Personal Care

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?

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

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

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

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

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

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

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

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

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

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.

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

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

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.

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.

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

Elimination and Continence Management

Common Terms Urination, micturition and voiding Defecation, elimination and moving/ opening the bowels Explain terms above

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

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

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

Many different methods: Bedpans Urinals Commode

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

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

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.

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

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.

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

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

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

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

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

Common Problems Piles Constipation Faecal impaction Diarrhoea Faecal incontinence Flatulence

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

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.

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.

Care of the Skin and Prevention of Pressure Sores

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

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

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

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

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

Assessment Extra care is needed if damage to the skin noted note skin folds and crevices invasive devices breaks in skin Redness or rash

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

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

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

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.

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

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

Pressure Areas

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

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

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

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

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

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.

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

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

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

Nutrition

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.

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

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

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

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)

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

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

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

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

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

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

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

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 ??

Assisting with Eating Consider……… Oral hygiene Elimination needs Clothing and linen Dentures Spectacles Hearing aids Hygiene – hand washing

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.

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

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

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

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.

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

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.

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

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

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

Fluid Balance Fluid intake and output must balance Excessive fluid = oedema Decrease of body fluid leads to dehydration

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

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

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

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

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.