1. Unit 8: Personal Hygiene

2. Key Terms AM care Aspiration Denture Diaphoresis Early morning care
Evening care
Morning care
Oral hygiene
Pericare
Perineal care
Plaque
PM care
Tartar

3. Hygiene
Hygiene promotes comfort, safety, and health. The skin is the body’s first line of defense against disease. Intact skin:
Prevents microbes from entering the body and causing an infection
Mucous membranes of the mouth, genital area, and anus must be clean and intact.
Besides cleansing, good hygiene prevents body and breath odors. It is relaxing and increases circulation.
Review the structures and functions of the skin and teeth in Box 19-1 on p. 304 in the textbook.

5. Good Hygiene Culture and personal choices affect hygiene.
Some people take showers, some tub baths
Some bathe in the morning, others at night.
Some bathe 1 to 2 times a day.
Some do not have water for bathing.
Some cannot afford, soap, deodorant, shampoo, toothpaste, or other hygiene products.
Many factors affect hygiene needs. Illness and aging changes can affect self-care abilities. Some people need help with hygiene.
Review the Caring About Culture: Personal Hygiene Box on p. 305 in the textbook.
Hygiene products used vary.
Review the Focus on Children and Older Persons: Personal Hygiene Box on p. 305 in the textbook.
Review the Focus on Communication: Personal Hygiene Box on p. 305 in the textbook.

6. Daily Care
Most people have hygiene routines and habits. For example, teeth are brushed and the face and hands washed after sleep.
Routine care is given during the day and evening.
Before breakfast (early morning care or AM care)
After breakfast (morning care)
After lunch and before the evening meal (afternoon care)
Before sleep (PM care or evening care)
You assist with hygiene whenever it is needed. You must protect the person’s right to privacy and to personal choice.
You must protect the person’s right to privacy and to personal choice.
Night shift or day shift staff members give AM care.
See p. 306 in the textbook for a list of measures performed during AM care, morning care, afternoon care, and PM care.

7. Before Breakfast
Routine care given before breakfast is called early morning care or AM care. Night shift or day shift staff members give AM care, which includes:
Assisting with elimination
Cleaning incontinent persons
Changing wet or soiled linens and garments
Assisting with hygiene-face, hand washing and oral care
Assisting with dressing and hair care
Positioning persons for breakfast
Making beds and straightening units

8. After Breakfast
Morning care is given after breakfast. Hygiene measures are more through at this time. They usually involve:
Assisting with elimination
Cleaning incontinent persons
Changing wet or soiled linens and garments
Assisting with hygiene- face, hand washing, oral care, hygiene, bathing, back massage and perineal care
Assisting with grooming- hair care, shaving, dressing, and undressing
Assisting with activity-range of motion exercises and ambulation
Making beds and straightening units

9. Afternoon Care
Routine hygiene is done after lunch and before the evening meal. It is done before the person takes a nap, has visitors, or attends activity programs.
Assisting with elimination before and after naps.
Cleaning incontinent persons before and after naps.
Changing wet or soiled linen before and after naps.
Changing wet or soiled garments before and after naps.
Assisting with hygiene and grooming- face, hand washing, oral hygiene, and hair care.
Assisting with activity- range of motion exercises and ambulation.
Straightening beds and units

10. Evening Care
Care given in the evening at bedtime is called evening care or PM care. Evening care is relaxing and promotes comfort. Measures performed before sleep include:
Assisting with elimination
Cleaning incontinent persons
Changing wet or soiled linens and garments
Assisting with hygiene- face, hand washing, oral hygiene, and back massages.
Helping persons change into sleepwear
Straightening beds and units.

11. Oral Hygiene Oral hygiene (mouth care) does the following:
Keeps the mouth and teeth clean
Prevents mouth odors and infections
Increases comfort
Makes food taste better
Reduces the risk for cavities (dental caries) and periodontal disease
Periodontal disease (gum disease, pyorrhea) is an inflammation of tissues around the teeth. Plaque and tartar build up from poor oral hygiene. Plaque is a thin film that sticks to teeth. When plaque hardens, it is called tartar. Tartar buildup causes periodontal disease.
The nurse, the speech/language pathologist, and the dietitian assess the person’s need for mouth care.
Review the Focus on Children and Older Persons: Oral Hygiene Box on p. 306 in the textbook.
Review the Focus on Children and Older Persons: Flossing Box on p. 307 in the textbook.

