Transcript File
Bathing and Personal Care Skills Things you can to that will add to your patient’s general comfort and feeling of well-being Schedule of Daily Care Early AM Care Before breakfast Elimination Needs Wash patient's hands/face Pass fresh ice/water Clean overbed table and position it to receive patient’s tray Raise HOB if permitted Certain instances would allow you to not wake the patient early Surgery Certain tests Schedule of Daily Care Morning Care After breakfast Offer bedpan/urinal Assist with oral hygiene Bathing Change patient’s gown Help male patient to shave Make bed Straighten/tidy room PM CARE Given at bedtime Quietly, unrushed to prepare for sleep Done before meds for sleep are given Provide mouth/hair care Elimination needs Backrub Patient and Resident Bathing Bathing will allow a patient to feel relaxed, clean and refreshed Why Bathe Our Patients? Removes dirt and perspiration Increases circulation Provides mild exercise Provides an opportunity for close observation Always report any abnormalities noted or any problems seen during the bathing procedure Where Can We Bathe Our Patients? Bed bath Shower bath Tub bath Whirlpool bath (using century tub) What Needs Special Attention? Between the legs Under the arms (axillae) Under the breasts Under the scrotum Between the buttocks Around the anus Under folds of skin or fat Anywhere that skin touches Genitalia (external reproductive organs) Special Situations Waterless Bathing Pre-moistened disposable washcloths May be warmed according to package directions in microwave Whirlpool 97 degrees No soap in water!! SUDS!! Check if incisions or pressure ulcers Must be cleaned following facility policy We don’t use these at Coastal Manor Nasty place with potential to harbor dangerous pathogens Therapeutic Stimulates circulation Bathing a Patient With Special Treatments Do not pull on tubes Never lower the IV container below the level of the insertion site Never raise drainage tubes above the drainage site Patients with oxygen must leave on their oxygen unless orders say it is ok to remove for bathing Guidelines for Patient Bathing Standard Precautions Clean shower/tub before use Turn on hot water last, turn off hot water first Water temp=105o Maintain privacy Never leave pt alone in tub/shower Do not leave patient alone if he/she falls or feels faint call for help Guidelines for Patient Bathing Good body mechanics Assist with transfers Wipe up water and spills immediately Check safety devices Hand rails, lifts, tub benches, etc Observe skin for pressure areas Keep room warm (70o--facility temp per OBRA=71o-81o Use bath blankets Wrap patient in bath blanket after bath or shower for modesty and warmth (we dress them) Perineal Care Will be given as part of the routine bathing or anytime the patient is incontinent or otherwise soiled Includes cleaning the genitals, the anus and surrounding areas Always wear gloves Guidelines for Perineal Care Avoid showing disgust Be sensitive to patient’s feelings Use proper terms when referring to body parts and excretions Avoid scrubbing back and forth Always wipe from clean to dirty with a single swipe of the cloth Avoid contamination Bed Bath Guidelines Complete bed bath All areas of the patient’s body are bathed 1-eyes, face and neck 2-far arm and hand 3-near arm and hand 4-chest and abdomen 5-far leg and foot 6-near leg and foot 7-back and buttocks 8-perineum Partial bed bath Consists of bathing the hands face back axillae buttocks genitals Bed Bath Guidelines Never use soap on the face unless the patient requests it Wipe eyes from inside to outside corner Always place a towel underneath the body part being washed (keeps the linen dry) Apply deodorant if the patient desires Fingernail and foot care can be done as part of the bathing procedure Bed Bath Guidelines Give a backrub during the bathing procedure Apply lotion to the patient’s back (warm it in the palm of your hand) You may need to change bath water many times After the arms, after the legs, and after the back Bed Bath Guidelines Never use a large amount of soap with doing peri care Difficult to rinse off and may irritate patient Carry out range of motion exercises as part of the bath Oral hygiene is usually given after the bed bath Linen is usually changed as part of the complete bed bath procedure Peri Care Female and Male Male Offer urinal Grasp penis and wash in a circular motion beginning at the meatus You must withdraw the foreskin if the patient is not circumcised (rinse and dry before replacing) Wash down the penis and the rest of the perineal area (including scrotum) Wash underneath the scrotum You must finish this by washing the anal area from perineum to coccyx on both males and females Female Offer the bedpan Use gloves Separate the vulva and use a single downward swipe to clean each side Rinse in the same manner and dry Separate the inner labia and repeat the above steps Cleanse from front to back Dressing and Undressing Patients Allow patients to choose their clothing Encourage patients to help as much as they are able Assist with shoes and socks (bending over can cause dizziness and loss of balance) Remove clothing from the unaffected side first Put clothing on the affected side first Procedures Complete bed bath Changing the patient’s gown and dressing the patient Female Perineal Care Male Perineal Care Fingernail care Foot Care Oral Hygiene When oral hygiene is performed, we are caring for the teeth and mouth Routine oral hygiene should be performed at least three times a day Patients should be encouraged to do as much as possible for themselves Providing oral care for your patient prevents tooth decay (caries), bad breath (halitosis) and contributes to the patient’s comfort Special Oral Hygiene This oral care is more involved than routine oral hygiene This is used for the patients that require more frequent oral hygiene and is performed using prepared lemon-glycerin swabs, Toothettes, or other preparations used by the facility Who requires Special Oral Hygiene? Unconscious Vomiting High fevers Dehydrated Breathing through the mouth Dying patient On oxygen Receiving certain medications Receiving tube feedings Infection Control Principles Store the patient’s toothbrush carefully It should be covered and away from other items Always wear gloves If there is a possibility of splashing or spraying, wear a gown, mask, gloves and face shield Watch piercings for pain, bleeding, increased saliva, swelling or other signs of infection Age-Appropriate Care Alert Aging causes patients to experience dry mouth and reduced saliva production Meds may also contribute to this Patients may also complain of burning