ADLs #1 - Final Flashcards
1
Q
True or false? Patients sped most of their time in bed.
A
True
2
Q
What kind of bed is an important contribution to the well-being and safety of the patient?
A
Clean, dry and wrinkle-free bed
3
Q
When and how often are beds made?
A
- in the morning, everyday
- should be changed according to facility’s protocol
- whenever soiled, wet or very wrinkled
4
Q
Describe a closed bed.
A
- made when the bed is expected to be unoccupied for a certain period of time or no patient is assigned to the bed
- mattress must be cleaned/disinfected and linens must be replaced for a new patient
- bedspread and top sheet cover the entire bed
- bed usually left in a high position
- top linen is pulled up
- bedspread is neatly pulled over the pillow (in some facilities, the pillow is placed on top of the bedspread)
- usually made when the client is up for most or all of the day
- clean linen used as needed
- after client is discharged, bed frame and mattress are cleaned and disinfected
5
Q
Describe an open bed.
A
- only difference between open and closed is that the top sheets are fan folded or folded to form an envelope to the foot of the bed to make it easier for the patient to get back into bed
- is made shortly before the bed is to be occupied
- top linen is folded back so that the client can get into bed easily
- made when the client is out of bed only for a short time or made just before the client goes to bed
6
Q
Describe an occupied bed.
A
- made when the client is still in the bed due to being unable to get out of bed(illness or injury)
- mechanical lifts may be used to lift the client out of the bed while it is being made
- Before starting, know restrictions and limits in the client’s movement or positioning, keep the patient’s condition in mind
- explain each step of the procedure to the client before it is done
- use good body mechanics
- most important: keep all linen free of wrinkles to prevent pressure ulcers
- a frail patient may need two people to make the bed (one to assist and support the patient and the other to make the bed)
- always keep the side rail up on the patient’s side and keep the patient covered for warmth and privacy at all times
7
Q
Which linens are involved in making a bed?
A
- bottom sheet (usually fitted)
- top sheet
- blanket(s)
- bedspread
- pillows, pillow covers and pillow cases
8
Q
Identify basic rules of bedmaking.
A
- use good body mechanics (bend hips and knees, stand facing the direction in which you are working to avoid twisting)
- follow rules of medical asepsis (wash your hands, never shake linens, place clean linens on clean surface, never put clean or dirty linen on the floor)
- follow routine practices
- make bed according to client’s wishes and care plan
- have a bag bin ready for disposal of soiled linen
- bring enough linen to client’s room
- do not use torn linen
- hold linen away from your uniform
- completely cover a plastic drawsheet (should NOT touch client’s body) with a cotton drawsheet
- make one side of the bed as much as possible before going to the other side
- make sure bed wheels are locked
- make sure handles of the bed to manually operate the bed are tucked in
- advise clients of the risk of having the bed up too high
9
Q
List the general steps when making any type of bed.
A
1) wash your hands
2) collect clean linen, mattress pad, bottom sheet (flat or fitted sheets), incontinence or turning pad, top sheet, blanket or comforter, bedspread, two pillowcases, gloves, laundry bag
NOTE: gloves should be worn where there are open lesions, wet linen or possible contact with body fluids, blood, mucous membranes or non-intact skin.
10
Q
Describe a partial bed change.
A
- When the facility’s practice does not change all the linens everyday, particularly if they are still relatively clean
- Involves changing only soiled linens
11
Q
Describe how to make an unoccupied, closed bed.
A
1) fold top blanket(s) and place on bedside chair for reuse
2) loosen linen on all sides
3) remove the pillows from the cases and place the pillows on the bedside chair
4) remove linen by rolling each piece toward the centre of the bed, don’t shake linens, watch for items such as bobby pins, pencils that may have fallen into cracks or between the sheets, place in laundry hamper right away
5) send blanket to the laundry as well if it is soiled, if the patient has an infection or if it has been on the bed for a long time
6) turn the mattress as necessary and push it to the top of the bed (done regularly-every week if the patient spends most of the day in bed-turned when the patient is discharged or transferred)
7)if used, a plastic mattress cover should be washed on a regular basis
8) if the patient is not in the room, open a window to let the room air out
NOTE: bedmaking is divided into making the bottom part (bottom sheet, soaker pad) then the top part (top sheet, blanket, and spread)
9) bottom part: position the fitted bottom sheet so that it covers the entire mattress, ensure no wrinkles or creases
10) top part: Centre the top sheet on the bed. The large hem should be even with the top of the mattress, the smaller hem should hang over the bottom of the mattress. Be sure the sheet has an equal amount hanging over on both sides of the bed. For a hospital bed, place the bedspread in the same way as the top sheet (it should cover the top sheet completely). Working with the top sheet and bedspread together as one, tuck a sufficient amount under the foot of the mattress, miter the bottom corners. Leave the sides of the top sheet and bedspread untucked. Turn the back top edge of the top sheet and bedspread together to create a “cuff”.
