SO WE'RE GOING TO CONTINUE ON WITH PERSONAL HYGIENE THINGS.
SO WHAT I WANT TO DO TO START IS DISCUSS SOME OF THE THINGS
WE CAN'T DO OR AREN'T GOING TO DO ON MANNEQUINS
BECAUSE YOU CAN'T BRUSH THEIR TEETH, LIKE THEY DON'T SPIT.
OKAY, SO THINGS LIKE THAT.
AND JUST SOME OTHER THINGS YOU NEED TO KNOW.
ALRIGHT, FIRST THING IS, I WANT TO TALK ABOUT HAIR CARE.
HAIR CARE IS A PRIORITY WHEN YOU'RE DOING PERSONAL HYGIENE.
I THINK I ELUDED TO LAST WEEK ABOUT BED HEADS SOME THINGS I DIDN'T EXPECT,
YOU KNOW, YOU CAN COMB YOUR OWN HAIR,
BUT YOU DON'T EXPECT THEIR HAIR TO BE ALL MATTED.
AND EVEN SOMETIME SOME BALDING ON THE BACK OF THEIR HEAD
COS THEY'VE BEEN LAYING IN BED FOR SO LONG.
SO WHAT DO YOU DO TO HANDLE HAIR?
FIRST OFF, THE HAIR NEEDS TO BE CARED FOR EVERY SINGLE DAY
IN THE HOSPITAL. I MEAN, IT NEEDS TO BE COMBED AND BRUSHED.
AND ACTUALLY, I THINK IT NEEDS TO AT LEAST BE DONE IN THE MORNING,
AND BEFORE BED TO GIVE THEM THEIR BEST CHANCES
OF NOT SO MUCH MATTING AND KNOTTING UP OF THEIR HAIR.
SOME THINGS YOU MIGHT WANT TO CONSIDER
WITH HAIR CARE IS WHEN YOU'RE COMBING OR BRUSHING LONGER HAIR,
START FROM THE BOTTOM AND WORK UP WITH THE KNOTS.
SO THAT YOU'RE NOT GETTING IT ALL INTO ONE, BIG, HUGE MAT IN THE MIDDLE.
SO, START UP.
IF YOU CAN'T GET A KNOT OUT, YOU MIGHT TRY A LITTLE MINERAL OIL
OR YOU MIGHT TRY A LITTLE ALCOHOL TO GET IT TO SLIP AND TO COME OUT.
IF YOU USE ALCOHOL, IT USUALLY DRIES FAIRLY CLEAN,
IF YOU'D USE A MINERAL OIL PRODUCT,
AND YOU CAN JUST GET MINERAL OIL OFF OF THE CART,
YOU HAVE TO WASH THEIR HAIR BECAUSE NOW IT'S A MESS.
THERE ARE SOME PRODUCTS FOR HAIR CARE TO CLEAN HAIR THAT,
YOU KNOW, THEY'RE THE POWDERY AND THE NO-RINSE STUFF
AND THAT'S OKAY FOR A DAY OR TWO.
BUT HONESTLY, HOW MANY OF YOU WANT YOUR HAIR WASHED LIKE THAT
FOR DAYS AND DAYS ON END? IT JUST BUILDS UP
AND THE OILS -- IT PULLS OUT SOME OF THE OIL,
BUT YOU HAVE POWDER IN YOUR HAIR AND IT JUST GETS NOT GOOD.
SO, AS MUCH AS POSSIBLE YOU NEED TO WASH PEOPLE'S HAIR.
AND I REMEMBER AS A NURSING STUDENT,
TALKING ABOUT SHAMPOOING HAIR AND GOING "YEAH, OKAY. WHATEVER."
AND THEN WHEN I WENT TO WORK I WAS SO OVERWHELMED WITH THE BIG STUFF.
YOU KNOW, THE IV'S AND THE SHOTS AND THE CATHETERS THAT WHO THINKS ABOUT HAIR?
AND I'VE BEEN A NURSE FOR A COUPLE OF YEARS,
THREE OR FOUR YEARS, I DON'T KNOW, AND I WAS WORKING THE EVENING SHIFT
AND I HAD THIS NURSE THAT WAS PAST FEAR.
YOU KNOW WHAT I MEAN? JUST REALLY COULD LOOK AT PEOPLE
AND CARE FOR THE TOTAL NEEDS OF PEOPLE.
AND IT WAS A NICE NIGHT AND WE WERE ALL, KIND OF, CAUGHT UP.
AND SHE SAYS "WELL, LET'S GO WASH EVERYBODY'S HAIR."
HUH? I MEAN THIS WAS LIKE A FOREIGN THOUGHT TO ME.
I NEVER EVEN CONSIDERED ANYBODY'S HAIR IN THE FIRST PLACE
MUCH LESS, LET'S DO HAIR WASHING ROUNDS.
AND SO WHAT WE DID WAS WE WENT AROUND EVERYONE
THAT COULDN'T GET OUT OF BED THAT WAS BEDRIDDEN, WE WASHED THEIR HAIR.
AND IT WAS THIS AH-HA MOMENT,
WE SHOULD BE DOING THIS AND WE SHOULD BE DOING THIS MORE OFTEN.
I MEAN, HOW OFTEN DO YOU WASH YOUR HAIR?
I PERSONALLY, WASH MINE EVERYDAY.
AND WHEN I'M SICK IN THE HOSPITAL AND YOU'RE CARING FOR ME,
I WOULD LIKE MY HAIR TO BE WASHED EVERYDAY
BECAUSE, YOU KNOW, PEOPLE COME TO SEE YOU IN THE HOSPITAL
AND YOU'LL LOOK UGLY AND STUFF.
SO HOW DO YOU DO IT?
PEOPLE THAT CAN'T GET OUT OF BED NEED THEIR HAIR WASHED PROBABLY WORSE
THAN THE PEOPLE THAT CAN GET UP AND GET PEOPLE TO HELP THEM.
SO WHAT WE HAVE IS A BED BOARD AND IF IT'S NOT IN YOUR CENTRAL SUPPLY AREA,
YOU CAN GET IT FROM CENTRAL SUPPLY.
THEY KEEP A WHOLE BUNCH OF THEM JUST AVAILABLE.
AND THEY CLEAN THEM, THEY'RE FOR RE-USE.
AND WHAT YOU DO IS YOU NEED TO GATHER UP YOUR SUPPLIES
WHICH WOULD BE THE HEAD BOARD, BED BOARD,
YOU NEED TO GET A COUPLE OF GARBAGE BAGS
OR PLASTIC LINERS FOR FLOODING THE BED.
AND YOU NEED TO GATHER UP SOME GRADUATES,
TWO OR THREE PITCHERS IF YOU CAN'T FIND ANY MORE GRADUATES,
SOMETHING THAT YOU CAN PUT SOME TWO OR THREE THINGS OF WARM WATER IN.
YOU NEED A TRASH CONTAINER OR A BUCKET OR SOMETHING
TO CATCH ALL THE WATER AND YOU NEED TO FIND A SHAMPOO.
MOST OF THE PEOPLE THAT WE WASH THEIR HAIR ARE --
THAT DAY -- I'LL NEVER FORGET THAT NIGHT,
THEY DIDN'T HAVE SHAMPOO COS NO ONE ELSE HAD BEEN WASHING THEIR HAIR EITHER.
SO WHAT WE DID IS WE WENT INTO ENEMA BUCKETS
AND ENEMA BUCKETS HAVE WHAT'S CALLED CASTILE SOAP IN THEM,
BECAUSE SOMETIMES ENEMAS -- WHEN WE GET TO ENEMAS.
WE GIVE SOAP SUDS ENEMAS.
AND WHAT IT IS, IS IT'S A MILD, MILD SOAP
THAT WORKS REALLY GREAT FOR SHAMPOOING.
