Bedtime CNA visit

READ REPORTS AND WHITE BOARD

In bedroom preparation:

• Get mouth supplies
• New diaper
• 5 paper towels
• Trach solution

In living-room: 

Take blue roll and rice off of belly
Water Management
Lung Suction

• Disconnect Urine Bag, hang in bathroom
• Plug condom
• Tissues in Shower Chair
• Remove burp tube
• Trach roll on hospital table

Transfer to Shower Chair

• Unplug Big Bertha
• Remove diaper, shorts, and shoes 
• Move to bedroom
• Lock Shower Chair
• Feet on Step stool
• New Diaper at ankles 
• Paper towel between legs
• Diaper at knees 

Mouth Care

• Remove Brace- life chin and hold head
• Wipe lips
• Put hands on knees- space for bucket
• Rinse mouth- twice
• Brush teeth with pink sponge
• Wipe mouth with paper towel
• New bib
• Replace Brace

PEG Care

• Roll shirt up and under
• Remover gauze, fold old gauze opposite way and wipe off pink stuff
• 2 wash cloths- one with soap, one without soap
• Wash belly- use Q-tip
• Rinse belly
• Colloidal Silver- 2 drops
• New gauze- 1 tape across bottom

Rub Belly- Colon Massage

• Start at Don's right, massage up, then down on left
• Lean forward- Batman pillow, chair forward, fold hands- ring on top
• Butt spread
• Paper towel on knees for spit
• Feet straight on stool
• Clips not stabbing arms
• Condom in bucket- unplugged

WHILE GOING

• Clean up mouth/teeth stuff
• Clean suction machine in Livingroom
• Drain and rinse urine bag- put in bedroom
• 3 baby wipes, scissors, Prep H

When done using commode

• Remove Batman pillow, wipe mouth, sit back
• Wipe bottom, Duoderm, Prep H
• Push condom on all the way
• Pull up scrotum, tuck diaper, hands in diaper

Water Management/Mouth Suction

Transfer to Bed

• Unlock Shower Chair
• Put shoes on
• Smooth shirt
• Lift up in Bed- make sure pillow is under head
• Lift tubes, make sure to LEFT of PEG tube
• Remove Brace
• Place Trach Roll with clips

Eye drops, tissue
Remove socks (need washed?)
Place foot foam, get wedgie, flatten diaper

LEG ROM

• Butterflys- 3x
• Get wedgie
• PeriCare- wipe out groin area, lower feet alittle
• Legs up, then bend,- 3x
• Pull feet back- 3x
•  Pull toes

Connect Urine tube to Right leg
Wrap short side
Blue roll under knees
Sheet sideways across legs and bed
Wet trach with water syringe

LEFT ARM ROM

• Fist, backwards fingers- 3x
• Arm up, sideways, bend elbow- 3x

Clean Trach

• 3 Q-tips in solution
• 1 Q-tip in Colloidal Silver
• A&D or Neosporin
• Clean up hospital table at foot of bed

RIGHT ARM ROM

Clean Nose

1. Sucky Machine
2. 2 wet Q-tips
3. Tissue

Wash Face and Ears
Corellas Beeswax Cream on Knuckles and Nose
Put gauze on Trach

Bed rails up

• Hang Catheter Bag on PUSH button

Place purple pillows and flower pillows, hand towels on bed
Ask PA for snack and meds

Smooth shirt under back and chuck and sheets

• Place arm pillows, flower pillow and hand towel, yellow finger thing
• Put head roll on bed (don't clip) 

Mouth Suction

Bedtime Snack- RED DROP, meds, food- clean up

Lung Suction with bullet ALWAYS:

• Feet on box

Flip pillow, put small foam pillow under pillow, clips on roll

• 3 tissues around neck collar, adjust pillows right arm
• Connect Burp Tube to roll
• Adjust foot foam

RIGHT Butt Spread

• Connect condom (push condom on), washcloth horseshoe over urine tube, close to Don

LEFT Butt Spread

• Fix Left arm pillows

Rice Pack (1 1/2 min)
Test Door Bell (lower head, move legs/feet)
Hair Management, place pillow behind head, tuck chin
Water Management, hoses up with cardboard
"Did we forget anything/"
Suction, Chapstick, Echinacia?
Lights Out, Goodnight

How to Lean Me Back in the Wheelchair

DRT 

How to lean Don back in his wheelchair

Before leaning back:

1. Ask Don if he wants to microwave his big Superman rice pack- not the small rice on his belly
2. Clamp burp
3. Lower feet until Don gives you the eye (His bottom has less pressure when his feet are down).
4. Water management
6. Move the black blind out of the way
           a. If Don is facing the TV, make sure the cart is out of the way
7. Sponge Bob blanket?
8. Mouth Suction

Leaning back:  (only AFTER he sets up Tobii on Track Status!) 

1. Hold and watch tubes as you lean Don back. Lean all the way until it stops
2. Blue FedEx blanket? If so, fold it in half and place blanket across chest and tuck it around elbows
3. Big rectangular Superman rice pack?
             If so, put it vertically across chest as low as possible covering hands.
             (This can be found to the right of the microwave).
4. To find out how long to lean for:
           a. Let Don know what time it is
           b. Start at 30 minutes - Go down in intervals of 5
                    until Don says you’ve reached the appropriate time in minutes.
5. Move the joystick out of the way only if Don is watching TV:

6. Look his way occasionally to make sure he’s doing okay
 Important - if Don starts coughing out of control ask if lung suction is needed! 

