Personal Care I

Mouth, Dentures, Hair, Feet and Shaving

Objectives:
After you take this class, you will be able to:

  1. Provide mouth care, denture care, hair care, foot and nail care according to the patientsí or residentsí unique needs.

  2. Adhere to basic safety, identification and standard precautions principles when providing personal care.

Introduction

Our patients and residents have a right to high quality personal care and hygiene. This class will give you a review about how to provide:

  • Mouth care
  • Denture care
  • Hair care
  • Foot care
  • Nail care
  • Shaving

The course called Personal Care II covers bathing, showering, perineal care and back rubs.

The Special Needs of Some Patients and Residents

Our patients and residents are different in terms of how much personal care they can do their own. Some patients and residents:

  • can take care of their own personal care needs without our help;
  • others need a little help;
  • some need a lot of help with this care;
  • and still others can do nothing on their own. They need the nursing assistant to provide all of their personal care to them.

Nursing assistants do not have to do anything, other than providing privacy, when a patient is able to do all of their personal care without any help. Self care and independence should be encouraged for these people.

Nursing assistants have to give their clients as much help as needed when a patient is not able to provide their own personal care. Nursing assistants must often provide total personal care to patients when they are too young, too ill, too confused or physically unable to do it themselves.

Some Personal Care Principles

When providing personal care to patients and residents:

  • wash your hands and put on gloves before you provide personal care. Use standard precautions.

  • provide privacy. Pull the curtain. Close the door. Knock before you enter a room if the person is doing their own personal care.

  • introduce yourself to the person and tell them what you are going to do before you do it.

  • determine the identity of the patient. Accurate patient identification is part of all processes, including personal care.

  • maintain the safety of the patient at all times. Never leave the bed in a high position when you are not next to the bed. Never leave an infant, young child or confused person in a bathtub alone. They could drown even in a little bit of water. Check the temperature of the bath water before you use it. Make sure that grab bars are in place and that they are strong enough to hold the weight of the person. Keep the floor dry. Wet floors lead to slips and falls.

  • let the person choose when they want personal care. All patients do not need a bath before lunch. Some may prefer it in the evening.

  • observe the patient during personal care. Look at the person. Check their skin condition. Report any skin tears or signs of skin breakdown. Is the skin pale? Is it intact?

  • Listen to the person. Do they have any fears or concerns? Are there any changes in their mental state? Are they more or less confused than they were in the past? Are they aware of the day of the week, the date and where they are?

  • Feel the person's skin. Is it hot? Is it cold? Is it wet or moist?

  • Smell. Does the person have any odors?

  • immediately report any unusual findings to the nurse.

  • document all personal care. A flow sheet is often used to document personal care and activities of daily living.

  • get organized. Gather all the supplies and equipment that you will need.

  • make personal care an enjoyable aspect of the person's life. Treat all your patients with respect and kindness.


Mouth Care

Mouth care should be provided for several times a day. Mouth care should be given before and/or after meals, in the morning and at night before the person goes to sleep. When a person is unconscious, they may need oral care every two hours.

Oral care keeps the mouth and teeth clean and without odors. It prevents cavities, infection, gum disease and bad breath. It is a very important part of care. If a person needs your help with mouth care, give them as much help as they need.

Mouth care is given using the following steps:

  • wash your hands and put on your gloves.

  • greet the person and explain the tooth brushing and/or denture care to the patient or resident.

  • place the person in a sitting position if they are in bed. A person should be at a 45-degree angle to prevent choking if the doctor allows the person to be up at this angle.

  • put a towel or a protective cover over the person's clothing and top sheet to keep these items dry and clean.

  • remove dentures if the patient has them.

  • if the person needs your help, wet the toothbrush with water and put the toothpaste on the toothbrush.

  • gently brush all surfaces of the teeth, the gums, tongue and cheeks. Use an oral applicator for mouth care if the person is unconscious so that water does not have to be used.

  • have the person rinse and swish their mouth with cool fresh water. Use a straw if needed.

