Guidance For Wheelchair & Adventures

DRT 

Wheelchair and Van Checklist for Adventures

Inside House

·        Switch vents – turn off Baby Bertha 
Feed Little Bertha's tubes up under Don's left side as shown: 

·    Then put in Little Bertha "air life" tube under the white accordion tube where the Big Bertha tubes were

·    Big Bertha will beep, power it off and Baby Bertha if you have not already (power switch on the side)

** If Don wants to check if Little Bertha is charging, there is a "charge status" label on L.B. If charging, it will be orange and the small grey cord will be connected to the small grey lithium battery cord.**

·        Mouth suction

·        Ask Don if he wants lung suction 


Go here to learn how to do lung 

·        Yellow levers up on wheels

·        Empty suction machine bowl then put in bag

·        Bring suction machine power cord

·        Bring blanket and jacket, check bags for water bottles

·        Feet down like leaning back

Turn on van (if hot outside turn on air conditioning, if not open ramp)
·        Or take cart outside with suction machine for patio adventures
·        Move Tobii only after Don goes to the tracking status box! 

• Glasses on before head strap. 

·        Head strap on as shown: 

·

 Always Velcro to the bottom rear behind my head.  Place trach roll as shown to keep tubes secure:

                                                            

·        Tilt forward until green using front joy stick 

·        Important - Unplug from power strip

·        Turn wheel chair on green green (slow)

Going Outside

·        Hold Don’s head going over bumps

·        If van ramp isn’t down put it down

·        Position in front of ramp

·        Tilt head down all the way

·        Take off head strap

Getting in van

·        Put in van (hold head down) facing rear column where seat belt is

·        Put head band on (don’t raise head up yet)

·        Move front joy stick sideways – otherwise you can’t turn:                                                
                                                       

·        Face front middle two seats – you don’t have to be perfectly centered – it’s okay to be somewhat behind the passenger seat

·        Tilt head back - look at Don 

·        Feet up without touching seat

·        Plug in Bertha to car charger, only for highway trips! (check charging status)

·        Plug suction into car charger

·        Mouth Suction

·        Ask Don if he needs anything

·        To put ramp up push the black button to my right – step off the ramp!

·        When you get into the driver’s seat . . .

·        Check with Don to see if he is hot or cold

·        Don prefers windows down just a little bit instead of air conditioning if weather permits

·        Ask if radio is okay

Arrival

·        Park in handicap spot – the rear license has a handicap label

·        Mouth suction

·        Unplug both chargers and put over seats – loop both and secure in the arm  rests of the front seats:  

·        Move front joystick back to normal position
·        Feet down

·        Turn towards door - you don't have to be lined up exactly perfect 

·        Close burp tube and tuck elbows

·        Lean body down all the way

·        Take off head strap

·        Hold left shoulder back, with a little force and don't let go! 

Out of van

·        Head strap back on

·        Burp tube open

·        Lean head back and raise feet up ( except when you are going into my doctor's office) Sharp corners when turning! 

·        Show Don the ambu bag  and hang it on the rear of the WC

·        Ask Don if he is hot or cold

·        Ask Don if there is anything else he needs

** Railroad Tracks**

·        Turn on hazard lights a ways before going over to warn cars you’ll be going very slowly however the railroad tracks on Prospect and College doesn’t require hazard lights.

When We Get Home
·        Switch vents
·        Check lithium batteries! Tell Don their charged status- charge if 2 or more green dots do not appear
·        Turn on Baby Bertha
·        Unlock WC wheels
·        Put away medicine from doctors
·        Restock suction bag

In general:

• Automatically shuts off after about 20 minutes. 
• There are two joy sticks. One up front and one in the rear. The rear joy stick is removable for easy steering!  
• There are separate controls for my feet, my head and my back tilts. Another great feature is you can lean my back and feet into the leaning position almost flat (like in bed)! 
• On the front joy stick are two special buttons. The button with only one line is the drive mode. The second button with two lines controls the different tilts. Move joy stick from side to side to select which tilt to change. 
• Another cool feature is the WC can be charged during the day!
• It takes getting used to controlling the up or down tilts. It’s just like an airplane’s joy stick!
• There are four WC tilt options. The following pictures show all. 