WE DON'T GIVE THAT MANY SOAP SUDS ENEMAS,
BUT WE COULD SNATCH UP THESE LITTLE PACKETS FOR FREE.
SO WE GOT OUR SHAMPOO AND WE, KIND OF, SETTLE -- AND TOWELS, LOTS OF TOWELS...
HIGH FIVE, OF COURSE, BUT WE WEREN'T REALLY IDENTIFYING CLIENTS AT THIS POINT,
WE'RE JUST WASHING HAIR, SOMEONE'S LIKE, "YOU KNOW WHAT..."
WE HAVE OUR CART AND OUR BUCKETS AND OUR STUFF.
IF WE WANT TO -- HEAD INJURY CLIENT OBVIOUSLY, YOU WOULDN'T BE DOING THAT.
YOU'RE GOING TO -- IF THEY CAN HAVE THE --
LET'S GET YOU DOWN THERE.
YOU'RE GOING TO PUT A TRASH BAG UNDERNEATH THEIR SHOULDERS
TO BE LIKE A BARRIER.
AND THEN YOU'RE GOING TO PUT THIS BED BOARD UNDERNEATH
AND THEN THEIR HEAD FALLS INTO THE HEAD SLOT.
IT'S A LITTLE HARD TO SEE, BUT THEIR NECK IS IN THERE.
NOW THAT'S NOT REALLY VERY COMFORTABLE
SO WHAT WE FOUND WORKED REALLY WELL IS IF -- THANKS.
IS IF YOU TAKE A TOWEL AND, KIND OF, WRAP THEIR NECK
THEN YOU GOT A LITTLE PADDING ON THIS BOARD.
SO HOW ARE YOU DOING? IS IT OKAY?
ALRIGHT, NOW WHAT HAPPENS IS NOW I'M GOING TO BE POURING WATER
AND IT'S GOING TO FLOW OFF OF HERE.
YOU MAY HAVE TO PUSH DOWN A LITTLE BIT TO GET IT TO COME OUT.
OTHERWISE THEY'RE SITTING, KIND OF, IN THIS PUDDLE.
SO, GLOVES, IF YOU THINK YOU NEED THEM OR NOT, IT DOESN'T REALLY MATTER,
IT JUST DEPENDS, BODY FLUIDS NOT USUALLY IN THE HAIR.
YOU'RE GOING TO WET THE HAIR AND THEN YOU'RE GOING TO PUT THE SOAP IN.
AND MAY I JUST SUGGEST THAT YOU NOT USE VERY MUCH
BECAUSE THE MORE YOU PUT IN THE MORE YOU GOT TO RINSE OUT.
AND IT CAN BE A LONG PROCESS. WE --
I PERSONALLY OVER-SOAPED THE FIRST ONE.
SO, RINSE. AND THEY NEED SOMETHING TOO BECAUSE YOU'RE NOT GOING TO BE
A VERY GOOD AIM WITH ALL OF THIS STUFF AND DRY.
AND RINSE THEIR HAIR ALL OUT.
THEN THIS IS GOING TO RUN OFF INTO THE TRASH CONTAINER,
SOME KIND OF CONTAINER THAT'S NOT CRACKED.
CHECK YOUR TRASH CANS BECAUSE THAT CAN BE DISASTROUS TOO.
MAKE SURE YOU'RE HITTING THE TRASH CAN.
AND THEN AFTER THEY'RE DRY,
YOU JUST REMOVE ALL OF THIS STUFF AGAIN AND DRY
AND THEN COMB THEIR HAIR.
IF THEY'RE A BEDRIDDEN CLIENT...
..YOU'RE GOING TO WANT TO COMB THEIR HAIR
AND NOT JUST LEAVE IT LOOSE LIKE THIS AGAIN.
THEY NEED IT TO BE CONTAINED OR IT JUST GETS MATTED.
SO, I WOULD SUGGEST THAT YOU PUT IT IN A PONYTAIL IF YOU CAN,
BUT THINK ABOUT THAT. THE GIRLS ALREADY GET IT RIGHT AWAY.
YOU CAN'T LAY ON YOUR PONYTAILS.
SO, IT'S GOING TO HAVE TO BE A PONYTAIL UP HERE AT THE TOP
OR YOU'RE GOING TO HAVE TO BRAID IT OUT TO THE SIDES
AND DO LIKE LONG, BUT THINK ABOUT LAYING INSTEAD OF BEAUTY HERE.
IT'S TO CONTAIN AND PREVENT THE MATTING AND THEN IT'S ALSO
SO THEY CAN BE COMFORTABLE WITH WHATEVER YOU DO.
AND WE GAVE THEM, YOU KNOW, THE LITTLE, KIND OF, BRAIDS DOWN THE SIDE
AND THEY LOOKED SOMETIMES A LITTLE HOKEY,
BUT THE MAT WAS SO OUT OF CONTROL AT THE BACK THAT YOU JUST,
YOU GOT TO DO SOMETHING TO HELP THEM OUT WITH THAT.
SO, TAKE ON HAIR AND CLEAN HAIR.
ONE OF THE THINGS YOU MAY RUN INTO IS HEAD LICE ALONG THE WAY.
HEAD LICE NEEDS TO BE ADDRESSED IMMEDIATELY
BECAUSE HEAD LICE IS VERY CONTAGIOUS AND YOU'VE ALL PROBABLY BEEN
THROUGH SCHOOL SYSTEMS WHERE THEY'VE ADDRESSED HEAD LICE.
IT'S PRETTY, A PRETTY BIG ISSUE THESE DAYS WHEN YOU GET INTO BIG GROUPS,
BUT WHEN IT GETS INTO THE HOSPITAL WE ALSO HAVE A PROBLEM OF ISOLATION,
CONTAINMENT, AND GETTING RID OF HEAD LICE.
LICE CAN BE IN THREE BASIC AREAS.
IT CAN BE ON THE HEAD, IT CAN BE IN THE PUBIS
AND I LOST MY LITTLE POST IT. WHERE IS THE THIRD PLACE?
PUBIC LICE, HEAD LICE... - BODY LICE.
- BODY LICE, THANK YOU.
OKAY. WELL, THAT WAS A BAD, LITTLE DEAL.
ANYWAY, WHEREVER THERE'S HAIR ON THE BODY.
SO LICE IS DIFFERENT THAN DANDRUFF OR DIFFERENT THAN JUST SCALING
BECAUSE IF YOU CAN JUST FLICK IT OFF, IT'S NOT HEAD LICE.
HEAD LICE THE EGGS ATTACH TO THE HAIR SHAFT AND YOU HAVE TO SLIDE THEM OFF.
THAT'S HOW YOU KNOW IT'S A NIT OR AN EGG.
WHEN THEY HAVE HEAD LICE, YOU'RE GOING TO HAVE TO GET A DOCTOR'S ORDER
FOR A PRODUCT TO USE ON THEIR HEAD IN THE HOSPITAL.
WE CAN GET IT OVER THE COUNTER IF IT HAPPENED IN YOUR HOME FOR EXAMPLE.
PROBABLY WHAT THEY'LL PRESCRIBE, A REALLY POPULAR PRODUCT IS NIX,
AND NIX IS A SHAMPOO PRODUCT, IT'S THE NICEST
BECAUSE OF TWO REASONS.
ONE, IT HAS A BUILT-IN CONDITIONER,
SO THE HAIR DOESN'T FEEL DRY AND, KIND OF, FRIED-LIKE
AND IT STAYS ON THE HAIR FOR ABOUT SEVEN DAYS.
SO IT'S FIGHTING THE RE-INFESTATION, WHICH IS REALLY IMPORTANT.
RID DOESN'T STAY ON FOR THAT LONG.
IT'S ALSO AN OVER-THE-COUNTER PRODUCT AND IT WILL DEAL WITH THE HEAD LICE,
BUT YOU DON'T GET THE LONGEVITY THAT YOU DO WITH NIX
AND IT ALSO DOESN'T HAVE THE CONDITIONER.
