How about a little Continuing Education Credit for you?

This is the post-test portion of one of the learning activities I wrote at work for my staff members. Thought you may find it interesting. There is a learning guide to accompany but it took up too much blogspace to include here... also sorry about some of the formatting glitches when I posted this.


Pain in Confused Elders Self Study for CNA’s Name:________________________
1 hr credit Learning Activity Portion (Post test) date:__________________________

Please read the information below and complete the questions for credit. Return to Ruth’s mailbox. Thanks.

My name is Nadia. I am 67 years old. Well, actually, I can’t talk to you or tell you my name; I have dementia and also, I am originally from Brazil; I converse in a mixture of languages and you can’t quite understand me. I mumble. But if I could talk to you, I would tell you this: I hurt! My pain is nearly killing me. I don’t understand why I hurt and I wish I could get some help! But I can’t tell you that, so you will have to take my verbal and non verbal cues, and put the picture together.

What verbal or non verbal cues would you expect to see from someone like Nadia, that could help you guess that she is in pain? Circle any cues that you think are possible.

Moaning- grimacing -crying- rubbing an arm or other part of body-
Frowning -appears frightened -aggressive when approached -irritable -
Restless- wringing hands -resists cares -not sleeping well -not eating well
Withdrawn- more confused that usual- trying to elope(new behavior) -guarded

You noticed many of these behaviors in Nadia and reported them to the nurse, who reported them to the doctor, who has seen Nadia. He concluded from history and current information that Nadia is suffering from poorly controlled Rheumatoid Arthritis pain. You learned this today in report. You are thinking about what you can do to help Nadia, since you are a caring and loving staff member and you hate to think that she is in such horrible distress. You decide that when you notice she seems to be in pain you should:

(Circle all that apply)
Y Tell the nurse right away
Y Make sure you take care of her basic needs (like toileting)
Y Totally avoid Nadia because you can’t stand her wailing
Y Sit with her, give her a hug, offer assurance if at all possible
Y React to her in a calm manner, avoid rushing while with her
Y Use the skills that seem to have worked with Nadia in the recent past

If you tell the nurse right away, you could expect what to happen?

Y The nurse will likely assess the pain level and then decide what to do for Nadia.
Y You know that Nadia has a prn pain medication ordered. You expect the nurse to perhaps
give her this.




In addition to Dementia, Nadia has a few other limitations. One of them is that she is wheelchair bound (cannot get up by herself) and needs you to help her reposition, transfer and move. She requires one assist to reposition in chair or bed and two assist to transfer. How could this affect her comfort level?

Y She is more likely to get stiff and sore, since she cannot move by herself.
Y It is harder to meet her needs on some shifts and at certain times.
Y This does not affect Nadia’s comfort level. She can sit in her chair for long hours on end
without pain. Can’t everyone?
Y I would be certain to look at pressure areas often as she is also at risk for painful sores if
she cannot move, besides becoming stiff from lack of movement.

Nadia has been referred to the restorative program for help with range of motion, since it is getting harder and harder for her to complete activities. You are really happy about this. You know that the assistance and attention will help Nadia in what ways?

Y She is likely to retain more function for a longer time.
Y She probably will enjoy the personal one-to-one time with a caregiver.
Y Frequent movement may decrease pain for her.


Nadia initially enjoyed the ROM exercises and the attention, but recently has begun to resist them, shows agitation, and hits out at the caregiver providing them. She then seems to reclude to an area by herself and cry. From these verbal and non-verbal cues, you begin to wonder about what?

(Choose the one most likely answer)
Y Nadia doesn’t like her caregiver anymore.
Y Nadia doesn’t like the exercises anymore.
Y The exercises are causing pain for Nadia.

You talked with the nurse about the changes you noticed in Nadia’s behavior. The nurse was really glad that you explained to her what you had seen, and asked you to let her know at least ½ hr before the next ROM exercises. You do so, and the nurse gives Nadia the prn pain medication. This becomes the common practice as you notice that Nadia once again enjoys the ROM exercises she is doing. Great job helping your resident!

Based on what you know about her, is Nadia at risk for a fall?

Probably yes, because:



Probably no, because:




I felt this learning activity was enjoyable and helpful. yes no no opinion
I like this format better than the previous self study formats. yes no either is ok

Guess I'm lucky after all...