Feet only:

For only back recline or tilt forward:

Tilt feet and recline or forward:

Head tilt forward or back:

• The new wheelchair does not have tilt numbers. When you tilt feet, look the foot pedals and when they extend that's the point to indicate when to stop. 
• The seat belts have side padding so the right belt lies down in the seat. The left belt hangs over the left arm rest. 
• In the rear are four blue buttons. Three are labeled, one does nothing. 
  

• To unlock the wheels the yellow levers face down as shown: 
  

• To take off the head  rest for haircuts turn the quick release as shown below: 
  

• This is important. The joy stick has a special feature to indicate where the head tilt number is even though no numbers are shown. As you lean head back the light in the middle bottom of joy stick is green. When the tilt gets to the perfect tilt it turns red!

After Shower - Little Bertha Setup:

• The following picture shows how to loop the vent tubes with the Velcro strip: 
  

• The following picture shows how to loop the power cord over the left handle: 
  

Here's a picture of how the power box is secured to the frame: 

Lung suction guidance:

• Before lung suction raise my feet up until my foot pedals start to extend, stop immediately. 
• Place hands as shown: 
  

• If I am not on Tobii you can recline only my back to make lung suction easier to reach me. 
• After lung suction you can use both feet and recline options to lower feet and raise head. 

CNA guidance:

• On both front sides are silver handles to pull the wheelchair forward during the CNA shift. 
  
• Unfortunately when the front wheels are turned to the side it's nearly impossible to pull or push the WC. 

                                              

• Make sure both front wheels are straight as shown when you push WC back: 
  
  
  
  The same is true for pushing the WC forward as shown: 
                                        

• Transfer from shower chair to WC requires the PA to lock both wheels when they bring the WC up to Don's legs.
• After transfer my PA must unlock both wheels as shown below: 

SunHaven Trips and Overnight

DRT 

How to Get Ready for Sunhaven - Lists and Guidance

Essentials List:

1. __Erica or Tobii

2. __Ambu bag
3. __Sponge Bob blanket from the guest room
4. __Black box and stool.
5. __Fully charged lithium battery.
6. __Shower chair with bucket.
7. __One white circuit for backup
8. __3 Diapers

Overnight Vacation Checklist:

From Bedroom:

• __ 7 Blue Washcloths (Bedtime, Morning, and extra for Peg Tube.)
• __2 White Towels
• __ Socks and/or Ted Hose
• __ Preparation H
• __ Colloidal Silver
• __ Large Q-Tips (Do not bring any small q-tips, and skip anything that uses them)
• __Water Syringe for Trach
• __ 3 Condoms
• __ 5 Alkare wipes for condom
• __ Alcohol Wipes (A lot... more than 10)
• __ Any Blankets or sheets that Don wants
• __ Razor ** and charger **
• __ Calmoseptine
• __ Eye drops
• __ Nose Sucky Machine
• __ Paper cups and Trach. Solution 

From Bathroom:

• __Pink Sponges
• __ Mouthwash
• __ Wet Wipes
• __ 2 Gauze Packets
• __ Tissues
• __ FULL roll of paper towels
• __ Toothbrush ** and charger **
• __ Toothpaste
• __ Mouthwash
• __ Orange Bucket
• __ Body Wash to clean Trach.
• __ Numbing Gel
• __ Deodorant
• __ Spit Bucket and Cup
• __ Duo Derm, little scissors, adhesive removal wipes
• __ 6 extra feeding tube

Optional:

1. Big Bertha
2. Extra blue circuit for backup
3. Extra water bag
4. Camera with film from my bedroom closet

Shopping Instructions (including bone broth)

Shopping goddess - Overview and Helpful Hints: 

Basic Overview: shopping every other week takes about 2 hours (give or take). Keep an eye on the shopping list and inventory to determine when to go shopping. When something gets circled on the list, we still have one of whatever left. That way, you can let the list build up a little bit to make the trip worth it.

During PA shift check the shopping list and inventory because sometimes things don’t get circled and you’ll get an idea of when you need to go. 

Before you Go: before you leave check the list and inventory again just to make sure everything you need to get is circled. More often than not, people forget to circle things so ALWAYS double check inventory and shopping list. Also ask Don about credit card limit. Remember to bring reusable grocery bags. When you return from shopping read the totals from the receipts to Don and put them in “Kate’s Box” (the horizontal file holder on Kate’s desk).

