2 Personal Care Assisting Clients with Personal Care, Hygiene Routines Dressing/UndressingWashing/Bathing/ShoweringOral CareGroomingAlways assess the level of dependency of your client. What he/she will need assistance with?
3 Personal Care Client Safety Comfort Equipment Privacy Communication IndependenceSafetyDiscuss importance of 6 subgroups in relation to client while carrying out personal careClientEquipmentComfortPrivacyDignityCommunication
4 Washing, Showering, Bathing Preparation:Prepare the area,Check safety equipmentCheck room temperatureCheck water temperatureClear bathroom for easy mobilityGather equipment required:Towels, face towels, soap, shampoo, body wash, toothbrush, toothpaste, clean clothesAlways encourage independenceEnsure dignity, privacy, choice and respect for the clients wishes are maintained at all times
5 Caregiver Guidelines Offer toilet facilities before commencing Always explain procedure to clientAsk permission to proceedAlways observe minimal exposureCarry out procedure in sequential mannerHead, face, eyes, ears and neckArms and hands, bodyThigh, legs and feet.Genital area
6 PreparationAsk client to remove glasses, jewellery, hair pins, dentures, clothes.Assist client where necessaryWhen undressing ensure minimal exposureProvide appropriate cover at all times.Prepare YourselfWear gloves providedPlastic apronsShoe covers
7 Procedure Recheck water temperature Start with washing hair, face, neck, arms. followed by the body, legs, perineal areaWash well in between the toesWash the perineal area last using separate clothUse face cloths appropriatelyEncourage client to participate as their ability allows.Change the water when necessary, dirty/cold
8 Completion Dry the client quickly. Use a patting motion and avoid rubbing.Observe for any signs of redness, skin breakages, bruising.Ensure client is dry,Commence dressing, ensure client iscomfortable and warm.On completion clean bathroom, ensurebathroom floor dry.Remove gloves, aprons and shoe covers as appropriate.Show Bed bath / showering dvd
9 Oral Care Digestion starts in the mouth Research indicates that a clean mouth prevents gum disease, aspiration pneumonia and helps prevent heart disease.Salivary flow is reduced by some medications and medical treatmentsReduced saliva flow results in less natural washing away of oral bacteria
10 Equipment Toothbrush/ toothpaste Clean glass/ cup for rinsing Mouthwash if necessaryClean bowel or sink to rinse intoPaper tissues.TowelGloves if assisting client
11 Caregiver GuidelinesWhere possible allow client to carry out own mouth care.Explain procedure to clientWash hands and wear glovesObserve the whole mouth,Brush clients teeth gums and tongueBrush the inner and outer aspects of teeth with firm individual strokes directed outward from the gumsGive beaker or glass of water/mouthwash to rinse.Provide tissues to client
12 Caregiver GuidelinesIf a client is unable to rinse and void, use a rinsed toothbrush to clean teeth, gums and tongue.If required apply lubricant to dry lips, i.e.; Vaseline.Disguard remaining mouthwash solutionsRemove gloves, wash and dry hands.
13 Denture Care Ask permission and explain procedure to client Wash hands and wear glovesRemove dentures from mouthPlace in suitable containerClean dentures on all surfaces with toothbrush and denture pasteRinse well and return to clientDentures should be removed overnight and soaked in suitable solution
14 Shaving Do not carry out a wet shave on any client Electric shaves allowed. Ensure equipment is cleaned after each use.If client requests a wet shave pleasecontact the officeThere may be a specific situation where a wet shave is allowed. This must be agreed with client and office staff. A shaving form must be signed in this situation
15 Hair Care Ensure that hair is well groomed and clean Everyone loves to have their hair looking well. It is the “Crowning Glory” for many womenAlways allow client to look inmirror when brushing hair.Keep hairbrushes, combs cleanIf washing hair in shower or bath ensure you dry the hair quickly.Check temperature of hairdryer if using.Do not use dyes or chemicals on a clients hair.Shampoo and conditioner can be used.
