Download Activities of Daily Living: Hygiene

Activities of Daily Living: Hygiene
Occupationally Specific Knowledge and Skills
Objective:
Upon completion of this lesson, you
will be able to perform the tasks of
basic hygiene, activities of daily
living, in the laboratory and clinical
setting.
The most basic of daily hygiene
activities can be overlooked when
one is sick or elderly.
What is your normal
morning routine?
Oral Hygiene
Definition
1. Care of the mouth and teeth
2. Ideally should be done three times a
day
3. Realistically in a nursing home is
done once a day
4. Residents should always be
encouraged to be independent as
much as possible
Residents/Patients requiring
frequent oral hygiene (as often
as least every 2 hours)
1. unconscious
2. vomiting
3. those experiencing high temperature
4. those receiving certain medications
5. dehydrated
6. mouth breathers
7. those receiving oxygen
Why provide Oral Hygiene?
• Keeps mouth clean
and teeth clean.
• Prevents mouth odors
(Halitosis) and
infection
• Increases comfort
• Makes food taste
better.
• Reduces risk for
cavities
• Some drugs cause:
A bad taste in mouth
Whitish coating in mouth
and on tongue (thrush)
Redness/swelling in
mouth on tongue
Dry mouth (O2, smoking,
decreased intake,
anxiety)
Brushing Teeth
• Hold brush at 45
• On bottom teeth, start
degree angle for inner
at inner aspect, then
and outer aspect of
outer, then chewing
teeth. Hold horizontally
surfaces.
for chewing surfaces.
• Clean tongue.
• Start on top teeth.
• Make sure suction is
Start at inner aspect.
set up.
Then outer aspect.
Then chewing surface.
Oral Hygiene
If someone has trouble swallowing,
unconscious, better to use a special
mouth sponge with toothpaste in the
sponge. Also used in pt’s with sore,
tender mouths.
a. dipped in ½ strength mouthwash and
water
b. excess water squeezed out
c. head of resident turned to side and
mouth cleaned
When doing oral hygiene
a. all surfaces of the teeth should be
cleaned
b. tongue should be cleaned
c. mouth washed after cleansing with ½
strength mouth wash, if safe for resident
d. gloves worn throughout
Oral Hygiene Video
Denture Care
a. rinse with lukewarm to cool water. HOT
or very COLD water can crack them
b. put gloves on to remove and use a tissue
to remove top dentures first.
1. Place index finger against the roof
of the mouth
2. Thumb against front teeth
3. Gently press and lift out at same
time
4. You will feel seal release
5. Then remove lower dentures
c. When replacing dentures in mouth, lower
dentures first, then uppers. Lowers
help secure uppers.
d. brush all surfaces of dentures, upper and
lower
e. before replacing, wash mouth and tongue
with sponge cleaner and rinse with ½
strength mouthwash and water
Denture Care (continued)
• Use extreme care
when handling
dentures
• See that dentures are
not lost or broken
• Keep in container
labeled with Pt’s name
• Store in clean, cool,
water or cleaning
solution
• When preparing to
clean, place cloth over
drain in sink and fill
with 2 inches of water
Eyeglasses
A. Keep clean by rinsing with water and drying with special
lens paper or soft, nonabrasive tissue.
B. Store in container in bedside stand when not in use.
C. Glasses should be kept in easy reach of patient.
D. Encourage resident to wear whenever possible.
Daily Shaving
A. Residents should be shaved daily
B. Remember, when shaving
1. use the resident’s own shaving
equipment if possible. Otherwise use
disposable, sharp safety razors
2. if resident is receiving
anticoagulants, use an electric razor
if possible
3. if oxygen is being administered,
discontinue for this procedure if
possible
4. elderly women sometimes grow
hair on their faces and chins.
Shaving is permitted but you must have
a doctor’s order to do so in some
facilities.
