2. ADMINSTERING PERSONAL HYGIENE NA LTC Unit 5 LP1

3. Personal Care For The Residents: Objectives Identify activities that make up personal care Identify points to consider when planning personal care Identify key points in helping residents maintain general hygiene. Identify appropriate clothing fore residents Describe major areas of personal care Identify points to remember when performing personal care activities Identify adaptive measures that may be necessary to take when giving personal care to residents with special conditions

4. Personal Hygiene Personal Hygiene includes: Bath Back care Perineal care Oral Hygiene Hair Care Nail Care Shaving if necessary Dressing Sensitivity to patients needs, cultural and/or religious beliefs Respect patients right to privacy

5. Planning Personal Care Check care plan Know residents capabilities Encourage independence. Do not save time et by doing personal care for the resident Provide choices What do you want to wear? How do you want to wear your hair? Invading personal space Do NOT treat resident like a child. Dignity et Respect!!

6. Purpose of Good Personal Hygiene Prevent infection Eliminate odors Promote relaxation Stimulates circulation, provide mild exercise Enhances self-esteem Allows the healthcare worker to develop a good and caring relationship with the patient Observation

7. Personal Hygiene Elderly May Experience: Eyesight less sharp Hands may tremble Activities take effort et energy Clothes may be soiled Teeth not brushed Food spilled on clothes Shirts not properly buttoned

8. Types of Baths The type of bath depends on the patients condition et ability to help, Dr. Order Elderly - thin, dry skin they may bathe 1 or 2x a week Three Types of Baths  Complete bed bath (CBB)  Partial Bed bath (PB)  Tub bath, Whirlpool or Shower

9. Complete Bed Bath (CBB)  Health assistant bathes the entire body  Water temperature 115 F, cools quickly  Provides oral hygiene, back care, back rub, hair et nail care, perineal care, and shaving if necessary  Usually given to patient who is confined to bed or is too weak or ill to bathe

10. Partial Bed Bath  2 meanings  Partial bath- patient is too weak or ill, only the face, arms,axilla, hands, back and perineal area is bathed  Partial bath- patient is able to wash most of body and assistant completes the bath, usually washing the legs and back  assistant prepares supplies needed for the patient

11. Tub Bath or Shower  Some patients are allowed to take a tub bath, whirlpool or shower  Bath water temperature 105 F  Assistant helps by providing towels et supplies, preparing tub or shower area, et assisting patient as situation indicates

12. General Guidelines for Assisting with Bed Bath  Care plan (ex Dr. order type of bath, special information, patients ability to assist, adaptive devices, patient needs and preferences  Bed raised to working height, patient moved to the side of bed that is near you.  Privacy, room temperature warm  Offer the bedpan or urinal, warm water can stimulate the urge to urinate or defecate

13. General Guidelines Related to Giving a Bed Bath  Gloves are worn for parts of bathing procedure  Wash Mitt  Keep body covered with bath blanket for modesty et warmth, expose only body part you are washing  Offer patients choices  Bed bath water temp is 115F, cools quickly  Wash cleanest to dirtiest  Change water if it cools becomes soapy or dirty

14. General Guidelines for Assisting with Bed Bath  Soap can be irritating and drying to skin, rinse thoroughly  Keep soap in soap dish when not using  Warm lotion in bath water during bath  Washing farthest extremity first prevents dripping water across part cleaned

15. General Guidelines for Tub and Shower Bath  Tub bath is for residents who can get out of bed but may not like showers  Tub bath= greater relaxation, helps resident feel cleaner  If transporting patient to tub or shower room cover patient body  Use gait belt over clothing  Use safety belts and locks on tub lifts and shower chairs

16. General Guidelines for Tub or Shower Bath  Tub room temperature 75-80 F, free from drafts  Test temperature of bath water 105 degrees F. Do NOT add oils to water, slippery  Assist pt in et out of tub or shower  Resident usually stays in tub for 10-15 minutes to prevent chilling  Never leave resident unattended

17. Tub Bath If Resident becomes Faint during a Tub Bath Call for help Drain water from tub Lower head as much as possible Cover resident with bath blanket Note: Fainting is caused by warm water dilating the blood vessels of the skin, increasing amt of blood to skin, decreasing the blood flow to the brain

18. Shower Bath Safety Measures Shower is frequently chose due to residents poor mobility, difficulty getting in or out of tub Shower chair locks Shower room temp 75-80 F Face resident to the door of the shower stall Once a towel has been used below the waist do NOT use it above the waist Never leave resident unattended Do NOT lock bathroom door

19. Shower Bath Resident Becomes Faint during Shower Call for help Turn off water If resident is standing, sit them down Lower head as much as possible Cover with bath blanket

20. Bed bath, Tub or Shower  Dry skin very well, pay attention to folds et creases  Apply deodorant after bath unless patient objects  Upon completion of bathing dress patient appropriately, cover the body  Patients preference under garments  Nonskid slippers or house shoes

21. General Infection Control Guide General Infection Control Guidelines for Personal Care Procedures a) Wear gloves when in contact with blood, body fluids, secretions, excretions, mucous membranes or nonintact skin b) Wear gloves when washing mucous membranes eyes,nose, mouth et genital areas c) Disinfect tub, shower chair, or whirlpool according to policy d) Follow facilities infection control policy when handling clean et soiled linen

22. Oral Care Oral Care includes cleaning of the.. a) Mouth b) Teeth c) Tongue d) Gums Purposes of Proper Oral Care a) Prevent tooth decay and dental disease/problems b) Stimulate appetite, provide comfort c) Prevent halitosis or bad breath d) Stimulate circulation of gums e) Create a feeling of well being f) OBSERVATION

23. Oral Care Observation Observe et report signs of :  Tooth decay (blackened teeth)  Irritation  sores  loose teeth  pain  swelling  white patches  or other abnormalities to your supervisor

24. Oral Care Frequency a) At least 3 times a day. Before breakfast, after meals, at bedtime b) Frequent oral care based on pts condition may be every two hours. Ex mouth breather, NPO, TF, oxygen c) Inspect residents mouth et report Routine Oral Hygiene a) Regular tooth brushing et flossing b) Patient often independent, assistance needed to gather supplies needed c) Health care assistant may need to assist or completely provide oral care to the patient

25. Oral Care General Guidelines for Giving Oral Care a) Independence of pt b) 1 st choice bathroom sink not in bed c) Always wear gloves when assisting d) Explain procedure to every pt even if confused or unresponsive e) Turn patients head to side f) Moisten lips with lip balm If oxygen is in use use water soluble lubricant g) Mouth wash does not replace the need to brush teeth h) Dilute Mouthwash should be 1oz to 1 oz water

26. Oral Care Denture Care a) Pt has dentures or artificial teeth b) Privacy, respect pts preferences c) Extreme care to prevent damage to dentures a) Handle with washcloth or paper towel to prevent slipping b) Keep in water when not in mouth c) Soaking in solution does NOT eliminate need for brushing d) Line sink with wash cloth or paper towel. Do NOT rinse in standing water e) Label denture cup

27. Oral Care General Guidelines for Denture Care a) Always wear gloves b) Handle dentures very carefully c) Let pt remove dentures from their mouth, if able d) Check dentures for cracks, chips, or loose teeth e) Store dentures in marked denture container. Some dentures you store dry others with cool water. When in doubt store in cool water.

28. Oral Care Special Oral Hygiene a) Care provided to unconscious or semiconscious pts b) Mouth breathers c) Complete Oral care: mouth, teeth, gums, tongue d) Special supplies: toothettes, lemon glycerin swabs

29. Hair Care Purpose of Hair Care Clean hair of dirt particles et dead cells; prevent matting Stimulate scalp circulation Improves ones appearance Observation of hair et scalp Sores Redness Dry scalp, excessive dandruff Swollen areas

30. Hair Care  When Hair Care Should be Done 1. Comb et brush in morning et prn  Brushing, hold hair gently above tangle, brush tangle from end to scalp  Bed ridden pt tangled and knots in hair  Use alcohol to remove tangles from oily hair  Use petroleum jelly to remove tangles from dry hair

31. Hair Care When Hair Care Should be Done Washed at least weekly. Refer to care plan Younger may prefer daily Do NOT shampoo as part of shower or tub bath. Salon Appts Resident independently comb with assistive devices

32. Hair Care Observation Sores Redness Dry scalp, excessive dandruff Swollen Areas

33. Specific Measures Related to Hair Care Label residents comb et brush Brushing hair apply towel to residents shoulders Clean brush after every use Hair dryers, keep your hand under air stream to avoid burning Shampoo- water temp 105 F Coarse thick hair, use softening baby shampoo

34. Hair Care Shampooing a) Dr. Order, refer to care plan b) Various types of dry chemical or fluid shampoos ex no rinse shampoo c) Read instructions carefully before using d) Special devices available to use ex shampoo tray

35. Nail Care Purpose of Nail care Decrease bacteria build up that could cause infection Neat appearance Prevent cuts/scratches from long nails

