1. Define important words in this chapter

1. Define important words in this chapter
additive a substance added to another substance, changing its effect. axilla underarm or armpit area. bridge a type of dental appliance that replaces missing or pulled teeth. dandruff excessive shedding of dead skin cells from the scalp.

dentures artificial teeth. edema swelling in body tissues caused by excess fluid. edentulous lacking teeth; toothless. gingivitis an inflammation of the gums.

grooming practices to care for oneself, such as caring for fingernails and hair. halitosis bad-smelling breath. hygiene methods of keeping the body clean. partial bath bath that includes washing the face, underarms, hands, and perineal area.

pediculosis an infestation of lice. plaque a substance that accumulates on the teeth from food and bacteria. tartar hard deposits on the teeth that are filled with bacteria; may cause gum disease and loose teeth if they are not removed.

2. Explain personal care of residents
Define the following terms: hygiene methods of keeping the body clean. grooming practices to care for oneself, such as caring for fingernails and hair.

Assisting with a.m. care includes the following: Taking resident to the bathroom, offering a bedpan, urinal, or an incontinent brief change, helping with perineal care, if needed, and washing resident’s hands Helping with mouth care or denture care before and/or after breakfast, as the resident prefers Assisting with washing face and hands in bed, shower room, or in bathroom

Assisting with a.m. care (cont’d.): Changing resident’s gown, pajamas, or clothing Providing breakfast and fluids Assisting with bathing, as the resident prefers Helping resident with shaving, hair care, hand and fingernail care, foot care, and cosmetics Making the bed and tidying resident’s room

Assisting with p.m. care includes the following: Taking resident to the bathroom, offering bedpan or urinal, or an incontinent brief change and assisting with handwashing Helping with mouth care or denture care after lunch and dinner, as the resident prefers Providing lunch, dinner, snacks, and fluids; giving fresh drinking water Assisting the resident with bathing, if evening is preferable

Assisting with p.m. care (cont’d.): Giving a back massage Changing into resident’s gown or pajamas Helping resident with hair care Assisting with washing face and removing makeup as needed Changing linens as needed and preparing the bed for the resident’s return Tidying resident’s room

Think about this question: Can you think of any additional personal care tasks (other than those listed) that you might assist residents with in the morning or in the evening?

Transparency 12-1: Assisting with Personal Care
Promote self-care and help the resident be as independent as possible. Be empathetic. Always explain what you will be doing and answer any questions. Provide privacy. Allow enough time for tasks without rushing or interrupting residents. Provide for personal choice. Be patient. Be respectful and provide privacy during phone calls and visits. Keep residents covered during bathing and dressing. Promote residents’ safety. Talk during personal care and report changes, concerns, or problems.

Think about this question: For each point listed on the transparency (also listed below), can you think of specific things you can do when working with residents? Promote self-care and help the resident be as independent as possible. Be empathetic. Always explain what you will be doing and answer any questions. Provide privacy. Allow enough time for tasks, without rushing or interrupting residents. Provide for personal choice.

Think about this question (cont’d.): For each point listed on the transparency (also listed below), can you think of specific things you can do when working with residents? Be patient. Be respectful and provide privacy during phone calls and visits. Keep residents covered during bathing and dressing. Promote residents’ safety. Talk during personal care and report changes, concerns, or problems.

3. Describe different types of baths and list observations to make about the skin during bathing
Define the following terms: partial bath bath that includes washing the face, underarms, hands, and perineal area. additive a substance added to another substance, changing its effect. edema swelling in body tissues caused by excess fluid.

Know the four basic types of baths and how each is best suited to particular residents: Partial bath (set-up bath) is best suited to a resident who has drier, fragile, and more sensitive skin, should not have daily full baths, is unable to get up to take a shower or tub bath, and/or wants a quick bath before a meal and plans on taking a shower or bath later in the day. Shower is best suited to a resident who is able to stand during a shower, and/or is able to safely sit in a shower chair.

Four basic types of baths (cont’d.): Tub bath is best suited to a resident who is able to transfer into and out of a tub and/or has a doctor’s order for a special bath using an additive. Complete bed bath is best suited to a resident who is unable to get out of bed to shower or bathe, and requires a full bath.

REMEMBER: During personal care, you can you obtain information about residents by making observations and asking questions.

Be sure to observe and report any of the following during bathing: Change in size of one or both pupils Difference in appearance from one eye to another Yellow or red color in whites of the eyes Changes in vision, ability to hear, and sense of smell Drooping on one side of the face Weight loss Drainage coming from any area, including eyes, ears, nipples, or genitals

Observe and report during bathing (cont’d.): Foul odors from any body area Pale, blue-tinged (cyanotic), white, reddened, or purple areas on the skin Dry, flaky, broken, or cracked skin Lumps or bumps on the skin Moles or spots on the skin, especially those that are red, white, yellow, dark brown, gray, or black Rashes or any skin discoloration Bruises Blisters Cuts, scrapes, or scratches

Observe and report during bathing (cont’d.): Open sores or ulcers on any area of the body Changes in open sore, wound, or ulcer (color, size, drainage, odor, overall depth of sore) Swelling/edema of any area, especially the knuckles, fingers, groin, abdomen, legs, ankles, or feet (edema is swelling in body tissues caused by excess fluid) Poor condition of fingernails or toenails Nails in need of trimming Dry, cracked, or broken skin in between toes or toenails

Observe and report during bathing (cont’d.): Itching or scratching Change in emotional state Change in level of mobility Complaints of pain or discomfort Stiff neck Numbness, burning, warmth, or tingling in the extremities or other areas of the body

4. Explain safety guidelines for bathing
REMEMBER: Safety must be the highest priority when bathing residents. Many accidents happen in the bathroom or shower room. Assess the area for any risks before bathing a resident.

