Concordia Home Care and Nursing Services LLC Concordia Health Mobile Lab
A participant in this lesson will learn how to:
• Respect the rights and privacy and maintain the comfort and safety of a patient during the personal
• Correctly provide and assist with all major aspects of personal care and grooming
Encourage the patient to select clothing if possible. Make sure it is clean and neat. As you assist, watch for signs of dizziness or unsteadiness and be sure the patient is properly supported. As you assist the patient, make sure the patient can safely perform these dressing tasks.
1. Dress and undress the upper body first
2. If the patient has a weak side because of a stroke or other disability, dress that side first
3. Put the patient’s footwear on before he or she gets out of bed
To put on pants:
1. Have the patient sit down
2. Put on underwear, socks, and pants, pulling the underwear and pants as high as the thighs
3. Put on shoes and help the patient stand up, and then pull the underwear and pants all the way up
4. If the patient cannot sit up, ask the patient to raise his or her hips off the bed while you pull the pants up
To remove pants:
1. Remove shoes and help the patient lie down
2. Unfasten pants, and pull pants off while the patient raises his or her hips off the bed by pushing with the feet
When assisting a patient with a tub bath or shower, be alert to slippery floors, overly hot water, drafts, or dizziness. As you assist the patient, make sure the patient can safely perform these bathing tasks.
Procedure for tub or shower bath:
1. Assemble soap, washcloth, towel, and gloves. Clean the floor of the shower if the patient is taking a shower.
2. Place a rubber mat on the shower floor and a towel or mat on the tub bottom. Put a bath mat in front of the tub or shower.
3. Fill the tub or get shower water to a comfortable 98–102 degrees.
4. Assist the patient to remove clothing and carefully enter the tub or shower.
5. Let the patient wash as much as possible, and then wash any areas the patient cannot reach.
6. Assist the patient out of the tub or shower and assist to pat dry (pat, don’t rub) and dress.
7. Clean the tub or shower.
Definitions of partial bath and soaks
• Soak: Place a body part in water for a period of time—usually warm water between 98 and 102 degrees.
• Sitz: Soak the perineal area in warm water.
• Partial bath: Bathe only certain parts of the body. Patients may need you to assist only with parts they can’t reach, such as the back, or they may prefer to wash only certain areas on some days to prevent the dry skin that can be caused by daily all-over bathing. Often a partial bath refers to washing only the following areas: the face, the armpits, the perineum (private parts), the hands, and the feet.
Procedure for Shaving
1. Patient should be sitting up if possible. Assemble razor, soap, shaving cream/lotion, towel, and washcloth.
2. Cover the chest and neck with a towel. Have warm (98–102 degrees) water handy in a basin or sink.
3. Wash the face and neck to soften the beard.
4. Rub shaving cream over the beard, or use shaving lotion for an electric razor if appropriate.
5. Hold the head steady with one hand and shave with the other, using smooth downward strokes on the face and upward strokes on the neck and under the chin.
6. Wipe clean.
If you cut a patient’s skin with a razor, apply direct pressure to the cut with your gloved finger until the bleeding stops.
Hair and Nail Care Assistance
1. Place the patient in a sitting position
2. Cover the patient’s shoulders (and pillow, if in bed) with a towel
3. Remove glasses, hairpins, and clips
4. Brush gently in sections
5. Remove tangles without pulling or tugging
6. Style in the manner the patient requests
Clean hair is necessary for good grooming. You may need to assist the patient in the tub or shower, or you may need to wash the hair in bed.
1. Water temperature must be 98–102 degrees.
2. Hair should be brushed before washing.
3. Give the patient a towel to cover the eyes while washing the hair.
4. Wet hair thoroughly before applying shampoo. Warm the shampoo in your hands before putting it on the patient’s head.
5. Massage the patient’s scalp as you lather the shampoo.
6. Rinse the hair and wrap it in a towel. Dry the patient’s face.
7. Comb the hair and dry it with a hair dryer or put it in rollers, styling as the patient requests.
When washing hair in bed, follow the same steps given above, with the following differences:
• Have the patient lie down without a pillow, with the head and shoulders on the side of the bed nearest you (but don’t have the patient too close to the edge of the bed).
• Use a shampoo trough under the patient’s head, with a basin on a chair next to the bed so the water flows from the trough into the basin. Remove the trough when finished.
Nail care: Soak, clean, and shape fingernails and toenails with an emery board. Only trim nails if you have your supervisor’s permission.