11) fold the blanket crosswise and lay along the foot of the mattress (in some facilities the blanket is placed between the top sheet and the bedspread, and is mitered and cuffed with together with them)
12) open the pillowcase with one hand, grasp the centre of the closed end of the case, with the other hand gather the open pillowcase up over the hand at the closed end
13) grasp the pillow with the covered hand while holding it away from your body, using your other hand pull the open edges down over the pillow, adjust the pillow inside the case
14) place pillow on bed with open end away from the door, if there is a second pillow, put it on top of the first one
15) lower the bed
***the finished bed should be smooth and free of wrinkles to prevent pressure areas on the skin and promote comfort, it should be easy to get into, the top layers should be loose enough to allow room for the patient’s feet to move.
12
Q
True or false? You save time and energy by going back and forth on either side while making the bed.
A
False. You save time and energy by first making as much of the bed as possible on one side before going to the other side
13
Q
Why is it important for all the bottom linens to be pulled smooth?
A
To prevent pressure ulcers and shearing of the skin. To promote comfort. To prevent pressure areas on the skin.
14
Q
Describe the general steps for post-procedure of making a bed.
A
1) attach the call light to the bed
2) lower the bed to its lowest position, lock the bed wheels
3) follow your employer’s policies as to where you put the clean linen in your client’s room
4) remove the laundry bag from the room
5) perform hand hygiene
15
Q
Describe a surgical bed.
A
- in an acute care setting, it s made up while the patient is in the operating room
- bottom linens are placed as for a closed bed but the top linens are fan folded or positioned so transfer of the patient from the stretcher to the bed is easier
16
Q
Describe how to make an occupied bed. How does this differ when making an unoccupied bed (pre-procedure)?
A
- differences in pre-procedure steps with making an unoccupied bed
1) identify the client, according to employer policy
2) explain the procedure to the client
3) perform hand hygiene
4) collect laundry bag, clean linen
5) place linen on a clean surface
6) provide for privacy
7) remove the call bell
8) place the laundry bag near the bed
9) raise the bed to a comfortable working height (follow care plan for bed rail use)
10) Lower the head of the bed, it should be as flat as possible, lower the bed rail ear you. - one bed rail is lowered near you so the client doesn’t fall off on the other side
17
Q
Define hygiene and hygiene practices
A
- Activities which contribute to an individual’s cleanliness and health.
- hygiene practices help to reduce body odours, improve circulation and make us feel more comfortable and relaxed
- an activity of daily living
18
Q
How are different routines for meeting personal hygiene and grooming needs influenced?
A
- culture
- personal choice
- economics
19
Q
When are most hygiene and grooming activities performed in a hospital or personal care home?
A
In the morning, duties assigned to health care aides
20
Q
Discuss routine hygiene schedules for AM care (early morning and morning care)
A
- assist to bathroom
- give partial bath for perineal care
- grooming (hair care, shaving, dressing, mouth care, perineal care)
- GentleCare technique: allow clients to continue sleeping if they desire and providing them with a late breakfast
- in some facilities, showers are in each room so clients can shower each day
21
Q
A hospital bed
A) cannot be raised or lowered
B) cannot be controlled by the client
C) usually has bed rails
D) Is kept in the highest position at all times
A
C
22
Q
Which of the following requires a linen change?
A) soiled linen
B) loose linen
C) linen after the client has had an afternoon nap
D) wrinkled linen
A
A
23
Q
When handling linen
A) put dirty linen on the floor
B) hold linen away from your body and uniform
C) Shake linen to remove crumbs
D) Take the extra linen to another client’s room
A
B
24
Q
You are using a plastic draw sheet. Which is true?
A) A cotton draw sheet must completely cover the plastic draw sheet
B) Disposable bed protectors are needed
C) The client’s consent is needed
D) The plastic must be in contact with the client’s skin
A
A
25
An open bed is made
A) When the bed will be unoccupied for a period
B) Shortly before the bed is to be occupied
C) With the client in it
D) So that a client can be moved to or from a stretcher
B
26
When making an occupied bed you should,
A) Cover the client with a clean top sheet
B) remove all pillows
C) Lower the bed rails if bed rails are used
D) Fanfold top linens to the foot of the bed
A
27
Discuss routine hygiene schedules for afternoon care
- clients like to get care completed before going for a nap, visiting time or activity programs
- assistance with going to the bathroom, oral hygiene, face and hand washing, hair care
28
Discuss routine hygiene schedules for PM care (evening care)
- HS: hours of sleep, aimed at relaxing the client and increasing comfort
- face and hand washing, oral hygiene, perineal care, back massages, assisting to the bathroom
- bed linens and units are made neat and comfortable
- client helped into sleepwear
29
What are the general guidelines when performing personal hygiene for clients?
