Chapter 6 Personal Care Skills

Question 1

Personal care

Answer 1

Tasks that are concerned with the person’s body, appearance and hygiene.

Nas should encourage clients to do as much as they are able to and be patient.

Promote as much Independence with personal care as possible.

During personal care, the na should look for any physical or mental problems or changes that have occurred. Foster communication when possible. Some residents will share symptoms, feelings and concerns during personal care. Keep a small notebook to document accurately and report to the nurse.

If the resident appears tired stop and take short breaks. Do not rush.

Observe and report:
*Skin color, temperature, redness
*Mobility
*Comfort level or pain or discomfort
*Strength and the ability to perform ADLs
*Mental and emotional state
*Clients complaints

Question 2

A.M. Care

Answer 2

Offering bedpans or urinals. Assisting the client to the bathroom. Perineal care as needed

Assisting with washing the clients face in hands assisting with hair care, dressing and shaving

Assisting with mouth care before or after breakfast

Question 3

P.M. Care

Answer 3

Offering snacks

Assisting with changing into night clothes

Assisting with mouth care

Giving back rubs

Question 4

Guidelines for providing skin care and preventing pressure injuries

Answer 4

Regularly inspect/observe areas of the body with bony prominences. The skin here is at a much higher risk for skin breakdown. These areas include:

Elbows
Shoulder blades
Tailbone
Hips and knees (inner / outer)
Ankles
Heels
Toes
Back of the head

Other at-risk areas:

Ears
Under the breasts / scrotum
Area between the folds of the abdomen

Question 5

The 4 stages of pressure injuries

Answer 5

1) skin is intact, but it may look red and the redness is not relieved after removing pressure. Darker skin may not look red but may appear to be a different color than the surrounding area.

2) the injury is pink a red and moist and may look like a blister. There’s partial - thickness skin loss.

3) there is full - thickness skin loss in which fat is visible in the injury. The damage may extend down to, but not through, the tissue that covers muscle

4) there is full hyphen thickness skin loss extending through all layers of the skin, tissue, muscle, tendon, and bone. The injury will look like a deep crater.

Question 6

Observing and reporting: client’s skin

Answer 6

Look for discoloration, blisters, bruises or wounds

Differences in temperature of the skin when compared to the area around it

Complaints of tingling, warmth or burning of the skin

Dry cracked or flaking skin

Itching or scratching

Rash

Fluid or blood draining from the skin

Broken skin anywhere including between the toes or around the toenails

Changes in existing injury (size, depth, drainage, color or odor)

Question 7

Basic skin care guidelines

Answer 7

Reposition immobile residents often (at least every 2 hours)

Give frequent, thorough skin care as often as needed for residents who are incontinent. Change clothing and linens often. Check on clients at least every two hours

Keep rough, scratchy fabrics away from the resident’s skin. Report to the nurse if the client’s shoes are causing blisters

Massage the skin often. Use light, circular strokes to increase circulation. Do not massage bony areas. Do not massage a white, red or purple area or put any pressure on it. Massage the healthy skin and tissue around the area

Be careful attention to skin under the folds. Keep it clean and dry

Keep plastic or rubber materials from coming into contact with the resident’s skin. They prevent air from circulating, causing the skin to sweat. (Does the mattress have a plastic protector over it?)

For those clients who are immobile:

Keep the bottom bed sheet tight and free of wrinkles. Keep the bed free of crumbs. Keep clothing or gowns free of wrinkles too.

Do not pull the resident across the sheets during transfers or repositioning.

Relieve pressure under bony prominences by using pillows and other devices

You special foam overlays or flotation cushions to make beds or chairs more comfortable

He’s a bad cradle to keep top sheets from rubbing the resident’s skin

Reposition wheelchair residents at least every hour and cannot change their positions easily

Question 8

Positioning devices

Question 9

Bed/foot cradles

Answer 9

Used to keep the bed covers from resting on a resident’s legs and feet

Question 10

Footboards

Answer 10

Padded boards placed against the residence fee to keep them properly aligned. The help prevent foot drop

Question 11

Foot drop

Answer 11

A weakness of muscles in the feet and ankles that causes problems with the ability to flex the ankles and walk normally

Footboards and foot splints are used to help prevent

Question 12

Hand rolls

Answer 12

A cloth covered or rubber items that keep the hand / fingers in a normal natural position.

Examples washcloth, gauze bandage, rubber Ball

Hand rolls can help prevent finger, hand or wrist contractures

Question 13

Orthotic device (orthosis)

Answer 13

A device that helps support and align a limb and improve its functioning.

