June 16, 2012
Vitals: BP110/70, Temp: 37.5, O2Sat: 96, HR: 75, RR: 23
HOMECARE ESSENTIALS 8
A CAREFUL BLADDER AND GASTROINTESTINAL CARE
Doctors from Day 1 always commented about Melit’s bloated stomach, and she has been subjected to treatments including omeprazole, laxatives like Dulcolax, and had her NGT on “open to drain”.
We always say, a bit jokingly, that Melit always had a big fat tummy with cholesterol and all, but we are also aware that she always had digestive problems and her stomach is very particular about the food she takes.
We thought her stomach and her bladder are the part of the essential focus points of her recovery (thankfully she had no history of diabetes, no kidney problems, no liver complaints, no reproductive health issues to deal with).
Comatose patients do still need to eat and digest food – only in a different way. In fact, we make it a point that Melit have a slight “taste” of anything she eats by dapping a small cotton ball of whatever OF she is having and squeezing the fluid in her lips. Sometimes, she ignores it, sometimes, she licks it with her tongue.
These are the things we have in our list for this tummy and pee concerns:
- Careful, sterile preparations of her feedings including Ensure and OF
- Daily monitoring of her fluid intake and outputs
- Daily dose of omeprazole, a drug used in the treatment of dyspepsia, peptic ulcers, and acidosis, among others.
- Daily multivitamins and minerals to provide whatever elements she needs for digestion.
- Using stop gap measures like laxatives for her bowel movements and hot-and-cold compress on her stomach to induce urine discharge, or if worse, we use a straight catheter.
- A regular schedule of perineal care that make sure all aspects are cleaned.
This is the Melit Balase brand of perineal care:
You need: a basin of warm water with Lactacyd; two pairs of clean gloves; two people – one for lifting and the other one for cleaning; two towels (coded green in our homecare) – one for wet and one for drying purposes; one diaper; one underpad; a sachet of Calmoseptine; and one plastic bag for the soiled diapers and underpads.
- Prepare all materials near the bed.
- Flatten the bad to at least 30 degrees.
- Wear masks and gloves.
- Open patients’ legs in spread-eagled position. This allows a clear path for cleaning; encourages Melit to release some more (make sure you keep your face away from the area during the first few minutes or you will be surprised); exercises her major muscles and joints in the legs; and allows easy lifting.
- Using the clean parts of the diaper to catch the water, squeeze soapy water in the perineal area. Clean the vagina thoroughly at first, then the anal area (away from the vaginal opening), and back to the vagina to avoid any contamination.
- Dry the perineal area with the dry towel and remove the soiled diapers and place them in the plastic bag for disposal (tie thoroughly or the neighborhood dogs will make a feast out of them in the garbage area).
- Place calmoseptine in areas where there are rashes (there will be rashes, trust us).
- Replace clean diaper and underpads.
- Raise the bed back to its original elevation.
- Wash your hands and rest.
THIS WE LEARNED ALONG THE WAY:
Before this happened to Melit, we always look at elimination of waste as just another human function and we take for granted its importance. Now, we sometimes include it in our prayer – that Melit should be able to release her bowels because it can be fatal, as we later found out in the days to come.
Despite all precautionary measures, we knew there was something wrong because there her feces was black, signs of bleeding and her urination was difficult. We thought there must be something happening and wanted a urine and stool analysis as well as CBC. Unfortunately, labs are closed on weekends.