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How to Assist a Client with Personal Hygiene
Abstract:
While oral and body hygiene and skin care is not generally a
complicated task, it is nonetheless considered very important to a
client’s sense of wellbeing and overall health. Certified nurse assistants
must follow facility policy related to standard prevention when
supporting clients with their personal hygiene, which contributes to a
client’s sense of safety and security. Respecting client dignity and
independence, and aiming at continuously improving their level of
comfort is essential to good health outcomes when clients are unable
to attend to their own basic care needs. It also helps clients to feel
assured that their physical needs are being observed and that
caregivers will appropriately respond to them.
Learning Goals:
1. Explain the rules and procedures to follow when caring for a client’s
activities of daily living.
2. Describe how to help clients with mouth care, personal hygiene and
skin care, and elimination needs.
3. Describe the unique skin changes that occur for elderly and
immobile clients.
4. Describe how to perform a bed bath while maintaining client
privacy and dignity and comfort.
Introduction
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Helping clients with their mouth care, personal hygiene and skin care,
and elimination will often be the responsibility of the certified nursing
assistant (CNA). This will include information and instruction that will
guide the CNA in helping the client wash themselves, complete
personal hygiene and skin care, with mouth care, with elimination, and
other aspects of personal hygiene and grooming. It may also involve
the CNA delivering the care for clients when they cannot care for
themselves.
Standard Prevention
The first and most important rule the CNA must follow when helping
clients with mouth care, personal hygiene and skin care, or elimination
is to always wash the hands and put on disposable gloves before
starting any procedure, except those procedures that are approved by
the health facility that can be done without the application of gloves.
These tasks are not complicated but they are very important. Good
standard prevention practices by the CNA when supporting clients with
their personal hygiene needs helps them maintain a sense of safety
and security during routines aimed at respecting their dignity and
independence, and improving their level of comfort. Assisting clients
with personal hygiene or performing these basic tasks for them, while
following standard prevention and safety rules when they are unable
to care for themselves, helps clients feel assured that their basic needs
are understood and being met.
Oral Hygiene
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The anatomy and physiology of the oral cavity, commonly called the
mouth, should be briefly reviewed before discussing safe and
appropriate oral hygiene and mouth care.
The mouth has several important structures and functions and
contains the tongue, the lips, the teeth, and the openings to the
salivary glands. The posterior areas of the mouth connects to the
pharynx, which is the first section of the digestive tract. The mouth
also connects with the trachea, which is the first section of the
respiratory tract.
The primary functions of the oral cavity and its structures are
digestion, speech and respiration.
Digestion
The teeth break food down into manageable pieces. The salivary
glands lubricate the food bolus so it is easy to swallow and they also
produce digestive juices that help to break food down into nutrients
that can be absorbed in the stomach and bowel.
The tongue also helps move the food into the pharynx before
swallowing and passing the food bolus along through the esophagus
where it is propelled toward the stomach.
Speech
The lips and the tongue assist in the formation of speech.
Respiration
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The oral cavity is technically the first section of the respiratory tract as
it connects with the trachea (commonly called the windpipe), a short,
muscular tube that intersects with the bronchial tubes that lead to the
lungs. Although the oral cavity is essentially a passive structure, the
contact of air with the warm, moist environment of the mouth helps
protect the lower respiratory passages and the lungs from cold and it
helps humidify air that is going to the lungs.
The condition of the gums, teeth, and mouth is extremely important to
a person’s health. Poor oral hygiene has been associated with an
increased risk for developing pneumonia, as well as heart disease and
other medical conditions.
Maintaining Oral Health
Drinking, eating, and communicating are dependent on the integrity of
these structures. Poor oral hygiene and poor dentition will impact a
client’s ability to eat, which also affects a client’s nutritional status.
Poor gum, teeth, and mouth conditions can make swallowing difficult
or painful. Aspiration of food or liquids may occur.
The production of saliva, which provides an important defense against
infection, may be decreased. Xerostomia (dry mouth) may develop.
Xerostomia is uncomfortable and may lead to other oral/dental
problems.
Dental pain caused by dental caries (tooth decay) can interfere with
eating and nutrition. A client may limit his or her social interaction due
to speech difficulties or because of embarrassment from missing teeth
or halitosis (bad breath).
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A healthy mouth should be free from chronic pain, lesions, infections,
gum disease, tooth decay and tooth loss, or other conditions that
affect eating, drinking, nutrition, or speech. CNAs will be caring for
many clients who have or at risk of oral hygiene problems or dental
problems.
