Bathing, Grooming, Skin Care Duty: Assist client with Personal Hygiene Task : A.04 Assist client with bathing A.04 Provide skin care to client A.05 Assisting with dressing/undressing A.06 Assist client with oral care A.07 Assist client with shaving A.08 Assist client with nail care A.09 Provide foot care A.10 Assist client with hair care

Section Objectives: • •

Describe the home care aide’s role in assisting client with personal hygiene. Describe guidelines for assisting with grooming.

Bathing, Grooming, Skin Care

Objectives (cont.) • • • • • • • • • •

Define pressure points and pressure sores. Describe the four stages of pressure sores. Demonstrate a bed bath. Demonstrate perineal care for a female. Demonstrate nail care. Demonstrate hair care. Demonstrate applying lotion to client’s legs. Demonstrate morning mouth care. Demonstrate denture care. Demonstrate dressing/undressing.

Bathing, Grooming, Skin Care Personal hygiene (cleanliness) is important for maintaining health. Good grooming enhances self-esteem. Providing personal care is one of the most important roles of the home care aide. Whether only assisting the client or doing all personal care for the client, this is what the aide will spend most of her visit time doing. Encourage as much self care as possible. Offer support, encouragement and assistance as needed. Provide training in self-care as needed.

Before providing personal care, always check the client’s care plan for any restrictions.

Bathing, Grooming, Skin Care Guidelines for assisting with personal care: • Help the client be as independent as possible. • Follow client preferences, routines and customs. • Always explain what you will be doing. • Provide privacy. • Assure client safety. • Use good body mechanics • Properly complete all steps in the procedure. • Observe the client while giving personal care • Report any changes in the client’s condition.

Bathing, Grooming, Skin Care

Bathing provides more than cleanliness. Baths stimulate circulation, prevent skin breakdown and promote relaxation. Bath time allows the home care aide to observe for skin breaks, bruises, or pressure areas.

Complete baths are only necessary every other day; and for the elderly only one to two times per week.

Bathing, Grooming, Skin Care Guidelines for assisting an ambulatory client take a shower or tub bath: • Use extreme caution to prevent slips and falls. • Use non-skid bath rug and rubber bath mat. • Be sure client has on non-skid slippers or shoes. • Never use bath oils. • Always assist the client in and out of the tub. • Use assistive devices such as tub bench or shower chair and grab/safety bars. • Test the water temperature, then have the client test it. • Wear gloves if performing perineal care or if the client has broken skin.

Bathing, Grooming, Skin Care • Assure bathing supplies are within easy reach. • Stay with the client or check on the client every five minutes. • Assure client has a signal device to call for assistance.

Bathing, Grooming, Skin Care Guidelines for assisting client with a bed bath: • • • • •

Check water temperature and having client check it. Keeping room temperature comfortable. Keep the client warm with a bath blanket. Provide privacy Use safety techniques such as body mechanics and keeping wheels locked on an adjustable bed. • Change the bath water when it becomes cools, soapy or dirty. • Discard soiled linen and bath water properly.

Bathing, Grooming, Skin Care Perineal care (or pericare) is cleansing of the genitalia and rectum. Care is always don’t from front to back to prevent urinary tract infection. Principles for providing perineal care: • For female clients, separate the labia and cleanse the area with downward strokes. • For male clients, pull the foreskin back if the client is uncircumcised. Hold the penis by the shaft and wash in a circular motion from the tip down to the base, then wash the scrotum and groin. • For both female and male, use single stokes and a clean area of the washcloth for each stroke. • Change the water after cleaning groin. • Have the client turn to side lying position to clean rectal area from front to back.

Bathing, Grooming, Skin Care Guidelines for providing nail care & foot care: • Nail care should only be provided if it was specifically assigned. • Never cut nails of a diabetic client. • Poor circulation can lead to an infection if skin is accidentally cut while caring for a client’s nails. • Clean and dry between toes . Never put lotion between toes. • Close observation of the feet during care is important. Report any signs of reddened areas, swelling, breaks or tears in skin, ingrown nails, change in color, excessively dry skin, blisters, change temperature.

