LINCOLN COUNTY PUBLIC HEALTH

925 Sage, Ste. 106 421 Jefferson, Ste. 401

Kemmerer, WY 83101 Afton, WY 83110
307-877-3780, FAX 307-828-3114 307-885-9598, FAX 307-885-0175
phnkmer@lcwy.org phnafton@lcwy.org

Caring for the Sick at Home – When It’s the Only Option DVD
Script of Slide Narrations

1. This instructional program is intended to provide very basic skills for caring for the sick in a
home setting during an emergency or disaster that stretches healthcare resources over their limit.
We felt it was important to help the public care for themselves in the event of any contagious
disease or emergency.

2. The program is brought to you by Lincoln County Public Health, Lincoln County, Wyoming.
The program was created and researched by Constance E. Sweeney, R.N., B.S.N. It was edited
and approved by Suzanne Pearson, R.N., Manager of Lincoln County Public Health.

3. The program was developed to share information about coping with a public health problem.
The information presented is not meant as a substitute for professional care. We do not clam the
information provided is sufficiently accurate or useful to make clinical decisions. It takes
professional judgment and specific information to know when it applies to a particular
individual. As a legal matter, no one who provides information here takes responsibility for the
results or consequences of using it for the practice of medicine.

4. Any emergency that results in wide spread illness will not only overtax the health care system
but may disrupt our daily lives significantly. For example, with a contagious disease such as a
pandemic flu, there will most likely not be a vaccine or other medication available to treat the
disease for many months. At the time this program is being written the most likely threat is a
pandemic of influenza. Therefore, we will use such an event as an example. The basic principles
we discuss could be applied to many other similar situations. Influenza pandemics often occur in
waves. Each wave may last 6-8 weeks and 30-40% of the population may become infected. Once
infected, the person can be contagious before the symptoms appear. In the past, unlike the
seasonal flu, pandemic flu affected children and otherwise healthy, young adults more severely.
With 30-40% of the population seriously ill, hospitals will not be able to cope. Most people will
need to be treated at home. Again, with 30-40% of the population out sick or caring for the sick,
public services such as water, power, waste disposal, communications, and transportation will
likely be interrupted. Deliveries of food and other essential supplies may be halted. There may be
panic and civil disorder due to shortages and desperation.

5. Shelter-in-place or self-quarantine is the process of staying where you are and taking shelter,
rather than trying to evacuate. When a disaster occurs or when the pandemic influenza arrives in
a community, the hospitals and medical personnel will be overwhelmed in 24 to 48 hours. They
will not only fill their beds but they will not have personnel to care for the sick and injured. Also,
they may be sick, injured or must stay home to care for their sick family members themselves.
The best use of the medical facilities during a pandemic influenza may be to continue to care for
the usual broken bones, heart attacks, and childbirths, while you care for your flu victim at home.
A virus causes influenza. You have to realize that there is very little medical professionals can do
for viral infections. They can treat the symptoms, but they cannot kill the virus and cure the
person. You can treat the symptoms of a pandemic flu at home just as well if not better than the
medical professionals will have the capabilities to do in the hospital. That is the reason we
designed this program, to prepare you to care for your family at home under self-quarantine or
shelter-in-place.

6. To be fully prepared for an emergency or contagious disease outbreak, we would encourage

the viewer to participate in other trainings on general disaster preparedness. Due to time
constraints we have not included this information. It can be easily found on the web or in your
public library. Most disaster information covers the 72-hour kit. Remember, we said that a
pandemic of influenza comes in waves and you may need supplies for up to 8 weeks. So, the 72-
hour kit is a start, but it must be expanded in amounts of food and water. It should also include
items to care for the sick listed in this program.

7. Consider these basic preparedness tips: Prepare ahead. DON’T PANIC!! Get a regular
seasonal flu vaccine to help prevent a secondary infections and flu. If you’re over 50 years
young, get a pneumovax immunization to prevent a secondary pneumonia. Prepare to isolate
yourself and family for 3-6 months. Stock up on supplies. Accumulate sick time and vacation
time at work.

8. Make contingency plans with your work place to be able to work from home, if possible. Be
prepared for essential services to be shut down. Get you will in order. Will you need security?
You may not live through a pandemic. Dr. Woodson, whose work inspired this production,
estimates that one in forty won’t. Do you have life insurance? Is it enough? Do you want to have
more for yourself and your family? If those who have not prepared as well as you have want
what you’ve got, are you prepared to protect yourself and your family?

Everything we present here can be adapted to most emergency or disaster situations. However,
we plan to focus on the issues that arise around a pandemic flu outbreak. We know people will
catch it. We would like you to know how to protect yourselves and others, as much as possible,
from it. With that in mind, here is how it’s done.

9. Prevention and containment is essential. The first lines of defense against a communicable
disease are hand washing, protecting yourself and others from coughs and sneezing, not having
or attending large gatherings of people, treat blood and body fluids as to not spread the virus, and
handle contaminated surfaces and materials to prevent contamination of yourself and others.

10. Hand washing-Why is hand washing so important? Hand washing is by far the best way to
prevent germs like viruses from spreading and to prevent you and your family from getting sick.
Did you know that one in three people do not wash their hands after using the restroom? Hand
washing is the first line of defence against germs.
11. Germs such as bacteria and viruses can be transmitted several different ways:
Through contaminated water and food
Through droplets released during a cough or a sneeze
Through dirty hands

12. Through contaminated surfaces, through the sick person’s body fluids, for example:

Blood
Saliva
Urine
Feces
Vaginal secretions

13. Washing your hands correctly is very important. You will need warm water, soap (bar or
liquid, antibacterial is not necessary) and a clean towel. Paper towels are preferred because
another person has not used them.

14. This is how to properly wash your hands. Step 1: Use soap and water.

15. Scrub your hands for 15-20 seconds. Knowing the words to the “Happy Birthday” song is
helpful because singing the song three times all the way through is the perfect length of time to
scrub your hands with soap before thoroughly rinsing. Wash all the surfaces including your
wrists, palms, back of the hands, fingers, and under the fingernails.

16. Dry your hands thoroughly with a paper towel or other clean towel and use it to turn off the
faucet. Remember, paper towels are preferred because shared cloth towels can spread germs.

