24-hour nursing care. That’s what I do.
I take care of this pack of pekingese: one has chronic glaucoma and needs special eye care; one has end-stage liver disease and needs medication and special diet; one is suffering from an intestinal Claustridium infection and needs medication, special diet, and probiotics.
I need a beer. And more clean towels.
A Case Study: Joey, age 7, needs eye drops in his right eye every twelve hours to treat a progressive degenerative eye disease that will eventually result in blindness. He had a left side enucleation (removal of the eye) six months ago which he tolerated remarkably well. His family is supportive, but very nervous about his eye care and worried about his future blindness. He is an active guy, otherwise healthy, with a very positive attitude. However, he is understandably squirmy when his eye drops are due. Our challenge is to develop a daily routine for eye drop administration that is workable for Joey and at least two family members. Right now, only mom is able to give the eye drops and she needs backup. Ideas?
Discussion: Eye drops are tricky. If you’re giving them for a one-shot deal, you can use the come-from-the-side sneak attack strategy, but long-term daily use demands a different approach. In this case, as is generally true, everybody will have an easier time if the patient has a relaxed face. Relaxing the face is itself a challenge. In Joey’s case, we found a good relaxation trigger by accident while treating his enucleation post-op: applying moist compresses, alternately cold and warm, on the incision area helped relax his entire face. When his face was relaxed, it was easier to administer the drops in the fellow eye. Obviously, the entire process went more smoothly when he was in a quiet environment and the care giver was not rushed. Joey was encouraged to sit quietly before getting the drops; he began to associate the “quiet time” away from siblings as a positive experience. He was given “treats” (ideas: stickers, apple slices, etc.–whatever is used as positive reinforcement) following the administration of the drops. After the surgical incision healed we continued to used warm compresses on the face for a few minutes before giving the drops–classical conditioning at its finest. Now we are working with family members to use the facial relaxing techniques on fellow adults before moving on to Joey’s care. Encouraging consistency, relaxation, an unhurried tempo, and positive reinforcement is making the process easier for everyone.
FULL DISCLOSURE: “Joey” is really our Pekingese dog, Otis. I have learned a lot from doing his eye care these last six months. I realize my approach while working as an EENT nurse, chunking out pre-op eye drops, will not work in the long term. You do have to be deft, of course, but the take home message is “take enough time and work on relaxation cues.” Nobody, man nor beast, likes to have something coming at his eye. Be sure to prepare the dropper (gently roll the bottle, unscrew the cap, load the dropper end so you’re not madly shaking it) before getting the patient ready. Have the patient comfortably seated; place a warm compress on the fellow eye or forehead–whatever position is relaxing; give a reward (Otis gets Liva Snaps).
I’m working with my husband to help him learn Otis’ eye care. He’s freaked out, but willing to try. We’re both very sad about Otis’ inevitable blindness from glaucoma, but we will stave it off as long as we can with good eye care.
