Fundamentals of Nursing Care: Concepts, Connections, & Skills
Chapter 15
Personal Care
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Activities of Daily Living (ADLs)
Related to Personal Care
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Bathing
Washing and styling hair
Brushing and flossing teeth
Dressing
Shaving
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Routine Care
 Who’s job is it?
 Delegate?
 Responsibility
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Scheduled Care
 A.M. Care
 Before or after breakfast
 ADL’s
 Linen’s
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Scheduled Care
 P.M. Care
 Address any needs—hourly rounding
 Straighten sheets
 Back rub?
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Scheduled Care
 Bedtime (hs) Care
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Prepare for sleep
Brush teeth, remove dentures
Remove glasses, remove hearing aid
Back rub?
Extra blanket
Dim lights
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Benefits of Bathing Patients
 Patient
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Cleansing the skin
Increasing circulation and sensation
Providing comfort and relaxation
Improving self-esteem
 Nurse
 Opportunity for skin assessment
 Nurse–patient relationship
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Benefits of Bathing
 Skin assessment
 Look for redness, cracking, and maceration
 Crevices, under breasts and scrotum, axilla and
groin, between toes, and between buttocks
 Excoriation or scrapes on skin
 Temperature
 Breakdown
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Benefits of Bathing
 Gain your patient’s trust and respect
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Respect
Preserve modesty
Demonstrate care and compassion
More time spent with patient=ability of patient to
confide in you
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Factors to Consider When Planning
Patient Care and Bathing
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Patient preferences
Patient’s culture
Timing of the care
Patient’s abilities
 Understands directions
 Moves and turns enough to assist
 Tolerates physical demands of a bath
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Preparing
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Ability to turn
Follow directions
Need for assistance
Is patient in pain? Experiencing fatigue? SOB?
Determine appropriate bath
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Supplies
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Basin or bag
Several towels, washcloths, bath blanket
Linens
Laundry bag or somewhere to place dirty linen
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Bath
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Test water temperature
Provide privacy
Position bed to appropriate height
Lower siderail nearest you
Place bath blanket
Remove gown
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Approach is Important
 Positive attitude
 Do not rush patient
 Do not make their care seem like a chore to
you
 How would you like to be treated or your
family member
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Three Categories of Personal Care
 Self-care: patients who are able to perform
ADLs without assistance
 Assisted care: patients who need some
assistance with ADLs
 Total care: patients who are able to do very
little or nothing for themselves
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Types of Baths
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Complete bed bath
Assisted or help bath
Partial bath
Tub bath*
Shower*
Therapeutic bath
Towel or blanket bath*
Bag bath*
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Complete Bed Bath
 View video
 Skill 15-1 pg. 294
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Assisted Bath
 Bed or chair
 Patient participates as much as possible
 Nurse completes what patient can not reach
or if becomes fatigued
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Special Considerations
 Older adults
 Sebaceous and sweat glands produce less oil and
sweat
 Optional daily full bath—cleanse areas of
necessity
 Prevent dryness
 Keep patient warm
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Partial Bath
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Only selected areas are washed
Patient condition
Post-op
Dryness
Face, hands, axilla, buttocks, and perineal
area, or parts of the patient that would cause
odor if not washed
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Tub Bath
 Sits in tub
 Whirlpool
 Disadvantages—difficult to get in and out of
tub, risk of falls
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Shower
 Shower chair
 Monitor temperature of water
 Wash hair
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Key Points
 Tub baths, showers, or therapeutic baths
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Monitor water temperature
Warm water dilates blood vessels (vasodilatation)
Lowers blood pressure
Possible dizziness or fainting
Stay with patient or in close proximity
Inform patient of emergency call system
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Bag Bath
 12-15 washcloths saturated with no-rinse skin
cleanser
 Heat bag in microwave
 Each washcloth washed one part of body—
then discard
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Guidelines
 Use of bath blanket
 Fold washcloth into a mitt
 Move cleanest to dirtiest areas—prevent
transferring bacteria
 Extremities—distal to proximal
 Start with extremity farthest away from you—
prevent contamination
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Guidelines
 Change water
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Dirty
Soapy
Cool
After bathing buttocks and rectal area
 Perform perineal care during bath and
anytime patient is incontinent
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nurse Responsibilities When
Bathing Patients
 Assess the skin for rashes, bruises, and lesions
 Complete the bathing process in timely
manner
 Be alert to signs of patient fatigue
 Intervene in ways to conserve patient energy
during the bath
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Oral Care
 Freshens mouth
 Decrease bacterial count
 Assess mouth for problems
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Teeth—decaying, broken, or missing
Reddened or bleeding gums
Ulcerations
Coating on the tongue
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Examples of Patients Needing
Special Mouth Care
 Patients who are NPO
 Patients receiving oxygen by cannula or mask
 Patients having a nasogastric or feeding tube
in place
 Patients who are unconscious
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Unconscious Patient
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Oral care needs to be provided
Highest priority—Prevent aspiration of fluids
Proper positioning
Availability of suction
Assess for lesions and sordes (dried mouth
secretions)
 Skill 15-4, pg. 298
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Conscious Patient
 Independent—help with necessary supplies
 Assistance needed—use small amount of
toothpaste, circular motion on inner and outer
surface of teeth, and back and forth motion
on chewing surfaces
 Possible swallowing difficulties*--stay with
patient and position patient properly
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Denture Care
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Be careful!