Sprouts: depending on how much frozen food we have, buy 3 bunches of kale (or whatever greens you pick, kale is the easiest to cook and is usually on sale) for 1 package of chicken. We usually go through greens quicker so that’s just a general guideline to use so sometimes you might have to adjust it. There should technically always be four containers of frozen greens and protein, its okay if there’s less, but just make sure we don’t run out.  Typically buy 3 bushels of parsley, if there’s still a whole one in the fridge get 2. Buy fennel bulb based on bone broth; if we have bones and can start a batch, get a fennel bulb. Overall, just use your judgment.

Vitamin Cottage: there are a few things we get from here that we go through quickly so buy multiple:

Burts Bees Honey chapstick (3)

Rosemary (4)

Plant enzymes (2)

Dish soap (2)

Water: good way to determine when to go shopping. If three or more of the 5 gallon jugs are empty check the shopping list/inventory, use your judgment. It is easiest to bring 2 of the jugs in, get everything else on the list, check-out and tell the cashier how much water you have/will be getting and make two trips if necessary. Also, they will help you load the water into your car if you want, sometimes they offer but you might have to ask.

Rewards: sign up online so you can use your phone number. Go to naturalgrocers.com and in the upper right-hand corner click Npower sign up/log in.

Sam’s Club: the most important thing we get at Sam’s is paper towels so buy 2 depending on how much we have. Also there’s a few things you can get here or wherever is most convenient:

-organic extra virgin olive oil (EVOO)

-hydrogen peroxide

Online Shopping: the billing address is  my home address in Collierville, TN 38017. Also the phone number for the billing address is my wife's cell  phone (all of this information is on the paper above the phone in the kitchen). When you order from Herbal Healers when you check out click “order with credit card on file” and then scroll down and enter the “HHA Member Number” which is DB1048. You’ll still have to put in the credit card info even though it says it’s on file. For Super II, order 3; Reishi Mushroom, ½ pound ground; and Colloidal Silver, 2oz with dropper BUT check with Don before you buy anything.

Other: there are some things that you can obviously get at multiple different stores (such as EVOO, hydrogen peroxide, Burts bees chapstick, etc.) to save time and gas, get it where it’s convenient. For example if we need EVOO but nothing else from Sam’s Club get it at Sprouts or Vitamin Cottage. Also, generally speaking, get the bigger quantity of things if it is available (ex., T gel shampoo, hand lotion, coconut oil, etc.).

As the shopping goddess, you’re also in charge of running other errands for Don unless he asks someone else. The most common would be sending his mail. If Don asks you to mail something go to Leonard’s Mail Store (off Magnolia and Howes). Kate and Ken have an account there so when it’s time to pay say he/Kate has an account.

Also, when you return from shopping don’t hesitate to ask the PA to help you unload water and groceries.

IMPORTANT: the shopping goddess is in charge of getting cash for Don’s haircuts ($15) and staff meetings (usually about $100). You can get cash back and Wal-Mart and King Soopers in amounts of $60 so try to plan ahead as much as you can by looking at the calendar to see when haircuts and staff meetings occur. Sometimes you’ll just have to go to either King Soopers or Wal-Mart and get something we use but it’s not circled on the list (ex. Hydrogen peroxide, dryer sheets, etc. use your judgment). Also Wal-Mart doesn’t have 10 dollar bills so get change at King Soopers or a bank. As a last resort it is possible to get checks from Kate so if it comes down to it, text her to see if she or Ken will be in town, but again, this is a last resort situation.

Bones: we usually go through Meadow Maid Foods at farmers markets. Email Cindy Ridenour (cindyr@meadowmaidfood.com) to see if/when she will be in Fort Collins and to place an order. 20 lbs lasts about 4-5 months. She only takes cash or check. If you can’t get cash text Kate to see if you can get a check. If that doesn’t work out you can buy organic bone broth at Sprouts/Vitamin Cottage. Try getting on Google and searching for organic grass-fed beef bones. They don’t have to be beef, but they do have to be organic. If that doesn’t work consult Kate.

Additional liquid bone broth options. There is a big difference between beef broth and bone broth! In terms of vitamins, minerals and nutritional content. Bone broth must be organic and can be found premade in those square boxes they put soup in nowadays at Vitamin Cottage (now called Natural Grocers) and Whole Foods. Check for some at Sprouts. Buy organic beef bones from Vitamin Cottage or Whole Foods but of course they cost more. Get knuckle bones and or marrow bones.