12. Periodontal disease
Periodontal disease is an inflammation of tissues around the teeth. Plaque and tartar build up from poor oral hygiene.
Plaque is a thin film that sticks to teeth. It contains saliva, microbes, and other substances. It causes tooth decay (cavities). Hardened plaque is called tarter. Tartar builds up at the gum line near the neck of the tooth. Tartar buildup causes periodontal disease. The gums are red and swollen and bleed easily. As the disease progresses, bone is destroyed and teeth loosen. Tooth loss is common.

13. Illness, disease, and some drugs cause:
A bad taste in the mouth
A whitish coating in the mouth and on the tongue
Redness and swelling in the mouth and on the tongue
Dry mouth. Dry mouth also is common from oxygen, smoking, decreased fluid intake, and anxiety.
The nurse assessed the person’s need for mouth care. So may the speech/language pathologist and the dietitian.

14. Flossing
Dental floss is a soft thread used to clean between the teeth. Flossing:
Removes plaque and tartar from the teeth
Removes food from between the teeth
Usually done after brushing, it can be done at other times. Some people floss after meals. If done once a day, bedtime is the best time to floss. You need to floss for persons who cannot do so themselves.

16. Equipment
A toothbrush, toothpaste, dental floss, and mouthwash are needed. A toothbrush with soft bristles is best. Sponge swabs are used for persons with sore, tender mouths. They are also used for unconscious persons. Use sponge swabs with care. Check the foam pad to make sure it is tight on the stick. The person could choke on the foam pad if it comes off the stick. You also need a kidney basin, water cup, straw, tissues, towels, and gloves. Many persons bring oral hygiene equipment from home.

19. Brushing and flossing teeth
Many people perform oral hygiene themselves.
Some persons need help gathering and setting up equipment.
Determine type of equipment needed based on patient’s needs.
You may have to brush the teeth of persons who:
Are very weak
Cannot use or move their arms
Are too confused to brush their teeth
The toothbrush should have soft bristles.
Use only denture cleaning products for dentures..
When using sponge swabs, check the foam pad to make sure it is tight on the stick.
Review the Delegation Guidelines: Oral Hygiene Box on p. 307 in the textbook.
Review the Promoting Safety and Comfort: Oral Hygiene Box on p. 307 in the textbook.

20. Remember to: Beginning Tasks
Wash hands, introduce self, explain procedure
Be gentle
Collect all of the necessary equipment for oral care;(toothbrush, toothpaste, mouthwash, dental floss, water, glass, hand towel, paper towels, gloves, and straw)

21. Performance Skill #2: Perform Oral Hygiene
Positioned resident
Cleaned oral cavity using appropriate oral hygiene products
Rinsed oral cavity
Repeated steps 3 and 4 until oral cavity was clean
Cleaned and rinsed teeth, dentures if applicable
Assisted resident to clean and dry mouth area

22. Video Link

23. Tip: Gum Health
Take care of your residents’ gums (and your own) by giving proper, regular oral care. Studies have shown a possible link between gum disease and the risk of having heart disease, a stroke, and diabetes. In addition, cranberries have been shown to reduce bacterial growth on gum tissue and to limit gum disease. Cranberry extract is being added to some toothpastes.

24. Mouth care for the unconscious person
Unconscious persons cannot eat or drink. Some breathe with their mouths open. Many receive oxygen. These factors cause mouth dryness. They also cause crusting on the tongue and mucous membranes. Oral hygiene keeps the mouth clean and moist. It also helps prevent infection.
The care plan tells you what cleaning agent to use. Use sponge swabs to apply the cleaning agent. Applying a lubricant to the lips after cleaning prevents cracking of the lips.
Oral hygiene keeps the mouth clean and moist. It also helps prevent infection.

