Tuesday, July 14, 2015

Stress Management

We’ve all been stressed…it’s that overwhelming feeling that makes us anxious in anticipation related to a situation going on in our lives.  Stress if your body’s way of responding to any demand that is made upon it.  Stressors can be physical (demanding of the body), or psychological (demanding of the mind).  Stressors can be either good or bad, but either one causes a biological response to happen in your body.  Of course, good stressors are usually better.  Total Home Health completely understands the concept of stress and how it plays a role in our day to day functioning.  We are eager to begin our services with you in order to promote your well-being and help you manage your stressors so they have a positive impact on your life.

Individuals need the presence of some stressors in their life in order to peak their interest and give them purpose to their actions and life.  However, it is when you experience too much stress or have too many different things attributing to your stress, that it can cause distress in your life.  Anxiety and anger would be examples of stressors that are damaging to your body and cause it distress.  Whenever your body faces a situation where it is put under an increased demand, such as in a stressful situation, general adaptation syndrome (GAS) occurs in response.  The first stage of GAS is known to us as the “fight or flight” response, where you will either take on what the situation is throwing at you, or run and try another coping method to handle the situation.

You should remember though, that if stress is prolonged your body may begin to respond in ways that are not good for you…which could cause a variety of health complications such as weight loss or weight gain, depression, chronic pain, high blood pressure, chronic anxiety, and more.  Therefore, stress management is very important and it is your ability to cope with different types of stress, while also being able to experience appropriate emotions during the situation.  Here are some stress management facts that may give you a little more insight:

  •   If you manage your stress in a healthy manner by using a variety of coping skills, you will generally have better outcomes in your situations.
  •   Keep in mind that your responses to stress and anxiety are affected by factors such as your age, gender, culture, life experiences, and the type of lifestyle you lead.
  •   The effects of the stressful situations you encounter are cumulative.  For example, the death of a family member may cause a huge amount of stress.  So, if you are also experiencing other stressful events at the same time, complications to your health could arise due to all the negative effects on your body from the great amount of stress.
  •  Your ability to use successful stress management techniques can improve your stress-related medical conditions and improve your functioning and outlook on life.

There are protective factors that can increase your ability to resist the effects of stress to generate a more positive situation for yourself if burdened by stress, including:

  •   Good physical health
  •   Having a strong sense of self
  •   Following religious or spiritual beliefs
  •   Having a positive outlook on life
  •   Engaging in hobbies and other social events
  •   Having interpersonal relationships that are satisfying
  •   Strong social support systems, such as friends and family
  •   Finding the humor in your stressful situation

Total Home Health has a program that will fit your stress management needs perfectly.  Our nursing care will involve working to educate you on various ways to reduce the stressors in your life, which will be discussed further once you enroll with us!  Some of these ways to reduce your stressors include reframing your thought processes, increasing relaxation, starting to keep a journal, restructuring your priorities, music therapy, introducing  you to more relaxing hobbies, educating you how to communicate more effectively, and more.  Total Home Health and our professional staff look forward to teaching you how to manage your stress more effectively in order to avoid serious health problems.  We aim to keep you in tip top shape, keep you smiling, and enjoying being able to watch you lead a satisfying life.

PUD, Lactose Intolerance, IBD, & Liver Disease

The list of gastrointestinal disorders (GI) seems never-ending.  You GI system can be affected in so many unwelcomed ways.  Total Home Health understands just how much of a nuisance these disorders can cause for you and your loved ones in your daily lives.  During your services with us you will be continuously educated and always encouraged to do what is best for you and your well-being.  The passion of our highly-skilled and professional staff is to keep you at the center of our focus and see that you receive state-of-the-art care in your own home environment.

Our purpose here is to discuss and educate you on some of these unwelcomed GI disorders you may experience, along with what our professional staff can do for you in those instances.  Our focus throughout this article will be on the GI disorders of peptic ulcer disease (PUD), lactose intolerance, irritable bowel disease (IBD) and liver disease.  Each of these disorders will be discussed more in-depth for your information, including nursing interventions to help you through your experience with each one.

