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

Trach Replacement- Instructions

DRT 
Instructions for Hospital Trach Replacement 

What to bring to the Hospital:

• Two gauze pads for after replacement 
• Trach from my closet (hospital may provide one instead of using ours)
• Blue collar  
• Check suction bag for enough worms and gloves
• Bring lunch meds and food
• Lunch meds are the same except leave out Plant Enzymes
• Food is not the normal Lunch food!! This is a little too hard on my system after all the drugs. Make breakfast but use half the amount of bone broth. 
• In a small blender bottle, add in the usual breakfast ingredients but only use 4 oz. of Bone Broth. Shake well.
• In the little pot, heat up 2 Tbsp. of Coconut Oil and 4 oz. of bone broth. Add to blender bottle. Shake well. 
• You should have about 12 oz. A little extra is OK because I won't have eaten since the night before and will be hungry. 
• Do NOT add Fiber and do NOT refrigerate!!! 

At the hospital:

• Ask if I need lung suction before replacement 
• Tilt WC back slightly and recline until I say so. Take off brace.  
• Take a towel the wrap around my chest to keep blood from getting on my shirt (ask a nurse for a towel).
• When Dr. Hoyt removes the gauze pads, make sure he keeps the white foam!
• Very important! When you take off brace right before he pulls old trach out, lift chin up during the whole procedure (have one hand behind neck pulling up and one hand on forehead pushing back)
• Once Dr. Hoyt is done and they've cleaned up most the blood, put in the new gauze pads and put old white foam back in. Make sure the blue collar seems tight enough. Replace it if it got bloody (save the new white foam if you use a new one).  
• After replacement I usually need lung suction. It's OK to keep brace off for this.  
• Get WC back to normal and replace brace. 
• Give me lunch meds and food. 
• If I make a face get the spell board. Keep in mind I'm pretty drugged for this so spelling things may be a challenge.  

At home

• When I get home for my afternoon visit, replace inner canulla if necessary

How to replace brace

• Put back of brace behind my neck (arrows up) 
• Make a bib for chin (double paper towel)
• Take off trach and quickly put front brace on (arrows up) 
• Use CPR chin lift to raise chin up high 
• Keep holding chin and pull Velcro on my right side tight to snug on the front 
• Let go of my chin and do the same thing to the left Velcro while really squeezing the brace tight on both sides. You won’t choke me 
  
• Push both sides of the rear brace down 
• Fold the brace pads off both of my ears 
  
  Left and right side view 
• Ask me if okay 

Dr. Billica Office Visit

DRT 
Prerequisites before visit to Dr. Billica's office:

·         Know and understand lip reading for example, up and off.

·         The railroad tracks are smooth by College Ave so you don’t have to turn on emergency flashers.

·         Know how to get to the doctors office.

     o   East on Prospect past Timberline, turn left at the first light after Timberline.

     o   Drive slowly because the road is bumpy at first.

     o   Drive straight ahead to the doctor’s office.

     o   Look for orange cones.

·         Know how to troubleshoot vent failures. Ambu bag me in emergency situations.

·         Know and understand my short hand list of words.

Before the visit duties for the morning pa:

·         Prepare my lunch and medicine. Use the following guide: 

1)      Get blue lunch box above stove

2)      Make lunch and meds (meds go in clear containers with green lids or recycled medicine bottles to the left of the sink in basket). Use tan tape to label meds.

a.       11:30 Liposomal Vitamin C

b.      Lunch (in small blender bottle)

c.       Lunch meds (H20 and Elyte and dry meds in separate containers)

d.      2:30 meds (ok to add pteridin 3 to H20 and Elyte)

3)      Put all food and meds in lunch box, then into fridge

a.       If Don is about to leave, put an icepack in the lunchbox, otherwise make sure you or whomever is taking him puts an icepack in there

4)      Get Dr. Billica list (taped to fridge)

a.       Check cabinet and freezer for anything that wasn’t circled

b.      Put Dr. Billica list in the outside pocket of wheelchair bag

·         Get my iPod touch and check battery, charge if necessary. When done include ear phones
           and put it in WC bag.

·         VERY IMPORTANT! Get the Dr Billica list in the kitchen and put in WC bag.

·         Make sure the suction bag is well stocked with red worms, gloves and water bottle.

