NA Chapter 6 Personal Care Skills

Providing person care is one of the most important roles of the NA Providing person care is one of the most important roles of the NA. Whether the care is only to assist or to do all the personal care for the resident, NAs will spend most of their time doing these tasks. Need to be done properly and safely for the resident and the NA Habits built will be the foundation of care-giving career Should be based on respect for the resident, excellent skills, and a sense of pride in caring for others.

Hygiene- ways to keep bodies clean and healthy Grooming- practices like caring for fingernails and hair ADLs- Activities of Daily Living- includes hygiene, grooming, dressing, eating, transferring and toileting A.M. care: assisting with toileting, helping to wash face and hands, assisting with mouth care P.M. care: assisting with toileting, helping to wash face and hands, giving a snack, assisting with mouth care, giving a back rub

Personal care assisting Help the resident be as independent as possible Be aware of resident preferences and routines Always explain what you will be doing Provide privacy Observe the resident during care, note and report signs and symptoms, mental state, any changes. Leave the resident’s room clean and tidy. Leave the bed in lowest position, call light within reach

Promote respect, dignity, and privacy Knock before entering resident’s room Explain care Provide privacy Let him make decisions Don’t interrupt residents in the bathroom Respect their belongings Don’t interrupt residents while they are dressing Keep resident covered whenever possible when you help with dressing.

Never rush the resident After care, always ask if they would like anything else Keep a small notepad to write down exactly what the resident says and report these comments about symptoms, feelings and concerns Performing the task is only half the job, promoting independence and dignity is the other.

s/s to observe and report Skin color, temperature, reddened areas Mobility Flexibility Comfort or pain level Strength and ability to perform ADLs Mental and emotional state Complaints

Pressure sores Immobility reduces the amount of blood that circulates to the skin Residents who have less mobility have greater risk of skin deterioration at pressure points. Pressure point are areas of the body that bear much of its weight. Mainly located at bony prominences- areas where the bone lies close to the skin. Makes the skin there at much higher risk to break down. Other areas at risk are the ears, under the breasts, and the scrotum

Beginning skin break down: skin becomes pale, white or a reddened color. Darker skin may look purple. May feel tingling or burning in the area. Discoloration does not go away even when the position is changed. If pressure is allowed to continue the skin will break down farther and become a wound “pressure sore”, “bed sore”, “decubitus ulcer”. Prevention is the key

Decubitus ulcer/pressure sore Stage 1- skin intact but redness that isn’t relieved within 15-30 minutes after removing pressure Stage 2- partial skin loss of the outer and/or inner layer of skin- superficial, looks like a blister or shallow crater Stage 3- full skin loss that may extend down to but not through the tissue that covers muscle. Looks like a deep crater Stage 4- full skin loss with major destruction, tissue death and damage to muscle boe or supporting structures.

s/s to observe and report Pale, white, red, or purple areas, blister 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 existing wound Broken skin, toes or toenails (darker skin: change in feel of the tissue, change in purplish hue or “orange-peel “ look, extremely dry, crust-like areas)

Guidelines for skin care Report changes Provide regular skin care Reposition often, at least every two hours Give skin care often for incontinence, change clothing and linen often Avoid scratching or irritating skin Massage skin frequently but no over white, red, or purple areas Avoid pulling or tearing skin during transfers Pay special attention to skin under folds Encourage to eat well-balanced meals Keep plastic or rubber materials from skin contact Follow care plan

Guidelines for skin care for bed bound residents Keep bottom sheet tight and wrinkle-free Avoid shearing (layer of skin being pulled away due to pressure during sliding across a surface) Place sheepskin, chamois skin, or bed pad under back and buttocks Relieve pressure under body prominences- pads, heel and elbow protectors 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 often if they can’t change their own position

Positioning devices Backrests Bed cradles Draw sheets Footboards Hand rolls Splints-orthotic device Trochanter rolls Pillows

Bathing Complete bed bath, tub bath or shower is generally done every other day, twice a week or per the care plan. Partial bath is done on days when a complete bath is not done. It includes washing the face, hands, axillae (underarms) and perineum (the genital and anal area)

Techniques Start at head, work down, front first. Wash, rinse, and dry one part of the body at a time. Keep the rest covered. Place a towel under the body part being washed. Use a clean area of the washcloth for each stroke. Never clip a resident’s toenails Do not apply lotion between the toes.

