Chapter 21 Grooming Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Grooming Grooming measures: People differ in their grooming measures. Are important to many people Prevent infection and promote comfort Address love, belonging, and self-esteem needs People differ in their grooming measures. The person should tend to his or her own grooming measures to the extent possible. The person may use adaptive devices for grooming. Tending to grooming measures promotes the person’s independence and quality of life. Review the Teamwork and Time Management: Grooming Box on p. 354 in the Textbook. See Figure 21-1 on p. 354 in Textbook for an example of adaptive devices. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Hair Care The look and feel of hair affect mental well-being. You assist with hair care whenever needed. The nursing process reflects: The person’s culture Personal choice Skin and scalp condition Health history Self-care ability Review the Focus on Long-Term Care and Home Care: Hair Care Box on p. 354 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Hair Care (cont’d) Skin and scalp conditions Alopecia means hair loss. Male pattern baldness occurs with aging. Hair also thins in some women with aging. Other causes include cancer treatments, skin disease, stress, poor nutrition, pregnancy, some drugs, and hormone changes. Hirsutism is excessive body hair. It can occur in men, women, and children from heredity and abnormal amounts of male hormones. Dandruff is the excessive amount of dry, white flakes from the scalp. Skin and scalp conditions include hair loss, excessive body hair, dandruff, lice, and scabies. Some skin or scalp conditions may alarm you. Remain professional and do not say things that may embarrass the person. Tell the nurse if you see an abnormal skin or scalp condition. Sometimes dandruff affects the eyebrows and ear canals. Medicated shampoos correct the problem. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Hair Care (cont’d) Pediculosis (lice) is the infestation with wingless insects. Pediculosis capitis is the infestation of the scalp with lice. Pediculosis pubis is the infestation of the pubic hair with lice. Pediculosis corporis is the infestation of the body with lice. Report signs and symptoms of lice to the nurse at once. Complaints of a tickling feeling or something moving in the hair Itching Irritability Sores on the head or body caused by scratching Rash Pediculosis capitis is commonly called head lice. Pediculosis pubis is also called crabs. Lice easily spread to others through clothing, head coverings, furniture, beds, towels, bed linens, and sexual contact. They also are spread by sharing combs and brushes. Treatment involves medicated shampoos, lotions, and creams specific for; thorough bathing; and washing clothing and linens in hot water. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Hair Care (cont’d) Scabies is a skin disorder caused by a female mite. The female mite burrows into the skin and lays eggs. The person has a rash and intense itching. Scabies is highly contagious. Persons at risk include those living in crowded living settings and those with weakened immune systems. Common sites include: Between the fingers, around the wrists, in the underarm area, on the thighs, and in the genital area The breasts, waist, and buttocks Treatment involves using special creams, cleaning the person’s room, and washing clothing and linens in hot water. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Hair Care (cont’d) Brushing and combing hair Encourage patients and residents to do their own hair care. Assist as needed. Provide hair care for those who cannot do so. The person chooses how to brush, comb, and style hair. Brushing and combing prevent tangled and matted hair. To brush and comb hair, start at the scalp. Then brush or comb to the hair ends. Brushing or combing hair are part of early morning care, morning care, and afternoon care. This may be done at bedtime and whenever needed. Make sure you provide hair care before visitors arrive. Brushing increases blood flow to the scalp. It brings scalp oils along the hair shaft to help keep hair soft and shiny. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Hair Care (cont’d) Do not braid hair without the person’s consent. Never cut matted or tangled hair. Special measures are needed for curly, coarse, and dry hair. The person’s hair care practices and products are part of the care plan. Tell the nurse if the person has matted or tangled hair. Use a wide-tooth comb for curly hair. Let the person guide you when giving hair care. Review the Caring about Culture: Brushing and Combing Hair Box on p. 356 in the Textbook. Review the Focus on Children and Older Persons: Brushing and Combing Hair Box on p. 356 in the Textbook. Review the Delegation Guidelines: Brushing and Combing Hair Box on p. 356 in the Textbook. Review the Promoting Safety and Comfort: Brushing and Combing Hair Box on p. 356 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Shampooing Many factors affect frequency, including: The condition of the hair and scalp Hairstyle Personal choice Shampoo hair when the nurse tells you to. The nurse tells you what method to use. The shampoo method depends on: The person’s condition Safety factors Most people shampoo at least once a week. Some shampoo 2 or 3 times a week. Others shampoo every day. Some persons use certain shampoos and conditioners. Others use medicated products ordered by the doctor. The person may need help shampooing. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Shampooing (cont’d) Shampoo methods include: During the shower or tub bath At the sink On a stretcher In bed Hair is dried and styled as quickly as possible after the shampoo. Check with the nurse before curling or rolling up hair. When shampooing is done at the sink, a folded towel is placed over the sink edge to protect the neck. When shampooing is done on a stretcher, a towel is placed under the neck. When shampooing is done in bed, a shampoo tray is placed under the head. Review the Focus on Children and Older Persons: Shampooing Box on p. 358 in the Textbook. Review the Focus on Long-Term Care and Home Care: Shampooing Box on p. 359 in the Textbook. Review the Delegation Guidelines: Shampooing Box on p. 359 in the Textbook. Review the Promoting Safety and Comfort: Shampooing Box on p. 359 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Shaving Many men shave for comfort and mental well-being. Many women: Shave their legs and underarms Shave facial hair Use other hair-removal methods Waxing, hair removal products, plucking, threading Review the rules in Box 21-1 on p. 361 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Shaving (cont’d) Safety razors or electric shavers are used. Follow agency policy for cleaning electric shavers. Safety razors are not used on persons who: Have healing problems Take anticoagulant drugs Soften the beard before shaving. Mustaches and beards need daily care. Ask the person how to groom his mustache or beard. Never trim a mustache or beard without the person’s consent. If the agency’s shaver is used, clean it after every use. Follow the manufacturer’s instructions for brushing out whiskers. Older persons with wrinkled skin are at risk for nicks and cuts from blade razors. An anticoagulant is a drug that prevents or slows down blood clotting. Bleeding occurs easily and is hard to stop. A nick or a cut can cause serious bleeding. Review the Focus on Children and Older Persons: Shaving Box on p. 361 in the Textbook. Review the Delegation Guidelines: Shaving Box on p. 361 in the Textbook. Review the Promoting Safety and Comfort: Shaving Box on p. 362 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Shaving Shave the face in the direction of hair growth. Use longer strokes on the larger areas of the face. Use short strokes around the chin and lips. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Nail and Foot Care Nail and foot care prevents infection, injury, and odors. Hangnails, ingrown nails, and nails torn away from the skin cause skin breaks. Long or broken nails can scratch skin or snag clothing. Dirty feet, socks, or stockings harbor microbes and cause odors. Breaks in the skin are portals of entry for microbes. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Nail and Foot Care (cont’d) Injuries occur from: Stubbing toes Stepping on sharp objects Being stepped on Shoes that fit poorly Poor circulation prolongs healing. Infections or foot injuries are very serious for older persons and persons with circulatory disorders. Diabetes and vascular diseases are common causes of poor circulation. Gangrene and amputation are serious complications. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Nail and Foot Care (cont’d) Trimming and clipping toenails can easily cause injuries. Use nail clippers to cut fingernails. Never use scissors. Some agencies do not let nursing assistants cut or trim toenails. Follow agency policy. Nails are easier to trim and clean right after soaking or bathing. Use extreme caution when trimming nails to prevent damage to nearby tissues. Review the Focus on Long-Term Care and Home Care: Nail and Foot Care Box on p. 364 in the Textbook. Review the Delegation Guidelines: Nail and Foot Care Box on p. 364 in the Textbook. Review the Promoting Safety and Comfort: Nail and Foot Care Box on p. 364 in the Textbook. Review the Teamwork and Time Management: Nail and Foot Care Box on p. 364 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Changing Clothing and Hospital Gowns You may need to assist with changing garments. Follow these rules: Provide for privacy. Encourage the person to do as much as possible. Let the person choose what to wear. Make sure garments and footwear are the correct size. Remove clothing from the strong or “good” side first. Put clothing on the weak side first. Support the arm or leg when removing or putting on a garment. Patients and residents change into clean sleepwear or gowns after bathing. Do not expose the person. Make sure the person chooses the right undergarments. Review the Focus on Children and Older Persons: Dressing and Undressing Box on p. 366 in the Textbook. Review the Focus on Long-Term Care and Home Care: Dressing and Undressing Box on p. 367 in the Textbook. Review the Focus on Communication: Dressing and Undressing Box on p. 366 in the Textbook. Review the Delegation Guidelines: Dressing and Undressing Box on p. 367 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Changing Clothing and Hospital Gowns (cont’d) Changing hospital gowns Gowns are usually worn for IV therapy. Some agencies have special gowns for IV therapy that open along the sleeve and close with ties, snaps, or Velcro. Sometimes standard gowns are used. If there is injury or paralysis: Remove the gown from the strong arm first. Support the weak arm while removing the gown. Put the clean gown on the weak arm first and then on the strong arm. Review the Delegation Guidelines: Changing Hospital Gowns Box on p. 371 in the Textbook. Review the Promoting Safety and Comfort: Changing Hospital Gowns Box on p. 371 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Copyright © 2012 by Mosby, an imprint of Elsevier Inc Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.