Care considering the characteristics of the elderly

* Assess the contents and methods of lymphedema care based on age-related changes (skin tissue changes and decline of immunity, muscle strength, and cognition) and the status of ADL.

* Know the patient’s motivation to live after the experience of a loss and assess self-care motivation.

* Observe the skin and keep it moisturized after the cleanliness care desired by the patient.

* Explain self-drainage again, since patients often do not remember the guidance provided during hospitalization.

* Select elastic clothing suitable for weak skin and reduced grip strength and consider methods for putting it on and taking it off with the patient to encourage wearing it.

* Discover complications such as lymphatic leakage earlier, maintain cleanliness, and prevent infection.

* If the patient’s skin is itchy, keep it moisturized and provide nail care to prevent wounds.

* Pay attention to diseases characteristic of the elderly, such as osteoporosis and heart failure, and consider methods and frequencies with the patient to avoid overloading them.

* If it is difficult for the patient to put on and take off clothes or it is difficult for the family alone to provide support, choose easy-to-wear elastic clothing and encourage the patient to wear it according to his/her lifestyle rhythm.

* Recognize the accumulation of daily efforts and small efforts and provide praise while accepting that they were “bothersome” or “forgotten”.

Guidance based on lifestyle and support for continuation

* Know the time to onset after surgery and the lifestyle until onset.

* Assess the contents of lymphedema care during hospitalization and whether they can be continued at home.

* Consider with the patient ways to put into practice points to keep in mind in daily life without changing the lifestyle the patient has had up to then.

* Know about dietary habits, hygiene habits, and preferences with respect to clothes to wear. If they are factors in the deterioration of lymphedema, consider how to improve them.

* Provide encouragement and praise for continuation.

* Encourage the patient to incorporate family and work together with them on exercises the patient was good at.

* If the patient experiences skin problems caused by hobbies or housework, devise countermeasures, such as protecting the skin, instead of discontinuing the activities.

* During visits, check the self-drainage technique in conjunction with the performance of visiting-nurse manual lymph drainage.

* Do not disallow daily self-drainage; instead, teach how to comply with the manual when visiting.

Care closely linked to daily life utilizing the strengths of home-visit nursing

* Know the living environment (house/room) and lifestyle and assess the impact on lymphedema.

* Life problems caused by lymphedema and self-coping methods.

* Arrange the environment around sofas and beds for daily life so that patients can relax.

* If the structure of the house or layout of the furniture is a factor in the deterioration of lymphedema, work with the patient to consider and implement improvements.

* Propose exercises that can be done in daily life, such as cleaning and washing clothes.

* Predict the looseness of elastic bandages from the level of household tasks (range of behavior) and consider who will take on the role of removing the bandages based on the lifestyle rhythm.

* If the patient has over-the-counter drugs (such as ointments) that are used regularly, check the application and provide guidance on how to use them.

Factors influencing lymphedema care

Building relationships with family and people around the patient

* Know the family background, whether or not there are family members or caregivers, and other surrounding people and assess their care abilities.

* Know the relationships with care managers and assess their management abilitie.

* Show points to keep in mind in daily life while envisioning life with family or living alone.

* Implement support with the cooperation of family members. If the patient is able to continue, provide praise and help the patient to continue, and also provide support to get help so that the burden does not increase.

* Build a relationship of trust by devising methods (touch and massage) that can make the time peaceful during your visits, leading to motivation to fight difficult situations.

* Because a single problem makes it difficult for a patient to accept care the next time, cooperation with nursing care should be assessed, obtained, and implemented.

* Respond to family concerns when skin problems occur.