American Medical Association Family Medical Guide - American Medical Association [138]
Liquid diet
Sometimes doctors prescribe a liquid diet, in which the person cannot eat any solid food. In this case, ask the doctor to recommend a dietitian who can plan an appropriately balanced diet. You also may want to ask the doctor about giving the person liquid nutritional supplements, which are widely available in single-serving cans.
When giving liquids, always elevate the person’s head slightly to help prevent choking and spilling. The best way to do this is to hold the cup or glass while the person drinks through a flexible drinking straw. Keep the person’s head elevated for at least 20 minutes after eating to help prevent choking or regurgitation.
Meal Services
Special meal services such as Meals-On-Wheels provide home delivery of nutritionally balanced hot and cold meals for older or disabled people who are not able to prepare their own meals. Fees for this service are based on a person’s ability to pay. Because the demand for such services is high in some communities, preference may be given to people with limited income. In other communities, anyone who can pay the full fee is eligible. Special diets require a written order from a doctor.
Preventing Pressure Sores
A person who is confined to bed is at risk of developing pressure sores, especially if his or her movement is restricted or sensation impaired. Pressure sores develop on the parts of the body that bear weight or rub against bedding. They are the result of continuous pressure that interferes with blood circulation to the tissue in the surrounding area. Poor nutrition and incontinence also can contribute to the development of pressure sores.
A pressure sore begins as a patch of tender, reddened, inflamed skin. Gradually the skin turns purple, breaks down, and forms an open sore. The sore gradually grows larger and deeper, and can become infected. Pressure sores are usually very slow to heal. They will not heal at all unless pressure on the affected area is greatly reduced or eliminated.
Pressure sores
The most common sites for pressure sores are the base of the skull, shoulders, shoulder blades, elbows, lower back, hips, buttocks, sides of the knees, ankles, sides of the feet, and heels.
The best way to prevent pressure sores is to change the person’s position every 2 hours during waking hours. Gently move the person from one side onto his or her back, then to the other side; rotate positions throughout the day. Never drag the person from one position to another in bed—you could damage the skin, increasing the risk of developing pressure sores.
About once every hour, have the person stimulate circulation and prevent joint stiffening by wiggling his or her toes, rotating the ankles, flexing the arms and legs, tightening and relaxing the muscles, and stretching the entire body. If the person is immobile or very weak, you can perform passive exercises by gently bending and straightening his or her joints several times a day.
Help the person out of bed as often as possible (see page 191). Moving around also will help prevent fluid from collecting in his or her lungs, a major risk factor for pneumonia. If the person cannot get out of bed, encourage him or her to move around in bed frequently.
Place cushions and pillows between the person’s knees and under his or her shoulders to help relieve pressure. Alternating pressure mattresses, synthetic sheepskin mattress pads, and heel protectors allows air to circulate around the person’s skin and helps reduce pressure and friction against the bedding. A bed or foot cradle (a tentlike device placed at the foot of the bed) helps to keep the weight of blankets and other coverings off the person’s feet. You can rent or purchase these items from drugstores and medical supply companies. Remember that, even when you use them, you still need to turn the person frequently to prevent pressure sores.
Keep the person’s skin clean and dry, especially in areas most vulnerable to pressure