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Personal Care

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Personal Care

Assisting Clients with Personal Care, Hygiene Routines

• Dressing/Undressing • Washing/Bathing/Showering• Oral Care• GroomingAlways assess the level of dependency of your

client. What he/she will need assistance with?

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Personal Care

ClientClient

CommunicationCommunication

ComfortComfort

SafetySafetyIndependenceIndependence

EquipmentEquipment

PrivacyDignityPrivacyDignity

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Washing, Showering, Bathing

Preparation:• Prepare the area,• Check safety equipment• Check room temperature• Check water temperature• Clear bathroom for easy

mobilityGather equipment required:Towels, face towels, soap,

shampoo, body wash, toothbrush, toothpaste, clean clothes

• Always encourage independence

• Ensure dignity, privacy, choice and respect for the clients wishes are maintained at all times

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Caregiver Guidelines

• Offer toilet facilities before commencing• Always explain procedure to client• Ask permission to proceed• Always observe minimal exposure• Carry out procedure in sequential mannerHead, face, eyes, ears and neckArms and hands, bodyThigh, legs and feet.Genital area

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Preparation

• Ask client to remove glasses, jewellery, hair pins, dentures, clothes.

• Assist client where necessary• When undressing ensure minimal exposure• Provide appropriate cover at all times.Prepare Yourself • Wear gloves provided• Plastic aprons• Shoe covers

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Procedure

• Recheck water temperature• Start with washing hair, face, neck, arms. followed by

the body, legs, perineal area• Wash well in between the toes • Wash the perineal area last using separate cloth• Use face cloths appropriately• Encourage client to participate as their ability allows.• Change the water when necessary, dirty/cold

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Completion

• Dry the client quickly.• Use a patting motion and avoid rubbing.• Observe for any signs of redness, skin breakages,

bruising.• Ensure client is dry, • Commence dressing, ensure client is

comfortable and warm.• On completion clean bathroom, ensure

bathroom floor dry.• Remove gloves, aprons and shoe covers as appropriate.

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Oral Care

• Digestion starts in the mouth• Research indicates that a clean mouth

prevents gum disease, aspiration pneumonia and helps prevent heart disease.

• Salivary flow is reduced by some medications and medical treatments

• Reduced saliva flow results in less natural washing away of oral bacteria

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Equipment

• Toothbrush/ toothpaste• Clean glass/ cup for rinsing• Mouthwash if necessary• Clean bowel or sink to rinse into• Paper tissues.• Towel• Gloves if assisting client

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Caregiver Guidelines

• Where possible allow client to carry out own mouth care.

• Explain procedure to client• Wash hands and wear gloves• Observe the whole mouth,• Brush clients teeth gums and tongue• Brush the inner and outer aspects of teeth with firm

individual strokes directed outward from the gums• Give beaker or glass of water/mouthwash to rinse.• Provide tissues to client

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Caregiver Guidelines

• If a client is unable to rinse and void, use a rinsed toothbrush to clean teeth, gums and tongue.

• If required apply lubricant to dry lips, i.e.; Vaseline.

• Disguard remaining mouthwash solutions• Remove gloves, wash and dry hands.

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Denture Care

• Ask permission and explain procedure to client• Wash hands and wear gloves• Remove dentures from mouth • Place in suitable container• Clean dentures on all surfaces with toothbrush

and denture paste• Rinse well and return to client• Dentures should be removed overnight and

soaked in suitable solution

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Shaving

• Do not carry out a wet shave on any client• Electric shaves allowed. Ensure equipment is

cleaned after each use.• If client requests a wet shave please

contact the officeThere may be a specific situation where a wet

shave is allowed. This must be agreed with client and office staff. A shaving form must be signed in this situation

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Hair Care• Ensure that hair is well groomed and clean• Everyone loves to have their hair looking well. It is

the “Crowning Glory” for many women• Always allow client to look in • mirror when brushing hair.• Keep hairbrushes, combs clean• If washing hair in shower or bath ensure you dry

the hair quickly.• Check temperature of hairdryer if using.• Do not use dyes or chemicals on a clients hair.• Shampoo and conditioner can be used.

