1. Explain personal care of residents Define the following terms: Hygiene Grooming ADLs AM and PM care

Transparency 13-1 Assisting with Personal Care Help the resident be as independent as possible. Be aware of resident preferences and routines. Always explain what you will be doing. Provide privacy. Observe the resident during care. Note and report signs and symptoms. Observe mental state of resident. Report any changes. Leave the resident’s room clean and tidy.

1. Explain personal care of residents It is important to observe and report the following during personal care: Skin color, temperature, reddened areas Mobility Flexibility Comfort or pain level Strength and ability to perform ADLs Mental and emotional state Complaints

2. Identify guidelines for providing good skin care and preventing pressure sores Define the following terms: Pressure points Bony prominences Pressure sore

Transparency 13-2 Pressure Sore Danger Zones

Transparency 13-3 Observing the Skin Pale, white, red, or purple areas, blisters or bruises Tingling, warmth, or burning Dry or flaking skin Itching or scratching Rash or discoloration Swelling or blisters Fluid or blood draining Broken skin Wounds or ulcers Changes in existing wound (size, depth, drainage, color, or odor) Broken skin (toes or toenails)

2. Identify guidelines for providing good skin care and preventing pressure sores Guidelines for skin care include: Report changes in resident’s skin. Provide regular skin care. Reposition frequently. Give skin care often for incontinent residents. Change clothing and linen often. Avoid scratching or irritating skin; report blisters or sores on feet. Massage skin frequently. Do not massage white, red, or purple areas. Avoid pulling or tearing skin.

2. Identify guidelines for providing good skin care and preventing pressure sores Guidelines for caring for residents who are at a high risk for pressure sores (bed bound): Keep bottom sheet tight and wrinkle-free. Avoid shearing. Use special protective aids such as: Sheepskin or chamois under back and buttocks Sheepskin or foam rubber under bony prominences or heel and elbow protectors

2. Identify guidelines for providing good skin care and preventing pressure sores Use special protective aids such as (con’t.): Flotation pads or egg crate mattresses on bed or chair Repositioning residents in chairs or wheelchairs

2. Identify guidelines for providing good skin care and preventing pressure sores Examples of positioning devices are: Backrests Bed cradles Draw sheets Footboards Hand rolls Splints Trochanter rolls

3. Explain guidelines for assisting with bathing Define the following terms: Partial bath Additive Perineum Groin

3. Explain guidelines for assisting with bathing The following guidelines for bathing are: Baths are for health and relaxation. The face, hands, underarms, and perineum should be washed every day. Complete baths are necessary every other day or less often. Use facility-approved products. Keep room temperature comfortable.

3. Explain guidelines for assisting with bathing The following guidelines for bathing are (con’t.): Make sure water temperature is safe and comfortable. Have resident test water temperature. Gather supplies beforehand so a resident is not left alone while bathing. Remove all soap from the skin. Keep a record of bathing schedule.

Giving a complete bed bath Equipment: bath blanket, bath basin, soap, bath thermometer, 2-4 washcloths, 2-4 bath towels, orangewood stick or emery board, lotion, deodorant, clean gown or clothes, gloves Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 14

Giving a complete bed bath Provide for the resident’s privacy with curtain, screen, or door. Be sure the room is a comfortable temperature and there are no drafts. Adjust bed to a safe level, usually waist high. Lock bed wheels. Adjust position of side rails to ensure resident safety at all times. 15

Giving a complete bed bath Place a bath blanket or towel over resident (Fig. 13-11). Ask him to hold on to it as you remove or fold back top bedding. Keep resident covered with bath blanket (or top sheet). Fill the basin with warm water. Test water temperature with thermometer or your wrist and ensure it is safe. Water temperature should be 105° to 110° F. It cools quickly. Fig. 13-11. 16

Giving a complete bed bath (con’t.) Have resident check water temperature. Adjust if necessary. Change the water when it becomes too cool, soapy, or dirty. If resident has open wounds or broken skin, put on gloves. Ask and help resident to participate in washing. Uncover only one part of the body at a time. Place a towel under the body part being washed. 17

Giving a complete bed bath 12. Wash, rinse, and dry one part of the body at a time. Start at the head. Work down, and complete the front first. Fold the washcloth over your hand like a mitt and hold it in place with your thumb (Fig. 13-12). Fig. 13-12. 18

