1. Explain personal care of residents

1. Explain personal care of residents • Define the following terms: • hygiene • practices to keep bodies clean and healthy. • grooming • practices to care for oneself, such as caring for fingernails and hair.

1. Explain personal care of residents NAs may provide the following a.m. care for residents: Assisting with toileting Helping wash face and hands Assisting with hair care, dressing, and shaving Assisting with mouth care

1. Explain personal care of residents NAs may provide the following p.m. care for residents: Assisting with toileting Helping wash face and hands Giving a snack Assisting with mouth care Assisting with changing into nightclothes Giving a back rub

Transparency 6-1: Assisting with Personal Care • Help the resident be as independent as possible. • Be aware of resident preferences and routines. • Always explain what you will be doing. • Always provide privacy. • Observe the resident during care. • Note and report signs and symptoms. • Observe resident’s mental state. • Report any changes. • Leave the resident’s room clean and tidy. • Leave the bed in the lowest position and the call light within resident’s reach.

1. Explain personal care of residents NAs can promote residents’ dignity during personal care by Encouraging residents to do as much as they are able to do and being patient Knocking and waiting for permission to enter the resident’s room Not interrupting residents while they are in the bathroom Leaving the room when residents receive or make phone calls Respecting residents’ private time and personal things Not interrupting residents while they are dressing Keeping residents covered whenever possible when helping with dressing

1. Explain personal care of residents Think about these questions: How else can NAs help promote privacy, respect, and dignity during personal care? What else do you think can be accomplished while providing personal care?

1. Explain personal care of residents While providing personal care NAs should observe for and report the following: Skin color, temperature, or reddened areas Mobility Flexibility Comfort or pain level Strength and ability to perform ADLs Mental and emotional state Complaints

2. Identify guidelines for providing skin care and preventing pressure ulcers Define the following terms: pressure points areas of the body that bear much of its weight. bony prominences areas of the body where the bone lies close to the skin. pressure ulcer a serious wound resulting from skin breakdown; also called pressure sore, bed sore, or decubitus ulcer.

2. Identify guidelines for providing skin care and preventing pressure ulcers Define the following terms: shearing rubbing or friction that results from the skin moving one way and the bone underneath it remaining fixed or moving in the opposite direction. draw sheet an extra sheet placed on top of the bottom sheet; used for moving residents in bed.

2. Identify guidelines for providing skin care and preventing pressure ulcers Define the following terms: foot drop a weakness of muscles in the feet and ankles that causes problems with the ability to flex the ankles and walk normally. orthotic device, or orthosis a device that helps support and align a limb and improve its functioning.

2. Identify guidelines for providing skin care and preventing pressure ulcers REMEMBER: Prevention is the key to skin health. Once a pressure ulcer forms, it can get bigger and deeper and become infected. Pressure ulcers are painful and difficult to heal.

Transparency 6-2: Pressure Ulcer Danger Zones

Transparency 6-3: Observing the Skin • Pale, white, reddened, or purple areas • Blisters or bruises • Tingling, warmth, or burning • Dry or flaking skin • Itching or scratching • Rash or discoloration • Swelling • Fluid or blood draining • Broken skin • Wounds or ulcers • Changes in wound or ulcer (size, depth, drainage, color, or odor) • Redness or broken skin between toes or around toenails

Transparency 6-3: Observing the Skin In darker complexions, also look for • Any change in feel of the tissue • Any change in appearance of the skin, such as an “orange-peel” look • Purplish hue • Extremely dry, crust-like areas that might be covering a tissue break

2. Identify guidelines for providing skin care and preventing pressure ulcers NAs should remember these guidelines for skin care: Report changes in residents’ skin. Provide regular skin care. Reposition often, at least every two hours. Give skin care often for incontinent residents. Change clothing and linen often. Avoid scratching or irritating skin; report blisters or sores on feet.

2. Identify guidelines for providing skin care and preventing pressure ulcers Guidelines for skin care (cont’d): Massage skin frequently. Do not massage white, red, or purple areas. Avoid pulling or tearing skin. In overweight residents, pay special attention to skin under folds. Encourage residents to eat well-balanced meals. Keep plastic or rubber materials from coming into contact with skin. Follow the care plan and nurse’s instructions.

