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Ashwana Raveendran :!!:Topic: ADL Hygiene and Parkinsons Disease :!!: …

- - - - Thank you. You see theres nothing wrong with me!
        
        Patient and daughter leave clinic
      - Unrelated to sleep - nurse must probe more
    - - There isn't anything on my mind. She complaining because I haven't been taking my showers, brushing or changing my clothes Its just become so difficult. I'm telling her not to worry and dad will be okay!
        
        I can understand where your daughters concerns are for you. She cares about you and she just wants to make sure her dads okay. Can you tell me me why you havn't been showering, brushing or changing your clothes?
        
        Its become hard. I cant get my self to get to the washroom. I get up and loose balance. The other day I fell.
        
        Oh no! I hope you are okay. It sounds to me that you are losing coordination in the morning and it can be hard for you to go to the washroom. We wouldn't want you to have another fall, so I am going to send over supplies to your home such as a commode to keep at the bedside. How does that sound?
        
        That will be very helpful. Some days are better than others. If I cant get my self up I can easily use the commode if its right beside me.
        
        That is great. I'll make that arrangement for you. Is there anything else I can assist you with to help with your care needs at home?
        
        Great, I have another client now.
        
        That is good to hear. I am happy you are open to the idea. We can try it out and see if it's something that works for you. Let's talk about what else I can help you with.
        
        Let's complete a gait assessment this way we will be able to see how far you are able to walk and how much energy you can exert. It is important for you to conserve your energy and we can practice some techniques that can help.
        
        That sounds like a good idea. I know I am getting older and I cant be the workaholic that I am!
        
        Perfect, some techniques that you can use are plan your days, when you plan make sure to include rest periods. Ensure during this time you sit down and if you cant do something on your own ask for help!
        
        So stay in bed longer, don't get up if you cant.
        
        Nurse is rude. Pt is expressing that he is loosing balance.
        
        Patient and daughter nod okay.
        
        You're free to do whatever you want. I do not see the problem here.
        
        Daughter upset. Nurse not addressing family concerns. The daughter knows this isn't typical of her dad and wants to know what may be happening to her father.
        
        **Inappropriate comment to situation - nurse not considering daughters feelings.
        
        I don't think your daughter is trying to complain, she wants to know her dad is okay. What is making these tasks difficult for you?
        
        My whole body feels stiff, I sometimes can't get my self to get up out of bed. Sometimes I get my self up and I forget what I am supposed to do. I haven't changed because the whole process is time consuming.
        
        So it sounds like to me from what you are saying, the stiffness comes on in the morning, and because of this you cant get up and get your self to change because of the stiffness. is that correct?
        
        Yes thats right.
        
        I know how important it is for you to want to do things on your own and at the same time it's okay to ask for help as well. Right now, with the symptoms you are feeling its truly not safe for you to do things on your own. Are you comfortable with having your daughter help you get to the washroom in the morning?
        
        I hear you. Its important to take care of your hygiene to prevent other risk factors. If you are not able to on your own, we can set up a home care nurse or psw who can stop by in the morning to help you with your morning care.
        
        We can work on way to not exert much energy in the morning because of the stiffness. Would you prefer maybe brining some of your items close to your bed such as your tooth brush, cup of water and clothes so that way it is within a reachable distance for you and you can take your time.
- - - - It sounds like you are experiencing tremors, during this time it is important to take things slow. What we can do is look at substitutions that can help with your hygiene especially with getting dressed. We can incorporate button hooks, sock aids, elastic show laces and dressing sticks!
      - just give it another few weeks and see how it goes.
      - These are tremors. The best way to manage is to slow down. Take rests when you can and try to sit when grooming, dressing and bathing. The more you sit the more stable you will feel during those times.
  - - - Hmm, maybe try to use your hands less.
      - That must be frustrating for you. Let's try to find ways to help you. Perhaps, during the times you are having tremors we can keep your clothes near by so you can easy access them.
      - To me, this sounds like you are experiencing tremors. In times like this it is important to take it slow. Take rests and sit when able. Its important to plan out scheduled rest breaks.