PCC CNA Unit 9

1. PROCESS (Continued)
HELEN SAWYER PLAZA MIAMI, FL
Personal Care and Hygiene
Unit 9
•Brushing the Person’s teeth
•Giving a Back Massage
•Giving Nail and Foot Care
•Providing mouth care for the unconscious
person
•Giving Female and Male Perineal care
•Providing Denture Care
•Brushing and Combing a Person’s Hair
•Giving a Complete Bed Bath
•Shampooing the Person’s Hair

2. PROCESS (Continued)
HELEN SAWYER PLAZA MIAMI, FL
Factors that affect a persons
cleanliness needs and personal
practices
• Individuals will have preferences and
habits that have been developed over a
lifetime.
• Individual preferences should be
respected and accommodated when
possible.

3. PROCESS (Continued)
HELEN SAWYER PLAZA MIAMI, FL
More Factors
• Age-related changes should be
considered
– Skin is thin, drier, less elastic, less resilient
when subjected to stressors.
– Dental/oral
• Res may have dental prostheses for extracted
teeth.
• Res may have decreased saliva production
Thinner hair growth, drier hair.

4. PROCESS (Continued)
HELEN SAWYER PLAZA MIAMI, FL
And More Factors
• Fever, other illnesses and incontinence
will change frequency of skin care.
• Dementia behaviors will influence how the
CNA approaches and assists the resident
with personal hygiene.
• Adaptive devices can help the res perform
everyday self-care activities, maintaining
independence.

5. PROCESS (Continued)
HELEN SAWYER PLAZA MIAMI, FL
Oral Hygiene
• Caring for the res mouth (teeth, gums,
tongue) and removable appliances
– Remove food particles and plaque that
promote bacterial growth.
– Bacterial growth causes inflammation of gums
(gingivitis), dental decay and can contribute to
systemic infections
– Maintain moisture in mouth cavity to promote
healthy gums and teeth.

6. PROCESS (Continued)
HELEN SAWYER PLAZA MIAMI, FL
Oral Hygiene continued…
• Refresh res mouth, promoting appetite.
• Observe res mouth for signs of problems
while providing care.

7. PROCESS (Continued)
HELEN SAWYER PLAZA MIAMI, FL
Practices for oral hygiene
• Mouth care(including brushing teeth or
dentures) is generally done at least twice
a day, in the AM and HS.
• Mouth care is needed even if the resident
has no teeth or dentures
• Encourage the resident to do as much as
possible for himself/herself, providing set-
up and cure as needed, as well as using
assistive devices.

8. PROCESS (Continued)
HELEN SAWYER PLAZA MIAMI, FL
Recognize situations where
attention is needed
• A resident with facial weakness (result of CVA or
other impairment) may accumulate food debris
between gums and cheek.
• A resident who has little fluid intake, is
unresponsive, is receiving O2 or who is a mouth
breather will need more frequent care.
• Report observations to the nurse
• Follow standard precautions while giving
mouth care. ALWAYS WEAR GLOVES

9. PROCESS (Continued)
HELEN SAWYER PLAZA MIAMI, FL
Brushing Res Teeth

11. Oral Care
• Denture Care
– Use of denture cup
– Removal of dentures
from mouth.
– Replacing dentures in
mouth.
– Water temperature
– Protecting from
breakage
– Care for mouth
– Observation of fit
• Unresponsive Res
– Side lying position
– Protecting bed
– Mouth swabs
– Safety with liquid
– Lip care
– Frequency of oral care

16. Goals for Bathing
• Clean the skin
• Eliminate the odor
• Stimulate circulation
• Refresh and relax res
• Provide a little exercise, through
movement of body parts during bathing
• Observe res skin and general condition

17. Practices for bathing
• Bathing options-creative bathing options are
available, ranging from ways to approach res,
innovative bathing techniques, to bathing
equipment that allows res easier access.
• Check res care plan for type of bath and for
restorative goals
– Encourage the res to do as much as possible for
himself/herself.
– Understand effective approaches for bathing res with
dementia.

18. Practices for bathing
continued…
• After a res bathes, he/she puts on fresh
clothing. Hair is combed
– Some res may go to beauty shop every week
therefore do not get hair washed on bath day.
Skin is often cleansed with soap that has
cleaning/moisturizing properties to prevent
skin dryness.
Some are designed to be “rinse free”. Waterless
cleansers are also available.
Understand what kind of soap the res uses.

19. Practices for bathing
• Plan ahead
– Check for needed supplies before starting
– Provide privacy
Follow standard precautions while bathing the
resident
Wash from cleaner body areas to less clean
(face to perennial)
Wear gloves
Reports observations to the nurse!!!!

20. Shower/Bath
• Moving to and from shower room
• Privacy
• Safe use of shower chair
• Maintaining safe water temperature
• Protecting res from chilling
• Staying with resident
• Maintaining safety while floor and resident
are wet and slippery
• Infection control measures for bathing
equipment

22. Whirlpool Bath
• Check with nurse to check if resident has
break in skin or skin infection.
• Use same precautions as with a regular
shower or bath.

25. Bed Bath
• Handling washcloth efficiently
• Keeping the res from becoming chilled,
keeping water comfortably warm and
clean
• Keeping res from exposure
• Washing and patting dry the res in an
orderly manner
• Providing back massage
• Changing bed linens after bath

26. Bed Bath variations
• Towel bath-using warm wet towels
remaining under the top sheet or bath
blanket.
• Bag bath- packet of body wipes saturated
with waterless, no-rinse cleanser.