Transparency 12-2: Safety Guidelines and Bathing
Ask for help if you need it. Follow the care plan. Keep residents covered as much as possible. Clean areas and equipment before and after use. Make sure floor in shower room is dry. Use nonslip mats in regular tubs. Make sure safety bars are in working order. Encourage residents to use them. Gather all needed supplies and equipment and place these items within reach. Do not use bath oils or talcum powder. Set water at a comfortable temperature for each resident. Temperature should not be over 105° F. Store electrical appliances away from water source. Do not leave residents alone while bathing.

5. List the order in which body parts are washed during bathing
Define the following term: axilla underarm or armpit area.

REMEMBER: When assisting with bathing, washing from the cleanest area to the dirtiest reduces the risk of transferring microorganisms.

Transparency 12-3: Bathing Wheel
1. Eyes 2. Face 3. Ears 4. Neck 5. Arms, Axilla (axillae), and Hands 6. Chest and Abdomen 7. Legs and Feet 8. Back 9. Perineal Area 10. Buttocks

Know the correct order to wash body parts, as listed on the Bathing Wheel: 1. Eyes 2. Face 3. Ears 4. Neck 5. Arms, axilla (axillae), and hands 6. Chest and abdomen 7. Legs and feet 8. Back 9. Perineal area 10. Buttocks

6. Explain how to assist with bathing
Remember these points about bathing: Bathing increases circulation and provides an opportunity to observe the skin. Clean and prepare the shower or tub room and gather supplies before moving the resident there. Keep the room warm enough. Resident should help choose a comfortable water temperature.

Points to remember about bathing (cont’d.): Wear gloves while bathing a resident and change gloves before giving perineal care. Make sure all soap residue is removed. Make sure the resident understands what will happen before providing perineal care. Observe the skin closely during bathing.

Giving a complete bed bath
Equipment: bath blanket, bath basin, soap, bath thermometer, 2-4 washcloths, 2-4 bath towels, clean gown or clothes, 2 pairs of gloves, lotion, deodorant, orangewood stick or emery board 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

4. Provide for the resident’s privacy with a curtain, screen, or door. Be sure the room is at a comfortable temperature and there are no drafts. 5. Adjust bed to safe working level, usually waist high. Lock bed wheels. 6. Place a bath blanket or towel over resident. Ask him to hold onto it as you remove or fold back top bedding. Remove gown, while keeping resident covered with bath blanket (or top sheet).

7. Fill the basin with warm water. Test water temperature with thermometer or your wrist and ensure it is safe. Water temperature should not be over 105°F. It cools quickly. Have resident check water temperature. Adjust if necessary. Change the water when it becomes too cool, soapy, or dirty. 8. Put on gloves. 9. Ask the resident to participate in washing. Help him do this whenever needed.

10. Uncover only one part of the body at a time. Place a towel under the body part being washed. 11. Wash, rinse, and dry one part of the body at a time. Start at the head. Work down, and complete the front first. When washing, use a clean area of the washcloth for each stroke.

Eyes, Face, Ears, Neck: Wash face with wet washcloth (no soap). Begin with the eye farther away from you. Wash inner area to outer area. Use a different area of the washcloth for each eye. Wash the face from the middle outward. Use firm but gentle strokes. Wash the ears and behind the ears and the neck. Rinse and pat dry with blotting motion.

Arms and Axillae: Remove one arm from under the towel. With a soapy washcloth, wash the upper arm and underarm. Use long strokes from the shoulder to the wrist. Rinse and pat dry. Repeat for the other arm.

Hands: Wash the hand in a basin. Clean under the nails with an orangewood stick or nail brush. Rinse and pat dry. Make sure to dry between the fingers. Give nail care (see procedure later in this chapter) if it has been assigned. Repeat for the other hand. Put lotion on the resident’s elbows and hands if ordered.

Chest: Place the towel across the resident’s chest. Pull the bath 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.

Abdomen: Keep towel across chest. Fold the bath blanket down so that it still covers the genital area. Wash the abdomen, rinse, and pat dry. Cover with the towel. Pull the bath blanket up to the resident’s chin. Remove the towel. 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.

Place another towel under the foot. Move the basin to the towel. Place the foot into the basin. Wash the foot and between the toes. Rinse foot and pat dry. Dry between toes. Give nail care 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. Do not apply lotion between the toes. Repeat steps for the other leg and foot.

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. Apply lotion if ordered.

12. Place the towel under the buttocks and upper thighs. Help the resident turn onto his back. If the resident is able to wash his or her perineal area, place a basin of clean, warm water and a washcloth and towel within reach. Hand items to the resident as needed. If the resident wants you to leave the room, remove and discard gloves. Wash your hands. Leave supplies and the call light within reach. If the resident has a urinary catheter in place, remind him not to pull on it.

13. If the resident cannot provide perineal care, you will do so. Remove and discard your gloves. Wash your hands. Put on clean gloves. Make sure to provide privacy at all times. 14. Perineal area and buttocks: Change bath water. Wash, rinse, and dry perineal area. Work from front to back (clean to dirty).