17. Here are some interesting hand washing facts:

Nine out of ten adults say they wash their hands after using the public restrooms, but only
six in ten were observed doing so.
Women wash their hands more often than men.
Americans with college degrees say they wash their hands less than those without college
degrees.

18. Hand washing should be a rule for every one, especially”

Before eating and cooking

After using the bathroom
After cleaning around the house
After touching animals, including your own pets
After visiting or caring for sick
After blowing one’s nose, coughing, or sneezing
After being outside shopping, gardening, etc.
19. Please, don’t underestimate the power of hand washing. The few seconds you spend at the
sink could very well save you from the flu and/or save your life!

20. How clean is your steering wheel? Do you sneeze all over everything around you or do you
turn your head and cover your mouth? Do you cough into your elbow and sneeze on your toes?
After washing your hands, do you turn off the faucet with the towel? Do you use a towel to open
the door to the bathroom? Others may not have been as thoughtful as you when they opened the
door. Do you take off jewelry when you cook or care for the sick? Jewelry can harbor many
germs. Do you wash between activities to prevent cross contamination? Spreading bacteria from
one thing to another. How many germs do you think you spray on the telephone receiver or your
cell phone when you talk into it. Or, how many are on it when you pick it up? Do you touch your
nose, mouth, face or hair with your hands and then go on cooking or caring for the sick person
without washing? Then there is money! Probably the worst offender for spreading germs,
bacteria, and who knows what else!

21. If soap and water are not readily available an alternative is the alcohol-based hand sanitizers
on the market. These can be used when you are in the sick person’s room and need to clean your
hands. Always wash your hands as soon as you can get to soap and water even when you have
used a sanitizer product.

22. The main way illnesses are spread is from person to person through respiratory droplets.

23. Another way is from surfaces that have been coughed or sneezed on.

24. A third way is to touch a surface that was touched by someone who had sneezed or coughed
on his or her hands.

25. Cover your mouth and nose when coughing or sneezing. WASH YOUR HANDS OFTEN!

Remind others in your family to do the same.

Refrain from touching your mouth or nose. Cough or sneeze into a tissue and then throw
it away in a proper trash can. Then clean your hands, and do so every time you cough or
sneeze. Try covering a cough or sneeze near your armpit if you do not have a tissue. If all
else fails, cough on your elbow and sneeze on your shoes.

26. Refrain from kissing especially if you think you have been exposed to an illness. All those
grandmas out there, it is so hard to resist kissing those little faces. Wash your hands after
touching anyone else who is sneezing, coughing, blowing their nose, or whose nose is running.

27. Don’t share things like cigarettes, towels, lipstick, toys, computers, pens, pencils, clothes,
sheets or blankets. Avoid sharing food, utensils or beverage containers with others. Last, but not
least, STAY HOME if you have a cough and fever. Remember, containment is the objective.
Don’t take a virus to school or work.

28. The postponement of large gatherings may be necessary such as:

 Schools and school events
Church services
Athletic events
Restaurants/bars/recreation centers/gyms may be closed, as shopping malls or retail
stores.
Any place groups of people gather.

29. Grocery shopping may need to be done by appointment or online with a delivery service.
What if grocery shelves were empty? What if truckers were sick and unable to get supplies to
town? Are you prepared to self-quarantine for 6-8 weeks or more?
Even when you have been meticulous in following these prevention strategies, you or a friend or
family member may fall victim to the disease and need your care at home. The next section of
this program will give you basics of home care.

30. It will be very important to keep the sick and their bed and bed clothing clean and dry. The
sick rooms and bathrooms need to be maintained in good condition.

31. The best disinfectant available is a bleach and water solution.

Mix 1 gallon of water with ¼ cup bleach.

Mix a fresh batch every time you use it.
Disinfectant wipes containing bleach could be substituted, if available.

32. Soiled garments and bed linens should be washed in HOT water, soap, and chlorine bleach.
Hard surfaces should be wiped clean with soap & water; followed by spraying with 1:10 bleach
to water solution & wiped down again. This will effectively remove all trace of body fluids,
vomitus, and excrement and neutralize all infectious viral particles.

33. What to disinfect:

Doorknobs
Light switches
Handles
Toys
Other surfaces commonly touched

34. Bacteria cause odors. Bacteria need moisture, warm temperatures, oxygen, darkness, and
nourishment to multiply. Eliminating any of these will cut down on bacterial growth, thus cutting
down on odor.

35. To eliminate strong odors you can sprinkle the area with baking soda. Leave a full/partially
full can of finely ground coffee opened under the bed or in the area where the odors are
produced. Or you could pour a few drops of mouthwash in containers used to dispose of human
waste or place mouthwash-saturated cotton balls in the room.
36. Or spray fine mist of a solution of white distilled vinegar with a few drops of eucalyptus or
peppermint oil. Saturated cotton balls with vanilla extract and place in areas with strong odors.
Then there is always the commercial devices or sprays, if they are available.

37. PLASTIC BAGS ARE YOUR FRIENDS!!! As are large, covered garbage cans. You might
want to stock up on these when you are gathering things for your basic survival kits.
You will want to double bag all contaminated waste in the sick room. Double bagging serves two
purposes-it prevents leaks and protects others from the outside of a contaminated bag. Line the
initial disposal container with a plastic bag (it may be a small one). When these containers get
full bring a larger, clean plastic bag to the door of the room. Open the large bag and rollback the
top toward the outside of the bag. Tie the smaller bags closed as you remove them from their
container. Carefully place the smaller bags in the larger ones. Avoid touching the outside of the
larger bag with your contaminated bags or hands. Wash your hands and then pull the sides of the
bag up around the smaller ones by holding on to the outside of the larger bag. Tie the large bag
tightly so animals and rodents don’t get to it. The city and county waste disposal departments
will determine how to remove the garbage from here. If burning is allowed, you can burn the
waste in a safe place or burn barrel.

38. Do not carry soiled linen close to your body. NEVER, NEVER shake dirty items or put
soiled linens on the floor. Shaking soiled linens puts germs contained in droplets into the air.
Store infected soiled linen in a leak-proof plastic bag and tie it tightly shut. Bag soiled laundry in
the same place where it is used. Double-bag it like you do the garbage. You don’t want to carry
uncovered soiled linens throughout the house contaminating as you go. And don’t put soiled
linen on the floor. Soiled linens can contaminate the floor and germs will be spread throughout
the house on the soles of shoes.