Bathing, Grooming, Skin Care Guidelines for providing hair care: • Hair should be shampooed at least once a week. • Shampooing in the shower is easiest. • Shampooing in bed requires special equipment, such as a trough. • When combing or brushing hair, handle hair gently. • Brush in two-inch sections from root to the ends.

Bathing, Grooming, Skin Care Guidelines for assisting a client to dress and undress: • When client has a weak side, refer to it as the affected, weaker, or involved side. Do not to use the term “bad” when referring to weaker extremities. • Clients should dress in regular clothing in the daytime. • Always provide privacy. • Allow client to choose clothing. • Client should do as much self-care as possible. Use adaptive devices • If the client ahs a weak side. remove clothing from the stronger side first when undressing; dress the weaker side first.

Bathing, Grooming, Skin Care Guidelines for providing oral care: • Oral care should be done twice a day – in the morning and evening. • Be sure the client is sitting upright. • Brushing teeth is the most important part of oral care, but extends to gums and tongue. • Flossing removes plaque (bacteria) that the toothbrush misses. • Oral care for an unconscious client should be done every two hours. • Use lemon glycerin swabs and put lubricant on the lips.

Bathing, Grooming, Skin Care Guidelines for providing denture care: • Dentures should be removed for at least eight hours a day to prevent pressure on the gums. • Dentures should be cleaned at least once a day. • Break the suction by giving a slight downward pull • Carry the dentures in a cup, not in the hand. • Do not use hot water to clean or store dentures because that could warp them. • Dentures are expensive and need to be handled with care. • Observe and report signs of irritation, pressure, ulcers, Infection, or pain.

Bathing, Grooming, Skin Care Guidelines for shaving a client: • Check the care plan before shaving a client. Do not use a safety razor if client is on a blood thinner. • Beard must be softened with warm water before beginning. • Lather the face with shaving cream or soap and warm water before beginning. • Do not use a rusty or dull safety razor. • Hold the skin taut and shave in the direction of hair growth. • If using an electric razor, do not use it near any water source, when oxygen is in use, or if client has a pacemaker.

Bathing, Grooming, Skin Care Skin care: Aging skin is fragile and needs gentle care. Home care aides help maintain healthy skin by relieving pressure, controlling moisture, and observing skin for any problems. Guidelines for providing basic skin care: • Keep skin clean and dry. • Avoid harsh soap or detergents. • Massage and moisturize skin. • Maintain adequate nutrition and fluid balance. • Relieve prolonged pressure. • Provide frequent skin care for incontinent client. • Observe skin for changes.

Bathing, Grooming, Skin Care Report these skin changes:

• • • • • •

Pale, white, reddened, or purple areas Blisters, bruises, or ulcers Rash, itching or scratching Excessive warmth or coldness Drainage from skin Broken skin or changes in the size of a wound.

Bathing, Grooming, Skin Care Bed-bound clients are high risk for developing skin problems and require special attention. Preventative measures: • Keep bottom sheet tight and wrinkle-free • Use sheepskin or chamois under back and buttocks • Place sheepskin or foam under bony prominences • Use floatation pads on bed or chair • Place a bed cradle to prevent rubbing sheets • Reposition clients in bed, chairs or wheelchairs every two hours.

Bathing, Grooming, Skin Care Bony prominences re area of the body where the bone lies close to the skin. Pressure points are areas of the body that bear much of the body weight and are located mainly at bony prominences. Pressure points that are most at risk for developing pressure sores are: Ears Backbone Knees Breasts Coccyx Heels Elbows Buttocks Ankles Shoulder blades Hips Toes

Bathing, Grooming, Skin Care Pressure sore/decubitus ulcer/bed sore is a wound or sore on the skin as a result of pressure on the skin that decrease blood circulation to the area

The 4 stages of pressure sores are : Stage 1 - skin becomes pale, white or a reddened color. Darker skin may appear purple. Client may complain of tingling or burning. The discoloration does not go away even when the client’s position is changed. Stage 2 – blister or other break in the skin Stage 3 - subcutaneous destruction into muscle with or without infection Stage 4 – Involvement of bone or joint with or without infection

Demonstrable Skill Bed Bath on One Side of the Body-Using Mannequin 1. Identifies that hands should be washed and explains procedure to the client/mannequin. 2. Pulls privacy curtain and fills basin with comfortably warm water. 3. Raises bed between mid thigh and waist level, if adjustable and covers client with a bath blanket 4. Fanfolds bed linens at least down to waist or moves linens to opposite side and puts on gloves 5. Removes client's gown without exposing client. 6. Washes face without soap and dries face. 7. Washes client's upper body with soap on one side of the body (including hand, arm, under arm, stomach and chest area) 8. Rinses and dries client's upper body 9. Washes client's leg and foot with soap and water. 10. Rinses and dries client's leg and foot.