16 Grooming Always ask client if she wants make up, face creams on. Assist with the application if necessary.Provide mirrorNails can be filed and nail varnishapplied if desired.All grooming will help to promotepositive well being for client.
17 After the Procedure Cleaning of equipment, bath, shower, wash basin, commodeCorrect storage of clients own washing, grooming equipmentFollow standard procedure for linen and clothes for washingEnsure client is comfortable, leave personal belongings, aids for mobility nearby
19 Common Terms Urination, micturition and voiding Defecation, elimination and moving/ opening the bowelsExplain terms above
20 Normal Urination Eliminating waste is a physical need The urinary system removes waste products from the blood and maintains the body’s water balanceHealthy adult excretes approx 1500ml of fluid a dayMinimum amount of urine production – 30mls per hourFactors that affect urine productionAge, disease, amount of fluids, dietary salt and drugsFactors that increase urine productionCoffee, tea, alcohol and some drugs
21 Observation of Urine Urine is normally yellow in colour (amber) Clear with no particlesObserve urine for colour, clarity, odor, amount and particlesSome foods affect urine colourRed food dyes, beetroot, blackberries and rhubarb causes red urineCarrots and yams = bright yellowAs do drugs e.g. IV vitamin BAsparagus causes a strong odour
22 Urine Observations Frequency of micturition Recording of fluid intake Measuring the amount of urine passedReport any abnormaltiesSmellColourCrystals in the urineSave urine for inspectionReport complaints of urgency, burning or painReport difficulty passing urine
24 Promoting Continence Identify the person’s normal urination pattern Prompt the person to use the toilet and offer assistance as requiredOffer commode, urinal, bedpan etc at regular intervalsAdapted clothingEasy access to toilet facilitiesUse of pads and devices e.g. conveen catheterPractical demonstration of incontinence pads
25 Care of the client Check the person at regular intervals Offer commode, bedpan etc. if appropriateObserve urine for signs of infectionProvide for regular cleaning of the skin and observe for signs of redness and broken areasIf incontinence wear is used check and change accordingly
26 Urinary CatheterA urinary catheter is a tubes that is passed into the bladder attached to a drainage bagA suprapubic catheter is passed via the abdomen through the urethra into the bladder above the pubic boneTypes:Indwelling catheterTemporary catheterDraw urinary system on flip chart.
27 Reasons for Catheterisation Difficulty with urinationObstruction e.g. enlarged prostateTo accurately measure urine outputTo allow area to heal after surgeryN.B. Catheterisation is not a solution for incontinence
28 Catheter Care Caregiver Guidelines Make sure urine flows freely through the catheter or tubing, no kinks.The person should not lie on the tubingTubing must not loop below the drainage bagAttach drainage bag to the correct stand (never to the bed rail)Make sure the catheter is connected to the drainage tubing, check for leaks.
29 Catheter Care Caregiver guidelines contin… Keep the drainage bag below the bladder (prevents urine from flowing backward into the bladder)Empty drainage bag when it is ¾ fullFollow standard precautionsProvide perineal care daily and after bowel movements
30 Catheter Care If indicated, measure and record the amount of urine, Do not let the opening on the bag touch any surfaceReport if urine changes colour, becomes foul smelling or there is evidence of pus in urine
31 Perineal Care with Catheter Wash genital area with warm water and gentle soapSeparate the labia, or retract the foreskin check for crusting, abnormal drainage or secretionsClean the catheter from the urethra down the catheter about 4 inchesUse soap and water and a disposable clothAvoid pulling or tuggingEnsure the catheter is securedPractical demonstration of catheter equipment; drainage bags, catheter tubes /conveen catheters / catheter stand. EtcCaregiver to practice opening and closing valve on drainage bagDiscuss infection control around catheter care
32 Bowel Frequency of bowel movements varies from person to person One a day, one every 2-3 days some people have 2-3 BM’s per dayTimes of day may be the sameStools are normally brown in colourStools are normally soft, formed, moist and shaped like the rectum
34 Common Problems Piles Constipation Faecal impaction Diarrhoea Faecal incontinenceFlatulence
35 Management of Constipation Assess what the person’s normal patternEncourage fluid intakeEncourage high fibre diet where appropriateCitrus fruits, prunes, fruit juicePrivacy and ample time to use the toiletMedicationsStool softeners Bulking agents Laxatives Enemas
36 ColostomyA colostomy is a surgical procedure that involves connecting a part of the colon onto the stomach wall leaving the patient with an opening called a stoma.After a colostomy, faeces leave the patient's body through the stoma, and collects in a pouch attached to the patient's abdomen which is changed when necessary.Demonstrate using stoma equipment.