39. Wash soiled linen separately from other clothes. Fill the machine with hot water, add bleach
(no more than ¼ cup) and detergent, rinse twice, and then dry. Clean the washer. Run the washer
through a cycle with one cup of bleach or other disinfectant to clean it. Use rubber gloves to
handle soiled linen. Wash your hands THOROUGHLY!! Remember, more bleach is not better.
You will get the same disinfecting power with ¼ cup as with a full cup when it comes to linens.
If urine is highly concentrated because of bladder infections or dehydration, do not use bleach for
the first wash. The concentration of ammonia in the urine and bleach can cause toxic fumes.
Wash the linens a second time in bleach.

40. When handling body fluids like urine, feces, vomit, or blood, wear gloves, if they are
available. Cover your clothing with suggested cover-ups. Wipe up with a cloth or mop using the
1:10 bleach solution. Pour slowly when you are discarding the fluid to avoid splashing. Discard
the fluid in a toilet, if possible, or double-bag the cloth or disposable container and discard the
contents in the garbage.

41. If you must share equipment and supplies with other members of the family they should be
sterilized to cut down on infection. Equipment used only by the person being cared for can be
wiped with a cloth soaked in alcohol or the 10% bleach solution.
42. So, how do you sterilize equipment? First…NEVER use the microwave oven to disinfect any
non-food items. NEVER use the microwave oven to warm blankets, towels or other linens.
THEY CAN CATCH FIRE OR EXPLODE!!

43. To “wet” sterilize equipment that can be submerged in water: Fill a large pot with water. I
sterilizing glass pieces, put a cloth in the bottom of the pot. Put the items to be sterilized in the
pot. Cover the pot and bring the water to a boil. Boil undisturbed and covered for 20 minutes.
Leave the items in the pot until ready to use. You won’t need to drain the pot as the water is
sterile as well until you take off the comer and take out an item. A hot iron held on cloth for a
few seconds can effectively sterilize it.

44. Ok, now how do you as the caregiver protect yourself? Well, bacteria and viruses can be
transmitted on your clothing. When caring for the sick person, it’s wise to cover your everyday
clothing while you’re in the room. Here are some suggestions for cover-ups:

45. A large garbage bag with holes cut for your head and arms, back for easy entry. You can then
tape the back closed.

An old raincoat
An over-sized shirt worn backwards
A bathrobe worn backwards
You may want to wear a short sleeve shirt underneath these to keep from getting too
warm.

46. You’ve protected your clothing, now how do you get it off without contaminating yourself?
REMEMBER the outside of the cover-up is CONTAMINATED!! Take hold of the cover-up at
the neck near the shoulder seams. Pull it off the shoulders as you turn the inside over the
contaminated outside. Slide the cover-up off your arms as you wrap the inside over the outside.
Do not touch the outside. Roll the cover-up and dispose of it as soiled linen. Carefully wash your
hands and arms thoroughly.

47. What about masks? Are they necessary? Which ones are best? Masks come in many types.
This type is called an N95. It’s recommended to filter out particles the size of an influenza virus.
If and when masks are advised, this mask, the N95, is the recommended type. However,
scientists disagree as to whether a mask is useful during a pandemic or not. Dr. Michael
Osterholm, during his appearance on the Oprah Winfrey Show, cautions, some virus’ like the
Avian (bird flu) virus can live outside the mask for two to three days. After one wear, you have
to properly dispose of the mask to avoid contact with harmful germs.

48. This type is often called a surgical mask. They can be used, but do not filter out very small
particles like viruses. The next problem with masks…there won’t be enough to go around, Dr.
Osterholm says. Pandemics can last for up to two years, and since many of our medical supplies
are shipped from overseas sources, Dr. Osterholm predicts, “America will run out of masks,
prescription drugs and other necessities before the threat is over.”
49. Here is an alternative to the commercial masks. It has been tested by experts and can be
helpful, but it is not the best option nor is it guaranteed to prevent you from contracting a disease.
A mask and maintaining personal space of 3-6 feet may be of some protection. This mask must
be washed between wearing in hot water and chlorine bleach. You will need several for each
household member.

This mask consists of 1 outer layer (14 ½” x 28 ½”) rolled and cut as in panel B with 8 inner
layers (8” x 8”) placed inside (against the face). The nose slit is first placed over the bridge of the
nose, and the roll is tied below the back of the neck. The area around the nose is adjusted to
eliminate any leakage. If the seal is not tight, it is adjusted by adding extra material under the roll
between the cheek and nose by pushing the rolled fabric above or below the cheekbone. Tie b is
tied over the head. A clothe extension is added if tie b is too short. Finally, tie c is tied behind the
head.

50. To put one of the tie-back masks on, first place the nose piece on the nose and fit it tightly as
you tie the strings toward the top of the back of the head. If the mask has a metal nosepiece,
press it around the nose to create a seal. Then tie the bottom string tight enough at the back of the
neck to create a seal under the chin and on the sides of the face. To remove it reverse the process,
but only handle the mask by the ties, strings, or elastic bands. Dispose of the single use masks in
the garbage and the cloth re-usables in the soiled linen.

51. Let’s move on to gloves. There are different types, plastic, rubber, latex, disposable,
powdered, un-powdered, etc. If you haven’t stocked up on disposable gloves by now, it may be
too late. You can buy the household re-usable gloves and disinfect them between uses.

52. Putting on gloves is pretty easy. These pictures are self-explanatory.

53. Taking off contaminated gloves is a little harder because you don’t want to contaminate
yourself as you do it. Grasp one glove at the wrist and pull it down to the fingers. Pull your hand
out. While holding onto the contaminated glove with the other gloved hand, slide your fingers
under the top of the other glove. Slide the glove down until you can grasp enough to form a cuff
with the inside of the glove facing out. Pull the glove by the top of this cuff until you have pulled
it over the other glove in your hand. This leaves the uncontaminated side of the second glove
covering both gloves. If the gloves are disposable throw them in the garbage. If they are reusable
place them in warm, soapy water before you separate them. Wash them thoroughly then spray
them with the 1:10 bleach solution. Allow them to air dry.

