Nursing Assistant CH 13

Hygiene: a term used to describe practices that keep bodies clean and healthy

Grooming: practices like caring for fingernails and hair, shaving, and applying makeup

ADLs (activities of daily living)

  • Hygiene and grooming activities, dressing, eating, transferring, and elimination

Those who may need help with personal care

  • Person with long-term chronic condition

  • Person who is frail because advanced age

  • Person is permanently disabled

  • Person is dying

Personal care: bathing, perineal care, elimination, mouth care, shampooing, conditioning, hair, nail care, shaving, dressing, eating, walking, and transferring

NAs must:

  • Encourage independence

  • Be aware of residents individual preferences

  • Knock and wait for permission to enter residents room

  • Not interrupt resident while in br

  • Leave room when resident is on call

  • Respect residents private time

  • Not interrupt resident while they are drsg

  • Keep residents covered whenever possible when helping dress

During Procedure:

  • Check for any changes in residents' appearance or state

    • Skin color, temp, redness, mobility, flexibility, comfort level, pain, discomfort, strength, ability to perform ADLs, mental and emotional state, residents' complaints

  • If resident appears tired, NA stops and takes break

After care:

  • NA always asks if resident would like anything else

  • Leave area clean and tidy

  • Make sure call light is in reach

  • Check room has proper lighting and comfortable temperature

  • No electrical cords/objects in walkway

  • Bed left in lowest position

Pressure points: areas of the body that bear much of the body weight

Body prominences: areas of the body where the bone lies close to the skiin

  • Higher risk for skin breakdown

  • Elbows, shoulder blades, sacrum, hips, knees, ankles, heels, toes, back of head

  • Between ears, under breasts/scrotum, area between folds of buttocks/abdomen, skin between legs

Pressure injuries: injuries/wounds resulting from skin deterioration and shearing

  • Pressure ulcers, pressure sores, decubitus ulcers, bed sores

  1. Pressure on area reduces circulation, decreasing O2 cells receive

  2. Warmth/moisture contributes to skin breakdown

  3. Surface skin weakens and breaks down

  4. Can become infected, damaging underlying tissues

  • Stages

  1. Skin intact, but looks red/different color

    1. Area swollen/painful/firm/soft/warmer/cooler

  2. Partial-thickness skin loss with inner/outer layers

    1. Injury is pink/red/moist/blistering

  3. Full-thickness skin loss in which fat is visible in ulcer

    1. slough/eschar present

      1. Slough: yellow/tan/grey/green/brown tissue that is usually moist

      2. Eschar: dead tissue that is hard/soft and block/brown/tan/similar to scab

    2. Damage extends to tissue near muscle

  4. Full-thickness skin loss extending through all layers of skin, tissue, muscle, bone, other structures (tendons)

    1. May look like a deep crater

  • Unstageable pressure injury: full-thickness skin and tissue loss but the extent cannot be determined (covered in slough/eschar)

  • Deep tissue pressure injury: skin area is intact/non-intact and is deep red/purple/maroon

    • May appear as blood-filled bilister

    • Painful, warmer/cooler than surrounding tissue

    • Discoloration

  • Observing and Reporting

    • Pale/white/reddened/grey/purple skin

    • Blisters/bruises/wounds

    • Difference in temp of skin

    • Complaints of tingling/warmth/burning of skin

    • Dry/cracked/flaky

    • Itching/scratching

    • Rash/skin discoloration

    • Swelling

    • Fluid/blood draining

    • Broken skin anywhere on body (toes/toenails)

    • Changes in existing injury (size/depth/drainage/color/odor)

Positioning Devices: 

  • Bedrests: provide support and comfort for the back

  • Bed cradles: keep bed covers from resting on the residents legs and feet

  • Draw sheet: assists with turning, lifting, or moving residents in bed

  • Footboard: keep feet properly aligned

  • Handrolls: keep the hand and/or fingers in a normal, natural position

  • Orthotic Device: helps support and align a limb and improve its functioning

  • Trochanter Rolls: keep the resident’s hips and legs from turning outward

  • Abduction Pillow/wedges/splint/pads: keep the hips in the proper position after their surgery

Bathing: removes perspiration, dirt, oit and dead skin cells, prevent skin irritation and body odor, increases circulation

  • Partial bath: washing face, hands, axillae, perineum

    • Axillae: armpits

    • Perineum: genital and anal area

  • Additive: substance added to another substance that changes its affects

    • Bran: relieve itching

    • Oatmeal: inflamed skin

    • Sodium Bicarbonate: psoriasis (skin disorder causing red, scaly patches on skin)

    • Epsom salt: reduce pain and swelling

    • Pine: refresh, calm, cool

    • Tar coal: treat eczema and other skin conditions

    • Sulfur: skin rashes and eczema as well as relieve inflammation related to arthritis

Complete bed bath:

  • Equipment: bath blanket, bath basin, soap, bath thermometer, 2-4 washcloths, 2-4 bath towels, clean gown/clothes, 2 pairs of gloves, orangewood stick, lotion, deodorant, brush/comb

  • Order: 

    • Eyes, middle of face, around face, ears, neck

    • Arms and axillae (shoulder down to wrist)

    • Hands

    • Chest

    • Addomen

    • Legs and Feet (thigh down to feet)

    • Back

    • Perineal area and buttocks (new gloves)

Back rubs:

  • Equipment: cotton blanket/bath blanket, gloves, lotion, towel

  • Start from sacrum and move up and out across shoulders

Oral Care: care of the mouth, teeth, and gums

  • Promotes healthy appetite

  • Performed after every meal or at least BID

  • Brushing teeth, tongue, gums; flossing teeth with dental floss; caring for lips; caring for dentures

Dental floss: a special kind of string used to clean between teeth

Halitosis: bad breath

Observing and Reporting Oral Care: irritation; raised areas; coated or swollen tongue; ulcers; flaky white spots; dry, cracked, bleeding chapped lips; loose, chipped, broken, or decayed teeth; swollen, irritated, bleeding, whitish gums; breath smells bad or fruity; reports of mouth pain

Oral Care:

  • Equipment: toothbrush, toothpaste, emesis basin, clothing protector, glass of water, lip moisturizer, gloves

Edentulous: having no teeth

Aspiration: the inhalation of food, fluid, or foreign material into the lungs; can cause death or pneumonia

Flossing: removes plaque and tartar buildup around the gum line

  • Equipment: dental floss, glass of water, emesis basin, towel, gloves