Lastly, don’t hesitate to ask questions about anything you aren’t sure about. Don and Barb are both good resources. You can also call stores to see if they have what we need or to price check. 

Morning CNA Visit

DRT 

• Call in with Assuricare (only if are in their system) 
• Read Reports and White Board
• Turn on ERICA and move her by the blue chair so Don can see it. 
• Wash hands
• Set Up Supplies for visit on Table at foot of bed
• Water syringe for  trach
• Condom cath and Allkare
• Lotion
• Trach solution
• Tissue
• Set up Supplies for cart by door
• 2 Gauze packages 
• 3 Q-tips
• Water Management and Mouth Suction
• Remove and place in cart by door: 
• Right hand, yellow finger foam 
• Hand Blue Bird Pillows, Hand Towels and Arm purple pillows
• Foam pillow behind head
• Move sheet to the left side of the bed 
• Remove blue roll under knees and place on dining room table
• Drain Condom Catheter hose - but first raise head up first and then feet down
• Disconnect Tube from Bag and remove condom
• Strap on Cart by door
• Grab 2 Blue Washcloths and place on bathroom counter
• Grab 2 more Blue Washcloths for face and belly and place on towel bar
• Drain Cath Bag in Bathroom
• At the same time- fill Orange Bucket with HOT water
• Put both washcloths in tub
• Take out 2nd washcloth and dab with soap
• Place Orange tub on Shower Chair in bedroom
• Cath Bag on cart by door
• Legs up for Butterfly
• Wash stomach, then groin area,  with soapy washcloth
• Rinse with other washcloth
• Then dry with Towel on back of Shower Chair (towel stays on bed foot board)
• Fold sheet

ROM- Both Legs

• Butterfly x3
• Remove foot foam and place in corner at headboard
• Leg straight then heel to butt x3
• Stretch foot back once
• Pull toes
• Remove bandanna - put it in laundry, foam pad (helpful hint:  use bandanna if foam just needs to be wiped clean otherwise wash if gross), and Wet Trach with water in syringe
• Keep 1 tissue for catching mucus under trach
• Lotion on Lower Legs and Foot (not between toes)
• Keep Right leg bent up

ROM- Left Arm 3x

• Thumb out, fingers in, then Thumb in, fingers stretched x3
• Arm up- sideways, bend arm x3

• Remove gauze and clean trach with 3 long wet Q-tips
• Use Colloidal Silver, A&D ointment
• Wad tissue and place under trach
• Put Condom on
• Apply Allkare- fan then apply condom
• Put on TED hose
• Important, put both feet beside the box (in place for lung suction - not on box) 
• Put things on Cart by door
• Return orange tub to bathroom
• Save washcloths to use on upper body
• Wet 2 Q-tips

ROM- Right Arm x3

• Same as LEFT
• Remove feeding tube and take peg out of shirt

Clean PEG tube

• Remove gauze on belly
• Get belly wash cloth from bathroom- dot of soap on one corner
• Clean PEG with soapy corner then rinse- 2 drops Colloidal Silver

• Nose Suction- use Sucky Machine, then 2 wet Q-tips then dry end, tissue (save tissue)
• Clean Sucky machine then grab face cloth
• Wash Face with HOT washcloth- eyes first, forehead, cheeks, chin, nose, mouth
• Turn over washcloth and wash ears
• Dry neck with tissue - save tissue for spit while dressing

• Mouth Suction
• Shave
• Lift chin up to shave Adams apple and neck
• Chin, cheeks and mustache
• Wipe hairs off lips after mustache 

• Last Q-tip- Calmoseptine, put on PEG tube
• Gauze- PEG tube and Trach
•  Important! Always put the balloon little tube over the gauze as shown: 
  
  
  
  When you put it under it hurts and causes a red mark as shown: 
  

• Lung suction- Bullet ALWAYS:
  
• Between first and second - get brace, unhook roll pillow

ROM- Neck Exercises

• Remove roll pillow and place in corner at headboard and put white pillow to the right of head
• Turn Neck- Up and Around- look up, turn right and back, turn left and back, side to side – 90  degrees
• Down and Around- look down
• Head to the side- massage sternoclaidomastoid
• Brace On
• Water Management

Transfer to Shower Chair - left hand on thigh, right hand off bed 

• Have your pa help swing my feet around, put shoes on and put feet on disk. 
• Move disk so legs are vertical 
• Your pa helps lift Don's hips
• Have your pa push the shower chair to Don's legs. 