54. This next section covers the actual care of the sick person.

55. Here are some common signs and symptoms of the flu. Remember, we have focused on the
possibility of a pandemic flu that is respiratory in nature. The person may have a fever, sore
throat, cough, runny nose, and general aches and pains. Additional signs and symptoms that may
occur as the disease progresses are irritability and/or confusion, difficult breathing or chest pain
with each breath, bluish skin, and/or stiff neck.
56. Who is going to take care of the sick person? This will be a decision that will need to be
made. Contact with the ill person needs to be limited, but can one person care for them 24 hours
a day/7 days a week? Do others have medical conditions that would make them less able to cope
with a viral infection? Who hasn’t been exposed to the infection? These are all things to be
considered when selecting the person or persons to care for the sick ones.

57. Now you’ve decided who’s going to care for the sick, where are they going to do it?
Generally a bedroom works the best because you can control traffic flow and close the doors of
most bedrooms. Bedrooms also usually have beds in them. You also need a close supply of water
for hand washing, bathing, and possibly toileting facilities. You may have to improvise using an
air mattress for a bed, or just blankets and linens on the floor. If more than one person is sick
with the same illness, you may want to have them all in the same room. In that case, you may
want to provide some way to protect each person’s privacy. Or you may be the ill one and have
to care for yourself. If the room is set up properly, you should be able to care for yourself or
others confidently. Include:

Large water supply available

Facial tissues
Big trash can
Vomit/”Barf” container
Plastic garbage bags (ample supply)
Medications-prescription and non-prescription ( over-the-counter)

Here are some suggestions for setting up a “sick room” whether you are home alone or caring for
others who are sick.

Put a large water supply on one nightstand, for example, one of those tea jugs or camping water
containers. Put more than one unbreakable cup next to it. You may not want to reach down for
one if you drop it, not for reasons of hygiene but because of the effort required. Put two boxes of
facial tissues on the other nightstand, with a big trash can beneath. Consider putting an emesis
(“barf”) container next to the trash can. Use a plastic trash can liner that you can tie shut after use
to control odor. Put a couple of extra bags under the tissue boxes. Intestinal problems are not
usual in influenza, but coughing fits can send you retching. Put all your medications on the water
table. Don’t forget the ones you may ordinarily take, such as medications for diabetes or blood
pressure. In addition to any prescribed flu treatment, include over the counter medications such
as: ibuprofen, acetaminophen, cough suppressant. If there are any medications recommended by
authorities during an epidemic, include them. Include any vitamins you usually take, as well.

58. More supplies and equipment for the room includes:

Meal replacement drinks and bars

Plastic bucket with lid for human waste
Something to use as a bedpan and something for a urinal
Rolls of toilet paper
Walker or cane
TV with remote control
 Telephone

Put a few cans of a meal replacement drink within reach. (Possible in a bucket of ice.) You may
want to add other nutritional solid food. It may be helpful to have electrolyte replacement at the
bedside such as the homemade type mentioned in the treatment of dehydration or commercially
manufactured brands. Consider a container that may be used for human waste in case you are too
weak to walk to the bathroom. Use something that can be closed in case you do not have strength
to empty it for a day or more. Toilet paper should be close at hand. If you have a walker or a
cane, put it by the bedside so that you can use it if you feel weak.
If you have a TV in the room, put the controls within reach of the bed. Plus a few other mental
distractions, like books or a game, though you probably won’t be awake much to use them.
Have a working phone within reach. Do not rely on any telephone that requires a power adapter
(something that plugs into the power outlet in a wall). If the power goes out, your phone is
useless. Every home should have at least one phone that only plugs into the telephone jack on
your wall, a separate system from you power, or a cell phone.

59. More things to consider having in the room are:

Mental distractions (books, games)

Extra blankets/pillows
Feminine hygiene products
Clock
Battery-operated radio
Flashlight

Have extra blankets (in case of power outage) and pillows within reach. Pillows are key because
if you develop pneumonia you will want to remain sitting up so that fluid collects in the lower
part of your lungs and leaves the upper parts with less fluid so that you can still breathe.
If you are female, put feminine protection products at hand, though your illness may throw your
cycle off.

A battery-operated radio and flashlight within reach would be important in case the power cuts
out.

60. On a stand outside the door you may want to keep these things handy:

Clothing cover-ups
Masks ( if available)
Gloves
Flannel lined plastic tablecloth (cut in 16-18” squares)
Nice but not necessary:
Bed tray for eating and entertainment
TV table and chair

61. Keeping a record of every sick person you care for is an important part of your duties as a
caregiver. It provides you with information to judge the effect your treatments are having on the
person. It also can provide information should you become ill and someone needs to take over
the care of the other person. It will be very useful for you to write down certain information
about the person or persons for whom you provide care. Keep a paper or notebook and a pen or
pencil at the bedside. Keep as accurate and careful records as you can.

62. Include vital signs, which are:

Temperature
Pulse rate
Breathing rate
Blood pressure (optional if you know how to take)
Intake and output

63. Prior to putting the person to bed you may want to add these things to the bed:

Plastic under the mattress pad, a piece from a flannel lined plastic tablecloth, a flat sheet folded
in thirds. The flat sheet folded in thirds should be placed lengthwise across the middle of the bed.
Leave the ends untucked. This will be handy to help turn and move the person if they become
too weak or unable to move themselves. Plastic under the mattress pad protects the mattress. You
may have to throw the mattress pad away after the person is no longer bed ridden, but your
mattress may be fine. Cut a flannel lined plastic tablecloth in appropriate sizes to fit under the
person’s buttocks to save on linen changes should the person have diarrhea or urine
incontinence. It also protects from spills should the person need to use a makeshift bedpan or
urinal. These pieces can be washed and reused.

64. Before you change an occupied bed remember the techniques for handling soiled linen. First
and foremost you want to protect yourself so you do not become ill and cannot take care of your
family. Then you do not want to spread the virus to other members of the family.

65. Making a bed with someone in it can be relatively easy if you follow these steps:

Gather equipment
Plastic Bags
Large garbage size to put contaminated linens in
Bottom sheet
Can be flat or fitted
Top Sheet
Draw Sheet
This can be a second flat sheet folded in half. It is used to help move and
turn the person in bed. It also saves on linen because the person may only
soil this sheet.
Pillowcases
Flannel-lined tablecloth square
Blankets x 2
Towel
Washcloth
Lotion
 This is an excellent time to freshen up the person and give them a good
massage.