  • have the person spit the remaining water into the emesis basin
  • floss between the teeth with dental floss

  • have the person rinse their mouth with cool fresh water and spit out the excess into the emesis basin

  • use mouthwash when needed. Have the person swish it and spit the remainder into the emesis basin.

  • clean and dry the skin areas around the mouth.

  • clean or dispose of all the equipment and leave the area clean unless you are about to do denture care.

Denture Care

If a person has dentures, denture care is done before the rest of the mouth care. Denture care is given using the following steps:

  • with washed and gloved hands, remove or have the person remove their dentures. If you are removing them, it is best to hold the upper denture and gently pull them down and out of the mouth. To remove the lower denture, hold them and gently pull them up out of the mouth.

  • place the dentures in the emesis basin or denture cup.

  • line the sink with a paper towel or water to help avoid any denture breakage should you drop them.

  • run cool or room temperature water. Do NOT use hot water. Hot water can damage dentures.

  • rinse the dentures.

  • gently brush the dentures using a toothbrush and toothpaste while holding them safely and firmly in your hand.

  • rinse the dentures under the running water.

  • place the dentures in a denture cup or emesis basin with cool water or mouthwash until they are put back in the person's mouth after mouth care.

If the person removes their dentures at night, they should be cleaned and put in the denture cup with water, mouthwash or a denture cleaning tablet until the morning. Make sure that the denture cup is labeled with the person's name and room number. Keep them in a safe place so they do not fall or get thrown into the trash by mistake.

If you notice any of the things below during oral care, they must be reported and documented:

  • Sores, redness or bleeding in the mouth, on the gums, cheeks or lips
  • Pain during mouth care
  • Coating of the tongue or cheeks
  • Broken teeth or dentures
  • Bad breath

Hair Care

Hair can be washed in the shower, in the bathtub and in the bed. Patients on complete bed rest and those that are unconscious can be given a shampoo using a special bed tray, water and regular shampoo or by using a dry shampoo that is made just for shampoos without water.

Independent patients usually shampoo their own hair while taking their regular shower or bath. Many nursing homes and assisted living facilities have hair care professionals visit on a regular basis to cut, curl, color and perm the hair of men and women who live there.


As with all procedures, including personal care, you must wash your hands, put on gloves, introduce yourself to the client, explain what you are about to do, identify the patient and maintain privacy, standard precautions, caring, respect, comfort and safety throughout the task.

If you are giving a person a shampoo in bed, follow these added steps:

  • get all of your supplies at the bedside

  • cover the pillow with a towel or protective cover to keep it dry

  • put a towel under the person's neck and arms after untying the gown or loosening the bed clothing

  • put the bed shampoo pan under the person's head

  • place a washcloth over the person's eyes so the shampoo does not burn them. "Tearless", baby shampoo is very good to use when the patient has it.

  • check the temperature of the water to make sure it is about 110 degrees

  • pour a small amount of water on the hair using a water pitcher and keeping as much water as possible off the face

  • put a small amount of shampoo on the head

  • gently massage the hair and scalp with your fingertips. Do NOT use the fingernails. Fingernails can scratch the scalp.

  • rinse the head using the water. Start at the top of the head and let the water work its way down to the bottom of the head.

  • repeat the rinsing and shampooing if needed

  • raise the person to a sitting position

  • dry the face

  • dry the head using a hair blower if you can

  • change the gown or bed clothes if needed

  • clean up the area and place the person in a comfortable position with the bed in the lowest position

You must report and document any of these things while you are giving hair care:

  • Sores, redness or bleeding
  • Flaking, dandruff or scalp dryness
  • Bugs or other bodies



Hair should also be brushed or combed several times a day beginning with the morning care. Here are the steps for combing or brushing hair:

  • cover the pillow with a towel if the person is in bed.

  • gently comb or brush one section at a time. Do not pull it. Do not break it or cause any discomfort. If the hair is tangled, comb the ends first and then work your way to the scalp.

  • braid the hair if the person wants braids. Braids prevent tangles.

  • remove the towel and let the person see how they look using a mirror.

  • clean the brush or comb. Do NOT share combs or brushes with other clients.

