Transcript Enable Clients to Maintain their Personal Hygiene and

Personal Care
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Aims
• To have a knowledge of different aspects
of personal care
• To learn practical skills required to deliver
personal care
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National Care Standards
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Dignity
Privacy
Choice
Safety
Realising Potential
Equality and Diversity
What does Personal Care
Include?
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Personal Care Includes
• Bathing, showering, hair washing, oral hygiene & nail
care
• Toileting, catheter/stoma care, skin care, incontinence
laundry, bed changing
• Assistance with the preparation of food and assistance
with the fulfilment of special dietary needs
• Dealing with the consequences of being immobile or
substantially immobile
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Personal Care Includes
• Behaviour Management, psychological support,
reminding devices
• Assistance with medication (including eye drops),
application of creams and lotions, simple dressing,
oxygen therapy
• Assistance with dressing, surgical appliances,
prostheses, mechanical and manual aids. Assistance to
get up and go to bed. Transfers including the use of a
hoist
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The Skin
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Functions of the Skin
• Protective covering for body
• End organ – pain, touch & temperature
• Secretes sebum- oily fluid which keeps skin and hair
moisturised
• Absorbs small amounts of oily substances
• Origin of hair and nails
• Contains cholesterol, substance converted into Vit D by
the action of sunlight
• Secretes sweat – removes waste water and salts and
plays important part in regulating body temperature
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Importance of skin care
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Keeping skin clean and fresh is essential for general health and
wellbeing
Dirty skin collects dried sweat, dead skin cells and secretions from the
glands – bacteria breeds and causes odours and infections
It is important to clean the skin at least daily.
If a service user is not willing to either have a bath or a shower then
they should be encouraged to have a daily wash. (even using body
wash or baby wipes) especially to folds of skin
If someone has a skin condition, this should be noted in their support
plan.
Older skin loses elasticity and sensation- be aware of extreme
temperatures and use care when drying
Pressure problems caused by- unable to move position, friction,
continence issues, diet etc
Infection
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Bacteria – UTI, chest infection
Viruses- common cold
Fungi- thrush, athletes foot
Parasites- scabies, head lice
Cross Infection
Definition
 Cross infection is the physical movement or
transfer of harmful bacteria from one person,
object, or place to another, or from one part of
the body to another
(Encyclopaedia of Nursing & Allied Health)
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Infection Control
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Wash hands!!
Check washing facilities are clean
Use handwashing gel if no suitable facilities
Wear gloves and apron where required
Wash hands after taking off latex gloves or before
putting on a new pair
• Dispose of waste appropriately
• Seek advice if someone has known infection e.g.
MRSA, Clostridium
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Personal Hygiene
• Maximises a feeling of freshness and
comfort
• Looks after the skin and prevents
damage to it
• Assisting someone with personal
hygiene can help to identify early signs
of injury, rashes, or skin dryness or
soreness
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Personal Hygiene
• Using the bathing/washing period to assess
individual progress, can identify change of mood
or ability to co-operate
• Note any physical signs, e.g pain on movement
of a limb or bruising. This is important as
confused or disabled people may be unable to
recall a fall or knock.
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Dressing / grooming
• Helps the person retain an interest in their
appearance and standard of grooming
• Consider hair styling, make up etc
• Respect choices but prompt with appropriate clothing
e.g. for weather
• May need to support with sensory aids, prostheses
and orthoses
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The Importance of food & drink
• Food & drink are basic essentials for
human beings to survive
• Food is an important part of social
events in most cultures and there are
often special customs associated with
eating
• Meal times are opportunity to spend
time with family / friends
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Nutrients required for a balanced
diet
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Proteins
Carbohydrates
Fats
Vitamins
Possible Causes of Poor
Nutrition in dementia
• Not recognising that it is time for a meal
(orientation)
• Forgetting to eat or drink/thought of having
eaten already (memory)
• Difficulties cooking food / Not waiting to cook
food properly (concentration)
• Food placed wrongly e.g sausages in cleaning
cupboard (confusion)
• Physical causes e.g. sore mouth
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Things you might try
• Allow plenty of time to eat
• Keep noise or activity around the table to a
minimum
• Remove distracting items from table
• Keep crockery simple and a different colour from
the table cloth
• Make sure there is adequate lighting
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Things you might try (cont)
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Serve one course at a time
Serve food that is familiar to the service user
Keep eating simple- finger foods
Be aware of food temperatures
Check sell by dates etc
Encourage fluids- may not recognise
sensation of thirst
• Find out preferences/choices- use pictures,
recipe books, TV programmes
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PEG feeding
• Percutaneous Endoscopic Gastrostomy
• Daily nutritional requirements fed directly
into the stomach
• Person may still be able to eat and drink
small amounts
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Peg Tube
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Continence & Dementia
• Approximately 50 – 60% of people with
dementia are thought to suffer from
incontinence. (mostly urinary)
• Rare for someone in earlier stages of
dementia to suffer from incontinence.
