1. Explain personal care of residents

1. 1. Explain personal care of residents • Define the following terms: • hygiene • practices to keep bodies clean and healthy. • grooming • practices to care for oneself, such as caring for fingernails and hair. • activities of daily living (ADLs) • daily personal care tasks, such as bathing; caring for skin, nail, hair, and teeth; dressing; toileting; eating and drinking; walking; and transferring. • perineal care • care of the genitals and anal area.

2. 1. Explain personal care of residents • NAs provide the following care in the morning (a.m. care): • Assisting with toileting • Helping wash face and hands • Assisting with mouth care

3. 1. Explain personal care of residents NAs provide the following care in the evening (p.m. care): Assisting with toileting Helping wash face and hands Giving a snack Assisting with mouth care Giving a back rub

4. Transparency 13-1: Assisting with Personal Care • Help the resident be as independent as possible. • Be aware of resident preferences and routines. • Always explain what you will be doing. • Always provide privacy. • Observe the resident during care. • Note and report signs and symptoms. • Observe resident’s mental state. • Report any changes. • Leave the resident’s room clean and tidy. • Leave call light within resident’s reach.

5. 1. Explain personal care of residents Think about these questions: Why do you think that performing the personal care task is only half the NA’s job? What else do you think can be accomplished while providing personal care?

6. 1. Explain personal care of residents REMEMBER: While providing personal care an NA can obtain important information about the resident by asking questions and making observations.

7. 1. Explain personal care of residents It is important for NAs to observe and report changes in the following areas during personal care: Skin color, temperature, or reddened areas Mobility Flexibility Comfort or pain level Strength and ability to perform ADLs Mental and emotional state

8. 1. Explain personal care of residents REMEMBER: NAs must report any complaints a resident might express during personal care.

9. 2. Identify guidelines for providing skin care and preventing pressure ulcers Define the following terms: pressure points areas of the body that bear much of its weight. bony prominences areas of the body where bone lies close to the skin. pressure ulcer a serious wound resulting from skin breakdown; also called pressure sore, bed sore or decubitus ulcer.

10. 2. Identify guidelines for providing skin care and preventing pressure ulcers Define the following terms: foot drop a weakness of muscles in the feet and ankles that causes difficulty with the ability to flex the ankles and walk normally. orthotic device, or orthosis a device that helps support and align a limb and improve its functioning.

11. 2. Identify guidelines for providing skin care and preventing pressure ulcers REMEMBER: Pressure ulcers are painful and difficult to heal. They can lead to life-threatening infections. Prevention is very important and is the key to skin health.

12. Transparency 13-2: Pressure Ulcer Danger Zones

13. 2. Identify guidelines for providing skin care and preventing pressure ulcers REMEMBER: Observation is very important in the prevention of pressure ulcers.

14. Transparency 13-3: Observing the Skin Pale, white, reddened, or purple areas Blisters or bruises Tingling, warmth, or burning Dry or flaking skin Itching or scratching Rash or discoloration Swelling Fluid or blood draining Broken skin Wounds or ulcers Changes in wound or ulcer (size, depth, drainage, color, or odor) Redness or broken skin between toes or around toenails

15. Transparency 13-3: Observing the Skin (cont’d) In darker complexions, also look for Any change in feel of the tissue Any change in appearance of the skin, such as an “orange-peel” look Purplish hue Extremely dry, crust-like areas that might be covering a tissue break

16. 2. Identify guidelines for providing skin care and preventing pressure ulcers NAs should follow these guidelines for skin care: Report changes in residents’ skin. Provide regular skin care. Reposition frequently, at least every two hours. Give frequent skin care for incontinent residents. Change clothing and linen often. Avoid scratching or irritating skin; report blisters or sores on feet. Massage skin often. Do not massage white, red, or purple areas.

17. 2. Identify guidelines for providing skin care and preventing pressure ulcers Guidelines for skin care (cont’d): Avoid pulling or tearing skin. In overweight residents, pay special attention to skin under folds. Encourage residents to eat well-balanced meals. Keep plastic or rubber materials from coming into contact with skin. Follow the care plan and nurse’s instructions.

18. 2. Identify guidelines for providing skin care and preventing pressure ulcers NAs may be assigned to apply ointments, lotions, or powders to a resident’s skin. Not all NAs are allowed to do this, so it is important for an NA to know the rules in his facility. If he is assigned to do this task and permitted to do it, an NA should follow guidelines: Read the directions. Know exactly where it is to be applied. Know if it should be rubbed in or left on the top of the skin. Wash hands before and after application. Wear gloves Avoid getting any on clothing, as it may stain. Ask questions if anything is unclear.