Demonstrable Skill Bed Bath on One Side of the Body-Using Mannequin (cont.) 11. Dresses client in a clean gown. 12 Re-covers client with dry previously fan folded linens as bath blanket is removed. 13. Disposes of soiled linen in appropriate container. 14. Empties, rinses and dries equipment and returns to storage. 15. Removes gloves turning inside out and disposes of gloves in appropriate container. 16. Lowers bed, if adjustable. 17. Maintains client's dignity throughout procedure. 18. Maintains privacy throughout procedure. 19. Identifies that hands should be washed.

Demonstrable Skill Perineal Care for a Female 1. Identifies that hands should be washed and explains procedure to the client/mannequin. 2. Pulls curtain; provides privacy and raises the bed between mid thigh and waist level. 3. Fills basin with comfortably warm water and raises side rail opposite working side of bed. 4. Places bath blanket on mannequin and places waterproof pad under client's buttocks by turning client toward side OR raises hips 5. Returns client to his/her back and puts on gloves and exposes perineum only. 6. Separates labia, while verbalizing the action and uses water and soapy wash cloth to cleans both sides and middle of labia from top to bottom. 7. Uses a clean portion of a wash cloth with each stroke. 8. Rinses the area from top to bottom and dries the area from top to bottom. 9. Covers the exposed area with the bath blanket or clean sheet

Demonstrable Skill Perineal Care for a Female (cont.) 10. Assists client to turn onto side away from working side of the bed hands should be washed 11. Uses a new clean wash cloth cleans the rectal area using water, wash cloth and soap 12. Cleans area from vagina to rectal area using single strokes and clean portion of the wash cloth with each stroke. 13. Rinses area from vagina to rectal area and dries area from vagina to rectal area. 14. Removes water proof pad from under buttocks 15. Positions client (mannequin) on her back and disposes of all soiled linen including the bath blanket or sheet in the hamper or equivalent 16. Empties, rinses and dries equipment 17. Returns equipment to storage and removes gloves turning inside out 18. Disposes of gloves in appropriate container 19. Lowers bed and side rail. 20. Identifies that hands should be washed

Demonstrable Skill Nail Care One Hand 1. Identifies that hands should be washed. 2. Explains procedure to the client and assembles equipment 3. Immerses nails in comfortably warm water. 4. Soaks nails for at least five (5) minutes. a. (The five minutes may be verbalized by the candidate and acknowledged by the observer) 5. Dries hand thoroughly and carefully dries between fingers. 6. Gently cleans under nails with orange stick or nail brush. 7. Files each fingernail and gently pushes cuticle back with a wash cloth. 8. Massages hand with lotion and indicates observing for skin irritation or injury. 9. Empties, rinses and dries equipment and returns to storage. 10. Discards soiled linen in linen hamper or equivalent. 11. Maintains respectful, courteous interpersonal interactions at al times. 12. identifies hands should be washed.

Demonstrable Skill Hair Care 1. Identifies that hands should be washed. 2. Explains procedure to the client and gathers equipment. 3. Provides privacy and places towel on shoulders 4. Asks/discusses with client how s(he) would like his/her hair combed. 5. Combs/brushes hair gently and completely. 6. Discards linen in appropriate container. 7. Leaves hair neatly brushed/combed/styled. 8. Maintains respectful, courteous interpersonal interactions at all times. 9. Identifies that hands should be washed.

Demonstrable Skill Applying Lotion to a Client’s Legs 1. Identifies hands should be washed 2. Exposes the client's legs and observes skin for areas for breakdown. 3. Squirts lotion onto hands and rubs hands together to warm the lotion. 4. Applies the lotion to the client's legs. 5. Covers the client's legs and indicates that any observed change in the client would be reported to a supervisor. 6. Identifies that hands should be washed.