Giving a complete bed bath Eyes and Face: Wash face with wet washcloth (no soap). Begin with the eye farther away from you. Wash inner aspect to outer aspect (Fig. 13-13). Use a different area of the washcloth for each eye. Wash the face from the middle outward. Use firm but gentle strokes. Wash the neck and ears and behind the ears. Rinse and pat dry. Fig. 13-13. 19

Giving a complete bed bath Arms: Remove the resident’s top clothing. Cover him with the bath blanket or towel. With a soapy washcloth, wash the upper arm and underarm. Use long strokes from the shoulder to the elbow. Rinse and pat dry. Wash the elbow. Wash, rinse, and dry from the elbow down to the wrist (Fig. 13-14). Fig. 13-14. 20

Giving a complete bed bath Wash the hand in a basin: Clean under the nails with an orangewood stick or nail brush (Fig. 13-15). Rinse and pat dry. Give nail care (see procedure later in this chapter) only if it has been assigned. Do not give nail care for a diabetic resident. Repeat for the other arm. Put lotion on the resident’s elbows and hands if ordered. Fig. 13-15. 21

Giving a complete bed bath Chest: Place the towel again across the resident’s chest. Pull the blanket down to the waist. Lift the towel only enough to wash the chest. Rinse it and pat dry. For a female resident, wash, rinse, and dry breasts and under breasts. Check the skin in this area for signs of irritation and chafing. 22

Giving a complete bed bath Abdomen: Fold the blanket down so that it still covers the pubic area. Wash the abdomen, rinse, and pat dry. If the resident has an ostomy, or opening in the abdomen for getting rid of body wastes, give skin care around the opening (chapter 15 includes more information about ostomies). Cover with the towel. Pull the cotton blanket up to the resident’s chin. Remove the towel. 23

Giving a complete bed bath Legs and Feet: Expose one leg. Place a towel under it. Wash the thigh. Use long downward strokes. Rinse and pat dry. Do the same from the knee to the ankle (Fig. 13-16). Place another towel under the foot. Move the basin to the towel. Place the foot into the basin. Fig. 13-16. 24

Giving a complete bed bath Legs and Feet (con’t.): Wash the foot and between the toes (Fig. 13-17). Rinse foot and pat dry. Make sure area between toes is dry. Give nail care (see procedure later in this chapter) only if it has been assigned. Do not give nail care for a diabetic resident. Never clip a resident’s toenails. Apply lotion to the foot if ordered, especially at the heels. Repeat steps for the other leg and foot. Fig. 13-17. 25

Giving a complete bed bath Back: Help resident move to the center of the bed. Ask resident to turn onto his side so his back is facing you. If the bed has rails, raise the rail on the far side for safety. Fold the blanket away from the back. Place a towel lengthwise next to the back. Wash the back, neck, and buttocks with long, downward strokes. Rinse and pat dry (Fig. 13-18). Apply lotion if ordered. Fig. 13-18. 26

Giving a complete bed bath Place the towel under the buttocks and upper thighs. Help the resident turn onto his back. Ask if he is able to wash the perineal area. If the resident is able to do this, place a basin of clean, warm water and a washcloth and towel within reach. Leave the room if the resident desires. If the resident has a urinary catheter in place, remind him not to pull it. 27

Giving a complete bed bath If the resident cannot provide perineal care, you must do so. Put on gloves (if you haven’t already done so) first. Provide privacy at all times. Change bath water. Wash, rinse, and dry perineal area. Work from front to back. For a female resident: Wash the perineum with soap and water. Work from front to back, using single strokes (Fig. 13-19). Fig. 13-19. 28

Giving a complete bed bath 15. (con't.) Do not wash from the back to the front. This may cause infection. Use a clean area of washcloth or a clean washcloth for each stroke. First wipe the center of the perineum, then each side. Then spread the labia majora, the outside folds of perineal skin that protect the urinary meatus and the vaginal opening. Wipe from front to back on each side. 29

Giving a complete bed bath 15. (con't.) Rinse the area in the same way. Dry entire perineal area. Move from front to back. Use a blotting motion with towel. Ask resident to turn on her side. Wash, rinse, and dry buttocks and anal area. Clean the anal area without contaminating the perineal area. For a male resident: If the resident is uncircumcised, pull back the foreskin first. Gently push skin towards the base of penis. 30