For a female resident: Use water and a small amount of soap, and clean from front to back. Use single strokes. Do not wash from the back to the front, as this may cause infection. Use a clean area of washcloth or clean washcloth for each stroke.

First separate the labia majora, the outside folds of perineal skin that protect the urinary meatus and the vaginal opening. The meatus is the opening of the female urethra that is above the vaginal opening. Clean from front to back on one side with a clean washcloth, using a single stroke. Using a clean area of washcloth, clean the other side. Clean the perineum (area between genitals and anus) last with a front to back motion. Rinse the area thoroughly in the same way. Make sure all soap is removed.

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. 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.

Thoroughly 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. Rinse thoroughly 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.

15. Empty, rinse, and dry bath basin. Place basin in designated dirty supply area or return to storage, depending on facility policy. 16. Place soiled clothing and linens in proper containers. 17. Remove and discard gloves. 18. Wash your hands. 19. Provide deodorant.

20. Put clean gown or clothes on resident. Assist with brushing or combing resident’s hair (see procedure later in the chapter). 21. Remove bath blanket. Replace bedding. Make resident comfortable. 22. Return bed to lowest position. Remove privacy measures.

23. Leave call light within resident’s reach. 24. Wash your hands. 25. Be courteous and respectful at all times. 26. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

Think about this question: Why is it important to change the bath water whenever it becomes too cool, soapy, or dirty?

REMEMBER: Perineal care is considered a procedure and should be done as a step-by-step technique, which is different for males and females. Be sure to turn the resident on his or her side and to clean the anal area to complete the procedure.

Think about this question: Why is it so important to clean the anal area without contaminating the perineal area?

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, gloves, trough and catch basin, comb and brush, hair dryer 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands.

3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with a curtain, screen, or door. Be sure the room is at a comfortable temperature and there are no drafts. 5. Adjust bed to safe working level, usually waist high. Lock bed wheels.

6. Lower the head of bed. Remove pillow. 7. Test water temperature with thermometer or your wrist. Ensure it is safe. Water temperature should not be over 105°F. Have resident check water temperature. Adjust if necessary. 8. Put on gloves.

9. 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. 10. Place the trough under resident’s head. Connect trough to catch basin. Place one towel across the resident’s shoulders. 11. Protect resident’s eyes with dry washcloth.

12. Use pitcher or attachment to wet hair thoroughly. Apply a small amount of shampoo, usually the size of a quarter. 13. Lather and massage scalp with fingertips. Use a circular motion from front to back. Do not scratch the scalp.

14. Rinse hair until water runs clear. Apply conditioner. Rinse as directed on container. Be sure to rinse the hair thoroughly to prevent the scalp from getting dry and itchy. 15. Wrap resident’s hair in a clean towel. Dry his face with washcloth used to protect eyes. Gently rub the scalp and hair with the towel.

16. Remove trough and waterproof covering. 17. Empty, rinse, and wipe bath basin/pitcher. Return to proper storage. 18. Place soiled linen in proper container. 19. Remove and discard gloves. Wash your hands. 20. Raise head of bed.

Dry and comb resident’s hair as he or she prefers. See procedure later in the chapter. Return hair dryer and comb/brush to proper storage. Make resident comfortable. Return bed to lowest position. Remove privacy measures. Leave call light within resident’s reach.

25. Wash your hands. 26. Be courteous and respectful at all times. 27. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

Shampooing hair at a sink versus on a stretcher: Some residents will have their hair shampooed at a sink. In this case, you will seat the resident in a chair that is the correct height for the sink, and you will pad the edge of the sink so that the resident’s neck is comfortable. The resident’s head should be tilted back slightly, in a comfortable position that is not overextended. When assisting a resident on a stretcher with shampooing hair, you will bring the stretcher to the sink and adjust the height of the stretcher to be even with the sink. You will lock the stretcher wheels and fasten safety straps. You will need to raise one side rail on the side farthest from you.

Giving a shower or 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, 2 pairs of gloves, lotion, deodorant 1. Wash your hands. 2. Place equipment in shower or tub room. Put on gloves. Clean shower or tub area and shower chair.

3. Remove and discard gloves. 4. Wash your hands. 5. Go to resident’s room. Identify yourself by name. Identify the resident. Greet the resident by name. 6. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

7. Provide for the resident’s privacy with a curtain, screen, or door. 8. Help resident to put on non-skid footwear. Transport resident to shower or tub room. For a shower: 9. If using a shower chair, place it into position and lock its wheels. Safely transfer resident into shower chair.

10. Turn on water. Test water temperature with thermometer. Water temperature should be no more than 105°F. Have resident check water temperature. Adjust if necessary. Check water temperature frequently throughout the shower. For a tub bath: 9. Safely transfer resident onto chair or tub lift.

10. 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 for either procedure: 11. Put on clean gloves. 12. Help resident remove clothing and shoes.

13. Help the resident into shower or tub. Put shower chair into shower and lock wheels. 14. Stay with resident during the entire procedure. 15. Let resident wash as much as possible on his or her own. Help to wash his or her face.

16. Help resident shampoo hair. The resident’s head should be tilted back slightly for the shampoo. The head should not be extended beyond its normal range. Carefully spray water over the hair, taking care that the water and shampoo/conditioner do not get into the eyes. Rinse the hair thoroughly.