o   Peptic ulcer disease (PUD)
·         PUD is characterized by an erosion (wearing away) of a layer of your stomach.
·         Typically, the cause of this is a bacteria called H.pylori; a chronic use of NSAIDs (aspirin, ibuprofen) may also be the cause.
·         You may have no symptoms with PUD, or you may report dull, gnawing pain, a burning sensation in your back or in the mid/lower area of your stomach, heartburn, constipation or diarrhea, sour taste in your mouth, burping, bloating, nausea, vomiting, and tarry stools.
·         Remember…eating may temporarily relieve your pain.
·         If your case of PUD is caused by the bacteria H.pylori, your provider will most likely prescribe a triple therapy for you (a combination of antibiotics and medications that reduce the acid made in your stomach), which is usually taken for 2 weeks.
·         You should avoid eating frequent meals and snacks, as they promote your stomach to make more and more acid each time you eat, which can irritate your PUD.
·         It is best for you to avoid coffee, alcohol, caffeine, aspirin, cigarette smoking, black pepper, and spicy foods.

o   Lactose intolerance
·         Results from an inadequate supply of lactase (an enzyme) in your intestine.  This enzyme is the one that is responsible to digest lactose.
·         If you are lactose intolerant you may experience a distended (bloated) stomach, stomach cramps, flatulence (gas), and diarrhea.
·         Our nurses will encourage you to avoid or limit your intake of foods that are high in lactose which include milk, cheese, ice cream, cream soups, sour cream, puddings, chocolate, and coffee creamer.
·         During your care with us we will make sure to monitor you for deficiencies of vitamin D and calcium.

o   Inflammatory bowel disease (IBD)
·         This category consists of disorders that have periods when they do not cause you any trouble, but at other times they can flare-up.
·         Symptoms of IBD may include nausea, vomiting, abdominal cramps, fever, fatigue, anorexia, weight loss, and fatty-stools.
·         Your nutrition therapy will be focused on providing the nutrients you need in forms that you can tolerate…without running to the bathroom per say.
·         Most likely, your diet will be low in fiber so that your bowel will be less stimulated to move and cause bowel movements.
·         Get ready to be prescribed a diet that is low-residue, high-protein, high-calorie, with vitamin and mineral supplements as needed.
·         Our nurses will educate you to avoid intake of substances that cause or exacerbate diarrhea, and we will advise you to avoid nicotine.
·         Once you are enrolled with us, we will discuss other, more serious measures that could possibly be taken to treat your illness with IBD.

o   Liver disease
·         Your liver is involved in the metabolism of almost all the nutrients in your body.
·         Disorders affective the liver include cirrhosis, hepatitis, and cancer.
·         Commonly malnutrition goes hand in hand with liver disease.
·         In the case of liver disease, dietary protein is increased due to the liver being compromised and breaking down what protein is stored there.
·         Carbohydrates generally are not restricted because they are an important calorie source.
·         Based upon the continual evaluations by our nursing professionals your caloric requirements, or your needs for multivitamin and mineral supplements will be determined if they are necessary.
·         Alcohol, nicotine, and caffeine should be eliminated at all costs.

Ultimately these GI disorders can prove to be very discomforting and interrupt your daily routine.  Total Home Health and our professionals completely understand the toll these conditions can take on your body emotionally, spiritually, physically, and psychologically.  Our staff will provide you with continuous education and always encourage you to make positive changes to maintain the best health possible for yourself.  Let’s get started, enroll today!

Nausea/Vomiting, Constipation, Diarrhea, & GERD

Gastrointestinal (GI) disorders are those that deal with your stomach and how it functions on a daily basis.  All of our professionals at Total Home Health realize that some GI disorders can be very discomforting, cause multiple problems with your health, and make you have to avoid food and drink that you really enjoy.  Our nurses will work to gain an awareness of your nutritional needs based on any GI disorders you may being experiencing.  Having you play an active role in your care is important to us, so we will explore your dietary needs with you, and recommend any modifications that go hand in hand with your disease process to increase your chances of successful treatment.

The purpose of this reading will be to discuss and educate you on some of the more common GI disorders and what our professional staff can do for you in those instances.  Our focus throughout this article will be on the GI disorders of nausea and vomiting, constipation, diarrhea and gastroesophageal reflux disease (GERD).  Each of these disorders will now be discussed more in-depth for your information, with nursing interventions to help you through each one.