37 UrostomyA urostomy is a stoma for the urinary system. A urostomy is made in cases where long-term drainage of urine through the bladder and urethra is not possible, e.g. after extensive surgery or in case of obstructionA "continent urostomy" is an artificial bladder formed out of a segment small bowel. This is fashioned into a pouch, which can be emptied intermittently with a catheter. It avoids the need for a stoma bag on the urostomy.
38 Care of the Skin and Prevention of Pressure Sores
39 Care of the Skin Maintaining the skin’s integrity is essential to the prevention of infectionand the promotion of health. The skin has several functions:Maintenance of temperatureProtectionExcretionSensation
40 Anatomy and Physiology The skin is made up of three layers:the epidermis,dermis andthe subcutaneous layer.
41 Anatomy and Physiology Changes occur due to :temperaturetextureelasticityability to change to environment & stimuliINTEGRITY, CONTINUITY AND CLEANLINESS ARE ESSENTIAL FOR PHYSIOLOGICAL FUNCTION
42 AssessmentSeveral factors may influence the appearance of the skin tissue.HydrationAge, health, mobility, presence of pressureulcersTreatment therapies, allergies or drug reactionsAny concurrent or previous skin conditions.Dietary habitsEmotional stress
43 Observe For…. Colour- redness, pallor, yellow or brown discolouration. Evidence of bruising or bleeding.Moisture, dryness, sweating, oiliness.Temperature.Texture: rough or smoothSize, shape, colour and dryness of any lesions and their distributionOdour
44 Assessment Extra care is needed if damage to the skin noted note skin folds and crevicesinvasive devicesbreaks in skinRedness or rash
45 Care of the Skin When an abnormality is observed it is important to ascertain:When it was first observed (if problem present)Whether the lesion(s) persist or come & go, or change in appearanceThe extent to which it has spreadIf it itches, hurts, is dry, moist or dischargingAny changes must be reported and documented
46 Care of the skin Choice of cleansing agents: Respect the choices of the patientMay use prescribed cleansing agentsUse non abrasive solutionsUse non-drying agentsPerineal and perianal areas use warm water as it is less irritating to the area
47 Care of the Skin Prevention of the spread of infection: Do not share equipmentPatient to have own suppliesUse gloves for washing perineumClean equipment after use e.g. bath or showerEnsure towels, facecloths sponges and basins are cleaned after each use
48 Pressure Area Care A pressure sore is a lesion that is due to… unrelieved pressure on the skin causing ischaemia, impaired blood supplysheering or friction causing mechanical stress on the tissuesor a combination of these,that results in underlying tissue damage. It usually occurs over a bony prominence.
