practices to care for oneself, such as caring for fingernails and hair.
Help the resident be as independent as possible.
Always explain what you will be doing.
Provide privacy.
Note and report signs and symptoms.
Observe mental state of resident.
Observe and report the following during personal care:
Skin color, temperature, reddened areas
Mobility
Flexibility
Comfort or pain level
Strength and ability to perform ADLs
Mental and emotional state
Complaints
Draw sheets
sheets that are placed under residents to help with turning, lifting, or moving up in bed.
Pressure points
areas of the body that bear much of its weight.
Bony prominences
areas of the body where the bone lies close to the skin.
Pressure sore
a serious wound resulting from skin breakdown; also known as a bed sore or decubitus ulcer.
There are four stages of pressure sores. These are the characteristics of each stage:
Stage 1: Area where skin is intact but there is redness that is not relieved within 15 to 30 minutes after removing pressure.
Stage 2: Partial skin loss involving the outer and/or inner layer of skin. The ulcer is superficial. It looks like a blister or a shallow crater.
Stage 3: Full skin loss involving damage or death of tissue that may extend down to but not through the tissue that covers muscle. The ulcer looks like a deep crater.
Stage 4: Full skin loss with major destruction, tissue death, damage to muscle, bone, or supporting structures.
Note - Pressure sores can lead to life threatening infections
Remember the following guidelines for skin care:
check the residents skin daily and report changes.
Reposition often, at least every two hours.
Give skin care often for incontinent residents.
Change clothing and linen often.
Do not massage white, red, or purple areas.
Avoid pulling or tearing skin during transfers.
In overweight residents pay special attention to skin under folds.
REMEMBER TO ALWAYS REPORT
Pale, white, red, purple areas or blisters and bruises
Itching and scratching
Fluid or blood draining
Wounds or ulcers
Changes in existing wound (size, depth, drainage, color, or odor)
Broken skin (toes or toenails)
Any change in appearance of the skin, such as an “orange-peel” look or purplish hue
Remember these points as you care for residents who are at a high risk for pressure sores (bed-bound):
Keep bottom sheet tight and wrinkle-free.
Use special protective aids such as air mattresses or other pressure reliever under bony prominences
Flotation pads on bed or chair
Bed cradle to keep top sheets from rubbing on skin
Perineal care should be performed daily
Remember -Always wipe from front to back when cleaning perineum area.
Remember these guidelines for bathing:
The face, hands, underarms, and perineum should be washed every day (partial bath).
Complete baths are only necessary every other day or less often.
Make sure room temperature is warm enough to ensure comfort for patient during bath.
Gather supplies beforehand so a resident is not left alone while bathing.
Always allow the resident to test the water temperature to ensure their comfort during the bathing process.
Electric razor
type of razor that runs on electricity; does not require the use of soap or shaving cream.
Disposable razor
type of razor, usually plastic, that is discarded after use; requires the use of shaving cream or soap.
Safety razor
a type of razor that has a sharp blade with a special safety casing to help prevent cuts; requires the use of shaving cream or soap.
Remember the following points when assisting with shaving:
Respect personal preferences regarding shaving.
Wear gloves.
Do not share razors between residents.
Soften hair on face first if using disposable or safety razor.
Shave in direction of hair growth.
Discard disposable shaving products properly.
Do not use electric razors near water, oxygen, or pacemakers.
Remember to observe and report the following during foot care:
Dry, flaking skin
Breaks or tears in skin
Discoloration of the feet
Blisters
Long, ragged toenails
Ingrown toenails
Differences in temperature of the feet.
Remember these points for combing or brushing hair:
Let residents choose their own hairstyles.
Do not style resident’s hair in a childish manner.
Handle hair gently as hair can be pulled out when combing or brushing.
REMEMBER:
Watch carefully for symptoms of pediculosis while combing or brushing hair and report any symptoms you observe.
Affected side
a weakened side from a stroke or injury; also called the weaker or involved side.
Involved
term used to refer to the weaker, or affected, side of the body after a stroke or injury.
REMEMBER:
Do not refer to “bad” side or a “bad” leg or arm; refer to the affected, weaker or involved side.
Remember these guidelines for dressing a resident with an IV:
Never disconnect IV lines or turn off the pump.
Always keep the IV bag higher than the IV site on the body.
First remove clothing from the side without the IV. Then gather the clothing on the side with the IV.
Lift clothing over the IV site. Move it up the tubing toward the IV bag. Lift the IV bag off its pole. Carefully slide the clothing over the bag. Place the bag back on the pole.
Apply clean clothing first to side with the IV. Slide the correct arm opening over the bag, then over the tubing and the resident’s IV arm. Place the IV bag back on the pole.
Check that the IV is dripping properly. Make sure none of the tubing is dislodged. Check to see that the IV site dressing is in place.
REMEMBER:
Anti-embolic (elastic) stockings can help prevent swelling and blood clots and aid circulation.
They need to be put on before the resident gets out of bed, when there is less swelling in the legs.
Oral care
care of the mouth, teeth, and gums.
Dentures
artificial teeth.
Remember the following when cleaning and storing dentures:
Dentures are expensive.
Handle them carefully.
Wear gloves when cleaning dentures.
Report problems with denture to the nurse.
Do not use hot water to clean dentures because it may damage them.
Place them in labeled cup or return them immediately to the resident.
REMEMBER:
Oral care may involve brushing the teeth and gums, flossing the teeth with dental floss, and denture care.
Observe and report the following during oral care:
Irritation
Coated tongue
Ulcers
Dry, cracked, bleeding, or chapped lips
Loose or decayed teeth
Note- Oral care should be performed at least 2 times a day.
Remember the following when providing oral care for an unconscious resident:
Swabs with lemon juice and glycerin may be used
Use as little liquid as possible to avoid aspiration.
Squeeze swabs after dipping them in solution to remove excess liquid.
Fracture pan
a bedpan that is flatter than a regular bedpan.
Note -Fracture pan’s are used on residents who cannot assist in raising their hips onto a bedpan (hip fractures)
Portable commode
a chair with a toilet seat and a removable container underneath; used when patient is able to get out of bed but is unable to walk to the restroom.
Urinal: used by male patients for urination when they're unable to get out of bed.
Note: Always wear gloves when disposing of waste.
Positioning
the act of helping people into positions that will be comfortable and healthy for them.
Supine
position in which a person lies flat on his back.
Lateral
position in which a person is lying on either side.
Prone
position in which a person is lying on his stomach.
Fowler’s
position in which a person is in a semi-sitting position (45 to 60 degrees).
Logrolling
method of moving a person as a unit without disturbing the alignment of the body.
Dangle
to sit up with the feet over the side of the bed to regain balance.
Transfer belt
a belt made of canvas or other heavy material used to assist residents who are weak, unsteady, or uncoordinated; also called a gait belt.
*Note: When using a transfer belt the NA should always place over patients clothing
Hydraulic / mechanical lifts (Hoyer lift): device will allow patient to be lifted with minimal physical effort and minimal risk of injury to patient.
Remember the following guidelines for wheelchairs:
Know how to use the wheelchair, including brake, arm rests and foot rests.
Lock before transfer; unlock after.
Keep resident safe and comfortable during transfers.
Reposition wheelchair-bound resident at least every two hours.