Oral Care Assistance
Procedure for handling dentures:
1. Handle with gauze so you have a good grip on the dentures.
2. Use only cold water to wash and soak dentures. Hot water can warp them.
3. Use denture cleaner to brush the dentures. Only store in the patient’s personal holder.
Procedure for brushing teeth:
1. Everyone should brush their teeth at the beginning and end of every day and after meals if possible. If you assist with oral care, be sure to wear gloves.
2. Cover clothing and linens with a towel.
3. Use a wet toothbrush and toothpaste.
4. Use a gentle horizontal back-and-forth motion for brushing the inside and outside of the teeth.
5. When brushing the inside of the front teeth, hold the brush at an angle and use a side-to-side motion.
6. Be careful not to cause choking or gagging by putting the brush too far into the mouth.
7. Allow the patient to rinse with a glass of water and spit it out and then wipe his or her mouth.
Oral care in bed:
1. When assisting a bedbound patient, raise the patient to a sitting position if possible, or place the patient on his or her side. Follow the steps given above, using a basin for spitting.
Procedure for flossing teeth:
1. Take about 18 inches of dental floss and wrap the ends around the middle finger of each hand. Wind around one finger until fingers are about eight inches apart.
2. Use your thumbs and index fingers to position the floss between each tooth. Gently move the floss up and down against the teeth, moving from tooth to tooth.
3. Unwind new floss about every other tooth, winding the used floss around the other finger.
4. Let the patient rinse.
Bathing the Bedbound Patient
Bed baths are given to patients who can’t get out of bed for reasons that may be either temporary or permanent. The patient’s entire body is washed one part at a time. The bath is usually given after elimination has occurred and is given along with oral care and a change of bed linens. To avoid irritating the patient’s skin, always pat with the washcloth and towel; don’t rub. Procedure for bed bath:
1. Place the patient in a supine (lying down) position and cover with a blanket.
2. Remove the patient’s clothing, keeping him or her covered with the blanket.
3. Assemble equipment (basin, washcloth, soap, gloves, towel) and fill the basin with warm water. The water temperature should be between 98 and 102 degrees.
4. Put on disposable gloves. Place a towel over the patient’s chest and blanket.
5. Wet the washcloth in the basin and form a mitt around your hand with the washcloth.
6. Wipe the patient’s eyes with the washcloth and clear water, using a different corner of the mitt for each eye so you don’t spread infection. Wipe each eye gently from the inside corner out.
7. Apply soap to your washcloth mitt. Wash the face, neck, ears, and behind the ears with the soapy mitt, and then rinse and pat dry.
8. Place a towel under the patient’s far arm and wash the arm, shoulder, and underarm with the soapy mitt. Support the patient’s elbow as you wash the arm. Rinse and pat dry.
9. Put the basin on the bed and place the patient’s hand in the water. Wash the hands and between the fingers with soap and water. Clean under the fingernails carefully. Dry the hand and cover the arm with the blanket. Repeat steps 8 and 9 for the near arm and hand.
10. Pull the blanket back to the waist and cover the patient’s chest with the towel. Lift the towel to wash the chest with the soapy mitt. Rinse and pat dry. Wash, rinse, and dry thoroughly under the female breast.
11. Repeat for the abdomen, keeping the patient covered everywhere besides the abdomen.
12. Place a towel under the far leg. Support the leg under the knee while washing, rinsing, and drying.
13. Wash the foot and between the toes in the basin, dry thoroughly, and cover the leg with the blanket. Repeat steps 12 and 13 for the near leg and foot.
14. Change the bath water. Turn the patient on the side, facing away from you. Put a towel on the bed beside
the back. Uncover the back and buttocks and wash, rinse, and dry from neck to buttocks.
15. Provide perineal care last. Perineal care involves cleaning the private parts, or the genitals and anus.
1. Protect the bed with a waterproof pad under the patient’s hips.
2. Lift the knees so the patient’s feet are flat on the bed.
For females: Spread the folds of genital skin (labia) apart and wipe each side from the front toward the back in one motion. Use a clean part of the cloth for each side. Replace the cloth as necessary. Repeat until clean, and then rinse and pat dry.
For males: Lift the penis and wipe around the tip in a circular motion, and then rinse. Wash the shaft of the penis by wiping from the tip to the base and rinsing. Wash and rinse each side of the scrotum (testicles) and the inside of the thighs. Pat everything dry.
Anal area (sometimes called the rectum or rectal area): Turn the patient on the side, facing away from you. Wipe the anal area from the front of the genitals toward the back in one motion. Wipe first with toilet paper, and then wash one side at a time with a clean area of the washcloth. Replace the washcloth as needed.