Ok….so I absolutely had to go car shopping. I was in a little bind; I had work related commitments Thursday, and the chili pepper was acting up since Sunday, laid to rest on Wednesday. A moment of silence for my cute little red van, please… Moving on. This meant, I have no car! And unless I wanted to drive the pickup (without power steering) 44 miles to daycare and work, I had to do some quick problem solving. Here are the possible solultions as they came to me in that moment:
A. Drive the pickup. Good exercise.
B. Buy a hot sexy Mustang convertible, after all, you DO have to go car shopping…
C. Get a cheap 4 banger asap and make it do.
D. I SO WANT a stickshift! I refuse to compromise my values in this aspect….
E. Just get yourself to the dealership and look around, Ruth, don’t stand here daydreaming. You have 4 hours to figure this out!

So off we went (Dad included) to the nearest dealership at which we knew someone. It happened to be Hokah Auto Outlet, twenty minutes down the highway from where my van gave up. They had three vehicles within the price range I could afford (I could? From what budget was I pulling this figure?). There was a ’99 Ford Windstar, and ‘96 Mercury van, and a 2003 Chevy Venture (van). I sized them up. My spirits sank a little lower.

None of them were red or sexy, sigh….

We drove the powder blue Windstar first. I decided before I even sat in it that I didn’t like it, couldn’t own it and hate it. Too bad. It ran nice and included a DVD player. Well, it did have a “check engine” light on the whole time. I told Dad forget it, I don’t want it. He told the dealer about the light and the dealership put it on the computer at no charge to us. It had three minor problems with a total of 300-500 USD to fix it. This made that vehicle STILL the cheapest option among the three.

We walked past a royal blue GT two seater 5 speed on the way to the garage where we were going to have coffee and warm up. I tried not to look at it too much.

Next up was the Mercury van. I am not familiar with the Merc Vans. It wasn’t there, because one of the dealer boys had driven it home last night. He said it was a great little deal and ran awsome. It had a new old engine in it since it recently blew a gasket or something like that. The guys around there used it for a runner.

Since the runner wasn’t there we drove the Chevy Van next. I drove it first, it was quiet, and it was fast. It is mechanically sound and rust free. There end the perks of this vehicle-but that is pretty perky. I mentally decided to make a lousy offer for this one and forget the one we hadn’t seen. I needed something I could drive home right now. So I decided how high I was wiling to go and no further.

Step back for one minute and realize, neither of these vehicles are what I really like in a car. All of them are bulky and high. The pale blue one looked like a sausage somehow, I think it was the way the hood was designed; the Chevy was silver, of all awful colors, and an auto 4 speed tranny . But….reality sets in when you slip your hand in near your pocketbook….not in a position to be choosy…need a way to work tomorrow….had to decide what to do. Consider I need a vehicle with room for three car seats all the time and sometimes other riders. A van is the practical answer to this.

While I was thinking, drinking coffee and staring out the window the dealer was chatting with Dad. They both walked over toward me, so I figured Dad needed a cup of coffee too. Then, a good thing happened.

“You can take this one home tonight, get a feel for it, ya know…take her to work tomorrow. Check in with us tomorrow night and let us know what you think.” This solved my problems for exactly 24 hours and I shook on it.

I would like to notate here: I was going 60 on the bottom of Shibley hill. There were four vehicles behind me. Just to check out the vehicle I put the pedal down and pulled away from them all. Guess Chevy had reasons for putting a 6 cyl 3.4 in this thing! Zoom. Going nearly 70 by the top of the hill and no lack of power at all. I laid off a little to avoid speeding too much (with a car I didn’t own besides).

I drove it home. It drives great. Really quiet. I have to listen really carefully when turning the ignition-it turns over so smooth. Automatic windows, locks, doors and stuff. I don’t even know how to use all that stuff. I took it to work, and thought it looked pretty darn decent in its parking spot.

That evening I did go back to the dealer. The mercury still wasn’t there. I made a low offer on the Chevrolet Venture. They grimaced a little. The dealers had to discuss this. Eventually we agreed upon a price which seemed fair enough to all and I now am the proud owner….

of a not red vehicle which is not a stick. But oh well! Guess my pride has to wait until next time. But hopefully there won’t be a next time for a long while! I have decided by willpower to like silver vehicles…

with red seatcovers. (I just had to get some red on that thing!)

How lucky or not lucky am I ??