25. Continued
Unconscious persons usually cannot swallow. Protect unconscious persons from choking and aspiration (breathing fluid, food, vomit, or an object into the lungs). It can cause pneumonia and death. To prevent aspiration:
Position the person on one side with the head turned well to the side. Fluid runs out the mouth.
Use only a small amount of fluid to clean the mouth.
Do not insert dentures.
Keep the person’s mouth open with a padded tongue blade.
Always assume that unconscious persons can hear. (Explain the procedure)
Mouth care is given at least every 2 hours.
Aspiration can cause pneumonia and death.
Sometimes oral suctioning is needed.
Dentures are not worn when the person is unconscious.
Do not use your fingers to keep the person’s mouth open.
Explain what you are doing step by step.
Tell the person when you are done, when you are leaving the room, and when you will return.
Review the Promoting Safety and Comfort: Mouth Care for the Unconscious Person Box on p. 310 in the textbook.

28. Denture Care
A denture is an artificial tooth or a set of artificial teeth. They are often called false teeth, they replace missing teeth. Full and partial dentures are common.
Full denture: the person has no upper or no lower natural teeth. Dentures replace the upper and lower teeth.
Partial denture: the person has some natural teeth. The partial denture replaces the missing teeth.
With full dentures, the person has no natural teeth. Dentures replace the upper and lower teeth.
With a partial denture, the person has some natural teeth. The partial denture replaces the missing teeth.
During cleaning, firmly hold dentures over a basin of water lined with a towel.
If not worn after cleaning, store dentures in a container with cool water, or a denture soaking solution.
Review the Promoting Safety and Comfort: Denture Care Box on p. 312 in the textbook.

30. Mouth care is given and dentures cleaned as often as natural teeth
Mouth care is given and dentures cleaned as often as natural teeth. Dentures are slippery when wet. They easily break or chip if dropped onto a hard surface. Hold them firmly when removing or inserting them. During cleaning, firmly hold them over a basin of water lined with a towel. This prevents them from falling onto a hard surface.
Persons with dentures need a denture cleaner, denture cup, and denture brush or toothbrush. Use only denture cleaning products. Otherwise, you could damage dentures.

31. To use a cleaning agent, follow the manufacturer’s instructions.
Hot water causes dentures to lose their shape (warp).
If not work after cleaning, store dentures in a container with cool or warm water or a denture soaking solution. Otherwise, they can dry out and warp.
Dentures are usually removed at bedtime.
Remind patients and residents not to wrap dentures in tissues or napkins.
You clean dentures for those who cannot do so

32. Remove dentures with a piece of gauze.

34. Edentulous Residents
The term for lacking teeth or being toothless is edentulous. Giving oral care to an edentulous resident is similar to caring for a resident who has teeth. You will clean the outside and inside of the mouth, including the lips, top and bottom gums and the inside of the mouth with a moistened swab. Make sure to clean the tongue too.

35. Bathing Bathing has the following benefits: It cleans the skin.
It cleans the mucous membranes of the genital and anal areas.
Microbes, dead skin, perspiration, and excess oils are removed.
A bath is refreshing and relaxing.
Circulation is stimulated and body parts exercised.
Observations are made and you have time to talk to the person.

36. Bathing Method Depends on: The person’s condition Self-care abilities
Personal choice
The person’s choice of bath time is respected whenever possible. Bathing frequency is a personal matter. Ill persons may have fevers and perspire heavily. They need frequent bathing. Other illnesses and dry skin may limit bathing to every 2 or 3 days.
Personal choice, weather, activity, and illness affect bathing frequency.
The rules for bed baths, showers, and tub baths are listed in Box 19-2 on p. 314 in the textbook.
Review the contents of Table 19-1 on p. 315 in the textbook.
Review the Focus on Children and Older Persons: Bathing Box on p. 315 in the textbook.
Review the Delegation Guidelines: Bathing Box on p. 316 in the textbook.
Review the Promoting Safety and Comfort: Bathing Box on p. 316 in the textbook.

37. Persons with bariatric needs
Persons with bariatric needs often have problems providing their own hygiene. They may not be able to reach body parts. Skin folds are common. Good hygiene and skin care are needed for comfort and to prevent pressure ulcers.
You may need help to hold skin folds while your clean, dry, and apply skin care products. Allow extra time to complete hygiene measures. Ask your co-workers for help in advance.

