1. Personal Care

2. Personal Care Assisting Clients with Personal Care, Hygiene Routines
Dressing/Undressing
Washing/Bathing/Showering
Oral Care
Grooming
Always assess the level of dependency of your client. What he/she will need assistance with?

3. Personal Care Client Safety Comfort Equipment Privacy Communication
Independence
Safety
Discuss importance of 6 subgroups in relation to client while carrying out personal care
Client
Equipment
Comfort
Privacy
Dignity
Communication

4. Washing, Showering, Bathing
Preparation:
Prepare the area,
Check safety equipment
Check room temperature
Check water temperature
Clear bathroom for easy mobility
Gather equipment required:
Towels, face towels, soap, shampoo, body wash, toothbrush, toothpaste, clean clothes
Always encourage independence
Ensure 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 client
Ask permission to proceed
Always observe minimal exposure
Carry out procedure in sequential manner
Head, face, eyes, ears and neck
Arms and hands, body
Thigh, legs and feet.
Genital area

6. Preparation
Ask client to remove glasses, jewellery, hair pins, dentures, clothes.
Assist client where necessary
When undressing ensure minimal exposure
Provide appropriate cover at all times.
Prepare Yourself
Wear gloves provided
Plastic aprons
Shoe covers

7. Procedure Recheck water temperature
Start with washing hair, face, neck, arms. followed by the body, legs, perineal area
Wash well in between the toes
Wash the perineal area last using separate cloth
Use face cloths appropriately
Encourage 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 is
comfortable and warm.
On completion clean bathroom, ensure
bathroom 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 treatments
Reduced saliva flow results in less natural washing away of oral bacteria

10. Equipment Toothbrush/ toothpaste Clean glass/ cup for rinsing
Mouthwash if necessary
Clean bowel or sink to rinse into
Paper tissues.
Towel
Gloves if assisting client

11. Caregiver Guidelines
Where possible allow client to carry out own mouth care.
Explain procedure to client
Wash hands and wear gloves
Observe the whole mouth,
Brush clients teeth gums and tongue
Brush the inner and outer aspects of teeth with firm individual strokes directed outward from the gums
Give beaker or glass of water/mouthwash to rinse.
Provide tissues to client

12. Caregiver Guidelines
If 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 solutions
Remove gloves, wash and dry hands.

13. Denture Care Ask permission and explain procedure to client
Wash hands and wear gloves
Remove dentures from mouth
Place in suitable container
Clean dentures on all surfaces with toothbrush and denture paste
Rinse well and return to client
Dentures 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 please
contact the office
There 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 women
Always allow client to look in
mirror when brushing hair.
Keep hairbrushes, combs clean
If 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 mirror
Nails can be filed and nail varnish
applied if desired.
All grooming will help to promote
positive well being for client.

17. After the Procedure Cleaning of equipment, bath, shower,
wash basin, commode
Correct storage of clients own washing, grooming equipment
Follow standard procedure for linen and clothes for washing
Ensure client is comfortable, leave personal belongings, aids for mobility nearby

18. Elimination and Continence Management

19. Common Terms Urination, micturition and voiding
Defecation, elimination and moving/ opening the bowels
Explain 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 balance
Healthy adult excretes approx 1500ml of fluid a day
Minimum amount of urine production – 30mls per hour
Factors that affect urine production
Age, disease, amount of fluids, dietary salt and drugs
Factors that increase urine production
Coffee, tea, alcohol and some drugs

21. Observation of Urine Urine is normally yellow in colour (amber)
Clear with no particles
Observe urine for colour, clarity, odor, amount and particles
Some foods affect urine colour
Red food dyes, beetroot, blackberries and rhubarb causes red urine
Carrots and yams = bright yellow
As do drugs e.g. IV vitamin B
Asparagus causes a strong odour

22. Urine Observations Frequency of micturition Recording of fluid intake
Measuring the amount of urine passed
Report any abnormalties
Smell
Colour
Crystals in the urine
Save urine for inspection
Report complaints of urgency, burning or pain
Report difficulty passing urine

23. Many different methods:
Bedpans
Urinals
Commode

24. Promoting Continence Identify the person’s normal urination pattern
Prompt the person to use the toilet and offer assistance as required
Offer commode, urinal, bedpan etc at regular intervals
Adapted clothing
Easy access to toilet facilities
Use of pads and devices e.g. conveen catheter
Practical demonstration of incontinence pads

25. Care of the client Check the person at regular intervals
Offer commode, bedpan etc. if appropriate
Observe urine for signs of infection
Provide for regular cleaning of the skin and observe for signs of redness and broken areas
If incontinence wear is used check and change accordingly

26. Urinary Catheter
A urinary catheter is a tubes that is passed into the bladder attached to a drainage bag
A suprapubic catheter is passed via the abdomen through the urethra into the bladder above the pubic bone
Types:
Indwelling catheter
Temporary catheter
Draw urinary system on flip chart.

