Personal Care: Grooming and Dressing

Grooming and Dressing - Week 5, Chapter 18

• Grooming and dressing are essential aspects of providing optimal client support and personal care.

Objectives

• The importance of hair care and shaving should be explained.
• Factors that affect hair care should be identified.
• How to care for matted and tangled hair should be explained.
• How to shampoo hair should be described.
• Knowledge of steps for shaving a client should be demonstrated.
• Why nail and foot care is important should be explained.
• How to dress and undress clients should be described.
• The purpose of elastic stockings and bandages should be explained.

Personal Grooming

• Personal grooming involves keeping hair, nails, and clothes clean.
• Personal grooming is important for clients because it:
• Promotes emotional well-being.
• Enhances self-confidence.
• Prevents infection.
• Increases comfort.

Client Preferences

• Clients may have different preferences and place different importance on personal grooming.
• Grooming is a very personal activity usually done independently and in private.
• Some clients want their hair styled daily.
• Some clients are okay with just washing and brushing.
• Some clients want their nails manicured, while some men prefer to be shaved daily.
• Others may not prioritize looking groomed.

Hair Care

• Illness and disability can interfere with hair care.
• PSWs can assist with hair care as needed.
• Individual hair preferences, rituals, and needs should be considered.
• These include culture, personal choice, skin and scalp condition, physical/mental health, and self-care abilities.
• A persons hair appearance and feel can impact their emotional well-being.
• Hair care should be done usually in the morning and at bedtime.
• Encourage clients to do their own hair care or assist them.
• Clients decide how to brush, comb, and style their hair.
• Never cut hair unless instructed to do so, as it requires a signed consent form.
• Hair should be brushed gently.

Hair Problems

• Alopecia is hair loss that may be complete or partial.
• Male pattern = baldness.
• Female pattern = thinning.
• Causes include chemotherapy, radiation, medications, pregnancy, hormone changes, stress, poor nutrition, and skin disease.
• In some cases hair can grow back if issues are resolved.
• Hirsutism involves excessive hair growth, commonly seen in women where hair does not usually grow (e.g., face).
• In men, hirsutism refers to a male pattern of increased body hair.
• Hirsutism primarily has a psychological impact; but can indicate a serious medical problem.

Hair Problems - Dandruff and Lice

• Dandruff involves dry, white flakes on the scalp, hair, and shoulder, that often causes itchiness and can affect eyebrows and ear canals.
• Excessive scratching can cause wounds.
• Medicated shampoos may help.
• Pediculosis (lice) is an infestation of tiny, insect parasites that live on skin and hair and feed on human blood, laying eggs on body hair and in clothing.
• Although not causing dangerous infections, lice can carry pathogens, and excessive scratching can cause wounds.
• Lice are often found in overcrowded areas with inadequate bathing and laundry facilities.
• Lice spreads easily, so do not share brushes, combs, towels, hair clips, etc.
• Treatment includes medicated shampoo, destroying both live lice and eggs.
• Linens and clothing must be washed in hot water.
• A supervisor should be notified in the event of lice.

Brushing Hair and Observations

• When brushing hair, consider placing a towel over the client's shoulders, or a towel over the pillow if the client is in bed.
• Start near the bottom of the hair and work your way up to the scalp.
• Handle hair gently and avoid hurting clients, brushing slowly and never pulling or tugging.
• If matted or tangled hair is found, discuss it with a supervisor.
• When brushing a client's hair, observe for scalp sores, flaking, lice, patches of hair loss, and very dry or oily hair.

Washing Hair

• Shampoo hair only with instructions from a supervisor.
• Check the care plan for the appropriate method to use (shower, tub bath, sink, or in bed).
• Check if the client has any position restrictions or limits.
• Remove hearing aids to prevent them from getting wet or damaged.
• Follow standard practices by wearing gloves if the client has scalp lesions or head lice or if using medicated shampoos.
• The client's care plan will specify if gloves are required.
• Check the water temperature before washing.
• Prevent shampoo from getting into the client's eyes by using a face towel or washcloth.
• When rinsing the hair, cup a hand against the client's forehead to prevent water from running into their eyes.

Care of Nails and Feet

• Feet are easily injured and infected.
• Nail and foot injuries can be serious in older adults.
• Those with circulation problems may have impaired wound healing.
• Diabetes and vascular disease is the most common cause of poor circulation that results in impaired wound healing.
• Gangrene and amputations are serious complications that can arise from improper foot care.
• Long or broken nails can scratch skin.
• Torn away nails can become an entry point for microbes.
• Dirty or moist feet, socks, and stockings harbor microbes.

Care of Nails and Feet - Considerations

• In some facilities, PSWs are restricted from cutting or trimming toenails depending on your agency's policies.
• Do not trim toenails on clients with diabetes, poor circulation to legs and feet, prescribed medications that affect blood clotting, or thick or ingrown nails.
• A podiatrist is a physician who specializes in the evaluation and treatment of diseases of the foot and may oversee treatment.

Observations During Foot Care

• Observe and report on:
• Very dry skin.
• Foot odors.
• Cracks or breaks in the skin especially between toes.
• Ingrown nails.
• Loose nails.
• Reddened/irritated/calloused areas on the feet, heels, or ankles.
• Drainage or bleeding.
• Changes in color/texture of nails (black, thick, brittle).
• Corns, bunions, or blisters.

Changing Clothing and Hospital Gowns

• Clients undress and dress at least once a day.
• Might be more often if soiled.
• Normal clothing occurs within:
• Nursing homes
• LTC Facilities
• Client homes
• Hospitalized Clients get hospital gowns:
• Mostly for clients receiving IV therapy
• Easier to remove and open at the back
• Assess for pain during dressing to provide comfort.
• Moving joints can be very uncomfortable for many clients.
• Never jerk or pull the client's limbs.
• Clients with arm/leg injuries or paralysis require specific steps.
• Stay organized, efficient, and as quick as possible.
• Provide privacy.
• Allow client to choose as much as possible.
• Encourage client to participate (good opportunity for ROM).