66. Simple steps to making a bed with someone in it:

Look at the bed as having two parts-the side a person is lying on and the side you are
making.
Cover the person with a clean blanket or sheet. Pull the old sheet from under the clean
sheet.
Roll the person on their side to one side of the bed. Loosen all the linen on both sides of
the bed.

67. Roll all the old bottom linens toward the person

Fold the clean sheet, along with other mattress covers, lengthwise.
Unfold the clean sheet and bring enough of it toward you to cover half of the bed.
Gently lift the mattress and tuck the sheet in
Tuck the free edge of the draw sheet under the mattress on your side of the bed.
Ask the person to roll over the linen in the middle of the bed to the clean side.
Move the pillows to the edge of the other side of the bed
Bend as close to the person’s body as possible, place your hand and arm under the
person’s shoulders, and move the person and the bath blanket over the hump of linen in
the center of the bed.

68. Go to the other side and remove all soiled linen. Tuck in all the linen and pull tight on the
sheets to remove all wrinkles. Wrinkles can rub and irritate the skin causing open sores.

Change the pillow cases

Spread the top sheet over the person and blanket
Ask the person to hold the sheet while you pull the blanket away
Tuck the sheet under the mattress at the foot of the bed.

69. Let’s talk about the finer things in life-like toileting. There are a few key things to know
about toileting a person in bed. First you will need to improvise, as most of us do not keep a
bedpan in our homes.

Some suggested substitutions are:

Dishpans
Cake pans
Cooking pots
Frying pans

You can probably come up with some other solutions when you look around your home. Cover
the top edges with rolled up towels or washcloths for comfort. Spray the inside with cooking
spray or coat with cooking oil or grease to make for easier cleaning after each use. Or place a
tissue or water in the pan to help the contents empty easily and completely.

70. Prepare the person by removing undergarments or other clothing from the waist down.

Place a folded hand towel over the sides and back of the “bedpan”.
Ask the person to raise their hips.
If the person cannot raise the hips, turn them on their side and roll the hips back onto the
“bedpan”.
Place the pan with the towel covering the edges, under the person’s buttocks.

71. If the person cannot do so, clean the anal area with bathroom tissue and then a wet tissue to
keep the area clean.

After a woman has urinated, pour a cup of warm water over her genitals and pat the area
dry with a towel.
Remove and gently empty the pan in the toilet or waste container being careful not to
splash.
Wash the person’s hands.
Be sure to wash your hands.

72. Males using a urinal:

Again, you will more than likely improvise.

Some suggested substitutions:
Large whipped topping containers with lids
Plastic soda bottles with lids
Salad dressing bottles or jars
A large drinking glass
Be Creative!

73. Dehydration results when the body loses more liquid than it takes in. this can happen with
severe diarrhea, especially when there is vomiting too. It can also happen in very serious illness,
when a person is too sick to take much food or liquid.

74. People of any age can become dehydrated, but dehydration develops more quickly and is
most dangerous in small children and frail elderly. It is important that everyone know the signs
of dehydration and how to prevent and treat it.

75. What are the signs of dehydration?

Thirst is often a first, early sign of dehydration.

The person puts out little or no urine and the urine is dark yellow.
The person experiences sudden weight loss.
They may complain of dry mouth.
Their eyes may be sunken and tearless.
 There is loss of elasticity or stretchiness of the skin.
When a person has watery diarrhea, or diarrhea and vomiting, do not wait for signs of
dehydration. Begin treatment!

76. To prevent or treat dehydration:

Give lots of liquids to drink.

Rehydration Drink is best. We have included two recipes for this drink.
or
Thin cereal, porridge or gruel
Teas
Soups
Water
Continue to give solid food for as long as the person tolerates it.

77. This is rehydration drink #1.

78. This is a second recommended rehydration drink mixture.

79. To treat dehydration, give sips of fluid every 5 minutes, day and night, until signs of
dehydration decrease.

A large adult needs 3 or more quarts of fluid per day.

A small child needs at least 1 quart per day.
Keep giving small sips, even if the person vomits.

80. When a person is vomiting or feels too sick to eat, he should continue to try to drink:

Meat, egg, or bean broth to increase the protein.

Rehydration drinks whether homemade or commercially manufactured.

81. As soon as the person is able to eat- in addition to drinks, start:

Ripe or cooked bananas

Crackers
Rice
Oatmeal
Potatoes
Applesauce (cooked)

82. Tracking intake and output is important to determine when hydration is adequate. Using a
measuring cup, measure how much fluid each type of cup or glass you plan to use for the sick
person holds. When the sick person drinks from one of those containers you will know how
much they take in and can write it in your record. To maintain good hydration, it is important
that a person take in as much or more than he/she puts out.
83. You can then measure how much a coffee can, whipped cream container, old pitcher or some
other container will hold. Use that container to measure the person’s urine or other fluid output
( liquid stool, emesis). If that is distasteful to your senses, you can use an educated estimate.
Measure different quantities of water in a container to help you learn what a cup of water looks
like or three cups looks like. Then when the person urinates or vomits you can estimate the loss
of fluid.

84. To maintain good health, one needs to eat the right balance of foods from each of these food
groups (vegetables/fruit, meat/fish, cereal/potatoes) and drink plenty of fluids. Your body needs
a combination of nutrients-proteins, carbohydrates, fats, vitamins, minerals, and fiber-to satisfy
all of its requirements.

85. Even the sick need to eat a well balanced meal. Allow the sick person to feed him or herself
as long as they are able. When they are no longer able to feed themselves, follow these general
guidelines:

86. Let’s start with some precautions:

Be sure the person is awake and alert to avoid choking.

Use caution when offering hot liquids. You can test it on your wrist first.
Offer food slowly and in small amounts.

87. Now you will need to prepare the supplies for feeding the person. You need a towel and
washcloth, and special eating utensils, such as a small glass, straws, spoons. Then you will
prepare the person by toileting them, if needed, washing their hands and face, and making sure
they have their glasses on and dentures in.

88. Then, wash your hands; sit the person up as far as possible; cover their chest with a towel;
clean the area to be used to feed the person; use a tray across the bed or a table at the side; place
a fresh drink of water within reach.

89. For the procedure, place the food within their reach; open all the containers; add additional
seasonings, as the person prefers.

To offer liquids:

Stir the liquid to distribute the heat evenly.

Place the straw in their mouth and let them suck and swallow as desired.
Avoid too much liquid before they try more solid food.
Feed slowly, naming each food as you give it.