AT LEAST, I HAVEN'T USED IT FOR AWHILE, BUT FOR THE LAST TIME I USED IT.
WE USED TO USE A PRODUCT CALLED QUELL.
QUELL IS A PRODUCT THAT YOU HAVE TO HAVE A DOCTOR'S PRESCRIPTION TO GET.
AND MY KIDS HAD THE LITTLE HEAD LICE THING FROM SCHOOL
AND WE WERE DOING THAT AND I DIDN'T GET RID OF IT WITH THE --
WHATEVER I USED. IT WAS NIX OR RID OR SOMETHING, I DON'T KNOW.
SO, I ASKED FOR QUELL,
I HEARD ABOUT IT THAT YOU SHOULD USE THIS.
SO, I GOT A DOCTOR'S ORDER FOR IT AND I PICKED IT UP
AND IT WAS THE MOST NASTY STUFF YOU COULD EVER IMAGINE.
IT'S THICK AND IT MAKES THE HAIR DRY,
I COULDN'T GET THE STUFF OUT
AND THEN IT COMES WITH THESE CAUTIONS THAT IT HAS NEURAL SIDE EFFECTS
IF YOU LEAVE IT ON THAT IT CAN GET TO THE BRAIN,
IF YOU LEAVE IT ON TOO LONG AND I'M THINKING,
"WHOA! THIS STUFF'S REALLY UGLY."
SO, THEY'VE ACTUALLY QUIT USING QUELL AS MUCH,
BUT YOU'LL READ ABOUT IT SOME IN YOUR BOOKS.
AND SO, I JUST WANTED YOU TO APPRECIATE THAT WHEN YOU CAN --
THE BETTER PRODUCT RIGHT NOW IS NIX FOR HEAD LICE.
SO, YOU WANT TO GET THAT CONTAINED.
AND ONCE THE NITS ARE ALL GONE AND OFF THE HAIR
AND YOU CAN'T FIND EVIDENCE OF THAT
THEN THEY CAN BE PUT BACK INTO THE POPULATION,
INTO SCHOOL POPULATION AND THEY CAN BE IN A SEMI-PRIVATE ROOM,
ONCE IT'S BEEN CONTAINED.
IF YOU ARE A SCHOOL NURSE OR YOU KNOW THE NEIGHBORHOOD
KNOWS YOU'RE A NURSE AND THEY CALL YOU, "THIS ONE KID HAS HEAD LICE."
AND YOU GO TO CHECK WHAT YOU WANT TO DO IS YOU WANT TO GET
OVER HERE BY THE EARS AND THE NAPE OF THE NECK,
LIFT THE HAIR AND I USUALLY TAKE A STICK OR SOMETHING
AND LOOK IN HERE AT THE HAIR SHAFTS
TO SEE IF THERE'S LITTLE WHITE SPECKS.
AND IT'S USUALLY DOWN HERE WHERE IT'S NICE AND WARM
AND THEY CAN FEED BETTER
SO YOU DON'T ALWAYS JUST SEE THEM UP HERE AT THE TOP.
OKAY. OH, HERE'S MY NOTES. YES.
HEAD, BODY, CRAB LICE. SHOULD WE DO IT?
OKAY. LET'S SEE HOW I HAVE DONE HERE? SHAVING.
CLIENTS NEED TO BE SHAVED.
MALE AND FEMALE NEED TO BE SHAVED.
MY GIRLFRIENDS WERE JOKING AROUND,
"IF I'M IN A COMA AND MY LEGS ARE FURRY AND I WAKE UP,
I'M NOT GOING TO BE HAPPY,
YOU KNOW. REMEMBER THAT.
IF I'VE GOT CHIN HAIRS STICKING OUT, I'M NOT GOING TO BE HAPPY EITHER.
SO YOU BETTER BE TAKING CARE OF THAT."
PEOPLE ARE DIFFERENT AGES AND THEY HAVE PERSONAL HYGIENE ISSUES.
AND DON'T JUST GO, "OH, I WONDER IF SHE KNOWS."
OH, HELLO. YES.
SHE WOULD KNOW SO YOU GOT TO TAKE CARE OF BOTH ISSUES.
SO LET'S TALK ABOUT MEN FIRST, SHAVING.
OBVIOUSLY FACIAL HAIR AT THIS POINT,
IF THEY'RE A REGULAR SHAVER AND NEED TO BE KEPT UP,
WHAT WE DO IS TWO THINGS.
YOU CAN SHAVE WITH A RAZOR IF THEY HAVE A RAZOR,
BUT REMEMBER NOT EVERYBODY CAN BE TREATED THE SAME.
YOU NEED TO MAKE SURE THAT THEY'RE NOT ON ANY BLOOD THINNERS
BECAUSE PEOPLE ON BLOOD THINNERS CAN'T HAVE ANY STRAIGHT RAZORS
BECAUSE YOU MIGHT NICK THEM AND THEN THEY CAN HEMORRHAGE.
SO, KNOW THEIR CONDITION AND KNOW THEIR MEDICATIONS.
OTHERWISE, IF YOU'RE GOING TO USE A RAZOR,
THE MEN HAVE TOLD ME THAT THE BEST THING TO DO
IS TO PUT A WARM WASH CLOTH AND SOFTEN THE BEARD.
SO WARM, WARM.
AND LADIES, I KNOW WE SHAVE OUR LEGS WITH SOAP,
BUT GUYS DON'T THINK THAT'S SO GOOD.
SO -- YOU GUYS ARE GOING "OH, OH, OH." YOU KNOW.
SO YOU WANT TO GET SOME SHAVING CREAM.
AND YOU USUALLY CAN GET JUST A LITTLE TRAVEL CREAM,
THEY'VE STARTED STOCKING THOSE ON THE CENTRAL SUPPLY CART
AND YOU WANT TO USE SHAVING CREAM OVER JUST A SOAP ON THE FACE, KIND OF, A DEAL.
IT'S NOT VERY EXPENSIVE AND IF YOU CAN HAVE A FAMILY MEMBER BRING IN SOME CREAM.
I MEAN, MOST PEOPLE CAN WAIT A DAY OR TWO TILL SOMEONE CAN GET IT IN.
COS IT'LL PROBABLY COST AS MUCH FOR THIS LITTLE THING
AS THEY CAN BRING IN A FULL-ON BIG CAN,
IF YOU CHARGE IT FROM THE HOSPITAL.
PUT THE SHAVING CREAM ON AND THEN YOU'RE SUPPOSED TO GO
WITH THE DIRECTION OF THE HAIR IS WHAT EVERYTHING SAYS.
SO AS THE HAIR IS GROWING THAT'S WHAT YOU DO RATHER THAN GO AGAINST THE HAIR.
NOW GUYS, YOU CAN TELL ME, DON'T YOU GO AGAINST THE HAIR SOME TO GET REALLY CLOSE?
- 8 HOURS. - YOU HAVE TO, RIGHT?
- THERE ARE CERTAIN AREAS YOU DON'T REALLY WANT TO DO IT ON --
- RIGHT SO. HERE'S WHAT I DO. UH-HUH, LIKE HERE.
SO, IF THEY'RE ALERT AND ORIENTED MAYBE THEY'VE JUST GOT BROKEN ARMS
OR SOMETHING AND THEY CAN'T DO IT JUST ASK HOW DO YOU DO IT?
AND THEY'LL MAKE THEIR FACE GO FOR YOU, AND THEY'LL TELL YOU,
"NOW GO UP HERE, AND GO AROUND MY CHIN."
BUT IF THEY WERE IN A COMA AND COULDN'T TALK TO ME,
I'M JUST GOING TO GO WITH THE HAIR FLOW.