Guidelines for Changing Client's Clothing (with weakness)

• Dress Affected side First (DAF).
• Remove Unaffected side First (RUF).
• 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 help prevent blood clots.
• Use on clients who have circulatory disorders, heart disease, and those on bed rest.
• Apply when a patient:
• The elastic exerts pressure on the veins, which promotes venous blood flow to the heart.
• They provide support and reduce swelling from injuries.
• Ordered by physicians.
• Must be applied as part of their daily dressing routine.
• They apply in the morning before the client gets out of bed.
• Removed every 8 hours for 30 minutes or according to the care plan.
• Can harm the client if applied incorrectly.
• Come in a variety of sizes and lengths.

Elastic Stockings and Bandages (continued)

• Stockings have openings near the toes to check circulation, skin color, and temperature.
• Ensure stockings are smooth, not bunched up or binding, without twists, creases, or wrinkles.
• Report and record skin color, leg and foot swelling, skin breakdown, pain, tingling, or numbness.

Oral Hygiene - Week 5, Chapter 18

• Providing optimal client support and personal care depends on a plan for oral hygiene.

Weekly Objectives in Oral Hygiene

• Explain the importance of oral hygiene.
• Describe steps for oral hygiene.
• Describe important observations.

Oral Hygiene: Mouth Care

• Mouth care is important for preventing mouth odors, infections, and cavities and, in general, prevents gum disease. Increases comfort.
• Food tastes better after oral care.
• Gum disease impacts nutrition in elderly or chronically ill patients.
• Oral hygiene in the elderly or chronically ill increases the likelihood that clients will eat well.
• Gums become red and swollen and bleed easily, bone is destroyed as the disease progresses, and teeth become loosened, eventually resulting in tooth loss.

Poor Oral Hygiene and Disease

• Poor oral hygiene can lead to illness.
• Bacteria can grow in the oral cavity and be aspirated into the lungs, causing respiratory diseases such as pneumonia.
• Gum disease can increase a person's risk of heart disease because some studies show those with oral disease are at greater risk for thickening of the arteries, which leads to heart disease, stroke, and heart attack.
• Illness can also lead to poor oral hygiene.
• 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.
• Blood thinners increase bleeding in the mouth.
• Some medications cause dry mouth.
• Dry mouth results from oxygen administration, smoking, low fluid intake, mouth breathing, and anxiety.

When to Provide Oral Care

• Oral care should be provided:
• When the client awakens,.
• After each meal.
• At bedtime.
• Sometimes, before meals to increase desire to eat and is important to prevent lung, cardiac, and systemic infections.
• Check the client's care plan regarding the type of mouth care and assistance needed.

Observations - Oral Hygiene

• Dry, cracked, swollen, blistered lips should be observed.
• Redness, swelling, irritation, and sores should be observed.
• White patches in the mouth or tongue should be observed.
• Bleeding, swelling, or redness of the gums should be observed.
• Loose teeth should be observed.
• Rough, sharp, or chipped areas on dentures should be observed.
• Pain or discomfort should be observed.

Brushing the Client's Teeth: Considerations

• Always start at the gum line.
• Allow the client to choose where to brush their teeth (bathroom, sink, bedside).
• Tooth brushing of the client may be preformed by other clients which depends on:
• If the client has the ability to their own
• That they are very weak or confused
• If the client has dementia makes it difficult to give mouth care, it's important even a small amount of mouth care is beneficial

Mouth Care for Unconscious Clients

• Special considerations exist for these clients as they are at high risk for poor oral care.
• Unconscious clients characteristics:
• Do not eat or drink by mouth.
• Breathe with their mouths open.
• Often receive oxygen therapy using a mechanical ventilator which causes dryness and crusting on the tongue and mucous membranes.
• Routine measures keep the mouth clean and moist and help prevent infection.

Mouth Care for Unconscious Clients continued

• Unconscious clients are at a significant risk of aspiration during mouth care and may not swallow or cough.
• Position such patients on one side so that fluids drain out of the mouth.
• Use sponge swabs to apply the cleaning agent, using very little water.
• Apply lubricants to the lips after oral care to prevent cracking of the lips.
• Oral care is done at least every two hours.
• Remember that unconscious clients can hear and are aware of their environment.
• Communicate, introduce yourself, tell the client what you are doing, and say goodbye as you leave.

Denture Care

• Dentures are artificial teeth that can be complete or partial.
• Dentures should be cleaned as often as natural teeth.
• Dentures should be removed at bedtime.
• Some clients do not wear their dentures all the time.
• Clients that help clean their own dentures require help to collect cleaning items or to get to the bathroom.
• They may only wear them when eating and remove them after meals.
• Dentures are slippery when wet, easily break or chip if dropped onto a hard surface, and must be handled carefully because they are expensive.

Denture Care: Considerations

• Dentures cannot be left in cleaning agent longer than recommended time because damage can occur if soaked.
• Make sure the water is not too hot because that causes warping.
• Store in a container and covered with water because not covering them may cause warping.
• Remind clients to avoid wrapping dentures in tissues or napkins to prevent them getting thrown in the trash by mistake.
• Many clients dislike being seen without their dentures and will restrict the ability to clean them accordingly.
• Providing privacy for clients who clean their own dentures is important.

Providing Denture Care

• Place a towel on your client's chest.
• Wear gloves.
• Use gauze or a clean cloth to grasp the dentures so they do not 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 the upper denture with a back and forth motion.
• Remove top denture first, then bottom.