Define the following terms:

1. Define the following terms: • Hygiene • practices used to keep bodies clean and healthy. • Grooming • practices to care for oneself, such as caring for fingernails and hair.

2. Transparency 6-1: 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. Leave the bed in the lowest position and call light within reach.

3. 1. Explain personal care of residents • Think about these questions: • How can you promote dignity, respect and privacy while providing personal care? • Why do you think that performing the task is only half the job? • What else do you think can be accomplished while providing personal care?

4. 1. Explain personal care of residents • REMEMBER: • NAs can obtain important information about the resident by asking questions and making observations during personal care.

5. 1. Explain personal care of residents • 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

6. Define the following terms: • Pressure points • areas of the body that bear much of its weight. • Bony prominences • areas of the body where the bone lies close to the skin. • Pressure sore • a serious wound resulting from skin breakdown; also known as a bed sore or decubitus ulcer.

7. Define the following terms: • Draw sheets • sheets that are placed under residents to help with turning, lifting, or moving up in bed. • Foot drop • a weakness of muscles in the feet and ankles that causes problems with the ability to flex the ankles and walk normally. • Orthotic device • a device that helps support and align a limb and improve its functioning and helps prevent or correct deformities.

8. Transparency 6-2: Pressure Sore Danger Zones

9. 2. Identify guidelines for providing skin care and preventing pressure sores • There are four stages of pressure sores. These are the characteristics of each stage: • Stage 1: Area where skin is intact but there is redness that is not relieved within 15 to 30 minutes after removing pressure. • Stage 2: Partial skin loss involving the outer and/or inner layer of skin. The ulcer is superficial. It looks like a blister or a shallow crater. • Stage 3: Full skin loss involving damage or death of tissue that may extend down to but not through the tissue that covers muscle. The ulcer looks like a deep crater. • Stage 4: Full skin loss with major destruction, tissue death, damage to muscle, bone, or supporting structures.

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

11. 2. Identify guidelines for providing skin care and preventing pressure sores • Remember that in darker complexions you must also observe for the following: • Any change in feel of the tissue • Any change in appearance of the skin, such as an “orange-peel” look or purplish hue • Extremely dry, crust-like areas

12. 2. Identify guidelines for providing skin care and preventing pressure sores • Remember the following guidelines for skin care: • Report changes in resident’s skin. • Provide regular skin care. • Reposition often, at least every two hours. • 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 during transfers.

13. 2. Identify guidelines for providing skin care and preventing pressure sores • Guidelines for skin care (cont’d.): • In overweight residents pay special attention to skin under folds. • Encourage residents to eat well-balanced meals. • Keep plastic or rubber materials from coming into contact with skin. • Follow the care plan and nurse’s instructions.

14. 2. Identify guidelines for providing skin care and preventing pressure sores • Remember these points as you care 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, chamois skin, or bed pad under back and buttocks • Sheepskin or other pressure-reliever under bony prominences • Flotation pads on bed or chair • Bed cradle to keep top sheets from rubbing on skin • Reposition residents in chairs and wheelchairs often if they cannot easily change position themselves.

15. 2. Identify guidelines for providing skin care and preventing pressure sores • The following positioning devices can help make residents more comfortable and safe: • Backrests • Bed cradles • Draw sheets • Footboards • Hand rolls • Splints • Trochanter rolls • Pillows

16. Define the following terms: • Perineum • the genital and anal area.

17. 3. Describe guidelines for assisting with bathing • Remember these guidelines for bathing: • The face, hands, underarms, and perineum should be washed every day. • Complete baths are only necessary every other day or less often. • Only use facility-approved products. • Keep room temperature comfortable. • Be familiar with safety and assistive devices.

18. 3. Describe guidelines for assisting with bathing • Guidelines for bathing (cont’d.): • 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 the bathing schedules.

19. Giving a complete bed bath • Equipment: bath blanket, bath basin, soap, bath thermometer, 2-4 washcloths, 2-4 bath towels, clean gown or clothes, gloves, orangewood stick or emery board, lotion, deodorant • Wash hands. Provides for infection control. • Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Identifying resident by name shows respect and establishes correct identification.

20. Giving a complete bed bath (cont’d.) • Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. • Provide for resident’s privacy with curtain, screen, or door. Be sure the room is at a comfortable temperature and there are no drafts. Maintains resident’s right to privacy and dignity.

21. Giving a complete bed bath (cont’d.) • Adjust bed to a safe working level, usually waist high. Lock bed wheels. Prevents injury to you and to resident. • Place a bath blanket or towel over resident. Ask him to hold onto it as you remove or fold back top bedding. Remove gown, while keeping resident covered with bath blanket (or top sheet).

22. Giving a complete bed bath (cont’d.) • 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. Have resident check water temperature on his or her wrist. Adjust if necessary. Change the water when it becomes too cool, soapy, or dirty. Resident’s sense of touch may be different than yours; therefore, resident is best able to identify a comfortable water temperature.

23. Giving a complete bed bath (cont’d.) • Put on gloves. Protects you from contact with body fluids. • Ask and help resident to participate in washing. Promotes independence. • Uncover only one part of the body at a time. Place a towel under the body part being washed. Promotes resident’s dignity and right to privacy. Also helps keep resident warm.

24. Giving a complete bed bath (cont’d.) • Wash, rinse, and dry one part of the body at a time. Start at the head. Work down, and complete the front first. When washing, use a clean area of the washcloth for each stroke.

25. Giving a complete bed bath (cont’d.) • Eyes and Face: Wash face with wet washcloth (no soap). Begin with the eye farther away from you. Wash inner aspect to outer aspect. 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.