Giving a complete bed bath 15. (con't.) Hold the penis by the shaft. Wash in a circular motion from the tip down to the base. Use a clean area of washcloth or clean washcloth for each stroke (Fig. 13-20). Rinse the penis. If resident is uncircumcised, gently return foreskin to normal position. Then wash the scrotum and groin. The groin is the area from the pubis (area around the penis and scrotum) to the upper thighs. Fig. 13-20. 31

Giving a complete bed bath (con't.) Rinse and pat dry. Ask the resident to turn on his side. Wash, rinse, and dry buttocks and anal area. Clean the anal area without contaminating the perineal area. Provide deodorant. Remove and dispose of gloves properly. Put clean gown on resident. Brush or comb the resident’s hair (see procedure later in the chapter). 32

Giving a complete bed bath Make resident comfortable. Make sure sheets are dry and free from wrinkles and the bed free from crumbs. Return bed to appropriate position. Remove privacy measures. Put call light within resident’s reach. Place soiled clothing and linens in proper containers. Empty, rinse, and wipe bath basin. Return to proper storage. 33

Giving a complete bed bath Wash your hands. Report any changes in resident to the nurse. Document procedure using facility guidelines. 34

Equipment: bath blanket or towel, lotion Wash your hands. Giving a back rub Equipment: bath blanket or towel, lotion Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. 35

Giving a back rub Adjust bed to a safe working level, usually waist high. Lock bed wheels. Position resident lying on his stomach (Fig. 13- 21). If this is uncomfortable, have him lie on his side. Cover with a cotton blanket. Expose back to the top of the buttocks. Back rubs can also be given with the resident sitting up. Fig. 13-21. 36

Giving a back rub Warm lotion by putting bottle in warm water for five minutes. Run your hands under warm water. Pour lotion on your hands. Rub them together. Always put lotion on your hands rather than on resident’s skin. Place hands on each side of upper part of the buttocks. Make long, smooth upward strokes with both hands. 37

Giving a back rub 8. (con’t.) Move along each side of the spine, up to the shoulders (Fig. 13- 22). Circle hands outward. Move back along outer edges of the back. At buttocks, make another circle. Move hands back up to the shoulders. Without taking hands from resident’s skin, repeat for three to five minutes. Fig. 13-22. 38

Giving a back rub 9. Knead with the first two fingers and thumb of each hand. Place them at base of the spine. Move upward together along each side of the spine. Apply gentle downward pressure with fingers and thumbs. Follow same direction as with the long smooth strokes, circling at shoulders and buttocks (Fig. 13-23). Fig. 13-23. 39

Finish with some long, smooth strokes. Giving a back rub Gently massage bony areas (spine, shoulder blades, hip bones). Use circular motions of fingertips. If any of these areas are red, massage around them. Finish with some long, smooth strokes. Dry the back if extra lotion remains on it. Remove blanket and towel. 40

Store supplies. Place soiled clothing and linens in proper containers. Giving a back rub Help the resident get dressed. Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs. Store supplies. Place soiled clothing and linens in proper containers. Return bed to proper position. Remove privacy measures. Before leaving, place call light within resident’s reach. 41

Report any changes in resident to the nurse. Giving a back rub Wash your hands. Report any changes in resident to the nurse. Document procedure using facility guidelines. 42

Shampooing a resident’s hair in bed Equipment: shampoo, hair conditioner if requested, 2 bath towels, washcloth, bath thermometer, pitcher or handheld shower or sink attachment, waterproof pad, bath blanket, trough, basin, comb and brush, hair dryer Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 43

Shampooing a resident’s hair in bed Provide for the resident’s privacy with curtain, screen, or door. Be sure the room is a comfortable temperature and there are no drafts. Adjust bed to safe level, usually waist high. Lock bed wheels. Remove pillows. Place resident in a flat position. Test water temperature with thermometer or your wrist. Ensure it is safe. Water temperature should be 105°F. 44

Shampooing a resident’s hair in bed (con’t.) Have resident check water temperature. Adjust if necessary. Raise the side rail farthest from you. Place the waterproof pad under the resident’s head and shoulders. Cover the resident with the bath blanket. Fold back the top sheet and regular blankets. 45

Shampooing a resident’s hair in bed Place collection container under resident’s head (e.g., trough, basin). Place one towel across the resident’s shoulders. Protect resident’s eyes with dry washcloth. Using the pitcher or attachment, wet hair thoroughly. Apply small amount of shampoo to your hands. 46

