An incident relating to mobility and acceptable risk I would like to
share with you has to do with a Huntington's client I had in my practice, for an admission assessment.
My report I had received prior to her being transferred to our facility
was that she was acting out, aggressive and difficult to manage, so they medicated her with 2 mg of Lorazepam. So when this
client arrived by ambulance she initially was verbally aggressive to me.
I approached her in a calm, pleasant manner, encouraging her to relax
as I just wanted to ask her a few questions, her primary caregiver was also present with her. She got off the stretcher with
the help of her caregiver and sat in a chair demanding a coffee. I made her a coffee as she liked it and put it in a plastic
handled mug we had on the unit, as the styrofoam cup was too unsafe for her, due to her quick and constant movements. I gave
her the mug and she voiced pleased with me taking the time to consider a mug being easier for her.
She requested to go to the bathroom and did not want to
go in the wheelchair but instead to walk herself. Of course there was the increased
risk of falls due to her movements and recently being medicated, but there was no reasoning with her. She walked to the bathroom
with her caregiver on one side and I followed behind with the wheelchair. She did do well at that time walking on her own.
After finished in the bathroom she walked back to the waiting room in the same manner.
I completed my assessment with her and then it was time for her to
meet with myself and the doctor. She again wanted to walk to the interview room on her own. As she would be more influenced
by the lorazepam by this time I encouraged her to allow me to assist her getting up and walking. Again she refused, wanting
to do it herself.
Her caregiver and the doctor went across to the interview room while
I stayed with my client for standby assistance. She got up easily, but as she started to take her first step she started leaning
backwards. I acted quickly and grabbed onto her shirt and pants, as she was falling away from me. But I was able to keep her
from falling and hitting her head on the wall.
She looked at me and then asked me to help her and she took my arm.
She voiced to me that this scared her and was thankful that I allowed her to do it herself but more thankful that I did not
just walk away but was there to catch her.
I allowed my client to do as she wished as to aid and encourage her
independence, even though I knew she was at a very high risk to fall. By allowing her to try I empowered her. I used the acceptable
risk and she appreciated this and thanked me, especially when I helped her from falling. |
As the disease has been progressing there are many safety issues that had
to be put into place, assessments of safety issues and also safety precautions have continually needed to be put into place.
The safety issues all become so important with the progression of the disease
as the movement disorder worsens, the cognitive abilities continually changing, thus putting your client at a high risk for
harm.
One issue with a person with Huntington's Disease that causes concern is their
delayed response to pain, hot and cold sensitivity, these being important issues when dealing with everyday activities such
as moving about even in bed, eating, bathing and for many, smoking.
There are a lot of persons with Huntington's Disease that refer to smoking
as " one of the last pleasures I have left ", thus smoking becomes symbolic of independence for them. Nicotine also does have
a noticeable effect in helping decrease some of their movements.
This can cause problems between the smoker and their caregivers as a person
with Huntington's Disease poses a safety risk. This being related to behavior changes such as disinhibition, personality changes,
impaired judgment and diminished capacity for self observation, and simultaneously the impairment in voluntary movements increase
in the chorea movements.
As people with Huntington's Disease often have a diminished sense of hot and
cold and often burn their fingers when lighting their cigarettes or smoking it down to the butt. Due to their impaired judgment
they become unaware of the danger of burning themselves or the floor.
So basically to aid in allowing a person their pleasure, a plan needs to be
put into place. Your plan can include setting certain times in the day for smoking only in designated areas. Please do not
allow them to smoke in bed. A good setting would be in a room with no rugs on the floor, wearing flame resistant clothing
and supervised.
Other things you may try earlier on in the disease progression , is discussing
with your client and their families about nicotine patches or the use of Zyban to aid in smoking cessation.
The main importance for you as a caregiver is to help keep your client safe
in all aspects, but this does not mean limiting their pleasures, it is important to be accommodating and flexible to help
them stay safe from harming themselves. |