49 What is a Pressure Sore? It is an area of damaged skin it is usually caused by sitting or lying in one position for too long without moving.a pressure sore can develop in only a few hoursskin colour change (redder or darker)blisters developSkin breaks downdeep wound develops
50 Pressure Areas Heels Ankles Knees Elbows Shoulders Hips Bottom Base of spineHandout: Skin. Pressure areas
52 Factors Contributing Extrinsic factors, (outside the individual) PressureShearingFrictionIntrinsic (to do with individual himself)MoistureAcute illness (temperature, infection)AgeingEmaciationObesityPoor nutritionPain (rheumatoid arthritis)AnaemiaDiabetes
53 Factors Contributing Reduced mobility Reduced sensation to pressure and pain such as neurologically induced by multiple sclerosis, spinal cord injury, strokeSedation can cause some people to be too drowsy to move aroundDepression could lead to lack of motivation to move aroundThose with dementia are unable to respond to pressure stimuli and spontaneously alter their position
54 Prevention Nurse Assesses the risk using tool i.e. Caregiver Role… Norton scale, Waterlow scaleCaregiver Role…Encourage mobilityEncourage adequate fluid and food intakeAvoid frictionCheck skin for signs of damaged reddened areasReport findings to care manager
55 Prevention Caregiver role…. Keep skin clean & dry Avoid rubbing or massaging your skinAvoid talcum powder (causes drying of skin)For those who are incontinent change pads and carry out skin care as required.Assistive devices where needed
56 For those in bedChange position every 2hrs (min) alternating between back and sidesUse pillows to help positioning, can protect knees and anklesUse protectors (elbows and heel protectors)Bed cradle or duvet. Avoid sheets made of synthetic materialAvoid creases or crumbsWhen sitting in bed preventsliding as this can frictionSpecial mattresses
57 Wheelchair / ChairAlleviate pressure every 15 minutes by getting the person to lean forward or pushing up on the arms of the chairCan also roll from cheek to cheek for a short whilePressure relieving cushionsAvoid dragging legs and armsShow dvd on skin care / pressure sores.
58 Personal Effectiveness Caregiver SupportAsk caregivers how they can improve their own personal effectiveness as a caregiver.Discuss the Qualities of a Good Caregiver.Personal Effectiveness
59 Caregiver SupportWhat are the practical and financial supports available to carers?Caregivers can do this research themselves between study days.Review what caregivers came up with on research
60 Stress Recognise the demands on caregivers How to cope with the stress involved in providing care to vulnerable people.Home Instead basic training guide.Get them to discuss stress and the demands on caregivers in their work.Discuss ways they can cope with stress
62 Nutrition Nutrition is the study of food and its digestion in the body Our nutritional intake is our ability to take in a well rounded healthy diet full of the nutrients (building blocks) we need to maintain a healthy body.
63 Nutrition Older people are at risk of malnutrition. Causes Poverty Inability to shop or feed oneselfLiving alone, social isolationBereavementDementia, confusionDepressionSwallow reflexPoor dentition
65 Inadequate Diet Side effects of medication can cause… Loss of appetite Nausea and vomitingConstipationSedation
66 Eating and DrinkingThe need for food and water is a basic physical need necessary for life. The amount and quality of foods in the diet are important. They effect a person’s current and future well-being”(Sheila A. Sorrentino, 2000)
67 Guidelines for Healthy Eating Eat a variety of foodsMaintain a healthy weightChoose a diet low in fat, saturated fat and cholesterolChoose a diet with plenty of fruit vegetables and whole grainsUse sugar only in moderationUse Salt only in moderationIf you drink alcohol do so in moderation(Sorrentino 2000)Hand out food pyrymidExamples of foods
68 Diet For Adult YearsGive out sample diet sheetsHand out food pyramid
69 Digestive System The alimentary canal: Mouth Pharynx Oesophagus StomachSmall intestineLarge intestine
71 Nutrition Macro nutrients Micro nutrients Fats Carbohydrates Protein UnsaturatedSaturatedCarbohydratesStarchesSugarsFibreProteinMicro nutrientsVitaminsFat soluble A, D, E and KWater soluble B group and CMineralsIronCalciumSodiumZincGive examples
72 Factors that effect Eating and Drinking CultureReligionFinancesAppetitePersonal choiceIllnessHealthAge
73 Community Care Role of the caregiver; Shopping for groceries Planning economical nutritious mealsAssisting and encouraging oral intakeManagement of special diets.Monitoring client’s food/fluid intakeAssist with eating and drinking
74 Organising Meal Times Ideally meal times should be flexible Mealtimes should be organised according to clients habits and wishes.Some clients with dementia may prefer finger food to a full meal. It may be difficult to have set mealtimes in this case??
75 Assisting with Eating Consider……… Oral hygiene Elimination needs Clothing and linenDenturesSpectaclesHearing aidsHygiene – hand washing
76 Assisting with Eating Positioning and seating Bed Chair Dinning room / kitchenSpecial needsDemonstrate correct positioning in above situations.Discuss special needs. Equipment, Communication, assistance with feeding, Visual impaired, Hearing impaired, Swallowing difficulties.