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Grooming

• Always ask client if she wants make up, face creams on.

• Assist with the application if necessary.• Provide mirror• Nails can be filed and nail varnish

applied if desired.• All grooming will help to promote

positive well being for client.

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After the Procedure

• Cleaning of equipment, bath, shower, wash basin, commode• Correct storage of clients own washing,

grooming equipment• Follow standard procedure for linen and

clothes for washing• Ensure client is comfortable, leave personal

belongings, aids for mobility nearby

Elimination and Continence Management

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Common Terms

• Urination, micturition and voiding

• Defecation, elimination and moving/ opening the bowels

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Normal Urination

• Eliminating waste is a physical need• The urinary system removes waste products from

the blood and maintains the body’s water balance• Healthy adult excretes approx 1500ml of fluid a day• Minimum amount of urine production – 30mls per

hour• Factors that affect urine production

– Age, disease, amount of fluids, dietary salt and drugs

• Factors that increase urine production– Coffee, tea, alcohol and some drugs

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Observation of Urine

• Urine is normally yellow in colour (amber)• Clear with no particles• Observe urine for colour, clarity, odor, amount and

particles• Some foods affect urine colour

– Red food dyes, beetroot, blackberries and rhubarb causes red urine

– Carrots and yams = bright yellow• As do drugs e.g. IV vitamin B• Asparagus causes a strong odour

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Urine Observations

• Frequency of micturition• Recording of fluid intake• Measuring the amount of urine passed• Report any abnormalties

– Smell– Colour– Crystals in the urine

• Save urine for inspection• Report complaints of urgency, burning or pain• Report difficulty passing urine

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• Many different methods:– Bedpans– Urinals– Commode

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Promoting Continence

• Identify the person’s normal urination pattern• Prompt the person to use the toilet and offer

assistance as required• Offer commode, urinal, bedpan etc at regular

intervals• Adapted clothing• Easy access to toilet facilities• Use of pads and devices e.g. conveen catheter

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Care of the client

• Check the person at regular intervals• Offer commode, bedpan etc. if appropriate• Observe urine for signs of infection• Provide for regular cleaning of the skin and

observe for signs of redness and broken areas• If incontinence wear is used check and change

accordingly

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Urinary Catheter

• A urinary catheter is a tubes that is passed into the bladder attached to a drainage bag

• A suprapubic catheter is passed via the abdomen through the urethra into the bladder above the pubic boneTypes: Indwelling catheter Temporary catheter

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Reasons for Catheterisation

• Difficulty with urination• Obstruction e.g. enlarged prostate• To accurately measure urine output• To allow area to heal after surgery• N.B. Catheterisation is not a solution for

incontinence

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Catheter Care

Caregiver Guidelines• Make sure urine flows freely through the

catheter or tubing, no kinks. • The person should not lie on the tubing• Tubing must not loop below the drainage bag• Attach drainage bag to the correct stand

(never to the bed rail)• Make sure the catheter is connected to the

drainage tubing, check for leaks.28

Catheter Care

Caregiver guidelines contin…• Keep the drainage bag below the bladder

(prevents urine from flowing backward into the bladder)

• Empty drainage bag when it is ¾ full • Follow standard precautions• Provide perineal care daily and after bowel

movements

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Catheter Care

• If indicated, measure and record the amount of urine,

• Do not let the opening on the bag touch any surface

• Report if urine changes colour, becomes foul smelling or there is evidence of pus in urine

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Perineal Care with Catheter

• Wash genital area with warm water and gentle soap • Separate the labia, or retract the foreskin check for

crusting, abnormal drainage or secretions• Clean the catheter from the urethra down the

catheter about 4 inches• Use soap and water and a disposable cloth• Avoid pulling or tugging• Ensure the catheter is secured

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Bowel

• Frequency of bowel movements varies from person to person

• One a day, one every 2-3 days some people have 2-3 BM’s per day

• Times of day may be the same• Stools are normally brown in colour• Stools are normally soft, formed, moist and

shaped like the rectum

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Factors affecting bowel elimination

• Privacy• Personal habits• Diet• Fluids• Activity• Medications• Age

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Common Problems

• Piles• Constipation• Faecal impaction• Diarrhoea• Faecal incontinence• Flatulence

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Management of Constipation

• Assess what the person’s normal pattern• Encourage fluid intake• Encourage high fibre diet where appropriateCitrus fruits, prunes, fruit juice• Privacy and ample time to use the toilet• Medications Stool softeners Bulking agents Laxatives Enemas

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Colostomy

• A colostomy is a surgical procedure that involves connecting a part of the colon onto the stomach wall leaving the patient with an opening called a stoma.