19. 2. Identify guidelines for providing skin care and preventing pressure ulcers When caring for residents who are at a high risk for pressure ulcers (bed bound) NAs should remember these guidelines: Keep bottom sheet tight and wrinkle-free. Avoid shearing. Place sheepskin, chamois skin, or bed pad under back and buttocks. Relieve pressure under bony prominences. Make bed or chair softer with flotation pads. Use bed cradle to keep top sheets from rubbing skin. Reposition residents seated in chairs or wheelchairs every 15 minutes if they cannot easily change positions themselves.

20. 2. Identify guidelines for providing skin care and preventing pressure ulcers NAs should be familiar with the following positioning devices: Backrests Bed cradles Draw sheets Footboards Hand rolls Orthotic devices Trochanter rolls Pillows

21. 3. Explain guidelines for assisting with bathing Define the following terms: partial bath a bath given on days when a complete bath or shower is not done; includes washing the face, hands, underarms, and perineum. axillae underarms. perineum the genital and anal area.

22. 3. Explain guidelines for assisting with bathing Define the following terms: additive a substance added to another substance, changing its effect. groin the area from the pubis (area around the penis and scrotum) to the upper thighs. shower chair a sturdy, water- and slip-resistant chair designed to be placed in a bathtub or shower.

23. 3. Explain guidelines for assisting with bathing NAs should remember the following guidelines for bathing: Baths are for health and relaxation. The face, hands, underarms, and perineum should be washed every day. Complete baths are necessary every other day or less often. Use facility-approved products. Keep room temperature comfortable.

24. 3. Explain guidelines for assisting with bathing Guidelines for bathing (cont’d): Be familiar with safety and assistive devices. Gather supplies beforehand so that a resident is not left alone while bathing. Make sure water temperature is safe and comfortable. Have resident test water temperature. Remove all soap from the skin. Keep a record of bathing schedules.

25. Giving a complete bed bath • Equipment: bath blanket, bath basin, soap, bath thermometer, 2-4 washcloths, 2-4 bath towels, clean gown or clothes, 2 pairs of gloves, orangewood stick or nail brush, lotion, deodorant • Identify yourself by name. Identify the resident by name. • Wash your hands. • Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

26. Giving a complete bed bath • Provide for the resident’s privacy with curtain, screen, or door. Be sure the room is a comfortable temperature and there are no drafts. • Adjust bed to a safe level, usually waist high. Lock bed wheels. • Place a bath blanket or towel over resident. Ask him to hold onto it as you remove or fold back top bedding. Remove gown, while keeping resident covered with bath blanket (or top sheet).

27. Giving a complete bed bath • Fill the basin with warm water. Test water temperature with thermometer or against the inside of your wrist. Water temperature should not be over 105°F. Have resident check water temperature to see if it is comfortable. Adjust if necessary. The water will cool quickly. During the bath, change the water when it becomes too cool, soapy, or dirty. • Put on gloves.

28. Giving a complete bed bath • Ask the resident to participate in washing. Help him do this whenever needed. • Uncover only one part of the body at a time. Place a towel under the part being washed. • Wash, rinse, and dry one part of the body at a time. Start at the head, work down, and complete the front first. When washing, use a clean area of the washcloth for each stroke.

29. Giving a complete bed bath Eyes, Face, Ears, and Neck: Wash face with wet washcloth (no soap). Begin with the eye farther away from you. Wash inner area to outer area. Use a different area of the washcloth for each stroke. Wash the face from the middle outward using firm but gentle strokes. Wash the ears and behind the ears and the neck. Rinse and pat dry.

30. Giving a complete bed bath Arms and Axillae: Remove the resident’s top clothing. Cover him with the bath blanket or towel. Remove one arm from under the towel. With a soapy washcloth, wash the upper arm and underarm. Use long strokes from the shoulder down to the wrist. Rinse and pat dry. Repeat for the other arm.

31. Giving a complete bed bath Hands: Wash one hand in a basin. Clean under the nails with an orangewood stick or nail brush if available. Rinse and pat dry. Give nail care (see procedure later in this chapter) if it has been assigned. Repeat for the other hand. Put lotion on the resident’s elbows and hands if ordered.

32. Giving a complete bed bath Chest: Place the towel again across the resident’s chest. Pull the blanket down to the waist. Lift the towel only enough to wash the chest, rinse it, and pat dry. For a female resident, wash, rinse, and dry breasts and under breasts. Check the skin in this area for signs of irritation.

33. Giving a complete bed bath Abdomen: Keep the towel across chest. Fold the blanket down so that it still covers the pubic area. Wash the abdomen, rinse, and pat dry. If the resident has an ostomy, or opening in the abdomen for getting rid of body wastes, give skin care around the opening (Chapter 17 has information about ostomies). Cover with the towel. Pull the cotton blanket up to the resident’s chin. Remove the towel.

34. Giving a complete bed bath Legs and Feet: Expose one leg and place a towel under it. Wash the thigh. Use long, downward strokes when washing. Rinse and pat dry. Do the same from the knee to the ankle.

