Activities of Daily Living: Hygiene Occupationally Specific Knowledge and Skills

Objective: Upon completion of this lesson, you will be able to perform the tasks of basic hygiene, activities of daily living, in the laboratory and clinical setting.

The most basic of daily hygiene activities can be overlooked when one is sick or elderly.

What is your normal morning routine?

Oral Hygiene Definition 1. Care of the mouth and teeth 2. Ideally should be done three times a day 3. Realistically in a nursing home is done once a day 4. Residents should always be encouraged to be independent as much as possible Residents/Patients requiring frequent oral hygiene (as often as least every 2 hours) 1. unconscious 2. vomiting 3. those experiencing high temperature 4. those receiving certain medications 5. dehydrated 6. mouth breathers 7. those receiving oxygen

Why provide Oral Hygiene? Keeps mouth clean and teeth clean. Prevents mouth odors (Halitosis) and infection Increases comfort Makes food taste better. Reduces risk for cavities Some drugs cause: A bad taste in mouth Whitish coating in mouth and on tongue (thrush) Redness/swelling in mouth on tongue Dry mouth (O2, smoking, decreased intake, anxiety)

Brushing Teeth Hold brush at 45 degree angle for inner and outer aspect of teeth. Hold horizontally for chewing surfaces. Start on top teeth. Start at inner aspect. Then outer aspect. Then chewing surface. On bottom teeth, start at inner aspect, then outer, then chewing surfaces. Clean tongue. Make sure suction is set up.

Oral Hygiene If someone has trouble swallowing, unconscious, better to use a special mouth sponge with toothpaste in the sponge. Also used in pt’s with sore, tender mouths. a. dipped in ½ strength mouthwash and water b. excess water squeezed out c. head of resident turned to side and mouth cleaned When doing oral hygiene a. all surfaces of the teeth should be cleaned b. tongue should be cleaned c. mouth washed after cleansing with ½ strength mouth wash, if safe for resident d. gloves worn throughout Oral Hygiene Video

Denture Care a. rinse with lukewarm to cool water. HOT or very COLD water can crack them b. put gloves on to remove and use a tissue to remove top dentures first. 1.Place index finger against the roof of the mouth 2.Thumb against front teeth 3.Gently press and lift out at same time 4.You will feel seal release 5.Then remove lower dentures c. When replacing dentures in mouth, lower dentures first, then uppers. Lowers help secure uppers. d. brush all surfaces of dentures, upper and lower e. before replacing, wash mouth and tongue with sponge cleaner and rinse with ½ strength mouthwash and water

Denture Care (continued) Use extreme care when handling dentures See that dentures are not lost or broken Keep in container labeled with Pt’s name Store in clean, cool, water or cleaning solution When preparing to clean, place cloth over drain in sink and fill with 2 inches of water

Eyeglasses A. Keep clean by rinsing with water and drying with special lens paper or soft, nonabrasive tissue. B. Store in container in bedside stand when not in use. C. Glasses should be kept in easy reach of patient. D. Encourage resident to wear whenever possible.

Daily Shaving A. Residents should be shaved daily B. Remember, when shaving 1. use the resident’s own shaving equipment if possible. Otherwise use disposable, sharp safety razors 2. if resident is receiving anticoagulants, use an electric razor if possible 3. if oxygen is being administered, discontinue for this procedure if possible 4. elderly women sometimes grow hair on their faces and chins. Shaving is permitted but you must have a doctor’s order to do so in some facilities.

Steps of Shaving a Patient: 1. Moisten the beard with warm, wet washcloth (check razor for damage by rubbing on folded piece of gauze) 2. Apply shaving cream 3. Do not moisten beard if you intend to use an electric razor 4. Start in front of the ear a. hold skin taut b. bring razor down over cheek toward chin c. repeat until lather has been removed and area shaved d. remove hair from under the nose and above upper lip by moving razor in short, downward strokes from nose to lip e. shave skin carefully; having person tense area helps f. shave neck area on each side, bringing razor up toward chin g. use short, firm strokes; rinse razor often h. wash face and neck; dry thoroughly i. if skin is nicked, apply pressure directly over are and report to nurse in charge j. always wear gloves Shaving Video

Feeding a Patient Good nutrition is an important part of a patient’s treatment (enjoyment, helps healing wounds Make mealtimes as pleasant as possible Mealtimes are regarded as social time Important to talk with Pt. while feeding People enjoy eating with others Delay of meals Check food tray