2. Identify guidelines for providing skin care and preventing pressure ulcers Bed-bound residents are at a high risk for pressure ulcers. When caring for these residents NAs should Keep bottom sheet tight and wrinkle-free. Avoid shearing. Place sheepskin, chamois skin, or bed pad under back and buttocks. Relieve pressure under bony prominences. Make bed or chair softer with flotation pads. Use bed cradle to keep top sheets from rubbing skin. Reposition residents seated in chairs or wheelchairs at least every hour if they cannot change positions easily themselves.

2. Identify guidelines for providing skin care and preventing pressure ulcers All of these positioning devices can help keep residents comfortable and reduce the risk of skin breakdown: Backrests Bed cradles Draw sheets Footboards Hand rolls Orthotic devices Trochanter rolls Pillows

3. Describe guidelines for assisting with bathing Define the following terms: partial bath a bath given on days when a complete bath or shower is not done; includes washing the face, hands, underarms, and perineum. perineum the genital and anal area.

3. Describe guidelines for assisting with bathing Remember these guidelines for bathing: Baths are for health and relaxation. The face, hands, underarms, and perineum should be washed every day. Complete baths are necessary every other day or less often. Use facility-approved products. Keep room temperature comfortable. Be familiar with safety and assistive devices.

3. Describe guidelines for assisting with bathing Guidelines for bathing (cont’d): Gather supplies beforehand so a resident is not left alone while bathing. Make sure water temperature is safe and comfortable. Have resident test water temperature. Remove all soap from the skin. Keep a record of bathing schedules.

Giving a complete bed bath Equipment: bath blanket, bath basin, soap, bath thermometer, 2-4 washcloths, 2-4 bath towels, bed pads, clean clothes, 2 pairs of gloves, orangewood stick or nail brush, lotion, deodorant, brush or comb When bathing, move resident’s body gently and naturally. Avoid force and over-extension of limbs and joints. 1. Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Identifying resident by name shows respect and establishes correct identification. 2. Wash your hands. Provides for infection prevention. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence.

Giving a complete bed bath 4. Provide for resident’s privacy with curtain, screen, or door. Be sure the room is at a comfortable temperature and there are no drafts. Maintains resident’s right to privacy and dignity. 5. Adjust bed to a safe level, usually waist high. Lock bed wheels. Prevents injury to you and to resident.

Giving a complete bed bath 6. Place a bath blanket or towel over resident. Ask him to hold onto it as you remove or fold back top bedding. Remove gown, while keeping resident covered with bath blanket (or top sheet). Place gown in proper container.

Giving a complete bed bath 7. Fill the basin with warm water. Test water temperature with thermometer or against the inside of your wrist. Water temperature should not be over 105°F. Have resident check water temperature to see if it is comfortable. Adjust if necessary. The water will cool quickly. Change the water when it becomes too cool, soapy, or dirty. Resident’s sense of touch may be different than yours; therefore, resident is best able to identify a comfortable water temperature. 8. Put on gloves. Protects you from contact with body fluids. 9. Ask the resident to participate in washing. Help him do this when needed. Promotes independence.

Giving a complete bed bath 10. Uncover only one part of the body at a time. Place a towel or bed pad under the part being washed. Promotes resident’s dignity and right to privacy. Also helps keep resident warm. 11. Wash, rinse, and dry one part of the body at a time. Start at the head. Work down, and complete the front first. When washing, use a clean area of the washcloth for each stroke.

Giving a complete bed bath Eyes, Face, Ears, and Neck: Wash face with wet washcloth (no soap). Begin with the eye farther away from you. Wash inner to outer area. Use a different area of the washcloth for each stroke. Wash the face from the middle outward. Use firm but gentle strokes. Wash the ears and behind the ears. Wash the neck. Rinse and pat dry.

Giving a complete bed bath Arms and Axillae: Remove top clothing. Cover with bath blanket. Remove one arm from under the towel. With a soapy washcloth, wash the upper arm and underarm. Use long strokes from the shoulder down to the wrist. Rinse and pat dry. Repeat for the other arm.

Giving a complete bed bath Hands: Wash one hand in a basin. Clean under the nails with an orangewood stick or nail brush. Rinse and pat dry. Give nail care (see procedure later in this chapter). Repeat for the other hand. Put lotion on the resident’s elbows and hands.

Giving a complete bed bath Chest: Place the towel across the resident’s chest. Pull the blanket down to the waist. Lift the towel only enough to wash the chest. Rinse it and pat dry. For a female resident, wash, rinse, and dry breasts and under breasts. Check the skin in this area for signs of irritation. Abdomen: Keep towel across chest. Fold the blanket down so that it still covers the pubic area. Wash the abdomen, rinse, and pat dry. If the resident has an ostomy, give skin care around the opening (Chapter 4). Cover with the towel. Pull the cotton blanket up to the resident’s chin. Remove the towel.