Steps of Shaving a Patient:
1. Moisten the beard with warm, wet washcloth (check razor for damage by
rubbing on folded piece of gauze)
2. Apply shaving cream
3. Do not moisten beard if you intend to use an electric razor
4. Start in front of the ear
a. hold skin taut
b. bring razor down over cheek toward chin
c. repeat until lather has been removed and area shaved
d. remove hair from under the nose and above upper lip by
moving razor in short, downward strokes from nose to lip
e. shave skin carefully; having person tense area helps
f. shave neck area on each side, bringing razor up toward chin
g. use short, firm strokes; rinse razor often
h. wash face and neck; dry thoroughly
i. if skin is nicked, apply pressure directly over are and report to
nurse in charge
j. always wear gloves http://youtu.be/QC47Au3naGs
Feeding a Patient
• Good nutrition is an important part of a patient’s treatment
(enjoyment, helps healing wounds
• Make mealtimes as pleasant as possible
• Mealtimes are regarded as social time
• Important to talk with Pt. while feeding
• People enjoy eating with others
• Delay of meals
• Check food tray
Before Feeding
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Check for ALLERGIES
Make sure Pt. is not NPO or scheduled for procedure
Offer bathroom or bedpan prior to eating
Allow Pt. to wash hands
Provide oral hygiene if Pt. desires
Position Pt. comfortably
Clear table and wipe down
Make sure tray has correct name and type of diet
Feeding a Patient
(continued)
• Allow patient to feed themselves
whenever possible
• Assist by cutting food, opening items, buttering bread
• Test temperature of food ( check small amount on
your wrist)
• DON’T BLOW ON HOT FOOD
• Relaxed, unhurried atmosphere
• Observe for any signs of choking (if suspect choking
STOP feeding and notify nurse or doctor)
Feeding a Patient
• Give sips of liquid in between bites of food (moistens food
to prevent choking)
• Give Pt. enough time to swallow
• Give small amounts
• Use straws UNLESS pt has dysphagia (difficulty
swallowing)
• Use thickener if needed (helps solidify food making it
easier to swallow)
• Observe and record amount of food eaten (I&O)
Feeding the Patient
• Hold utensils at right angle (90 degrees) to patient’s mouth
• Feed from tip of utensil
• Give small amounts and make certain the resident has
carefully chewed and swallowed the food
• Fill spoon or fork one-third to one-half full
• Use towel to cover chest and wipe mouth
• If feeding someone with weakness on one side of mouth or
both sides, make sure that food isn’t being packed into the
cheeks
• Patients can’t always feel food in their mouths and would
not be aware of some was being stashed in the cheeks
Feeding the patient
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Be careful when removing the fork or spoon so utensil
does not scrape the roof of the mouth (palate)
Use a straw when giving liquids. Direct the straw by
holding it
between two fingers. Hold the straw until the patient
releases it
from his/her mouth
Offer fluids often. Some need it after each mouthful of
solid food
Vary each mouthful.
Feed as you would eat
When preparing the tray, find out how resident wants
their food.
For example, some do not like butter, but prefer jam,
sugar in tea
Feeding Video
END
Dysphagia
• Dysphagia means difficulty swallowing food.
• Food thickness can be changed to meet person’s needs
• Speech/Language pathologist, Doctor, nurse assesses for
right food thickness
• Thickened liquid (creamy, sauce like), medium thick
(nectar like, V8 juice), Extra thick ( honey-like, mounds on
the spoon), puree (no lumps, thick like mashed potatoes)
Signs of Dysphasia
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Person avoids foods that require chewing
Tires during meal
Food spills out of mouth while eating
Pockets food
Eats very slowly
Complains food doesn’t go down or feels stuck
Frequently clears throat before, during, or after swallowing
Spits out food suddenly or vomits after eating
Excessive drooling of saliva
Dysphagia
• http://leavingbio.net/human%20nutrition/Human%20Nutriti
on_files/image014.gif
Aspiration
• Aspiration is breathing fluid, food, vomitus, or an object
into the lungs.
• Signs of Aspiration- choking, coughing, difficulty
breathing during or after meals, abnormal breathing or
respiratory sounds, decreased spo2 after eating.
• How do you prevent Aspiration?
Preventing Aspiration
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Help person with meals
Position Pt. as upright as possible
Have Pt. stay in upright position an hour after eating
Check person’s mouth after eating for pocketing (inside
cheeks, under tongue, on roof of mouth)
• Remove any food left in mouth
Dressing a Patient
A. Let person select their clothing
B. Let them do as much of the
dressing as possible
C. Position in front of a mirror if one
is available
D. Dress weakest side first, then
strongest
E. Undress strongest first, then
weakest
F. Use tools to assist the resident to
care for herself/himself
Dressing a Patient Video
Daily Hair Care
A. Usually performed after bath
B. Brushing hair
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stimulates circulation of the scalp
refreshes the patient
Start at scalp going towards ends
OBSERVE for scalp sores,
flaking, itching, Nits, Lice, hair
C. Tangled or matted hair
NEVER CUT TANGLED HAIR
1. work section by section
2. untangle hair, beginning near the
ends and working toward the
scalp
3. gum may be
removed with
ice or peanut
butter
Shampooing
• Shampoo during shower
• Shampoo in bed- Person’s head is tilted over the edge of
the sink. Use a water pitcher to wet hair. Place shampoo
tray under head to protect linens. Place cloth over eyes.
• Commercially prepared shampoo caps- contains cleaning
agent that doesn’t require rinsing. Warm package in
microwave. Check temp. Massage gently1-3 minutes.
Towel dry
http://youtu.be/_rg59kHKNt8
Nail Care
A. Care to the fingernails is allowed by the state of Texas. Care of
toenails by nurse aides is not. Due to diminished circulation of the
lower extremities in elderly and ill people
B. Should a cut occur, infection might set in and healing be very difficult
C. Podiatrists are brought in to perform foot care
D. Even where fingernails are concerned, do not do on a diabetic
individual
E. Procedure
1. soak nails for at least 5-10 minutes.