77 Serving Meals Client in bed; Wash hands Make sure tray is complete Address the person by nameIntroduce yourself by name and titleEnsure that person is in comfortable positionPlace the tray within easy reachRemove food covers, open milk cartons and cereal boxes. Cut food up and butter bread if indicated.Ensure that napkin/clothes protector is in placeTake note of the amount and type of food eatenRemove trayAssist with or offer oral hygiene and hand and face washing
78 Feeding the PersonProvide a relaxed attitude. Ensure that the person does not feel rushedAllow for religious practice.Give choiceSpoons are usually considered safer than forks. Spoon should be no more than 1/3 full.Wash handsMake sure tray is completeAddress the person by nameEnsure that person is in comfortable positionShoe DVD
79 Feeding the PersonRemember that meal times provide social contact – engage in conversation making sure the person has ample time to chew and swallowSit at eye level with the person and demonstrate a relaxed manner.Drape a napkin across the chest and under the chinPrepare the food for eatingTell the person what food is on the trayServe the food in the order the person prefers alternating between liquids and solids. Allow enough time for chewing do not rush the person
80 Feeding the Person Wipe the person’s mouth with napkin Note how much and what food was eatenMeasure and record intake in client journal if appropriateRemove tray/dishesReturn the person to sitting roomProvide for oral or other hygiene needsProvide for comfortWash handsReport observations to care manager;Complaints of nausea or dysphagiaAny persistent coughing while eating or drinking.
81 Swallowing disorders in adults - Dysphagia StrokeBrain injurySpinal cord injuryParkinson’s diseaseMultiple sclerosisDecayed or missing teethMuscular dystrophyCerebral palsyAlzheimer’s/DementiaSevere intellectual disabilitiesCancer of mouth, throat or oesophagusTrauma to head and neck
82 General Signs of Dysphagia Coughing during the night or after eating and drinkingWet gurgly sounding voice after eating and drinkingExtra effort or time needed to chew and swallowFood or liquid leaking from or getting stuck in the mouthRecurring pneumonia or chest congestion after eatingWeight loss or dehydration from being unable to eat or drink enough.
83 Dysphagia may result in… Poor nutritional statusDehydrationAspiration which can lead to pneumonia and chronic lung diseaseLess enjoyment of eating and drinkingEmbarrassment or social isolation
84 Treatment Treatment varies depending on the cause Speech therapist may recommend special exercises, positions or strategies to help the person swallow more effectivelySpecific food and liquid textures that are easier to swallowPEG feeding
85 Caregivers and Family Can Help By… Asking question to understand the problem and the recommended treatmentAssist in following the care plan –Help with exercisesPrepare the recommended food and liquidRecord food and fluid intake if necessary
86 Fluid Balance Fluid intake and output must balance Excessive fluid = oedemaDecrease of body fluid leads to dehydration
87 Normal fluid requirements Adult requires – 1500 ml water per day.Daily intake to maintain balance =2000 –2500 ml per dayOlder people often take medication that can causes loss or retention of fluid
88 Special Orders Encourage fluid intake Restrict fluids Nil by mouth Sips30ml1 litre1 litre + outputNil by mouth
89 Intake and Output Recording Used to assess fluid balance and kidney functionMay also be used to assess fluid intakeIf person is receiving intravenous therapy or tube feedingUsed to plan and evaluate medical treatment
90 Intake and Output Recording all fluids taken by mouth including tea, coffee, milk, water, juices, soups and soft drinks. Ice cream custard and other soft foods should also be measured.Tube feedsI.V. fluidsOutput:UrineVomitusDiarrhoeaWound drainageNote excessive perspiration
91 Intake and Output Recording Measure amount that water glass holdsMost cups contain approx. 180ml but will varyFluid charts are normally completed in mls.If person is ambulant give instruction on measuring and provide appropriate measuring receptaclesDemonstrate with a measuring jug, cups mugs.