1. Explain personal care of residents

1. 1. Explain personal care of residents Define the following terms: Hygiene Grooming ADLs AM and PM care

2. Transparency 13-1 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. Provide privacy. Observe the resident during care. Note and report signs and symptoms. Observe mental state of resident. Report any changes. Leave the resident’s room clean and tidy.

3. 1. Explain personal care of residents It is important to observe and report the following during personal care: Skin color, temperature, reddened areas Mobility Flexibility Comfort or pain level Strength and ability to perform ADLs Mental and emotional state Complaints

4. 2. Identify guidelines for providing good skin care and preventing pressure sores Define the following terms: Pressure points Bony prominences Pressure sore

5. Transparency 13-2 Pressure Sore Danger Zones

6. Transparency 13-3 Observing the Skin Pale, white, red, or purple areas, blisters or bruises Tingling, warmth, or burning Dry or flaking skin Itching or scratching Rash or discoloration Swelling or blisters Fluid or blood draining Broken skin Wounds or ulcers Changes in existing wound (size, depth, drainage, color, or odor) Broken skin (toes or toenails)

7. 2. Identify guidelines for providing good skin care and preventing pressure sores • Guidelines for skin care include: • Report changes in resident’s skin. • Provide regular skin care. • Reposition frequently. • Give skin care often for incontinent residents. • Change clothing and linen often. • Avoid scratching or irritating skin; report blisters or sores on feet. • Massage skin frequently. Do not massage white, red, or purple areas. • Avoid pulling or tearing skin.

8. 2. Identify guidelines for providing good skin care and preventing pressure sores Guidelines for caring for residents who are at a high risk for pressure sores (bed bound): Keep bottom sheet tight and wrinkle-free. Avoid shearing. Use special protective aids such as: Sheepskin or chamois under back and buttocks Sheepskin or foam rubber under bony prominences or heel and elbow protectors

9. 2. Identify guidelines for providing good skin care and preventing pressure sores Use special protective aids such as (con’t.): Flotation pads or egg crate mattresses on bed or chair Repositioning residents in chairs or wheelchairs

10. 2. Identify guidelines for providing good skin care and preventing pressure sores Examples of positioning devices are: Backrests Bed cradles Draw sheets Footboards Hand rolls Splints Trochanter rolls

11. 3. Explain guidelines for assisting with bathing Define the following terms: Partial bath Additive Perineum Groin

12. 3. Explain guidelines for assisting with bathing The following guidelines for bathing are: 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.

13. 3. Explain guidelines for assisting with bathing The following guidelines for bathing are (con’t.): Make sure water temperature is safe and comfortable. Have resident test water temperature. Gather supplies beforehand so a resident is not left alone while bathing. Remove all soap from the skin. Keep a record of bathing schedule.

14. Giving a complete bed bath Equipment: bath blanket, bath basin, soap, bath thermometer, 2-4 washcloths, 2-4 bath towels, orangewood stick or emery board, lotion, deodorant, clean gown or clothes, gloves Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

15. Giving a complete bed bath Provide for the resident’s privacy with curtain, screen, or door. Be sure the room is a comfortable temperature and there are no drafts. Adjust bed to a safe level, usually waist high. Lock bed wheels. Adjust position of side rails to ensure resident safety at all times.

16. Giving a complete bed bath Place a bath blanket or towel over resident (Fig. 13-11). Ask him to hold on to it as you remove or fold back top bedding. Keep resident covered with bath blanket (or top sheet). Fill the basin with warm water. Test water temperature with thermometer or your wrist and ensure it is safe. Water temperature should be 105° to 110° F. It cools quickly. Fig. 13-11.

17. Giving a complete bed bath (con’t.) Have resident check water temperature. Adjust if necessary. Change the water when it becomes too cool, soapy, or dirty. If resident has open wounds or broken skin, put on gloves. Ask and help resident to participate in washing. Uncover only one part of the body at a time. Place a towel under the body part being washed.