o   Nausea and vomiting
·         Potential causes of this include a decrease in the acid that is made by your stomach; a decrease in the way your stomach and intestinal muscles spontaneously and actively move; having an allergy to certain foods; a bacterial or viral infection; increased pressure in your brain; adverse effects of some medications; or disorders of your liver, gall bladder, or pancreas.
·         The underlying cause of any nausea and vomiting you experience will be investigated by your professional Total Home Health team.
·         Being able to observe what your emesis (vomit) looks like will help to determine your diagnosis and treatment.  For example, if your emesis looks like coffee-grounds, that indicates the presence of blood.
·         Once your episodes of nausea and vomiting start to get better, your diet will consist of clear liquids followed by full liquids, and then will be advanced as you can tolerate it.
·         During nausea and vomiting episodes, easy-to-digest, low-fat carbohydrate foods are usually tolerated well.  These foods include crackers, toast, oatmeal, pretzels, and plain bread.
·         It’s best to avoid liquids with meals because they cause you to feel full.
·         Avoid hot and spicy foods.
·         Eat food that is at room temperature or chilled.
·         Avoid foods high in fat because they are hard to digest.

o   Constipation
·         Difficult or infrequent passage of stools, which may be hard and dry.
·         Causes of this include irregular bowel habits, inactivity, long-term use of laxatives, obstruction, medications, GI disorders, and inadequate consumption of fiber and fluid.
·         Exercise will be encouraged, along with a diet high in fiber which is the preferred treatment.  Adequate fluids will also be promoted to make passage of stool easier.
·         Medications may have to be changed if they are causing constipation.
·         Our professionals will assess what is normal for your bowel movement patterns, along with your activity level, dietary intake, and stress.
·         It is important to remember that long-term use of laxatives should be avoided.

o   Diarrhea
·         This may cause depletion of potassium, sodium, and fluid in your body…as well as nutritional complications.
·         Common causes of diarrhea include emotional and physical stress, GI disorders, infections, and certain drug therapies.
·         A high-fiber diet may be prescribed to you, unless it is the fiber that is causing your diarrhea.
·         Nutrition therapy will vary with the severity and duration of your diarrhea episode.  Generally, a liberal intake of fluid is needed to replace what losses occur.

o   Gastroesophageal Reflux Disease (GERD)
·         GERD is the result of an abnormal reflux of gastric secretions back up into the esophagus.  This leads to indigestion and feelings of heartburn.
·         Long-term GERD, if left untreated, can cause serious complications…including cancer.
·         Signs of GERD include heartburn, painful swallowing, regurgitation, coughing, hoarse voice, and pain in your upper stomach area.  Sometimes, pain from GERD may be mistaken for a heart attack.
·         You should avoid situations that lead to increased pressure on your stomach, such as wearing tight clothing.
·         Avoid eating 2 hours or less before lying down.
·         Elevate your head and upper body instead of lying flat, avoid large meals, and avoid snacks at bedtime.
·         Weight loss will be encouraged if needed.
·         You should know that foods that trigger GERD include citrus fruits and juices, spicy foods, and carbonated beverages.
·         It is a good idea to avoid the following items to decrease you chance of experiencing GERD: fatty foods, caffeine, chocolate, alcohol, cigarette smoke, and peppermint/spearmint.

Overall, those GI disorders can prove to be very unwelcomed and interrupt your daily routine.  Total Home Health completely understands this and will provide you with continuous education and always encourage you to make positive changes to maintain the best health possible for yourself.  We look forward to being invited into your home and beginning a great journey of care for both you and those you love.  Enroll today!

Barriers to Adequate Nutrition

Your nutrition is a big deal to us at Total Home Health.  We strive to provide you and your loved ones with the best care possible in every aspect of your well-being.  Our professionals are compassionate, and understand that even the smallest of problems can cause you the greatest amount of stress.  When our staff enter your home we will do all we can to make you feel welcomed and as if you’re one of our own each and every day.  Many individuals have difficulty consuming a nutritional diet or one that has been prescribed to them due to factors that create a barrier.  It is a good idea for you to become familiar with these barriers so that you can possibly identify what it is that is causing you or your loved one to have an inadequate diet.

Medical, psychological, and social factors can all create nutritional barriers.  As part of both the initial health assessment and ongoing assessments for the duration of your time with Total Home Health, our nurses will always be observant to your condition and needs in order to educate you on which aspects could be causing your nutritional troubles.  Plus, our nursing staff will follow through with your care to make sure you have the necessary resources for all of your provider recommendations.  If we see resources are lacking, we will help you to make changes.  Following are barriers to your nutrition that your Total Home Health nurse may have to acknowledge at some point during your care:

  •   Poor quality of teeth, dental cavities, or ill-fitting dentures
  •   Low income status with a lack of access to resources
  •   Cognitive disorders
  •   Altered sensory perception
  •   Trouble swallowing
  •   Lack of knowledge and following incorrect information about nutrition