Foot Care

Feet and toes are washed and dried during every bath, but it is also important to give our patients and residents special foot care once in the while. Special foot care should be done with and without cutting the toenails. Special foot care is relaxing. It softens and cleans all areas of the feet.


The steps of special foot care are:

  • sit the person in a chair if it is possible. If the person is on bed rest, foot care can be done by flexing the person's leg and then doing this special care

  • fill a wash basin with water at about 110 degrees

  • put a towel under the basin

  • place the person's hand or foot in the basin to soak them for about 10 minutes

  • gently push the cuticles back with a nail care stick while soaking the other hand or foot

  • clean under the nails with a nail care stick

  • if the toenails are to be cut, follow the steps below in the section called Nail Care

Nail Care

Our clients also need their nails looked at every day. Nails should be clean, short and smooth. Dirty fingernails spread infection. Jagged fingernails can cause injury. Nail care is done best when the person is sitting in a chair. If the person is not able to sit in a chair, it can be done in the bed.

Some hospitals, home care agencies, nursing homes and assisted living facilities do not let nursing assistants cut the toenails, so check your policy. Do NOT, however, cut the toenails of anyone that has diabetes or bad circulation to the feet.

Again, before you do any procedures, including nail care, you must wash your hands, put on gloves, introduce yourself to the client, explain what you are about to do, identify the patient and maintain privacy, standard precautions, caring, respect, comfort and safety throughout the task.

The next steps are below:

  • fill a wash basin with water at about 110 degrees

  • put a towel under the basin

  • place the person's hand or foot in the basin to soak them for about 10 minutes
  • gently push the cuticles back with a nail care stick while soaking the other hand or foot

  • clean under the nails with a nail care stick

  • trim the nails using a clipper

  • file the edges with a nail file so that they are smooth

  • repeat the procedure for the other hand and feet, if permitted

  • dry the hands or feet

  • apply lotion to the hands and feet avoiding the areas between the toes.

When you are doing foot care, with or without cutting the toenails, it is important that you look at, clean and dry all parts of the foot, including between the toes.

You must report and document any of these abnormal signs:

  • Blue or pale nail beds
  • Broken nails
  • Bleeding
  • Corns or bunions on the feet

Shaving a Client

Many male patients prefer to have their face shaved every day. Others may want a face shaved less often. Allow your patients the choice.

Check with the nurse to find out if it is safe to shave your patients before you shave because some patients have bleeding problems.

As with other procedures, wear gloves during shaving because contact with blood is possible. Follow standard precautions. Also, label your clients' shaving supplies with their name and room number. Do not share razors and shaving supplies with other patients.

If the person is able to shave himself or herself but they need some help, help them as much as needed. If they are not able to do anything on their own, follow the steps below. The same steps are used when you shave the legs and under the arms of female patients.

  • gather all the needed supplies

  • raise the head of the bed up, if the person is allowed to be in a sitting position

  • put a towel or protective barrier under the area to be shaved

  • follow the instructions for an electric razor if you are using one. If you are using a regular razor, put warm water on the beard or hair to make it soft

  • shake the can of shaving cream

  • put the shaving cream in your hand

  • lather up the hair or beard with the shaving cream

  • hold the skin tight so that it is firm and tight

  • gently shave a small area in the direction that the hair grows. For example, if you are shaving the side of the face start at the side burn and shave downward. Shave upward when you are shaving the neck.

  • rinse the razor and repeat the above step until the entire area is done

  • wash and dry the area that has been shaved

  • apply lotion or after shave lotion if the person wants to use it

  • clean all equipment and supplies

Apply pressure to any area that you accidentally nick if it bleeds. Report and document all areas of bleeding.

Summary

This class has given you information about some personal care procedures. Take the class called Personal Care II so you can also learn about bathing, showering, perineal care and back rubs.

References

Berman, Audrey, Shirlee Snyder, Barbara Kozier and Glenora Erb. (2010). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. 8th Edition. Pearson Prentice Hall.

Copyright © 2010 Alene Burke



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