Story from the frozen north
If you happen to start your car, and it makes a cracking noise when you crank it over, that is a bad sign. If you also notice that the heater blows cold air on the hot air setting, warning sign! If it smokes all over the place and stinks you better take note. If you smell antifreeze shut her down!
I noticed all the warning signs and decided not to drive it home (this was Monday night, after work, with the kids at daycare and in the middle of a bad snowstorm). I called a buddy of mine who swung through town and took me home, while my mother was supposed to be getting the kids. She decided it was too dangerous and made Dad get the kids, that is how bad the storm was. I really, really hoped it was just a simple problem that could be solved with bars leaks and antifreeze or maybe a new muffler. NO SUCH LUCK.
I explained the symptoms to Dad when I finally got home (three hours later, in the storm) and we both didn’t smile. It sounded grim. We decided the next day when the storm broke we could try to get her home somehow. Poor little cute red van. However, the next day the storm cleared ok, but we didn’t have a vehicle to use to go after the van, and the roads were not clear until 3 pm. Oh well. That meant it had to wait until wednesday.
Wednesday we finally got over to my workplace to look at the van. Dad wore coveralls and I wore camo pants and my camo jacket (you can’t wear dress clothes to crawl around under cars). I brought my work clothes along hoping it was minor and Dad could drive her home while I went to work. NO SUCH LUCK.
We fired her up and nearly choked to death in the haze. We crawled under it looking for leaks and problems. We noticed the muffler had partly disconnected but that wasn’t the source of the acrid haze, which seemed to be coming from everywhere. We took the car to the auto shop and bought a gallon of antifreeze and bars leaks for the van.
After adding the bars leaks and antifreeze the smoke was a little less and we started out after warming her up good. We made it almost two miles when she boiled over. We pulled off into a parking area. We headed out for the auto shop, where we picked up two more gallons of antifreeze. We both didn’t say so but both wondered about the wisdom of this endevour…
We fired her up again. I was silently amazed that she started. Off we went in a blaze of glory cloud of haze heading homeward bound so we hoped.
We made another two miles when Dad decided we needed to stop. It wasn’t boiled over just yet….we gave her a chance to cool a little while we filled our hungry stomachs with cheap sandwiches and coffee. We didn’t talk much. We wondered some more.
We pulled out toward home, but before we could get home, we had to make it over the cass street bridge without killing the car or having it boil. I could hardly see my own car (that Dad was driving) through the smoke and exhaust. I had to leave a generous margin between us so that I could safely drive at all. Dad put the hammer down when he pulled away from the stop light and seemed to accelerate on a mission to make it over the bridge. I thought a small miracle occurred-we made it. We kept going and I really, really, hoped we could get to LaCrescent and that Dad would then shut her down. We had to stop one more time before LaCrescent. I couldn’t believe it. Well, then again, I could.
We made it through LaCrosse, and then managed to make it through the stoplights at LaCrescent. Just as I was thinking that the smoke was getting less severe, Dad signalled. We were pulling over again. GOOD CALL.
It so happens that Dad decided to pull into the shop and ask a few questions. The car killed for the last time just in front of the shop. She never started again….sigh. We called the wrecker.
I still think it is amazing. We made it 24 miles on a blown head gasket. Too bad we couldn’t make it another 21-since if we did, I wouldn’t have to pay the wrecker. But as it is, it’s a lucky thing that Dad accepts payment in donuts for his part in it. LUCKY ME.
After being forced to accept the sad fact that my red van, known as the red chili pepper, had earned a new name as Smoky Joe, and was destined for the car graveyard, we had to go car shopping. I need a car by tomorrow.
TOMORROW SHOULD BE ANOTHER ADVENTURE!
To be continued…

Cute Poem

Happy are the children

Wherever they are

Who live in a house

With a full cookie jar!

Found this cute little jingle on one of my mom's ceramic cookie jars. :)
I filled it with cookies. Smile! :)

Christmas Wishes

Christmas Wishes (2007)

I wish I was a musician to give you a song of Christmas
No, no, I wish I was the music!
I would be a perfectly tuned violin string
Vibrating with faultless pitch making you feel Christmas

I wish I was the wind that might have blown
Across the holy child that evening
That solo chance, one moment in time
In which I could have touched his tender face, just once

I wish I was all the good intentions that were wrapped
Gifted into each carefully chosen package
The ones intended for the children, the good little children
And then I could sense the essence of Christmas again

I wish I could give you a ray of light from a stained glass window
You could keep it in your wallet all year
And remember Christmas, be aware of it there with you
And know it like joy that keeps vibrant even when silent.