I'M GOING TO GET IT DOWN TO, YOU KNOW,
REASONABLE AND NOT WORRY ABOUT BEING AS CLOSED SHAVED
AS THEY WOULD PROBABLY DO THEMSELVES, KIND OF, A DEAL.
BUT BEST ADVICE JUST GO WITH THE DIRECTION OF THE HAIR.
NOW IT'S REALLY NICE IF YOU CAN GET AN ELECTRIC RAZOR,
BUT I WANT YOU TO KNOW THAT WITH AN ELECTRIC RAZOR
YOU ALSO HAVE TO HAVE IT CLEARED
BY THE SAFETY DEPARTMENT OF YOUR HOSPITAL, WHOEVER THAT IS.
THEY HAVE TO CLEAR IT ELECTRICALLY, TO MAKE SURE THAT IT'S GOT A GROUND.
SO, IF A CLIENT JUST BRINGS IN AN ELECTRIC RAZOR
THAT DOESN'T MEAN THAT YOU CAN JUST USE IT.
IF IT'S BATTERY OPERATED, IT'S USUALLY NOT A PROBLEM.
HOWEVER, YOU GOT TO BE SURE THAT THEY'RE NOT ON OXYGEN
OR ANYTHING FLAMMABLE WITH YOUR ELECTRIC PRODUCTS.
SO, YOU USUALLY HAVE TO TURN IT OFF
AND THEN YOU CAN SHAVE THEM AND THEN BACK ON.
SO YOU NEED TO KNOW IF THEY CAN TOLERATE THAT AS WELL.
ELECTRIC OBVIOUSLY, YOU CAN USE THOSE FOR YOUR CLIENTS
THAT ARE ON COUMADIN OR THE BLOOD THINNERS, HEPARIN THAT KIND OF THING.
I LOVE ELECTRIC BECAUSE THERE IS REALLY NO RULE FOR ELECTRIC.
YOU JUST CAN SCRUB AROUND AND IT GETS THE JOB DONE FOR YOU,
JUST MAKE SURE THAT IT'S CLEANED AFTERWARDS AND GET THE HAIR OUT OF IT.
ANY OTHER COMMENTS ABOUT ELECTRIC RAZORS, GUYS?
OKAY.
SO, ELECTRIC IS A NICE OPTION FOR THAT.
ALRIGHT, ORAL CARE WE NEED TO TALK ABOUT.
ORAL CARE, YOU NEED TO PROVIDE ORAL CARE FOR YOUR CLIENTS FREQUENTLY.
ESPECIALLY CLIENTS THAT ARE ON...
..DIETS THAT THEY'RE NOT EATING -- MAYBE MPO.
NOTHING BY MOUTH FOR AWHILE,
POST SURGICAL CLIENTS, CLIENTS THAT HAVE MEDICATIONS
THAT ARE DRYING THEIR MOUTH.
I HAD A FRIEND CLIENT THAT HAD A NOSE BLEED
FROM AN OVERDOSE OF COUMADIN OR BLOOD LEVEL GOT TOO HIGH AND SHE HAD A NOSE BLEED
AND SHE HAD A TUBE DOWN HER THROAT AND SHE JUST WASN'T GETTING ENOUGH ORAL CARE.
IF YOU'RE, KIND OF, OOZING BLOOD DOWN YOUR THROAT,
YOU'RE MOUTH IS GOING TO BE...HMM.
AND THEN YOU'RE GIVING THEM A LOT OF MEDICATION
TO GET THE BLOOD STRAIGHTENED OUT AND SHE WAS ON --
JUST STUFF AND HER MOUTH WAS SO DRY
AND SHE COULDN'T BREATHE THROUGH HER NOSE SO SHE'S MOUTH BREATHING.
THOSE KIND OF CLIENTS NEED ORAL CARE EVERY TWO HOURS.
NO JOKE AND, YOU KNOW, TO JUST DO IT IN THE MORNING WITH YOUR BATH,
THAT IS NOT ENOUGH.
WE NEED TO BE THINKING PAST,
"OH, I DO IV'S. I'M THE NURSE."
YOU'RE THE NURSE WHO CARES FOR THE CLIENT,
AND KNOWS THE SIDE-EFFECTS OF THE DRUGS AND THE DIAGNOSIS
AND THEY NEED ORAL CARE, FREQUENTLY.
SO, OFFER THEM A TOOTHBRUSH.
WITH SOMEONE THAT'S A BLEEDER,
YOU NEED TO BE CAREFUL THAT THEY HAVE A SOFT BRISTLE TOOTHBRUSH.
NOT THE MEDIUM OR THE STRONG BECAUSE THE TOOTHBRUSH
CAN CAUSE BLEEDING IN THEIR GUMS AS WELL.
SO, THEY MAY HAVE TO GO WITH WHAT'S CALLED A TOOTHETTE.
I HAVE TO HAVE MY PROPS SO I DON'T FORGET TO OFFER ORAL CARE ON MY BED.
BUT A TOOTHETTE IS A THING LIKE THIS.
IT'S A LITTLE SPONGE AND THEY COME IN PACKS OF, LIKE, THREE
AND THE TOOTHETTES ARE PRE-TREATED WITH, LIKE A,
ORAL POWDER.
IT'S A DRY POWDER AND IT'S A LITTLE BIT OF ABRASIVE
SO THAT YOU CAN GET THE STUFF OFF YOUR TEETH.
AND SO ALL YOU DO IS SCRUB AROUND WITH IT.
YOU DON'T EVEN HAVE TO WET IT, JUST SCRUB AROUND.
AND THEN IF THEY CAN RINSE THEN RINSE THE MOUTH.
SO THAT'S A NICE, EASY OPTION
FOR YOUR CLIENTS THAT NEED FREQUENT ORAL CARE.
YOU CAN JUST SET THEM UP WITH A LOT OF THESE TOOTHETTES AND SAY,
"USE THEM AS YOU NEED TO OR DIP THEM IN WATER IF YOU NEED TO,
YOU KNOW, TO CLEAN UP YOUR TEETH."
WHAT WE DON'T WANT TO DO IS USE LEMON GLYCERIN SWABS.
I HOPE THEY DON'T HAVE THEM MUCH IN THE HOSPITALS ANYMORE.
I HAPPEN TO HAVE AN OLD PACK SOMEONE --
WHEN PEOPLE ARE SICK AND THEY DON'T NEED THEIR SUPPLIES,
THEY JUST GIVE THEM TO ME AND IT'S WONDERFUL COS I GET SOME GOOD PROPS.
BUT LEMON GLYCERIN SWABS, WE DON'T USE ANYMORE
BECAUSE THEY ACTUALLY DRY OUT THE MOUTH.
THEY MAY TASTE, KIND OF, GOOD RIGHT AT THAT MOMENT,
BUT THEY FOUND THAT THEY ACTUALLY EAT AWAY
AT THE ENAMEL OF THE TEETH AND DRY THE MOUTH.
AND SO THEY'RE NOT A GOOD PRODUCT TO USE.
IF A CLIENT IS UNCONSCIOUS,
YOU STILL NEED TO DO ORAL CARE AND AGAIN, FREQUENT ORAL CARE,
AT LEAST ONCE A SHIFT, MORE OFTEN IF NOT.
HOPEFULLY YOU READ IN YOUR BOOK
THAT WHEN YOU PROVIDE ORAL CARE FOR SOMEONE THAT'S UNCONSCIOUS,
YOU EITHER NEED TO TURN THEM ON THEIR SIDE OR TURN THEIR HEAD TO THE SIDE
AND YOU ALSO NEED TO MAKE SURE THAT THEIR SUCTION'S STAND BY.
RIGHT, BECAUSE YOU GOT BODY FLUIDS.
SO WHAT WE WOULD DO IS SET UP A SUCTION -
OH, I DIDN'T LOOK AT THIS. WE GOT ONE OVER HERE.