17. Help to wash and rinse the entire body. Move from head to toe (clean to dirty). 18. Turn off water or drain the tub. Cover resident with bath blanket until the tub drains. 19. Unlock shower chair wheels if used. Roll resident out of shower, or help resident out of tub and onto a chair.

20. Give resident towel(s) and help to pat dry. Remember to pat dry under the breasts, between skin folds, in the perineal area, and between toes. 21. Place soiled clothing and linens in proper containers. 22. Remove and discard gloves. 23. Wash your hands.

24. Apply lotion and deodorant as needed. Help resident dress and comb hair before leaving shower or tub room (see procedures later in this chapter). Put on non- skid footwear. Return resident to room. 25. Make resident comfortable.

26. Leave call light within resident’s reach. 27. Wash your hands. 28. Be courteous and respectful at all times. 29. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

7. Describe how to perform a back rub
Remember the following about back rubs: Back rubs help relax tired, tense muscles and improve circulation. Back rubs are often given after bathing or prior to going to bed at night. They may also be given regularly to relieve pain or discomfort. Sometimes back rubs should not be given due to conditions or illnesses. Follow the care plan. If the resident has broken or open skin on his back, apply gloves before giving a back rub.

Equipment: bath blanket or towel, lotion
Giving a back rub Equipment: bath blanket or towel, lotion 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

Giving a back rub 4. Provide for the resident’s privacy with a curtain, screen, or door. 5. Adjust bed to safe working level, usually waist high. Lower the head of the bed. Lock bed wheels.

Giving a back rub 6. Position resident lying on his side (lateral position) or his stomach (prone position). Many elderly residents find lying on their stomachs uncomfortable. If so, have him lie on his side. Cover with a bath blanket. Expose back to the top of the buttocks. Back rubs can also be given with the resident sitting up.

Giving a back rub 7. 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 directly on resident’s skin.

Giving a back rub 8. Place hands on each side of upper part of the buttocks. Use the full palm of hand. Make long, smooth upward strokes with both hands. Move along each side of the spine, up to the shoulders. 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 this motion for three to five minutes.

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. 10. Gently massage bony areas (spine, shoulder blades, hip bones). Use circular motions of fingertips. Do not massage any pale, white, or red areas.

Giving a back rub 11. Finish with long, smooth strokes. 12. Dry the back if it has extra lotion remaining. 13. Remove bath blanket. Help the resident to get dressed. Make resident comfortable. 14. Return bed to lowest position. Remove privacy measures.

16. Leave call light within resident’s reach. 17. Wash your hands.
Giving a back rub 15. Store supplies. Place soiled clothing and linens in proper containers. 16. Leave call light within resident’s reach. 17. Wash your hands. Be courteous and respectful at all times. Report any changes in the resident to the nurse, including pale, white or red areas. Document procedure using facility guidelines.

7. Describe how to perform a back rub
REMEMBER: You should wear gloves when giving a back rub to a resident who has broken or open skin.

8. Explain guidelines for performing good oral care
Define the following terms: halitosis bad-smelling breath. plaque a substance that accumulates on the teeth from food and bacteria. tartar hard deposits on the teeth that are filled with bacteria; may cause gum disease and loose teeth if they are not removed. edentulous lacking teeth; toothless.

Define the following term: gingivitis an inflammation of the gums.

Oral care consists of the following: Brushing the teeth, tongue, and gums Flossing with dental floss, caring for the lips Caring for dentures

REMEMBER: Gloves must always be worn when performing oral care.

Remember to observe and report any of the following when performing oral care: Dry, cracked, bleeding, or chapped lips Cold sores on the lips Raised areas Swollen, irritated, red, bleeding, or whitish gums Loose, cracked, chipped, broken, or decayed teeth Yellow-filled or red sores, such as canker sores inside the mouth White spots inside the mouth

Observe and report when performing oral care (cont’d.): Pus or drainage Coated or swollen tongue Bad breath or fruity-smelling breath Change in the resident’s ability to drink, suck on a straw, or swallow Gagging or choking Resident reports of mouth pain

Providing oral care Equipment: toothbrush, toothpaste, emesis basin, gloves, towel, glass of water Maintain clean technique with placement of toothbrush throughout procedure. 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands.

Providing oral care 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with a curtain, screen, or door. 5. Adjust bed to safe working level, usually waist high. Lock bed wheels. Make sure resident is sitting upright.

Providing oral care 6. Put on gloves. 7. Place towel across resident’s chest. 8. Wet brush. Apply toothpaste.

Providing oral care 9. Clean entire mouth (including tongue and all surfaces of teeth and the gumline) using gentle strokes. First brush inner, outer and chewing surfaces of the upper teeth, then do the same with the lower teeth. Use short strokes. Brush back and forth. 10. Hold emesis basin to the resident’s chin. 11. Have resident rinse mouth with water and spit into emesis basin.

Providing oral care 12. Wipe resident’s mouth and remove towel. 13. Empty, rinse and wipe emesis basin. Rinse toothbrush. Return supplies to proper storage. 14. Dispose of soiled linen in the proper container. 15. Remove and discard gloves. Wash your hands.

16. Make resident comfortable.
Providing oral care 16. Make resident comfortable. 17. Return bed to lowest position. Remove privacy measures. 18. Leave call light within resident’s reach. 19. Wash your hands. Be courteous and respectful at all times.

Providing oral care 21. Report any changes in the resident to the nurse. Report any problems with teeth, mouth, tongue, or lips to nurse. This includes odor, cracking, sores, bleeding, and any discoloration. Document procedure using facility guidelines.

