Hygiene (Chp. 18) Day 2

Nursing Assistant Class

Evening Care

Care given in the evening at bedtime; PM care

Morning Care

Care given after breakfast; hygiene measures are more through at this time

Perianal Care

Cleaning the genital and areas

Hygiene

- Intact skin is the body’s first line of defense against disease
- It prevents microbes from entering the body and causing an infection

- Good Hygiene:
- Cleanse the body
- Prevents body and breath odors
- Is relaxing and increases circulation

- Culture and personal choice affect hygiene
- Many factors affect hygiene needs (e.g., perspiration, elimination, vomiting, drainage from wounds or body openings, bedrest, activity)

Daily Care

- Most people have hygiene routines and habits
- Weak and disabled persons need help with hygiene
- Assist with hygiene whenever it is needed
- Protect the person’s right to privacy and to pretend choice
- Daily care is given at these times:
- Before breakfast (early morning care, or AM care)
- After breakfast (morning care) - hygiene measures more thorough
- Afternoon care-done before a person takes a nap, has visitors, or attends activity’s programs
- Evening care (PM care) - is relaxing and promotes comfort

Oral Hygiene

- Keeps the mouth and teeth clean
- Prevents mouth odors and infections
- Increases comfort
- Makes food taste better
- Reduces the risk of periodontal disease (inflammation of the tissues around the teeth)
- Dry mouth from oxygen use, smoking, decreased fluid intake, and anxiety

Flossing (Oral Hygiene)

Flossing:
- Removes plaque and tartar from the teeth
- Removes food from between the teeth
- Is usually done after brushing
- You need to floss for persons who cannot do it themselves
- If done once a day, bedtime is the best time to floss

Equipment (Oral Hygiene)

Supplies Needed:
- A toothbrush, toothpaste, dental floss, and mouthwash
- Persons with dentures need a denture cleaner, denture cup, and denture brush or tooth brush. Use only denture cleaning products to avoid damaging denture
- Sponge swabs are used for persons with sore, tender mouths and for unconscious persons. Check the foam pad to make sure it is tight on the stick. It can be a potential chocking hazard.
- You also need a kidney basin, water glass or cup, straw, tissues, towels, and gloves. Many persons bring oral hygiene equipment from home

Brushing and Flossing Teeth (Oral hygiene)

- Most people perform oral hygiene themselves
- You may need to brush the teeth for persons who:
- Are very weak
- Cannot move or use their arms
- Are too confused to brush their teeth
- Some people need help gathering and setting up equipment
- Always wear gloves when giving oral hygiene

Mouth Care for the Unconscious Person (Oral Hygiene)

- The mucous membranes can dry out in mouth breathers or persons who receive oxygen
- Oral hygiene keeps the mouth clean, moist, and help prevent infection
- Protect unconscious persons from choking and aspiration by positioning the person on one side with the head turned to the side
- The care plan tells you what cleaning agent to use
- Keep the person’s mouth open with a padded tongue blade
- Use sponge swabs to clean mouth
- Always assume the unconscious person can hear
- Mouth care is given at least every 2 hours
- Always assume the unconscious person can hear
- Mouth care is given at least every 2 hours
- Follow the nurse’s direction and the care plan

Denture Care (Oral Hygiene)

Dentures are artificial teeth:
- Mouth care is given and dentures cleaned as often as natural teeth
- Dentures easily break or chip if dropped onto a hard surface
- Line the sink with a towel. Fill the sink halfway with water
- Use a gauze square to remove dentures to get a good grip on the slippery dentures
- To use a cleaning agent, follow the manufacturer’s instructions
- Hot water causes dentures to lose their shape (Warp). Use cool or warm water to clean. Store in cool water.
- Remind residents not to wrap dentures in tissues or napkins
- You clean dentures for those who cannot do so. Many people clean their own dentures. Some people need help collecting items used to clean dentures

Bathing (Info 1)

- Cleans the skin and mucous membranes of the genital and anal areas
- Circulation is stimulated and body parts are exercised
- Observations are made and you have time to talk to the person
- Dry skin occurs with aging and is easily damaged. Soap also dries the skin. Plain water is often used for older persons d/t dry skin
- Pat the skin dry after bathing to avoid irritating or breaking the skin. Do not run

Bathing (Info 2)

- Bathing frequency is a personal matter
- Older persons usually need a complete bath or shower twice a week
- Bath oils prevent dry skin. Showers and tubs become slippery from bath oils; safety measures are needed to prevent falls

- If using powder after bathing, apply to dry skin in a thin, even layer
- Bathing procedures can threaten persons with dementia. You must be calm, patient, and soothing

The Complete Bed Bath (bathing)

- Involves washing the persons entire body in bed
- Usually needed by person who are:
- Unconscious
- Paralyzed
- In casts or traction
- Weak from illness or surgery
- Hot water can burn the skin. Measure temp of water according to center policy
- Heat is lost rapidly in bath basins. Therefore, water temp for a complete or partial bed bath is usually between 110 degrees - 115 degrees

- Always observe the skin when bathing and report any unusual finding ie: rashes, skin breakdown

- Never use soap around the eyes. Only use water

Towel and Bag Bath (bathing)

- Towel baths are quick, soothing, and relaxing
- Perfect for persons with dementia
- Large towels are saturated with a cleaning agent, skin softener, and drying agent

- Bag baths are commercially prepared or prepared at the center

- Bag has 8-10 washcloths with a cleaning agent that does not need rinsing
- Washcloths are warmed in the microwave or warming unit

The Partial Bath (bathing)

- Involves bathing the face, hands, axillae, back, buttocks, and perineal area
- You can give partial baths to persons who cannot bathe themselves
- When setting a person up for a partial bath, place the call light in reach to signal when help is needed or bathing is complete

- Water temp is 110-115

Tub, Bath, and Shower (bathing)

- Falls, burns, and chilling from water are risks
- Safety is important
- The person’s privacy must be protected
- A resident can have a shower as often as they choose
- A tub bath can make a person fell faint, weak, or tired
- A tub bath lasts no longer than 20 minutes
- Water temp is 105
- Direct water away from the person while adjusting water temperature and pressure

The Back Massage

- Relaxes muscles and stimulates circulation
- Are given after the bath and with evening care

- Can be given after repositioning or to help the person relax
- Last 3 to 5 minutes
- Always ask for consent before doing
- Always keep your hands in contact with the persons skin
- Observe the skin before massage
- Lotion reduces friction during the massage
- Lotion is warmed before being appiled

Reporting and Recording

- You make many observations while assisting with hygiene
- Report at once the following:
- Bleeding
- Signs of skin breakdown
- Discharge from the urinary tract or vagina
- Unusual odors
- Any change from prior observations
- Report and Record the care given
- If care is not recorded, it is assumed the care was not given