Activities of Daily Living: Hygiene

1. Activities of Daily Living: Hygiene Occupationally Specific Knowledge and Skills

2. Objective: Upon completion of this lesson, you will be able to perform the tasks of the following basic hygiene activities of daily living both in the laboratory and clinical setting Today’s Focus: • Oral Hygiene • Shaving • Feeding

3. What is an ADL? • Take a few minutes to jot down & indentify any activity you consider an • ADL’s

4. The most basic of daily hygiene activities can be overlooked when one is sick or elderly.

5. What is your normal morning routine?

6. Oral Hygiene

7. Oral Hygiene Definition 1. Care of the mouth and teeth 2. Ideally should be done three times a day 3. Realistically in a nursing home/Hospital setting it is done only once aday 4. Residents should always be encouraged to be independent asmuch as possible

8. Oral Hygiene Residents/Patients requiring frequent oral hygiene (maybe as often as every 2 hours) 1. unconscious 2. vomiting 3. those experiencing high temperature 4. those receiving certain medications 5. dehydrated 6. mouth breathers 7. those receiving oxygen

9. Oral Hygiene If a patient has trouble swallowing ( dysphagia) • use a special mouth sponge with toothpaste in the sponge a. dip in ½ strength mouthwash & water b. excess water squeezed out c. HOB with patient head turned to side while cleaning the mouth

10. Oral Hygiene (continued) When performing oral hygiene Wear gloves all surfaces of the teeth should be cleaned tongue should be cleaned mouth rinsed with ½ strength mouth wash, if safe for resident gloves worn throughout Oral Hygiene Video

11. Denture Care

12. Denture Care Introduce yourself, explain procedure, gather equipment & provide privacy • Have patient rinse mouth with lukewarm to cool water • Don gloves to remove upper denture first • Place index finger against the roof of the mouth • Thumb against front teeth • Gently press and lift out at same time • You will feel seal release • Then remove lower dentures

13. Oral Hygiene (continued) 6. brush all surfaces of dentures, upper and lower 7. before replacing dentures • wash mouth & tongue with sponge cleaner • rinse with ½ strength mouthwash and water When replacing dentures in mouth, *** lower dentures firstthen uppers ***Lowers help secure uppers

14. Shaving

15. Daily Shaving A. Patients/residents should be shaved daily B. Remember, when shaving 1. use the resident’s own shaving equipment otherwise use disposable, sharp safety razors 2. if resident is receiving anticoagulants, use an electric razor if possible

16. Daily Shaving (continued) 3. If oxygen is being administered • discontinue for this procedure if possible 4. Elderly women sometimes grow hair on their faces & chins In some facilities shaving requires a Physician order Always check with the RN

17. Steps of Shaving a Patient: Introduce yourself, explain procedure to patient, gather equipment, secure patient privacy 1.Moisten the beard with warm, wet washcloth 2. Apply shaving cream 3. Do not moisten beard if you intend to use an electric razor 4. Start in front of the ear a. hold skin taut b. bring razor down over cheek toward chin c. repeat until lather has been removed and area shaved

18. Steps of Shaving a Patient d. remove hair from under the nose & above upper lip using short, downward strokes from nose to lip e. shave skin carefully; having person tense area helps f. shave neck area on each side, bringing razor up toward chin g. use short, firm strokes; rinse razor frequently h. wash face & neck; dry thoroughly i. if skin is nicked, apply pressure directly over are & report to nurse in charge Shaving Video

19. Feeding Patients

20. Feeding Patients • Good nutrition is essential • Mealtimes are regarded as social interactive events • People who eat alone often have poor appetites & poor nutrition • Proper mealtime preparation is important

21. Feeding the patient Allow patient to do as much for themselves as possible • Wash hands, offer hand hygiene to patient & elevate the HOB • give small amounts & make certain patient has chewed & swallowed the food • if weakness exists make sure that food isn’t being packed into the cheeks • patients can’t always feel food in their mouth & would not be aware of some was packed in the cheeks • use caution when removing utensils does not scrape the roof of the mouth (palate) Feeding Video

22. Feeding Patients (continued) 6. Use a straw when giving liquids- • Direct the straw by holding it between two fingers • Hold the straw until the patient releases it from his/her mouth • EXCEPTION to straw use= ASPIRATION PRECAUTIONS 7. Offer fluids often • some need it after each mouthful of solid food 8. Feed as you would eat/ vary food choices 9. When preparing the tray, find out how resident wants their food. For example, some do not like butter, but prefer jam, sugar in tea

23. Eyeglasses A. Keep clean by rinsing with water and drying with special lens paper or soft, nonabrasive tissue. B. Store in container in bedside stand when not in use C. Glasses should be kept in easy reach of patient D. Encourage resident to wear whenever possible

24. Daily Hair Care A. Usually performed after bath B. Brushing hair • stimulates circulation of the scalp • refreshes the patient C. If hair is tangled 1. work section by section 2. untangle hair, beginning near the ends and working toward the scalp 3. gum may be removed with ice or peanut butter

25. Nail Care A. Care to the fingernails is allowed by the state of Texas. Care of toenails by nurse aides is not. Due to diminished circulation of the lower extremities in elderly and ill people B. Should a cut occur, infection might set in and healing be very difficult C. Podiatrists are brought in to perform foot care D. Even where fingernails are concerned, do not do on a diabetic individual E. Procedure 1. soak nails for at least 5 minutes. 2. Nails can be cleaned while soaking 3. Use an orange stick to push cuticles back 4. Clip the nails either straight across or slightly rounded 5. File any rough edges

26. Dressing a Patient A. Let person select their clothing B. Let them do as much of the dressing as possible C. Position in front of a mirror if one is available D. Dress weakest side first, then strongest E. Undress strongest first, then weakest F. Use tools to assist the resident to care for herself/himself Dressing a Patient Video

27. Is your patient ready to step into the batter’s box this morning?

28. Activity • Divide into pairs- one person is the patient the other student is the PCT • Shave the patient using a safety razor with the blade cap still in place. Shaving cream to be used, procedure to be followed • Perform oral hygiene on your patient using the proper procedure • Feed your patient using applesauce, offering fluids with a straw and without a straw • Then switch!

29. SCENARIO • Mr. Gonzalez is a 88 year old geriatric patient admitted to North Hills 2 days with right sided weakness, slurred speech, and facial droop (he is right handed) • Dr. Smith has confirmed a Left Sided CVA • You are assigned to assist Mr. Gonzalez with his morning care today • It is 7:30 am and the breakfast trays arrive at 8:00 am • Dr. Smith has written an order to shave the patient with caution ASAP and maintain ASPIRATION PRECAUTIONS during all meals!!! • ***** Mr. Gonzalez is rings the call bell and says, • “I want to be shaved and have my teeth brushed NOW before breakfast arrives!!!!”