38. Complete Bed Bath
The complete bed bath involves washing the person’s entire body in bed. You give such baths to persons who cannot bathe themselves.
Unconscious
Paralyzed
In casts or traction
Weak from illness or surgery
A bed bath is new to some people. Some are embarrassed to have their bodies seen. Some fear exposure. Explain how you give the bath. Also explain how you cover the body for privacy.
You give complete bed baths to persons who cannot bathe themselves.
Some people are embarrassed and fear exposure. Explain how the bed bath is given. Explain how you cover the body for privacy.
Review the Focus on Children and Older Persons: The Complete Bed Bath Box on p. 316 in the textbook.
The nurse and the care plan tell you when to use a towel bath. To give a towel bath, follow agency policy.
Review the Focus on Children and Older Persons: Towel Baths Box on p. 320 in the textbook.
Follow the nurse’s directions and the manufacturer’s instructions for bag baths.

39. Towel baths
For a towel bath, an over-sized towel is used. It covers the body from the neck to the feet. The towel is completely wet with a solution-water and cleaning, skin softening, and drying agents. The drying agent promotes fast drying of the person’s body. The nurse and care plan tell you when to use a towel bath. Follow agency policy.

40. Bag baths
Bag baths are commercially prepared or prepared at the agency. A plastic bag has 8 to 10 washcloths. They are moistened with a cleaning agent that does not need rinsing. To give a bag bath:
Warm the washcloths in a microwave oven. Follow the manufacturer’s instructions for what microwave setting to use.
Use a new washcloth for each body part
Let the skin air-dry. You do not need towels
Discard the washcloths following agency policy. Do not flush them down the toilet.

41. Partial Bath
The partial bath involves bathing the face, hands, axillae, back, buttocks, and perineal area. Odors or discomfort occur if these areas are not clean. Some persons bathe themselves in bed or at the skin. You assist as needed. Most need help washing the back. You give partial baths to persons who cannot bathe themselves.
You give partial baths to persons who cannot bathe themselves.
The rules for bathing in Box 19-2 on p. 314 in the textbook apply to partial baths, tub baths, and showers.
Follow the safety measures in Box 19-3 on p. 322 in the textbook.
Never let weak or unsteady persons stand in the shower.
Review the Focus on Long-Term Care and Home Care: Showers Box on p. 324 in the textbook.
Review the Delegation Guidelines: Tub Baths and Showers Box on p. 324 in the textbook.
Review the Promoting Safety and Comfort: Tub Baths and Showers Box on p. 324 in the textbook.
Review the Teamwork and Time Management: Tub Baths and Showers Box on p. 324 in the textbook.
Review the Focus on Ethics and Laws: Tub Baths and Showers Box on p. 325 in the textbook.

42. Performance Skill #6: Give Partial Bath
Prepared resident for partial bath
Filled basin with water at correct temperature to resident preference
Washed, rinsed, and dried face, hands, axilla, perineal area and other areas as appropriate
Removed linen used for bathing and placed in appropriate container
Prepared resident for dressing

43. Video Link

44. How to make a mitted washcloth

45. Order of washing body
This reduces the risk of transferring microorganisms from a dirty area to a clean area of the body.
Eyes, face, ears, neck, arms, axilla, and hands, chest and abdomen, legs and feet, back, perineal area, buttocks.

53. Tub Baths
Falls, burns, and chilling from water are some of the risks. Safety is important.
Tub baths are relaxing. They can make a person feel faint, weak, or tired. It can last no longer than 20 minutes
Gather appropriate equipment (Transfer bench, wheelchair or mechanical lift.)
Whirlpool tubs have a cleansing action. You wash the upper body. Carefully wash under the breasts and between skin folds. Also wash the perineal area.
Pat dry the person with towels after the bath

54. Showers
Some people can stand and use a regular shower. They use the grab bars for support. Never let weak or unsteady persons stand in the shower.
Shower chairs: water drains through an opening. You use the chair to transport the person to and from the shower. Lock the wheels during the shower to prevent the chair from moving.
Some shower rooms have two or more stations. Provide for privacy. The person has the right not to have his or her body seen by others. Properly screen and cover the person. Also close doors and the shower curtain.

