Activities of Daily Living: Hygiene

Occupationally Specific Knowledge and Skills

Objective:Upon completion of this lesson, you will be able to

perform the tasks of the following basic hygiene activities of daily living both in the laboratory and clinical setting

Today’s Focus:1. Oral Hygiene

2. Shaving3. Feeding

What is an ADL?• Take a few minutes to jot down & indentify any

activity you consider an

• ADL’s

The most basic of daily hygiene activities can be

overlooked when one is sick or elderly.

What is your normal morning routine?

Oral Hygiene

Oral HygieneDefinition

1. Care of the mouth and teeth2. Ideally should be done three times a day3. Realistically in a nursing home/Hospital

setting it is done only once a day4. Residents should always be encouraged to

be independent as much as possible

Oral Hygiene Residents/Patients requiring frequent oral hygiene (maybe as often as every 2 hours)

1. unconscious2. vomiting

3. those experiencing high temperature4. those receiving certain medications

5. dehydrated6. mouth breathers

7. those receiving oxygen

Oral Hygiene

If a patient has trouble swallowing ( dysphagia)

• use a special mouth sponge with toothpaste in the sponge

a. dip in ½ strength mouthwash & water

b. excess water squeezed outc. HOB with patient head

turned to side while cleaning the mouth

When performing oral hygiene Wear gloves

a) all surfaces of the teeth should be cleaned

b) tongue should be cleanedc) mouth rinsed with ½ strength mouth

wash, if safe for residentd) gloves worn throughoutOral Hygiene Video

Oral Hygiene (continued)

Denture Care

Denture Care Introduce yourself, explain

procedure, gather equipment & provide privacy

a) Have patient rinse mouth with lukewarm to cool water

b) Don gloves to remove upper denture first1. Place index finger against the roof of

the mouth2. Thumb against front teeth3. Gently press and lift out at same time4. You will feel seal release5. Then remove lower dentures

Oral Hygiene (continued)

6. brush all surfaces of dentures, upper and lower

7. before replacing dentures• wash mouth & tongue with sponge

cleaner • rinse with ½ strength mouthwash and

waterWhen replacing dentures in mouth,*** lower dentures first then

uppers***Lowers help secure uppers

Shaving

Daily Shaving

A. Patients/residents should be shaved daily

B. Remember, when shaving1. use the resident’s own shaving equipment otherwise use disposable, sharp safety razors2. if resident is receiving anticoagulants, use an electric razor if possible

Daily Shaving (continued)

3. If oxygen is being administered• discontinue for this procedure if possible

4. Elderly women sometimes grow hair on their faces & chins

In some facilities shaving requires a Physician order Always check with the RN

Steps of Shaving a Patient:

Introduce yourself, explain procedure to patient, gather equipment, secure patient privacy

1.Moisten the beard with warm, wet washcloth2. Apply shaving cream3. Do not moisten beard if you intend to use an electric razor4. Start in front of the ear

a. hold skin tautb. bring razor down over cheek toward chinc. repeat until lather has been removed and area

shaved

Steps of Shaving a Patient

d. remove hair from under the nose & above upper lip using short, downward strokes from nose to lip

e. shave skin carefully; having person tense area helps

f. shave neck area on each side, bringing razor up toward chin

g. use short, firm strokes; rinse razor frequently h. wash face & neck; dry thoroughlyi. if skin is nicked, apply pressure directly over are &

report to nurse in chargeShaving Video

Feeding Patients

Feeding Patients • Good nutrition is essential • Mealtimes are regarded as social interactive

events• People who eat alone often have poor appetites &

poor nutrition• Proper mealtime preparation is important

Feeding the patient

Allow patient to do as much for themselves as possible1. Wash hands, offer hand hygiene to

patient & elevate the HOB2. give small amounts & make certain

patient has chewed & swallowed the food3. if weakness exists make sure that food

isn’t being packed into the cheeks4. patients can’t always feel food in their

mouth & would not be aware of some was packed in the cheeks

5. use caution when removing utensils does not scrape the roof of the mouth (palate)

Feeding Video

Feeding Patients (continued)

6. Use a straw when giving liquids-• Direct the straw by holding it between two fingers• Hold the straw until the patient releases it from his/her

mouth• EXCEPTION to straw use= ASPIRATION PRECAUTIONS7. Offer fluids often • some need it after each mouthful of solid food8. Feed as you would eat/ vary food choices9. When preparing the tray, find out how resident wants their

food.For example, some do not like butter, but prefer jam, sugar

in tea

Eyeglasses

A. Keep clean by rinsing with water and drying with special lens paper or soft, nonabrasive tissue.

B. Store in container in bedside stand when not in use

C. Glasses should be kept in easy reach of patientD. Encourage resident to wear whenever possible

Daily Hair Care

A. Usually performed after bathB. Brushing hair

• stimulates circulation of the scalp• refreshes the patient

C. If hair is tangled1. work section by section2. untangle hair, beginning near the

ends and working toward the scalp

3. gum may be removed with ice or peanut butter

Nail Care

A. Care to the fingernails is allowed by the state of Texas. Care of toenails by nurse aides is not. Due to diminished circulation of the lower extremities in elderly and ill people

B. Should a cut occur, infection might set in and healing be very difficultC. Podiatrists are brought in to perform foot careD. Even where fingernails are concerned, do not do on a diabetic

individualE. Procedure1. soak nails for at least 5 minutes.2. Nails can be cleaned while soaking3. Use an orange stick to push cuticles back4. Clip the nails either straight across or slightly rounded5. File any rough edges

Dressing a Patient

A. Let person select their clothingB. Let them do as much of the

dressing as possibleC. Position in front of a mirror if one

is availableD. Dress weakest side first, then

strongestE. Undress strongest first, then

weakestF. Use tools to assist the resident to

care for herself/himselfDressing a Patient Video

Is your patient ready to step into the batter’s box

this morning?

Activity• Divide into pairs- one person is the patient the other

student is the PCT• Shave the patient using a safety razor with the blade cap

still in place. Shaving cream to be used, procedure to be followed

• Perform oral hygiene on your patient using the proper procedure

• Feed your patient using applesauce, offering fluids with a straw and without a straw

• Then switch!

SCENARIO• Mr. Gonzalez is a 88 year old geriatric patient admitted to North Hills 2

days with right sided weakness, slurred speech, and facial droop (he is right handed)

• Dr. Smith has confirmed a Left Sided CVA• You are assigned to assist Mr. Gonzalez with his morning care today• It is 7:30 am and the breakfast trays arrive at 8:00 am• Dr. Smith has written an order to shave the patient with caution ASAP

and maintain ASPIRATION PRECAUTIONS during all meals!!!

• ***** Mr. Gonzalez is rings the call bell and says,• “I want to be shaved and have my teeth

brushed NOW before breakfast arrives!!!!”