Chapter 15

1. Chapter 15 Personal Care

2. Activities of Daily Living (ADLs) Related to Personal Care • Bathing • Washing and styling hair • Brushing and flossing teeth • Dressing • Shaving

3. Routine Care • Who’s job is it? • Delegate? • Responsibility

4. Scheduled Care • A.M. Care • Before or after breakfast • ADL’s • Linen’s

5. Scheduled Care • P.M. Care • Address any needs—hourly rounding • Straighten sheets • Back rub?

6. Scheduled Care • Bedtime (hs) Care • Prepare for sleep • Brush teeth, remove dentures • Remove glasses, remove hearing aid • Back rub? • Extra blanket • Dim lights

7. Benefits of Bathing Patients • Patient • Cleansing the skin • Increasing circulation and sensation • Providing comfort and relaxation • Improving self-esteem • Nurse • Opportunity for skin assessment • Nurse–patient relationship

8. Benefits of Bathing • Skin assessment • Look for redness, cracking, and maceration • Crevices, under breasts and scrotum, axilla and groin, between toes, and between buttocks • Excoriation or scrapes on skin • Temperature • Breakdown

9. Benefits of Bathing • Gain your patient’s trust and respect • Respect • Preserve modesty • Demonstrate care and compassion • More time spent with patient=ability of patient to confide in you

10. Factors to Consider When Planning Patient Care and Bathing • Patient preferences • Patient’s culture • Timing of the care • Patient’s abilities • Understands directions • Moves and turns enough to assist • Tolerates physical demands of a bath

11. Preparing • Ability to turn • Follow directions • Need for assistance • Is patient in pain? Experiencing fatigue? SOB? • Determine appropriate bath

12. Supplies • Basin or bag • Several towels, washcloths, bath blanket • Linens • Laundry bag or somewhere to place dirty linen

13. Bath • Test water temperature • Provide privacy • Position bed to appropriate height • Lower siderail nearest you • Place bath blanket • Remove gown

14. Approach is Important • Positive attitude • Do not rush patient • Do not make their care seem like a chore to you • How would you like to be treated or your family member

15. Three Categories of Personal Care • Self-care: patients who are able to perform ADLs without assistance • Assisted care: patients who need some assistance with ADLs • Total care: patients who are able to do very little or nothing for themselves

16. Types of Baths • Complete bed bath • Assisted or help bath • Partial bath • Tub bath* • Shower* • Therapeutic bath • Towel or blanket bath* • Bag bath*

17. Complete Bed Bath • View video • Skill 15-1 pg. 294

18. Assisted Bath • Bed or chair • Patient participates as much as possible • Nurse completes what patient can not reach or if becomes fatigued

19. Special Considerations • Older adults • Sebaceous and sweat glands produce less oil and sweat • Optional daily full bath—cleanse areas of necessity • Prevent dryness • Keep patient warm

20. Partial Bath • Only selected areas are washed • Patient condition • Post-op • Dryness • Face, hands, axilla, buttocks, and perineal area, or parts of the patient that would cause odor if not washed

21. Tub Bath • Sits in tub • Whirlpool • Disadvantages—difficult to get in and out of tub, risk of falls

22. Shower • Shower chair • Monitor temperature of water • Wash hair

23. Key Points • Tub baths, showers, or therapeutic baths • Monitor water temperature • Warm water dilates blood vessels (vasodilatation) • Lowers blood pressure • Possible dizziness or fainting • Stay with patient or in close proximity • Inform patient of emergency call system

24. Bag Bath • 12-15 washcloths saturated with no-rinse skin cleanser • Heat bag in microwave • Each washcloth washed one part of body—then discard

25. Guidelines • Use of bath blanket • Fold washcloth into a mitt • Move cleanest to dirtiest areas—prevent transferring bacteria • Extremities—distal to proximal • Start with extremity farthest away from you—prevent contamination

26. Guidelines • Change water • Dirty • Soapy • Cool • After bathing buttocks and rectal area • Perform perineal care during bath and anytime patient is incontinent

27. Nurse Responsibilities When Bathing Patients • Assess the skin for rashes, bruises, and lesions • Complete the bathing process in timely manner • Be alert to signs of patient fatigue • Intervene in ways to conserve patient energy during the bath