or sore throat, difficulty swallowing, hoarseness and dry nasal passages Artificial saliva products can help as chewing sugar-free gum or candy to increase saliva production (make sure this is OK with the nurse-the patient must be awake and alert) Procedures Let’s look and practice the procedures for Providing Oral Hygiene Providing Special Oral Hygiene Dentures Referred to as artificial teeth that can be removed Partial set Full set They must be cleaned just like real teeth Patients may feel embarrassed when having their dentures cared for-always provide privacy Denture Care Includes Cleaning dentures daily under cool running water Handling dentures carefully to prevent damage Store dentures in a safe place when out of the mouth (drawer of the bedside table, in a clearly labeled denture cup) Denture Care Includes Cleaning and checking the patient’s mouth for signs of irritation Checking the patient’s lips for cracking and dryness Applying cream, vaseline or glycerin to lips to prevent excessive dryness Denture Safety Alert Dentures must be removed from a comatose patient to prevent airway obstruction by the dentures themselves They must also be removed preoperatively to prevent accidental damage and obstruction in surgery Age-Appropriate Care Alert Dentures are intended to fit snugly into a patient’s mouth Natural changes in the bones and gums as we age can cause the shape of the mouth to change over time Dentures become loose or ill-fitting This can cause sores in the mouth and choking Use denture adhesives until referral to the dentist can be made Always report improperly fitting dentures Procedures Let’s look at and practice Providing Denture Care Backrubs When properly given, backrubs can be Stimulating Aid in preventing skin breakdown (decubitus ulcers) Soothing Refreshing Use warmed lotion to sooth your patients Backrubs Keep nails short to prevent injury You must observe the condition of the patient’s skin during the backrub This is the perfect opportunity to notice any signs of breakdown Long, smooth strokes are relaxing Short, circular strokes are stimulating Avoid massaging over bony prominences What to look for during backrubs? Reddened areas that do not blanche (whiten) when pressed Raw areas of skin Condition of the skin over bony prominences When should you give a backrub? Unless contraindicated, the backrub is given Routinely as part of the bath Following the use of the bedpan When changing the position of the helpless patient At bedtime When it could be a comfort to the patient For your safety… Always raise the bed to a comfortable working height when giving a backrub Stand with one foot in front of the other with knees slightly bent Use your arm and shoulder muscles, not your back Rock back and forth using your legs to massage the patient’s back Take a few minutes Backrubs were once thought to be a sacred, routine part of nursing Nowadays, we have become too “busy” to provide our patients with this simple act of comfort A good backrub is comforting and relaxing Use this simple technique to calm the agitated patient, sooth the pregnant mother’s backache and comfort the patient with spasticity Procedures Let’s review and practice The Backrub Daily Shaving Important routine part of self-care for most men May be done safely in a healthcare facility as long as you follow safety guidelines Some facilities do not allow female residents to be shaved by nursing assistants Always check policy on this matter Safety guidelines Always wear gloves when shaving with a nonelectric razor and discard this razor in the sharps container Use the patient’s own shaving equipment if possible Use of an electric razor is best Oxygen may be removed during shaving-check with the nurse Patient’s on anticoagulants (blood thinners) may require an electric razor-check with the nurse Infection control alert An electric razor used to shave a patient is the patient’s personal property Sharing electric razors (or razors of any kind) is not permitted due to possible exposure to blood Handle these expensive razors carefully and avoid dropping it Report any damage or frayed cords immediately Procedures Let’s look at and practice Shaving the Patient Daily Hair Care Hair care is usually performed after the patient’s bath The hair should be combed or brushed each morning Loosen tangles by sectioning the hair and begin at the roots, working your way up You may apply a small amount of alcohol or oil to the tangle to help loosen it Daily Hair Care Hold hair close to the scalp while brushing to avoid pulling Braiding long hair after brushing can help to reduce tangles-be sure to avoid braiding too tightly Using conditioners also helps control tangles in dry hair What does brushing the hair do? Stimulates circulation of the scalp Refreshes the patient Removes dirt and lint Helps to keep the hair shiny and attractive Dry shampoos are often used when additional hair care is needed Shampooing the hair may also be used but must be approved by the physician Bedbound patients should be shampooed every 2 weeks Procedures Let’s look at the procedure for Hair care Equipment used for the bed shampoo Comfort Devices These are used to relieve pressure on specific areas or to help maintain body position Examples: Bed cradle Footboard or footrest Pillows and bath blankets Bed Cradle Prevents the weight of the bedclothes from falling on some part of the body Over fractured limbs When there are burns To prevent skin lesions Over widespread skin conditions To prevent contractures of the feet Over a wet cast until it dries You may need to pad the cradle to prevent it from rubbing the patient You may use extra blankets to keep the patient warm Footboard or Footrest Placed between the mattress and bed to keep the feet at right angles Prevents foot drop (a contracture) Calf muscles tighten, causing toes to point downward Caused by inactivity Makes walking difficult A pillow folded lengthwise may be placed at the FOB and used for the same purpose Always pad footboards or footrests Pillows and Bath Blankets Used as supportive devices and to maintain alignment Trochanter rolls are used to prevent external rotation of the hip Position the patient in the center of folded bath blanket that extends from mid-thigh to above waist Roll each side of the blanket under and toward the patient until it is firmly against the patient Tuck the roll inward to secure in place Pillows and Bath Blankets Pillows can be used to relieve pressure for specific areas of the body This “bridging” elevates an area of the body off the surface of the bed Frequently used to relieve pressure from the heels, sacrum, hips and ankles, or breasts