Equipment: floss, cup with water, emesis basin, gloves, towel
Flossing teeth Equipment: floss, cup with water, emesis basin, gloves, towel 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

Flossing teeth 4. Provide for the resident’s privacy with a curtain, screen, or door. 5. Adjust bed to safe working level, usually waist high. Lock bed wheels. Make sure resident is in an upright sitting position. 6. Put on gloves. 7. Wrap the ends of floss securely around each index finger.

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. Continue to the gum line. At the gum line, curve the floss. Slip it gently into the space between the gum and tooth. Then go back up, scraping that side of the tooth. Repeat on the side of the other tooth.

Flossing teeth 9. After every two teeth, unwind floss from your fingers. Move it so you are using a clean area. Floss all teeth. 10. Offer water to rinse the mouth. Ask the resident to spit it into the basin. 11. Offer resident a face towel when done.

Flossing teeth 12. Discard floss. Empty basin into the toilet. Clean and store basin and supplies. 13. Dispose of soiled linen in the proper container. 14. Remove and discard gloves. Wash your hands. 15. Make resident comfortable. 16. Return bed to lowest position. Remove privacy measures.

Flossing teeth 17. Leave call light within resident’s reach. 18. Wash your hands. 19. Be courteous and respectful at all times.

Flossing teeth 20. Report any changes in the resident to the nurse. Report any problems with teeth, mouth, tongue, or lips to nurse. This includes odor, cracking, sores, bleeding, and any discoloration. Document procedure using facility guidelines.

9. Define “dentures” and explain care guidelines
Define the following terms: dentures artificial teeth. bridge a type of dental appliance that replaces missing or pulled teeth.

9. Define “dentures” and explain care guidelines
Know these points about denture care: Dentures are expensive and must be handled carefully. Wear gloves when cleaning dentures. Store dentures in lukewarm water in a covered, labeled denture cup. Match dentures to correct resident.

Cleaning and storing dentures
Equipment: denture brush or toothbrush, denture cleanser or tablet, labeled denture cup with cover, 2 towels, gauze squares, gloves, cup with water, emesis basin, denture cream or adhesive (if replacing dentures in mouth) Maintain clean technique with placement of dentures and toothbrush throughout procedure. 1. Identify yourself by name. Identify the resident. Greet the resident by name.

2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Encourage resident to assist if possible. 4. Provide for the resident’s privacy with a curtain, screen, or door.

5. Adjust bed to safe working level, usually waist high. Lock bed wheels. Make sure resident is in an upright sitting position. 6. Put on gloves. Line sink/basin with a towel(s) and partially fill sink with water. This prevents dentures from breaking if dropped. Handle dentures carefully. If you are allowed to do so, and if a resident cannot remove dentures, you will do it.

9. Remove the lower denture first. The lower denture is easier to remove because it floats on the gum line of the lower jaw. Grasp the lower denture with a gauze square (for a good grip) and remove it. The upper denture is sealed by suction. Firmly grasp the upper denture with a gauze square. Give a slight downward pull to break the suction. Turn it at an angle to take it out of the mouth.

10. Rinse dentures in tepid/lukewarm running water before brushing them. Do not use hot water. Hot water may warp or damage dentures. 11. Apply toothpaste or cleanser to toothbrush. 12. Brush the dentures on all surfaces. This includes the inner, outer, and chewing surfaces of the upper and lower dentures.

13. Rinse all surfaces of dentures under tepid/lukewarm running water. Do not use hot water. 14. Offer water to rinse the resident’s mouth. Ask the resident to spit it into the emesis basin. 15. Rinse denture cup if placing clean dentures inside it. 16. Place dentures in clean denture cup with special solution or lukewarm water and cover. Make sure cup is labeled with resident’s name. Return denture cup to storage.

17. Some residents will want to wear their dentures all of the time. They will only want them removed for cleaning. If replacing dentures in resident’s mouth, make sure resident is still sitting upright. Apply denture cream or adhesive to the dentures, if needed. When the resident’s mouth is open, place upper denture into the mouth by turning it at an angle. Straighten it. Press it onto the upper gum line firmly and evenly.

(cont’d.) Insert the lower denture onto the gum line of the lower jaw. Press firmly. 18. Clean, dry, and return the equipment to proper storage. 19. Dispose of soiled linen in the proper container and drain sink. 20. Remove and discard gloves. Wash your hands. 21. Make resident comfortable. 22. Return bed to lowest position. Remove privacy measures.

23. Leave call light within resident’s reach. 24. Wash your hands. 25. Be courteous and respectful at all times. 26. Report any changes in the resident or the appearance of dentures to the nurse. Document procedure using facility guidelines.

10. Discuss guidelines for performing oral care for an unconscious resident
Remember these points about oral care for an unconscious resident: Oral care must be done frequently. Oral care keeps the mouth clean and moist. Oral care removes sordes and helps prevent them from developing. Use as little liquid as possible to prevent aspiration. Turn resident’s head to the side. Unconscious residents may still be able to hear. Explain the procedure to the resident and treat the resident with the same respect you would with a conscious resident.

REMEMBER: Even when people are unconscious they still may be able to hear what is going on around them. Limit your discussions to the care you are providing. Speak to unconscious residents as you would to any resident.

