1. Chapter 16 Personal Hygiene

2. Chapter 16 Personal Hygiene Personal hygiene promotes comfort, safety, and health. Hygiene and grooming are basic activities of daily living (ADL). The skin is the body’s first line of defense against disease. Intact skin prevents microbes from entering the body and causing an infection. Personal hygiene promotes comfort, safety, and health. Hygiene and grooming are basic activities of daily living (ADL). The skin is the body’s first line of defense against disease. Intact skin prevents microbes from entering the body and causing an infection. Integumentary System: Is the largest organ system of the body Integumentary System: Is the largest organ system of the body Skin Skin Hair Hair Nails Nails

3. Skin: What does the skin do for our bodies? Box 16-1 pg 313 -skin is the first line of defense against injury and infection -absorbs medication -regulates internal temperature -acts as a sensor to heat, cold, and pain -helps make vitamin D and store minerals

4. General guidelines of hygiene and (ADL’S): 1. General guidelines of hygiene and (ADL’S): -special requirements for older residents (equipment, assistive devices) -use proper body mechanics -allow resident to do as much as possible for self -ensure safety and privacy at all times -explain procedure -use resident’s product as requested -follow standard/universal of precautions -follow a plan of care for the person

5. Safety Guidelines 2. Safety Guidelines: place rubber or non-skid mat in tub before resident enters Keep bathroom floor dry to prevent falls Do not add oil to bath water Be sure bath water is at a temperature comfortable for resident (95'-105') Remain with resident at all times Bath or shower chair should be locked use grab bars and rails Have resident use grab bars and rails Assist resident in all transfers Resident with special treatments, be careful and do not: -do not put stress on tubes -do not lower IV bottle below infusion site -do not raise drainage tube above site

6. 3. Daily care: Personal hygiene and grooming routines and personal habits ✱ Let the person do as much on their own as possible! Only Assist as neededPage 314 AM care:AM care: providing personal care for resident when they awaken & before breakfast. 1. Assist resident to the bathroom or offer the bedpan or urinal 2. Help resident wash face and hands 3. Assist resident with oral care 4. Assist resident to dress and groom for breakfast 5. Protect residents privacy Morning care Morning care: care given after breakfast -Always assist resident to the bathroom or offer the bedpan or urinal -bathing, back massage, grooming, ROM, exercise, ambulating

7. Afternoon care: care done after lunch and the evening meal HS or PM care: given just before bedtime. Care needs to be relaxing and comfortable 1. Assist resident to the bathroom or offer the bedpan or urinal 2.Help resident wash face and hands 3.Assist resident with oral care 4.Clean incontinent resident and change any soiled linens 5.Provide peri care 6.Assist resident to undress and put on gown or pajamas 7.Offer back massage 8.Straighten bed linens for residents comfort

8. 4. Oral Care ➊ keeps the mouth and teeth clean, ➋➚ comfort, ➌ food tastes better, ➍ prevent mouth odor and infection. A. General guideline: 2 x day 1. wear gloves 2. position resident for safety - sitting up 3. encourage resident to help when possible 4. avoid placing fingers into resident’s mouth 5. avoid vigorous cleaning causes bleeding 6. use products requested by resident B. Observe and report to the nurse: 1. Mouth: discoloration, irritation, redness, bleeding, paleness, sores, lesions or crack of mouth, gum or lips and swelling 2. Bad breath that does not improve after mouth care 3. Complaints of pain or discomfort of mouth related to dentures a. damaged, broken, ill-fitting or lost dentures 4. Changes in resident’s ability to participate in oral care

9. 5. Types of Oral Care A. Conscious oral care (Real teeth): Page 318 1. Brush 2 x day, floss once, rinse with 1 part mouthwash to 4 part water. 2. Sit resident up (fowler position) 3. Spread towel across chest 4. Clean all surfaces in an up and down/circular motion paying special attention to gum line 5. Allow resident to expectorate into a appropriate container 6. Assist resident to rinse mouth, wiping lips and mouth 7. Offer flossing and mouth wash if resident desires 8. Moisturize lips (resident’s using oxygen NO petroleum based products) 9. Report abnormalities such as bleeding gums, sores

10. B. Unconscious oral care/aspiration precautions Page 320 1. Every 2 hours or as needed 2. Place towel under head and chin 3. Lateral side lying with head turned or supine position with head turned to prevent aspiration or choking or as resident’s medical condition indicates 4.Insert swab/sponge tip - Do Not use toothbrush and toothpaste 5. Rotate against all tooth surfaces, mucous membranes and tongue 6. Clean and lubricate lips (on oxygen use KY Jelly) 7. Precaution: use very small amounts of fluid to prevent aspiration

11. C.Dentures: made from plastic/porcelain Page 324 1. Line sink with towel or washcloth or fill with water 2.Brush dentures under running water with toothbrush and toothpaste 3.Water should be neither hot nor cold (warm water) 4.Place dentures in denture cup with water, adding cleaning tablet (if available) 5.Cover with lid and allow to soak 6.Perform mouth care while dentures are out of mouth 7.Remove at bedtime and place in soaking solution 8.If dentures are left in overnight, they must be removed for 10 to 20 minutes during the day. 9.Denture don’t need to be flossed