90. To offer solid food:

Fill a spoon only 2/3rds full.

Touch the spoon to the lips and then to the tongue.
Allow the person time to chew between bites.
 Offer a liquid, then a few bites, and follow with liquid.
Wipe their mouth with a napkin or towel as needed.
Move the food away when they are finished.
Provide mouth care or at least have them rinse their mouth with water.

91. Remember, signs and symptoms of a pandemic flu are:

Cough
Sore throat
FEVER
Pneumonia or other acute respiratory distress.
Diarrhea
Not everyone has every symptom.

92. To properly treat a fever, you must take the person’s temperature. To take the person’s
temperature you must have a thermometer.

93. An oral thermometer is the most reliable. It is also the most versatile as it can be used for
axillary (armpit) temperatures. A thermometer can spread infection. If feasible, having a
thermometer for each member of the family, labeled with their names, would lower this risk. The
forehead plastic types are handy for this purpose.

94. If it is unreasonable for people to have their own thermometer, clean the thermometer
thoroughly as recommended by the manufacturer. Check digital thermometers at least monthly to
be sure your thermometer is working and the batteries are charged.

95. When taken orally (in the mouth) the normal reading should be 98.60 F. Normal body
temperature in Fahrenheit taken under the arm is 97.60 F. Fever may serve an important purpose-
most bacteria and viruses that infect humans find it hard to grow at higher than normal human
body temperatures.

96. The main danger from fever is rapid dehydration-the human body uses twice as much water
with every degree of temperature rise. Most physicians now recommend that we balance the
risks and benefits of the fever by only treating and attempting to reduce fevers if they are greater
than 1010 F.

97. These are considered high fevers:

Children and Adults: Greater then 1050

Babies 3 to 24 months old: 1030 F or higher
Babies up to 3 months: 100.40 F or higher

98. To take an oral temperature:

You should wait 20-30 minutes after the person has eaten or drunk liquids. Make sure there's no
gum or candy in the mouth. Place the tip of the thermometer under the tongue and have the
person close his/her lips. Follow instructions by manufacturer Take the person’s temperature a
minimum of every 4 hours. Read and write down the temperature reading and time of day in
your record.

99. To take an axillary temperature:

First, remove the person’s shirt. Place the thermometer under the armpit. Fold the person’s arm
across their chest. Follow instructions by the manufacturer. Take the person’s temperature a
minimum of every 4 hours. Read and write down the temperature reading and time of day in
your record.

100. Additional Tips: Never take a person’s temperature right after a bath or if they have been
bundled tightly for a while. Never leave the person unattended while taking a temperature.

101. You now know the person’s temperature is too high. What do you do if it’s high? Take off
the person’s unnecessary clothing. Give the person acetaminophen for fever over 1010 F. DO
NOT GIVE ASPIRIN TO CHILDREN OR TEENAGERS!! DO NOT USE
ACETAMINOPHEN IF THE PERSON HAS LIVER DISEASE OR LIVER ILLNESS.

102. Give plenty of cold fluids to drink. Encourage fluids in small amounts frequently. Children
may take ice pops better than drinking from bottles or cups. Water, juices (low acid), half
strength sports drinks work well.

After four hours, recheck the temperature and re-administer acetaminophen if needed.
Recheck the temperature any time the person’s behavior changes, they have chills, or
“feel hot”.

103. For a fever over 1040 F include these treatments:

Sponge the person while they sit in a tub of lukewarm, NOT cold, water for 20 minutes.
Have the person rest in bed for 20 minutes.
Recheck the temperature.
If the temperature remains over 1040 F, repeat the sponge bath as needed.
If the person can’t get in the tub, you can also apply cool, water-soaked towels while they
are in bed.
If the person starts shivering violently stop and try again in 20 minutes.

104. Ibuprofen can be used for fever reduction. It lasts longer than acetaminophen. Most
physicians recommend 600mg every 6 hours for adults. DO NOT take ibuprofen on an empty
stomach. For children over two years of age: Use ibuprofen liquid suspension according to the
label instructions. If you are using other cold and flu medicines check the label for the contents
before giving additional medicine like acetaminophen or ibuprofen to treat fever. They may
already be contained in the cold and flu medicines you have.
105. Some physicians recommend alternating fever control medicines. This technique helps
prevent sudden fever rise when a single medicine is wearing off, but it is not yet time to
administer another dose. This technique can be used for children or adults.

106. Start with either ibuprofen or acetaminophen.

Administer the correct dose for the person’s age.

Three hours later, check the person’s temperature.
If the fever is still over 1000 F, administer the second medicine.
If the fever continues, administer the first medicine. Continue every 3 hours as long as
you need to bring the fever down.

107. Acetaminophen dosing:

DO NOT use more than every four hours.

Ibuprofen Suspension dosing”
DO NOT use more than every six hours.
Remember both of these medications can be crushed if the person has difficulty
swallowing pills whole.

108. Two other measures can give you clues to the person’s condition. These are pulse and
respirations. A person’s heart beat or pulse increases when the person has a fever. There are two
easy-to–access places on the body to take a pulse. In this area you find the carotid artery.

109. In this area you will find the radial artery.

To obtain the person’s pulse and respirations follow these steps:

You’ll need a watch or clock with a second hand to time the pulse.
Using the index finger and middle finger of your hand, feel for the beat in this area of the
neck or wrist. After you find the beat, you need to count how many beats occur within 60
seconds. You can count how many beats you feel in 15 seconds and multiply by 4. Then
without taking your fingers away, watch the person’s chest rise and fall. Count how many
times the cycle happens in 60 seconds. Again, you can count for 15 seconds and multiply
by 4. It’s best not to make the person aware you are watching them breathe as this can
cause them to breath abnormally. The normal pulse rate for an adult averages 60-80 beats
per minutes. Faster rates can occur with exercise, fever, or heart problems. Respiratory
rates average 16-20 breaths per minute. Knowing the person’s pulse or respirations are
not normal may give you a clue to changes in their condition. However, depending on
what is causing the change in condition, you may not be able to do anything about them
except try the treatments we have presented to you here.

