Advice after your nerve block for surgery
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Introduction
It is common for people with long term respiratory conditions to feel breathless and tired when completing everyday tasks, especially when unwell, fatigued or having a bad day; even a simple task such as getting up from a chair or climbing the stairs can feel exhausting. This leaflet explains how to use Energy Conservation principles in everyday life to help maximise energy levels and remain independent at home.
The 5 P’s principle - Pacing, Planning, Prioritising, Positioning and Practice
We can use these principles to help avoid fatigue, pain and a flare up of our respiratory symptoms. It is also worth noting the impact of:
- Fatigue can cause us to feel weary, weak, and exhausted – this makes us less efficient and can affect our independence and safety. It can also create psychological difficulties.
- Pain not only affects us physically, but also emotionally, impacting relationships with others around us.
- Anxiety about things in our lives or being anxious about breathlessness impacts how we cope with being breathless.
- Shortness of breath can lead to avoiding activity, which then results in a reduction in independence and ability, and consequently a loss in self-esteem.
Pacing
It is very easy to get caught up in the over-activity/under-activity cycle (boom/bust). We complete tasks in an “all or nothing” attitude - we do too much, feel exhausted and then stop doing everything to compensate. For example – climbing all the stairs in one go (boom), then having to rest for a long period of time before being able to continue because we are exhausted (bust).
By learning to pace ourselves we can learn to manage our energy levels and our breathlessness much better making the task more manageable. Using the stair example again – we would climb a few steps and rest for a short period to get our breath back, then repeat until we get to the top. Although this might take longer, it is more manageable and doesn’t take so long to recover after. It is better for our bodies to have a steady use of energy rather than an “all or nothing” approach.
Planning
Everything we do, from waking up to going to bed is classed as an ‘activity’ and uses some form of energy. Learning to recognise our energy levels on a daily basis is useful to help us plan. Imagine that after a good night’s sleep you wake up fully charged like a battery – if we have had a bad night’s sleep or are unwell then we have less energy for the day ahead. Everything we do uses a different amount and type of energy – for example getting washed and dressed could take up to 15 or 20% of our charge in effort. So, how are you going to manage to use your energy well and wisely to last the day? Bear this in mind when you are planning.
Personal care, household tasks, leisure pursuits, work and social activities, all require different types of energy. Activities can also be classed into physical, mental and emotional for example:
• Physical – going upstairs, hanging out washing
• Mental – doing a crossword, sorting out finances
• Emotional – changes in mood, worrying about personal/family problems
Think about the following aspects of activity:
- Time: How long something takes to complete; what time of day? Will I need rest breaks? Am I better in the morning? Or the evening?
- Speed: Will you be sitting, standing or strolling?
- Distance: How far? Will you need a break?
- Rest: Incorporate rest into strenuous or demanding activity
- Strength: Limit time spent doing arduous tasks
- Resistance: Mowing and vacuuming are good exercise but tiring
- Complexity: Make activity simpler. Break it down into stages
- Psychological: Consider the mood you are in; your motivation and stress levels – when we are stressed / upset we are likely to have less concentration for tasks in hand, leaving things unfinished
- Social: What about others’ perceptions? Would they mind if you rest or ask for help?
The following may help you to challenge old habits and can help you to plan:
- Choose the best time of day for the activity
- Make a list or keep a diary - some people use a weekly or monthly planner
- Break a job down into stages and work out what is needed for the job.
- What does the task involve? For example – will you be sitting, standing or walking?
- Plan ahead, organise tasks and distribute heavier activities throughout the week. Balance heavy activities (such as heavy shopping, gardening, washing windows) with light activities (such as dusting, light weeding, buying a few items from a shop), alternate ”heavy” and “light” days if possible.
- Organise the timing of activities to avoid unnecessary trips, for example limit the need to go constantly up and down stairs.
- Use equipment that will make things easier to conserve your energy (e.g., bath board or perch stool).
- Bear in mind you cannot do as much on a bad day as on a good day, or if the weather is very hot/cold or you are recovering from an exacerbation. Adjust your activities and your expectations!
Prioritising
To help prioritise – ask yourself: What do I need to do today? What do I want to do today? What can wait for another day? Can I ask for help?
• Be realistic – set yourself realistic and achievable goals
• If it’s not urgent, let it wait!
• Don’t commit yourself to things that are unmanageable
• Check whether you can get someone to help you – don’t be afraid to ask for help
• Aim to complete the activities which are most important and satisfying to you
Top tips to help you conserve energy
- Take frequent rests before, during and after completing a task. Frequent short rest periods are better than a few long ones. The practice of resting before you become tired/exhausted is so effective that it should be your top priority in energy conservation. Don’t fall into the ‘five minutes more’ trap. Learn to recognise your energy levels.
- Use your breathlessness management techniques, including ‘pursed lip breathing’ and ‘blow as you go’ during activities.
Positioning
Poor posture can, over time, lead to pain and joint fatigue, and affect breathing and energy. Review the positions to help recover from breathlessness in the exercise handbook. Other tips include:
- Avoid bending right down to ground, reaching up and pushing/pulling or twisting. When you bend down or twist your lungs are squashed which makes it difficult to take in a deep breath. Any activities that involve having your arms above your head (e.g., hair washing) use more energy.
- When putting on shoes – breathe in before you move, breathe out as you bend down
- If you’re dressing, bring your foot up to you. Ask someone to help. Get long handled aids.
