Transcript Personal Care and Restraints

PERSONAL CARE AND RESTRAINTS
PERSONAL HYGIENE
One of the main functions of CNA
 Patients depend on CNA for all aspects of
personal care
 Need to be sensitive to patient needs and
respect right to privacy
 Hygiene includes bathing, back care,perineal
care, oral hygiene, hair care, nail care and
shaving
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BENEFITS OF PERSONAL HYGIENE
Promotes good hygiene habits
 Provides comfort
 Stimulates circulation
 Provides an excellent opportunity to develop a
good caring relationship with the patient
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TYPES OF BATHS
Complete bed bath—the CNA bathes all parts of
the patient’s body and provides oral hygiene,
back care, nail care and perineal care
 Partial bed bath—only parts of the body are
bathed
 Tub bath or shower
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ORAL HYGIENE
Care of the mouth and teeth
 Should be administered at least 3 times a day
 Proper oral hygiene prevents dental caries,
stimulates the appetite, prevents halitosis, and
provides comfort
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TYPES OF ORAL HYGIENE
Routine oral hygiene—regular, everyday
brushing and flossing
 Denture care—cleaning of dentures or artificial
teeth (Extreme care should be taken not to
damage dentures)
 Special oral hygiene—provided for the
unconscious or semiconscious patient
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HAIR CARE
An important aspect of personal care
 Patients confined to bed often have tangles
and knots in their hair
 Braiding long hair helps prevent tangles and
knots
 Brushing hair stimulates the scalp and helps
prevent scalp problems (it is important to
observe the condition of the hair and scalp)
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NAIL CARE
Often neglected area of personal care
 Nails harbor dirt which can lead to disease and
infection
 Do not cut nails unless you have been
instructed to do so
 NEVER clip toenails
 Learn the agency policy on nail care
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SHAVING
Regular or electric razors may be used
 Will always use an electric razor on a patient
who is on anticoagulants
 Correct technique must be used to avoid injury
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BACK RUB
Unless contraindicated, a back rub is given as
part of the bath
 It should be done every 8 hours if a patient is
confined to bed
 Good back rub takes 4-7 minutes
 Stimulates circulation
 Prevents pressure ulcers
 Leads to relaxation and comfort
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CHANGING GOWN OR CLOTHING
Most patients prefer to wear their own gown,
pajamas or clothing
 If the patient has a weak or injured arm or has
an IV the gown must be positioned with care
 Sleeve is removed from the uninjured or
untreated arm first
 Sleeve of clean gown is placed on the affected
arm first
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CLOTHING
Most residents in long term care wear their own
clothing
 It is important to help the resident as needed
to choose and dress in appropriate clothing
 If the resident is paralyzed always put the
clothing on the affected side first and remove it
from the affected side last
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RESTRAINTS
Used to limit movement
 Two kinds of restraints—chemical and physical
 Chemical restraints are medications that affect
patient behavior , ex-tranquilizers, sedatives
 Physical restraints are protective devices that
limit patient movement and are used only to
protect themselves or others and when all
other measures have failed
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PHYSICIAN’S ORDER REQUIRED
Restraints can be applied only under the order
of a physician
 Order must state the type of restraint, the
reason for its use, the length of time it can be
used, and where or when it can be used
 Least restrictive device is always used first
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FALSE IMPRISONMENT
A restraint applied unnecessarily can be
considered false imprisonment
 A health care worker should NEVER apply a
restraint without proper authorization
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WHEN RESTRAINTS MAY BE NEEDED
Irrational or confused patients
 Skin conditions (to keep patient from
scratching )
 Paralysis or limited muscular coordination
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STRAP OR SAFETY BELT RESTRAINTS
Usually found on wheelchairs
 Used to prevent a patient from falling out of the
device
 Should not be applied too tightly as it could
interfere with breathing or circulation
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LIMB RESTRAINTS
Wrapped around an arm or leg to limit
movement
 Straps are then attached to the bed or
stretcher
 At least two fingers should be slipped between
the restraint and the skin to assure it is not too
tight
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RESTRAINT JACKET
Used to prevent a patient from sitting up,
rolling, getting out of bed or falling out of a
wheelchair
 Come in different sized
 Must be applied so that they do not interfere
with breathing or circulation
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IMPORTANT POINTS
Use only when all other means of obtaining
patient cooperation has failed
 Restraints should be as unnoticeable to the
patient as possible
 Patients should be allowed as much freedom of
movement as possible without danger of injury
 Patient should always be informed of why
restraint is being used
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CHECKING RESTRAINTS
Circulation below a limb restraint should be
checked every 15-30 min
 Signs of poor circulation: paleness, cyanosis, cold
skin, edema, weak or absent pulse, poor return of
pink color after nail beds are blanched, patient c/o
pain, numbness, or tingling
 If any signs of poor circulation restraint should be
removed immediately and supervisor informed
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RELEASING RESTRAINTS
ALL restraints MUST be removed every 2 hours
for at least 10 minutes
 Patient should be repositioned, ROM exercises,
and skin care to skin under restraint
 Restraints should be removed as soon as there
is adequate supervision or as soon as the
danger of self-injury has passed
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POSSIBLE COMPLICATIONS
Physical and mental frustration—loss of
freedom imposed by restraints can cause
disorientation, depression, hostility, agitation or
withdrawal
 Impaired circulation
 Pressure ulcers
 Loss of muscle tone, stiffness, discomfort
 Respiratory or breathing problems
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KNOW THE RULES
Each facility has it own rules and policies
 It is your responsibility to know the rules in the
facility that you work in
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