Personal Care: Grooming and Dressing

Grooming & Dressing

• Grooming covers personal care like keeping hair, nails, and clothes clean
• Personal grooming promotes emotional well-being, enhances self-confidence, prevents infection, and increases comfort
• Clients have different preferences and place different importance on personal grooming
• It is important to be considerate and maintain client dignity, independence, preferences, privacy, and safety

Hair Care

• Illness and disability can interfere with hair care, and a PSW can assist as needed
• Individual hair preferences, rituals, and needs should be considered regarding culture, skin condition, health and self-care abilities
• How hair looks and feels significantly impacts emotional well-being

Considerations for Hair Care

• Hair care should be done usually in the morning and at bedtime
• Clients should be encouraged to do their own hair care, but assistance can be offered
• Clients decide how to brush, comb, and style their hair
• Cutting hair requires a consent form and should only be done if instructed
• Hair should be brushed gently

Hair Problems

• Alopecia is hair loss that can be complete or partial with male pattern including baldness and female pattern including thinning
• Chemotherapy, radiation, medications, pregnancy, hormone changes, stress, poor nutrition, and skin disease can cause alopecia
• Alopecia can resolve if the underlying issues are addressed
• Hirsutism is excessive hair growth in women where hair does not normally grow, such as on the face
• In men, hirsutism refers to a male pattern of increased body hair and can have a psychological impact or indicate a serious medical problem
• Dandruff presents as dry, white flakes on the scalp, hair, and shoulder, and often causes itchiness, and can involve eyebrows and ear canals, which may cause wounds from excessive scratching -Medicated shampoos usually help with dandruff
• Pediculosis (lice) is an infestation of tiny insect parasites that live on skin and hair, feed on human blood, and lay eggs on body hair and in clothing which can infest the head, genitals, and whole body
• Lice do not cause dangerous infections, but can carry pathogens
• Lice are found in overcrowded areas or places with inadequate bathing and laundry facilities
• Lice spread easily, so do not share brushes, combs, towels, and hair clips
• Medicated shampoos are used for treatment, and both live lice and eggs must be destroyed to prevent re-infestation
• Linens and clothing must be washed in hot water and supervisor must be notified

Brushing Hair & Observations

• Place a towel over the client's shoulders and before changing pillowcases in bed
• Start brushing near the bottom of the hair and work your way up to the scalp
• Handle hair gently to avoid hurting clients by brushing slowly and avoid pulling or tugging
• If you find matted or tangled hair, discuss with supervisor
• Check for scalp sores, flaking, presence of lice, patches of hair loss, and very dry or oily hair

Washing Hair

• Shampoo hair you are instructed to do so by a supervisor, and check the care plan for the method
• Check for position restrictions or limits
• Remove hearing aids to prevent them from getting wet and damaged
• Gloves should be worn and standard Practices followed if client has scalp lesions, head lice, or certain shampoos are required
• Check and maintain the water temperature
• Eye protection during shampooing can be provided by a towel or washcloth over the eyes or by cupping hand against the client's forehead when rinsing

Care of Nails and Feet

• Injuries to the feet are a serious concern for older adults and people with circulation problems
• Diabetes and vascular disease are the common causes of poor circulation and impaired wound healing
• Feet are easily injured and infected, and gangrene and amputations are serious complications from improper foot care
• Long or broken nails can scratch skin and nails that are torn away from the skin cause skin breaks and become portals of entry for microbes
• Dirty or moist feet, socks, and stockings harbor microbes

Nail and Foot Care Considerations

• PSW are restricted from cutting or trimming toenails in some facilities according to agency policies
• Do not trim toenails on clients with diabetes, poor circulation to legs and feet, those on medications that affect blood clotting, or those with thick or ingrown nails
• A podiatrist, a physician specializing in the evaluation and treatment of diseases of the foot, may oversee the treatment

Foot Care Observations

• Observe for very dry skin, foot odors, cracks or breaks in the skin between the toes, ingrown nails, reddened or calloused areas on the feet, heels, or ankles, drainage or bleeding, changes in color or texture of nails, corns, bunions, or blisters

Changing Clothing & Hospital Gowns

• Clients undress and dress at least once a day, more often if soiled
• Nursing home, LTC, client's home usually means normal clothing
• Hospitalized clients typically need to wear hospital gowns, especially those receiving IV therapy, because hospital gowns are easier to remove and open at the back
• Assess for pain during dressing and provide comfort, because moving joints can be very uncomfortable
• Never jerk or pull the client's limbs, and provide specific steps for those with arm or leg injuries or paralysis
• Being organized, efficient, and quick as possible, providing privacy, allowing client to choose, and allowing the client to participate are all part of the process

