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DEAR VANESSA,
My 76-year-old father must be on prolonged bed rest. He takes medications for his high blood pressure. As his primary caregiver, what long-term considerations and interventions to prevent complications should I be aware of?
KAYLA
DEAR KAYLA,
Your father’s condition predisposes him to a variety of complications: muscle and bone atrophy, contracture, pressure ulcer, constipation, urinary tract infection, disuse osteoporosis, kidney stones, hypostatic pneumonia, pulmonary embolism, postural hypotension, anorexia, insomnia, muscular weakness, and disorientation. Gently make him aware of bed rest dangers to keep him moving.
Weakness and hypotension are common signs and symptoms noted in an older adult on bed rest. Your father is at greater risk for orthostatic hypotension because of his hypertension. When ambulating your father for the first time, proceed slowly and cautiously. Observe him closely and encourage him to take slow, deep breaths with his eyes open looking straight ahead. Use assistive devices such as canes and walkers, and make sure he wears non-skid shoes.
Provide adequate support to help ensure his safety when moving him from a lying to a sitting position and from a sitting position to a standing position. And be sure the area is free of clutter, wet areas, and rugs that may slide.
After having maintained bed rest for a long time, your father may revert back to a favorite position. Frequently assess him, and turn or reposition him more often as needed; at least every 2 hours is recommended. Explain each step and avoid jerky, sudden movements. Offer support but give him a chance to assist with moving and positioning whenever possible to promote independence. The skin of older adults is more susceptible to injury. Use lift sheet as often as possible to prevent shearing forces on his fragile skin.
Encourage him to have an adequate intake of fluids and a well-balanced diet. Use a footboard to prevent the development of foot drops. Position his lower extremities properly by using a pillow or wedge between his legs. And encourage progressive ambulation: bed activities, sitting, transferring, standing, walking, and stair climbing.
Safety and maintenance checks of his ambulation devices should be carried out on a routine basis. Make periodic assessments to ensure that he is using his ambulation devices properly. A physical therapist can provide additional assistance or recommend range-of-motion exercises that can help combat the loss of muscle mass, strength, and functional capacity.
-VANESSA
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Passionate about living life and loving people fully. Has an adventurous spirit and an unusual craving for mangoes. Her mantra: Always be loving and kind.
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