1. NA Chapter 6 Personal Care Skills

2. 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.

3. 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

4. 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

5. 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.

6. 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.

7. 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

8. 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

9. 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

10. Decubitus ulcer/pressure sore
Stage 1- skin intact but redness that isn’t relieved within 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.

11. 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)

12. 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

13. 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

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

15. 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)

16. 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.

17. 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)

18. 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

19. 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

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

21. 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

22. 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.

23. 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.

24. 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.

25. 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

26. 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

27. 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

28. 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, 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

29. 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

30. 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.

31. 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.

32. 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.

33. 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

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