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? on Final Stage/incontinence/sleeping...please
Posted: Thursday, January 5, 2012 8:29 AM
Joined: 12/15/2011
Posts: 47

I have a question. Mom is definitely in stage 7. On top of this she has another UTI.


Here is my question:


Normally the nurses have told me to let her sleep. When she wakes up, I try to get her fed, give meds, change diaper.


Should I wake her or have the aides wake her to change her diaper? For example, she woke up yesterday around 1030. She stayed awake long enough to eat a little bit and for me to give her the antibiotics. The aide came in about 30 mins later and changed her. She has been asleep since then. Well, except for about 2 mins that I took advantage of and gave her the 2nd dose of antibiotic, this was around 1130 last night. Still asleep this morning.


I just don't know if I should wake her or what. I have set up at work to come in late so I can tend to moms needs in the morning because I only have a sitter until an actual aide comes in at 1 PM normally during the week. I am working on getting more hours so I can have trained aides during morning hours too.


She doesn't have any bed sore, even in her sleep she moves around quite a bit and also her mattress is for bed bound patients.


This is so new to me. I am doing my best to keep her at home for now. Hospice has been great support.

Posted: Thursday, January 5, 2012 10:37 AM
Joined: 12/16/2011
Posts: 393

Sorry, I don't have any experience with this, yet. But, I would be concerned about the ammonia in a wet diaper being on fragile skin for an extended period of time. Will the sitter change her if she wakes up, or is there a wait until the aide gets there in the early afternoon? If she doesn't get agitated upon being awakened, and usually goes back to sleep quickly, I think I would err on the side of her being clean and dry before leaving for work.
Posted: Thursday, January 5, 2012 11:52 AM
Joined: 12/15/2011
Posts: 47

No, the sitter is there strictly for that only. She does feed mom breakfast or lunch if mom wakes up long enough for that.


That is what I was thinking too. I am trying to get more help because it is hard to change her. She is not able to help at all.


What I have done is asked the experienced weekend aide that just started to train me in how to change mom & bed while mom is immobile and in the bed.


Last weekend was her first day with us so as she continues to work with us she is going to teach me methods that she was trained in. I think that will help with the changing in the morning.


As far as anxiety, it just depends on the day. Sometimes it terrifies her if we wake her up.


Hospice dr is on his way out to my house this afternoon since she has been asleep for so long, her decline has been really fast in the past few weeks.

Posted: Thursday, January 5, 2012 12:00 PM
Joined: 12/19/2011
Posts: 17

One of the things we did was use the disposable briefs, but place an incontinence pad in there with it. The overnight ones hold a lot. Meaning so much, during the day they got too heavy when she was still mobile. I threw a fit when I discovered a CNA using the nighttime ones during the day, so she could go a lot longer without changing them! During the day she got a fresh pad every two hours. Most of the time we could just change the pad (which was much easier - pull out the wet one and get a dry one in), as the brief was still dry. Of course everything would get cleaned and changed twice a day, but for the in between - this was much easier, and much less fuss.


The real worry of not keeping her dry right now is the UTI, as she is sitting in the bacteria. Actually, If you can't actually change just the pad, you might still be able to just remove it in the AM without much fuss, and the brief is basically still there for those few extra hours but much fresher than an all night incontinence?

Posted: Thursday, January 5, 2012 2:14 PM
Joined: 12/31/2011
Posts: 13

My thought !   Your doing real good, trying to think thru prepare and adapt. Keeping her dry and clean is the way to go, Drug store sells this sugery powder ( D-Mannose ) to use always after antibotics helps and works. What helps me is a walk in sit down bath/shower, keeping my mom clean. Your doing a good job !  my problem is getting a sample from a incontient Alz/dementia mom. Your mom's decline is due to the UTI, she is weak and tired meaning antibotics are working, I let my mom sleep as much as she wants but cleaning  your mom I doubt will keep her awake if tired.  Keep it up this rollercoaster is long and strange.    Roger and out
Posted: Thursday, January 5, 2012 3:51 PM

I personally would not wake her to change the undergarment for urine only, but I would likely do so for feces. 

If the goal is quality of life, I'm not sure the potential benefits of changing a wet garment sooner outweigh the fear and disruption she experiences being awakened. 

I'm so sorry it is so hard. This is a horrible disease, and it sounds as though you are doing everything you can to provide a loving environment and a good quality of life for her at this point.