28. Oral Care • Freshens mouth • Decrease bacterial count • Assess mouth for problems • Teeth—decaying, broken, or missing • Reddened or bleeding gums • Ulcerations • Coating on the tongue

29. Examples of Patients Needing Special Mouth Care • Patients who are NPO • Patients receiving oxygen by cannula or mask • Patients having a nasogastric or feeding tube in place • Patients who are unconscious

30. Unconscious Patient • Oral care needs to be provided • Highest priority—Prevent aspiration of fluids • Proper positioning • Availability of suction • Assess for lesions and sordes (dried mouth secretions) • Skill 15-4, pg. 298

31. Conscious Patient • Independent—help with necessary supplies • Assistance needed—use small amount of toothpaste, circular motion on inner and outer surface of teeth, and back and forth motion on chewing surfaces • Possible swallowing difficulties*--stay with patient and position patient properly

32. Denture Care • Be careful! • Expensive • Interfere with nutrition • Pad cleaning surface • Use cool rather than hot water • Follow policy or patient’s preference

33. Dressing • Underwear? • Intravenous line? • Size of patient • Don’t forget their HAIR!

34. Dressing • Let them select outfit • Any limitations? • Style hair • Apply makeup if desired

35. Hair Care • Keep patient well groomed • Improves self-esteem • Comb or brush—eliminate bed head—style age appropriate • Shampoo if needed or desired • Shower or no rinse shampoo • Shampoo board

36. Shaving • Shave in direction of hair growth • Electric razor—circular motion—clean razor when finished to prevent clogging • Safety: DO NOT USE a razor blade for any patient on anticoagulation therapy (blood thinning medication) A cut can cause excessive, difficult to control bleeding

37. Contraindications • Thrombolytic agents • High doses of aspirin • Blood disorders • Liver disease • Rashes, lesions, inflamed lesions • Suicidal patients

38. Nail Care • Follow facility policy • Do not cut nails on diabetics or patients with circulatory problems—Podiatrist • Clip nails straight then file—stay away from skin

39. Observations Made During Nail Care • Discoloration • Ridges • Redness • Infections • Thick yellow toenails (fungal infection)

40. Care of Piercings • New piercings • Keep clean—soap, water, and alcohol • S/S of infection—redness, swelling, pain, or drainage

41. Situations Requiring Removal of Jewelry From Piercings • Surgery • Intubation • Diagnostic testing • Catheterization • Table 15-1, pg. 289

42. Eye Care • Glassess • Clean with warm water and soft cloth • Inform patient of placement of glasses • Safe but accessible site

43. Removing Contact Lenses • Wash hands; put on gloves • Pull down on lower lid; place finger across upper lid; apply gentle pressure • Ask patient to blink • Grasp lens with fingers • Hold lens carefully and put in well • Fill the well with saline or soaking solution

44. Contact Lenses • Properly labeled containers (R and L) • Place in correctly • Saline or special soaking solution

45. Procedure for Removing a Prosthetic Eye • Wash your hands and put on gloves • Dip the end of the suction cup in saline • Lift the upper eyelid • Squeeze the suction cup and place it on the iris of the prosthesis • Stop squeezing • Use the handle of the suction cup to lift the prosthesis out of the socket

46. Cleansing Prosthesis • Cleanse prosthesis with sterile water or saline • Irrigate the eye socket with eye irrigating solution • Small amounts of mucus may accumulate • Observe for thick yellow or green mucus

47. Removing a Hearing Aid • Turn off the hearing aid • Turn the earmold slightly toward the nose and lift out • Store the aid in its case or moisture-control container

48. Inserting a Hearing Aid • Check the battery by turning the hearing aid on to full volume and listening for it to whistle, which indicates that it is working • If you do not hear a whistle, check the battery and replace as needed • Turn off the hearing aid and lower the volume • Insert the hearing aid into the ear and adjust the volume as needed

49. Types of Unoccupied Beds • Open bed: made with top linens fan folded to foot of bed • Surgical bed: made with top linens fan folded to side of bed • Closed bed: only used when patient is discharged; top linens are spread to the head of the bed

50. Nurse Responsibility in Bed Making • Often delegated to a CNA or UAP • Must be made tightly without wrinkles • Number one concern is patient safety • Use side rails appropriately • Apply drawsheet according to policy • Miter corners