IT WOULD LOOK LIKE THIS.
SUCTION'S ON THE WALL AND IT SHOULD ALREADY BE PRE-SET LIKE THIS.
THIS IS A CONNECTOR, YOU DON'T NEED.
AND YOU WOULD HOOK ON A YONKER WHICH IS JUST FOR ORAL CARE.
OKAY, AND SO WHEN YOU READ THAT IN THE BOOK
THAT'S WHAT THEY WERE TALKING ABOUT.
WHEN YOU DO ORAL CARE, YOU WANT TO TURN THIS ON
TO 80 MILLIMETERS OF MERCURY.
WE'LL DO MORE SUCTION NEXT SEMESTER AND WE'LL REALLY DRILL THOSE NUMBERS IN.
BUT JUST, YOU KNOW, YOU MAY HAVE TO DO A LITTLE ORAL CARE.
MAKE SURE YOU HAVE THIS STANDING BY
AND IT'S JUST THE PRESSURE THAT THE DENTIST HAS IN YOUR MOUTH.
A REALLY LIGHT PRESSURE AND THEN YOU CAN PUT IT BACK
IN THAT POSTERIOR SUB-LINEAL POCKET BECAUSE THAT'S WHERE THE JUICES PULL
AND YOU WANT TO JUST, KIND OF, CATCH THEM THERE.
AND I -- YOU CAN LEAVE IT SITTING WHILE YOU DO YOUR STUFF
OR HAVE IT JUST STAND BY IF THEY'RE NOT ABLE TO COOP --
OR IF THEY'RE ABLE TO, YOU KNOW, COOPERATE A LITTLE BIT WITH YOU.
ALRIGHT, SO YOU GOT YOUR SUCTION STANDING BY,
AND YOU CAN DO TOOTHETTES FOR THE UNCONSCIOUS.
YOU CAN DO A TOOTHBRUSH WITH NOT TOO MUCH TOOTHPASTE ON IT
BECAUSE THEY CAN'T SPIT.
SO SOMETIMES A BRUSH REALLY CLEANS THEM BETTER
THAN THE LITTLE TOOTHETTE CAN DO.
BUT THESE ARE THE COOLEST GADGETS AROUND.
AND THESE ARE KIND OF A SUCTION TOOTHETTE.
AND I WILL RE-SHOW THEM TO YOU WHEN WE DO...
..ORAL CARE.
BUT HOW THESE WORK -- NO, THAT'S ALREADY IN THERE.
THIS LITTLE SQUEEZE POUCH IS SOME ORAL HYGIENE LIKE
MOUTH WASH AND YOU CAN DIP YOUR LITTLE SPONGETTE
IN THE ORAL MOUTHWASH.
THEN YOU COME OVER HERE TO YOUR SUCTION.
CONNECT IT, YOU GOT A LITTLE FINGER TAB RIGHT HERE,
SO THAT WHEN YOU HIT HERE, YOU TURN IT ON.
WHEN YOUR FINGER'S ON, IT SUCTIONS.
SO YOU CAN BE SCRUBBING AND SUCTIONING AT THE SAME TIME.
[LAUGHTER]
BEAUTIFUL HUH?
SO THIS IS A GREAT THING. LOOK FOR THESE LITTLE STICKS
WHEN YOU CAN FIND THEM. SO THERE'S -- I'LL GIVE YOU THE BRAND NAME.
BUT YOU WANT LIKE A TOOTHETTE THAT HOOKS TO SUCTION
WHEN YOU'RE ASKING PLAN OFFS. AND I'LL LEAVE THESE PLAN OFFS SIMPLE SUPPLY.
THIS IS A SUCTION OR A SWAB BRUSH.
AND IT'S GOT YOUR NICE, LITTLE REFRESHING MOUTHWASH,
BEAUTIFUL PRODUCT FOR THE UNCONSCIOUS.
ALRIGHT, LET'S TALK A LITTLE BIT ABOUT CONSCIOUS.
THIS ONE ALSO HAD SOME LIP MOISTURE AND THAT'S A GOOD THING TO ADD
TO YOUR ORAL HYGIENE CARE.
ALRIGHT.
DENTURES ARE A FUN THING. I LOVE DENTURES.
I DON'T KNOW WHY, BUT I LOVE THEM.
OKAY, SO DENTURES.
JUST THINK, ISN'T IT JUST AMAZING?
YOU GOT TO JUST POP THEIR TEETH OUT AND HAND IT TO YOU, LIKE...
ALRIGHT, DENTURES.
WHAT YOU WANT TO DO IF THEY HAVE DENTURES --
I HAVE A LITTLE DENTURE CUP HERE, SO.
IS JUST ASK YOUR CLIENT TO TAKE THEM OUT FOR YOU,
AND -- IF THEY CAN'T DO IT THEMSELVES,
I MEAN IF THEY CAN DO IT THEMSELVES, YOU'RE OUT OF THE PICTURE.
BUT IF THEY CAN'T AND THEY CAN POP THEM OUT FOR YOU,
THEN LET THEM POP THEM OUT.
AND I'LL SHOW YOU HOW TO POP THEM OUT IF THEY CAN'T, HERE IN A SECOND.
HAVE THEM POP THEM OUT, PUT THEIR LITTLE TEETH IN THE CUP.
AND I'LL JUST EXPLAIN THAT THEY'RE NASTY LOOKING AT THIS POINT
BECAUSE WHAT HAPPENS, MOST OF THE PEOPLE THAT
I'VE DONE THEIR CARE FOR THEY DON'T USE LIKE THE POLYGRIP
AND STUFF IN AND SO THEY'RE KIND OF LOOSEY-GOOSEY IN THEIR MOUTH.
AND ALL THEIR FOOD PARTICLES ARE IN THERE AND SO THEY'RE UNDERNEATH, YOU KNOW,
WHERE IT'S -- THEY'RE JUST FULL OF FOOD AND I DON'T KNOW.
AND SO WHAT YOU DO IS YOU GET THE TOOTHBRUSH AND THE WHOLE -- TOOTHPASTE.
THE WHOLE DEAL, GO TO THE SINK
AND YOU WANT TO PUT A WASH CLOTH IN THE SINK. WHY?
- IN CASE THEY FALL OFF. - SO THEY DON'T BREAK.
- OKAY. - NOT SO THAT THEY DON'T FALL DOWN THE DRAIN.
MOST DRAINS HAVE A LITTLE SCOOPER ON IT.
RIGHT, SO IT'S JUST SO THAT THEY DON'T BREAK IF YOU DROP THEM.
THEY'RE EXPENSIVE AND IF WE BREAK THEM OR IF WE LOSE THEM,
THE HOSPITAL HAS TO REIMBURSE THEM FOR THEM.
AND THEY'RE PRETTY EXPENSIVE.
AND WHO WANTS TO BE WITHOUT THEIR TEETH FOR AWHILE.
I MEAN, THAT'S, KIND OF, BAD.
SO BRUSH THEM ALL UP, RINSE THEM
AND THEN YOU CAN GIVE THEM BACK TO THE CLIENT TO PUT IN.
OR IF IT'S AN OVERNIGHT DEAL, YOU CAN GET LIKE A SPECIMEN CUP
OR THEY USUALLY HAVE DENTURE CUPS
AND THEY'RE LABELED DENTURE CUPS.
AND YOU CAN STORE THEM IN JUST WATER OR IF THEY LIKE POLY -
WHAT IS THIS STUFF, THE FIZZY -- IT'S NOT POLYGRIP.
- EFFERDENT. - EFFERDENT, YEAH.
AND THAT CLEANSES THEM THROUGH THE NIGHT AND REFRESHES THEM, SO.
ALRIGHT. IF THEY CAN'T GET THEM OUT, THIS IS VERY IMPORTANT.