Shampooing a resident’s hair in bed With your fingertips, lather and massage scalp. Use a circular motion, from front to back (Fig. 13-24). Do not scratch the scalp. Rinse hair until water runs clear. Apply conditioner. Rinse as directed on container. Cover resident’s hair with clean towel. Dry his face with washcloth used to protect eyes. Fig. 13-24. 47

Shampooing a resident’s hair in bed Remove trough and waterproof covering. Raise head of bed. Gently rub the scalp and hair with the towel. Dry and comb resident’s hair as he or she prefers (see procedure later in the chapter). Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs. 48

Shampooing a resident’s hair in bed Return bed to proper position. Remove privacy measures. Before leaving, place call light within resident’s reach. Empty, rinse, and wipe bath basin/pitcher. Return to proper storage. Clean comb/brush. Return hairdryer and comb/brush to proper storage. 49

Shampooing a resident’s hair in bed Place soiled linen in proper container. Wash your hands. Report any changes in resident to the nurse. Document procedure using facility guidelines. 50

3. Explain guidelines for assisting with bathing It is important to keep body parts covered with towels and bath blankets for privacy and warmth. Other procedures such as nail care, shampooing, and back rubs are often done at the time of bed baths.

3. Explain guidelines for assisting with bathing The safety guidelines for showers or tub baths are: Clean tub or shower before and after use. Be sure floor is dry. Be familiar with and use assistive devices as necessary. Have resident use safety bars to get into or out of tub or shower. Keep resident covered during transport.

3. Explain guidelines for assisting with bathing The safety guidelines for showers or tub baths are (con’t.): Place items within reach. Do not leave resident alone. Do not use bath oils. Test water temperature to make sure it is safe and comfortable.

Giving a shower or a tub bath Equipment: bath blanket, soap, shampoo, bath thermometer, 2-4 washcloths, 2-4 bath towels, clean gown and robe or clothes, non-skid footwear, gloves, lotion, deodorant Wash your hands. Place equipment in shower or tub room. Clean shower or tub area and shower chair. 54

Giving a shower or a tub bath Go to resident’s room. Identify yourself by name. Identify the resident by name. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. Help resident to put on non-skid footwear. Transport resident to shower or tub room. 55

Giving a shower or a tub bath For a shower: If using a shower chair, place it into position. Lock wheels. Safely transfer resident into shower chair. Turn on water. Test water temperature with thermometer. Water temperature should be no more than 105°F. Have resident check water temperature. 56

Giving a shower or a tub bath For a tub bath: Safely transfer resident onto chair. Fill the tub halfway with warm water. Test water temperature with thermometer. Water temperature should be no more than 105° F. Have resident check water temperature. Remaining steps: Put on gloves. Help resident remove clothing and shoes. 57

Giving a shower or a tub bath Help the resident into shower or tub. Put shower chair into shower and lock wheels. Stay with resident during procedure. Let resident wash as much as possible. Help to wash his or her face. Help resident shampoo and rinse hair. Help to wash and rinse the entire body. Move from head to toe. 58

Giving a shower or a tub bath Turn off water or drain the tub. Cover resident with bath blanket while tub drains. Unlock shower chair wheels if used. Roll resident out of shower, or help resident out of tub and onto a chair. Give resident towel(s) and help to pat dry. Pat dry under the breasts, between skin folds, in the perineal area, and between toes. 59

Giving a shower or a tub bath Apply lotion and deodorant as needed. Place soiled clothing and linens in proper containers. Remove gloves and dispose of them. Wash your hands. Help resident dress and comb hair before leaving shower room. Put on nonskid footwear. Return resident to his or her room. 60

Giving a shower or a tub bath Make sure resident is comfortable and safe. Before leaving, place call light within resident’s reach. Report any changes in resident to the nurse. Document procedure using facility guidelines. 61

4. Explain guidelines for assisting with grooming See Transparency 13-4 Assisting with Grooming

Transparency 13-4 Assisting with Grooming Residents should do as much for themselves as they can. Let residents make as many choices as possible. Follow the care plan. Follow resident’s routine. Be sensitive. Only provide nail care if assigned. Never cut toenails.