And I wish I was an antique hand-carved wooden creche
That was scented of old wood oils and sweat and care
And was kept in the closet all the year long until December
When the family would fondly remember Grandfather’s faith

I wish to say a prayer for you this Christmas season
That makes you remember that its more than plastic and glitz
So you can feel Christmas, really grasp it, moving, coming alive
Because that it what it should become to us.

A recipe to try

Not Quite Pie

recipe by Ruth

Give this a try some adventurous afternoon at home.

This dish has two parts: the mixed fruit on the bottom and the biscuit-like topper. Any mixed fruit would do well, as long as it is moist but not runny. If you mix a fruit combo that is too moist, you may try adding tapioca (sago) to firm it up a bit. The original idea involved peaches. I ended up adding sago to the last one I made but the quality was still great.

Here is the fruit combo I used last:

1 lb fresh cranberries
two large apples cut up
one generous hand full of raspberries
a little sugar to taste
a little salt (say, ½ t.)
cinnamon, allspice, cloves, scant to taste

Boil the fruit together in a saucepan until it meshes and bubbles. Set aside off heat to cool. There should be some juice/sauce but not a lot.

Note: IF you happen to be in a tropical country (smile) you may like to try something involving mangoes. Or, apple raisin and rambutan??? You have to experiment with what you have. You can always rely on sago if you have to. I made this with just apple and raisin too and it was a nice, warm autumn comfort food taste.

Biscuit topper:

2 c. flour
2 T. baking powder
1 t. soda
little salt
enough milk, buttermilk, or cream to make the batter a thick pancake batter consistency, probably 2 cups or more

Mix this all together, dry ingredients first, adding the milk at once last.

Put the fruit mixture in the bottom of a large pie tin. Lay the biscuit batter over it in an even layer, sealing the edges so the fruit mixture doesn’t show much. Sprinkle a little cinnamon and sugar across the top. Put the pie tin on a cookie sheet to catch any drips. Bake ½ hour at 350 or until biscuit part is fully done. Serve warm. Have seconds.