27. Reasons for Catheterisation
Difficulty with urination
Obstruction e.g. enlarged prostate
To accurately measure urine output
To allow area to heal after surgery
N.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 tubing
Tubing must not loop below the drainage bag
Attach 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 full
Follow standard precautions
Provide 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 surface
Report 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 soap
Separate the labia, or retract the foreskin check for crusting, abnormal drainage or secretions
Clean the catheter from the urethra down the catheter about 4 inches
Use soap and water and a disposable cloth
Avoid pulling or tugging
Ensure the catheter is secured
Practical demonstration of catheter equipment; drainage bags, catheter tubes /conveen catheters / catheter stand. Etc
Caregiver to practice opening and closing valve on drainage bag
Discuss 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 day
Times of day may be the same
Stools are normally brown in colour
Stools are normally soft, formed, moist and shaped like the rectum

33. Factors affecting bowel elimination
Privacy
Personal habits
Diet
Fluids
Activity
Medications
Age

34. Common Problems Piles Constipation Faecal impaction Diarrhoea
Faecal incontinence
Flatulence

35. Management of Constipation
Assess what the person’s normal pattern
Encourage fluid intake
Encourage high fibre diet where appropriate
Citrus fruits, prunes, fruit juice
Privacy and ample time to use the toilet
Medications
Stool softeners Bulking agents Laxatives Enemas

36. Colostomy
A 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. Urostomy
A 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 obstruction
A "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 infection
and the promotion of health. The skin has several functions:
Maintenance of temperature
Protection
Excretion
Sensation

40. Anatomy and Physiology
The skin is made up of three layers:
the epidermis,
dermis and
the subcutaneous layer.

41. Anatomy and Physiology
Changes occur due to :
temperature
texture
elasticity
ability to change to environment & stimuli
INTEGRITY, CONTINUITY AND CLEANLINESS ARE ESSENTIAL FOR PHYSIOLOGICAL FUNCTION

42. Assessment
Several factors may influence the appearance of the skin tissue.
Hydration
Age, health, mobility, presence of pressure
ulcers
Treatment therapies, allergies or drug reactions
Any concurrent or previous skin conditions.
Dietary habits
Emotional stress

43. Observe For…. Colour- redness, pallor, yellow or brown discolouration.
Evidence of bruising or bleeding.
Moisture, dryness, sweating, oiliness.
Temperature.
Texture: rough or smooth
Size, shape, colour and dryness of any lesions and their distribution
Odour

44. Assessment Extra care is needed if damage to the skin noted
note skin folds and crevices
invasive devices
breaks in skin
Redness 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 appearance
The extent to which it has spread
If it itches, hurts, is dry, moist or discharging
Any changes must be reported and documented

46. Care of the skin Choice of cleansing agents:
Respect the choices of the patient
May use prescribed cleansing agents
Use non abrasive solutions
Use non-drying agents
Perineal 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 equipment
Patient to have own supplies
Use gloves for washing perineum
Clean equipment after use e.g. bath or shower
Ensure 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 supply
sheering or friction causing mechanical stress on the tissues
or 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 hours
skin colour change (redder or darker)
blisters develop
Skin breaks down
deep wound develops

50. Pressure Areas Heels Ankles Knees Elbows Shoulders Hips Bottom
Base of spine
Handout: Skin. Pressure areas

51. Pressure Areas

52. Factors Contributing Extrinsic factors, (outside the individual)
Pressure
Shearing
Friction
Intrinsic (to do with individual himself)
Moisture
Acute illness (temperature, infection)
Ageing
Emaciation
Obesity
Poor nutrition
Pain (rheumatoid arthritis)
Anaemia
Diabetes

53. Factors Contributing Reduced mobility
Reduced sensation to pressure and pain such as neurologically induced by multiple sclerosis, spinal cord injury, stroke
Sedation can cause some people to be too drowsy to move around
Depression could lead to lack of motivation to move around
Those 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 scale
Caregiver Role…
Encourage mobility
Encourage adequate fluid and food intake
Avoid friction
Check skin for signs of damaged reddened areas
Report findings to care manager

55. Prevention Caregiver role…. Keep skin clean & dry
Avoid rubbing or massaging your skin
Avoid 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 bed
Change position every 2hrs (min) alternating between back and sides
Use pillows to help positioning, can protect knees and ankles
Use protectors (elbows and heel protectors)
Bed cradle or duvet. Avoid sheets made of synthetic material
Avoid creases or crumbs
When sitting in bed prevent
sliding as this can friction
Special mattresses

57. Wheelchair / Chair
Alleviate pressure every 15 minutes by getting the person to lean forward or pushing up on the arms of the chair
Can also roll from cheek to cheek for a short while
Pressure relieving cushions
Avoid dragging legs and arms
Show dvd on skin care / pressure sores.