Giving a complete bed bath Legs and Feet: Expose one leg. Place a towel under it. Wash the thigh. Use long downward strokes. Rinse and pat dry. Do the same from the knee to the ankle.

Giving a complete bed bath Place another towel under the foot. Move the basin to the towel. Place the foot into the basin. Wash the foot and between the toes. Rinse foot and pat dry. Make sure areas between toes are dry. Apply lotion to the foot if ordered, especially at the heels. Do not apply lotion between the toes. Repeat steps for the other leg and foot.

Giving a complete bed bath Back: Help resident move to the center of the bed. Ask resident to turn onto his side so his back is facing you. If the bed has rails, raise the rail on the far side for safety. Fold the blanket away from the back. Place a towel lengthwise next to the back. Wash the back and neck with long, downward strokes. Rinse and pat dry. Apply lotion if ordered.

Giving a complete bed bath • Place the towel under the buttocks and upper thighs. Help the resident turn onto his back. If the resident is able to wash his perineal area, place a basin of clean, warm water, a washcloth, and towel within reach. Hand items to the resident as needed. If the resident wants you to leave the room, remove and discard gloves. Wash your hands. Leave supplies and the call light within reach. 13. If the resident cannot provide perineal care, you will do it. Remove and discard your gloves. Wash your hands and put on clean gloves. Provide privacy at all times. 14. Perineal area and buttocks: Change the bath water. Place a towel or bed pad under the perineal area. Wash, rinse, and dry perineal area. Work from front to back (clean to dirty).

Giving a complete bed bath For a female resident: Using water and a small amount of soap, wash the perineum from front to back. Use single strokes. Do not wash from the back to the front. This may cause infection. Use a clean area of washcloth or a clean washcloth for each stroke.

Giving a complete bed bath First spread the labia majora, the outside folds of perineal skin that protect the urinary meatus and the vaginal opening. Wipe from front to back on one side with a clean washcloth. Then wipe the other side from front to back, using a clean part of the washcloth. Clean the perineum (area between vagina and anus) last with a front to back motion. Rinse the area thoroughly in the same way. Make sure all soap is removed. Dry entire perineal area. Move from front to back, using a blotting motion with towel. Ask resident to turn on her side. Wash, rinse, and dry buttocks and anal area. Clean the anal area without contaminating the perineal area.

Giving a complete bed bath For a male resident: If the resident is uncircumcised, pull back the foreskin first. Gently push skin toward the base of penis. Hold the penis by the shaft. Wash in a circular motion from the tip down to the base. Use a clean area of washcloth or clean washcloth for each stroke.

Giving a complete bed bath Thoroughly rinse the penis and pat dry. If resident is uncircumcised, gently return foreskin to normal position. Then wash the scrotum and groin. The groin is the area from the pubis (area around the penis and scrotum) to the upper thighs. Rinse and pat dry. Ask the resident to turn on his side. Wash, rinse, and dry buttocks and anal area. Clean the anal area without contaminating the perineal area. 15. Cover the resident with the blanket. 16. Empty, rinse, and dry bath basin. Place basin in designated dirty supply area or return to storage, depending on facility policy. 17. Place soiled clothing and linens in proper containers. 18. Remove and discard gloves. 19. Wash your hands.

Giving a complete bed bath 20. Provide deodorant. Brush or comb the resident’s hair (see procedure later in this chapter). Help resident put on clean clothing. Help resident into comfortable position with proper body alignment. 21. Return bed to lowest position. Remove privacy measures. Lowering the bed provides for safety. 22. Place call light within resident’s reach. Allows resident to communicate with staff as necessary. 23. Wash your hands. Provides for infection prevention. 24. Report any changes in resident to the nurse. Provides nurse with information to assess resident. 25. Document procedure using facility guidelines. If you do not document the care, legally it did not happen.

Giving a back rub Equipment: cotton blanket or towel, lotion 1. Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification. 2. Wash your hands. Provides for infection prevention. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4. Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity. 5. Adjust bed to a safe level, usually waist high. Lower the head of the bed. Lock bed wheels. Prevents injury to you and to resident.