- preserve patient’s dignity when assisting with activities
- allow as much independence as possible
- respect sense of modesty, habits of privacy, general reluctance to have others present while personal needs being fulfilled
- avoid any embarrassment to the patient
- do not expose the patient unnecessarily (use bath sheets while bathing and close doors when toileting)
- do work efficiently
- use proper terminology for different parts of the body
30
List the benefits of bathing.
- removes dirt and bacteria
- eliminates body odour
- stimulates circulation
- provides some exercise
- helps prevent pressure ulcers
- relaxes and refreshes
- provides the caregiver with an opportunity to closely observe the patient
31
When and how often should bathing occur?
- usually in the morning after breakfast
- wash face and hands prior to breakfast
- some patients prefer to bathe less often or at night
- a complete bath may be scheduled twice a week
- depending on their condition and personal preferences, a patient may choose to have a tub bath, shower, complete bath or partial bath
32
What is the effect of soap on the skin?
-a drying affect on the already fragile dry skin of an older adult
33
Identify the general rules for bathing.
- be sure you have adequate help as required
- follow medical asepsis and routine practices
- check with the nurse as to what type of bath to give the patient
- use appropriate skin care products
- start at the face and work down the body, leaving perineal/rectal area for last (clean to dirty)
- wipe up any spilled water immediately
- make sure the client fully understands the procedure before you begin
- collect needed items before beginning
- provide for privacy by closing doors, shades, drapes, privacy curtains
- cover the client for warmth and privacy
- eliminate drafts
- protect the client from falling
- use good body mechanics at all times
- protect the client from burns and scalds
- check water temperature with a thermometer, inside of your wrist or your elbow
- keep bar soap in soap dish between lathering to prevent soapy water
- encourage the client to help out as much as safely possible
- rinse the skin thoroughly to ensure all soap is removed
- pat the skin dry
- dry under the breasts, between skin folds, in the perineal area and between fingers and toes
- bathe skin thoroughly to was off stool or urine
34
Identify safety measures associated with tub baths and showers.
- run the water before the patient gets in so that there is no danger of being scalded by hot water, ensure bath water is warm enough so that the patient does not become chilled
- help patient to get into and out of the tub or shower, some tubs have lifts to help position the patient in a tub
- use shower chairs if available
- many facilities require that someone stay with the patient at all times, if the patient can be left alone remind them not to lock the door to be able to check on them, teach them how to use the call bell that is within reach, put an occupied sign on the door to promote privacy
- place a bath mat in tub or shower
- drain the tub before the client gets out of the tub
35
How is the special chair used in whirlpool tubs?
- a special chair on wheels that can be taken to the bedside of the patient for transport to the tub
- chair is locked onto a lift at the foot of the tub and raised up and over the tub by a hydraulic lift
- chair is lowered into the tub
- make sure to explain the procedure to the client
- be sure that the client feels safe
36
List observations made while bathing a patient which should be reported to the nurse.
- colour of the skin, lips, nail beds, and sclera (whites of the eyes)
- the location and description of rashes
- dry skin
- bruises or open skin areas
- pale or reddened areas, particularly over bony parts
- drainage or bleeding from wounds or body openings
- swelling of feet and legs
- corns or calluses on feet
- skin temperature
- complaints of pain or discomfort
37
Differentiate between a complete bed bath and a partial bath.
Complete:
-provided to patients who are too sick or too weak or not permitted to use the shower or tub for some other reason
-done with the patient in their bed
-change the water frequently especially when it becomes soapy, soiled or cool
-some facilities no longer use basins filled with water for bathing patients, instead they use “bag baths” or “basin less baths” = consist of a package of about eight pre-moistened washcloths (one for each part of the body-face, arms, legs, torso, perineum) which can be warmed in the microwave before use
Partial:
-sometimes a complete bath is not desirable, necessary or possible on a daily basis
-only certain parts of the body are bathed, like the face, hands, underarms, back, under the breasts, buttocks, genital area, feet
-may be given to a very ill patient whose skin needs refreshing, older patients who have dry itchy skin, a patient who is incontinent several times over a 24-hour period, a patient who is largely independent in bathing but requires assistance in hard to reach areas like the feet and back
38
What is perineal care? “Peri care”
- means to wash the area around the genitals and anus
- may be done as part of a bath or as a separate procedure
- often “forgotten” possibly due to embarrassment on the part of both the patient and caregiver
- for patients with urinary catheters, this care is even more important and should be done at least twice a day
39
How would you do peri care if your female patient is unable to spread her legs very wide or lie on her back?