Following are more in-depth explanations of the nutritional barriers as listed above, along with nursing interventions that may be carried out by professionals at Total Home Health at any time during your care.  These areas include:

o   Poor quality of teeth, dental cavities, or ill-fitting dentures
·         If you have lost teeth or have teeth that need removed or repaired, there may be an impaired ability to chew.
·         After teeth are removed, it may be difficult to adjust to the feeling of dentures.
·         Nursing care of this area includes:
§  Educating you to limit consumption of processed carbohydrates, which can stick to your teeth and increase your chance of getting a cavity.
§  Encouraging use of a fluoride tooth paste.
§  Performing an oral assessment to identify any issues that could potentially impact your ability to eat properly.
§  Consultation with a dietician or your provider if needed, so we can begin a proper diet according to your needs.

o   Low income status with a lack of access to resources
·         Lack of finances to buy healthy foods if you have orders to follow a special diet.
·         Nutritious foods tend to be more expensive than canned and boxed foods.
·         The less expensive canned and boxed foods are poor choices for you if your diet restricts salt and calories.
·         Eating canned and boxed foods frequently can lead to malnutrition and/or obesity.
·         Lack of transportation to get to the local grocery store will result in not having the adequate supply of food in your home.
·         Nursing care of this area includes:
§  Collaboration with a dietician to discuss food options that are healthier for you to appropriately substitute in your diet.
§  Educating you that frozen fruits/vegetables may be a more affordable option, and can be kept longer in the freezer.
§  Educating our clients on how to correctly read food labels, if applicable.
§  Reaching out to community resources regarding the availability of food or meals to be delivered to your home.

o   Cognitive disorders
·         These disorders may include dementia and Alzheimer’s disease, and they could have a significant impact on your nutrition.
·         Impairments in your memory and judgment may be observed, which could make food selection difficult.
·         With progression of a cognitive disorder clients may refuse to eat or only choose to eat small amounts of food that will not provide them with adequate nutrition.
·         Nursing care of this area includes:
§  Encouraging you to make and follow a shopping list if you are still able to go to the grocery store on your own.
§  Evaluating your need for nutritional supplements.
§  Encouraging you to eat at the same time daily with minimal distractions.

o   Altered sensory perception
·         Altered senses may make it difficult to feed yourself or food may not satisfy you.
·         A decrease in vision may require frequent assistance with preparing food.
·         An altered sense of smell generally causes an altered sense of taste.
·         Smoking can cause a diminished sense of smell.
·         Chemotherapy and/or other types of medications can leave an unusual taste in the mouth (metallic taste), this may mask the real taste of food.
·         Chemotherapy can also cause nausea and anorexia, causing food aversion.
·         Nursing care in this area includes:
§  If you have a decrease in vision, we will try to reach out to community services that could deliver your groceries and/or meals straight to your home, or our professionals may be able to do your cooking/shopping.
§  We will educate you that if you have food aversions to try to eat foods that are served cool because they generally do not have quite as strong of an aroma, and are less likely to cause nausea.
§  Our nurses will suggest to you to eat foods that are spicy or tangy to compensate for your decreased sense of taste, if your condition permits.
§  Encouraging you to suck on hard candy, mints, or chewing gum to get rid of unusual tastes in your mouth.

o   Trouble swallowing
·         Clients with conditions such as Parkinson’s disease, cerebral palsy, or those who have suffered from a stroke can have difficulty in this area.
·         The conditions mentioned above can affect the muscles in your mouth and throat, which increase your risk for complications.
·         Nursing care of the area includes:
§  Continually monitoring you if you are at risk for choking during meals.
§  Working closely with a dietician in order to come up with an appropriate diet for you if you require modifications.
§  Thickening your fluids to allow for much easier swallowing.

o   Lack of knowledge and following incorrect information about nutrition
·         You may not have a good understanding about nutritional needs, which could cause you to be over nourished, under nourished, or not taking in the nutrients that you should be. 
·         Nutrition information may be confusing, or false advertising may be misleading.
·         Nursing care of this area includes:
§  Our professionals will always work closely with you until you understand the information to the best of your ability.

Total Home Health has a program that is right for you.  With us you will never be alone and someone will always be there to educate you, talk to you, encourage you, support you, and just be your best friend.  We understand that at your most vulnerable moments you want to be surrounded by only those you can trust, and we plan to be those people!