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 • Bathing, teeth, hair, dressing, shaving….. • Linen’s • Changed as needed

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

6. Hourly Rounding The five P’s: • Pain • Position • Potty • Po • Placement

7. Hourly Rounding • Must be completed every hour and documented • Decreases call bell use • Decreases incidence of falls • Sense of security

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

9. 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

10. 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

11. 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

12. Factors to Consider Prior to Bathing • Condition of patient • Weakness • Pain • Mental status • Confused • Emotionally upset • Limited mobility

13. 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

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

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

16. 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

17. 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

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

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

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

21. 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

22. 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

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

24. Shower • Shower chair • ↓ risk of falling • Lock wheels • Never leave patient • Monitor temperature of water • Cleanse all areas • Wash hair

25. 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

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

27. 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

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

29. 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

30. 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

31. 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

32. 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

33. Oral Care Unconscious Patient • Assess mouth • Check for gag reflex • Increased risk for aspiration • Position patient • Equipment—suction • Padded tongue blade

34. Oral Care Unconscious Patient • Clean all areas • Teeth • Tongue • Between cheeks and gums • Use multiple swabs • If using toothbrush-toothpaste-irrigate-drain

35. Oral Care Unconscious Patient • Water-soluble lip balm • Oxygen • Aspiration • Upon completion assess mouth

36. 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

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

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

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

40. 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

41. 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

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

44. 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

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

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

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

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

50. 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