-help her spread her legs as much as possible with her knees straight
40
Why give back massages?
- used to stimulate circulation, prevent skin breakdown, and soothe and refresh the patient
- given during or after a bath
- when changing the position of a patient who is on bedrest
- to relax a restless patient
- to provide comfort for a palliative patient
- to promote relaxation at bedtime
41
What are important guidelines to follow when giving a patient a back massage?
- keep your fingernails short so you do not scratch the patient
- use god body mechanics for yourself and the patient
- use an appropriate lubricant, a non-scented lotion is best (warm before using)
- pay careful attention to bony prominences and pressure points (shoulder blades, hips, knees, ankles, heels, elbows, back
- if reddened do not massage and report to the nurse
- remove excess moisture so as not to leave moisture for bacteria to grow in
42
Which adaptive devices are available to help the patient who has difficulty with certain aspects of bathing (Personal grooming aids)?
- soap-on-a-rope
- bath mitt
- long-handled bath brush (or sponge)
- built-up handles on water faucets
- electric toothbrush
- self-fastening curlers
43
Define oral hygiene (mouth care). When is it performed?
- involves keeping the mouth and teeth clean
- an essential part of a patient’s daily care
- performed each morning, after each meal, and at bedtime
- proper mouth care is refreshing, eliminates bad breath and helps to prevent cavities, gum disease, and tooth decay
- can also help to increase appetite
- for patients who can perform their own oral hygiene, the role of the health care aide may only be to offer privacy and provide the proper equipment
- at times, the patient’s condition may interfere with their independence and it will become necessary for the health care provider to take a more active role, care must be taken not to injure the patient by being too vigorous in your actions
44
Describe how to care for a patient’s dentures.
- need to be cleaned as often as real teeth
- are usually removed, cleaned and stored in cool water (to prevent cracking) in a special denture cup overnight
- make sure the container is labeled with the patient’s name and room number
- take extra care when handling due to being able to break if dropped and are expensive to replace
- do not use hot water on them as they can warp
45
Identify patients who may require special mouth care every two hours.
- unconscious
- vomiting
- dehydrated
- mouth breathing
- receiving oxygen
- palliative
46
List observations made while performing mouth care which should be reported to the nurse.
- dry, cracked, swollen or blistered lips
- redness, swelling, irritation, sores, or white patches in the mouth or on the tongue
- bleeding, swelling, or redness of the gums
- loose teeth
- rough, sharp, or chipped areas on dentures
- complaints of pain or discomfort
47
True or false? Hygiene is needed for comfort, safety and health.
True
48
True or false? Culture and personal choice affect hygiene practices.
True
49
True or false? Mrs. Lam’s toothbrush has hard bristles. They are good for oral hygiene.
False
50
True or false? Unconscious patients are kept in the supine position for mouth care.
False.
51
True or false? You use your fingers to keep an unconscious client’s mouth open for oral hygiene.
False.
52
True or false? Mrs. Lam has a lower denture. It is placed on a hard surface and washed in warm water.
False.
53
True or false? Bath oils cleanse and soften the skin.
False.
54
True or false? Powders absorb moisture and prevent friction.
True.
55
True or false? Deodorants reduce the amount of perspiration.
False.
56
True or false? The care plan says that Mrs. Lam can have a tub bath. You can allow her to take a 30-minute bath.
False.
57
True or false? Weak clients can be left alone in the shower if they are sitting.
False.
58
True or false? A back massage relaxes muscles and stimulates circulation.
True.
59
True or false? Perineal care helps prevent infection.
True.
60
True or false? The foreskin is returned to its normal position after cleaning.
True.
61
True or false? Sanitary pads should be changed at least every 3 to 5 hours.
True.
62
```
When providing mouth care to an unconscious client, the client should be positioned
A) on the back
B) on the side
C) sitting up
D) on the stomach
```
B
63
```
What is the purpose of bathing?
A) increasing circulation
B) Preventing odours and cleansing skin
C) Refreshing and relaxing the person
D) all of the above
```
D
64
```
Soaps do the following
A) remove dirt and debris
B) remove pigment
C) remove hair
D) moisten the skin
```
A
65
Which action is correct when bathing Mrs. Smith?
A) removing all the covers
B) Rinsing her skin thoroughly to remove all of the soap
C) washing from the dirtiest areas to the cleanest areas
D) rubbing the skin dry
B
66
```
Water for Mrs. Lam’s complete bed bath should be approximately
A) 37.8 degrees
B) 40.5 degrees
C) 43.4 degrees
D) 48.9 degrees
```
C
67
```
You are going to give Mrs. Lam a back massage. How long should it last?
