1. Personal/Oral Hygiene, Foot Care, ROM Exercises and Making an Occupied Bed Week 4

3. Bathing n Cleanses and conditions the skin n Helps to relax the patient n Promotes circulation n Acts as musculoskeletal exercise n Provides comfort n Helps improve self image n Time to develop a therapeutic relationship with your patient

4. Bathing n Allows you an opportunity to observe skin, hair, nails, bony prominences, for any adverse signs n Form of therapeutic touch n Opportunity to complete a thorough patient assessment, ask questions and to get to know the patient a little better

5. The Bed Bath n Only an option if the patient is not able to get up and ambulate n Observe good “body mechanics”  Assist patient or done completely by the nurse n Gather all equipment and linen as needed n Encourage toileting before you start n Ensure privacy - close curtain and door

6. Bed Bath n Use bath blanket and drape parts not being washed - remember dignity!! n Fold washcloth like a mitt n Wash face first - inner to outer eye n Soak hands and feet if possible n Face, neck, arms, hands, chest, abdomen, legs, feet, back, buttocks and anal area, long strokes towards body n Backrub will prove very soothing

7. n Change water, get new cloth and towel n Clean perineal area last! n Always wear gloves for perineal care n Female - wash from pubic area to perineum to anus n Male - retract foreskin if necessary and wash from tip of penis towards pubis; remember to replace foreskin be gentle with scrotum/testicles n Do not usually use powder as promotes bacterial growth no talc

8. Showers and Tub Baths #1 n Carefully determine how much assistance the patient will need n Provide a chair or bench for the patient n Bring all of the necessary supplies including fresh clothing with you n Ensure to check the water temperature n Assist the patient in and out as needed n Maintain privacy

9. #2 n Assist as needed n If patient is left alone, do not allow to lock the door n Hang a sign on the door to indicate that the room is in use and to avoid interruptions n Always ensure safety of patient!!

10. Giving a Back Rub #1 n Position patient for comfort & provide privacy n Assure pt. is covered and warm n Warm lotion in hand n Use light, gliding strokes to apply lotion to shoulders, back and sacral area n Place hands beside each other and start at sacral area, work up and back down using slow, continuous strokes

11. #2 n Massage shoulders, back, iliac crests and sacrum with circular strokes n Apply additional lotion as needed n Observe skin for redness or breakdown n Towel off excess lotion or moisture n Assess the patient’s response and document Provides relaxation, sleep, improves overall comfort, decreases pain

12. Oral Care #1 n If the patient is unconscious, turn head/body to one side n A toothbrush works best n Be “gently firm” but don’t overdo it!! n Use toothettes or a tongue depressor with gauze if no toothbrush available n Always remember to moisten the lips -if on oxygen, do not use petrolium jelly

13. #2 n Encourage the patient to keep dentures in when awake or the gum line may shrink n Always store dentures in water so they don’t dry out n Never use hot water with dentures as they may warp!! n Line sink with washcloth or papertowel- will chip or break if dropped

14. Hair Care and Shaving n Provides pt. with sense of well being n Don’t hyperextend neck n Can shampoo hair at the sink or in bed n Need ++ towels, cover pt. eyes n Best done in shower with assistance n Some hospitals have shampoo caps

15. Shaving n Usually use electric razors - especially if patient is on anticoagulants or at risk for bleeding n Razor shave: use shaving cream, pull skin taut, use short, firm strokes in direction of hair growth n Always wear gloves when shaving as may be at risk of exposure to blood n Follow patient’s direction

16. Diabetic Foot Care n File nails as necessary….do not cut! n Avoid heating pads, hot water bottles n Encourage elevation of feet if swelling evident n Avoid crossing legs, stockings with elastic tops and/or sitting for prolonged periods of time n Make referral to foot care specialist with calluses, corns, ingrown nails n Specially trained RN or RPN

17. Hearing Aids n Ensure ears are clean  Wipe off hearing aid if wax buildup evident n Check functioning before placing in ear n Usually remove at bedtime

18. Range of Motion (ROM)#1 n Is the normal and possible full extent movement of a joint n Improves joint mobility and circulation n Special attention to joints not being used n Active - patient does on own n Passive - nurse moves joint n Active-assistive - nurse provides help **Remember…..only active ROM exercises improves muscle mass, tone and strength

19. ROM #2 n Plan of care should include how, what and when so others can do the same n Avoid overexertion and fatigue n Avoid neck hyperextension and full ROM in the elderly n Start gradually and proceed slowly n Movements should always be smooth and rhythmic

20. ROM #3 n Move joint until resistance is felt but not pain n Use support measures: cupping, cradling, supporting n Always return joint to neutral position n Avoid friction n Do ROM exercises at least 2 times per day and repeat each exercise 2-5 times

21. ROM Positions n Head - flexion, extension, lateral flexion n Neck - rotation n Shoulder - flexion, extension, abduction, adduction, internal and external rotation n Elbow - flexion, extension n Forearm - supination, pronation n Wrist - flexion, extension, hyperextension

22. n Fingers - flexion, extension, abduction, adduction, opposition of thumb to fingers n Hip - flexion, extension, abduction, adduction, internal rotation, external rotation n Knee - flexion, extension n Ankle - dorsiflexion, plantar flexion, inversion, eversion n Toes - flexion, extension, abduction, adduction

23. Making an Occupied Bed n Do this only when necessary n Movement is good for the patient so always ambulate the patient if at all possible n Make ½ of the bed, then the other side n Use side rails for safety!! n May work side to side or top to bottom depending on the patient’s ability to assist

24. Nursing Skills Lab 1 n Week 5 n Lab Theory Test #1 n 35-40 multiple choice questions related to content discussed, demonstrated and practised in weeks 2-4 n Will be written during the first 40 minutes of this Lab

25. Nursing Skills Lab 1 n Week 5 n Ambulation n Patient Transfers and Restraints n Dressing the Dependent Client REMEMBER, to bring along an oversized shirt/sweater and pants for next week’s lab …………