7 M-CARE: Physiological needs

Mobile Training for Home and Health
Caregiver For People with Disabilities and
Older People
539913-LLP-1-2013-1-TR-LEONARDO-LMP
Module:
Physiological needs

Unit 1
• Nutrition
– Food elements
– Food groups
– Nutrition in Elderly

Nutrition
Food Elements
1. Proteins
2. Oils
3. Carbonhydrates
4. Vitamins and Minerals
5. Water

Food Groups
1. Meat – eggs
2. Milk
3. Bread and grains
4. Vegetables and Fruits
Nutrition
http://beslenme.gov.tr/index.php?lang=tr&page=188

• Food range
• At least 3 times a day
• Ideal Body Weight and Muscle Power must be reserved
• Food should be well stored and cooked.
• Fruit and Vegetable consumption should be increased
• Bread and other cereals should be consumed in
sufficient quantity
Nutrition for Elderly People

• Saturated fat consumption should be reduced
• Water and other liquids must be consumed in
sufficient quantity
• Fibre rich consumption should be increased
• High calcium content food should be consumed
• Salt and sodium consumption should be reduced
• Sugar consumption should be reduced
Nutrition for Elderly People

When communication about food with
a visually impaired person
• When addressing visually impaired people, a
good way of communicating when they are
eating is through the “clock method”:
– “The water is at 13 o' clock of your plate”
– “The mash is at 9 o' clock in your plate”

Unit 2
• Health Monitoring
– Body Temperature
– Pulse
– Respiration
– Blood Pressure
– Colour of the skin
– Pressure Sores

Health Monitoring
• Body Temperature
• Pulse
• Respiration
• Blood Pressure
• Oxygen saturation
http://degisimehazirim.com/tag/nefes-alma-teknikleri/
http://www.premierelektronik.com.tr/U2032,157,premier-pbp-209-
tansiyon-aleti.htmhttp://www.medicalnewstoday.com/articles/258118.php

Increasing Body Temperature can be caused by…
• Physical exercise
• Chills
• Increased environmental temperature
• The digestion of food
• Emotional states
Health Monitoring

Factors decreasing body temperature
• Disease and injury
• Malnutrition
• Sleep
• Depression of the nervous system
Health Monitoring

Classification of body temperature
• High body temperature:
– Fever >37.5
– Hyperthermia >37.5
– Hyperpyrexia >40.0
• Normal 36.5–37.5 °C
• Low body temperature
– Hypothermia<35.0 °C
Health Monitoring

How to measure the body temperature
• Oral
• Rectal
• Under the arm
• Ear
• Vaginal
Health Monitoring

Thermometer
• Glass,
• Electronic, often disposable
• heat-sensitive tape.
Health Monitoring

http://www.nlm.nih.gov/medlineplus/ency/imagepages/9961.htm

http://www.webmd.com/children/rectal-temperature

Pulse measurement
• This is a rhythmic contraction
of the heart in sistol and
diastol
• Can be obtained from the
peripheral veins
– Radial artery
– Temporal
– Carotit
– Femoral
– Dorsalis pedis
– Popliteal

Measuring pulse at the wrist of client
• Using the first and second fingertips, press firmly
but gently on the arteries until you feel a pulse.
• Begin counting the pulse when the clock's second
hand is on the 12.
• Count your pulse for 60 seconds (or for 15
seconds and then multiply by four to calculate
beats per minute).
• When counting, do not watch the clock
continuously, but concentrate on the beats of the
pulse.

Pulse Volume
• Pulse is measured by hand condition.
• Under normal conditions, the volume of each
pulse is equal.
– Normal pulse for healthy adults: 60 to 100 beats
per minute.
– Females aged 12 and older, in general, tend to
have faster heart rates than do males.
• Weak pulse should be immediately reported.

Pulse Rhythm
• The period of time between the pulses should
be equal.
• Irregular rhythm of the pulse is called
arrhythmia.