Providing oral care for the unconscious resident
Equipment: sponge swabs, tongue depressor, towel, emesis basin, gloves, lip lubricant, cleaning solution (check the care plan) 1. Identify yourself by name. Identify the resident. Greet 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. 2. Wash your hands.

3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with a curtain, screen, or door. 5. Adjust bed to a safe level, usually waist high. Lock bed wheels. 6. Put on gloves.

7. Turn resident on his side or turn 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. 8. Hold mouth open with tongue depressor. Do not use your fingers to open the mouth or keep it open.

9. Dip swab in cleaning solution. Squeeze excess solution to prevent aspiration. Wipe inner, outer, and chewing surfaces of the upper and lower teeth, gums, tongue, and inside surfaces of mouth. Change swab often. Repeat until the mouth is clean.

10. Rinse with clean swab dipped in water. Squeeze swab first to remove excess water. 11. Remove the towel and basin. Pat lips or face dry. Apply lip lubricant. 12. Clean and return supplies to proper storage. 13. Dispose of soiled linen in the proper container.

14. Remove and discard gloves. Wash your hands. 15. Make resident comfortable. 16. Return bed to lowest position. Remove privacy measures. 17. Leave call light within resident’s reach. 18. Wash your hands.

19. Be courteous and respectful at all times. 20. Report any changes in the resident to the nurse. Report any problems with teeth, mouth, tongue, or lips to nurse. This includes odor, cracking, sores, bleeding, and any discoloration. Document procedure using facility guidelines.

Remember these guidelines for giving eye care to an unconscious resident: Wear gloves. If using a washcloth, rinse it thoroughly before cleaning the opposite eye. If using cotton balls, use a clean cotton ball for one eye and then dispose of it. Wipe from the inner area of the eye to the outer area of the eye when cleaning. Follow the care plan when using moist compresses on the eyes. Use special lubricant as ordered.

11. Explain how to assist with grooming
Grooming is a very important part of the activities of daily living (ADLs). Each day, some residents will require help with brushing and styling their hair, shaving, dressing, caring for fingernails, and applying makeup and jewelry. Appearance has a great deal to do with the way people feel about themselves. Good grooming can have a positive effect on self-esteem, attitude, and independence. A well-groomed person is also likely to feel better physically because she is clean and neatly dressed. Promote self-care and independence whenever possible.

Remember these points for assisting with shaving: Wear gloves. Respect personal preferences regarding shaving. Wash and comb beards and mustaches every day. Do not trim facial hair. Soften hair first if using disposable or safety razor. Shave in direction of hair growth. Use after-shave, if desired.

Points for assisting with shaving (cont’d.): Discard disposable shaving products properly. Do not share razors between residents. Do not use electric razors near water, oxygen, or pacemakers. Handle safety razor blades carefully, and dispose of them properly.

Shaving a resident Equipment: razor, basin filled halfway with warm water (if using a safety or disposable razor), washcloth, 2 towels, mirror, shaving cream or soap, gloves, after-shave lotion 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

Shaving a resident 4. Provide for the resident’s privacy with a curtain, screen, or door. 5. Adjust bed to safe working level, usually waist high. Lock bed wheels. 6. Raise head of bed so resident is sitting up. Place towel across the resident’s chest, under his chin. 7. Put on gloves.

Shaving using a safety or disposable razor:
Shaving a resident Shaving using a safety or disposable razor: 8. Soften the beard with a warm, wet washcloth on the face for a few minutes before shaving. Lather the face with shaving cream or soap and warm water. 9. Hold skin taut. Shave in direction of the hair growth. Shave beard in short, downward, and even strokes on face and upward strokes on neck. Rinse the blade often in warm water to keep it clean and wet.

Shaving using an electric razor:
Shaving a resident 10. When you have finished, wash, rinse, and dry the resident’s face with a warm, wet washcloth. If he is able, let him use the washcloth himself. Offer mirror to resident. Shaving using an electric razor: 8. Use a small brush to clean razor, if necessary. Do not use an electric razor near any water source, when oxygen is in use, or if resident has a pacemaker.

Shaving a resident 9. Turn on the razor and hold skin taut. Shave with smooth, even movements. Shave beard with back and forth motion in direction of beard growth with foil shaver. Shave beard in circular motion with three-head shaver. Shave the chin and under the chin. 10. Offer mirror to resident.

11. Apply after-shave lotion as resident wishes.
Shaving a resident Final steps: 11. Apply after-shave lotion as resident wishes. 12. Remove the towel and place towel and washcloth in proper container. 13. Clean equipment and store it. For safety razor: rinse the razor and store it. For disposable razor: dispose of it in a sharps container. Do not recap razor. For electric razor: clean head of razor. Remove whiskers from razor. Recap shaving head. Return razor to case.

Shaving a resident 14. Remove and discard gloves. Wash your hands. 15. Make sure that there are no loose hairs. Make resident comfortable. 16. Return bed to lowest position. Remove privacy measures. 17. Leave call light within resident’s reach.

Shaving a resident 18. Wash your hands. 19. Be courteous and respectful at all times. 20. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

Remember these points when assisting with nail care: Washing and cleaning nails is part of the bathing process. Be gentle when using orangewood sticks. Do not cut resident’s toenails. Do not use nail equipment on more than one resident.