A) 3 to 5 minutes
B) 1 to 2 minutes
C) 10 minutes
D) 6 to 7 minutes
```
A
68
When should hair care be provided?
- at least once a day
- usually part of the morning routine
- more often as required or desired by the patient
69
What are the benefits of hair care (brushing or combing)?
- brushing and combing the hair stimulates circulation to the scalp and conditions the hair
- oils in the scalp are brought to the surface and spread through the hair to keep it lubricated
- makes the patient look better which can even help them to feel better
- important to one’s sense of well-being
- however, in health care settings, it is sometimes forgotten or avoided because it is seen as too much bother
70
If a patient is too ill or too weak to provide their own hair care, what adaptive devices may help with this?
Long-handled combs or brushes
71
Describe the correct way to comb/brush a patient’s hair.
1) turn the patient’s head away from you
2) divide the hair into sections
3) hold each section between your index fingers and thumb and comb with the other hand
4) instead of combing from the scalp toward the ends of the hair as one might normally do, start at the ends and comb short sections toward the scalp
5) be careful not to pull the hair
6) sometimes wiping the hair with an alcohol swab or applying a little hair conditioner will help loosen tangles
7) when one side is completed, turn head gently and work on the opposite side
8) select a hairstyle according to the patient’s wishes (braids)
9) when providing hair care to a patient in bed, protect the pillow from loose hair and dandruff by draping the pillow with a towel
10) wash the comb and brush out once a day to keep them clean and fresh for use
72
How often should a patient’s hair be washed?
- once a week or more often
- not on a daily basis
- depending on his condition and personal preference
- patients who take a regular shower or bath may be permitted to shampoo then
- others may need to have their hair shampooed while seated, leaning back into a sink or even while in bed (method used varies with the patient’s abilities and the facilities which are available)
73
True or False? A hairdresser or barber may work in or regularly visit the health care facility.
True. Appointments are usually required in advance and the health care aide will share in the responsibility of having the patient ready at the appointed time.
74
Describe the general rules when washing a patient’s hair in bed.
1) do so before you change the bed as the linen may get wet
2) make sure the room is free of drafts
3) protect the upper part of the bed with a waterproof sheet and a trough in which to place the patient’s head
4) a supply of clean water for washing and rinsing, and a receptacle to collect the used water will be necessary
5) be careful to protect the patient’s eyes and ears at all times
6) dry the hair well when finished to prevent chilling the patient
75
True or False. Before shaving any patient, be sure to check with the nurse as special precautions and restrictions may apply.
True.
76
True or false. You can use razor blade shavers on dementia patients
False.
77
How should you remove facial hair for a woman? What about armpits and legs?
- With tweezers, DO NOT shave
| - use a shaver or razor
78
List general safety rules for shaving.
- follow Routine Practices
- protect bed linens and/or clothing
- soften the client’s facial hair before shaving by applying a warm, moist cloth onto the skin
- encourage the patient to do a much as safely possible
- stretch the skin taught
- shave in the direction of hair growth when shaving the face and underarms
- rinse the shave area completely
- apply direct pressure to nicks or cuts, report them
- never rinse out an electric shaver under a running tap
- electric shavers are not to be used on patients receiving oxygen
79
How to clean out an ear piece?
- can be washed carefully with soap and water (be sure not to get the rest of the hearing aid wet!)
- ensure that the opening is not plugged with wax
- dry it well and help the patient to insert it
- check that it is turned on and the volume is adjusted to a comfortable level
- if the patient is unable to hear properly, check to ensure the battery is in place and that the battery is charged
- when putting the hearing aid away for the night remove the battery to promote the life time of the battery
80
When do you dress and undress patients?
- at various times of the day
| - usually before and after bathing and at bedtime
81
What do patients typically wear?
- in a hospital, a hospital gown
- some patients may prefer to wear jogging pants for comfort and warmth
- for rehabilitation patients or personal care home residents, dressing in street clothes is a part of their daily routine
82
What is your role as a health care aide when helping a patient get dressed and undressed?
- foster independence by encouraging the patient to participate as much as possible
- be prepared to assist with shoes and stockings
- additional assistance will likely be required for patients who have decreased joint mobility and strength or who have some degree of paralysis
83
Name the various assistive devices available for patients who have difficulty dressing independently.
