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Chapter 15

Chapter 15. Personal Care. Activities of Daily Living (ADLs) Related to Personal Care. Bathing Washing and styling hair Brushing and flossing teeth Dressing Shaving. Routine Care. Who’s job is it? Delegate? Responsibility. Scheduled Care. A.M. Care Before or after breakfast ADL’s

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Chapter 15

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  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

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