Providing fingernail care Equipment: orangewood stick, emery board, lotion, basin, soap, washcloth, 2 towels, bath thermometer Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 64

Providing fingernail care Provide for the resident’s privacy with curtain, screen, or door. If resident is in bed, adjust bed to safe level, usually waist high. Lock bed wheels. Fill the basin halfway with warm water. Test water temperature with thermometer or your wrist. Ensure it is safe. Water temperature should be 105°F. Have resident check water temperature. Adjust if necessary. 65

Providing fingernail care Place basin at a comfortable level for the resident. Soak the resident’s nails in basin of water. Soak all ten fingertips for two to four minutes. Remove hands. Wash hands with soapy washcloth. Rinse. Pat hands dry with towel, including between fingers. 66

Providing fingernail care Place the resident’s hands on the towel. Use the pointed end of the orangewood stick or a nail brush to remove dirt from under the nails (Fig. 13-28). Wipe orangewood stick on towel after cleaning each nail. Wash resident’s hands again. Dry them thoroughly. Groom nails with file or emery board. File in a curve. Fig. 13-28. 67

Providing fingernail care Finish with nails smooth and free of rough edges. Apply lotion from fingertips to wrists. Make resident comfortable. Make sure resident is comfortable and safe. Make sure sheets are free from wrinkles and the bed free from crumbs. Before leaving, place call light within resident’s reach. 68

Providing fingernail care Empty, rinse, and wipe basin. Return to proper storage. Dispose of soiled linen in the proper container. Wash your hands. Report any changes in resident to the nurse. Document procedure using facility guidelines. 69

4. Explain guidelines for assisting with grooming It is important to observe and report the following during foot care: Excessive dryness Breaks or tears in skin Ingrown nails Reddened areas Drainage or bleeding Change in color of skin or nails Soft, fragile heels Corns and blisters

Support the foot and ankle throughout procedure. Wash your hands. Providing foot care Equipment: basin, bath mat, soap, lotion, washcloth, 2 towels, bath thermometer, clean socks Support the foot and ankle throughout procedure. Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 71

Provide for resident’s privacy with curtain, screen, or door. Providing foot care Provide for resident’s privacy with curtain, screen, or door. If resident is in bed, adjust bed to a safe level, usually waist high. Lock bed wheels. Fill the basin halfway with warm water. Test water temperature with thermometer or your wrist. Ensure it is safe. Water temperature should be 105° F. Have resident check water temperature. Adjust if necessary. 72

7. Place basin on the bath mat. Providing foot care 7. Place basin on the bath mat. 8. Remove resident’s socks. Completely submerge resident’s feet in water. Soak the feet for five to ten minutes. Remove one foot from water. Wash entire foot, including between the toes and around nail beds, with soapy washcloth (Fig. 13-29). Rinse entire foot, including between the toes. Fig. 13-28. 73

11. Dry entire foot, including between the toes. Providing foot care 11. Dry entire foot, including between the toes. 12. Repeat steps 9 through 11 for the other foot. 13. Put lotion in hand. Warm lotion by rubbing hands together. Massage lotion into entire foot (top and bottom), except between the toes. Remove excess (if any) with a towel. Help resident to replace socks. Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs. 74

Providing foot care 16. Return bed to appropriate position. Remove privacy measures. 17. Before leaving, place call light within resident’s reach. 18. Empty, rinse, and wipe basin. Return to proper storage. 19. Dispose of soiled linen in the proper container. 75

Providing foot care 20. Wash your hands. 21. Report any changes in resident to the nurse. 22. Document procedure using facility guidelines. 76

4. Explain guidelines for assisting with grooming The following points are important when assisting with shaving: Respect personal preferences regarding shaving. Wear gloves. Soften hair on face first if using disposable or safety razor. Shave in direction of hair growth. Use after-shave if desired. Discard disposable shaving products properly. Do not use electric razors near water, oxygen, or pacemakers.