55. Performance Skill #7: Give a shower or tub bath
Prepared resident for shower or tub bath
Adjusted water temperature to resident preference throughout bath
Washed, rinsed, dried in appropriate head to toe sequence allowing for resident independence
Shampooed hair as appropriate
Prepared resident to leave shower or tub bath area

56. Video Link

57. Water Temperatures
It is your responsibility to protect residents from burns. Always turn on cold water first, point nozzle away from the person.
Be sure the water temperature is appropriate for the bath.
Complete bed bath= 110 to 115 degrees F
Partial bed bath= 110 to 115 degrees F
Tub bath= 105 degrees F
Showers= 105 degrees F
Perineal care=105 to 109 degrees F

58. Back Massage Back massages (back rubs):
Relax muscles and stimulate circulation
Are given after the bath and with evening care
Can be given after repositioning or to help the person relax
Last 3 to 5 minutes. Observe the skin before the massage. Look for breaks in the skin, bruises, reddened areas, and other signs of breakdown.
Lotion reduces friction during the massage. Warm the lotion before it is applied.
During the massage, use firm strokes. Keep your hands in contact with the person’s skin.
After the massage, apply some lotion to the elbows, knees, and heels to keep the skin soft.
Look for breaks in the skin, bruises, reddened areas, and other signs of skin breakdown.
To warm the lotion before applying it, do one of the following:
Rub some lotion between your hands.
Place the bottle in the bath water.
Hold the bottle under warm water.
During the massage, keep your hands in contact with the person’s skin.
Review the Delegation Guidelines: The Back Massage Box on p. 327 in the textbook.
Review the Promoting Safety and Comfort: The Back Massage Box on p. 327 in the textbook.

61. Perineal Care
Perineal care (pericare) involves cleaning the genital and anal areas. Cleaning prevents infection and odors, and it promotes comfort.
Perineal care is done:
Daily during the bath
Whenever the area is soiled with urine or feces
Perineal care is very important for person who:
Have urinary catheters
Have had rectal or genital surgery
Are menstruating
Are incontinent of urine or feces
Are uncircumcised
The genital and anal areas provide a warm, moist, and dark place for microbes to grow.

63. Perineal Care
The person does perineal care if able. This procedure embarrasses many people and nursing staff. Especially when it involves the other sex.
Use terms to describe perineal care that are familiar but tasteful to the person
Privates, private part, crotch, genitals, or area between the legs.
Standard Precautions, medical asepsis, and the Bloodborne Pathogen Standard are followed. Work from the cleanest are to the dirtiest (front to back) The uretheral area (front) is the cleanest. The anal area (back) is the dirtiest. This prevents transmission of bacteria from the anal area to the vagina and urinary system.
Use terms the person understands. The term must be in good taste professionally.
Work from the cleanest area to the dirtiest. This is commonly called cleaning from “front to back.”
Review the Focus on Children and Older Persons: Perineal Care Box on p. 329 in the textbook.
Review the Delegation Guidelines: Perineal Care Box on p. 329 in the textbook.
Review the Promoting Safety and Comfort: Perineal Care Box on p. 329 in the textbook.

64. The perineal area is delicate and easily injured
The perineal area is delicate and easily injured. Use warm water, not hot. Use washcloths, towelettes, cotton balls, or swabs according to agency policy. Rinse thoroughly. Pat dry after rinsing. This reduces moisture and promotes comfort.

66. Performance Skill #5: Perform Perineal Care
Filled basin with water at correct temperature to resident preference, if applicable
Covered the resident appropriately to avoid exposure and maintain dignity
Placed a waterproof pad under buttocks
Positioned resident appropriately
Wet washcloths and applied cleansing solution
Washed perineal area:
A. Females: Separated labia, cleaned front to back using downward strokes. Used a clean area of the cloth for each downward motion. Repeated using additional cloths, as needed.

