pressure on the body. The lower back, heels, and ankles are the most common sites for sores.
Signs of pressure ulcers are crater-like sores that are open and red. "Patients need to be moved every two hours and caregivers can set a soft alarm to facilitate this task," says Mario E. Lacouture, MD, Associate Member, Dermatology Service with Memorial Sloan-Kettering Cancer Center in New York.
Care at home, rather than in a hospital setting, decreases the likelihood of bed sores; however, proper personal care, including maintaining good nutrition, hydration, and hygiene and avoiding fatigue, is essential to keeping patients in the best possible health. In addition, keeping bedsheets pulled tight to reduce wrinkling and using a friction-reducing mattress and bedding can be beneficial. Frequent changing of sheets and dressings and frequent drying of any wounds can help reduce moisture. "Keeping the area dry and clean is very important," says Dr. Lacouture.
Proper care on a daily basis is crucial. Consistently keeping the patient clean and changing body positions can greatly reduce the incidence of additional medical issues, most notably infection.
Although pretty straightforward, wheelchair use can be dangerous if not handled correctly. “When possible, get instructions from a physical therapist on how to get around in a wheelchair or with assistive devices, including crutches and a walker,” says Susan Childress, RN, MSN, OCN, Director of Nursing Services, Huntsman Cancer Institute at the University of Utahin Salt Lake City. “Be careful of catching fingers or toes in the spokes. Many oncology patients have low blood counts and easily bleed or are susceptible to infection,” she warns.
In many cases, patients who are incontinent can learn to manage the situation with proper medical advice, appropriate equipment/supplies, and experience, says Kimberly Stump-Sutliff, MSN, RN, AOCNS, associate medical editor with the American Cancer Society’s home office in Atlanta. “Caregivers need to be supportive and understanding of this potentially embarrassing and uncomfortable situation,” she says. “If a patient is not able to manage incontinence and a caregiver must, a lot of attention must be given to skin care and cleanliness. Urine and stool can be very damaging if left on the skin; care must be given to minimize contact and manage the situation with medical help.”
The first two weeks following surgery are most important for proper wound care due to the high risk of infection. Dr. Lacouture says washing the area with soap and water, applying antibiotic ointment and clean dressing will reduce risk of infection. Also, patients or caregivers should be cautious of allergies to tape, medicine, or other dressings.
Patients should keep sun exposure to a minimum and avoid massaging the area, which can perpetuate scarring. After a full year, patients can consult with a plastic surgeon about their options to reduce the appearance of scars.
Above all, Dr. Lacouture says that many patients don't anticipate how dry skin, itching, or other conditions of the skin can impact their quality of life during or after surgery or treatment. "Seventy percent of patients will experience some type of dermotogical discomfort, and the use of topical creams or ointments and topical steroids is a proven method of assisting," he says. They should consult with their doctor to determine the best products to use to alleviate these uncomfortable conditions.
Regarding care of the mouth and teeth, Childress says that frequent and gentle brushing may help prevent infection. “If you have mouth sores, ask your physician for medication and suggestions to ease the pain and help keep your mouth clean,” she says. Visiting the dentist before starting cancer treatment can identify a potential dental issue that could be further affected by medicine or treatment, and can ensure that proper oral care is practiced.