Before Feeding Check for ALLERGIES Make sure Pt. is not NPO or scheduled for procedure Offer bathroom or bedpan prior to eating Allow Pt. to wash hands Provide oral hygiene if Pt. desires Position Pt. comfortably Clear table and wipe down Make sure tray has correct name and type of diet

Feeding a Patient (continued) Allow patient to feed themselves whenever possible Assist by cutting food, opening items, buttering bread Test temperature of food ( check small amount on your wrist) DON’T BLOW ON HOT FOOD Relaxed, unhurried atmosphere Observe for any signs of choking (if suspect choking STOP feeding and notify nurse or doctor)

Feeding a Patient Give sips of liquid in between bites of food (moistens food to prevent choking) Give Pt. enough time to swallow Give small amounts Use straws UNLESS pt has dysphagia (difficulty swallowing) Use thickener if needed (helps solidify food making it easier to swallow) Observe and record amount of food eaten (I&O)

Feeding the Patient Hold utensils at right angle (90 degrees) to patient’s mouth Feed from tip of utensil Give small amounts and make certain the resident has carefully chewed and swallowed the food Fill spoon or fork one-third to one-half full Use towel to cover chest and wipe mouth If feeding someone with weakness on one side of mouth or both sides, make sure that food isn’t being packed into the cheeks Patients can’t always feel food in their mouths and would not be aware of some was being stashed in the cheeks

Feeding the patient Be careful when removing the fork or spoon so utensil does not scrape the roof of the mouth (palate) Use a straw when giving liquids. Direct the straw by holding it between two fingers. Hold the straw until the patient releases it from his/her mouth Offer fluids often. Some need it after each mouthful of solid food Vary each mouthful. Feed as you would eat When preparing the tray, find out how resident wants their food. For example, some do not like butter, but prefer jam, sugar in tea Feeding Video

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Dysphagia Dysphagia means difficulty swallowing food. Food thickness can be changed to meet person’s needs Speech/Language pathologist, Doctor, nurse assesses for right food thickness Thickened liquid (creamy, sauce like), medium thick (nectar like, V8 juice), Extra thick ( honey-like, mounds on the spoon), puree (no lumps, thick like mashed potatoes)

Signs of Dysphasia Person avoids foods that require chewing Tires during meal Food spills out of mouth while eating Pockets food Eats very slowly Complains food doesn’t go down or feels stuck Frequently clears throat before, during, or after swallowing Spits out food suddenly or vomits after eating Excessive drooling of saliva

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Aspiration Aspiration is breathing fluid, food, vomitus, or an object into the lungs. Signs of Aspiration- choking, coughing, difficulty breathing during or after meals, abnormal breathing or respiratory sounds, decreased spo2 after eating. How do you prevent Aspiration?

Preventing Aspiration Help person with meals Position Pt. as upright as possible Have Pt. stay in upright position an hour after eating Check person’s mouth after eating for pocketing (inside cheeks, under tongue, on roof of mouth) Remove any food left in mouth

Dressing a Patient A. Let person select their clothing B. Let them do as much of the dressing as possible C. Position in front of a mirror if one is available D. Dress weakest side first, then strongest E. Undress strongest first, then weakest F. Use tools to assist the resident to care for herself/himself Dressing a Patient Video

Daily Hair Care A. Usually performed after bath B. Brushing hair stimulates circulation of the scalp refreshes the patient Start at scalp going towards ends OBSERVE for scalp sores, flaking, itching, Nits, Lice, hair C. Tangled or matted hair NEVER CUT TANGLED HAIR 1. work section by section 2. untangle hair, beginning near the ends and working toward the scalp 3. gum may be removed with ice or peanut butter

Shampooing Shampoo during shower Shampoo in bed- Person’s head is tilted over the edge of the sink. Use a water pitcher to wet hair. Place shampoo tray under head to protect linens. Place cloth over eyes. Commercially prepared shampoo caps- contains cleaning agent that doesn’t require rinsing. Warm package in microwave. Check temp. Massage gently1-3 minutes. Towel dry

Nail Care A. Care to the fingernails is allowed by the state of Texas. Care of toenails by nurse aides is not. Due to diminished circulation of the lower extremities in elderly and ill people B. Should a cut occur, infection might set in and healing be very difficult C. Podiatrists are brought in to perform foot care D. Even where fingernails are concerned, do not do on a diabetic individual E. Procedure 1. soak nails for at least 5-10 minutes. 2. Nails can be cleaned while soaking 3. Use an orange stick to push cuticles back 4. Clip the nails either straight across or slightly rounded 5. File any rough edges