• After a colostomy, faeces leave the patient's body through the stoma, and collects in a pouch attached to the patient's abdomen which is changed when necessary.

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Urostomy

• A urostomy is a stoma for the urinary system. A urostomy is made in cases where long-term drainage of urine through the bladder and urethra is not possible, e.g. after extensive surgery or in case of obstruction

• A "continent urostomy" is an artificial bladder formed out of a segment small bowel. This is fashioned into a pouch, which can be emptied intermittently with a catheter. It avoids the need for a stoma bag on the urostomy.

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Care of the Skin and Care of the Skin and Prevention of Pressure Prevention of Pressure

SoresSores

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Care of the Skin

• Maintaining the skin’s integrity is essential to the prevention of infectionand the promotion of health. The skin has

several functions:• Maintenance of temperature• Protection• Excretion• Sensation

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Anatomy and Physiology

• The skin is made up of three layers: – the epidermis, – dermis and – the subcutaneous

layer.

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Anatomy and Physiology

• Changes occur due to :– temperature– texture– elasticity– ability to change to environment & stimuli – INTEGRITY, CONTINUITY AND CLEANLINESS ARE

ESSENTIAL FOR PHYSIOLOGICAL FUNCTION

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Assessment

Several factors may influence the appearance of the skin tissue.

• Hydration• Age, health, mobility, presence of pressure ulcers• Treatment therapies, allergies or drug reactions• Any concurrent or previous skin conditions. • Dietary habits• Emotional stress

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Observe For….

• Colour- redness, pallor, yellow or brown discolouration.

• Evidence of bruising or bleeding.

• Moisture, dryness, sweating, oiliness.

• Temperature.

• Texture: rough or smooth

• Size, shape, colour and dryness of any lesions and their distribution

• Odour

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Assessment

• Extra care is needed if damage to the skin noted– note skin folds and

crevices– invasive devices– breaks in skin– Redness or rash

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Care of the Skin

When an abnormality is observed it is important to ascertain:

– When it was first observed (if problem present)– Whether the lesion(s) persist or come & go, or

change in appearance– The extent to which it has spread– If it itches, hurts, is dry, moist or discharging

Any changes must be reported and documented

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Care of the skin

• Choice of cleansing agents:– Respect the choices of the patient– May use prescribed cleansing agents– Use non abrasive solutions– Use non-drying agents– Perineal and perianal areas use warm water as it

is less irritating to the area

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Care of the Skin

• Prevention of the spread of infection:– Do not share equipment– Patient to have own supplies– Use gloves for washing perineum– Clean equipment after use e.g. bath or shower– Ensure towels, facecloths sponges and basins are

cleaned after each use

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Pressure Area Care

A pressure sore is a lesion that is due to…• unrelieved pressure on the skin causing

ischaemia, impaired blood supply• sheering or friction causing mechanical stress

on the tissuesor a combination of these, • that results in underlying tissue damage. It

usually occurs over a bony prominence.

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What is a Pressure Sore?

It is an area of damaged skin • it is usually caused by sitting or lying in one

position for too long without moving.• a pressure sore can develop in only a few

hours• skin colour change (redder or darker) • blisters develop• Skin breaks down• deep wound develops

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Pressure Areas

– Heels – Ankles – Knees– Elbows – Shoulders – Hips– Bottom – Base of spine

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Pressure Areas

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Factors Contributing

• Extrinsic factors,(outside the individual)

• Pressure• Shearing• Friction

• Intrinsic (to do with individual himself)

• Moisture• Acute illness (temperature,

infection)• Ageing• Emaciation• Obesity• Poor nutrition• Pain (rheumatoid arthritis)• Anaemia• Diabetes