26. Giving a complete bed bath (cont’d.) • Arms: Remove one arm from under the towel. With a soapy washcloth, wash the upper arm and underarm. Use long strokes from the shoulder to the elbow. Rinse and pat dry. Repeat for the other arm.

27. Giving a complete bed bath (cont’d.) • Wash the hand in a basin. Clean under the nails with an orangewood stick or nail brush. Rinse and pat dry. Give nail care (see procedure later in this chapter) if it has been assigned. Repeat for the other arm. Put lotion on the resident’s elbows and hands if ordered.

28. Giving a complete bed bath (cont’d.) • Chest: Place the towel 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.

29. Giving a complete bed bath (cont’d.) • Abdomen: Keep towel across chest. 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, give skin care around the opening (see Chapter 4). Cover with the towel. Pull the cotton blanket up to the resident’s chin. Remove the towel. • 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.

30. Giving a complete bed bath (cont’d) • Legs and Feet (cont’d.): Place another towel under the foot. Move the basin to the towel. Place the foot into the basin. Wash the foot and between the toes. Rinse foot and pat dry. Give nail care 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. Do not apply lotion between the toes. Repeat steps for the other leg and foot.

31. Giving a complete bed bath (cont’d.) • 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. Apply lotion if ordered.

32. Giving a complete bed bath (cont’d.) • Place the towel under the buttocks and upper thighs. Help the resident turn onto his back. If the resident is able to wash his or her perineal area, place a basin of clean, warm water and a washcloth and towel within reach. Hand items to the resident as needed. If the resident wants you to leave the room, leave supplies and the call light within reach.

33. Giving a complete bed bath (cont’d.) • If the resident cannot provide perineal care, you must do so. Provide privacy at all times. • Perineal area: Change bath water. Wash, rinse, and dry perineal area. Work from front to back.

34. Giving a complete bed bath (cont’d.) • For a female resident: Wash the perineum with soap and water from front to back. Use single strokes. Do not wash from the back to the front, as this may cause infection. Use a clean area of washcloth or 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.

35. Giving a complete bed bath (cont’d.) • Perineal area for female resident (cont’d.): • Wipe from front to back on each side. 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.

36. Giving a complete bed bath (cont’d.) • For a male resident: If the resident is uncircumcised, pull back the foreskin first. Gently push skin towards the base of penis. 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.

37. Giving a complete bed bath (cont’d.) • Perineal area for male resident (cont’d.): • 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. 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.

38. Giving a complete bed bath (cont’d.) • Cover the resident with the blanket. • Empty, rinse, and dry bath basin. Place basin in designated dirty supply area or return to storage, depending on facility policy. • Place soiled clothing and linens in proper containers. • Remove and discard gloves. Wash your hands.

39. Giving a complete bed bath (cont’d.) • Put clean gown on resident. Provide deodorant. Assist with brushing or combing resident’s hair (see procedure later in the chapter). • Make resident comfortable. Replace bedding. Make sure sheets are free from wrinkles and bed free from crumbs. • Return bed to lowest position. Remove privacy measures. Lowering bed provides for safety.

40. Giving a complete bed bath (cont’d.) • Place call light within resident’s reach. Call light allows resident to communicate with staff as necessary. • Wash your hands. Provides for infection control.

41. Giving a complete bed bath (cont’d.) • Report any changes in resident to the nurse. Provides nurse with information to assess resident. • Document procedure using facility guidelines. What you write is a legal record of what you did. If you don’t document it, legally it didn’t happen.

42. Giving a back rub • Equipment: cotton blanket or towel, lotion • Wash hands. Provides for infection control. • Identify yourself by name. Identify the resident by name. Resident has right to know identity of his or her caregiver. Addressing resident by name shows respect and establishes correct identification.

43. Giving a back rub (cont’d.) • Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Promotes understanding and independence. • Provide for resident’s privacy with curtain, screen, or door. Maintains resident’s right to privacy and dignity.

44. Giving a back rub (cont’d.) • Adjust bed to a safe working level, usually waist high. Lock bed wheels. Prevents injury to you and to resident. • Position resident lying on his side or his stomach. If this is uncomfortable, have him lie on his side. Cover with a cotton blanket or towel. Expose the back to the top of the buttocks. Back rubs can also be given with the resident sitting up.

45. Giving a back rub (cont’d.) • 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 directly on resident’s skin. Increases resident’s comfort.

46. Giving a back rub (cont’d.) • Place hands on each side of upper part of the buttocks. Use the full palm of hand. Make long, smooth upward strokes with both hands. Move along each side of the spine, up to the shoulders. 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 this motion for three to five minutes.

47. Giving a back rub (cont’d.) • (cont’d.) Long upward strokes release muscle tension; circular strokes increase circulation in muscle areas. • 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.

48. Giving a back rub (cont’d.) • Gently massage bony areas (spine, shoulder blades, hip bones). Use circular motions of fingertips. If any of these areas are red, massage around them rather than on them. Redness indicates that skin is already irritated and fragile. Include this information in your report to the nurse. • Let the resident know when you are almost through. Finish with some long, smooth strokes.

49. Giving a back rub (cont’d.) • Dry the back if extra lotion remains on it. • Remove blanket or towel. • Help the resident get dressed. Make resident comfortable. • Store supplies. Place soiled clothing and linens in proper containers.

50. Giving a back rub (cont’d.) • Return bed to lowest position. Remove privacy measures. Provides for resident’s safety. • Place call light within resident’s reach. Allows resident to communicate with staff as necessary. • Wash your hands. Provides for infection control.