Clients especially at risk for oral hygiene or dental problems include
those diagnosed with medical conditions and requiring certain
treatments, as well as the elderly.
Elderly
Many older adults have missing teeth or do not have teeth. The gums
shrink as people age, increasing the risk for dental caries, and the
salivary glands produce much less saliva and this causes dry mouth.
Older adults may also have physical disabilities or coordination and/or
eyesight issues that prevent them from doing their own oral hygiene
care.
Medical Conditions
Diabetes, certain types of cancer, dehydration, human
immunodeficiency virus (HIV) and other types of chronic infections,
radiotherapy treatment for cancer, or any disease that depresses the
immune system can affect the health of the oral cavity and increase
the risk for oral infections.
Medications
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There are many commonly used medications that can affect the health
of the oral cavity. Antibiotic, anticonvulsant, antidepressant, antiemetic, and antihypertensive medications can all decrease the
production of saliva. Chemotherapy suppresses the immune system
and increases the risk for oral infections, and oxygen can dry out the
oral mucosa.
Mental Health
Clients who have serious mental health problems may be unaware of
the need for daily oral hygiene care or be unable to perform it. Clients
who are severely depressed may deliberately neglect performing oral
care such as brushing and flossing.
Physical Disabilities
There are many physical disabilities that can affect oral hygiene or
dental health. Perhaps the most common is the client who has had a
cerebrovascular accident (CVA), often referred to as a stroke. Stroke
victims frequently suffer from paralysis and cannot perform self-care.
In addition, many stroke victims suffer from dysphagia (difficulty
swallowing), a condition that places the client at risk for aspiration.
Alterations in Consciousness
Clients who have a significant alteration in consciousness, such as
those who are comatose and are being mechanically ventilated,
obviously cannot perform oral self-care. Many clients who are
unconscious also mouth breath and this can cause oral hygiene
problems.
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These risk factors can be isolated or a client may have several or all of
them. However, each risk factor can be a significant contributor to
poor oral and dental health and they are likely to be present in many
of the clients requiring care.
Steps to Provide Mouth Care
Performing mouth care and helping clients perform mouth care is an
important part of a CNAs responsibilities. People who are ill often need
greater attention to oral hygiene than they normally might. They may
be dehydrated, they may mouth breath, or they may be taking a
medication that causes a dry mouth or a bad taste aside from the
health risks associated with poor oral hygiene and dental health.
Good mouth care is important for several reasons. Without good
mouth care, the client's mouth will be dry and unpleasant, lips and
tongue may crack and bleed, appetite may be affected, and dignity
and self-image will be affected. Before giving oral hygiene, the CNA
should always check the client's chart to determine if he or she is
allowed to have food or liquids. Some clients have medical conditions
that make swallowing food or liquids undesirable or even dangerous
and contraindicated, and, if so, the CNA will see the letters NPO (which
is an abbreviation for a Latin phrase that means “nothing by mouth”)
on the client’s chart.
If the client has an NPO order the CNA should make sure to not
swallow any liquids, mouthwash, or toothpaste when providing mouth
care. The CNA should also be familiar with situations in which the
client may be NPO. These are detailed in Table 1, but these situations
are not absolute. In some healthcare facilities, a physician may want
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the client to abstain from drinking and eating before a procedure but
other physicians may not. If the CNA is uncertain, or thinks NPO status
may be required, the CNA should ask an immediate supervisor for
clarification.
Table 1: Conditions or Procedures Requiring NPO Status
Pre-operative clients
Post-operative clients
Bowel obstruction
Placement of a PEG tube (Usually)
Before certain procedures
Clients who are on aspiration precautions
Clients who have recently had a stroke
The CNA should also check to see if a client is on aspiration
precautions before performing mouth care. CNAs should be familiar
with aspiration precautions (which are not be reviewed here). If a
client needs greater attention to oral hygiene and can perform it
without assistance, the CNAs responsibility will be to provide him or
her with mouthwash, toothpaste, towels, and any other supplies, and
to determine how much assistance the client needs. For other clients,
oral hygiene will need to be done for them.
Conscious Client and Oral Hygiene
The procedure for providing oral hygiene is relatively simple and does
not take a long time to complete.
• Wash the hands.
• Apply disposable gloves.
• Identify the client by checking his or her name band.
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• Inform the client that oral hygiene will be given and obtain the
client’s agreement for the procedure.
• Spread a towel across the client's chest in order to keep the client
dry.
• Offer the client a glass of water or mouthwash/water mix. Instruct
the client to rinse and spit.