Be sure resident wants you to shave him before you begin. Shaving a resident Equipment: basin, 2 towels, washcloth, bath thermometer, mirror, shaving cream or soap, after-shave (optional), gloves, razor Be sure resident wants you to shave him before you begin. Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 78

Provide for the resident’s privacy with curtain, screen, or door. Shaving a resident Provide for the resident’s privacy with curtain, screen, or door. If the bed is adjustable, adjust bed to a safe level, usually waist high. Lock bed wheels. Raise head of bed so resident is sitting up. 79

Shaving using a safety or disposable razor: Shaving a resident Shaving using a safety or disposable razor: 7. Fill bath basin halfway with warm water. Drape towel under resident’s chin. Apply gloves. Moisten beard with warm washcloth. Put shaving cream or soap over area. 80

Offer mirror to resident. Shaving a resident 11. Hold skin taut. Shave beard in downward strokes on face and upward strokes on neck. Rinse razor often in warm water to keep it clean and wet (Fig. 13-30). Offer mirror to resident. Wash, rinse, and dry face after the shave. Apply after-shave lotion as requested. Fig. 13-30. 81

Shaving using an electric razor: Shaving a resident 14. Remove towel. Remove gloves. Shaving using an electric razor: 7. Do not use an electric razor near any water, when oxygen is in use, or if resident has a pacemaker. Drape towel under resident’s chin. 9. Apply gloves. Apply pre-shave lotion as resident wishes. 82

Hold skin taut. Shave with smooth, strokes. Shave in circular motion. Shaving a resident Hold skin taut. Shave with smooth, strokes. Shave in circular motion. Offer mirror to resident. Apply after-shave lotion as resident wishes. Remove towel. Remove gloves. 83

Return bed to appropriate position. Remove privacy measures. Shaving a resident Final steps: 16. Make sure that resident and area are free of loose hairs. Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs. Return bed to appropriate position. Remove privacy measures. Before leaving, place call light within resident’s reach. 84

20. Return supplies and equipment to proper storage. Shaving a resident 19. For safety razor: Rinse safety razor. For disposable razor: Dispose of a disposable razor in biohazard container. For electric razor: Clean head of electric razor. Remove whiskers from razor. Re-cap shaving head. Return razor to case. 20. Return supplies and equipment to proper storage. 21. Wash your hands. 85

Shaving a resident 22. Report any changes in the resident to the nurse. 23. Document procedure using facility guidelines. 86

4. Explain guidelines for assisting with grooming Define the following terms: Dandruff Pediculosis

4. Explain guidelines for assisting with grooming The following points are important when combing or brushing hair: Let residents choose their own hairstyles. Do not style residents’ hair in a childish manner. Handle hair gently. Never cut residents’ hair.

Combing or brushing hair Use hair care products that the resident prefers for his or her type of hair. Equipment: comb, brush, towel, mirror, hair care items requested by resident Wash your hands. Identify yourself by name. Identify the resident by name. 89

Combing or brushing hair Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. If the bed is adjustable, adjust bed to a safe level, usually waist high. Lock bed wheels. 90

Combing or brushing hair Raise head of bed so resident is sitting up. Place a towel under the head or around the shoulders. Remove any hair pins, hair ties, and clips. Remove tangles first by dividing hair into small sections. Put a small amount of detangler or leave-in conditioner on the tangle. Hold lock of hair just above the tangle so you do not pull at the scalp. Gently comb or brush through the tangle. 91

Combing or brushing hair After tangles are removed, brush two-inch sections of hair at a time. Brush from roots to ends (Fig. 13-32). Residents who have dry, brittle hair may require a special treatment with oil or hair lotion. Residents whose hair is tightly curled may use a comb with large teeth, or a pick. Fig. 13-32. 92

Combing or brushing hair Style hair as resident prefers. Avoid childish hairstyles. Each resident may like different styles and different hair products. Offer mirror to resident. Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs. Return bed to appropriate position. Remove privacy measures. 93

Combing or brushing hair Before leaving, place call light within resident’s reach. Return supplies to proper storage. Clean hair from brush/comb. Dispose of soiled linen in the proper container. Wash your hands. Report any changes in the resident to the nurse. Document procedure using facility guidelines. 94

5. List guidelines for assisting with dressing Define the following terms: Affected Involved

Transparency 13-5 Assisting with Dressing Preferences should be followed. Allow resident to choose clothing. Resident should dress in regular clothes in the daytime. Resident should do as much as possible. Provide privacy. Roll or fold down socks before putting them on. Front-fastening bras are easier for residents to work by themselves. Put back-fastening bras on waist and fasten in front first before rotating around. Place weak arm or leg through garment first.