Factors affecting pulse rate
1- movement and sports
2- body temperature
3- pain, emotional status
4- long lasting pain
5- medication
6- blood loss
7- position of the body parts

Respiration
• Breathing is the exchange of oxygen and
carbon dioxide with the organism and its
environment.
• The body uses the oxygen and discards the
carbon dioxide. This is done in the alveoli of
the lungs.
• Breathing can be divided into internal and
external.

http://www.freediving.biz/features/breathing.html

http://kedahsportsschool.blogspot.com.tr/2011/06/inhalation-dan-exhalation.html

Factors affecting respiration speed
1- movement and sports
2- body temperature
3- pain, emotional status
4- long lasting pain
5- medication
6- blood loss
7- position of the body parts
8- diseases

Blood pressure
It is the force of
the blood pushing
against the artery
walls. Each time
the heart beats, it
pumps blood into
the arteries,
resulting in the
highest blood
pressure as the
heart contracts.
Sourceimage:
http://www.bloodpressureuk.org/BloodPressureandyou/Thebasics/Bloo
dpressurechart/main_content/Jm5d/downloadPublication

http://inflammationreliefcenter.com/

Colour of the skin
• The skin colour
comes from the
pigment and the
blood.
• The colour of the
skin can give
some clues
regarding the
oxygen level in
the body.
• Red skin
•high blood level
•fever
•high temperature
•exposure to carbon
monoxide
• White skin
•shock
•anxiety
•low temperature
• Blue skin
•low levels of oxygen

Pressure Sores
• As a PCG it is crucial that you manage to detect, early on,
pressure sores.
– They occur mostly in immobile clients or wheelchair users.
– They start as a red spot on the skin (where pressure is put by a
garment e.g. shoe, or by a bone e.g. ankle).
– Should you find one you must immediately contact a doctor.
– If not treated right away it will get bigger, turn to a sore, infect
and then the infestation can move the heart through the vain
causing irreparable damage.
– To avoid pressure sores you should meticulously dry the skin
after a bath, ensure your client wears the right shoes, avoid
keeping them in the same position for too long and thoroughly
search often their body for pressure sores.

Stages of Pressure Sores
Source: http://www.webmd.com/skin-problems-and-treatments/four-stages-of-pressure-sores
• At stage 2, the skin breaks open, wears away, or forms an ulcer, which is usually tender and painful.
The sore expands into deeper layers of the skin. It can look like a scrape (abrasion), blister, or a
shallow crater in the skin. Sometimes this stage looks like a blister filled with clear fluid. At this
stage, some skin may be damaged beyond repair or may die.
• During stage 3, the sore gets worse and extends into the tissue beneath the skin, forming a small
crater. Fat may show in the sore, but not muscle, tendon, or bone.
• At stage 4, the pressure sore is very deep, reaching into muscle and bone and causing extensive
damage. Damage to deeper tissues, tendons, and joints may occur.
• Stage 1 sores are not open wounds. The skin
may be painful, but it has no breaks or tears.
The skin appears reddened and does not
blanch (lose colour briefly when you press
your finger on it and then remove your
finger). In a dark-skinned person, the area
may appear to be a different colour than the
surrounding skin, but it may not look red.
Skin temperature is often warmer. And the
stage 1 sore can feel either firmer or softer
than the area around it.

Unit 3
• Toileting and changing diaper
– Perineal Hygenia
– Changing the diaper

Perineal Hygenia
• A bowl
• 41-43 degrees of water
• Soap
• Aceptic gauze
• Towel
• Toilette paper
• Diaper
• Gloves
• Latch

Process I
• Wash your hands
• Inform the patient
• Ask the patient
• Prepare the materials
• Use gloves
• Take off the underwear of the patient

Process II
• Take all the clothes from the bed
• Leave a bed sheet for the patient
• Position the patient
• Put the daiper under the patient
• Use some soap with aceptic gauze for the
cleaning
• Clean
• Dry

Process III
• Put the patient in side lying postion
• Cleaning of the anal region
– Clean with the toilet paper first
– Clean the anal region
• Dry the area

Process IV
• Take the diaper
• Take off the gloves
• Put on the clean cloths
• Remove the materials that you have used
• Clean your hands
• Record

How to Change a Disposable Adult
Diaper
http://www.wikihow.com/Image:Change-a-Disposable-Adult-Diaper-Step-1.jpg

STEP 1
Determine how far away from your nearest flat
surface the wearer is to changing that diaper.
• Almost any flat surface can be used to change
the diaper. Whether that flat surface is the
floor, a bed, or the sitting surface of a chair, or
even the edge of a wall, there is almost no
reason to ever be without a firm, flat surface
on which to change that diaper.

http://www.wikihow.com/images/c/c7/Change-a-Disposable-Adult-Diaper-Step-2.jpg

STEP 2
Read through and select the type of diaper
change that the wearer will feel confident with
having their diaper completed with.
• Whether that form is when the wearer is
laying down or sitting, or even standing up,
there are several ways to do this. Even those
who have chosen the pull-up type route,
there's even a method for them too.