• Put toothpaste on the toothbrush. If the client is able to do so, let
the client do the tooth brushing. If the client is unable to brush the
teeth, the CNA will need to do it.
• After brushing is completed instruct the client to rinse and spit.
• Offer dental floss to the client. If the client is unable to use the
floss, the CNA will need to perform this task.
• After flossing have the client rinse and spit again.
• Offer mouthwash if this is allowed.
• Offer a lip moisturizer if needed.
Unconscious Client and Oral Hygiene
Oral hygiene is perhaps more important if the client is unconscious.
This procedure is identical to the procedure of providing oral hygiene
for a client who is conscious, but there are some differences. Each
healthcare facility should have a policy or a standard of care that
describes how oral hygiene should be done and how often it should be
performed in clients who are unconscious. However, for the
unconscious client it is safe to say that oral hygiene - minus brushing
and flossing - should be performed several times a day and perhaps as
often as every two hours.
Mouth care for unconscious patients may be as simple as swabbing the
client’s mouth to keep it moist, applying a moisturizer to the client’s
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lips and then performing more complete mouth care once or twice a
day. The procedure is as follows.
• Wash the hands.
• Apply disposable gloves.
• Identify the client by checking his or her name band.
• Lift the head of the bed to approximately a 45-degree angle.
• Gently turn the client's head to one side and place a towel under
the head. Place another towel on the client’s chest immediately
below the chin.
• Place an emesis basin directly under the client's chin.
• Gently open the client's mouth by pulling down on the chin (do not
insert fingers into the client’s mouth to force opening the mouth).
• Brush and floss the teeth.
• Take a mouth swab and carefully and gently wipe the mouth and
the tongue.
• Apply a moisturizer to the client's lips.
Cleaning Dentures
Cleaning the client’s dentures should be done as follows.
• Wash the hands.
• Put on disposable gloves.
• Identify the client by checking his or her name band.
• Inform the client that his or her dentures will be cleaned and obtain
the client’s permission to do so.
• Remove the client's dentures or have the client remove them.
Place the dentures in an emesis basin that is lined with a paper
towel.
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• Carry the dentures to the sink. Place a towel in the sink to avoid
breaking the dentures if accidentally dropped.
• Use toothpaste or denture cleaner and clean all denture surfaces.
• Rinse the dentures with cool running water.
• Fill the denture cup with water, mouthwash, or a denture solution
and place the dentures in the client’s denture cup.
• Return the dentures to the client or put them in an appropriate
place.
When cleaning dentures, the CNA should always remember to place a
towel or something soft in the sink or over the surface the dentures
are being cleaned on. Dentures are expensive and it takes time to
replace them, and in the interim the client’s nutrition and quality of life
suffers while the dentures are missing.
Personal Hygiene And Skin Care
Not all clients will need special attention and assistance with personal
hygiene and skin care but there are two specific client populations who
generally need support to maintain their hygiene and skin health,
which includes immobile and elderly individuals. Understanding the
anatomy of the skin is important for knowing why immobile and
elderly clients cannot move and need special attention and assistance
with body hygiene and skin care.
Anatomy of the Skin
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The skin is the largest organ in the body, and it is comprised of three
layers. The epidermis is the outer layer. It is very thin, only 0.05 mm,
although in some areas, such as the soles of the feet, the epidermis
will be thicker.
The epidermis has many important functions and the most important
is to prevent bacteria, viruses, and other pathogens from entering the
bloodstream and deeper tissues. The cells of the epidermis are densely
and tightly aligned and because of this the epidermis forms a physical
barrier that is the body’s first line of defense against infection. The
epidermis also contains cells of the immune system and it controls the
amount of water that people lose to the environment.
Finally, the epidermis is the layer of skin that holds the pigmentation
that gives skin tone. There are no blood vessels in the epidermis; it
receives its blood supply from the dermis.
The second layer of skin is called the dermis. The dermis is
considerably thicker than the epidermis and it contains many
important structures. The dermis is where the connective tissue of the
skin is located; connective tissue is a tough, fibrous material that gives
the skin its tone and resiliency. The dermis also contains many blood
vessels, hair follicles, sebaceous glands that make skin oils, sweat
glands, and sensory receptors for touch and heat.
The third and final layer of the skin is the subcutaneous tissue, more
commonly called fat. Subcutaneous tissue is distributed through the
body; some places have a thick subcutaneous layer while in other
areas the subcutaneous layer is very thin. Most of the subcutaneous
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tissue acts as a protective padding but it also provides a layer of
insulation that keeps people warm and preserves body heat.