IF THEY'RE NOT CONSCIOUS AND THEY'RE NOT COOPERATIVE,
NEVER EVER, EVER STICK YOUR FINGERS IN SOMEONE'S MOUTH. OH, IT'S NOT GOOD.
BUT IF THEY JUST CAN'T GET THEM OUT AND THEY NEED SOME HELP,
WHAT YOU WANT TO DO IS PUT YOUR GLOVES ON.
AND I'D LIKE TO GET A 4X4,
IF THEY'RE HAVING A LITTLE TROUBLE GETTING THEM.
[LAUGHTER]
GAUZE. I FORGOT THAT WORD. 4X4 GAUZE, NOT A...
THAT'S GOOD. I DIDN'T KNOW THAT. OKAY.
THAT WILL GET THEM RIGHT OUT. NOW WITH THEIR HEAD RIGHT OFF GOODLUCK. RIGHT OFF.
ALRIGHT.
THE REASON FOR THE GAUZE IS SOMETIMES IT'S, KIND OF, SLIPPERY IN THERE
SO YOU NEED SOMETHING TO, KIND OF, HELP TO GET A GRIP.
BUT WHAT YOU WANT TO DO IS STICK YOUR FINGER IN
AND POP THEM DOWN AND THEN GET THE TOP FIRST, OKAY.
SO, YOU CAN JUST STICK YOUR FINGER IN AND SEE IT'S VERY LIKE REAL.
THESE MAYBE A LITTLE TOUGHER THAN A REAL PERSON,
BUT IT'S THE SAME IDEA, FEELING THAT RIDGE AND POPPING THEM DOWN.
THEN WHAT YOU WANT TO DO IS GET YOUR FINGER AND POP --
MY FINGER IS NOT GETTING IN THERE.
CAN YOU HELP ME MR -- THAT IS REALLY STUCK ON THERE TIGHT.
THERE YOU GO, POP IT AND THEN THEY'RE OUT.
ISN'T IT JUST FUN? I MEAN, CLEAN THEM UP.
ALRIGHT, SO MAKE SURE YOU CLEAN UNDER,
BRUSH THEM OUT AND GET ALL THE FOOD OUT.
NOW, IF ALL THAT FOOD WAS IN THEIR DENTURES HOW DO YOU SUPPOSE THEIR MOUTH IS?
YEAH, SO YOU NEED TO MAKE SURE YOU GIVE THEM A GOOD RINSE,
GET A TOOTHETTE AND GET THOSE GUMS CLEANED UP BEFORE YOU RE-INSERT.
SO, I DO TOP FIRST AND THEN BOTTOM AND THEN I RE-INSERT.
JUST THE OPPOSITE, BOTTOMS IN...
..AND THEN TOP.
AND IT'S NICE IF THEY CAN JUST, KIND OF, LIKE I SAID, DO IT THEMSELVES.
BUT YOU CAN SEE STICKING YOUR FINGERS IN SOMEONE'S MOUTH
THAT'S NOT COOPERATIVE, IT COULD BE FATAL.
ALRIGHT, LAST, BUT NOT LEAST, ON ORAL CARE.
THEY MENTIONED DENTAL FLOSSING.
AND I HAVE TO HONESTLY SAY, I GUESS, BAD NURSE ME.
BUT I'VE NEVER DENTAL FLOSSED A PATIENT'S TEETH IN MY LIFE.
AND I WOULDN'T, IF THEY WERE UNCONSCIOUS AGAIN
BECAUSE FOR YOUR OWN PROTECTION.
BUT SOMEONE THAT'S A QUADRIPLEGIC, I MEAN,
WHY WAS I NOT THINKING OF DENTAL FLOSSING? JUST BRUSHING ISN'T ENOUGH.
YOU'RE SUPPOSED TO DENTAL FLOSS. I'VE DENTAL FLOSSED MY OWN TEETH
SO YOU NEED TO CONSIDER THAT AND JUST LIKE THE DENTIST, I MEAN.
THEY CAN PUT THEIR HEAD BACK A LITTLE
SO YOU CAN GET IN BETWEEN THE TEETH, THAT'S NICE.
AND THEN THEY HAVE THOSE LITTLE STICKS WHERE THE LITTLE STRING
IS HELD TIGHT AND THAT'S MUCH EASIER THAN WRAPPING YOUR OWN FINGER
AND CUTTING OFF YOUR CIRCULATION TRYING TO GET INTO THEIR MOUTHS.
SO THAT'S HELPFUL. A WATER PICK IS HELPFUL
AND THAT CLEANS IN BETWEEN THE TEETH,
IF YOU CAN GET ONE OF THOSE FOR ORAL CARE.
FINALLY, ON ORAL CARE WITH THE TOOTHETTES,
YOU NEED TO BE VERY CAREFUL ABOUT YOUR CONFUSED CLIENTS.
AND MY STORY OF THE DAY IS,
I WENT OUT IN A HOME CARE ENVIRONMENT.
I WAS SUPERVISING A HOME HEALTH AID
AND WE HAD TO GO OUT AND WATCH THEM DO CARE FOR THEIR RAISES AND THEIR ANNUAL REVIEWS.
SO I WAS OUT WITH THIS LITTLE GAL, SHE'S BEEN IN AID FOR A LONG TIME.
CUTE AS COULD BE.
SHE WAS SPANISH SPEAKING,
AS WELL AS THE CLIENT WAS SPANISH SPEAKING
AND I AM MUY POQUITO SPANISH SPEAKING.
SO THEY WERE DOING THEIR CARE AND THE MAN WAS VERY, VERY CONFUSED.
HE HAD ALZHEIMER'S AND A STROKE AND HE WAS JUST VERY CONFUSED.
AND THEN SHE WAS TALKING TO HIM AND HE WAS SAYING --
I DON'T KNOW WHAT, BACK AND FORTH.
SO SHE WENT TO DO HIS ORAL CARE WITH THE TOOTHETTE
AND SHE WENT TO PUT IT IN HIS MOUTH AND IT MADE HIM MAD.
AND HE BIT IT.
OH, AND HE BIT IT.
AND HE WOULD NOT LET GO. I HOPE YOU DON'T THINK...
"OH, THIS IS GOOD." AND SHE STARTED SAYING SOMETHING IN SPANISH AND HE...
SO MAD. AND I'M THINKING,
"OH, MY GOSH, I'M GOING TO HAVE TO DO THE HEIMLICH ON HIM.
HE'S GOING TO JUST -- " YOU KNOW.
WELL, SHE DECIDED SHE NEEDED TO GET THAT OUT.
SO SHE TWISTED AND TWISTED
AND IT BROKE.
AND NOW THE TOOTHETTES IN HIS MOUTH.
HE'S GOT THE TOOTHETTE AND WE'RE GOING, "OH, MY GOD!"
SO NOW I AM REALLY THINKING I'M GOING TO HAVE TO DO THE HEIMLICH.
WHAT IF HE GETS THAT TOOTHETTE SPONGE DOWN HIS THROAT?
AND HE WAS SO MAD, SO SHE STARTS TELLING HIM TO SPIT IT OUT IN SPANISH.
AND I'M GOING, "COME ON NOW. YOU KNOW, SPIT THAT OUT."
AND HE WAS JUST SO MAD AND THEN ALL OF A SUDDEN HE JUST WENT...
AND SPIT IT ACROSS THE ROOM. AND HERE'S ME AND THAT AIDE GOING,
"OH, THANK HEAVENS,"
BECAUSE WHAT WOULD WE HAVE DONE WITH THAT TOOTHETTE, YOU KNOW?
SO, MORAL OF THE STORY, IF THEY BITE ON THE THING
JUST LET IT BE. DON'T TRY TO TWIST IT OUT.
WE WE'RE BETTER OFF TO HAVE A STICK.
HE WOULD HAVE FINALLY GOT MAD AND LET IT GO.
