Thursday Feb. 5

Home Care visits
Bernie and I went with Theresa a clinic nurse and Karen the nurse from Connecticut who acted as our interpreter for home visits yesterday. I had never known that Bernie and I have so much in common. We are both oncology nurses and former home care nurses as well.

The first home visit had two patients who are elderly bedridden parents of Theresa. Dr Christian came along because her mother was having breathing problems. She is on oxygen and had broken a hip two years ago. She fell out of bed five days ago and probably has some chest muscle damage or broken ribs not to mention bruising. She may have broken her nose as well. Dr Christian was so great with her holding her hand while he talked with her and Theresa and then he was stroking her hair. Dr Christian then had to return to the clinic. Theresa's father has been bedridden for 6 years with polynephritis. He also has renal failure and is blind. He has debubitus ulcers on his coccyx and on his right back. We had a great opportunity for teaching as Theresa was very open in asking what to do about the wounds. Karen said they tend to vigorously scrub wounds with betadine or other solutions. So we explained about the benefits of gentle cleaning with saline, turning at least every two hours, duoderm type dressings that we have in the States, keeping the wound bed dry when the wound is dry and not applying ointments then, etc. He said he has pain all over and they have very poor pain control. We talked about giving a little acetaminphen for aches because his kidneys are poor. He also has his days and nights mixed up and yells out all night and thinks he is walking. We explained that he probably thinks he is as he is so restless he is moving his arms and legs as if walking. Theresa has been giving him Xanax to calm him and he seems to get worse then. So we explained about the metabolites due to his failing kidneys. We said we would ask Dr Larry what else to give. In Peru they can go into any pharmacy and ask for what they want without a prescription but we wanted to clarify with Larry first. We agreed that we see the same problems in the U.S. and this is not unique to Peru.

The second home has two elderly sisters, Olga and Edith. Olga also broke her hip two years ago and has been bedridden ever since and Edith takes care of her. Their two room house is packed to the absolute brim with all kinds of (junk) treasures and there is only enough room for a path about two feet wide to walk between their bedroom and the kitchen. Father Alex says they won't even let him move the dust because he has tried sending people in to clean for them. Olga also has coccyx bedsores and this time I got to do the wound care. They use a 4x4 and regular scotch tape to hold it in place. We did teaching about position changes and exercises and Olga can even lift herself off the bed. We were counting in Spanish and she says she will do this twice every day. We will see because as nurses we know that sometimes people say one thing and then it doesn't happen. Theresa and Karen can assess that on their next visit.

Edith was getting jealous of the attention. She hasn't been feeling well, is dizzy, has leg and ankle pain, etc. The doctor had prescribed medicine which she said she was taking. Theresa taught her about her new meds. As any good homecare nurse will do as part of the assessment, we asked her to open the bottle. She couldn't. It was one with a childproof cap. So, like any "good" patient she told us what we wanted to hear in saying she was taking the medicines. We showed her to not tighten the cap on the pill bottle all the way so she could open it easier. Then we discovered that she couldn't swallow the pill anyway nor could she chew it. It was only a baby aspirin but she has poor teeth and (swallowing difficulty). She went to the kitchen and crushed the pill with her self made pill crusher, mixed it with water and sugar, and said it was good. Now we think she will take her medicine but Karen and Theresa will assess that as well next time. Edith's blood pressure was fine while she was sitting when Bernie first took it. But later she became dizzy while walking so I wanted to get a pressure while she was standing. It dropped systolically 30 points. She doesn't drink enough and is dehydrated we presume. So we taught about drinking more. This is so classic even in the States with the elderly. Edith has discolored lower legs and they are extremely dry. She actually had some Lubiderm on their nightstand and the legs were not weeping so I applied the lotion and told her to do that daily. I don't think the bottle was ever opened before. She said she could do the lotion, otherwise Karen said she could stop by. Her legs felt much better after that.

Bernie had some chocolates she gave them and they had a blast eating them and getting it all over their mouths and hands. They said they want two kilos of chocolates, one kilo for each of them. They are so funny! Olga was singing to Bernie while I took care of Edith and they are just so sweet. As we were getting ready to leave I took a picture of them together and they said their home is ours and we can come anytime. Hugs and kisses and then we left. We are so blessed to have met them. A poor lady stopped by to sell carrots and Karen bought a few even though she didn't need them.. I did not bring any money today. Karen gave her 5 soles which is a little less than 2 dollars and the lady said that was way too much. That is so typical of the people here. So honest and so loving even though they have nothing. Karen made her take the money anyway. And that is so typical of Karen. I am honored to know her as well.
Sally Marohn