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Factors Contributing

• Reduced mobility• Reduced sensation to pressure and pain such as

neurologically induced by multiple sclerosis, spinal cord injury, stroke

• Sedation can cause some people to be too drowsy to move around

• Depression could lead to lack of motivation to move around

• Those with dementia are unable to respond to pressure stimuli and spontaneously alter their position

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Prevention

• Nurse Assesses the risk using tool i.e.– Norton scale, Waterlow scale

Caregiver Role…• Encourage mobility• Encourage adequate fluid and food intake• Avoid friction• Check skin for signs of damaged reddened areas• Report findings to care manager

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Prevention

Caregiver role….• Keep skin clean & dry• Avoid rubbing or massaging your skin• Avoid talcum powder (causes drying of skin)• For those who are incontinent change pads

and carry out skin care as required.• Assistive devices where needed

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For those in bed• Change position every 2hrs (min) alternating

between back and sides• Use pillows to help positioning, can protect knees

and ankles• Use protectors (elbows and heel protectors)• Bed cradle or duvet. Avoid sheets made of

synthetic material• Avoid creases or crumbs• When sitting in bed prevent

sliding as this can friction• Special mattresses

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Wheelchair / Chair

• Alleviate pressure every 15 minutes by getting the person to lean forward or pushing up on the arms of the chair

• Can also roll from cheek to cheek for a short while

• Pressure relieving cushions• Avoid dragging legs and arms

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Caregiver Support

Personal Effectiveness

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Caregiver Support

What are the practical and financial supports available to carers?

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Stress

• Recognise the demands on caregivers

• How to cope with the stress involved in providing care to vulnerable people.

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Nutrition

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Nutrition

• Nutrition is the study of food and its digestion in the body

• Our nutritional intake is our ability to take in a well rounded healthy diet full of the nutrients (building blocks) we need to maintain a healthy body.

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Nutrition

Older people are at risk of malnutrition.Causes• Poverty• Inability to shop or feed oneself• Living alone, social isolation• Bereavement• Dementia, confusion• Depression• Swallow reflex• Poor dentition

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Inadequate Diet / Malnutrition

Increased risks of:Infection, decreased immune responseReduced muscle strengthHealing problemsVitamin deficienciesFatigue / apathyAccidents and injuriesImpaired thermoregulation

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Inadequate Diet

Side effects of medication can cause…• Loss of appetite• Nausea and vomiting• Constipation• Sedation

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Eating and Drinking

The need for food and water is a basic physical need necessary for life. The amount and quality of foods in the diet are important. They effect a person’s current and future well-being”

(Sheila A. Sorrentino, 2000)

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Guidelines for Healthy EatingEat a variety of foodsMaintain a healthy weightChoose a diet low in fat, saturated fat and

cholesterolChoose a diet with plenty of fruit vegetables and

whole grainsUse sugar only in moderationUse Salt only in moderationIf you drink alcohol do so in moderation(Sorrentino 2000)

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Diet For Adult Years

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Digestive System

The alimentary canal:Mouth PharynxOesophagus StomachSmall intestineLarge intestine

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Digestive System

Accessory organs:– Teeth– Tongue– Salivary glands– Liver – Gallbladder– Pancreas

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Nutrition

• Macro nutrients– Fats

• Unsaturated• Saturated

– Carbohydrates• Starches• Sugars• Fibre

– Protein

• Micro nutrients– Vitamins

• Fat soluble A, D, E and K• Water soluble B group and C

– Minerals• Iron• Calcium• Sodium• Zinc

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Factors that effect Eating and Drinking

Culture ReligionFinancesAppetite Personal choiceIllnessHealth Age

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Community Care

Role of the caregiver; Shopping for groceries Planning economical nutritious meals Assisting and encouraging oral intake Management of special diets. Monitoring client’s food/fluid intake Assist with eating and drinking

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Organising Meal TimesIdeally meal times should be flexible

Mealtimes should be organised according to clients habits and wishes.