I MEAN, YOU KNOW,
BUT DON'T BE TWISTING AND CARRYING ON.
PEOPLE WILL DO FUNNY THINGS AND THEY WILL SURPRISE YOU.
SO THINK PAST THE INITIAL ACTION
TO WHAT MIGHT HAPPEN IF YOU PURSUE.
SO THAT WAS FUN AND WE HAVE NO BAD STORIES TO TELL AFTER THAT.
ALRIGHT, THE LAST THING IS COS WE NEED TO GET TO OUR BATH,
WHICH IS WHAT WE'RE DOING TODAY.
NO, I FORGOT NAILS. WE'RE GOING TO DO A BED BATH.
THERE ARE MANY FORMS OF THE BATH.
THERE'S A COMPLETE BATH WHICH IS WHAT WE'RE GOING TO DO
AS IF THE CLIENT CAN'T DO ANYTHING.
THERE'S A PARTIAL BATH
BECAUSE WHENEVER POSSIBLE I'D LET THE CLIENT TRY
TO DO AS MUCH FOR THEMSELVES AS THEY CAN.
SO, I WOULD SET UP A TABLE LIKE THIS,
SLIDE IT OVER MY CLIENT IF THEY'RE BEDRIDDEN AND SAY,
"GET YOUR FACE AND YOUR PRIVATE AREAS,
I'LL DO THE REST."
YOU KNOW, SO THAT THEY DON'T FEEL EMBARRASSED
AND I'M GETTING THEIR BACK AND THEIR FEET
AND THEIR BOTTOM AND THAT KIND OF STUFF.
SO A PARTIAL. IF THEY CAN AND EVEN BETTER YET GET INTO A CHAIR,
YOU CAN SIT THEM IN A CHAIR WITH ALL THEIR STUFF.
SO THAT YOU CAN CHANGE THE BED AND THEY CAN REACH MORE OF THEIR BODY.
BETTER YET, INTO THE BATHROOM WITH THE CHAIR.
CLOSED DOOR, THE SINK AND THEY CAN DO MORE.
THEY'RE A LITTLE MORE INDEPENDENT. MAYBE THEY HAVE AN IV
AND THEY CAN'T GET INTO THE SHOWER, BUT THEY'RE PRETTY MOBILE.
THAT'S ANOTHER OPTION. AND THEN OF COURSE THERE ARE SHOWERS,
IF THEY COULD SHOWER,
THEY HAVE -- THE IV'S MAYBE HAVE A LOCK ON IT OR SOMETHING
AND THEY CAN GET INTO THE SHOWER, BETTER YET.
AND THERE'S JUST DIFFERENT PIECES OF IT.
SO ALL THAT TO SAY YOU CAN WASH ANY PART,
BUT TODAY WE'RE DOING IT ALL. ALRIGHT.
THERE'S ONE OTHER THING I WANT TO MENTION AS FAR AS THE BED BATH GOES.
ON A BED BATH WE'RE GOING TO DO YOUR BASIC BASIN AND WATER, BED BATH.
THERE IS A BED BATH CALLED BATH IN A BAG.
THEY'RE USING IT AT KAISER. I THINK THEY JUST GOT IT ON
SOME OF THE FLOORS AT COMMUNITY HOSPITAL,
MAYBE SOME OF YOUR NURSING HOMES.
I DON'T KNOW WHO CARRIES WHAT THESE DAYS,
BUT WHAT IT IS IT'S, LIKE, 20 BABY WIPES,
YOU KNOW HOW IF YOU GOT WIPES,
THE BIGGER ONES. NOT THE LITTLE, TINY LITTLE ONES.
BUT A GOOD DEAL LITTLE DISPOSABLE CLOTH.
THEY'RE PRE-MOISTENED AND WHAT YOU DO IS YOU TAKE THOSE
TO THE MICROWAVE AND YOU HEAT THEM UP
AND THEN WHEN YOU COME TO DO THE BATH,
YOU USE ONE ON THE BODY UNTIL IT'S DRY OR SOILED AND YOU PITCH IT.
AND YOU JUST KEEP GOING AND JUST KEEP PITCHING THEM
SO THAT YOU DON'T HAVE THIS DIRTY BASIN
THAT'S BEING USED OVER AND OVER AND OVER AGAIN.
BATH IN A BAG WAS ACTUALLY CREATED BY A NURSE
WHO AFTER SEEING THE BASIN USED SO MANY TIMES WENT,
"I WONDER WHAT'S GROWING IN THIS."
YOU KNOW, BECAUSE WE'RE NOT THAT GREAT ABOUT CLEANING IT UP,
YOU KNOW, PEOPLE EACH SHIFT AND SO FORTH.
AND SO SHE STARTED CULTURING BATH BASINS
AND HER FINDINGS WERE ASTOUNDING.
SO THAT'S WHEN SHE CREATED THIS BATH IN A BAG
TO KEEP DOWN NOSOCOMIAL INFECTION FOR THE CLIENTS.
SO WHENEVER POSSIBLE, IT'S REALLY CHEAP.
THEY'RE NOT THAT COSTLY AND IT'S NICE FOR THE CLIENT.
IT DOES KEEP INFECTION DOWN AND YOU DON'T HAVE TO BOTHER WITH ALL THE SOAP PRODUCTS.
IT HAS A NO-RINSE SOAP PRODUCT INTO THE WIPE PART
AND YOU JUST CLEAN AWAY AND THEN YOU'RE DONE.
SO, THAT'S A BEAUTIFUL THING,
BUT CREATED TO KEEP DOWN NOSOCOMIAL INFECTION.
ALRIGHT, THE LAST THING I WANTED TO MENTION
BEFORE WE HIT THE BATH HERE IS NAIL CARE.
WE'VE TALKED ABOUT HAIR, MOUTH,
I DIDN'T REALLY TALK MUCH ABOUT EYES, YOU CAN READ ABOUT THAT.
WE'LL TALK A LITTLE AS I GO THROUGH THE BATH.
NAILS NEED TO BE CARED FOR AS WELL.
YOU WANT TO BE CHECKING THE NAILS FOR THE COLOR
AND THE CONTOUR, THE SHAPE, AND HOW THEY'RE LOOKING.
WHY WOULD WE CARE ABOUT NAIL COLOR?
WHAT DOES THAT HAVE TO DO WITH ANYTHING? - CIRCULATION.
- CIRCULATION, IS IT BLUE, IS IT PALE, IS IT FLUSHED, IS IT CLUBBED?
YOU'RE JUST LOOKING. WHAT IS CLUBBING?
- FLAT. - FLAT BECAUSE OF...
- LACK OF OXYGEN. - LACK OF OXYGEN FOR AN EXTENDED PERIOD OF TIME.
YOU'LL GET TO THAT STUFF EVENTUALLY, BUT THAT'S WHAT WE'RE LOOKING FOR
TO GET AN INDICATION OF WHERE OUR CLIENT'S AT.
AND THEN WE'RE GOING TO FEEL THINGS TO SEE
ABOUT TEXTURE AND BRITTLENESS AND SO FORTH.
SO WHAT WE WANT TO BE LOOKING FOR IS NAILS
AND IF NAILS ARE LONG AND JAGGED,
YOU CAN FILE THEM. AND IF YOU CLIP THEM,
YOU CAN CLIP THEM STRAIGHT ACROSS AND FILE.
TOE NAILS ARE ANOTHER SUBJECT.
TOE NAILS NEED TO BE CHECKED FOR AND CHECKED REGULARLY
FOR THE SAME THINGS. BUT WHEN A TOE NAIL IS JAGGED OR LONG,
WE'RE NOT ALLOWED TO CUT THEM.