35. Giving a complete bed bath Place another towel under the foot. Move the basin to the towel. Place the foot into the basin. Wash the foot and between the toes. Rinse foot and pat dry, making sure areas between toes are dry. Give nail care (see procedure later in this chapter) if it has been assigned. Never clip a resident’s toenails. Apply lotion to the foot if ordered, especially at the heels. Do not apply lotion between the toes. Repeat steps for the other leg and foot.

36. Giving a complete bed bath Back: Help resident move to the center of the bed. Ask resident to turn onto his side so his back is facing you. If the bed has rails, raise the rail on the far side for safety. Fold the blanket away from the back. Place a towel lengthwise next to the back. Wash the back, neck, and buttocks with long, downward strokes. Rinse and pat dry. Apply lotion if ordered.

37. Giving a complete bed bath • Place the towel under the buttocks and upper thighs. Help the resident turn onto his back. Ask if he is able to wash the perineal area. If so, place a basin of clean, warm water, a washcloth, and towel within reach. Hand items to the resident as needed. If the resident wants you to leave the room, remove and discard gloves. Wash your hands. Leave supplies and the call light within reach. If the resident has a urinary catheter in place, remind him not to pull it.

38. Giving a complete bed bath • If the resident is unable to provide perineal care, you will do it. Remove and discard your gloves. Wash your hands and put on clean gloves. Provide privacy at all times. 14. Perineal area and buttocks: Change the bath water. Wash, rinse, and dry perineal area, working from front to back (clean to dirty).

39. Giving a complete bed bath For a female resident: Using water and small amount of soap, wash the perineum from front to back, using single strokes. Do not wash from the back to the front, as this may cause infection. Use a clean area of washcloth or a clean washcloth for each stroke.

40. Giving a complete bed bath First spread the labia majora, the outside folds of perineal skin that protect the urinary meatus and the vaginal opening. Wipe from front to back on one side with a clean washcloth. Then wipe the other side from front to back, using a clean part of the washcloth. Clean the perineum (area between the vagina and anus) last with a front to back motion. Rinse the area thoroughly in the same way. Make sure all soap is removed.

41. Giving a complete bed bath Dry entire perineal area moving from front to back, using a blotting motion with towel. Ask resident to turn on her side. Wash, rinse, and dry buttocks and anal area. Clean the anal area without contaminating the perineal area.

42. Giving a complete bed bath For a male resident: If the resident is uncircumcised, pull back the foreskin first. Gently push skin toward the base of penis. Hold the penis by the shaft. Wash in a circular motion from the tip down to the base. Use a clean area of washcloth or clean washcloth for each stroke.

43. Giving a complete bed bath Thoroughly rinse the penis. If resident is uncircumcised, gently return foreskin to normal position. Then wash the scrotum and groin. The groin is the area from the pubis (area around the penis and scrotum) to the upper thighs. Rinse and pat dry. Ask the resident to turn on his side. Wash, rinse, and dry buttocks and anal area. Clean the anal area without contaminating the perineal area.

44. Giving a complete bed bath • Cover the resident with the blanket. • Empty, rinse, and dry bath basin. Place basin in designated dirty supply area or return to storage, depending on facility policy. • Place soiled clothing and linens in proper containers. • Remove and discard gloves. • Wash your hands.

45. Giving a complete bed bath • Provide resident with deodorant. Brush or comb the resident’s hair (see procedure later in this chapter). Help resident put on clean clothing and get into a comfortable position with proper body alignment. • Return bed to lowest position. Remove privacy measures. • Place call light within resident’s reach. • Wash your hands.

46. Giving a complete bed bath • Report any changes in resident to the nurse. • Document procedure using facility guidelines.

47. Giving a back rub • Equipment: cotton blanket or towel, lotion • Identify yourself by name. Identify the resident by name. • Wash your hands. • Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. • Provide for resident’s privacy with curtain, screen, or door.

48. Giving a back rub • Adjust bed to a safe working level, usually waist high. Lower the head of the bed. Lock bed wheels. • Position the resident so he is lying on his side or his stomach. Many elderly people find that lying on their stomachs is uncomfortable. If so, have the resident lie on his side. Cover the resident with a cotton blanket, then fold back bed covers. Expose the resident’s back to the top of the buttocks. Back rubs can also be given with the resident sitting up.

49. Giving a back rub • Warm lotion by putting bottle in warm water for five minutes. Run your hands under warm water. Pour lotion on your hands and rub them together to spread it. Always put lotion on your hands first, rather than directly on the resident’s skin.

50. Giving a back rub • Place your hands on each side of upper part of the buttocks. Use the full palm of each hand. Make long, smooth upward strokes with both hands. Move along each side of the spine, up to the shoulders. Circle your hands outward. Then move back along outer edges of the back. At the buttocks, make another circle. Move your hands back up to the shoulders. Without taking your hands from resident’s skin, repeat this motion for three to five minutes.