– The Laying Down Method is one of the most popular
ways to change an adult diaper. If the adult is laying
down and is competently able to change their own
diapers and is the only one in the room, the style to
change these diapers is a bit different.
– While an adult diaper can be changed while the
person is in a sitting position, this Sitting Method is by
far the hardest one to change.
– The Standing Method is by far the easiest method to
accomplish and only requires the wearer to change
their own diaper. As long as the adult wearer is able to
stand up, a diaper-style adult diaper can be changed
this way.
– Some adult disposable diapers offer a Pull-up Style-
like Method. For those featuring this style, changing
one of these is possible

http://www.wikihow.com/images/e/ec/Change-a-Disposable-Adult-Diaper-Step-3.jpg

STEP 3
Try to contemplate the privacy issues that may
result from the diaper-change.
• Some diaper-changing methods are more
private than others, while some aren't very
private.

http://www.wikihow.com/images/c/c1/Change-a-Disposable-Adult-Diaper-Step-4.jpg

STEP 4
Decide which one best fits the style of diaper
the wearer has chosen to wear, and whichever
one makes the wearer feel the least bit
embarrassed to have completed on them.

http://www.wikihow.com/images/a/aa/Change-a-Disposable-Adult-Diaper-Step-5.jpg

STEP 5
Use the steps provided in the article, to
complete that style of diaper-change that had
been chosen for the wearer, dependent on the
type of diaper and amount of comfort the
wearer has chosen.
– Realize that a diaper-change is dependent on two
key overall steps: removal of the old diaper, and
replacement with the new diaper.

http://www.wikihow.com/images/a/ac/Change-a-Disposable-Adult-Diaper-Step-6.jpg

STEP 6
• Clean up the mess that was made from the
diaper-changing area.

Unit 4
• Heimlich Manoeuvre
https://thatblindref.files.wordpress.com/2011/06/choking.jpg

• A choking person’s airway may be completely or
partially blocked. A complete blockage is an
urgent medical emergency. A partial obstruction
can quickly become life threatening if the person
loses the ability to breathe in and out sufficiently.
Without oxygen, permanent brain damage can
occur in as little as 4 minutes. Rapid first aid for
choking can save a life.
• The universal distress signal for choking is
grabbing the throat with one or both hands.
• DO NOT perform first aid if the person is coughing
forcefully and able to speak – a strong cough can
dislodge the object on its own.

1. Ask the person:
• "Are you choking?"
• "Can you speak?"
2. Send someone to call 112 or your local
emergency number.
3. Lean the person forward and give them 5
blows to the back with the heel of your hand.
Heimlich Manoeuvre

4. If this does not work, stand behind the person
and wrap your arms around the person’s waist.
5. Make a fist with one hand. Place the thumb side
of your fist just above the person’s navel, well
below the breastbone.
6. Grasp the fist with your hand.
7. Make 5 quick, upward and inward thrusts with
your fists.
8. Alternate between 5 blows to the back and 5
thrusts to the abdomen until the object is dislodged
and the person breathes or coughs on their own.

On a child
• Performing first aid for a choking child is very
similar to an adult. If the child does not clearly
grab their throat, other danger signs for a child
(and an adult) include:
– Inability to speak
– Weak, ineffective coughing
– Noisy breathing or high-pitched sounds while inhaling
– Difficulty breathing
– Bluish skin color
– Loss of consciousness if blockage is not cleared

• 1. Send someone to call 112 or your local emergency
number.
• 2. Lean the child forward and make 5 blows to their
back with the heel of your hand.
• 3. If this does not work, stand behind the child and
wrap your arms around the child’s waist.
• 4. Make a fist with one hand. Place the thumb side of
your fist just above the child’s navel, well below the
breastbone.
• 5. Grasp the fist with your hand.
• 6. Make 5 quick, upward and inward thrusts with your
fists.
• 7. Alternate between 5 blows to the back and 5 thrusts
to the abdomen until the object is dislodged and the
child breathes or coughs on their own.