Giving a back rub 6. Position resident lying on his side or stomach. Cover resident with a cotton blanket or towel. Fold back bed covers. Expose the back to the top of the buttocks. Back rubs can also be given with the resident sitting up. 7. Warm lotion by putting bottle in warm water for five minutes. Run your hands under warm water. Pour lotion on your hands. Rub them together. Always put lotion on your hands first, rather than on the resident’s skin. Increases resident’s comfort.

Giving a back rub 8. Place hands on each side of upper part of the buttocks. Use the full palm of each hand. Make long, smooth upward strokes with both hands. Move along each side of the spine, up to the shoulders. Circle your hands outward. Move back along outer edges of the back. At buttocks, make another circle.

Giving a back rub Move your hands back up to the shoulders. Without taking your hands off resident’s skin, repeat this motion for three to five minutes. Long upward strokes release muscle tension; circular strokes increase circulation in muscle areas.

Giving a back rub 9. Knead with the first two fingers and thumb of each hand. Place them at base of the spine. Move upward together along each side of the spine. Apply gentle downward pressure with fingers and thumbs. Follow the same direction as with the long smooth strokes, circling at shoulders and buttocks. 10. Gently massage bony areas (spine, shoulder blades, hip bones). Use circular motions of your fingertips. If any of these areas are pale, white, or red, massage around them rather than on them. Redness indicates that skin is already irritated and fragile. Include this information in your report to the nurse. 11. Let the resident know when you are almost through. Finish with some long, smooth strokes. 12. Dry the back if extra lotion remains on it. 13. Remove blanket or towel.

Giving a back rub 14. Help the resident get dressed. Help resident into comfortable position. 15. Store supplies. Place soiled clothing and linens in proper containers. 16. Return bed to lowest position. Remove privacy measures. Provides for resident’s safety. 17. Place call light within resident’s reach. Allows resident to communicate with staff as necessary. 18. Wash your hands. Provides for infection prevention. 19. Report any changes in resident to the nurse. Provides nurse with information to assess resident. 20. Document procedure using facility guidelines. If you do not document the care, legally it did not happen.

Shampooing hair in bed • Equipment: shampoo, hair conditioner (if requested), 2 bath towels, washcloth, bath thermometer, pitcher or handheld shower or sink attachment, waterproof pad, bath blanket, trough and catch basin, comb and brush, hair dryer 1. Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

Shampooing hair in bed 2. Wash your hands. Provides for infection prevention. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. 4. Provide for resident’s privacy with curtain, screen, or door. Be sure room is at a comfortable temperature and there are no drafts. Maintains resident’s right to privacy and dignity. 5. Arrange the supplies within reach. 6. Test water temperature with thermometer or against the inside of your wrist. Water temperature should be no higher than 105°F. Have resident check water temperature. Adjust if necessary. Resident’s sense of touch may be different than yours; therefore, resident is best able to identify a comfortable water temperature.

Shampooing hair in bed 7. Remove all pillows and place the resident in a flat position. Adjust bed to a safe level, usually waist high. Lock bed wheels. Prevents injury to you and to resident. 8. Place the waterproof pad under the resident’s head and shoulders. Cover the resident with the bath blanket. Fold back the top sheet and regular blankets. Protects bed linen. 9. Place the trough under resident’s head. Connect trough to the catch basin. Place one towel across the resident’s shoulders. 10. Protect resident’s eyes with dry washcloth. 11. Use pitcher or attachment to wet hair thoroughly. Apply a small amount of shampoo to your hands and rub them together.

Shampooing hair in bed 12. Lather and massage scalp with fingertips (not fingernails). Use a circular motion from front to back. Do not scratch the scalp. 13. Rinse hair until water runs clear. Use conditioner if resident wants it. Rinse as directed on container. Be sure to rinse the hair thoroughly to prevent the scalp from getting dry and itchy. 14. Wrap resident’s hair in a clean towel. Dry his face and neck with the washcloth.

Shampooing hair in bed 15. Remove trough and waterproof pad. 16. Raise the head of bed. 17. Gently rub the scalp and hair with the towel. 18. Comb or brush hair. Dry hair with a hair dryer on low setting if facility allows this. Style hair as resident prefers. 19. Return bed to lowest position. Remove privacy measures. Lowering the bed provides for safety. 20. Place call light within resident’s reach. Allows resident to communicate with staff as necessary. 21. Empty, rinse, and wipe bath basin/pitcher. Take to proper area. 22. Clean comb or brush. Return hair dryer and comb or brush to proper storage. 23. Place soiled linen in proper container.

1. Explain personal care of residents