Skin Changes in Immobile and Elderly Clients
A person’s skin changes as he or she grows older. The epidermis
becomes thinner, more fragile, and more susceptible to injury. The
connective tissue that gives the skin its strength and elasticity
becomes weaker so the skin becomes weaker.
A person loses subcutaneous tissue as he or she ages. Because
subcutaneous tissue preserves body heat, older people are more likely
to suffer from the cold. With age, blood vessels become weaker and
more prone to breaking. The sebaceous glands in the skin produce less
oil so the skin becomes drier, making the skin more susceptible to
injury.
Finally, the sweat glands produce less sweat so an older person is
more likely to become overheated. It is important to be aware of these
changes when providing hygiene care for an elderly client. Clients who
are immobile are dependent on caregivers for body hygiene and skin
care and they are obviously at risk for skin breakdown and ulcers.
Essentials of Personal Hygiene and Skin Care
Personal hygiene and skin care should be performed every day and
some clients will need attention to personal hygiene and skin care
several times during the course of a day. Personal hygiene and skin
care have many beneficial effects. They help the client relax, they
eliminate body odors, they help prevent skin breakdown, and they can
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stimulate the circulation. Being clean and having good personal
hygiene also promotes dignity and self-respect.
Personal hygiene and skin care responsibilities of a CNA when caring
for a patient includes: skin inspection, giving/assisting with a bath,
providing perineal care, washing the hair, shaving, and caring for the
nails.
Skin Assessment
Assessment of a client’s skin is quick and simple. It should be done
before assisting or providing body hygiene and skin care, but a full
assessment typically is only needed once a day. The two techniques
used during skin assessment are 1) inspection and 2) palpation.
First, the CNA should carefully and systematically inspect at the
client’s skin. Normal skin should be intact (no open areas) and there
should be no bruises. The CNA should look for any areas that appear
swollen, especially the ankles, feet, and hands. The elbows, the back
of the head, the heels, the hips, and the area at the base of the spine
should be inspected for redness, which is the first sign of a pressure
ulcer. Inspecting a client for early signs of pressure ulcers is necessary
for all elderly individuals since they may be less active and may have
thinner-than-normal skin, but it is especially important for clients who
are immobile.
If the client has diabetes, the CNA should pay special attention to the
client’s ankles, feet and the areas around the toenails. Poor circulation
and nerve damage are common complications of diabetes and diabetic
clients can easily develop ulcers and infections in the lower
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extremities. If the client has diabetes and there are signs of infection
in the ankles, feet, or nail beds around the toes, the CNA should notify
an immediate supervisor as soon as possible.
Palpation can be performed separately or while inspecting the client’s
skin and it is best done when not wearing gloves. Palpation, like
inspection, should be systematic. The hands should always be washed
first and when the inspection is finished. Starting at the head or the
toes, gently touch the skin. Take note of parts of the body that seem
unusually cold or hot to the touch. The CNA should also determine if
there are any areas that are swollen or painful.
Bathing The Client
Depending on the client's situation and medical conditions, daily
bathing can be in the form of a shower, a tub bath, a partial bed bath,
or a complete bed bath. During bathing of the client, the CNA should
observe the client's skin for any unusual marks, red areas,
breakdowns, rashes, etc. The CNA should not cut or trim the client's
fingernails or toenails unless specifically instructed to do so. Many
clients who require assistance for bathing will become chilled easily,
and keeping the patient warm and comfortable should be kept in mind.
Client comfort should also include attending to the toileting needs of
the client before bathing is started. The clinician should always be
mindful of the client's need for privacy and dignity.
Helping the client with a shower, tub bath, and partial bed bath will
not be discussed here. These procedures are less complicated than
providing a complete bed bath, and a CNA can easily perform them by
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using the basic instructions for a complete bed bath, which is
discussed in the next section.
How often a client bathes will depend on several factors but clients
who need a complete bed bath should be washed every day. Other
clients may need to be washed several times a day, i.e., a client who
has a fever and is sweating often.
Complete Bed Bath
The procedure for a complete bed bath is not complicated but it does
require planning to perform the procedure in an efficient and organized
manner.
• Wash the hands.
• Apply disposable gloves.
• Identify the client by checking his or her name band.
• Make sure that the client's privacy is protected; close the door or
draw the curtains around the bed.
• Position the bed so that the client is flat, if this is allowed. Some
clients need to have the head of the bed elevated and not all
clients can tolerate being completely flat, so each situation should
be assessed individually.