67. Continued Washed perineal area Rinsed the perineal area, if applicable
Males: Retracted foreskin in uncircumcised male. Grasped penis, cleaned tip to penis using a circular motion, washed down shaft of the penis and washed testicles. Replaced foreskin of uncircumcised male
Rinsed the perineal area, if applicable
Turned the patient on their side facing away. Cleaned anal area by washing from front to back
Patted area dry, if applicable
Removed waterproof pad and discarded

68. Video Link

72. Don’t forget to retract the foreskin when done cleaning!

73. Reporting and Recording
Report the following observations at once:
Bleeding
Signs of skin breakdown
Discharge from the vagina/penis or urinary tract
Unusual odors
Changes from prior observations
Report and record the care given.
If care is not recorded, it is assumed that care was not given. This can cause serious legal problems.
You make observations while assisting with hygiene.
Not recording observations and care can cause serious legal problems.

74. Unit 8
Grooming

75. Key Terms Alopecia Anticoagulant Dandruff Hirsutism Lice (pediculosis)
Mite
Pediculosis capitis
Pediculosis corporis
Pediculosis pubis

76. Grooming Measures
Hair care, shaving, and nail and foot care are important to many people. Like hygiene, these grooming measures prevent infection and promote comfort. They also affect love, belonging, and self-esteem needs. People differ in their grooming measures. The person should tend to his or her own grooming measures to the extent possible. This promote independence and quality of life. The person may use adaptive devices for hair care and dressing.
Tending to grooming measures promotes the person’s independence and quality of life.
Review the Teamwork and Time Management: Grooming Box on p. 335 in the textbook.
See Figure 20-1 on p. 336 in textbook for example of adaptive devices.

81. Hair Care The nursing process reflects: The person’s culture
How the hair looks and feels affects mental well-being. You assist with hair care whenever needed.
The nursing process reflects:
The person’s culture
Personal choice
Skin and scalp condition
Health history
Self-care ability
Review the Focus on Long-Term Care and Home Care: Hair Care Box on p. 335 in the textbook.

82. Skin and scalp conditions..
Alopecia means hair loss.
Hair loss may be complete or partial
Male pattern baldness occurs with aging.
Hair thins in some women with aging.
Other causes include cancer treatments, skin diseases, stress, poor nutrition, pregnancy, some drugs, and hormone changes.
Hirsutism is excessive body hair.
It occurs in women and children from heredity and abnormal amounts of male hormones.
Dandruff is the excessive amount of dry, white flakes from the scalp. Itching is common.
Sometimes dandruff affects the eyebrows and ear canals. Medicated shampoos correct the problem.

84. Pediculosis
Pediculosis (lice) is infestation with wingless insects. Can easily spread
Pediculosis capitis is the infestation of the scalp with lice. Commonly called head lice.
Pediculosis pubis is the infestation of the pubic hair with lice. Also called crabs.
Pediculosis corporis is the infestation of the body with lice.
Easily spread through clothing, head coverings, furniture, beds, towels, bed linen, and sexual contact. They are also spread by sharing combs and brushes.
Pediculosis pubis is also called “crabs.”
Lice easily spread to others through clothing, head coverings, furniture, beds, towels, bed linen, and sexual contact. They also are spread by sharing combs and brushes.
Treatment involves medicated shampoos, lotions, and creams; thorough bathing; and washing of clothing and linens in hot water.

85. Report signs and symptoms of lice to the nurse at once:
Complaints of a tickling feeling or something moving in the hair
Itching
Irritability
Sores on the head or body caused by scratching
Rash

87. Scabies
Scabies is a skin disorder caused by a female mite. A mite is a very small spider-like organism.
The female mite burrows into the skin and lays eggs.
The person has a rash and intense itching.
Common sites are between the fingers, around the wrists, in the underarm area, on the thighs, and in the genital area. Other sites include breasts, waist, and buttocks.
Scabies is highly contagious.
Persons at risk include those living in crowded living settings and those with weakened immune systems.
Common sites include:
Between the fingers, around the wrists, in the underarm area, on the thighs, and in the genital area
The breasts, waist, and buttocks
Treatment involves using special creams, cleaning the person’s room, and washing clothing and linens in hot water.