18. Giving a complete bed bath 12. Wash, rinse, and dry one part of the body at a time. Start at the head. Work down, and complete the front first. Fold the washcloth over your hand like a mitt and hold it in place with your thumb (Fig. 13-12). Fig. 13-12.

19. Giving a complete bed bath Eyes and Face: Wash face with wet washcloth (no soap). Begin with the eye farther away from you. Wash inner aspect to outer aspect (Fig. 13-13). Use a different area of the washcloth for each eye. Wash the face from the middle outward. Use firm but gentle strokes. Wash the neck and ears and behind the ears. Rinse and pat dry. Fig. 13-13.

20. Giving a complete bed bath Arms: Remove the resident’s top clothing. Cover him with the bath blanket or towel. With a soapy washcloth, wash the upper arm and underarm. Use long strokes from the shoulder to the elbow. Rinse and pat dry. Wash the elbow. Wash, rinse, and dry from the elbow down to the wrist (Fig. 13-14). Fig. 13-14.

21. Giving a complete bed bath Wash the hand in a basin: Clean under the nails with an orangewood stick or nail brush (Fig. 13-15). Rinse and pat dry. Give nail care (see procedure later in this chapter) only if it has been assigned. Do not give nail care for a diabetic resident. Repeat for the other arm. Put lotion on the resident’s elbows and hands if ordered. Fig. 13-15.

22. Giving a complete bed bath Chest: Place the towel again 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 and chafing.

23. Giving a complete bed bath Abdomen: 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, or opening in the abdomen for getting rid of body wastes, give skin care around the opening (chapter 15 includes more information about ostomies). Cover with the towel. Pull the cotton blanket up to the resident’s chin. Remove the towel.

24. 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 (Fig. 13-16). Place another towel under the foot. Move the basin to the towel. Place the foot into the basin. Fig. 13-16.

25. Giving a complete bed bath Legs and Feet (con’t.): Wash the foot and between the toes (Fig. 13-17). Rinse foot and pat dry. Make sure area between toes is dry. Give nail care (see procedure later in this chapter) only if it has been assigned. Do not give nail care for a diabetic resident. Never clip a resident’s toenails. Apply lotion to the foot if ordered, especially at the heels. Repeat steps for the other leg and foot. Fig. 13-17.

26. 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, neck, and buttocks with long, downward strokes. Rinse and pat dry (Fig. 13-18). Apply lotion if ordered. Fig. 13-18.

27. Giving a complete bed bath Place the towel under the buttocks and upper thighs. Help the resident turn onto his back. Ask if he is able to wash the perineal area. If the resident is able to do this, place a basin of clean, warm water and a washcloth and towel within reach. Leave the room if the resident desires. If the resident has a urinary catheter in place, remind him not to pull it.

28. Giving a complete bed bath If the resident cannot provide perineal care, you must do so. Put on gloves (if you haven’t already done so) first. Provide privacy at all times. Change bath water. Wash, rinse, and dry perineal area. Work from front to back. For a female resident: Wash the perineum with soap and water. Work from front to back, using single strokes (Fig. 13-19). Fig. 13-19.

29. Giving a complete bed bath 15. (con't.) 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. First wipe the center of the perineum, then each side. Then 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 each side.

30. Giving a complete bed bath 15. (con't.) Rinse the area in the same way. Dry entire perineal area. Move from front to back. Use 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. For a male resident: If the resident is uncircumcised, pull back the foreskin first. Gently push skin towards the base of penis.

31. Giving a complete bed bath 15. (con't.) 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 (Fig. 13-20). Rinse the penis. 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. Fig. 13-20.

32. Giving a complete bed bath (con't.) 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. Provide deodorant. Remove and dispose of gloves properly. Put clean gown on resident. Brush or comb the resident’s hair (see procedure later in the chapter).