They also help prevent or correct deformities

The skin area around them should be cleaned at least once daily

Question 14

Trochanter rolls

Answer 14

Rolled towels or blankets used to keep a residence hips and legs from turning outward

Question 15

Abduction pillows/wedges

Answer 15

Keep hips in the proper position after hip surgery

Question 16

Guidelines for assisting with bathing

Answer 16

Partial baths should be given every day. (Face, hands, axillae and perineum)

Be sure to test the temperature of the water and have the client verify that it’s comfortable

Back rubs given after baths help relax tired muscles, relieve pain and increase circulation.

Has open sores on the scalp

Question 17

Guidelines for showers and tub baths

Answer 17

Make sure bathroom or shower room floors dry

Check that handrails, grab bars and lifts are in working order

Have clients use safety bars to get in or out of the tub / shower

Place all needed items within reach

Test water temperature and have the client verify that it’s comfortable before bathing

No bath oils, lotions or powders in showers or tubs. They make surfaces slippery

Question 18

Guidelines for assisting with grooming

Answer 18

Encourage the client to make as many choices as possible

Nail Care should be given when nails are dirty or have jagged edges

NA’s cannot cut toenails (for a client with diabetes, a cut could lead to an infection which could result in a severe wound or even amputation)

Do not share manicuring tools between clients. Each client gets their own.

Orange Wood sticks are used to clean nails

File the client’s nails to prevent tearing skin

Handle clients hair very gently

You must don gloves when shaving residents

Razors are disposed of in The biohazard container

Do not use electric razors near water or when oxygen is in use

Question 19

Pediculosis

Answer 19

An infestation of lice

Question 20

Guidelines for assisting with dressing

Answer 20

Know what limitations the client has.

The affected/involved side is weaker due to stroke or injury

When dressing place the weaker arm or leg through the garment first. When undressing start with the stronger or unaffected side.

Make sure there are no twister wrinkles and socks after they are put on

If the client has an IV:

Never disconnect the lines or turn off the pump.

First remove clothing from the side without the IV. Slide clothing off the IV side first.

Question 21

Anti-embolic stockings
(TED hose)

Answer 21

Elastic stockings that gently squeeze the legs and feet promoting circulation.

Used to help prevent embolisms

Question 22

Embolism

Answer 22

An obstruction of a blood vessel usually by a blood clot. The embolism can travel from where it was formed to another part of the body, blocking blood flow. It can cause serious damage and even death.

Question 23

Guidelines for proper oral hygiene

Answer 23

Brushing upper teeth first lessons production of saliva in the lower part of the mouth.

Be sure to brush the tongue

Use as little liquid as possible when giving mouth care to an unconscious client. This can prevent aspiration. Turning them on their side can also help. Only use swab soaked in tiny amounts of fluid to clean the mouth.

Question 24

Aspiration

Answer 24

The inhalation of food, fluid or foreign material into the lungs. It can cause pneumonia or death.

Question 25

Guidelines for assisting with toileting

Question 26

Fracture pan

Answer 26

A bedpan that is flatter than the standard bedpan. It is used for clients who cannot assist with raising their hips.

Question 27

Portable commode

Answer 27

A chair with a toilet seat and a removable container underneath

Question 28

Guidelines for safely positioning and moving clients

Answer 28

Changing positions prevents pressure on one area that can cause a decrease in circulation / bed sores.

Bed bound clients should be repositioned at least every 2 hours

Wheelchair clients should be repositioned at least every hour

Each time you reposition you should document the time and position. Check the skin for signs of irritation each repositioning

Always have a co-worker assistive in repositioning

Logrolling: moving a resident as a unit without disturbing the alignment of the body. The head, back and legs must be kept in a straight line. Used in cases of neck or back problems, spinal cord injuries or after back/hip surgeries

Before a resident who has been lying down stands up, they should dangle. To dangle means to sit up on the side of the bed with the legs hanging over the side. It helps clients regain balance by allowing blood pressure to stabilize preventing dizziness and fainting. If the client is dizzy for more than one minute have them lie down again and report to the nurse.

Do not use transfer belts if a resident has fragile bones, fractures or has had certain kinds of surgery recently.

A slide or transfer board may be used to help transfer residents who are unable to bear weight on their legs. Slide boards should not be used against bare skin

Never try to reverse a client’s fall. Widen your stance and bring the client’s body close to you. Bend at the knees and slowly lower them to the floor. (You can drop to the floor with them as needed) Stay with the resident and Call for help.

Have a co-worker help when using a hoyer lift. Make sure you are using the correct sling. Check the sling and straps for any fraying or tears. If found, do not use the lift. Open the leg of the stand to the widest position before helping the resident into the lift. If the device has S hooks it should face away from the resident.

Question 29

Five basic body positions

Answer 29

Supine: flying flat on the back

Lateral: lying on either side

Prone: lying on the stomach

Fowler’s: semi-sitting position (45 to 60°)

Sims: lying on the left side with the left arm behind. the right leg is drawn up at the knee. The right arm is bent at a 90° angle. This position is used to apply suppositories.