Expensive
Interfere with nutrition
Pad cleaning surface
Use cool rather than hot water
Follow policy or patient’s preference
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Dressing
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Underwear?
Intravenous line?
Size of patient
Don’t forget their HAIR!
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Dressing
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Let them select outfit
Any limitations?
Style hair
Apply makeup if desired
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Hair Care
 Keep patient well groomed
 Improves self-esteem
 Comb or brush—eliminate bed head—style
age appropriate
 Shampoo if needed or desired
 Shower or no rinse shampoo
 Shampoo board
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Shaving
 Shave in direction of hair growth
 Electric razor—circular motion—clean razor
when finished to prevent clogging
 Safety: DO NOT USE a razor blade for any
patient on anticoagulation therapy (blood
thinning medication) A cut can cause
excessive, difficult to control bleeding
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Contraindications
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Thrombolytic agents
High doses of aspirin
Blood disorders
Liver disease
Rashes, lesions, inflamed lesions
Suicidal patients
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nail Care
 Follow facility policy
 Do not cut nails on diabetics or patients with
circulatory problems—Podiatrist
 Clip nails straight then file—stay away from
skin
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Observations Made
During Nail Care
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Discoloration
Ridges
Redness
Infections
Thick yellow toenails (fungal infection)
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Care of Piercings
 New piercings
 Keep clean—soap, water, and alcohol
 S/S of infection—redness, swelling, pain, or
drainage
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Situations Requiring Removal of
Jewelry From Piercings
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Surgery
Intubation
Diagnostic testing
Catheterization
Table 15-1, pg. 289
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Eye Care
 Glassess
 Clean with warm water and soft cloth
 Inform patient of placement of glasses
 Safe but accessible site
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Removing Contact Lenses
 Wash hands; put on gloves
 Pull down on lower lid; place finger across
upper lid; apply gentle pressure
 Ask patient to blink
 Grasp lens with fingers
 Hold lens carefully and put in well
 Fill the well with saline or soaking solution
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Contact Lenses
 Properly labeled containers (R and L)
 Place in correctly
 Saline or special soaking solution
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Procedure for Removing
a Prosthetic Eye
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Wash your hands and put on gloves
Dip the end of the suction cup in saline
Lift the upper eyelid
Squeeze the suction cup and place it on the iris of
the prosthesis
 Stop squeezing
 Use the handle of the suction cup to lift the
prosthesis out of the socket
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Cleansing Prosthesis
 Cleanse prosthesis with sterile water or saline
 Irrigate the eye socket with eye irrigating
solution
 Small amounts of mucus may accumulate
 Observe for thick yellow or green mucus
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Removing a Hearing Aid
 Turn off the hearing aid
 Turn the earmold slightly toward the nose and
lift out
 Store the aid in its case or moisture-control
container
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Inserting a Hearing Aid
 Check the battery by turning the hearing aid
on to full volume and listening for it to
whistle, which indicates that it is working
 If you do not hear a whistle, check the battery
and replace as needed
 Turn off the hearing aid and lower the volume
 Insert the hearing aid into the ear and adjust
the volume as needed
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Types of Unoccupied Beds
 Open bed: made with top linens fan folded to
foot of bed
 Surgical bed: made with top linens fan folded
to side of bed
 Closed bed: only used when patient is
discharged; top linens are spread to the head
of the bed
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Nurse Responsibility in Bed Making
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Often delegated to a CNA or UAP
Must be made tightly without wrinkles
Number one concern is patient safety
Use side rails appropriately
Apply drawsheet according to policy
Miter corners
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Common Bed Positions
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Flat
Fowler’s—45 to 60°
Semi-Fowler’s or low-fowler’s—30°
High Fowler’s—sitting upright in bed
Trendelenburg
Reverse Trendelenburg
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Controlling the Patient
Environment
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Provide for privacy
Arrange furniture
Keep patient door closed to block noise
Control odors by removing bed pans
Remove clutter from room
Keep pathway to bed clear of equipment
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Orient Patient to Surroundings
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Use of bed controls
Importance of siderails
Call light and television controls
Over bed table—compartments
Importance of cleanliness and order
Bedside stand
Closet
Copyright © 2011 F.A. Davis