·         Check the lithium battery lights. 

Before going to Doctor Billica’s: 

·         Feed me my snack and ask if I would like M and M.

• Flush my picc line twice. 

·         Always empty suction bowl and take power cord for suction machine.

·         Switch vents and remember to unplug Little Bertha from wall before driving away.

·         Always put head band on before my glasses.

·         If you put my jacket on with my arms in sleeves be sure to put your hands in the sleeve in
        and grab my hand to pull my arm through. It’s important to pull my sleeve up over elbow
        so my hand is free.

·         A gentleman always carries his suction machine on his lap for his lady! 

At the doctor’s office:

·         For parking, there should be two spots off to the left of the lot blocked off by orange cones.

• Park in the farthest left one so that you can lower the ramp into the other one.  
• Replace the orange cones so nobody can park in the space where the ramp comes down after you move towards the sidewalk ramp. 
• In the van get my ambu bag and put it on the back of WC. Tell me when you did it. 
• Hold my head when going over bumps.

Please read -New Wheelchair Guidance especially how to wrap the power cords as shown:

·         When you get to the door, the receptionist is usually ready to open the door for you;
       if she's not just use one of the chairs or the suction machine to prop it open for you. She will show you where the room is.

·         Lower my feet almost all the way  to turn corners.

·         When you get in the room, push the patient table against the wall, move my wheelchair pretty
       close to the appointment table, and facing the door to see when people walk by. Head at 19,
       feet to normal level. Then you can just chill out on the recliner until Don wants to go for a walk in
       between visits.  He can communicate with you to tell you where the WC should be angled.

Here's a picture of the placement: 

·         Unfortunately there’s no wireless in the office.

·         I wear regular socks because I get a special treatment called FSM.

       The nurse puts two electrodes on my shins. Also two on my upper back. 

·         It’s best to plug in the vent into the outlet to my immediate right,
       check little Bertha’s charging light after plug in.

·         The suction machine goes on the chair to my right and the outlet is to the left of the chair.
       Check that the charging light is on. Sometimes you have to turn on the light switch to get
        power to the outlet.
·         Once set up, do Mouth Suction.
·         Keep track of time for meds, lunch, etc.

·         There are 3 IV treatments spaced an hour apart and my PICC dressing is replaced.
        It takes about 3 hours.

·         If the weather is nice after the first treatment take me for a walk. Please take medicine and lunch.

·         Half way through the visit give me chapstick, please.

·         Eye tracking hints. I don’t have my bell on when given treatments so look at me now and again.

     o   Looking down = feet up or down.

     o   Looking to my right and down = burp tube. Either clamp or burp me.

After the doctor visit:

·         Ask me if I am hot. If so take off blanket and jacket.

·         Put WC back in morning position.

·         Tilt head to 19 and feet  up to normal level. 

·         Switch vents. Don’t forget baby bertha.

·         Put me on Erica.

·         Empty WC bag.

·         Check iPod battery.

·         Replenish suction bag.

·         Plug in suction machine.

·         Suction Don.

• When I am good to go, continue with PA duties

Transportation for Don

DRT 
Don is set up to use Dial-A-Ride whenever you cannot use his van for any reason. That includes if his caregiver is not van trained and you need to get to Tri-Life.

As far as I know Don and your caregiver are eligible for these rides free. When you call it is important that you ask if there’s a charge! The catch is you must reserve his ride 48 hours in advance of needing it. Plus allow about 45 minutes travel time each way to include how late they can sometimes be to get you. 

You just call Dial-A-Ride at 970-224-6066 to book his ride. Also you must tell them how TALL you are in his wheelchair so they do not send a vehicle that is too short for you to get into. Don’s caregiver has to get you into the vehicle (usually very easy) then the driver will secure you.

Also through Dial-A-Ride you can call Yellow Cab and ride them. Dial-

a-Ride will pay the first $20 towards that ride- usually totally covers cost. They have fewer cabs that can accommodate his wheelchair height, but they do have some. So it is important to tell them about his height. They also need a 24 hour notice and are a little more prompt. For them you call Yellow Cab directly and reserve a cab. Tell them you are on the Dial-A-Ride rolls, how tall you are, and that you will have a caregiver with you. Yellow Cab will bill Dial-A-Ride.

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