89. Brushing and Combing Hair
Encourage patients and residents to do their own hair care. Assist as needed. Perform hair care for those who cannot do so. The person chooses how to brush, comb, and style hair.
Brushing and combing prevent tangled and matted hair. It also increased blood flow to the scalp.
When brushing and combing hair, start at the scalp. Then brush or comb to the hair ends. It brings scalp oils along the hair shaft.
Brushing or combing hair is part of early morning care, morning care, and afternoon care. This may be done at bedtime.
It also may be done or bedtime and before visitors arrive.
Brushing or combing hair is done whenever needed.
Brushing increases blood flow to the scalp. It brings scalp oils along the hair shaft to help keep hair soft and shiny.

90. Brushing & Combing hair continued
Long hair easily mats and tangles. Daily brushing and combing prevent this. So does braiding. Do not braid hair without the person’s consent.
Never cut hair for any reason.
Special measures are needed for curly, coarse, and dry hair.
The person’s hair care practices and hair care products are part of the care plan.
Tell the nurse if the person has matted or tangled hair.
Use a wide-tooth comb for curly hair.
The person can guide you when you are giving hair care.
Review the Caring about Culture: Brushing and Combing Hair Box on p. 337 in the textbook.
Review the Focus on Children and Older Persons: Brushing and Combing Hair Box on p. 337 in the textbook.
Review the Delegation Guidelines: Brushing and Combing Hair Box on p. 337 in the textbook.
Review the Promoting Safety and Comfort: Brushing and Combing Hair Box on p. 337 in the textbook.

91. Matted & braided Hair

92. Shampooing
Most people shampoo at least once a week. Many factors affect frequency, including:
The condition of the hair and scalp
Hairstyle
Personal choice
Do not shampoo a person’s hair unless the nurse tells you to do so. The nurse tells you what method to use.
The shampoo method depends on:
The person’s condition
Safety factors

93. Shampoo Methods Shampoo during the shower or tub bath
Use a hand-held nozzle, direct water to hair.
Shampoo at the sink
Head tilted back, use nozzle or water pitcher
Shampoo on a stretcher
Shampoo in bed
Shampoo tray to protect the linens.
Wash cloth may be placed over eyes to prevent shampoo or water getting into eyes
Hair is dried and styled as quickly as possible after the shampoo.
Check with the nurse before curling or rolling up hair.
When shampooing is done at the sink, a folded towel is placed over the sink edge to protect the neck.
When shampooing is done on a stretcher, a towel is placed under the neck.
When shampooing is done in bed, a shampoo tray is placed under the head.
Review the Focus on Children and Older Persons: Shampooing Box on p. 339 in the textbook.
Review the Focus on Long-Term Care and Home Care: Shampooing Box on p. 339 in the textbook.
Review the Delegation Guidelines: Shampooing Box on p. 340 in the textbook.
Review the Promoting Safety and Comfort: Shampooing Box on p. 340 in the textbook.

95. Shaving Many men shave for comfort and mental well-being. Many women:
Shave their legs and underarms
Shave coarse facial hair
Use other hair removal methods (waxing, plucking, threading)
Review the rules in Box 20-1 on p. 341 in the textbook.

96. Always dispose of in sharps container.
Safety razors or electric shavers are used.
Safety razors are not used on persons:
Who have healing problems
Who take anticoagulant drugs
Bleeding occurs easily and is hard to stop.
Soften the beard before using an electric shaver or safety razor.
Apply a moist, warm washcloth or towel for a few minutes.
If you nick or cut a person apply direct pressure.
Shave in the direction of hair growth
Never trim a mustache or beard without the person’s consent.
Always dispose of in sharps container.
If the agency’s shaver is used, clean it after every use. Follow the manufacturer’s instructions for brushing out whiskers.
Older persons with wrinkled skin are at risk for nicks and cuts from blade razors.
An anticoagulant prevents or slows down blood clotting. A nick or a cut can cause serious bleeding.
Review the Focus on Children and Older Persons: Shaving Box on p. 342 in the textbook.
Review the Delegation Guidelines: Shaving Box on p. 342 in the textbook.
Review the Promoting Safety and Comfort: Shaving Box on p. 342 in the textbook.
Review the Focus on Ethics and Laws: Shaving Box on p. 342 in the textbook.
Many women shave their legs and underarms. Follow the rules in Box 20-1 on p. 341 in the textbook.