110. A respiratory disease such as a pandemic flu causes congestion in the lungs making
breathing difficult or labored. Postural drainage, clapping, and controlled coughing are
recommended for persons who produce a lot of thick, sticky mucus and have an ineffective
cough that does not do the job of removing the mucus.
111. Postural drainage uses gravity to move mucus from the lower part of the lungs to the upper
part where it can be coughed up and out through the person’s mouth. The person should remain
in each position for 5 to 10 minutes. Each drainage position is designed to relieve the congestion
in parts of the lungs. If after holding one of these positions for the specified length of time, a
moderate amount of mucus is brought up, the position for the specified length of time, a
moderate amount of mucus is brought up, the position may be held for a longer period of time.

Have the person sit up and cough properly before changing to a new drainage position. To
minimize the possibility of vomiting, drainage is best done before meals or at least one hour after
eating. Early morning and at bedtime are best. Note: if the person has high blood pressure or a
heart condition, check with your physician before attempting postural drainage. Also, a pillow
may be used for the head only. Shoulders must rest on the bed. Wedge material must be solid.
Use books covered with pillows or a sturdy suitcase covered with pillows.

112. Positions for clearing each area are shown in these next slides.

113. No narrative.

114. Clapping with a cupped hand over the area of the lung to be drained helps dislodge mucus
and starts it flowing into larger airways so it can be easily coughed out. Place the person in one
of the postural drainage positions. Using your hand in a cupped position; and, as the hand firmly
but not painfully, claps the chest; it creates percussion throughout the area to be drained and
helps to mobilize the mucus. The cupped hand, which forms a pocket of air cushions the blows
to the chest with about 5 pounds of pressure. Clapping is performed only over the chest area and
is never done over bare skin.

115. Controlled coughing should be performed after each drainage position and clapping. During
postural drainage, it is important to breathe properly using your diaphragm and abdominal
muscles. Except when gently coughing, use pursed-lip breathing during exhalation. Pursed-lip
breathing helps keep the airways open and this is absolutely essential in order for postural
drainage to be effective. Coughing gently or making short grunting noises with the mouth
slightly open will help loosen the mucus. Do this periodically throughout the drainage procedure.
Controlled coughing is one of the essential techniques in good respiratory care. You should
perform this maneuver after each drainage position and often throughout the day. There is more
to a cough than just “cough!” It is important that you don’t waste energy on an unproductive
cough.

116. To perform the controlled coughing technique, have the person assume a sitting position
with the shoulders relaxed, head and spine slightly flexed, and feet firmly on the floor to provide
the body with support whey leaning forward. Have them gently fold their arms and hands across
their stomach holding a pillow if they find this more comfortable. Have them force their arms
sharply inward and upward while coughing in order to cause the abdominal muscles and
diaphragm to aid in the cough. This will be less tiring and will produce a more effective cough.
Have the person try to inhale slowly and deeply through the nose allowing the stomach to come
out and the diaphragm to drop. They should hold their breath 2 to 4 seconds.
117. Now they should cough 2-3 small blasts of air. The first cough loosens the mucus and the
next moves it so it can be expectorated. If the person produces a low pitched, hollow sound, the
cough is coming deep from within the chest. High-pitched noises generally originate higher in
the chest. The high-chested cough may be good for clearing the upper airways once the mucus
has traveled that far; but it is not conducive to getting the mucus up from the lower airways.
Have the person relax…breath easily. Do not have the person take big, gulping breaths after a
cough as this may cause coughing spasms and may force the mucus back into the lungs. If they
still feel the urge to cough, try drinking a little tepid water or gargle with equal parts of lemon
juice and hot water. Lemon juice seems to be especially good to cut phlegm and to soothe the
throat. Repeat the process throughout the day and after each postural drainage position. Inspect
the mucus. Note its color and consistency for this is very important for early detection of other
concerns/complications.

118. Body mechanics is using the body in an efficient and careful way. It involves the use of
good posture, balance, and the strongest and largest muscles of the body to perform work. We
teach good body mechanics here because we want to protect the caregiver from injury so they
can remain well to give needed assistance to the sick person. Posture, or body alignment, is the
way the body parts are aligned with one another. Good body alignment (posture) allows the body
to move and function with strength and efficiency.

119. Balance-base of support is the area upon which an object rests. The feet provide the base of
support for human beings. A good base of support is needed for balance. The strongest and
largest muscle groups, which are the shoulders, upper arms, hips, and thighs, should be used to
lift and move heavy objects.

120. Use the strong muscles of your thighs and hips by bending at the knees and squatting to lift
heavy objects. Avoid bending from the waist when lifting. Bending from the waist involves the
small muscles of the back. Hold objects close to the body without the object touching your
clothing. If the object is held away from the body, strain is placed on the smaller muscles of the
lower arms.

121. The following rules will help you use good body mechanics to lift and move people and
heavy objects safely and efficiently:

Stand in good alignment and with a wide base of support (your feet should be 12 to 18
inches apart.
Use the stronger and larger muscles of your body. Remember, they are in the shoulders,
upper arms, thighs, and, hips.
Keep objects close to your body when you lift, move or carry them.
Avoid unnecessary bending and reaching. If possible, have the height of the bed level
with your waist when giving care.
To prevent unnecessary twisting, face the area in which you are working.
Push, slide or pull heavy objects whenever possible rather than lift them.

122. Use both hands and arms when you lift, move, or carry heavy objects.
Turn your whole body when you change the direction of your movement.
 Work with smooth and even movements. Avoid sudden motions.
Get help from another person to move heavy objects or the ill person.
Squat to lift heavy objects from the floor. Use the strong hip and thigh muscles to raise
yourself to a standing position.

123. Pain is an individual experience that is tied to both physical and mental states. Even noise
makes a person tense, which can contribute to pain. Fatigue, depression and anxiety can make
pain harder to tolerate. (Lying in bed does not lessen the pain, although it may appear that the
person is comfortable and relaxed.) Types of pain people experience are acute and chronic.
Acute is short-term pain from illness or injury, which can be managed with prescribed narcotics
or analgesics. Chronic pain is continual over a long period of time. You will most likely be
dealing with acute pain in this situation. You may only have over-the-counter medications, such
as ibuprofen or acetaminophen and good massages.

124. How do you know when the person can be out among others? Generally, after the fever has
been gone for 24-48 hours and the cough has limited.

125. While it is very difficult to think about , people do die. No matter what you do , you may
have to deal with the person dying at home with only you in attendance.