Demonstrable Skill Morning Mouth Care 1. Identifies that hands should be washed. 2. Explains procedure to the client and gathers equipment/supplies. 3. Provides for client's privacy 4. Drapes the chest with a towel (cloth or paper) to prevent soiling. 5. Candidate puts on gloves only after supplies have been gathered. 6. Candidate wets toothbrush and applies toothpaste to toothbrush. 7. Brushes client's teeth, including the inner surfaces of all upper and lower teeth, while verbalizing the surfaces they are cleaning. 8. Brushes client's teeth, including the outer surfaces of all upper and lower teeth, while verbalizing the surfaces they are cleaning. 9. Brushes client's teeth, including chewing surfaces of all upper and lower teeth, while verbalizing the surfaces they are cleaning. 10. Cleans tongue and assists client in rinsing mouth. 11. Wipes client's mouth and removes soiled chest barrier.

Demonstrable Skill Morning Mouth Care (cont.) 12. Places soiled chest barrier (cloth or paper) in the appropriate container. 13. Empties rinses and dries emesis basin and returns to storage. 14. Rinses toothbrush and returns equipment to storage. 15. Removes gloves turning inside out and disposes of gloves in appropriate container. 16. Leaves client in position of comfort 17. Maintains respectful, courteous interpersonal interactions at all times. 18. Identifies that hands should be washed.

Demonstrable Skill Denture Care 1. Identifies that hands should be washed. 2. Explains procedure to client. 3. Lines sink with a protective lining that would help prevent damage to the dentures. (Towel or washcloth) 4. Puts on gloves and removes dentures from cup. 5. Handles dentures carefully to avoid damage, wets brush and applies toothpaste. 6. Thoroughly brushes denture inner surfaces of upper and/or lower dentures. (Toothettes may be utilized instead of a toothbrush as long as all of the surfaces listed above are cleaned.) 7. Thoroughly brushes denture outer surfaces of upper and/or lower dentures. (Toothettes may be utilized instead of a toothbrush as long as all of the surfaces listed above are cleaned.)

Demonstrable Skill Denture Care (cont.) 8. Thoroughly brushes denture chewing surfaces of upper and/or lower dentures. (Toothettes may be utilized instead of a toothbrush as long as all of the surfaces listed above are cleaned.) 9. Rinses dentures using clean cool water and rinse denture cup and places dentures in rinsed cup. 10. Adds cool clean water to denture cup. 11. Cleans, dries and returns equipment to storage 12. Discards protective lining in an appropriate container. 13. Removes gloves, turning inside out as they are removed. 14. Disposes of gloves in an appropriate container. 15. Identifies that hands should be washed.

Demonstrable Skill Dressing/Undressing a Client with Weakness on One Side 1. Identifies that hands should be washed and explains the procedure to the client. 2. Raises bed between mid-thigh and waist level, if adjustable and keeps client covered while removing gown. 3. Removes gown from unaffected side first. a. Gown was removed from client's ________ side. (Write Left or Right in the blank.) 4. Places used gown in laundry hamper. 5. When dressing the client in a shirt/blouse, the candidate inserts his/her hand through the sleeve of the shirt/blouse and grasps the hand of the client. 6. When dressing the client in a shirt/blouse, the candidate dressed from the weak side first. a. Candidate dressed _______ side first.

Demonstrable Skill Dressing/Undressing a Client with Weakness on One Side (cont.) 7. The candidate assists the client to raise his/her buttocks or turns the client from side to side and draws the pants over the buttock and up to the client's waist. 8. When dressing the client in pants the candidate always dressed from the weak side first. a. Candidate dressed _______ side first. 9. When putting on the client's socks, the candidate draws the socks up the client's foot until they are smooth. 10. When putting on the client's shoes, the candidate slips each shoe on and securely fastens the shoe with Velcro tabs or ties. 11. Leaves the client comfortably/properly dressed and leaves the client in a position of safety. 12. Maintains respectful, courteous interpersonal interactions at all times. 13. Identifies that hands should be washed.