PROCESS (Continued)

HELEN SAWYER PLAZA MIAMI, FL

Personal Care and HygieneUnit 9

•Brushing the Person’s teeth•Giving a Back Massage•Giving Nail and Foot Care•Providing mouth care for the unconscious person•Giving Female and Male Perineal care•Providing Denture Care•Brushing and Combing a Person’s Hair•Giving a Complete Bed Bath•Shampooing the Person’s Hair

PROCESS (Continued)

HELEN SAWYER PLAZA MIAMI, FL

Factors that affect a persons cleanliness needs and personal

practices• Individuals will have preferences and

habits that have been developed over a lifetime.

• Individual preferences should be respected and accommodated when possible.

PROCESS (Continued)

HELEN SAWYER PLAZA MIAMI, FL

More Factors

• Age-related changes should be considered– Skin is thin, drier, less elastic, less resilient

when subjected to stressors.– Dental/oral

• Res may have dental prostheses for extracted teeth.

• Res may have decreased saliva production

Thinner hair growth, drier hair.

PROCESS (Continued)

HELEN SAWYER PLAZA MIAMI, FL

And More Factors

• Fever, other illnesses and incontinence will change frequency of skin care.

• Dementia behaviors will influence how the CNA approaches and assists the resident with personal hygiene.

• Adaptive devices can help the res perform everyday self-care activities, maintaining independence.

PROCESS (Continued)

HELEN SAWYER PLAZA MIAMI, FL

Oral Hygiene

• Caring for the res mouth (teeth, gums, tongue) and removable appliances– Remove food particles and plaque that

promote bacterial growth. – Bacterial growth causes inflammation of gums

(gingivitis), dental decay and can contribute to systemic infections

– Maintain moisture in mouth cavity to promote healthy gums and teeth.

PROCESS (Continued)

HELEN SAWYER PLAZA MIAMI, FL

Oral Hygiene continued…

• Refresh res mouth, promoting appetite.• Observe res mouth for signs of problems

while providing care.

PROCESS (Continued)

HELEN SAWYER PLAZA MIAMI, FL

Practices for oral hygiene

• Mouth care(including brushing teeth or dentures) is generally done at least twice a day, in the AM and HS.

• Mouth care is needed even if the resident has no teeth or dentures

• Encourage the resident to do as much as possible for himself/herself, providing set-up and cure as needed, as well as using assistive devices.

PROCESS (Continued)

HELEN SAWYER PLAZA MIAMI, FL

Recognize situations where attention is needed

• A resident with facial weakness (result of CVA or other impairment) may accumulate food debris between gums and cheek.

• A resident who has little fluid intake, is unresponsive, is receiving O2 or who is a mouth breather will need more frequent care.

• Report observations to the nurse• Follow standard precautions while giving

mouth care. ALWAYS WEAR GLOVES

PROCESS (Continued)

HELEN SAWYER PLAZA MIAMI, FL

Brushing Res Teeth

Oral Care

• Denture Care– Use of denture cup– Removal of dentures

from mouth.– Replacing dentures in

mouth.– Water temperature– Protecting from

breakage– Care for mouth– Observation of fit

• Unresponsive Res– Side lying position– Protecting bed– Mouth swabs– Safety with liquid– Lip care– Frequency of oral care

Goals for Bathing

• Clean the skin • Eliminate the odor• Stimulate circulation• Refresh and relax res• Provide a little exercise, through

movement of body parts during bathing• Observe res skin and general condition

Practices for bathing• Bathing options-creative bathing options are

available, ranging from ways to approach res, innovative bathing techniques, to bathing equipment that allows res easier access.

• Check res care plan for type of bath and for restorative goals– Encourage the res to do as much as possible for

himself/herself. – Understand effective approaches for bathing res with

dementia.

Practices for bathing continued…

• After a res bathes, he/she puts on fresh clothing. Hair is combed– Some res may go to beauty shop every week

therefore do not get hair washed on bath day.Skin is often cleansed with soap that has

cleaning/moisturizing properties to prevent skin dryness.

Some are designed to be “rinse free”. Waterless cleansers are also available.

Understand what kind of soap the res uses.

Practices for bathing

• Plan ahead– Check for needed supplies before starting – Provide privacyFollow standard precautions while bathing the

residentWash from cleaner body areas to less clean (face to perennial)Wear gloves

Reports observations to the nurse!!!!

Shower/Bath• Moving to and from shower room• Privacy• Safe use of shower chair• Maintaining safe water temperature• Protecting res from chilling• Staying with resident• Maintaining safety while floor and resident

are wet and slippery• Infection control measures for bathing

equipment

Whirlpool Bath

• Check with nurse to check if resident has break in skin or skin infection.

• Use same precautions as with a regular shower or bath.

Bed Bath• Handling washcloth efficiently • Keeping the res from becoming chilled,

keeping water comfortably warm and clean• Keeping res from exposure• Washing and patting dry the res in an

orderly manner• Providing back massage• Changing bed linens after bath

Bed Bath variations

• Towel bath-using warm wet towels remaining under the top sheet or bath blanket.