Dressing a resident with an affected right arm When putting on all items, move resident’s body gently and naturally. Avoid force and over-extension of limbs and joints. Equipment: clean clothes of resident’s choice, non-skid footwear Wash your hands. Identify yourself by name. Identify the resident by name. 97

Dressing a resident with an affected right arm Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. Ask resident what she would like to wear (Fig. 13-35). Dress in outfit of her choice. Fig. 13-35. 98

Dressing a resident with an affected right arm Remove resident’s gown. Do not completely expose resident. Take off clothes from stronger side first when undressing. Help resident to put the right (affected) arm through the right sleeve of the shirt, sweater, or slip before placing garment on left (unaffected) arm. 99

Dressing a resident with an affected right arm 8. Help resident to put on skirt, pants, or dress. Place bed at lowest position. Help to apply non-skid footwear. Tie laces. Finish with resident dressed appropriately. Make sure clothing is right-side-out and zippers/buttons are fastened. 100

Dressing a resident with an affected right arm Remove privacy measures. Place gown in soiled linen container. Before leaving, place call light within resident’s reach. Wash your hands. Report any changes in the resident to the nurse. Document procedure using facility guidelines. 101

6. Identify guidelines for good oral care Define the following terms: Plaque Tartar Gingivitis Halitosis Oral care includes brushing the teeth and gums, flossing the teeth with dental floss, and denture care.

6. Identify guidelines for good oral care It is important to observe and report the following when performing oral care: Irritation Infection Raised areas Coated or swollen tongue Ulcers Flaky, white spots Dry, cracked, bleeding, or chapped lips Loose, chipped, broken, or decayed teeth

6. Identify guidelines for good oral care It is important to observe and report the following when performing oral care (con’t.): Swollen, irritated, bleeding, or whitish gums Bad or fruity breath Reports of mouth pain

Identify yourself by name. Identify the resident by name. Providing oral care Equipment: toothbrush, toothpaste, emesis basin, gloves, towel, glass of water Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 105

Provide for resident’s privacy with curtain, screen, or door. Providing oral care Provide for resident’s privacy with curtain, screen, or door. Adjust bed to a safe level, usually waist high. Lock bed wheels. Make sure resident is in an upright position. Put on gloves. Place towel across resident’s chest. Wet brush. Put on small amount of toothpaste. 106

Hold emesis basin to the resident’s chin. Providing oral care 9. Clean entire mouth (including tongue and all surfaces of teeth). Use gentle strokes. First brush upper teeth, then lower teeth. Use short strokes. Brush back and forth. Hold emesis basin to the resident’s chin. Have resident rinse mouth with water and spit into emesis basin (Fig. 13-37). Fig. 13-37. 107

Wipe resident’s mouth and remove towel. Providing oral care Wipe resident’s mouth and remove towel. Dispose of soiled linen in the proper container. Clean and return supplies to proper storage. Remove and dispose of gloves properly. Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs. 108

Return bed to appropriate position. Remove privacy measures. Providing oral care Return bed to appropriate position. Remove privacy measures. Before leaving, place call light within resident’s reach. Wash your hands. 109

Document procedure using facility guidelines. Providing oral care Report any problems with teeth, mouth, tongue, and lips to nurse. This includes odor, cracking, sores, bleeding, and any discoloration. Document procedure using facility guidelines. 110

Equipment: floss, cup with water, emesis basin, gloves, towel Flossing teeth Equipment: floss, cup with water, emesis basin, gloves, towel Wash your hands. Identify yourself by name. Identify the resident by name. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 111

Provide for the resident’s privacy with curtain, screen, or door. Flossing teeth Provide for the resident’s privacy with curtain, screen, or door. Adjust bed to a safe level, usually waist high. Lock bed wheels. Make sure resident is in an upright sitting position. Put on gloves. 112

Flossing teeth 7. Wrap the ends of floss securely around each index finger (Fig. 13-38). Fig. 13-38. 113

Flossing teeth 8. Starting with the back teeth, place floss between teeth. Move it down the surface of the tooth. Use a gentle sawing motion (Fig. 13-39). Fig. 13-39. 114

Flossing teeth 8. (con’t.) Continue to the gum line. At the gum line, curve the floss into a letter C. Slip it gently into the space between the gum and tooth. Then go back up, scraping that side of the tooth (Fig. 13-40). Repeat this on the side of the other tooth. 9. After every two teeth, unwind floss from your fingers. Move it so you are using a clean area. Floss all teeth. Fig. 13-40. 115