33. Giving a complete bed bath Make resident comfortable. Make sure sheets are dry and free from wrinkles and the bed free from crumbs. Return bed to appropriate position. Remove privacy measures. Put call light within resident’s reach. Place soiled clothing and linens in proper containers. Empty, rinse, and wipe bath basin. Return to proper storage.

34. Giving a complete bed bath Wash your hands. Report any changes in resident to the nurse. Document procedure using facility guidelines.

35. Giving a back rub Equipment: bath blanket or towel, lotion Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door.

36. Giving a back rub Adjust bed to a safe working level, usually waist high. Lock bed wheels. Position resident lying on his stomach (Fig. 13-21). If this is uncomfortable, have him lie on his side. Cover with a cotton blanket. Expose back to the top of the buttocks. Back rubs can also be given with the resident sitting up. Fig. 13-21.

37. Giving a back rub 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 rather than on resident’s skin. Place hands on each side of upper part of the buttocks. Make long, smooth upward strokes with both hands.

38. Giving a back rub 8. (con’t.) Move along each side of the spine, up to the shoulders (Fig. 13-22). Circle hands outward. Move back along outer edges of the back. At buttocks, make another circle. Move hands back up to the shoulders. Without taking hands from resident’s skin, repeat for three to five minutes. Fig. 13-22.

39. 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 same direction as with the long smooth strokes, circling at shoulders and buttocks (Fig. 13-23). Fig. 13-23.

40. Giving a back rub Gently massage bony areas (spine, shoulder blades, hip bones). Use circular motions of fingertips. If any of these areas are red, massage around them. Finish with some long, smooth strokes. Dry the back if extra lotion remains on it. Remove blanket and towel.

41. Giving a back rub Help the resident get dressed. Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs. Store supplies. Place soiled clothing and linens in proper containers. Return bed to proper position. Remove privacy measures. Before leaving, place call light within resident’s reach.

42. Giving a back rub Wash your hands. Report any changes in resident to the nurse. Document procedure using facility guidelines.

43. Shampooing a resident’s 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, basin, comb and brush, hair dryer • Wash your hands. • Identify yourself by name. Identify the resident by name. • Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

44. Shampooing a resident’s hair in bed • Provide for the resident’s privacy with curtain, screen, or door. Be sure the room is a comfortable temperature and there are no drafts. • Adjust bed to safe level, usually waist high. Lock bed wheels. Remove pillows. Place resident in a flat position. • Test water temperature with thermometer or your wrist. Ensure it is safe. Water temperature should be 105°F.

45. Shampooing a resident’s hair in bed (con’t.) Have resident check water temperature. Adjust if necessary. Raise the side rail farthest from you. 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.

46. Shampooing a resident’s hair in bed Place collection container under resident’s head (e.g., trough, basin). Place one towel across the resident’s shoulders. Protect resident’s eyes with dry washcloth. Using the pitcher or attachment, wet hair thoroughly. Apply small amount of shampoo to your hands.

47. Shampooing a resident’s hair in bed With your fingertips, lather and massage scalp. Use a circular motion, from front to back (Fig. 13-24). Do not scratch the scalp. Rinse hair until water runs clear. Apply conditioner. Rinse as directed on container. Cover resident’s hair with clean towel. Dry his face with washcloth used to protect eyes. Fig. 13-24.

48. Shampooing a resident’s hair in bed Remove trough and waterproof covering. Raise head of bed. Gently rub the scalp and hair with the towel. Dry and comb resident’s hair as he or she prefers (see procedure later in the chapter). Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs.

49. Shampooing a resident’s hair in bed Return bed to proper position. Remove privacy measures. Before leaving, place call light within resident’s reach. Empty, rinse, and wipe bath basin/pitcher. Return to proper storage. Clean comb/brush. Return hairdryer and comb/brush to proper storage.

50. Shampooing a resident’s hair in bed Place soiled linen in proper container. Wash your hands. Report any changes in resident to the nurse. Document procedure using facility guidelines.