Providing fingernail care
Equipment: orangewood stick, emery board, basin, soap, gloves, washcloth, 2 towels, bath thermometer 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

4. Provide for the resident’s privacy with a curtain, screen, or door. 5. If the resident is in bed, adjust bed to safe working level, usually waist high. Lock bed wheels. 6. Fill the basin halfway with warm water. Test water temperature with thermometer or your wrist. Ensure it is safe. Water temperature should not be over 105°F. Have resident check water temperature. Adjust if necessary. Place basin at a comfortable level for resident.

7. Put on gloves. 8. Soak the resident’s nails in the basin of water. Soak all 10 fingertips for at least five minutes. 9. Remove hands. Wash hands with soapy washcloth. Rinse. Pat hands dry with towel, including between fingers. Remove the hand basin. 10. Place resident’s hands on the towel. Gently clean under each fingernail with orangewood stick.

11. Wipe orangewood stick on towel after each nail. Wash resident’s hands again. Dry them thoroughly, especially between fingers. 12. Shape nails with file or emery board. File in a curve. Finish with nails smooth and free of rough edges. 13. Empty, rinse, and wipe basin. Place basin in proper area for cleaning or clean and store it according to policy. 14. Dispose of soiled linen in the proper container.

15. Remove and discard gloves. Wash your hands. 16. Make resident comfortable. 17. Return bed to lowest position. Remove privacy measures. 18. Leave call light within resident’s reach. 19. Wash your hands.

20. Be courteous and respectful at all times. 21. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

Remember these points when assisting with hair care: Allow residents to choose their own hairstyles. Do not comb residents’ hair in a childish style. Be gentle when handling hair. Do not cut residents’ hair.

Define the following terms: dandruff excessive shedding of dead skin cells from the scalp. pediculosis an infestation of lice.

Know the causes of dandruff: Climate, especially dry, cold areas Stress Excessive sweating A type of fungus Hormonal changes Some types of dermatitis

Combing or brushing hair
Equipment: comb, brush, towel, mirror, hair care items requested by resident Use hair care products that the resident prefers for his or her type of hair. 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands.

3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with a curtain, screen, or door. 5. If the resident is in bed, adjust bed to safe working level, usually waist high. Lock bed wheels. 6. Raise head of bed so resident is sitting up. Place a towel under the head or around the shoulders.

7. Remove any hair pins, hair ties and clips. 8. Remove tangles first by dividing hair into small sections. Gently comb out from ends of hair to roots. Be careful not to break hair or cause any discomfort. 9. After tangles are removed, brush two-inch sections of hair at a time. Brush from ends to roots.

10. Neatly style hair as resident prefers. Avoid childish hairstyles. Each resident may prefer different styles and different hair products. Offer mirror to resident. 11. Make resident comfortable. 12. Return bed to lowest position. Remove privacy measures.

13. Return supplies to proper storage. Clean hair from brush/comb. Clean comb and brush. 14. Dispose of soiled linen in the proper container. 15. Leave call light within resident’s reach. 16. Wash your hands. 17. Be courteous and respectful at all times. 18. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

Remember these points about lice, or pediculosis: Parts of the body that may have lice infestation include the head, the pubic area, and other areas of the body, such as the underarms. Symptoms of lice include intense itching, scratching, and scratch marks or rashes on the scalp, neck, or body. Lice eggs can be seen on the hair, behind the ears, and on the neck. Lice droppings look like a fine black powder. Report symptoms immediately. Lice can spread very quickly.

Remember these points when assisting with dressing and undressing: Refer to a weaker side as “weaker,” “affected,” or “involved.” Do not refer to it as “bad side” or “bad leg” or “bad arm.” When dressing residents, always begin with the weaker side of the body. Remember the acronym “POW”: put on weak When undressing, begin with the stronger side of the body. Treat clothing carefully. Encourage independence with dressing and undressing. Do not rush residents when dressing. Make sure all clothing is marked with resident’s name. Allow residents to choose their own clothing.

Assisting with dressing and undressing (cont’d.): Make sure clothing fits properly. Provide privacy when dressing and undressing. Keep residents covered. Gently smooth socks and stockings to remove wrinkles and twists. Front-fastening bras are easier for residents to work by themselves. Put back-fastening bras on waist and fasten them in front first before rotating around. Clothing with elastic waistbands are easier to get on and off. Use assistive devices when needed.

Equipment: clean clothes of resident’s choice, non-skid footwear
Dressing a resident Equipment: clean clothes of resident’s choice, non-skid footwear When putting on all items, move resident’s body gently and naturally. Avoid force and over-extension of limbs and joints. 1. Identify yourself by name. Identify the resident. Greet the resident by name. 2. Wash your hands.

Dressing a resident 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with a curtain, screen, or door. 5. Ask resident what she would like to wear. Dress her in outfit of choice.

Dressing a resident 6. Remove resident’s gown. Do not completely expose resident. Take clothes off stronger, or unaffected, side first when undressing. Then remove from weaker side. 7. Gather up sleeve to ease pulling over affected arm. Insert your hand through sleeve and grasp resident’s hand to support arm while dressing. Assist resident to put the affected/weaker arm through the sleeve of the shirt, sweater, or slip before placing garment on the unaffected/stronger arm.

Dressing a resident 8. Help resident to put on skirt, pants, or dress. Put the affected/weak leg through skirt or pants first. Raise the buttocks or turn resident from side to side to draw pants over the buttocks up to waist. 9. Place bed at the lowest position. Lock bed wheels.