Offer resident a face towel when done flossing all teeth. Flossing teeth Offer water to rinse the mouth. Ask the resident to spit it into the basin. Offer resident a face towel when done flossing all teeth. Dispose of soiled linen in the proper container. Clean and return supplies to proper storage. Remove and dispose of gloves properly. 116

16. Return bed to appropriate position. Remove privacy measures. Flossing teeth Make resident comfortable. Make sure sheets are free from wrinkles and the bed free from crumbs. 16. Return bed to appropriate position. Remove privacy measures. Before leaving, place call light within resident’s reach. Wash your hands. 117

Document procedure using facility guidelines. Flossing teeth 19. Report any problems with teeth, mouth, tongue, and lips to nurse. This includes odor, cracking, sores, bleeding, and any discoloration. Document procedure using facility guidelines. 118

7. Define “dentures” and explain guidelines for good denture care Define the following term: Dentures

7. Define “dentures” and explain guidelines for good denture care The following are important points about denture care: Dentures are expensive. Handle them carefully. Wear gloves when cleaning dentures. Report problems with dentures to the nurse. Do not use hot water to clean dentures because that could warp them. Place them in a labeled cup.

Cleaning and storing dentures Equipment: denture brush or toothbrush, denture cleanser or tablet, labeled denture cup, 2 towels, gloves Wash your hands. Put on gloves. Line sink/basin with a towel(s). Rinse dentures in cool running water before brushing them. Do not use hot water. Hot water may damage dentures. 121

Cleaning and storing dentures Apply toothpaste or cleanser to toothbrush. Brush dentures on all surfaces (Fig. 13-41). Rinse all surfaces of dentures under cool running water. Do not use hot water. Rinse denture cup if placing clean dentures inside it. Fig. 13-41. 122

Cleaning and storing dentures Place dentures in clean denture cup. Cover dentures completely with solution or cool water. Make sure cup is labeled with resident’s name. Clean and return the equipment to proper storage. Dispose of towels in proper container. Remove your gloves. Dispose of gloves properly. 123

Cleaning and storing dentures Wash your hands. Report any changes in appearance of dentures to the nurse. Document procedure using facility guidelines. 124

8. Describe guidelines for performing oral care for an unconscious resident Define the following term: Aspiration

8. Describe guidelines for performing oral care for an unconscious resident The following are important points about oral care for someone who is unconscious: The purpose is cleanliness and to moisturize the mouth. Unconscious residents may still be able to hear. Explain the procedure and behave normally. Different solutions could be used.

8. Describe guidelines for performing oral care for an unconscious resident The following are important points about oral care for someone who is unconscious (con’t.): Turn resident’s head to the side and use minimal solution to lessen risk of aspiration. Padded tongue blades may not be used in your facility. If they are used, demonstrate how to make one (Figure 13-43, p. 189 in textbook).

Providing oral care for the unconscious resident Equipment: sponge swabs, padded tongue blade, towel, emesis basin, gloves, lip moisturizer, cleaning solution (check the care plan) Wash your hands. Identify yourself by name. Identify the resident by name. Even residents who are unconscious may be able to hear you. Always speak to them as you would to any resident. 128

Providing oral care for the unconscious resident Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Provide for the resident’s privacy with curtain, screen, or door. Adjust bed to a safe level, usually waist high. Lock bed wheels. Put on gloves. 129

Providing oral care for the unconscious resident Turn resident’s head to the side. Place a towel under his cheek and chin. Place an emesis basin next to the cheek and chin for excess fluid. Hold mouth open with padded tongue blade (Fig. 13-43). Fig. 13-43. 130

Providing oral care for the unconscious resident 9. Dip swab in cleaning solution. Wipe teeth, gums, tongue, and inside surfaces of mouth. Change swab often. Repeat until the mouth is clean (Fig. 13-44). Rinse with clean swab dipped in water. Remove the towel and basin. Pat lips or face dry if needed. Apply lip moisturizer. Fig. 13-44. 131

Providing oral care for the unconscious resident Dispose of soiled linen in the proper container. Clean and return supplies to proper storage. Remove your gloves. Dispose of gloves properly. Make sure sheets are free from wrinkles and the bed free from crumbs. 132

Providing oral care for the unconscious resident 16. Return bed to appropriate position. Remove privacy measures. Before leaving, place call light within resident’s reach. Wash your hands. Report any changes in resident to the nurse. Document procedure using facility guidelines. 133