Baling memory story

We worked hard on the farm, when I was a kid. You know the farm cannot produce without the farmer. And the farmer cannot do it all, and that is why the farmer has kids! Ha! This is more true than not.
A lot of summers have flown by since I was a kid and some things have changed since then. One thing in this big old world that is largely the same is the old family farm. I can envision the years that have gone by like shadowy ghosts when I walk the familiar fields and hilltops of home.
One of the most important jobs on a farm in the summer is making hay. That year we made hay while the sun shined. The sun was so hot that year you could feel it for hours after it went down in the evening. The sun was relentless in June. It was relentless in July. It was simply unyielding heat summer through fall, and we made hay all through it, including the dog days and fair week.
We ALL made hay. Those years we used an old Allis baler that made square bales. The sounds that came out of that machine would make alternative rock bands jealous. Every once in awhile it would shear a pin and really make noise. It pooped out heavy packed square building blocks in bunches all over the field and around the bend and beyond what I could see through the sweat that dripped across my eyes.
We started the operation after breakfast. Mom would fill the big jug with green juice-a combination of various citrus juices that came from a frozen mix and was supposed to be good for us somehow. We didn’t argue. There wasn’t anything else so we filled at least two of them. We tried to get the water as cold as we could. She made peanut butter or just butter sandwiches enough to fill an empty bread sack and we were ready.
Dad drove the Allis 185. Andy and I stood on either side and Mom drove the one ton ’67 ford over with the two “kids” with her. Of course Andy and I were kids but we were the “big kids” and we knew the difference. The little kids could quit when they got tired. Big kids can’t. We knew by now we were destined to a day, a summer, a life of constant work. We also knew better than to whine or complain about it. It only took us 5 minutes to drive down one hill and up the other to where we were baling. Then the work began.
Our job was to stay on the back of the pickup as Dad made bales. Mom would follow and pick them up with a heave and throw them into the tonner with the high rack on the back. When she did we would have to pack them one by one in tight rows. We had a bale buncher so they were already in piles all over the field and would be pitched up to us in overwhelming multiplicity. So we were scrambling for awhile then would get just enough time to catch our breath while mom drove toward the next bunch.
Our conversations were probably something like this-
“Oh man, theres a lot of bales on that bunch.”
“Yeah.”
“I’m awful tired Andy.”
“Not as tired as me, I’m doin’ all the work here.”
“You are not! Jus’ cuz your bigger don’t make it so!”
“I am too.”
And by then we would lurch to a stop next to the bunch of monster bales and pack them in straight even rows. My hands were too small to wear the jerseys comfortably so eventually my fingers would bleed. Oddly even though they would bleed they never hurt. They also seemed to always be ok by the next day.
Finally it was time to stop for lunch. That meant we could get out of the hot truck box. We would jump down over the endgate and run after mom for the drinks and lunch. Dad would bring the tractor around close by that round, or else he would stop it way off and walk over. If you are convinced that we kids worked hard, it was nothing compared to Dad. He was the iron of the family and no one could work harder than he. We knew this intuitively and respected him for the black grease on his hands and the furrow in his brow.
Dad was not a hard man then and he is not a difficult man now. Rough and gruff on the outside, and contemplative, but in front of us kids, he was all humor and soft smiles. We craved a break not only to get a drink of juice and a lousy sandwich but also because it meant 30 minutes with Dad. We sat around in the shade of the big truck and listen to some Ole and Lena jokes Dad was telling in between stories from his childhood. Mom was kept busy trailing after the little kids who never knew she would have liked to sit.
I grabbed the juice jug. It was lukewarm. If you tilted it fast you might get the cooler stuff from the middle but even that wasn’t cold anymore. I slugged it down anyway. I thought for the hundreth time how awful green juice tastes. I tried hard to eat the peanut butter sandwich but it was all mushy and had hay stuck to it. I gave it to my little brother. He would eat anything. I picked the berries off the nearby bushes and that was much better.
We settled in for a short rest while mom and dad solved some baler problem. We sat in the shadow of the big tires of the truck. I would have fallen asleep if I didn’t ache so much in the shoulders.
I didn’t realize then that aches in childhood go away when you sleep at night. I never thought about it at all. Now I know, childhood is a magical, wonderful time when aches and pains don’t last and hard times are hidden from the kids by loving parents who shoulder it with grace.
We would start dragging after lunch. It was so hard to go back to work after a rest. We work half as well and twice as slow. Usually there was another two hours in us, then another break, and mom would have to take us home for a real rest. And a bath. We would be allowed to spend the rest of the day ourselves. This may involve lounging around the living room, which was cooler than outside, creating a monumental mess by flooding the sandbox and then “farming” it, burrowing in to the middle of the lilac bush to play cowboys and indians, and ambush each other, and various other games. Toward evening we would be enlisted to assist with chores and the day would be over, destined to repeat itself with the next sunrise.
If Dad could spare the time we might play a little softball just before sunset.
Isn’t it amazing what we overlook as the time passes? Now that I am grown and have seen other places and other ways to live, memories like this seem so precious. I don’t have any resentment about being made to work. Quite on the contrary, it seems like a cherished gift.
I live on the home farm now with my kids. When I get the chance to walk across the fields out there the realness of the land hasn’t changed. It is firm and stable. I get the sense the land hasn’t noticed my absence. I’m just grateful that my own senses are alive again and I can see, smell, hear and feel the natural world all around me, and can be aware of what it is worth to work the land.

Millet Bulgur Dressing

Millet, Bulgur and Chestnut Stuffing from the current Martha Stewart Living Nov 2008

--I think adding a meat or tofu protein source could make this a great main dish as well. Ruth

½ cup millet, prepared to use
½ cup bulgur, prepared to use
2 T extra virgin olive oil
1/8-1/4 cup minced shallots
½ cup chopped celery
2 garlic cloves minced (I used jarred garlic 2 T)
1 ½ cups chopped shitatke mushrooms (I used less)
5 ounces whole peeled chestnuts, halved (or 1 cup)
1 T chopped fresh sage
1 T fresh thyme
3 cups low salt chicken stock (I used all natural venison stock and it was good)
¾ cup dried cranberries (I used a lot more than that)
1 teaspoon coarse salt
½ teaspoon coarse ground pepper

1. Cook grains to prepare separately.
2. Heat oil, add shallots celery, garlic, about 5 minutes. Add mushrooms, chstnuts, herbs, cook another 5 minutes.
3. Slowly add stock, riase heat to medium. Simmer 5 minutes. Stir in cranberries, simmer 3 minutes more.
4. Add millet, bulgur, salt and pepper, cook until heated through. Serve immediately.

If you’re a northern’r dairy farmer like me you might also add some home churned sweet butter….
Love, Ruth