Unit 5
• Postural Drainage
– Implementation of postural drainage
– Cough

Postural Drainage
• This is a way to help treat breathing problems
due to swelling and too much mucus in the
airways of the lungs. It helps drain fluid out of
the lungs.
• The best time to do postural drainage is either
before a meal or 1 ½ hours after a meal, when
the client’s stomach is the emptiest.

Postural drainage
http://www.nlm.nih.gov/medlineplus/ency/patientimages/000266.htm

• There are 6 to 12 positions a person with
pulmonary disease may take to drain mucus
from a certain part of the lungs.
• Another person may tap in certain areas to
help loosen the mucus and allow it to be
coughed out.
• Other ways to relieve the lung congestion of
cystic fibrosis or bronchiectasis include
percussion vests and inhaled aerosols.

How to do postural drainage
• Use one of the following positions:
– Sitting
– Lying on the back, stomach, or side
– Sitting or lying with the head flat, up, or down
– Stay in the position for as long as the doctor
instructed (at least 5 minutes).
• Client should wear comfortable clothes and use pillows to
get as comfortable as possible.
– Repeat the position as often as instructed.
– The client must breathe in slowly through the nose,
and then out through the mouth. Breathing out
should take about twice as long as breathing in.

Percussion or vibration
• The doctor may also recommend doing
percussion or vibration.
– Percussion helps break up thick fluids in the lungs.
Clap a hand on the ribs while client is lying down. This
can be done with or without clothing on the chest.
– Form a cup shape with the hand and wrist.
– Clap the hand and wrist against the chest (or clap the
back, if the doctor told to do so).
– You should hear a hollow or popping sound, not a
slapping sound.
– Do not clap so hard that it hurts.

Percussion or vibration
• Vibration is like percussion, but with a flat hand
that gently shakes the ribs.
– Let the client take a deep breath, then blow out hard.
– With a flat hand, gently shake the ribs.
– The doctor, nurse, or respiratory therapist will show
how to do this the right way.
– Do percussion or vibration for 5 to 7 minutes in each
area of the chest. Do this on all of the areas of the
chest or back. When finished, let the client take a
deep breath and cough. This helps bring up any
phlegm, which the client can then spit out.

When to call the doctor
• Call the doctor if the client has one of
following symptoms:
– Indigestion
– Vomiting
– Pain
– Severe discomfort
– Difficulty breathing

How to Control a Cough
• The need to cough vigorously can be embarrassing at
times but the client should never try to hold a cough.
• Coughs are natural!
• Some guidelines for the client
– Drink plenty of water
– Have some cough sweets
– Put on a flu rub (cream)
– Plenty of hot drinks like soup, tea, or coffee to help soothe
the throat
– Avoid going out in cold weather
– Avoid eating ice cream
– Do not strain voice (no yelling or talking loudly)

If the client is coughing as a bad habit more than
a necessity, s/he should be aware that coughing
is like scratching a bug bite - it only increases the
urge to scratch.
• Client should try:
– swallowing or drinking water instead.
– distracting him/herself from the itch.
– Drinking a cold drink (may be more effective than
a hot drink).

• Maybe it's a "minor" cough, a little clearing of
the throat
– a post-nasal drip: when the mucus produced by
the nose/sinus runs down the back of the throat
instead of out the nostrils.
• There are many causes, such as allergies.
• Cough may not bother the client very much,
but may be quite annoying to others.
If client has a chronic cough, s/he
should see a doctor.

References:
• Ed: AY Fatma Akça, Temel Hemşirelik, İstanbul Medikal Yayıncılık, 2008 , İstanbul
P:259-261 ISBN -975-6395-70-2
• http://drjkm.com/wp-content/uploads/2013/05/Female-Genitalia.jpg
• http://www.kahsa.org/files/public/PsycosocialNeeds.pdf
• http://www.megep.meb.gov.tr/?page=moduller
• http://www.wikihow.com/Change-a-Disposable-Adult-Diaper
• http://www.nlm.nih.gov/medlineplus/ency/presentations/100222_1.htm
• http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000051.htm
• http://www.nlm.nih.gov/medlineplus/ency/imagepages/18084.htm
• http://www.wikihow.com/Control-a-Cough

7 M-CARE: Physiological needs

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