Personal/Oral Hygiene, Foot Care, ROM Exercises and Making an Occupied Bed

Week 4

Bathing Cleanses and conditions the skin Helps to relax the patient Promotes circulation Acts as musculoskeletal exercise Provides comfort Helps improve self image Time to develop a therapeutic

relationship with your patient

Bathing Allows you an opportunity to

observe skin, hair, nails, bony prominences, for any adverse signs

Form of therapeutic touch Opportunity to complete a thorough

patient assessment, ask questions and to get to know the patient a little better

The Bed Bath Only an option if the patient is not able

to get up and ambulate Observe good “body mechanics” Assist patient or done completely by

the nurse Gather all equipment and linen as

needed Encourage toileting before you start Ensure privacy - close curtain and door

Bed Bath Use bath blanket and drape parts not

being washed - remember dignity!! Fold washcloth like a mitt Wash face first - inner to outer eye Soak hands and feet if possible Face, neck, arms, hands, chest,

abdomen, legs, feet, back, buttocks and anal area, long strokes towards body

Backrub will prove very soothing

Change water, get new cloth and towel Clean perineal area last! Always wear gloves for perineal care Female - wash from pubic area to

perineum to anus Male - retract foreskin if necessary and

wash from tip of penis towards pubis; remember to replace foreskin

be gentle with scrotum/testicles Do not usually use powder as promotes

bacterial growth no talc

Showers and Tub Baths #1 Carefully determine how much

assistance the patient will need Provide a chair or bench for the patient Bring all of the necessary supplies

including fresh clothing with you Ensure to check the water temperature Assist the patient in and out as needed Maintain privacy

#2 Assist as needed If patient is left alone, do not allow to

lock the door Hang a sign on the door to indicate

that the room is in use and to avoid interruptions

Always ensure safety of patient!!

Giving a Back Rub #1 Position patient for comfort & provide

privacy Assure pt. is covered and warm Warm lotion in hand Use light, gliding strokes to apply lotion

to shoulders, back and sacral area Place hands beside each other and

start at sacral area, work up and back down using slow, continuous strokes

#2 Massage shoulders, back, iliac crests

and sacrum with circular strokes Apply additional lotion as needed Observe skin for redness or breakdown Towel off excess lotion or moisture Assess the patient’s response and

document

Provides relaxation, sleep, improves overall comfort, decreases pain

Oral Care #1 If the patient is unconscious, turn

head/body to one side A toothbrush works best Be “gently firm” but don’t overdo it!! Use toothettes or a tongue depressor

with gauze if no toothbrush available Always remember to moisten the lips -if on oxygen, do not use petrolium jelly

#2 Encourage the patient to keep

dentures in when awake or the gum line may shrink

Always store dentures in water so they don’t dry out

Never use hot water with dentures as they may warp!!

Line sink with washcloth or papertowel- will chip or break if dropped

Hair Care and Shaving Provides pt. with sense of well being Don’t hyperextend neck Can shampoo hair at the sink or in bed Need ++ towels, cover pt. eyes Best done in shower with assistance Some hospitals have shampoo caps

Shaving Usually use electric razors - especially

if patient is on anticoagulants or at risk for bleeding

Razor shave: use shaving cream, pull skin taut, use short, firm strokes in direction of hair growth

Always wear gloves when shaving as may be at risk of exposure to blood

Follow patient’s direction

Diabetic Foot Care File nails as necessary….do not cut! Avoid heating pads, hot water bottles Encourage elevation of feet if swelling

evident Avoid crossing legs, stockings with

elastic tops and/or sitting for prolonged periods of time

Make referral to foot care specialist with calluses, corns, ingrown nails

Specially trained RN or RPN

Hearing Aids

Ensure ears are clean

Wipe off hearing aid if wax buildup evident

Check functioning before placing in ear

Usually remove at bedtime

Range of Motion (ROM)#1 Is the normal and possible full extent movement

of a joint Improves joint mobility and circulation Special attention to joints not being used Active - patient does on own Passive - nurse moves joint Active-assistive - nurse provides help

**Remember…..only active ROM exercises improves muscle mass, tone and strength

ROM #2 Plan of care should include how, what

and when so others can do the same Avoid overexertion and fatigue Avoid neck hyperextension and full

ROM in the elderly Start gradually and proceed slowly Movements should always be smooth

and rhythmic

ROM #3 Move joint until resistance is felt but not

pain Use support measures: cupping,

cradling, supporting Always return joint to neutral position Avoid friction Do ROM exercises at least 2 times per

day and repeat each exercise 2-5 times

ROM Positions Head - flexion, extension, lateral flexion Neck - rotation Shoulder - flexion, extension, abduction,

adduction, internal and external rotation Elbow - flexion, extension Forearm - supination, pronation Wrist - flexion, extension,

hyperextension

Fingers - flexion, extension, abduction, adduction, opposition of thumb to fingers

Hip - flexion, extension, abduction, adduction, internal rotation, external rotation

Knee - flexion, extension Ankle - dorsiflexion, plantar flexion,

inversion, eversion Toes - flexion, extension, abduction,

adduction

Making an Occupied Bed Do this only when necessary Movement is good for the patient so

always ambulate the patient if at all possible

Make ½ of the bed, then the other side Use side rails for safety!! May work side to side or top to bottom

depending on the patient’s ability to assist

Nursing Skills Lab 1 Week 5

Lab Theory Test #1 35-40 multiple choice questions

related to content discussed, demonstrated and practised in weeks 2-4

Will be written during the first 40 minutes of this Lab

Nursing Skills Lab 1 Week 5 Ambulation Patient Transfers and Restraints Dressing the Dependent Client

REMEMBER, to bring along an oversized shirt/sweater and pants for next week’s lab …………