- large buttons, button hooks, Velcro fasteners, zipper pulls
- brassieres with elastic straps that slip on over the head
- sock pullers (socks are easier to put on than stockings)
- long-handled shoehorn
- elastic shoelaces which are permanently tied or shoes with Velcro straps
- wrap-around or front-opening dresses
- pullover tops (rather than those with buttons, snaps) (clothing with short sleeves are easier to manage than long sleeves)
84
Facts about skin.
- the skin is the body’s protective outer covering
- largest organ of the body
- known as the integumentary system
85
Identify the two main layers of the skin.
1) epidermis
- thinner than the dermis
- made up of several layers of different kinds of cells
- cells in outer (or horny) layer are constantly being shed and replaced by cells from the bottom layers (dry skin)
- horny layer has no blood vessels (so it won’t bleed if injured) and few nerves
- acts as the protective layer of the skin (as long as it remains intact, no microorganisms can enter through the skin)
2) dermis
- under the epidermis
- contains blood vessels and nerves (if you bleed after a cut, you know that you have cut into the dermis)
- touch, pain, pressure, heat and cold are felt through the nerves in this layer
- contains sweat glands, oil glands and hair follicles
- sweat glands produce perspiration which is carried to the surface of the skin through pores
- thousands of oil glands all over the body secrete an oily, colourless, odourless fluid through the hair follicles which helps keep hair flexible and skin lubricated
86
List general functions of the skin.
- protection against microorganisms
- protects from injury
- insulates against heat and cold
- eliminates body wastes
- protects against excessive exposure to ultraviolet (UV) rays
- helps to produce Vitamin D
- nerve endings provide sense of touch, heat, cold, pain and pressure
* these functions remain unchanged throughout lifetime, but aging process alters the skin’s appearance (infants=smooth and delicate, teens=prone to acne due to hormonal changes)
87
Name facts about nails and hair.
Nails:
- nails are part of the outer layer of skin and are formed in much the same way as hair
- grow out of the nailbed which is located in the dermis
- the hardness of the nails is due to a substance called keratin
Hair:
- hair and nails form part of the skin
- the roots of hair lie in hair follicles
- hair grows from the root, but the hair cells die while still in the follicle and become very solidly packed
- new hair cells grow from the bottom and push the packed hair cells out to the surface
- hair is actually very solidly compacted dead hair cells
- it serves as a protective device by trapping dust and other foreign particles
- provides warmth to the body
88
Identify skin changes that are associated wth aging.
- oil glands and sweat glands decrease their activity (contributes to dry skin)
- skin often takes on a yellowish tinge
- loss of elasticity and fatty tissue causes wrinkling
- skin is fragile and easily injured
- skin tabs and moles become more common
- hair loses its colour, less oil causes hair to become dull, amount of hair diminishes
- nail tends to thicken and become brittle, often splitting
- increased sensitivity to hot and cold, decreased sensitivity to pain
89
Define pressure ulcer.
- also called decubitus ulcer, pressure sore, bedsore
- an area of skin breakdown caused by prolonged pressure, which interferes with circulation to an area of the body
- the area first appears reddened
- as cells die from the lack of nourishment provided by the blood the skin breaks down and an ulcer (or open wound) forms
- these can become quite large and deep
90
Identify areas of the body which are prone to pressure ulcers
- occur most frequently over areas where bones come close to the surface
- sites referred to as bony prominences or pressure points
- can develop between folds of skin, particularly under the breasts, between the buttocks, between the thighs, the vaginal area in females and the scrotal area in men
- areas must be kept dry
91
What are the common causes of pressure ulcers (skin breakdown)
1) prolonged pressure: occurs when the skin over a bony prominence is squeezed between hard surfaces, in skinny people where two bony areas are in direct contact with each other, interferes with blood flow to the skin and underlying tissues preventing oxygen and nutrients from reaching cells
2) friction: scrapes skin and the resulting wound creates a portal of entry for microbes
3) shearing: caused when pressure on the skin, skin sticks to a surface and deeper tissues move downward, exerting pressure on skin, blood vessels and tissues are damaged, which reduces blood flow to the area and increases the risk of pressure ulcer
92
Identify patients who are prone to the development of skin breakdown.