Dressing a resident 10. Have resident sit down. Pull up socks until they are both smooth and without wrinkles. Put on non-skid footwear. Fasten securely. 11. Finish with resident dressed appropriately. Make sure clothing is right-side out and zippers/buttons are fastened. Make sure skirt, pants, or dress is not caught under resident’s shoes.

Dressing a resident 12. Make resident comfortable. Remove privacy measures. 13. Place gown in soiled linen container. 14. Leave call light within resident’s reach. 15. Wash your hands. 16. Be courteous and respectful at all times. 17. Report any changes in the resident to the nurse. Document procedure using facility guidelines.

Exam Multiple Choice. Choose the correct answer. 1. Hygiene is: (A) Practices like fingernail, foot, and hair care (B) Methods of keeping the body clean (C) Activities of daily living, such as eating, drinking, and elimination (D) A.M. care and P.M. care 2. One way to promote dignity and independence with personal care is to: (A) Encourage residents to perform tasks independently even if it takes longer (B) Choose which clothes and cosmetics the resident will wear (C) Encourage residents to do their ADLs quickly (D) Leave residents alone while bathing

Exam (cont’d.) 3. Ms. Martin is an elderly resident with very dry skin. What kind of bath would be appropriate for her? (A) Partial bath (B) Shower (C) Tub bath (D) Complete bed bath 4. Mr. Reynosa has a doctor’s order for epsom salt additives during bathing. What kind of bath would be most appropriate for him?

Exam (cont’d.) 5. Ms. Reid is unable to get out of bed due to recent surgery. She is very concerned with cleanliness and wants to bathe every day. Which kind of bath is most appropriate for her? (A) Partial bath (B) Shower (C) Tub bath (D) Complete bed bath 6. The decision on which bath to give a resident is made by: (A) The physical therapist (B) The nursing assistant (C) The doctor and the resident (D) The resident’s family

Exam (cont’d.) 7. Observing residents’ skin during personal care and bathing is especially important in the prevention of: (A) Depression (B) Abuse (C) Pressure ulcers (D) Diabetes 8. The highest priority when bathing residents is: (A) Speed (B) Safety (C) Making sure every resident has a bath every day (D) Observing for mobility

Exam (cont’d.) 9. A nursing assistant can make bathing safer for residents by: (A) Asking for help if she cannot safely handle the task alone (B) Gathering all needed equipment after entering the bath/shower area (C) Making sure the water temperature is not over 120°F (D) Leaving residents alone while bathing or showering 10. A general rule for bathing a person is: (A) Wash from dirtiest to cleanest (B) Wash from cleanest to dirtiest (C) Wash body parts in whatever order the resident prefers (D) Wash body parts in whatever order the nursing assistant prefers

Exam (cont’d.) 11. The part of the body that should be washed first is: (A) Face (B) Neck (C) Eyes (D) Hands 12. Which of the following should be washed every day? (A) Hair (B) Knees (C) Chest (D) Perineum

Exam (cont’d.) 13. To shampoo the hair of a resident on a stretcher, the nursing assistant should: (A) Transfer the resident to a bed (B) Transfer the resident to a chair near the sink (C) Bring the stretcher to the sink and adjust height to be even with the sink (D) Transfer the resident to the tub 14. If the nursing assistant notices redness around bony areas during a massage, she should: (A) Massage around these areas (B) Massage these areas (C) Discontinue the massage (D) Apply extra lotion to these areas

Exam (cont’d.) 15. How often must oral care be provided for residents? (A) Once a day (B) At least twice a day (C) Only when the resident requests it (D) Every other day 16. A resident who is edentulous: (A) Lacks teeth (B) Has bad-smelling breath (C) Is wearing dentures (D) Has tartar deposits on the teeth

Exam (cont’d.) 17. Which of the following is true about oral care? (A) Residents without teeth will not require any oral care. (B) Residents who are unconscious and do not eat do not require any oral care. (C) Oral care is not just care of the teeth, but also the mouth, tongue and gums. (D) Residents who wear dentures do not require oral care. 18. Which of the following is the proper temperature for rinsing and storing dentures? (A) Cold (B) Lukewarm (C) Hot (D) Boiling

Exam (cont’d.) 19. The primary risk for unconscious residents is: (A) Mouth dryness (B) Aspiration (C) Gingivitis (D) Mouth sores 20. In which of the following procedures must a nursing assistant always wear gloves? (A) Shaving a resident (B) Combing or brushing hair (C) Dressing a resident (D) Turning a resident

Exam (cont’d.) 21. Ways to prevent aspiration during oral care of unconscious residents include: (A) Pouring mouthwash slowly into the resident’s mouth (B) Turning residents on their backs when giving oral care (C) Avoid performing oral care on unconscious residents (D) Using as little liquid as possible when giving oral care 22. A nursing assistant should give nail care: (A) Whenever she has time (B) When she is bathing a resident (C) When she notices a resident’s nails are getting long (D) When the resident’s nail polish wears off

Exam (cont’d.) 23. Which of the following statements is true? (A) Residents’ hair should be handled gently because hair can be pulled out when combing or brushing it. (B) Residents’ hair should be combed or brushed into childish hairstyles. (C) Nursing assistants should cut residents’ hair if it is getting long. (D) Pediculosis (lice) cannot spread quickly. 24. When assisting a resident who has one weak side with dressing: (A) Clothing should be put on the weak side first (B) Clothing should be put on the strong side first (C) The weak side should be referred to as the “bad side” (D) It does not matter which side clothing is put on first

1. Define important words in this chapter

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