58. Personal Effectiveness
Caregiver Support
Ask caregivers how they can improve their own personal effectiveness as a caregiver.
Discuss the Qualities of a Good Caregiver.
Personal Effectiveness

59. Caregiver Support
What 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

61. Nutrition

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 oneself
Living alone, social isolation
Bereavement
Dementia, confusion
Depression
Swallow reflex
Poor dentition

64. Inadequate Diet / Malnutrition
Increased risks of:
Infection, decreased immune response
Reduced muscle strength
Healing problems
Vitamin deficiencies
Fatigue / apathy
Accidents and injuries
Impaired thermoregulation

65. Inadequate Diet Side effects of medication can cause… Loss of appetite
Nausea and vomiting
Constipation
Sedation

66. Eating and Drinking
The 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 foods
Maintain a healthy weight
Choose a diet low in fat, saturated fat and cholesterol
Choose a diet with plenty of fruit vegetables and whole grains
Use sugar only in moderation
Use Salt only in moderation
If you drink alcohol do so in moderation
(Sorrentino 2000)
Hand out food pyrymid
Examples of foods

68. Diet For Adult Years
Give out sample diet sheets
Hand out food pyramid

69. Digestive System The alimentary canal: Mouth Pharynx Oesophagus
Stomach
Small intestine
Large intestine

70. Digestive System Teeth Tongue Salivary glands Liver Gallbladder
Accessory organs:
Teeth
Tongue
Salivary glands
Liver
Gallbladder
Pancreas

71. Nutrition Macro nutrients Micro nutrients Fats Carbohydrates Protein
Unsaturated
Saturated
Carbohydrates
Starches
Sugars
Fibre
Protein
Micro nutrients
Vitamins
Fat soluble A, D, E and K
Water soluble B group and C
Minerals
Iron
Calcium
Sodium
Zinc
Give examples

72. Factors that effect Eating and Drinking
Culture
Religion
Finances
Appetite
Personal choice
Illness
Health
Age

73. Community Care Role of the caregiver; Shopping for groceries
Planning economical nutritious meals
Assisting and encouraging oral intake
Management of special diets.
Monitoring client’s food/fluid intake
Assist 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 linen
Dentures
Spectacles
Hearing aids
Hygiene – hand washing

76. Assisting with Eating Positioning and seating Bed Chair
Dinning room / kitchen
Special needs
Demonstrate 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 name
Introduce yourself by name and title
Ensure that person is in comfortable position
Place the tray within easy reach
Remove food covers, open milk cartons and cereal boxes. Cut food up and butter bread if indicated.
Ensure that napkin/clothes protector is in place
Take note of the amount and type of food eaten
Remove tray
Assist with or offer oral hygiene and hand and face washing

78. Feeding the Person
Provide a relaxed attitude. Ensure that the person does not feel rushed
Allow for religious practice.
Give choice
Spoons are usually considered safer than forks. Spoon should be no more than 1/3 full.
Wash hands
Make sure tray is complete
Address the person by name
Ensure that person is in comfortable position
Shoe DVD

79. Feeding the Person
Remember that meal times provide social contact – engage in conversation making sure the person has ample time to chew and swallow
Sit at eye level with the person and demonstrate a relaxed manner.
Drape a napkin across the chest and under the chin
Prepare the food for eating
Tell the person what food is on the tray
Serve 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 eaten
Measure and record intake in client journal if appropriate
Remove tray/dishes
Return the person to sitting room
Provide for oral or other hygiene needs
Provide for comfort
Wash hands
Report observations to care manager;
Complaints of nausea or dysphagia
Any persistent coughing while eating or drinking.

81. Swallowing disorders in adults - Dysphagia
Stroke
Brain injury
Spinal cord injury
Parkinson’s disease
Multiple sclerosis
Decayed or missing teeth
Muscular dystrophy
Cerebral palsy
Alzheimer’s/Dementia
Severe intellectual disabilities
Cancer of mouth, throat or oesophagus
Trauma to head and neck

82. General Signs of Dysphagia
Coughing during the night or after eating and drinking
Wet gurgly sounding voice after eating and drinking
Extra effort or time needed to chew and swallow
Food or liquid leaking from or getting stuck in the mouth
Recurring pneumonia or chest congestion after eating
Weight loss or dehydration from being unable to eat or drink enough.

83. Dysphagia may result in…
Poor nutritional status
Dehydration
Aspiration which can lead to pneumonia and chronic lung disease
Less enjoyment of eating and drinking
Embarrassment 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 effectively
Specific food and liquid textures that are easier to swallow
PEG feeding

85. Caregivers and Family Can Help By…
Asking question to understand the problem and the recommended treatment
Assist in following the care plan –
Help with exercises
Prepare the recommended food and liquid
Record food and fluid intake if necessary

86. Fluid Balance Fluid intake and output must balance
Excessive fluid = oedema
Decrease 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 day
Older people often take medication that can causes loss or retention of fluid

88. Special Orders Encourage fluid intake Restrict fluids Nil by mouth
Sips
30ml
1 litre
1 litre + output
Nil by mouth

89. Intake and Output Recording
Used to assess fluid balance and kidney function
May also be used to assess fluid intake
If person is receiving intravenous therapy or tube feeding
Used 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 feeds
I.V. fluids
Output:
Urine
Vomitus
Diarrhoea
Wound drainage
Note excessive perspiration

91. Intake and Output Recording
Measure amount that water glass holds
Most cups contain approx. 180ml but will vary
Fluid charts are normally completed in mls.
If person is ambulant give instruction on measuring and provide appropriate measuring receptacles
Demonstrate with a measuring jug, cups mugs.