MNAMosby’s Long Term Care Assistant Chapter 20 Hygiene

Hygiene

Promotes comfort, safety and healthPrevents body and breath odorsRelaxing and increases circulation

Daily Care

Most people have hygiene routines or habits

Routine care is given during day and evening

Assist whenever needed.

Before Breakfast

Am careAssist with:

eliminationface and hand washingOral hygieneDressing and hair careChanging incontinent residentsPositioning for mealsStraightening unit and making bed

After Breakfast

Morning CareAssist with:

eliminationBathOral hygieneDressing Hair careShavingROM

Afternoon Care

After lunch and the evening meal

Assist with: eliminationOral hygieneActivitiesChanging incontinent residentsChanging wet or soiled linen

Evening Care

HS CareAssist with:

eliminationOral hygieneChanging into sleepwearChanging incontinent residentsChanging wet or soiled linen

Oral Hygiene

Keeps mouth and teeth clean

Prevent mouth odors and infections

Increases comfortIncreases appetiteReduces risk of

cavities and gum disease

Residents with dry mouth (those using O2) will need frequent oral care.

Follow Standard

Precautions and

Bloodborne Pathogen

Standards:

Wear GLOVES

Oral Hygiene

Equipment:ToothbrushToothpasteMouthwashEmesis BasinDenture CupToothetteWaterGloves

Flossing:

Removes plaque and tarter

Done after brushing

If done only once a day – do at

bedtime

Oral Hygiene for the Unconscious Resident

Use Toothette

Lateral position to prevent aspiration

Use padded tongue blade to keep mouth open

Q2H

Denture CareCleaned as often as natural

teethSlipperyEasily broken when droppedLine sink or basin with

paper towelHot water causes warpingStore in cool water if not

wornUse gauze to grasp teeth if

assistance is needed with removing

Mouthwash for rinsing

Bathing

Cleans the skin Refreshing and

relaxingStimulates

circulationOpportunity to

make observations

Due to dry skin: Older persons usually need a complete bath

2x week.

BathingComplete Bath

Partial Bath (bath with assistance)

Partial Bath

Shower

Tub

Total care provided by CNA

Essentials: Face, hands, armpits, peri-care

Resident can assist. Will usually need assist with back and feet.

Provided by CNA

Provided by CNA

Rules for BathingFollow Care plan

Allow personal choice when possible

Practice Standard Precautions

Provide privacy

Cover for warmth and privacy

Protect from falling

Rules for BathingUse good body mechanics

Check water temperature

Wash from clean to dirty

Encourage resident to help

Rinse thoroughly

Dry between skin folds

Observe

Observations to makeSkin color

Rashes

Bruises

Open skin areas

Pale or red skin

Drainage or bleeding

Swelling

C/o pain

Complete bed bathEyesFaceFar arm, Near armChestAbdomenChange waterFar leg, near legFeetChange waterBackChange waterPeri-care

Use Bath blanket

Make a bath mitt

Use lotion and deodorant

ROM

Soak hands and feet prn

Report and record

Partial bed bathResident is too ill to

have complete bath

Resident had complete bath day before

Resident is having procedure or tests done soon

FaceHandsArm pitsPeri-care

Use Bath blanket

Make a bath mitt

Use lotion and deodorant

Report and record

Partial Bath (Bath with Assistance)Resident is capable

of completing much of own bath

Set resident up with all equipment needed.

Assist with areas resident could not get to, usually: back and feet.

May be done on SOB or in BR

Make a bath mitt

Use lotion and deodorant

Report and record

Shower TUBPrevent slipping,

falls, chills and burns

A chair is usually used

Protect privacy

Water temp 105 F

Prevent slipping, falls, chills and burns

Last no longer then 20 minutes

Clean before and after use

Bath mat

Fill tub before getting in

Protect privacy

Water temp 105 F

Back Massage

Relaxes muscles Stimulates

circulationAfter bath and with

HS careLast 3-5 minutesUse lotion to reduce

frictionSide lyingFirm strokesUpward

Do not massage reddened

areas:

can lead to further tissue

damage

Perineal Care

Peri-care

Cleaning the genital and anal area

QD and prn

Use common terms

Standard Precautions: GLOVES

Perineal CareMale:Retract foreskin if uncircumcised

Clean the tip using a circular motion

Repeat as needed working down the shaft

Rinse, Dry, replace foreskin if needed

Clean around and under the scrotum

Rinse, dry

Clean rectal area

Rinse, Dry

Perineal Care

Female:Separate the labia

Clean front to back using a different part of the wash cloth with each stroke

Repeat until clean

Rinse, Dry

Clean rectal area from vagina to anus

Rinse, Dry

Reporting and Recording

Report bleeding stat

Report Care given

Record on ADL Flowsheets

ADL Flow Sheet

Oral care

Skin care

Hygiene

Peri-care

Back Massage

ROM

Review

Hs care is given ?

At bedtime

Review

Hygiene measures decrease circulation.

True False

Review

Cleansing the genital and anal area is called

Peri-care

Review

When is the best time to floss?

At bedtime

Review

The unconscious resident needs oral care

_______________. Q2H

Review

How will you know what the residents hygiene needs are?

Care plan

Review

What can be used to provide oral care to the unconscious resident?

Toothette

Review

The unconscious resident is at

risk for _____________ during oral care.

aspiration

Review

Older persons need a complete bath at least 2x week.

True or False

Review

Residents who take tub baths and showers are at risk for

Burns and falls

Review

When providing male peri-care which part is cleaned first?

Tip of the penis

Review

Residents who take tub baths and showers are at risk for

Burns and falls

Review

When transporting the resident from room to shower be sure to

Keep the resident covered

Review

If you notice that a resident is incontinent when you begin his bath you should

A. Start the bath as usual, with the eyes

B. Provide peri-care first, change water and begin the bath

C. Pad the area with dry towels, begin the bath as usual

D. Doesn’t matter, begin as you choose.

Review

When providing peri-care

A. Use upward strokes, rectal area to urethra

B. Use bath oil to ensure adequate cleaning

C. Wash the rectal area first

D. Use a clean part of the wash cloth for each stroke.

Review

The far arm is washed before the near arm .

True or False

Review

AC

S

C

C/O

HS

OOB

TID

BID

Before meals

without

with

Complains of

bedtime

Out of bed

3X day

2X day

Questions??