12. 6. Lip care: 1. Water base lubricate (KY Jelly) use on patients with oxygen or everyone 2. Petroleum base (Vaseline, chap sticks, carmex) do not use on patients with oxygen 7. Skin Care: A. Principles of skin care: 1.Skin is fragile and easily injured 2.Special care of bony prominence (pressure points) 3.Soap must be completely rinsed from skin and pat dry

13. 7. Skin Care : B. Skin care products: pg 326 Box 16-1 AVOID use of SCENTED products Soaps: mild soap to prevent drying and irritation of skin Creams/Lotions: protect the skin and help with dry skin Powders: absorb moisture and prevent friction -don’t shake or sprinkle powder onto the person -sprinkle a small amount on hand or cloth -apply a thin layer ❑ do not use powders near people with respiratory problems. Inhaling powder irritates the airway and lungs. ❑ Avoid using around tubes: oxygen, foley catheter, G- tube, suprapubic catheter Deodorants can help to reduce body odors Barrier cream may be used for prevention of friction and pressure sores

14. C.Observe skin and REPORT problems to NURSE 1. Redness or irritation on skin 2. Breaks or cracks in skin; especially between toes 3. Pale, bluish or gray discoloration of skin 4. Corns, calluses, ingrown nails, or other complaints of hands or FEET 5. Bleeding 6. Pain

15. D. Back Rub/ Massage: a. Stimulates residents circulation. b. Prevents skin breakdown c. Soothe, refreshing and promotes relaxation d. May include areas other than the back: hands, scalp, feet e. Usually provided after a bath, at bedtime, or to promote relaxation F. Procedure: 3-5 min or as ordered 1. warm lotion in hands 2. apply with gentle pressure, using both hands and always keep your hands in contact with the skin. 3. start at the buttocks up to back of neck without pulling skin 4. use long firm stroke 5. use shorter circular strokes across the shoulders using both hands 6. inspect for reddened area or any skin condition ✱ Never massage a persons with heart disease, back injuries, back surgery, skin disease, and lung disorders ** Never massage a red area

16. 8. Bathing (assisted and total care) Page 329 A. Bathing 1.Cleanses the skin allows for observation 2.Provides activity (ROM) 3.Increases circulation 4.Relaxes the resident B. Guidelines for bathing: Bathing: 2-3 x week Water temperature 95'-105' F 1. provide privacy & only expose area being washed 2. keep person warm at all times 3. check water temperature: ✓ with bath thermometer ✓ with your wrist ✓ have patient feel the water 4. turn on cold water first ➟ then hot water 5. no longer than 20 minutes 6. lock wheels on shower chair observe the skin for problems 7. Good time to observe the skin for problems 8. Remain with resident at all times

17. 9.Types of baths Water temp: 95'-105' F A. Tub bath: no longer than 20 minutes -fill tub before person gets in & drain the tub before getting out -remain with the resident for the entire bath -clean & disinfect tub after each use C. Whirl pool: same as tub bath D. Shower: 1. Ensure residents modesty (Closing door & pulling shower curtain) 2. Use a shower chair, and go as fast as you can to prevent the resident from getting cold. 3. The resident’s hair may be shampooed during the showering process E. Complete Bed bath: Page 330-331 Unable to bath by self or on complete bed rest Privacy: only exposing area being washed Keep warm Wash front to back & cleanest to dirtiest Rinse and dry well Observe skin for possible problems F. Partial bath: water temp. 95' -105'F ➊ face, ➋ hands, ➌ axillary, ➍ back ➎ perineal area and buttocks. **Body parts needs to be done every day. To take care of most of their own bathing needs or have odor problem

19. 10. Peri-care: Provided any time the perineum needs to be cleansed, especially after a BM, urination, shower/bath, at bedtime, or when moisture or secretions are present. Page 344-345 1. Done as part of bath, every time they have a BM or urinate, or as needed. 2. Resident should do their own perineal care, if able 3. Follow standard precautions and the rules of medical asepsis A.Circumcised male per-care 1. Wash in a circular motion from the tip of the penis to the base of the penis 2. Clean scrotum and then the rectal area from front to back 3. Rinse and gently dry each area B.Uncircumcised male per-care 1. Retract foreskin and wash as above 2. Return foreskin to original position C.Female 1. Open the labia minora and wash the meatus and then sides 2. Wash the labia majora and then the rectal area from (FRONT TO BACK and clean to dirty)

20. Complete Bed bath: Page 330-331 Unable to bath by self or on complete bed rest 1. Wash cloth or mitt Eyes, face, ears and neck Arms and Hands Chest and abdominal area

21. Legs and Feet Back Peri-Care: Female Peri-Care Male Partial Bath Face Hands Axillary Back Buttocks Perineal area Body parts washed daily