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Stephanie Genovese: ADL Hygiene :!: Nick is an 85 year old man who…

- - - - I used to always be clean-shaven and I used to shower every single day, now I can't. I shake way too much and I am scared to fall or cut myself shaving.
        
        I can understand why you may be scared to fall or shave while experiencing tremors, that can definitely be frightening, though it's good that you want to be safe. Does anyone currently help you with bathing?
        
        I don't want to ask my daughters to help me with this. I usually wet a cloth with soap and water to clean myself and I haven't shaved in months as you can tell.
        
        Have you ever thought about speaking with your daughters about how you're feeling? I know it can be difficult but I'm sure it can help.
        
        Yes, I shake way too much now and I am scared. I don't want to burden my daughters to have to care for me. They're busy with their own kids.
        
        I can understand how that must feel, I'm sorry to hear that. I just also wanted to ask, if you experience any difficulty with oral care due to the tremors as well?
        
        1 more item...
        
        I'm sorry to hear that. I think that by verbalizing your feelings and communicating your needs to your family, this can truly help them understand the level of support you need and can help them to assist you.
        
        1 more item...
        
        Oh okay, I see what you mean.
        
        Do you have any shower chair or bench currently in the shower that can allow you to rest during showering when you feel tired?
        
        I don't have one of those, no.
        
        Okay, so maybe we could try to get you one of those. It will help you feel more safe if you can sit down while washing yourself. This will also decrease your risk of falls.
        
        I know it can be hard, but it is still best to try and shower.
        
        Yeah, I know, I'm just scared.
        
        Goal is that the patient will participate in self-care interventions that support their preferences and independence
        
        That's because you have Parkinson's disease. This disease is progressive and ends up affecting your abilities to care for yourself independently.
        
        I guess...
        
        I can imagine how your tremors may affect your ability to perform these tasks. Do you currently take any medications for your Parkinson's disease?
        
        Yeah, I take a yellow pill that has an L & C in it everyday. I can't seem to remember the name of it. My Doctor prescribed it for me years ago.
        
        I believe the medication you're referring to may be called Levodopa-Carbidopa. How are you doing with remembering to take your medications daily?
        
        I am good with remembering to take my medications. I just have trouble taking my morning dose on time because I usually take the pills when I do my morning care routine.
        
        We can always try having the morning dose with you while you complete your oral care etc in the morning, that way it is more easily accessible for you.
        
        Another suggestion I could make is we could try having the morning dose by the bedside with some water.
        
        Okay, that's good to know.
        
        Goal is that Nick will be well groomed and free of odors at all times
    - - Right now, sometimes my daughters come when they can. I usually try to do what I can by myself but it's getting more difficult. I notice I am even wetting myself more often because I can't make it to the bathroom on time, it's embarrassing.
        
        Aww don't be embarrassed, it happens sometimes. How often would you say this happens?
        
        It happens every morning because it takes me a while to get up.
        
        Do you find that your joints feel more stiff in the mornings?
        
        Yes, I usually feel very stiff in the mornings
        
        I think if we could incorporate some active range of motion exercises for your joints into your daily routine, this will help with the stiffness.
        
        I think another strategy would be to try bathing maybe in the evenings when you are not experiencing as much stiffness.
        
        Because of the increased stiffness in the mornings, would you be interested in trialing a urinal or commode by the bedside that is more accessible for you?
        
        Goal is: Will use active joint range-of-motion exercises daily
        
        Do you experience any pain in the mornings?
        
        I do have a little pain in the mornings, I usually just take a Tylenol and it helps me.
        
        Ohh I see, that makes sense why it happens more frequently in the mornings.
        
        Do you currently have any assistive device like a walker to use when you're walking to the bathroom?
        
        I have a walker somewhere, I don't really use it as much as I probably should.
        
        Did you recently get this walker or have you had it for some time?
        
        I've had it for some time when I first started having difficulty walking a few years ago. I just feel ashamed to use it.
        
        Do you feel that the walker helps you when walking?
        
        It does help me and I feel safer using it, I just don't.
        
        You should probably use the walker more.
        
        Oh, that's good, at least have your daughters to help you.
        
        nods
    - - nods