Stephanie Z
Posted: Thursday, January 5, 2012 9:38 PM
Joined: 12/15/2011
Posts: 4218

Hi, You should check her every 3 hours or so and if she is wet, be sure to change her. A UTI is not the only thing to worry about as a wet diaper can also contribute to diaper rash, yeast infections and decubitus ulcers. The other thing you should do when you change her is to change her position from side to back to other side. Place a small pillow up against the small of her back to keep her turned. This will help to prevent any redness which can lead to bed sores (decubitus).


Posted: Friday, January 6, 2012 8:26 AM
Joined: 12/15/2011
Posts: 47

Thank you all for the suggestions. We do a have a powder we use, the name escapes me right now, to keep yeast infections at bay.


Also, her mattress is made specifically to help prevent bed sores. The only problem we had was her agitation was so great that she wore a sore spot on her heal from digging into the bed so much. Fortunately, it is finally healed but we keed her heels off the mattress now.


She did wake up yesterday evening and was hungry. We tried a new pureed food made by Thick It. It is kind of thick, we tried the Chicken one. I mixed vanilla yogurt to make it thinner and tastier. She took it really well. I was also able to get her dose of antibiotic.


She is pretty out of it even when awake. So we are just trying the best we can each day.


If she wakes up this morning we will try the pureed omelette with bacon...Yummy LOL


Again I truly appreciate all the comments. I will definitely be using some of the suggestions.


We are in this together.

Posted: Friday, January 6, 2012 9:09 AM
Joined: 1/5/2012
Posts: 10

For the urinary incontinence: hospice educated me about using what they refer to as "butt creme", a thick ointment that is applied to freshly washed, clean, dry skin before fitting the brief or diaper. The butt creme helped immensely with protecting my LO delicate skin from irritation due to urine. There are night time briefs/diapers that wick the urine away from the skin, so are protective.


Keeping a totally incontinent, bed bound person dry continually is a herculean task. Fluids go in, fluids come out, sometimes within a matter of fifteen minutes.


I would clean, butt creme and fresh briefs on her late evening, then about 3am, then around 6am.


Fecal incontinence, in my experience, needs immediate cleanup, washup, butt creme and fresh brief or diaper. Otherwise, UTI sure to follow. Also skin infections.

Once you learn the tips to how to change the undergarment, it becomes a fairly quick routine.


I believe that our alz loved ones deserve dignity and respect. No one would choose to stay in soiled undergarments for any length of time.

Dan the Man
Posted: Friday, January 6, 2012 9:46 AM
Joined: 1/5/2012
Posts: 52

I second the "butt paste" rec.  We've been using it for over a year with our fella, and he hasn't gotten any bed sores.  Regarding the UTI, in addition to the antibiotics, I can recommend a whole lotta Cranberry juice.  Not sure if it's been the juice or the meds, or both, but we've made it through numerous UTI's over the years with that combo.  Take heart and good luck!!!

Posted: Friday, January 6, 2012 10:30 AM
Joined: 12/16/2011
Posts: 74

Mrs.G, my mom has days where she sleeps for 20-22 hours. The nurses told me to change while she sleeps. I was taught how to roll her and clean her up. Over the Christmas holidays mom wasn't doing well at all and even had a bm while sleeping, i was able to clean her and she never woke up. It's a job that i never thought i was going to have to do. Have the nurses show you how to do this. They told me to get on my knees, easier on the back. LOL

I think we are walking side by side in this journey and I'm holding your hand along the way. bless you

Posted: Friday, January 6, 2012 11:46 AM
Joined: 12/15/2011
Posts: 47

Yes, I definitely use tons of Butt paste. I think that really has helped.


I am definitely going to ask the Hospice staff to come and give me some training on changing her while she sleeps. I am sure they have techniques that are foreign to me that would help tremendously.


One day at a time, one lesson at a time.....


I completely agree that our ADLOs deserve the utmost dignity and respect.


Thank you all!


Posted: Saturday, January 7, 2012 6:51 PM
Joined: 12/21/2011
Posts: 13

Hi MrsG,


if your mother ever gets any kind of rash or sore, you can try apple cider vinegar (organic, unflitered and unpasteurised). You can dilute it in a little water, put the mixture on a paper towel and use it on the rash. You will see it work in front of your eyes.


It is also useful for UTI.


See these links: