1. Chapter 18
Grooming
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2. Grooming Hair care, shaving, and nail and foot care:
Prevent infection and promote comfort
Affect love, belonging, and self-esteem needs
Review Focus on Rehabilitation: Grooming on p. 293.
Review Teamwork and Time Management: Grooming on p. 293.
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3. Hair Care 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
Skin and scalp conditions include:
Hair loss or excessive body hair
Dandruff
Lice and scabies
How the hair looks and feels affects mental well-being.
Many nursing centers have beauty and barber shops for residents.
Review Focus on Communication: Skin and Scalp Conditions on p. 294.
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4. Skin and Scalp Conditions
Alopecia is hair loss.
Hirsutism is excessive body hair.
It can occur in women and children.
It results from heredity and abnormal amounts of male hormones.
Dandruff is the excessive amount of dry, white flakes from the scalp.
Itching often occurs.
Hair loss may be complete or partial. Except for hair loss from aging, hair usually grows back.
Hirsutism can occur in women and children. It results from heredity and abnormal amounts of male hormones.
Sometimes eyebrows and ear canals are involved in dandruff. Medicated shampoos correct the problem.
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5. Lice
Lice (pediculosis) is the infestation with wingless insects (lice).
Pediculosis capitis is the infestation of the scalp with lice (aka “head lice”).
Pediculosis pubis (crabs) is the infestation of the pubic hair with lice.
Pediculosis corporis is the infestation of the body with lice.
Lice easily spreads to others.
Report signs and symptoms of lice to the nurse at once.
Lice spread through clothing, head coverings, furniture, beds, towels, bed linen, and sexual contact. They also are spread by sharing combs and brushes. Lice attach their eggs (nits) to hair shafts. Nits are oval and yellow to white in color. They hatch in about 1 week.
Lice are treated with medicated shampoos, lotions, and creams.
Thorough bathing is needed, as is washing clothing and linens in hot water.
Signs and symptoms of lice include complaints of a tickling feeling or something moving in the hair, itching, irritability, sores on the head or body caused by scratching, or rash.
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6. Scabies Scabies is a skin disorder caused by a female mite.
A mite is a very small spider-like organism.
The female mite burrows into the skin and lays eggs.
When the eggs hatch, the females produce more eggs, so the person becomes infected with mites.
The person has a rash and intense itching.
Scabies is highly contagious and is transmitted by close contact.
Treatment is the application of creams to kill the mites.
The person’s room is cleaned, and clothing and linens are washed in hot water.
Scabies is a skin disorder caused by a female mite.
A mite is a very small spider-like organism.
Common sites for scabies are between the fingers, around the wrists, in the underarm area, on the thighs, and in the genital area. Other sites include the breasts, waist, and buttocks.
Persons living in crowded living settings are at risk, as are persons with weakened immune systems.
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7. Bed Bugs
Bed bugs are small, flat reddish-brown insects that live in or around where people sleep.
They feed on the blood of people or animals.
It is difficult to control infestation and professional pesticide companies are often used.
People often don’t know when they are bitten.
After red marks appear they realize they have been bitten.
The marks look like mosquito bites and are itchy.
There has been a recent surge of bed bug infestations in many different settings, including long-term care centers and hospitals.
Bed bugs can travel in luggage, bedding, furniture, and clothing. They often hide in places like seams of a mattresses, headboards, tables, and cracks of walls. It is difficult to control infestation of bed bugs. If you see bed bugs report this immediately. The use of high heat, chemical pesticides, and thorough cleaning may be used.
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8. Brushing and Combing Brushing and combing hair
Encourage residents to do their own hair care.
Assist as needed.
Perform hair care for those who cannot do so.
The person chooses how to brush, comb, and style hair.
When brushing and combing hair:
Start at the scalp.
Then brush or comb to the hair ends.
You must not:
Braid hair without the person’s consent
Cut matted or tangled hair
Cut hair for any reason
Special measures are needed for curly, coarse, and dry hair.
Brushing increases blood flow to the scalp and brings scalp oils along the hair shaft.
Long hair easily mats and tangles. Daily brushing and combing prevent the problem, as does braiding.
Tell the nurse if the person has matted or tangled hair. The nurse may have you comb or brush through the matting and tangling.
Review Caring about Culture: Brushing and Combing Hair on p. 296.
Review Delegation Guidelines: Brushing and Combing Hair on p. 296.
Review Promoting Safety and Comfort: Brushing and Combing Hair on p. 296.
Review the Brushing and Combing the Person’s Hair procedure on p. 297.
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9. Shampooing Shampooing
Shampooing frequency depends on the person’s needs and preferences.
The shampoo method depends on:
The person’s condition
Safety factors (for example, water temperature of 105 F [Fahrenheit] [40.5 C (centigrade)])
Personal choice
Methods include: shampoo during the shower or tub bath, shampoo at the sink, shampoo on a stretcher, and shampoo in bed.
Because oil gland secretion decreases with aging, older persons have dry hair. Usually shampooing is done weekly on the person’s bath day.
Persons may use regular shampoos and conditioners or medicated products ordered by the doctor.
Residents usually need help with shampooing.
Dry and style hair as quickly as possible after the shampoo.
Review Delegation Guidelines: Shampooing on p. 299.
Review Promoting Safety and Comfort: Shampooing on p. 299.