• Cover the client with a bath blanket.
• Remove the client's clothing and any jewelry. Place the jewelry in a
safe place. Removing the jewelry will prevent it from catching on
the washcloth, which could injure the client or damage the jewelry.
• Use warm, not hot water. The best temperature is 115°F, 46.1°C.
• Using a washcloth and soap, wash, rinse, and dry the body in
sections.
• Start at the face and head and move down the body.
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• When one section of the body has been washed then cover that
area with a dry towel or a section of the bath blanket.
• Change the water as needed.
It is very important to always wash, rinse, and dry the body in
sections. This preserves the client's modesty, keeps the procedure
organized, prevents unnecessary exposure, and keeps the client warm.
Once the bath has been finished, the client’s hair should be combed or
brushed, the client’s jewelry returned, and the client positioned
comfortably with the call light within reach. The linen and the gloves
should be discarded in the appropriate receptacles, and the CNA
should document what has been done. The CNA should not forget to
include any important observations about the condition of the client's
skin.
Perineal Care
The perineum is the area of the body around the external genitals and
the rectum. This area of the body requires special attention. It is less
exposed to the air and it can be exposed to urine, feces, and
secretions. Because of those issues the area is often moist and
irritation and skin breakdown are possibilities.
Providing perineal care can be a bit stressful for the client and for the
CNA. Issues of modesty, privacy, and embarrassment often arise. The
best way to handle these issues is to realize that providing this care is
part of the CNAs responsibilities, and it is an important part of the
client's personal hygiene and health.
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If the CNA is concerned about how the client will react, the CNA can
simply ask the client how to best make the procedure comfortable. The
CNA should reassure the client that every effort will be made to
preserve modesty. The procedure is listed below.
• Wash the hands.
• Apply disposable gloves.
• Identify the client by checking his or her name band.
• Ask the client if he or she needs to use the bathroom.
• Make sure that the client's privacy is protected; close the door or
draw the curtains around the bed.
• Use warm, not hot water. The best temperature is 115°F, 46.1°C.
• Cover the client with a bath blanket.
• Place a moisture-absorbent bed protector under the client's hips.
• Ask the client to flex the knees and separate the legs. If the client
cannot do this, you may need an assistant or you may need to use
pillows for support.
• Take the bath blanket back and expose the perineal area.
When providing perineal care for women, use a washcloth with soap
and gently wash down from front to back - once - then rinse and dry.
Separate the labia and repeat this process.
When providing perineal care for men, use a washcloth with soap, hold
the penis in one hand, and gently wash it from the meatus to the base
of the penis; rinse and dry. If the client is uncircumcised, gently
retract the foreskin and wash in the same way. Wash the scrotum;
rinse and dry.
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For men and women, the next step is to wash the rectal area. Instruct
the client to turn on his or her side. If this is not possible, use a small
pillow or a folded blanket placed under the client’s hips. Pull back the
bath blanket and expose the rectal area. Use a washcloth and soap
and gently wash the area; move from the front (perineum) to the back
(coccyx). Rinse and dry.
Once finished, the CNA should position the client comfortably with the
call light within reach. The linen and the gloves should be discarded in
the proper receptacles. The procedure should be documented,
including important observations about the condition of the skin in the
perineal area.
Hair, Shaving, and Nail Care
Hair and nail cleanliness and shaving are aspects of body hygiene and
skin care that are generally simple to perform. They are important
tasks related to a client’s personal hygiene.
Hair Washing
Washing the hair does not need to be done every day. The client's
chart should be reviewed for specific instructions or an immediate
supervisor consulted on how often this should be done. The procedure
includes:
• Wash the hands.
• Apply disposable gloves.
• Identify the client by checking his or her name band.
• Use warm, not hot water. The best temperature is 115°F, 46.1°C.
• Position the client so that his or her head is as close to the edge of
the bed as is safe and practical.
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• Place a towel or small pillow underneath the client's shoulder
blades.
• Place a waterproof bed protector underneath the client's head and
shoulders.
• Place a slightly damp washcloth over the client's eyes.
• Position a basin underneath the client's head to capture the water
and shampoo.
• Wet the hair thoroughly, apply the shampoo, and then rinse it off.
Using a small amount of water will help with hair drying. Dry the
hair with a towel.
Some people recommend placing cotton in a client's ears when
shampooing the hair. Check with a supervisor before using this
procedure.
Shaving
Shaving can be done every day, or when the client wants it to be
done. It can be done using an electric razor or a safety razor. The CNA
should follow this procedure if using a safety razor.