Some clients with dementia may prefer finger food to a full meal. It may be difficult to have set mealtimes in this case

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Assisting with Eating

Consider………Oral hygieneElimination needsClothing and linenDenturesSpectaclesHearing aidsHygiene – hand washing

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Assisting with Eating

Positioning and seatingBedChairDinning room / kitchenSpecial needs

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Serving MealsClient in bed; Wash hands Make sure tray is complete Address the person by

name Introduce yourself by name

and title Ensure that person is in

comfortable position Place the tray within easy

reach

Remove food covers, open milk cartons and cereal boxes. Cut food up and butter bread if indicated.

Ensure that napkin/clothes protector is in place

Take note of the amount and type of food eaten

Remove tray Assist with or offer oral

hygiene and hand and face washing

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Feeding the Person Provide a relaxed attitude.

Ensure that the person does not feel rushed

Allow for religious practice.

Give choice Spoons are usually

considered safer than forks. Spoon should be no more than 1/3 full.

Wash hands Make sure tray is

complete Address the person by

name Ensure that person is in

comfortable position

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Feeding the Person Remember that meal times

provide social contact – engage in conversation making sure the person has ample time to chew and swallow

Sit at eye level with the person and demonstrate a relaxed manner.

• Drape a napkin across the chest and under the chin

Prepare the food for eating Tell the person what food is

on the tray Serve the food in the order

the person prefers alternating between liquids and solids. Allow enough time for chewing do not rush the person

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Feeding the Person Wipe the person’s mouth

with napkin Note how much and what

food was eaten Measure and record intake

in client journal if appropriate

Remove tray/dishes Return the person to

sitting room Provide for oral or other

hygiene needs

Provide for comfort Wash hands Report observations to

care manager;1. Complaints of nausea or

dysphagia2. Any persistent coughing

while eating or drinking.

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Swallowing disorders in adults - Dysphagia

Stroke Brain injury Spinal cord injury Parkinson’s disease Multiple sclerosis Decayed or missing

teeth

Muscular dystrophy Cerebral palsy Alzheimer’s/Dementia Severe intellectual

disabilities Cancer of mouth, throat

or oesophagus Trauma to head and

neck

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General Signs of Dysphagia Coughing during the night or after eating and drinking Wet gurgly sounding voice after eating and drinking Extra effort or time needed to chew and swallow Food or liquid leaking from or getting stuck in the

mouth Recurring pneumonia or chest congestion after eating Weight loss or dehydration from being unable to eat

or drink enough.

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Dysphagia may result in…

Poor nutritional statusDehydrationAspiration which can lead to pneumonia and

chronic lung diseaseLess enjoyment of eating and drinkingEmbarrassment or social isolation

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Treatment

• Treatment varies depending on the cause

Speech therapist may recommend special exercises, positions or strategies to help the person swallow more effectively

Specific food and liquid textures that are easier to swallow

PEG feeding

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Caregivers and Family Can Help By…

Asking question to understand the problem and the recommended treatment

Assist in following the care plan –

1. Help with exercises2. Prepare the recommended food and liquid3. Record food and fluid intake if necessary

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Fluid Balance

Fluid intake and output must balance

Excessive fluid = oedema

Decrease of body fluid leads to dehydration

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Normal fluid requirements

Adult requires – 1500 ml water per day.Daily intake to maintain balance =2000 –2500

ml per dayOlder people often take medication that can

causes loss or retention of fluid

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Special Orders

Encourage fluid intakeRestrict fluids

– Sips– 30ml– 1 litre– 1 litre + output

Nil by mouth

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Intake and Output Recording

Used to assess fluid balance and kidney function

May also be used to assess fluid intakeIf person is receiving intravenous therapy or

tube feedingUsed to plan and evaluate medical treatment

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Intake and Output Recording

Intake: all fluids taken by mouth

including tea, coffee, milk, water, juices, soups and soft drinks. Ice cream custard and other soft foods should also be measured.

Tube feeds I.V. fluids

Output: Urine Vomitus Diarrhoea Wound drainage Note excessive

perspiration

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Intake and Output Recording

Measure amount that water glass holds

Most cups contain approx. 180ml but will vary

Fluid charts are normally completed in mls.

If person is ambulant give instruction on measuring and provide appropriate measuring receptacles

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