Review the Shampooing the Person’s Hair procedure on p. 300.
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10. Shaving Collect shaving items with bath items.
Many men shave for comfort and mental well-being.
Many women shave:
Their legs and underarms
Coarse facial hair
Safety razors or electric shavers are used.
If the center’s electric shaver is used, clean it after every use.
Collect shaving items with bath items.
Use the kidney basin to rinse the razor.
Do not use the bath water.
Whether women shave their legs and underarms varies among cultures.
Legs and underarms are shaved after bathing. The skin is soft at this time. Soap and water, shaving cream, or lotion is used for lather.
Review the rules for shaving in Box 18-1 on p. 299.
Follow the manufacturer’s instructions for brushing out whiskers from an electric shaver.
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11. Safety Razor Risk Factors and Caring for Facial Hair
Safety razors are not used:
On persons who have healing problems.
For those who take anticoagulant drugs.
On persons with dementia.
Mustaches and beards need daily care.
Because food and drainage from the mouth and nose can collect in the whiskers, daily washing and combing of mustaches and beards are needed.
Never trim a mustache or beard without the person’s consent.
Ask the person how to groom his mustache or beard.
Safety razors (blade razors) involve razor blades. They can cause nicks and cuts. Older persons with wrinkled skin are at risk for nicks and cuts.
An anticoagulant is a drug that prevents or slows down (anti) blood clotting (coagulant). Bleeding occurs easily and is hard to stop. A nick or cut can cause serious bleeding, so electric shavers are used instead.
Review Residents with Dementia: Shaving on p. 301.
Review Delegation Guidelines: Shaving on p. 301.
Review Promoting Safety and Comfort: Shaving on p. 301.
Review the Shaving the Person’s Face With a Safety Razor procedure on p. 302.
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12. Nail and Foot Care
Nail and foot care prevents infection, injury, and odors.
Injuries occur from:
Stubbing toes
Stepping on sharp objects
Being stepped on
Shoes that fit poorly
Trimming and clipping toenails in persons with diabetes and vascular diseases
Hangnails, ingrown nails (nails that grow in at the side), and nails torn away from the skin cause skin breaks. These breaks are portals of entry for microbes.
Long or broken nails can scratch skin or snag clothing.
The feet are easily infected and injured.
Dirty feet, socks, or stockings harbor microbes and cause odors. Shoes and socks provide a warm, moist environment for microbes to grow.
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13. Nail and Foot Care (Cont’d)
Poor circulation prolongs healing.
Infections or foot injuries are very serious.
Gangrene and amputation are serious complications.
Some centers do not let nursing assistants cut or trim toenails. Follow center policy.
Nails are easier to trim and clean right after soaking or bathing.
Use nail clippers to cut fingernails.
Never use scissors.
Diabetes and vascular diseases are common causes of poor circulation.
Trimming and clipping toenails can easily cause injuries.
Use extreme caution to prevent damage to nearby tissues.
Review Delegation Guidelines: Nail and Foot Care on p. 304.
Review Promoting Safety and Comfort: Nail and Foot Care on p. 304.
Review Teamwork and Time Management: Nail and Foot Care on p. 305.
Review the Giving Nail and Foot Care procedure on pp
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14. Changing Clothing and Gowns
You may need to assist with changing clothes and hospital gowns.
Provide for privacy.
Encourage the person to do as much as possible.
Let the person choose what to wear.
Remove clothing from the strong (unaffected) or “good” side first.
Put clothing on the weak (affected) side first.
Support the arm or leg when removing or putting on a garment.
In addition to morning and evening changes of clothing, garments are changed whenever wet or soiled.
You may need to assist with changing clothes and hospital gowns.
Review Residents with Dementia: Changing Clothing and Hospital Gowns on p. 307.
Review Focus on Communication: Dressing and Undressing on p. 307.
Review Delegation Guidelines: Dressing and Undressing on p. 307.
Review the Undressing the Person procedure on pp
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15. Dressing and Changing Gowns
Dressing and undressing
Some residents dress and undress themselves.
Others need help.
Personal choice is a resident right.
Changing hospital gowns
Some residents wear hospital gowns.
Gowns are usually worn for IV (intravenous) therapy.
If there is injury or paralysis:
The gown is removed 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.
Most residents wear street clothes during the day. Some wear hospital gowns. Gowns are usually used for IV therapy (see Chapter 20). Some residents may only wear hospital gowns at night. This makes changing incontinent products easier.
Review the Dressing the Person procedure on pp in the textbook.
Review Delegation Guidelines: Changing Hospital Gowns on p. 311.
Review Promoting Safety and Comfort: Changing Hospital Gowns on p. 311.
Review the Changing the Gown of the Person With an IV procedure on p. 312.
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16. Quality of Life Grooming measures:
Promote comfort.
Help the person’s body image and esteem needs.
Help mental well-being.
Encourage and allow personal choice whenever possible.
Carefully handle the person’s grooming products and personal care items.
Record your observations and the care given according to center policy.
Residents may not have energy for some procedures. The nurse tells you what care to give and when to give it.
Sometimes family members want to help with grooming. With the person’s permission, allow family members to assist as much as safely possible. This promotes social interaction and involves the family in the person’s care.
Report your observations to the nurse and record care given according to center policy (see Fig ). This information is needed to meet the person’s needs.
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