126. What influences people’s attitudes toward death?

Experiences
Culture
Religion
Age

Many people fear death. Others refuse to believe they will die. Some look forward to and accept
death. Attitudes and beliefs about death often change as a person grows older. They also are
affected by changing circumstances. Attitudes about death are closely related to religious beliefs.

127. Before you can deal with the death of others, you need to :

Know your beliefs and attitudes

Respect others’ beliefs
Respect and support differing attitudes and beliefs your family, friends and neighbors
may express.
Don’t assume your beliefs and attitudes are shared by them. Beware of pushing your
beliefs on others. This is not the time to proselytize. Respect other’s beliefs and attitudes.
Psychologists, counselors or spiritual advisors can help you deal with thoughts or feelings
that make it difficult for you to deal with death.

128. Remember in some situations like a pandemic flu:

Medical assistance may not be accessible. To avoid exposure to the disease, clergy, other
family members, and the coroner may not want to and perhaps should not come inside
 your home. You will have to deal with the dying person. You will have to care for the
person after death in a responsible, respectful manner that will not contaminate the
environment. As uncompassionate as it sounds, dead bodies spread disease. Bodies must
be handled wit care so others do not get sick and die.

129. There are two very important aspects of communication in dealing with the dying person.
These are listening and touch. The person needs to talk, express feelings and share worries and
concerns. Let the person express feelings and emotions in his or her own way. Just being there
and listening helps meet the person’s needs. Don’t worry about saying the wrong thing. Do not
worry about finding the right words to comfort the person. Nothing really must be said. Do not
feel that you need to talk. Silence, along with touch, is a very powerful and meaningful way to
communicate.

130. Physical needs:

Dying may take a few minutes, hours, days or weeks.

There is a general slowing of body processes, weakness, and changes in the level of
consciousness.
Provide for peace and dignity in death.
As the person weakens, you will need to meet the person’s basic needs. The person may
totally depend on you for basic needs and activities of daily living. Every effort must be
made to promote physical and psychological comfort.

131. Signs of dying:

Movement, muscle tone, and sensation are lost.

Digestion slows down
Circulation fails and body temperature rises.
The respiratory system fails. Slow or rapid and shallow respirations may be observed.
Pain decreases as the person loses consciousness.
This usually begins in the feet and legs and eventually spreads to the rest of the body.
When mouth muscles relax, the jaw drops. The mouth may stay open. There may be a
peaceful facial expression. If the person has suffered, there may be a tortured
expression.
There may be abdominal blotting, uncontrolled diarrhea, constipation, nausea, and
vomiting.
The person feels cool or cold, looks pale, and may perspires heavily. The pulse is fast,
weak, and irregular. Blood pressure begins to fall.
Mucus collects in the respiratory tract. You may hear a “death rattle” or gurgling sound
from the throat or you may hear short rapid breaths followed by long pauses.
Some persons could be conscious until the moment of death.

132. Signs that death has occurred:

Final absence of pulse.

Absence of respirations.
 Absence of blood pressure.
Pupils of the eyes remain enlarged (fixed and dilated).

133. Post-mortem (after death) care includes:

Maintaining good appearance of the body.

Treating the body with dignity and respect.

134. Steps of post-mortem care

First, wash your hands and gather necessary supplies:

Shroud (sheet, blanket, and/or body bag)
Clean clothing
Identification tags x 2
Gauze squares
Safety pins
Washbasin
Tape

135. Begin the procedure by putting on disposable gloves, if available.

Make sure the body is flat on the back with arms and legs straight.
Gently pull the eyelids over the eyes. Apply moistened cotton balls gently over the
eyelids if the eyes will not stay closed.
Place a rolled towel under the chin to support the mouth in the closed position, if
necessary.

136. Remove all jewelry and put it in a safe place.

Bathe soiled areas of the body with plain water. Dry thoroughly.
Place clean clothes on the body.
Brush and comb the person’s hair, if necessary.
Place an identifying tag on the ankle or toe.
Be sure to replace the body on the back with arms and legs straight.

137. Applying the shroud:

Place the body on the shroud, sheet or blanket.

Bring the top down over the head.
Fold the bottom up over the feet.
Fold the sides over the body.
Secure the shroud in place with safety pins or tape.
Attach the second ID tag to the shroud.

138. Place the body in a safe, COOL place until the coroner or his designee is available to pick
the body up.
 Strip the bed and bag the linens.
Wash your hands.

139. When a loved one is dying or dies, there is a grieving process you go through. Recovery is a
slow and emotionally painful one. You should try to understand that loss and grief is a natural
part of life. Learn to accept your loss and believe in yourself. Believe that you can cope with
tragic happenings. Let your experience be a psychological growth process that will help you to
deal with future stressful events.

The grieving process usually consists of the following stages. Note that not every one goes
through all of the stages nor is the progress through the stages the same for everyone.

Denial
Anger
Bargaining
Guilt
Depression
Acceptance & hope

140. How to cope with your lose:

Discuss you feelings with others

Maintain hope
Draw on your religion, if you choose

Take care of yourself. This piece is sometime neglected. Remember to get plenty of rest. Eat a
well-balanced diet. It takes time to heal. Some days will be better than others. Some signs that
you or others need more help to cope are deep depression, talk of suicide, heavy drinking, drug
abuse, violence, etc. Get counseling or help others get counseling if you see these signs.
Any pandemic could result in many millions of people becoming sick and dying. PREPARE
YOURSELF!

141. The inspiration for this program came from a document written by Grattan Woodson, M.D.,
F.A.C.P. The document was titled Preparing for the Coming Influenza Pandemic. He brought out
how important it was for the public to know how to care for themselves and others close to them
during very trying times. He based his work on the threat of a pandemic influenza. This “flu”
would be caused by a virus in birds. The experts feared it would change and be able to spread
from person to person in the very near future. We felt it was important to expand on his work to
help the public care for themselves in the event of any contagious disease or emergency that
would stretch the healthcare resources over capacity. When that happens, home may be the best
and only option to care for those close to you. For more information please call your local Public
Health office or check out our website at www.lcwy.org.

142. No narrative
143. The program is brought to you by Lincoln County Public Health, Lincoln County,
Wyoming. The program was created and researched by Constance E. Sweeney, R.N., B.S.N. It
was edited and approved by Suzanne Pearson, R.N., Manager of Lincoln County Public Health.