Personal Care

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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

• Dignity
• Privacy
• Choice
• Safety
• Realising Potential
• Equality and Diversity

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• 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

• 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

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Infection

• Bacteria UTI, chest infection
• Viruses- common cold
• Fungi- thrush, athletes foot
• Parasites- scabies, head lice

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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

• 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

• Proteins
• Carbohydrates
• Fats
• Vitamins

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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)

• 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

• Infection urine infection (UTI)
• Poor diet and/or fluid intake
• Constipation
• Medication side effects
• Alcohol

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Types of Incontinence

• Stress
• Urge
• Overflow
• Neurogenic
• Functional

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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

• Deterioration in personal hygiene
• Wandering/agitation/restlessness
• Anxiety
• Disturbed behaviour
• Communication
• Aggression

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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- dont 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

• 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 dont 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

• 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

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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??

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• Thank you for listening!