Friends--Dennis Greene sent this some time ago, and it may be useful to any
PWP facing hospitalization. You can modify it to fit your own situation, of
course.
**********
Date: Mon, 5 May 1997 19:08:26 -0400
From: Dennis Greene <[log in to unmask]>
Subject: Fw: Hospitalisation Form
>
> AS A PERSON WITH PARKINSON'S DISEASE I HAVE PROBLEMS
> WITH THE ITEMS CHECKED BELOW
>
>FullName:.......................................................................
>...............................................
Doctor:......................................................Neurologist:... ...
.........................................
> MEDICATION
1. I need my Parkinson's medication administered EXACTLY on schedule.
2. Without medication I will become rigid and disoriented.
3. Response to medication may affect physical therapy timing.
> AMBULATION
4. I have difficulty with balance.
5. I may freeze and fall.
6. I require help getting motion started and walking.
> ELIMINATION (underline specifics)
7. I have urinary problems: either hesitancy, frequency, inability
to wait, or incontinence.
8. I suffer from constipation, need special diet or other treatment.
Impaction is a significant danger.
> COORDINATION
9. I cannot open food containers easily.
10. I cannot always repeat a former action.
11. I may not have the strength to push a call button.
12. I have slow responses.
13. I have trouble turning over in bed.
> COMMUNICATION
14. I have low voice volume.
15. I have difficulty enunciating.
16. My face shows little or no emotion ("mask" of Parkinson's).
> EATING AND SWALLOWING
17. I choke on food and require a special diet.
18. I am a very slow eater.
> SLEEPING
19. I have trouble getting to sleep.
20. I sleep fitfully.
21. I have anxiety sweats
************
> Adapted from a list by Beverly Steward (Central Ohio Parkinson Society
> Newsletter) which has been designed to make your stay in hospital as
>satisfactory as possible. It is important to explain to the nurses some
significant facts about the way PD affects you. Ask to have this sheetput
in your file at the nurses' station. You might also consider having a
close family member get a limited power of attorney to represent you, and
if you have a Durable Power of Attorney, be sure the doctor and hospital
have copies.
