Medical Planning and Training for Uncertain Times, Part 1: Homecare Nursing
Guest post by Dave, LPN, EMT, WEMT
Medical planning and training is a huge subject. This article will be broken down into several areas, and the necessary gear and training for each topic will be covered.
I am a Licensed Practical Nurse, EMT, Wilderness EMT, phlebotomist, and a CPR/ First Aid instructor. I also instruct disaster medicine with a well known firm and am currently working on my RN. I work full-time as well and have done this over the last several years. In addition to this training, I have had the opportunity to care for two relatives that have been on hospice.
I have noticed that many preppers want to know how to suture a wound or remove “the bullet” or some other “glamorous” task. But the more training I receive and practice in the field, the more I realize how much I do not know. That concept really scares me but it’s a healthy fear. Preppers will benefit from that realization as well. Learn the basics. Have the proper supplies ready. And then take the next step to learn how to suture a wound or remove a bullet.
The most ignored area I have seen for survival is homecare nursing. I know it may be a boring subject, but it’s an absolute necessity to keeping your patient alive and viable. It is sad when I deal with a young person or older person who has contractures, bed sores, develops pneumonia or just fights to maintain some level of independence.
Good basic patient care can be learned and mastered by becoming a CNA (Certified Nursing Assistant). They are great at taking temperatures, blood pressures, giving bed baths, turning and feeding patients. They help monitor for bed sores, pressure areas, changing incontinent patients and providing basic necessary care. It may not have the glamour or prestige of removing a bullet but is actually more necessary.
I know people that do not understand that you cannot have someone lie in bed for hours/ days / weeks and not be really involved in their care. A patient that is not mobile needs to be turned and checked every two hours. If you turn them and see a red mark on their side, butt or back, you are probably looking at a bedsore very soon. Bedsores can kill patients!! I have seen Stage 4 pressure ulcers that go to the bone. Do not let that happen. Patients need to be clean, dry and intact – always!
Patients need to be exercised daily if they are bed bound. This will help prevent contractures, a shortening or distortion of muscle or connective tissue. Contractures ultimately have the patient going into a fetal position. In nursing school we have worked with patients that required four adults to just change them and get them out of bed. Very, very sad. Have them or help them move all of their joints for full range of motion. Start with the head by going side to side and rotations, move to the neck, shoulders, arms, fingers, knees and toes. Hopefully you get the idea.
I also use incentive spirometers for lung exercises. This can help prevent pneumonia. If that is not available, try chest physiotherapy. Try cupping your hands and have the patients on their side. Use your cupped hands and tap on the patients back to loosen anything in the lungs. Do not use too much pressure but tap several times a day.
- Gloves – no latex. I prefer Nitrile for durability. It is impossible to have too many. I personally have 10 –12 cases. Each case has 10 boxes of 100 gloves.
- Bed pans
- Urinals – male and female
- Wash basins
- Emesis basins
- Bed pads for incontinence – reusable or disposable. The reusables are strong and can be used to help turn/ reposition your patient
- Incontinence briefs (diapers) and pull-ups
- Baby wipes – you can never have enough.
- Thicken – makes liquids thick for people with swallowing difficulties
- Nosey cups – plastic cups with the nose section cut out to help with liquids for patients with limited mobility
- Incentive spirometers – lung exercisers.
- Bedside commodes
- Gait belts – assistive belt to help a patient ambulate
- Blood pressure cuff and stethoscope
- Manual wheelchair
- Hand Cleaner
- Clorox and sprayer
I have designed a “raised platform bed” to be used for homecare nursing. I could not justify a hospital bed with hand cranks at this point. The raised bed would allow me to care for the patient without killing my back.
This is just a starting list and concept. It is far from complete but should give you an idea about needs for your patients.
Remember, everyone needs the training and practice. The patient may be you someday, and these simple procedures may save a life, including your own. Also and most important, many of these tasks are not fun. Many are done for infants and young children without any thought. Please be kind and offer privacy and dignity to your patients. Treat them as you would want to be treated.
God Bless, good luck and please let me know what you think or if you have questions.
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