• Wash the hands.
• Apply disposable gloves.
• Identify the client by checking his or her name band.
• Use warm, not hot water. The specific temperature is not
important; simply make sure that it is comfortable to touch.
• Spread a towel across the client's chest and tuck it up under the
chin.
• Moisten the client's face using a washcloth and water.
• Spread shaving cream on the client's face.
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• Hold the skin with the fingers of one hand so that it is tight and
then move the razor in the same direction that the hair grows.
• Rinse the razor often. When finished, wash the skin with a
washcloth and water.
• If the client is cut during shaving, make sure this fact is
documented report it to an immediate supervisor.
The CNA should always check before using a safety razor to shave a
client. It might be contraindicated for clients with certain medical
conditions or who take certain medications such as blood thinners.
Nail Care
Trimming fingernails can be done using ordinary care and precautions
but trimming toenails should only be done if it is specifically allowed by
the healthcare facility; it is not a routine part of skin care. Cutting the
toenails can be hazardous. Clients with diabetes may have poor
circulation in their feet. With poor circulation, cuts can easily get
infected.
A client with diabetes may also have nerve damage to his or her
extremities. In these cases, the client may not feel pain or swelling
caused by cuts or an infection.
Elimination Needs And Skin Care
There are a variety of reasons why a client may be confined to bed,
but if the client is unable to walk (ambulate) or is not allowed to leave
the bed, he or she will need to use a urinal or a bedpan when the need
arises to urinate or defecate. In these situations, assisting the client
with elimination is one of the CNA responsibilities.
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If a male client needs to urinate, the procedure is as follows.
• Wash the hands.
• Apply disposable gloves, and offer the client the urinal, and place
the call light within reach. If the client is unable to hold the urinal
himself then simply place the penis inside the urinal and position it
so that there will be no spills. For some clients, it is advisable to
place a waterproof bed protector under the urinal. Dispose of the
gloves and leave the room.
• When the client signals that he is finished, put on disposable gloves
and retrieve the urinal. If he cannot signal, wait an appropriate
period of time and then return.
• If the client is able to answer, ask him or her if there was any
difficulty in urinating or passing the stool. If yes, make sure an
immediate supervisor is notified.
• Carefully measure and record the output. If the urine is excessively
cloudy or there is blood in the urine, notify a supervisor. Dispose of
the urine in the appropriate place.
If a female client needs to urinate or defecate or a male client needs to
defecate they will need to use a bedpan.
• Wash the hands and apply disposable gloves.
• Have the client raise his or her hips, and slide a waterproof bed
protector and the bedpan underneath the client.
• If the client cannot lift his or her hips, then the CNA will need to
provide assistance. The client can also be asked to roll to one side,
the bedpan placed against the back and buttocks, and the client
asked to roll back. If the client is unable to move at all then the
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CNA will have to do this for the client, but it is preferable to have
help. Place the call light within reach. Remove the gloves and
dispose of them.
• If the client is unable to use the call light, wait an appropriate
length of time and then return. If he or she can use the call light
then when the client signals, apply new gloves, remove the
bedpan, cover it, and then clean the client if he or she is unable to
do so.
• If the client is able to answer, ask him or her if there was any
difficulty in urinating or passing the stool. If the patient confirms
difficulty, a supervisor should be notified.
• Carefully measure and record the urine output. Document any
unusual observations about the appearance of the urine or the
stool. Discard the urine and feces in the appropriate place.
Summary
Assisting with or providing personal hygiene and skin care are
important responsibilities of the CNA. Responding to these client care
needs will help clients maintain a sense of dignity and safety. It will
also help maintain their health.
Personal hygiene and skin care involves assisting the client with
elimination needs, assessment of the skin using inspection and
palpation, perineal care and bathing the client, hair and nail care. The
need for each of these will depend on the client’s activity level and
state of health. None of these are complicated, but certain hygiene
practices, such as nail care, should only be done if specifically allowed
by the workplace. Medical conditions such as diabetes requires close
inspection of the lower extremities. When a complication arises, such
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as skin injury during provision of care, this should be carefully
documented and a supervisor informed.
There are a variety of reasons why a client may be immobile or
bedridden, and in such cases the client will require special care and
assistance, which is a CNA responsibility. Assisting clients with
personal hygiene needs or performing the basic tasks of cleanliness
and grooming, while following standard prevention and safety rules
when clients are unable to care for themselves, helps clients feel
assured that their basic needs are understood and being met.