2. Nails can be cleaned while soaking
3. Use an orange stick to push cuticles back
4. Clip the nails either straight across
or slightly rounded
5. File any rough edges
Bathing
• Complete bed bath- PCT bathes all parts of the
patient’s body, provides oral care, hair care, nail care,
and perineal care. (patients are confined to bed, or too
ill to bath themselves.
• Partial bed bath- PCT bathes some parts of the
patient’s body. ONLY face, arms hands, back, perineal
area are bathed OR patient washes most of their body
and PCT washes and helps with legs and back
• Disposable cleansing cloths- Used instead of basins,
they are cloths that contain rinse-free cleanser
*** Before leaving a pt. in a tub or shower, instruct pt.
how to use emergency call signal***
Back Rub
(Check facility Policy)
• Considered part of daily bath unless contraindicated by pt.
condition. Usually 4-7 minutes. Helps stimulate circulation,
prevents pressure ulcers, relaxing.
• Pt can lie on abdomen or side.
• Be alert for red areas, rash, sores, cuts, bony areas
• Use small amount lotion
• A. Begin at base of spine, RUB UP the center to neck, firm
pressure, around shoulders, and gentle pressure Down
the sides of the back . Down over buttocks and circle back
to starting point. USE long, soothing, firm pressure on
upward strokes and gentle pressure on downward strokes.
REPEAT x 4.
• B.Next, ON downward stokes use circular motion.
Back rub continued
C. Upward strokes with small circular motions going
downward ( using palm of hand to apply firm pressure) x 1.
D. Repeat step 1 for 3-5 minutes.
E. End with up and down motions over entire back for 1-2
minutes.
Assessment During Personal
Hygiene
REPORT any unusual observations including:
Sores, cuts, injuries: to skin, scalp, or mouth
Rashes: any type of rash (could be sign of allergic reaction)
Color : Redness (ERYTHEMA) of skin. Could be sign of
pressure sore. Blue color (CYANOSIS) Could be sign of
poor circulation. Yellow color (JAUNDICE) Could be sign of
liver disease
Swelling, or edema: Could be sign of poor circulation or
disease. Pay careful attention to hands, feet, ankles, toes.
Signs of distress: Dyspnea (difficulty breathing), Vertigo
(dizziness), unusual weakness, Diaphoresis (excessive
perspiration), Lethargy (abnormal drowsiness)
Complete Bed Bath
• Gather supplies ( linen basket, bath blanket, 3-4 wash
clothes, 2-3 bath towels, soap, basin, bath thermometer,
gown, supplies for hair, oral, shaving, and nail care, lotion,
gloves)
• Close door, draw curtain, adjust temperature in room
• Wash hands, apply gloves
• Prepare linen in order needed and place to side
• Replace top sheet with bath blanket
• Provide oral care
• Shave
• Fill basin about 2/3 full warm water at about 105-110
degrees F. Check temp with bath thermometer.
Bath Continued
• Remove gown
• Place towel over the upper edge of bath blanket
• Wash face with mitten ( keeps water from dripping), wash
eyes first. Start at inner area and wash to outside of eye
using a different section of cloth when you wash the
second eye.
• Rinse cloth. Apply soap. Wash face, neck, ears. Rinse.
Dry.
• Place bath towel lengthwise under pt’s arm farthest from
you. Put basin of water on bed and on towel at lower end.
• Wash, rinse, dry from axilla to hand. Soak nails and hand
in water. Repeat for other arm.
Bed Bath continued
• Discard water. Fill with clean water. Put a towel over chest.
Fold bath blanket to pt’s waist.
• Wash, rinse, dry chest and breasts (assess under breasts)
• Turn towel lengthwise to cover chest and abdomen
• Fold bath blanket down to pubic area
• Wash, Rinse, and dry abdomen. Replace bath blanket.
Remove towel.
• Fold bath blanket to expose leg farthest from you
• Place towel lengthwise under leg and foot. Place basin on
the bed on top of towel. Place foot in basin. Wash, Rinse,
dry leg and foot. Repeat for other leg.
• Change water. Turn pt to side. Place towel lengthwise on
bed along back.
Bed bath
• Wash, rinse, dry back.
• Give backrub
• Wash patients perineal area. Drape in dorsal recumbent
position. Place towel or pad under buttocks.
• Female wash front to back. Separate labia and cleanse
front to back motion. Use clean area of cloth between each
wipe.
• For male, cleanse tip of penis using circular motion. Clean
top to bottom. If uncircumcised, gently draw back foreskin
to wash area. Wash scrotum.
• Clean rectum with pt. on their side. Rinse and dry all
areas.
• Place gown, perform hair care, make occupied bed
CHECKPOINTS
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Before doing any procedure check facility policy
Position pt. in proper alignment
Elevate side rails, wheels locked
Lower bed to its lowest level
Place call bell within reach, Kleenex, glasses, etc..
Clean and replace used supplies (wash basin)
http://youtu.be/vfp8Qf0fg8A