Perineal area Female- Move from front to back. Use single strokes with a clean area of wash cloth for each stroke. For male if uncircumcised, pull the foreskin back first, wash in a circular motion from the tip down to the base, rinse and return the foreskin to normal position. Then the scroum and groin (area around the penis and scrotum to the upper thighs)

s/s to observe and report –foot care Dry, flaking skin, non-intact or broken skin Discoloration of the feet Blisters, bruises Blood or drainage Long, ragged toenails, ingrown toenails Differences in temperature of the feet

Hair care Handle gently, hair thins as people age Skin on heads is fragile Let choose own hairstyle Pediculosis- lice Symptoms: itching, bite marks on scalp, skin sores, matte, bad-smelling hair and scalp Don’t share combs, brushes, clothes, wigs or hats

Shaving Wear gloves Don’t share razors Soften hair on face first Shave in direction of hair growth

Dressing Resident should dress in regular clothes in the daytime Let choose clothing Place weaker/involved/affected arm or leg through garment first when applying

Dressing a resident with an IV Never disconnect IV lines or turn off the pump Always keep the IV bag higher than the IV site on the body First remove clothing from the side without the IV, then gather the clothing on the side with the IV. Lift clothing over the IV site, move it up the tubing toward the bag. Lift the bag off its pole, carefully slide the clothing over the bag. Place the bag back on the pole Apply clean clothing first to the side with the IV. Slide the correct arm opening over the bag, then over the tubing and the resident’s IV arm. Place the IV bag back on the pole. Check that the IV is dripping properly. Make sure none of the tubing is dislodge. Check to see that the IV site dressing is in place.

Anti-embolic stockings (TED hose, elastic stockings) Help prevent swelling and blood clots Aid in circulation Need to be applied before the resident gets out of bed, when there is less swelling in the legs.

Oral hygiene Involves brushing teeth and gums, flossing the teeth and also denture care. For unconscious resident involves good mouth care to keep mouth clean and moist. Swabs with lemon jusice and glycerin Use as little liquid as possible to avoid aspiration. Squeeze swabs after dipping them in solution to remove excess liquid.

s/s to observe and report –oral care Irritation Infection Raised areas Coated or swollen tongue Ulcers Flaky, white spots Dry, cracked, bleeding, or chapped lips Loose, chipped, broken, or decayed teeth Swollen, irritated, bleeding or whitish gums Bad or fruity breath Reports of mouth pain

Denture care Dentures are expensive, handle them carefully Wear glove when handling Do not use hot water to clean- it may damage them Place them in labeled cup or return immediately to the resident

Toileting Regular bedpan- position with wider end aligned with resident’s buttocks Fracture bedpan- positioned with handle toward foot of bed. (is flatter) Urinals and bedpans should be cleaned after each use. Keep in bathroom between uses. If share a bathroom, label the item. Never place on side or overbed table

Positioning and moving residents Five basic positions: Supine (flat on back) heels should be “floating” Lateral (on side) pillows supporting upper knee and arm Prone (on stomach) pillow keeping feet off bed Fowler’s (semi-sitting, 45-60 degrees) pillow at flexed knees and feet Sims’ (lying on left side with one leg drawn up) lower arm behind back pillows supporting upper knee and arm

Log rolling- you and a partner roll the patient together keeping spine/body in line. Dangling- sit up with feet over the side of the bed to regain balance and adjust to upright position

transfers Safety is important Ergonomics- science of designing equipment and work tasks to suit the worker’s abilities. Manual lifting of resident should be reduced in all cases and eliminated when possible due to risks of pain and injury Zero-lift or lift-free policies set strict guidelines for lifting and transferring- requiring use of mechanical equipment for all who need assistance.

Transfer belt/gait belt- safety devise for residents who are weak, unsteady, or uncoordinated. Gives you something firm to hold on to. Lessens pressure on resident’s fragile joints and bones. Slide or transfer board- helps with those who can’t bear weight on their legs for bed to chair transfers.

Wheelchairs Always lock before transfers Move foot rests out of the way to avoid injuries. Keep in good alignment, use cushions and pillows. Reposition at least every two hours or more.

Falls Widen your stance, bring resident’s body close to break the fall, bend your knees, lower to the floor. You may need to drop to the floor with them to avoid injury Don’t try to reverse or stop a fall. Call for help Report the fall to nurse for incident report

Mechanical lifts Don’t use without training Always use two people