98. Performance Skill #3: Shave a resident
Positioned resident
Shaved resident:
Non-Electric Shave:
Applied shaving cream or soap
Shaved resident, holding skin taut and using single, short strokes primarily in the direction of the hair growth rinsing razor frequently
Rinsed face with warm cloth
Applied after shave product as appropriate
Discarded razor into the appropriate container

99. Continued Electric Shave: Checked to be sure that the razor was clean
Verified that the resident was prepared with a clean, dry face
Turned on razor, observing precautions for using electrical equipment
Shaved resident by holding skin taut and moving the razor over a small area of the face in the direction of the hair growth until the hair was removed
Cleaned the razor after use
Applied after shave product as appropriate

100. Video Link

102. Remember
Shave in the direction of hair growth
Use longer strokes on the larger areas of the face
Use short strokes around the chin and lips

103. Nail and Foot Care
Nail and foot care prevents infection, injury, and odors. Hangnails, ingrown nails, and nails torn away from the skin cause skin breaks. Long or broken nails can scratch skin or snag clothing.
The feet are easily infected and injured. Dirty feet, socks, or stockings harbor microbes and cause odors.
Poor circulation prolongs healing. Diabetes and vascular diseases are common causes of poor circulation. Infections or foot injuries are very serious for older persons and persons with circulatory disorders.
Breaks in the skin are portals of entry for microbes.

104. Trimming & Clipping nails
Trimming and clipping toenails can easily result in injuries.
Use nail clippers to cut fingernails.
Never use scissors.
Never cut a diabetics toenails
Some agencies do not let nursing assistants cut or trim toenails.
Follow agency policy.
Clip in a rounded shape or straight across.
Nails are easier to trim and clean right after soaking or bathing.
Use extreme caution when trimming nails to prevent damage to nearby tissues.
Review the Focus on Long-Term Care and Home Care: Nail and Foot Care Box on p. 344 in the textbook.
Review the Delegation Guidelines: Nail and Foot Care Box on p. 344 in the textbook.
Review the Promoting Safety and Comfort: Nail and Foot Care Box on p. 344 in the textbook.
Review the Teamwork and Time Management: Nail and Foot Care Box on p. 344 in the textbook.

105. Nail clipping

106. Performance Skill #4: Perform Nail Care
Washed, soaked and dried the resident’s hands
Cleaned the nails
Clipped one nail at a time, so that edges are smooth according to resident preference
Filed nails, as needed, smoothing rough areas
Applied lotion as needed

107. Video Link

108. Changing clothing & Hospital Gowns
You may need to assist with changing clothes and hospital gowns. Follow these rules:
Provide for privacy. Do not expose the person.
Encourage the person to do as much as possible.
Let the person choose what to wear.
Remove clothing from the strong (unaffected) or “good” side first.
Put clothing on the weak (affected) side first.
Support the arm or leg when removing or putting on a garment.
Gowns or pajamas and garments are changed after the bath and when wet or soiled.
Make sure the right undergarments are chosen.
Review the Focus on Children and Older Persons: Dressing and Undressing Box on p. 347 in the textbook.
Review the Focus on Long-Term Care and Home Care: Dressing and Undressing Box on p. 347 in the textbook.
Review the Focus on Communication: Dressing and Undressing Box on p. 347 in the textbook.
Review the Delegation Guidelines: Dressing and Undressing Box on p. 347 in the textbook.

109. Changing hospital gowns
Many hospital patient wear gowns. Gowns are usually worn for IV therapy.
Some agencies have gowns for IV therapy that open along the sleeve and close with ties, snaps, or Velcro.
If there is injury or paralysis:
The gown is removed from the strong arm first.
Support the weak arm while removing the gown.
Put the clean gown on the weak arm first and then on the strong arm.
Review the Delegation Guidelines: Changing Hospital Gowns Box on p. 351 in the textbook.
Review the Promoting Safety and Comfort: Changing Hospital Gowns Box on p. 351 in the textbook.

110. Performance Skill #9: Dress a Resident
Asked resident preference and gathered resident’s own clean clothing
Dressed the resident in undergarments, top, pants (or dress) and footwear, as appropriate.

111. Video Link