Bathing Complete bed bath- PCT bathes all parts of the patient’s body, provides oral care, hair care, nail care, and perineal care. (patients are confined to bed, or too ill to bath themselves. Partial bed bath- PCT bathes some parts of the patient’s body. ONLY face, arms hands, back, perineal area are bathed OR patient washes most of their body and PCT washes and helps with legs and back Disposable cleansing cloths- Used instead of basins, they are cloths that contain rinse-free cleanser *** Before leaving a pt. in a tub or shower, instruct pt. how to use emergency call signal***

Back Rub (Check facility Policy) Considered part of daily bath unless contraindicated by pt. condition. Usually 4-7 minutes. Helps stimulate circulation, prevents pressure ulcers, relaxing. Pt can lie on abdomen or side. Be alert for red areas, rash, sores, cuts, bony areas Use small amount lotion A. Begin at base of spine, RUB UP the center to neck, firm pressure, around shoulders, and gentle pressure Down the sides of the back. Down over buttocks and circle back to starting point. USE long, soothing, firm pressure on upward strokes and gentle pressure on downward strokes. REPEAT x 4. B.Next, ON downward stokes use circular motion. REPEAT x 4

Back rub continued C. Upward strokes with small circular motions going downward ( using palm of hand to apply firm pressure) x 1. D. Repeat step 1 for 3-5 minutes. E. End with up and down motions over entire back for 1-2 minutes.

Assessment During Personal Hygiene REPORT any unusual observations including: Sores, cuts, injuries: to skin, scalp, or mouth Rashes: any type of rash (could be sign of allergic reaction) Color : Redness (ERYTHEMA) of skin. Could be sign of pressure sore. Blue color (CYANOSIS) Could be sign of poor circulation. Yellow color (JAUNDICE) Could be sign of liver disease Swelling, or edema: Could be sign of poor circulation or disease. Pay careful attention to hands, feet, ankles, toes. Signs of distress: Dyspnea (difficulty breathing), Vertigo (dizziness), unusual weakness, Diaphoresis (excessive perspiration), Lethargy (abnormal drowsiness)

Complete Bed Bath Gather supplies ( linen basket, bath blanket, 3-4 wash clothes, 2-3 bath towels, soap, basin, bath thermometer, gown, supplies for hair, oral, shaving, and nail care, lotion, gloves) Close door, draw curtain, adjust temperature in room Wash hands, apply gloves Prepare linen in order needed and place to side Replace top sheet with bath blanket Provide oral care Shave Fill basin about 2/3 full warm water at about degrees F. Check temp with bath thermometer.

Bath Continued Remove gown Place towel over the upper edge of bath blanket Wash face with mitten ( keeps water from dripping), wash eyes first. Start at inner area and wash to outside of eye using a different section of cloth when you wash the second eye. Rinse cloth. Apply soap. Wash face, neck, ears. Rinse. Dry. Place bath towel lengthwise under pt’s arm farthest from you. Put basin of water on bed and on towel at lower end. Wash, rinse, dry from axilla to hand. Soak nails and hand in water. Repeat for other arm.

Bed Bath continued Discard water. Fill with clean water. Put a towel over chest. Fold bath blanket to pt’s waist. Wash, rinse, dry chest and breasts (assess under breasts) Turn towel lengthwise to cover chest and abdomen Fold bath blanket down to pubic area Wash, Rinse, and dry abdomen. Replace bath blanket. Remove towel. Fold bath blanket to expose leg farthest from you Place towel lengthwise under leg and foot. Place basin on the bed on top of towel. Place foot in basin. Wash, Rinse, dry leg and foot. Repeat for other leg. Change water. Turn pt to side. Place towel lengthwise on bed along back.

Bed bath Wash, rinse, dry back. Give backrub Wash patients perineal area. Drape in dorsal recumbent position. Place towel or pad under buttocks. Female wash front to back. Separate labia and cleanse front to back motion. Use clean area of cloth between each wipe. For male, cleanse tip of penis using circular motion. Clean top to bottom. If uncircumcised, gently draw back foreskin to wash area. Wash scrotum. Clean rectum with pt. on their side. Rinse and dry all areas. Place gown, perform hair care, make occupied bed

CHECKPOINTS Before doing any procedure check facility policy Position pt. in proper alignment Elevate side rails, wheels locked Lower bed to its lowest level Place call bell within reach, Kleenex, glasses, etc.. Clean and replace used supplies (wash basin)