• More often problems start as dementia
progresses from moderate to severe stages.
• Often the incontinence is as a result of
“inappropriate” urinating or defeacating rather
than the person being totally unaware of their
action
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General obstacles to continence
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Infection – urine infection (UTI)
Poor diet and/or fluid intake
Constipation
Medication – side effects
Alcohol
Types of Incontinence
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Stress
Urge
Overflow
Neurogenic
Functional
Stress Incontinence
• Weakness of the muscles that support
the bladder (pelvic floor muscles)
• Leakage usually happens when
coughing, laughing etc.
• Usually affects women
• Can be caused by multiple pregnancies
or childbirth
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Urge Incontinence
• A sudden need to empty the bladder
and not able to get to toilet in time
• Can be caused by caffeine, alcohol,
anxiety or a neurological disorder such
as diabetes or a stroke
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Overflow Incontinence
• The bladder remains and does not
empty properly (what is passed is
overflow)
• There is sometimes a poor flow of
urine and constant dribbling
• Common in men with enlarged
prostate
• Constipation can cause this by
restricting flow of urine from bladder
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Neurogenic Incontinence
• The bladder loses its sensation and
empties with no warning
• Treat with regular toileting and perhaps
use incontinence pads (these can be
supplied by community nursing staff)
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Functional Incontinence
• The inability to reach the toilet on time
due to poor mobility, or the inability to
interpret the signs of a full bladder
• Common in people with dementia
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Factors affecting continence in
people with dementia
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Deterioration in personal hygiene
Wandering/agitation/restlessness
Anxiety
Disturbed behaviour
Communication
Aggression
Factors affecting continence in
people with dementia
• Memory- may forget what they set out to do
• Orientation – unable to find toilet especially in unfamiliar
environments
• Dis-inhibition- where and when appropriate
• Recognition- unable to recognise facilities or recognise
sensation of needing toilet
• Apathy- motivation to get up and go
• Physical difficulties- unable to remove clothing or get on /
off toilet due to e.g. arthritis, poor eyesight
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Promoting Continence - general
• Never accept incontinence as permanent or inevitable
• Overcome your own embarrassment- be aware of your
facial expressions, body language and tone of voice
• Use language that the person is familiar with
• Use short simple instructions- don’t chatter
• Consider other factors – e.g. diet, fluids (NB- never cut
down on fluids)
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Using the Toilet
To use the toilet you must be able to:
• Recognise you need to go to the toilet
• Plan ahead
• Be motivated to use the toilet
• Delay onset of passing urine
• Locate the toilet
• Possess the physical ability to get there,
adjust clothing and use the facilities
• Remember what you set out to do
• Use the toilet
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Things you might try - getting to the
toilet
• Establish a routine
• Tactful reminders- gentle coaxing, not forcing- ask if
the person wants to go with you
• Ensure toilet is within easy reach and sight- perhaps
have vacant toilet door slightly ajar
• Label toilet clearly, signposts
• Ensure way to toilet is free from obstacles
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Things you might try
-in the toilet
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Declutter toilet / bathroom
Clear away other receptacles e.g. bins
Ensure room is comfortable and not too cold / warm
Have floor and toilet seats different colours if possible
Consider aids e.g. handrails, raised seats, commodes
Be aware of your body position – don’t stand over person
Remember correct moving and handling
Keep skin clean- avoid too much soap
If using barrier creams – only thin layer as can reduce
effectiveness of incontinence pads
• Remember handwashing – prompt/assist person with dementia
to do so
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Urinary catheters
• A tube passed into the bladder – usually via the urethra,
sometimes through the skin above the pubic area
• Used when there is a medical need to drain or measure
urine. This may include maintaining the comfort of a
person who is very ill or dying.
• A catheter stays in place using a small, inflated balloon
which sits in the bladder
• You may be asked to empty/change the catheter bag
and assist in keeping the system clean.
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Urinary catheters
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Urinary catheters
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The main hazard is the introduction of infection and trauma
Always wash your hands before and after handling the catheter
Wear disposable gloves when emptying a catheter bag
Make sure there is no drag or pull on the catheter from the bag
Keep the drainage bag below the level of the bladder
Report any signs of redness, swelling or discharge
Unless otherwise directed, it is important the service user has a
healthy intake of fluids
Stoma Care
• An ‘ostomy’ is a surgically made opening, which
connects part of the internal body to the outside.
• Colostomy is an opening in the colon (bowel) to allow the
removal of bowel contents.
• The bowel contents bypass the back passage and are
collected into a bag (stoma bag) attached to the surface
of abdomen
• Ileostomy - opening from the small intestine to the
abdominal wall
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Stoma Care
• You may be asked to assist with emptying bags,
checking surrounding skin for sores /redness
and keeping the area clean and dry.
• Always wash your hands before and after
handling the stoma
• Wear gloves when emptying bags
• Report any signs of redness, swelling or
discharge
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Stoma Care
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Any questions??
• Practical sessions
• Feedback
• Thank you for listening!
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