- can occur at any age
- are confined to bed or chair
- require moderate to complete help in moving
- have loss of bowel or bladder control
- have poor nutrition
- have altered mental awareness
- have problems sensing pain or pressure
- have circulatory problems
- are older
- are obese or very thin
93
```
Mr. Lee has alopecia. This is
A) excessive body hair
B) dry, white flakes on the scalp
C) an infestation of lice
D) hair loss
```
D
94
When brushing hair that is not matted or tangled, start at
A) the forehead, and brush backward
B) the hair ends
C) the scalp, and brush toward the hair tips
D) the back of the neck, and brush forward
C
95
```
Brushing is important to keep the hair
A) soft and shiny
B) clean
C) free from lice
D) long
```
A
96
```
Mr. Lee wants his hair washed. You should
A) wash his hair during his shower
B) wash his hair at the sink
C) shampoo him in bed
D) follow the care plan
```
D
97
When shaving Mr. lee with a blade razor, you need to do the following
A) remove any existing beard or moustache
B) Moisten the beard before shaving to soften it
C) shave perpendicular to the direction of hair growth
D) shave when the skin is dry
B
98
```
Mr Lee is nicked during shaving. your first action should be to
A) Practice proper hand hygiene
B) apply direct pressure
C) tell your supervisor
D) apply a bandage
```
B
99
When shaving a man’s face, you should shave in the _____ direction
A) left to right, from one side to another
B) right to left, from one side to another
C) up to down from chin to neck
D) down to up from neck to chin
D
100
```
Fingernails are cut with
A) toenail clippers
B) scissors
C) a nail file
D) nail clippers
```
D
101
```
You should never attempt to trim nails on clients who are
A) alert and oriented
B) diabetic
C) paralyzed
D) awake
```
B
102
```
Elastic stockings are used to
A) reduce swelling in the legs
B) improve the appearance of the legs
C) exert pressure on the veins
D) reduce circulation
```
C
103
```
Elastic stockings are applied
A) Before the client gets out of bed
B) when the client is standing
C) after the client’s shower or tub bath
D) before the client goes to sleep
```
A
104
When applying an elastic bandage
A) the body need to be in good alignment
B) the fingers or toes are covered
C) it is applied from the largest to the smallest part of an extremity
D) it is applied from the upper to the lower part of the extremities
A
105
When dressing a client who has hemiplegia (paralysis) on the right side, you should place the client’s right arm inside the sleeve
A) first
B) last
C) not place her arm in a sleeve
D) you should not be dressing clients with hemiplegia
A
106
True or false? You can shave a client’s beard and moustache if you think he would be more comfortable without facial hair.
False
107
True or false? You can cut and trim toenails for a client who has diabetes.
False
108
True or false? Clothing is removed from the unaffected side first.
True
109
True or false? The client chooses what to wear.
True
110
True or false? Wigs should never be washed. They should only be dry-cleaned.
False
111
Discuss the four stages of skin breakdown.
1) skin appears reddened (sometimes blue-grey) which lasts longer than 30 minutes after pressure is relieved, area may be warm to touch, patient may complain of numbness in area
2) skin is reddened with abrasions or blisters or it may be broken with a shallow crater at the site, patient may complain of discomfort and a burning feeling in the area
3) all layers of the skin are destroyed and a deep crater has formed
4) ulcer extends through the skin, subcutaneous tissue and may involve muscle and bone
112
What is the best treatment for pressure ulcers?
- prevention of their occurrence in the first place
- health care aides are very important in this prevention
- once they have occurred, it is very difficult to reverse them
- special care at each stage can help prevent the ulcer from progressing to the next stage
113
Describe actions which help prevent skin breakdown.
- prevent them from occurring by:
- reposition patients at least q2h, teach patients who are sitting to shift their position every 15 minutes
- keep skin clean and dry, remove feces, urine, or moisture of any kind (perspiration) immediately
- encourage proper nutrition and adequate fluids
- keep clothing and linen dry and wrinkle-free
- check for improperly fitted braces, check restraints frequently if they are being used
- check nasogastric tubes and urinary catheters to see that they are not abusing irritation
- give a back massage after repositioning the client
- check with your supervisor before using soap on a client
- to reduce the likelihood of shearing, do not raise the head of the bed to more than 30 degrees
- do not massage pressure points, do not massage reddened areas but the skin around it, never scratch or irritate the skin
114
What special equipment may be used to prevent or help heal pressure ulcers?
- sheepskin
- foam or gel pillow, egg-crate pad
- bed cradle
- elbow/heel protector
- air mattress alternating pressure mattress
- water bed
115
What are nails?
- made of epithelial tissue which grows from the root of the nail bed
- usually pink in colour but as a person ages, thickening of the nails can cause them to look whitish
- may be brittle and crack or chip easily because of poor circulation
- many individuals have poor blood circulation to the hands and especially the feet
- skin may be rough, dry an itchy
- cracks i the skin increase the risk for infection
116
State why foot care is important, especially for elderly person.
- the hands, feet and nails need special attention to keep the skin on and around them healthy and intact
- keeping the nails short and smooth, and the area under the nails free of debris helps prevent infection, injury and odours
- nail care should be performed as frequently as necessary (daily, weekly or less often depending on the patient), a routine part of the morning hygiene
- feet are very important to a person’s physical and emotional health (do not realize until pain or discomfort occurs)
- foot pain can alter balance and cause an uneven distribution of weight which causes strain on different muscles and can produce aches elsewhere in the body (discomfort may cause the person to curtail much needed exercise)
117
Why may elderly people not be able to properly care for their feet?