36. Nail Care Observation Cuts Calluses, corns Change in skin color C/O of tenderness Swelling/edema Elderly nails thick, brittle, difficult to trim Change in nail color- Black fungal infection or injury, blue cyanosis, decreased circulation

37. Specific Measures Related to Nail Care 1. Dr. Order 2. Good source of light 3. Soak nails in water to make them softer 4. Dry thoroughly between toes et fingers; excess moisture can lead to skin break down 5. Residents incontinent, confused, or unconscious should have short fingernails so feces do not collect under nails

38. Specific Measures Related to Nail Care 6. If you a permitted to cut finger nails a) Use nail clippers, not scissors b) Clip the nails straight across c) Clip slowly et carefully d) File rough edges straight across e) Never cut Toenails 7. Injuries to feet are prone to infection et slow healing 8. File toenails straight across 9. Learn et follow agency policies on nail care

39. Shaving 1. Pt may be independent, dependant or require assistance 2. Gather supplies 3. Use electric or disposable razors, pt preference 4. Preference of shaving area (Male, or female) 5. Correct technique 6. Check orders, care plan 7. Shaving may be prohibited or special precautions for pts on anticoagulant, or medications that prevent blood from clotting. 8. Perform shaving in residents bedroom or bathroom not in public area

40. Back Rub 1. Part of daily bath unless contraindicated 2. Frequency pt confined to bed once every 8 hours 3. Time frame 4-7 minutes 4. Purpose a) Stimulates circulation b) Prevents pressure ulcers c) Relaxation et comfort

41. Back Rub/Skin Care Observation Irritation/redness Rashes Bruises- size, color, location Swelling Excessive dryness Sores, lumps, growth Cuts, Abrasions, burns Mottled skin that is cool to touch Check condition of skin over bony prominences

42. Specific Measures Related to Backrub/Skin Care Lotions needed- elderly skin very dry Powder used to absorb skin moisture at skin folds. Do not shake powder- inhale

43. Perineal Care Terms and Definitions Anus- outlet of rectum Male Reproductive Circumcision- surgical removal of the end of the foreskin of the penis Foreskin- loose skin at et covering the end of the penis Scrotum- encloses et protects the testes Testis- primary reproductive organ of male; sperm cell producing organ

44. Perineal Care Terms and Definitions Female Reproductive Tract Labia majora- 2 folds of hair covered skin that lie external to the labia minora Labia minora- flattened longitudinal folds forms the margins of the vestibule Vestibule- space between labia minora that includes the vaginal and urethral openings Vulva- includes the labia majora, minora, clitoris, vestibular glands

45. Purpose of Peri Care Cleans the peri area for the resident who is unable to or has difficulty with adequately cleaning self Prevents skin breakdown of peri area Prevents itching, burning, odor Prevents infection

46. When should Resident have Peri Care Continent- daily with a.m. care Incontinent- after each voiding or stool Indwelling catheter- once a shift et after every BM Necessary if feces are noted under fingernails

47. Perineal Observation Discharge or odors Signs of skin breakdown- redness irritation, rashes

48. Specific Measures Related to Peri Care Peri care (refer to care plan) Soap et water No rinse peri wash Periwash that requires rinsing Skin-barrier creams Pre moistened wipes

49. Specific Measures Related to Peri Care Wash from front to back. To prevent spreading fecal matter from anal area to vagina or urethra (opening to bladder) Offer bedpan or urinal before starting peri care Uncircumcised males- retract foreskin, cleanse circular, return foreskin over tip of penis Wear gloves Perineal area more sensitive to temperature than the rest of the body. Water needs to be slightly cooler Bed protector or pad

50. Key Points to Dressing et Undressing Day et night clothes. Identify time of day Supervise appropriate dress upon weather et occasion Remember elderly have poor circulation, little body fat, less active therefore they may complain of being cool Encourage handicapped resident to wear clothes that open down front Do NOT put residents clothes on backward

51. Key Points to Dressing et Undressing Family or facility laundry residents clothes Name sewn or marked with ink on all residents clothes Resident nonfunctioning weak side, dress weak side first Dependant resident dressed in bed before transferring to wheelchair Residents shoes must be on prior to standing

52. Key Points to Dressing et Undressing Monitor independent resident during dressing, assist if needed Assistive devices If Rx Apply Elastic Stockings, TEDS, Anti- embolism before getting out of bed Rationale- reduce incidence of inflammation of the veins et edema Teds 24 hours remove 30 minutes with am care et 30 minutes with pm care. Check care plan to see if Rx night Wash with mild soap, hang up to dry