Dressing a Client with Weakness

• DAF = dress affected side first
• RUF = remove unaffected side first
• Support the affected limb when removing or putting on garments
• Report and record observations and client's tolerance

Elastic Stockings and Bandages

• Knee-length socks or full stockings can help prevent blood clots in clients with circulatory disorders, heart disease and those on bed rest
• The elastic exerts pressure on the veins, which promotes venous blood flow to the heart and provide support and reduce swelling from injuries
• These are ordered by physicians and must be applied as part of the daily dressing routine and needs to be applied in the morning before the client gets out of bed
• These are removed every 8 hours for 30 mins or according to care plan and can harm the client if applied incorrectly
• Elastic stockings come in a variety of sizes and lengths and have openings near the toes to check circulation, skin color, and temperature
• Make sure that they are smooth and not bunched up or binding, without twists, creases, or wrinkles after applying them since Creases and wrinkles = skin breakdown
• Report and record skin color, leg and foot swelling, skin breakdown, pain, tingling or numbness

Oral Hygiene

• Oral hygiene covers maintaining mouth care, and is important because it prevents mouth odors, infections, and cavities and prevents gum disease
• Gum disease in elderly or chronically ill impacts nutrition and makes food taste better, which increases comfort and the likelihood that clients will eat well
• Gums become red and swollen and bleed easily and as the disease progresses, bone is destroyed ending with loosened and tooth loss
• Poor oral hygiene can lead to illness because bacteria can grow in the oral cavity and then be aspirated into the lungs causing respiratory diseases
• Gum disease can also increase a person's risk of heart disease because some studies show that clients with oral disease are at greater risk for thickening of the arteries, which leads to heart disease, stroke and heart attack
• Disease, medications and O2 treatments often cause problems in the mouth
  • Some medications and diseases cause a white coating on the mouth and tongue
  • Other medications cause redness and swelling of the mouth and tongue
  • Medications may cause dry mouth or increase bleeding

Providing Oral Care

• Oral care should be completed when client awakens, after each meal, and at bedtime
• It is important for increasing desire to eat and preventing lung, cardiac and systemic infections
• Review client’s care plan, as it outlines specifics, care type and assistance required
• Monitor for dry, cracked, swollen, blistered lips, redness, swelling, irritation, sores, white patches in the mouth or tongue, bleeding, swelling, or redness of the gums, loose teeth, rough, sharp, or chipped areas on dentures, and pain or discomfort

Brushing Teeth

• The gum line is where you should always start
• Provide options for clients where to brush teeth, e.g. bathroom, sink, or at bedside
• Keep in mind you may have to brush the teeth of clients who are very weak or confused
• Some clients can do a limited job and their own, but it’s often not adequate
• Mouth care will be difficult to provide to clients with dementia.
• Even partial mouth care is better than none

Mouth Care for Unconscious Clients

• There are special considerations for clients who are not conscious and at high risk for poor oral care
• Unconscious clients do not eat or drink by mouth, breathe with their mouths open, often receive oxygen therapy via mechanical ventilator, causing dryness & crusting on the tongue and mucous membranes, and who require oral hygiene to help keep the mouth clean, moist, and prevents infection
• They are at significant risk of aspiration because they can't swallow or cough or gag and must be positioned all the way on the side so fluids drain out of the mouth
• Sponge swabs are used to apply the cleaning agent with very little water
• Lubricants are applied to the lips after oral care to prevent cracking of the lips
• Oral care is done at least every 2 hours
• Remember that unconscious clients can hear and are aware and introduce yourself, tell client what you are doing and say goodbye when you leave

Denture Care

• Dentures are artificial teeth and can be complete or partial that should be cleaned as often as natural teeth and are removed at bedtime
• Some clients only wear dentures when eating and clients who can clean their own may need help to collect items or to bathroom
• Be mindful that dentures = can be slippery when wet and easily break or chip if dropped onto a hard surface and handle them carefully as they are very expensive

Denture Care Considerations

• Ensure dentures are not soaked longer than the recommended time because damage can occur if soaked in the cleansing agent for longer than recommended
• Use water that is not too HOT because it causes warping and ensure they are stored in a container and covered with water or it also causes warping
• Remind clients not to wrap dentures in tissues or napkins because they can be thrown out by mistake and be aware that many clients do not like being seen without their dentures
• Provide privacy for clients who clean their own dentures and adhere to the DIPPS protocol

Providing Denture Care

• Place a towel on the client's chest, wear gloves, and use gauze or a clean cloth to grasp the dentures so they don't slip
• Firmly hold the dentures over a basin of water lined with a towel
• Observe the dentures for sharp, rough edges, and chips
• Brush outer surfaces of upper denture with back and forth motion
• Remove top denture first then bottom