• Bag bath- packet of body wipes saturated with waterless, no-rinse cleanser.

Perineal Care(Peri-care)• Consists of bathing front to back, between

the res legs.• Res who are incontinent of urine or feces

receive perineal care each time they are incontinent.

• For females, this includes washing between the labia and around anus

• For Males, this includes cleaning under the foreskin and washing the scrotum and around anus.

Peri-care procedure• Handling washcloth or wipes efficiently and

safely to prevent transmission of infection.• Washing from front to back• Keeping the res from exposure• Caring for urinary catheter• Using skin barrier products, according to

facilities policy and procedure and res care plan.• Usually this will involve cleaning skin, then spray

or wipe on protective barrier.

Peri-care procedure continued…

• Cleansing all skin area that have been in contact with urine or feces when res has been incontinent.

• This may mean washing lower abdomen, buttocks and thighs.

Back Rub

• Purpose– Refresh and relax res– Stimulate circulation in tissueBack rubs are given as part of bathing routine,

at bedtime, when the res position is changed and when the res requests.

Use moisturizing lotionUse massage strokesAvoid skin areas that are reddened or broken

Assisting the res to dress and undress

• Res are encouraged to wear street clothing instead of gowns, robes and slippers.– Res in day clothing is ready to participate in

social activities.– Appropriate underwear is worn– Loose fitting clothing is easier to put on.– Clothing should be clean and in good repair

Assisting the res to dress and undress continued…

• Res should help select clothing to be worn

– If res has dementia, CNA may pre-select a few options that are appropriate for the time of year. Res can select from these options.

– Monitor res throughout day during toileting that clothes do not need to be changed.

Dressing/Undressing procedure

• Check res care plan for restorative goals– Encourage self care– Divide dressing procedure into segments if res

has difficulty comprehending the entire procedure or if res physically cannot perform the entire activity at one time.

– Provide cues as needed– Place one arm at a time into shirt or blouse.

(Joints maybe painful or have limited flexibility)

Dressing/Undressing procedure continued…

• If res has a weak side, dress that side first.(With undressing follow the opposite sequence-remove clothing from affected side last.)

• If res has tubing (IV tubing, gastrostomy tubing, urinary catheter) handle with care. Keep tubing from kinking or disconnecting.

Personal Grooming• Cleanliness and grooming of hair and nails is frequently

associated with a person’s sense of well-being.• Paying attention to grooming contributes to the res sense

of dignity.

• Check res care plan for restorative goals.– Encourage self-care by setting up needed

supplies/equipment.– Divide grooming procedure into segments if res

has difficulty comprehending the entire procedure.

– Provide cue as needed

Hair Care

• Comb/brush the res hair daily– Arrange in an appropriate manner, acceptable

to res/family.If possible, position res in front of mirror while

hair is combed and for other grooming activities.

Brushing the hair stimulates the blood circulation in the scalp, and distributes oils over hair surface.

Hair Care continued…

• How to deal with tangled hair• How to comb when res is bed bound• How to care for a variety of hair types

– Caucasian,– African American

Hair cutting-hair is cut as facility policy allows and with consent of resident/family

Shampooing

• Pay attention to frequency of shampooing• Assuring that soap is completely rinsed• Use of conditioner/detangler• How to wash a variety of hair types• Shampooing hair for resident who cannot

take shower or tub bath(washing hair in bed)

Facial Hair-Beard care

• Wash beard when hair is shampooed or when bath is taken. Wash more often if food or liquid is frequently spilled in beard.

• Comb or brush beard when hair is groomed.

• Resident’s beard is cut as facility policy allows and with consent of res/family

Facial Hair-male

• Male residents shave daily, unless they prefer a different interval

• Position resident in front of mirror, if possible

• Nurse will determine appropriate razor for safe use.– Electric razor and proper cleaning after use– Straight razor and how to dispose of properly

Facial Hair- female• Women with excess dark facial hair may be

accustomed to shaving or using a hair remover as part of grooming

• The CNA should ask the nurse for direction.• Applying make-up

– Respect res wishes regarding make-up use– If possible, position res in front of mirror– Set up resident with make up supplies,

providing cure for use.(Hand over hand technique)

Nail Care

• Nurse will determine which resident may have their nails cut by CNA.

• Nurse and other specialist are responsible for cutting toenails of resident with diabetes or poor circulation in feet.

• Nails are cleaned and trimmed at bath time.

• Assist resident to apply fingernail polish if desired.

Nail Care continued…

• Benefits of soaking nails• Tools to use for cleaning nails, clipping an

filing as permitted.• Length and shape for nails• Skin care for toes and feet• Observations to report to nurse

Prosthetics, Orthodontics and other assistive devices

• Prosthesis is a replacement of a body part– Limb– Breast – EyeOrthotic device is used to maintain function of a

body part or prevent deformity. (splint, glasses, or hearing aids)

Help resident apply properly as part of dressing at the beginning of the day.

Prosthetics, Orthodontics and other assistive devices cont…

• Understand how each functions • Check to see that each is clean and

operational before assisting resident to apply.

• Observe skin area where device is placed to see that skin is intact and healthy.

• Report observations to the nurse.