- poor vision
- hand tremors
- obesity
- inability to bend over
- individuals with diabetes may lose sensation to the feet and may not be aware that they have foot problems
* make sure to inspect their feet on a regular basis
118
What should you check for on the feet?
- vulnerable spots (heels and toes) for redness
- hardened skin
- excessive dryness
- lesions
- limping or unnatural gait causing changes in ambulation
119
Before beginning any foot care what should you do?
- ask the nurse for direction and supervision
- nail care is a delegated task and in some facilities nail cutting requires a doctor’s order
- there may be limitations as to what you are allowed to do
- certain patients due to their physical condition, may require special precautions (*never trim the nails of a patient with circulatory problems or diabetes), check with your supervisor before providing nail care on any client
120
Discuss basic nail and foot care
- ensure that the instruments you are using have been sanitized between clients
- soak hands and feet or 10-20 minutes before beginning re-warming the water as necessary, softening creams and olive-oil soaks help to soften the cuticles, while soaking perform ROM exercises on feet and toes
- rub heels, soles and sides of feet with pumice stone to remove dry and dead skin, never use scissors o razor blades to remove calluses, corns or dry skin
- cut nails straight across, file sharp edges if necessary, take special care not to injure the corners of nails (improper cutting is the biggest cause of infection), do not attempt to cut thickened nails
- dry feet well, especially between the toes
- check feet for blisters, cuts, sores, report any problems to the nurse
- any instruments that are used for foot care must be sterilized after use according to Health Canada guidelines
121
Identify common foot problems: Callus
- thickened epidermis caused by local friction or pressure
- commonly found on the soles of the feet
- usually painless
- care: soak the feet for 10-20 minutes in a solution of Epsom salts and warm water to soften the cell layers, then use a pumice stone to gently remove the hardened skin, use a lubricating jelly or cold cream helps keep them from recurring, because calluses are caused by friction or pressure, check that footwear fits properly
122
Identify common foot problems: Corns
- hard corns are hard, raised bumps on the tops of toes
- soft corns are found between the toes
- always painful because they grow into the dermis layer of the skin and cause pressure on nerve endings
- always caused by friction and pressure from poorly fitting shoes
- care: change footwear, avoid use of oval corn pads (increase pressure on toes and reduce circulation), surgery may be required depending on the size of the corn and the severity of the pain
123
Identify common foot problems: Plantar warts
- viral infection on the sole of the foot transmitted by going barefoot (wear shoes when in public areas)
- quite painful and make walking difficult
- may be contagious (use good medical asepsis and hand washing, wash patient’s sock separately)
- care: may be removed by burning (with an electrical spark) or freezing (with solid carbon dioxide)
124
Identify common foot problems: athlete’s foot
- fungal infection of the skin of the foot
- causes itching between the toes an on the soles of the feet
- small blisters may appear
- can spread to other parts of the body especially the hands
- is contagious and frequently recurs
- care: keep feet dry, dry well between toes after bathing, apply powder, wear clean socks, wear loose socks and shoes to allow air circulation between toes, air shoes out at night or alternate different pairs, special medication may be required
125
Identify common foot problems: ingrown nail
- growth of nails into soft tissue around the nail
- frequently results from improperly fitting shoes and from improper nail trimming
- can cause localized pain, inflammation or infection
- care: frequent soaks in a war antiseptic solution, instruct patient in proper nail trimming technique and the importance of proper footwear, it may be necessary to remove ingrown portion surgically
126
Identify common foot problems: Ram’s Horn nails
- unusually long, curved thickened nails
- care: patients should see doctor or a podiatrist, do not attempt to cut as there may be damage to the nail bed with risk of infection
127
Identify common foot problems: foot odour
- result of excess perspiration which promotes growth of microorganisms
- care: frequent washing, use of foot deodorants and powder, wearing clean footwear
128
What can you encourage patients to do with their nail and foot care?
- inspect feet daily, if unable have another family member view top and bottom of feet
- wear cotton socks or nylons with shoes, avoid knee-high nylons and garters, change daily
- ensure socks and shoes fit properly
- wear supportive, non-skid, closed-toe shoes to prevent injury, allow to air out and dry after wearing
- have 2 pairs of shoes and alternate daily, new shoes should only be worn for thirty minutes at a time
- report all problems to the nurse
- not apply hot water bottles or heating pads to the feet
- visit a podiatrist or podiatry clinic as necessary