After leaning back:

1. Lean forward - Look at Tobii and tilt forward until you see the white arrow is slightly above the green area to the right of the two white dots (eyes).
2. Take big rice off? Take FedEx blanket off?
3. Unclamp burp tube.
4. Put feet up until Don gives you the eye.
5. Mouth suction
6. Replace black blind if necessary.

Directions to ALS Support Group Meeting

DRT 

ALS Support Group

is at 1 pm -  2:30 the fourth Tuesday of every month at the

The Medical Center of the Rockies 

The meetings are at The Medical Center of the Rockies, located at  2500 Rocky Mountain Ave in Loveland on west side of I-25 just north of hwy 34.   G. P. S. the hospital address before we leave Fort Collins. 
We will be meeting in the Horsetooth Rooms. Go to the main entrance and then take the elevator down to the basement. Look for signs posts telling what room. It may vary depending on how many people.  

1. From Don’s house go south on Shields Street.

2. Shields Street changes name to Taft Avenue in Loveland. Continue on Taft Ave.

3. Follow your G. P. S.

*Special Sauce tips:

• The meeting starts at 1:00 p.m. and lasts until about 2:30 p.m. Leave Don’s house no later than 12:30, and bring 2:30 meds. 

Afternoon CNA Break

DRT 
 Composed by Marianna

• Wash hands
• Check to see if there are tissues in SC bucket and bring out SC and stool
• Water management / take out blue hot dog pillow/rice in microwave
• Prep 3 double paper towels and alcohol swab- put on dinner table
• Move blind and take Tobii away

Here's how you should position Tobii:

• Pull Don forward to about where the dinner table begins
• Mouth suction
• Lung Suction
• After LS…
• Open burp tube
• Lean Don forward
• Fix arms
• Lower feet 
• Put shoe strap around heels
• Take off seat-belt and loosen the left strap of seat-belt enough to drape over the arm of the WC
• Take out catheter bag (pull tube out from under legs so it’s sitting in between legs when draining) 
• Put tissues from tube on Bertha to reuse
• Hang leg strap on SC
• Put urine bag in bathroom
• Rip a small square off a paper towel in bathroome
• Use square from paper towel to plug condom
• Tuck condom into diaper
• Take off burp tube (put in sink & rinse with water) and take off trach roll
• Mouth suction

TRANSFER

• Put Don's feet on your shoulders
• Put strap on foot pedals and lower them all the way
• Have PA hold forehead
• Lean forward all the way- feet down so toes touch ground (may have to pull a little)
• Sandwich legs with yours
• Take off right arm lateral
• Transfer to Shower Chair

IN SHOWER CHAIR

• Hands in lap/shoes off/ lift feet and slide stool from behind legs/ diaper and shorts below knees
• Pull plug out of condom, do not take the condom off
• Check for “spot” in diaper
• Put double paper towel over junk into bucket
• Pull diaper and shorts over hands
• Belly rub over large intestine; with force. Watch video below 
• Batman pillow/ pull chair forward one notch/ lean Don forward
• Cross hands (ring hand on top)/ put hands over knees/tuck double paper towel into hand (tuck by thumb, should hang forward)
• Butt lift both sides
• Fold Batman pillow
• Check everything! (condom, push pillow down, socks over toes, toes not over stools, no clips stabbing, blue trach tube to the right of the white one & yellow tube up)

While Waiting

• Empty suction bowl and fill jar
• Get burp tube ready
• Empty catheter bag
• get prep H, baby wipes 

Complete Shower Chair

• Remove pillow/ wipe lips with paper towel from hand/ lean back
• Get catheter strap
• Connect catheter bag/ push condom on ALL the way
• Diaper and shorts up to hold hands
• Wipe away until baby wipe is totally clean
• Shoes on
• Mouth suction
• Get black box for transfer/ push condom all the way on one more time

Transfer!

• Use Black Box to Transfer
• Sandwich legs
• PA guide hips back as far as possible
• Push knees to get Don as far back as possible

Wheelchair Comfort

• Pull down and Straighten out the back of his shirt
• Lean back a little
• Feet on pedals
• Check and straighten condom, cath bag and tissues around blue tab position
• Roll under trach
• Straighten condom
• Left butt lift
• Seatbelt (make sure shorts are under the strap)
• Cross arms and lean all the way back
• Push HARD 2 times with hands just below kneecap & ask if it’s okay

THE SHOULDER TWIST 

• Put both of your hands on Don's shoulders 
• Put his left shoulder back while pushing right shoulder forward
• Lift up Don's right hand and push right lateral in.
  Push the right elbow rest in position. 
• Place blue roll pillow by left thigh
• Lung Suction
• Close burp tube
• Feet almost all the way up. Tilt head back until you can reach him, your decision. 
• Shoes off, blanket?
• Adjust Neck Brace (Chin lift to tighten) /NEW bib
• Move Wheelchair to big wheel in blue floor tape
• AM- Place black blind behind chair to stop glare on computer screen
• PM- Spin Don to face TV (hold power cord/ big wheels in line with blue tap)

Set Up Tobii

FINAL-

• Mouth suction
• Chapstick