- Keep your arms and body close to the activity you are performing
- Organise equipment/food to be within easy reach
- Sitting uses less energy than standing therefore where possible, consider sitting whilst ironing, washing dishes, strip washing, showering, kitchen prep, gardening making a phone call or working in the shed, keep a high stool or chair to use in your kitchen
- Keep most activities between the waist and shoulder level
Lifting
- Avoid heavy lifting where possible - do not carry or pull equipment if you can push it
- Carry objects close to your body - use both hands whenever possible while carrying
- Let your bigger muscles do the work, squat with your legs and avoid bending your back
- Divide the load up – e.g., carry bags of groceries indoors from the car in several trips, half fill the kettle, etc
- Avoid twisting the back or leaning sideways especially while the back is bent when lifting
- Keep your head up when handling the load. Look ahead, not down at the load once it has been held securely.
- Don't lift or handle more than you can easily manage. There's a difference between what people can lift and what they can safely lift.
- Blow as you lift!
Here are some handy hints on ways you can modify everyday activities:
Washing and Dressing
- Sit on a chair/stool to wash or shave. Support elbows on sink/table
- Have all toiletries/towels to hand
- If possible, request help with washing your hair – raising arms above your head uses more energy
- Use bath mats and grab rails to steady yourself.
- Use equipment like bathboards, a bath lift, a long-handled sponge, a back brush or a towel sling
- A towelling bathrobe will dry you with less effort than towel drying
- Maintain a warm temperature of water. Avoid hot, deep baths as they can drain your energy
- Ensure there is plenty of ventilation in the bathroom
- Chose lightweight stretchy clothing, with front fastening
- Dress your lower half first, minimise bending with shoe horns, sock aids, slip on shoes
- Exhale when bending and on effort
- Avoid aerosols such as deodorant and hairspray – can irritate the throat, making us cough
In the Kitchen
- Use convenience meals as a speedy alternative
- Plan ahead, e.g., write shopping lists and stock the freezer
- Sit down to prepare food. A perching stool may help
- Slide heavy dishes and pans – do not lift or overfill
- Fill the kettle using a jug or use a travel kettle
- Organise your kitchen - place items used often at waist level and in one place near your work area to minimise trips around the kitchen
- Prepare part of your meal earlier, e.g., peel vegetables in the morning
- Good ventilation when frying/stir-frying food – these methods can trigger fumes and smoke which can impact breathlessness
- Rest after eating and before clearing up
Shopping
- Plan weekly menus and keep a list as you run out of ingredients
- Familiarise yourself with the supermarket layout and shop methodically
- Use a small trolley rather than a basket or large trolley
- Order via the Internet or make use of home delivery services
- Ask for help in packing your bags and reaching for items up high or down low
- Load bags half full to aid carrying
- Shop at quiet times so that it is a less stressful, rushed experience
Household Tasks
- Transport laundry in a basket or trolley
- Have the washer/drier raised to avoid bending down
- When vacuuming, regulate your breaths with the push-pull motion
- Avoid using aerosol-type cleaning products which can irritate the airways
- Clean the floor with a long-handled mop and use long handled dustpan and brush
- Make the bed in stages and sit down when necessary, make one side at a time
Leisure
- Do not give up what you enjoy doing – the key is finding a balance between activity and rest
- When gardening, sit down and use a long-handled trowel or hoe. Consider having raised flower beds or a window box
Resources
Some standard equipment items can be ordered by your occupational therapist. Once you know what you are looking for, it’s worth searching independently as often Amazon, Argos and many larger supermarkets and stores offer some items at a lower price. If you don’t have internet access, you can always phone to ask for a catalogue: here are just a few suggestions:
www.
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The Motability Scheme
www.
The Motability Scheme enables disabled people to lease a new car, scooter or powered wheelchair, using their Government funded mobility allowance. If you receive the Higher Rate Mobility Component of Disability Living Allowance, the Enhanced Rate of the Mobility Component of Personal Independence Payment (PIP), the War Pensioners’ Mobility Supplement (WPMS) or the Armed Forces Independence Payment (AFIP) you may be eligible to join the Motability Scheme.
Help with Food shopping / Meals
Assisted Shopping - Sainsbury's Shop On-line Telephone Service
Anyone wishing to use this service has to register first. Orders do not necessarily have to be done online, they can be made over the telephone. Sainsbury's deliver seven days a week. Delivery charges apply and vary depending on the total cost of the shop, and the day delivery is requested.
Telephone: 0800 328 1700 Website: www.sainsburys.co.uk
Milk & More Online
The service needs to be set up online via computer. Your local milkman can deliver more than just milk! You will know the name of your local milkman and what their delivery days are. Worth considering if you are familiar with using a computer or have family/friends who will help. Phone direct for information, Customer Services 0845 606 3505 - www.
Cook offers frozen homemade meals – order online or check their website for a local shop – www.
Other useful reputable companies are Wiltshire Farm Foods and Oakhouse Foods.
Both companies have a range of meals that are delivered frozen on a weekly or fortnightly basis, which means that you can enjoy them whenever you like - all you have to do is pop them in an oven or microwave. Both offer a wide variety of options for people with different tastes or dietary requirements. Phone them to ask for a brochure.
Wiltshire Farm Foods 0800 773 773 Oakhouse Foods 0845 643 2009
Contact us
If you have any queries relating to this information, please contact the Respiratory medicine service.
About this information
Service:
Respiratory medicine
Reference:
W/043
Approval date:
16 August 2023
Review date:
1 August 2026
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.