When Don is sitting down: 

• Raise tubes on vent arm 
• Feet on Foot stool
• Paper Towel between legs

Remove Shirt

• Left arm out first, then Right arm
• Hand under shirt and brace
• Lift head up
• Remove Brace
• Reconnect trach under shirt
• Remove Shirt over head, put in laundry, check if shirt has food spots to be sprayed
• Important, the extra tissue goes under Don's chin 
• Make sure shoulders are straight 

 Important! On Saturday skip washing upper body.  Skip to putting shirt on below.  

• Get Diaper and cut
• Set up Mouth supplies in bathroom

• Toothbrush, tub, cup, pink sponge with mouth rinse

Upper Body Bath- in Shower Chair

• Hot Water in Orange Tub- hot, soapy washcloth
• Wash Chest, Arms, Back (don't hold head)
• Rinse Chest, Arms, and Back
• Dry Back and Lotion entire Back, pain cream on back? Ask Don where? Usually upper  spine or upper right. 
• Dry rest of body
• Need deodorant?

Put New Shirt On- Head, Right arm, Left Arm, Trach 

• Lean Forward, Straighten Shirt down Back
• Diaper on, Shorts on
• Connect Bag to leg
• Wait to connect to condom
• Lotion on Knuckles/Fingers and Psoriasis spot on Left Arm if necessary
• Ring Management
• Return Lotion and Orange Tub to Bathroom
• Grab mouth supplies already set up in bathroom, move to bedroom, get 5 double paper towels and put numbing gel on q-tip

Mouth Care

• Wipe out Mouth with paper towel
• Brush teeth
• Outside- up and down
• Inside
• Outside- up and down
• Inside
• Roof of Mouth and Tongue
• Wipe out Mouth with paper towel
• Lean forward, tub on lap, right hand over left 
• Mouth Rinse 2x
• Wipe teeth with pink sponge
• Wipe out Mouth with paper towel
• Numbing Gel on front teeth top and 

• Belly Rub
• Up on Right, across, down on Left x2
• Lean forward
• Place Batman pillow behind
• Hands on knees
• Butt lift on both sides, fold pillow down
• Fix feet
• Paper towel on hands to catch spit - make sure clips don't stab hands and the yellow tube on bertha is up
• During Wait
• Clean up Mouth supplies
• Set up Nighttime supplies- gauze, water syringe, 3 Q-tips, 2 washcloths, alcohol swab, and 2 tissues
• Make bed and empty suction bucket
• Shower chair back one notch
• Remove batman pillow when finished 
• Brace on
• Connect Condom Cath tube to bag 
• Use alcohol wipe on cath tube
• 2 Tissues on blue tab (if it falls off - this is optional) 
• Pull up diaper and shorts over knees
• Lay on Floor to Wipe Bottom
• Check Duo Derm if on bottom, Prep H
• Mouth Suction

• Move to Living-room

Transfer to Wheelchair

• Use Black Box to Transfer
• Push condom on 
• 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
• Feet on pedals
• Put bag in WC holding bag
• Check and straighten condom, cath bag and tissues around blue tab position
• Roll under trach
• Left butt lift
• Seatbelt (make sure shorts are under the strap)
• Cross arms and lean wheelchair all the way back
• Push HARD 2 times with hands just below kneecap & ask if it’s okay
• THE SHOULDER TWIST
• Right arm up, side lateral around – don’t push!
• Shoulder Twist- the lateral should click after this move
• Move wheelchair back into place
• place blue roll pillow by left thigh

• Lung Suction
• After lung suction – Burp tube while still leaning back
•  Head 19, Feet down until foot pedals extend

• Shoes off
• Adjust Neck Brace (Chin lift to tighten) /use the same bib
• Move Wheelchair to big wheel in blue floor tape
• AM- Place black blind behind chair to stop glare on computer screen, feet facing front door
• PM- Spin Don to face TV (hold power cord/ big wheels in line with blue tape)

Set Up ERICA

• ERICA should be horizontal with silver bar, twist Erica sideways if necessary
• Move Erica up/down by grabbing the edges of the screen. Move side to side by using bar. Don will help guide you to the correct positioning.
• Important. When Don says UP it means tilt Erica down so his eye goes up!

FINAL-

• Mouth suction
• Chapstick
• Set up Black Hand Bell