28. Perineal Care(Peri-care)
• Consists of bathing front to back, between
the res legs.
• Res who are incontinent of urine or feces
receive perineal care each time they are
incontinent.
• For females, this includes washing
between the labia and around anus
• For Males, this includes cleaning under
the foreskin and washing the scrotum and
around anus.

29. Peri-care procedure
• Handling washcloth or wipes efficiently and
safely to prevent transmission of infection.
• Washing from front to back
• Keeping the res from exposure
• Caring for urinary catheter
• Using skin barrier products, according to
facilities policy and procedure and res care plan.
• Usually this will involve cleaning skin, then spray
or wipe on protective barrier.

30. Peri-care procedure
continued…
• Cleansing all skin area that have been in
contact with urine or feces when res has
been incontinent.
• This may mean washing lower abdomen,
buttocks and thighs.

36. Back Rub
• Purpose
– Refresh and relax res
– Stimulate circulation in tissue
Back rubs are given as part of bathing routine,
at bedtime, when the res position is changed
and when the res requests.
Use moisturizing lotion
Use massage strokes
Avoid skin areas that are reddened or broken

38. Assisting the res to dress and
undress
• Res are encouraged to wear street
clothing instead of gowns, robes and
slippers.
– Res in day clothing is ready to participate in
social activities.
– Appropriate underwear is worn
– Loose fitting clothing is easier to put on.
– Clothing should be clean and in good repair

39. Assisting the res to dress and
undress continued…
• Res should help select clothing to be worn
– If res has dementia, CNA may pre-select a
few options that are appropriate for the time of
year. Res can select from these options.
– Monitor res throughout day during toileting
that clothes do not need to be changed.

40. Dressing/Undressing procedure
• Check res care plan for restorative goals
– Encourage self care
– Divide dressing procedure into segments if
res has difficulty comprehending the entire
procedure or if res physically cannot perform
the entire activity at one time.
– Provide cues as needed
– Place one arm at a time into shirt or blouse.
(Joints maybe painful or have limited
flexibility)

41. Dressing/Undressing procedure
continued…
• If res has a weak side, dress that side first.
(With undressing follow the opposite
sequence-remove clothing from affected
side last.)
• If res has tubing (IV tubing, gastrostomy
tubing, urinary catheter) handle with care.
Keep tubing from kinking or disconnecting.

42. Personal Grooming
• Cleanliness and grooming of hair and nails is frequently
associated with a person’s sense of well-being.
• Paying attention to grooming contributes to the res
sense of dignity.
• Check res care plan for restorative goals.
– Encourage self-care by setting up needed
supplies/equipment.
– Divide grooming procedure into segments if
res has difficulty comprehending the entire
procedure.
– Provide cue as needed

43. Hair Care
• Comb/brush the res hair daily
– Arrange in an appropriate manner, acceptable
to res/family.
If possible, position res in front of mirror while
hair is combed and for other grooming
activities.
Brushing the hair stimulates the blood
circulation in the scalp, and distributes oils
over hair surface.

44. Hair Care continued…
• How to deal with tangled hair
• How to comb when res is bed bound
• How to care for a variety of hair types
– Caucasian,
– African American
Hair cutting-hair is cut as facility policy allows
and with consent of resident/family

45. Shampooing
• Pay attention to frequency of shampooing
• Assuring that soap is completely rinsed
• Use of conditioner/detangler
• How to wash a variety of hair types
• Shampooing hair for resident who cannot
take shower or tub bath(washing hair in
bed)

47. Facial Hair-Beard care
• Wash beard when hair is shampooed or
when bath is taken. Wash more often if
food or liquid is frequently spilled in beard.
• Comb or brush beard when hair is
groomed.
• Resident’s beard is cut as facility policy
allows and with consent of res/family

48. Facial Hair-male
• Male residents shave daily, unless they
prefer a different interval
• Position resident in front of mirror, if
possible
• Nurse will determine appropriate razor for
safe use.
– Electric razor and proper cleaning after use
– Straight razor and how to dispose of properly

50. Facial Hair- female
• Women with excess dark facial hair may be
accustomed to shaving or using a hair remover
as part of grooming
• The CNA should ask the nurse for direction.
• Applying make-up
– Respect res wishes regarding make-up use
– If possible, position res in front of mirror
– Set up resident with make up supplies,
providing cure for use.(Hand over hand
technique)

51. Nail Care
• Nurse will determine which resident may
have their nails cut by CNA.
• Nurse and other specialist are responsible
for cutting toenails of resident with
diabetes or poor circulation in feet.
• Nails are cleaned and trimmed at bath
time.
• Assist resident to apply fingernail polish if
desired.

52. Nail Care continued…
• Benefits of soaking nails
• Tools to use for cleaning nails, clipping an
filing as permitted.
• Length and shape for nails
• Skin care for toes and feet
• Observations to report to nurse

53. Prosthetics, Orthodontics and
other assistive devices
• Prosthesis is a replacement of a body part
– Limb
– Breast
– Eye
Orthotic device is used to maintain function of a
body part or prevent deformity. (splint,
glasses, or hearing aids)
Help resident apply properly as part of dressing
at the beginning of the day.

54. Prosthetics, Orthodontics and
other assistive devices cont…
• Understand how each functions
• Check to see that each is clean and
operational before assisting resident to
apply.
• Observe skin area where device is placed
to see that skin is intact and healthy.
• Report observations to the nurse.