BECAUSE WE CAN CAUSE,
ESPECIALLY IN THE DIABETIC CLIENT AND THAT'S OUR PRIMARY CONCERN,
WE CAN CAUSE THEM TO LOSE A TOE IF CIRCULATION IS BAD
AND WE CAUSE AN INGROWN TOE NAIL
AND INFECTION AND NECROSIS AND SO FORTH.
SO, WE'RE NOT ALLOWED TO CUT THEM.
YOU CAN INSTRUCT THE CLIENT THAT THEY CAN CUT THE NAIL STRAIGHT ACROSS.
AND YOU WANT TO BE WATCHING FOR HOW THEY'RE CARING FOR THEIR NAILS,
THAT THEY'RE NOT ROUNDING THEM UP BECAUSE IF THEY CUT THEM REAL CLOSE
AND KEEP THEM REAL ROUNDED, THAT'S WHAT CAUSES THE INGROWN TOE NAIL.
AND THAT CAN GET THEM INTO TROUBLE. SO WE WANT THEM STRAIGHT ACROSS.
WHAT WE'RE LOOKING FOR IS TO MAKE SURE THEY'RE NOT JAGGED
AND THEY'RE NOT CATCHING ON THE LINEN.
AND IF YOU'VE WORKED IN THE GERIATRIC POPULATION AT ALL,
YOU KNOW THAT THE OLDER THEY GET THE THICKER THEIR NAILS OFTEN BECOME.
AND THE BECOME QUITE CALCIFIED AND SOMETIMES THEY CAN LOOK
ALMOST AS IF THE BONE IS GROWING OUT OF THEIR TOE NAILS.
IT'S JUST SO THICK AND SO CALCIFIED.
AND WHEN IT'S LIKE THAT, WE CAN'T EVEN HARDLY FILE THEM BECAUSE THEY'RE SO THICK.
AND SO WHENEVER THE NAILS LOOK OUT OF CONTROL LIKE THAT,
YOU NEED TO MAKE A PODIATRY CONSULT.
AND IT TAKES NOTHING TO DO AND EVERYONE KNOWS THE RULES.
ALL YOU NEED TO DO IS ASK THE DOCTOR THAT'S IN CHARGE
FOR A PODIATRIST TO COME IN.
AND THEN NURSING HOMES, IT WOULD BE INTERESTING
WHEN YOU GET THERE TO FIND OUT WHO ROUNDS ON FEET,
WHO'S YOUR IN-HOUSE PODIATRIST
AND CHECK FEET TO SEE WHEN THEY WERE LAST CHECKED.
TYPICALLY, WHEN I WORKED IN THE NURSING HOMES
THE PODIATRIST WILL COME ONCE A WEEK TO ONCE A MONTH
AND JUST ROUND ON EVERYBODY, CLIP ALL THOSE CALCIFIED TOES
AND GIVE THEM ALL A GOOD CHECK AND THEN MOVE ON.
ESPECIALLY, FOR THEIR IN-HOUSE CLIENTS.
SO MAKE SURE THAT FOR YOUR DIABETICS OR PEOPLE THAT HAVE NEUROPATHIES,
THEY'RE NOT FEELING REAL GOOD IN THEIR FEET,
THEY DON'T HAVE GOOD SENSATION BECAUSE OF THEIR DIABETES
THAT YOUR WATER'S NOT TOO HOT.
YOU WANT TO MAKE SURE THAT THEY'RE NOT USING HEATING PADS
OR ANYTHING LIKE THAT ON THEIR FEET, THAT THEIR FEET ARE CLEAN AND DRY
AND THAT THEY KEEP SOCKS ON THEIR FEET,
GOOD FITTING SHOES WHEN THEY'RE UP WALKING
SO THAT THEY DON'T INCUR AN INJURY.
I'VE HEARD OF PEOPLE LIKE CONSTRUCTION WORKERS,
THEY'VE BEEN OUT ON A ROOF AND THEY'VE STEPPED ON A NAIL
AND THEY'VE WALKED ON IT FOR A DAY OR TWO AND THEY DIDN'T EVEN KNOW.
THEY COULDN'T FEEL IT.
SO YOU WANT TO BE CONSCIOUS OF THAT CLIENTELE THAT HAVE NEUROPATHIES
AND THAT'S PARTICULARLY YOUR DIABETICS. THEY GET INTO THAT KIND OF TROUBLE
BECAUSE OF HIGH BLOOD SUGARS OVER A LONG PERIOD OF TIME.
ALRIGHT, THAT'S IT FOR JUST AN OVERVIEW.
YOU READ OVER CONTACTS AND FALSE EYES AND ALL THAT KIND OF STUFF.
I'VE NEVER DONE MUCH WITH THAT, SO.
I DON'T KNOW MUCH MORE THAN WHAT YOU'RE GOING TO READ IN THE BOOK.
- YOU SAID SOMETHING ABOUT HEATING PADS.
- NO, IT'S CONTRAINDICATED BECAUSE AGAIN,
THEY CAN'T FEEL THE HEAT AND THEY CAN BURN THEMSELVES
WITH THE HEATING PADS, SO.
IF THEY CAN FEEL WITH THEIR HANDS,
IF THEY'VE WARMED -- LIKE A WARM BOTTLE OR A WARM CLOTH OR SOMETHING
AND THEIR FEET ARE JUST COLD THEY COULD DO THAT,
BUT THEY DON'T RECOMMEND THE HEAT ON THEM AT ALL.
OKAY, WHAT WE'RE GOING TO DO IS A BED BATH AND THAT IS ALL. IT IS A TIMED ACTIVITY
AND LET'S JUST BE HONEST, IT'S A BED BATH AND YOU GUYS BATHE YOURSELF.
AND YOU CAN WIPE DOWN A MANNEQUIN AS GOOD AS I CAN WIPE DOWN A MANNEQUIN.
SO, WHAT WE'VE DONE IS BUILT IN
AN A-SKILL WITH THIS, A NURSING SKILL.
ONE OF THE PRIVILEGES THAT WE HAVE IN GIVING A BED BATH
IS THAT YOU ARE ABLE TO DO A FULL SKIN ASSESSMENT.
SO WHENEVER I CAN GIVE A BED BATH, I REALLY DON'T MIND
BECAUSE I CAN ASSESS MY CLIENT BETTER DOING A BED BATH
THAN I CAN JUST GOING IN AND TALKING TO HIM AND SAYING,
YOU KNOW, "ANY PROBLEMS, ANY SORES?"
THIS WAY I'M REALLY LOOKING AND I AM SEE IT FOR MYSELF
EVERYTHING THAT'S GOING ON.
SO WHAT I DID WAS I HAVE THE BED BATH ALL ON ONE PAGE,
BUT THEN I HAVE ONE PAGE THAT'S THE NURSING ASSESSMENT,
IT'S THE SKIN ASSESSMENT.
WHAT YOU'RE GOING TO BE DOING IS INCORPORATING THAT SKIN ASSESSMENT
THROUGH ALL ASPECTS OF THE BED BATH.
AND YOU'RE GOING TO BE TALKING THE WHOLE ENTIRE TIME
BECAUSE YOU'RE GOING TO TELL ME WHAT YOU'RE OBSERVING AND FEELING
ON THE SKIN OF THE PART THAT YOU'RE WASHING, ALL THE TIME.
SO, IT'LL GET THOSE REALLY INGRAINED INTO YOUR MIND FOR ONE,
AND TWO, IT'S WHAT YOU DO.
YOU'RE REALLY LOOKING AND CHECKING FOR THE THINGS WE'RE GOING TO CHECK FOR, SO.
THE HIGH FIVE WILL COUNT FOR BOTH AND THEN I'LL GO THROUGH
AND ASSESS AS WE GO THROUGH IT AND DESCRIBE THAT.
I FORGET WHAT THE TIMES ARE,
I DIDN'T EVER REALLY LOOK, BUT YOU KNOW THE SYSTEM.
SO YOU GOT YOUR UNSATISFACTORY COMPLETION TIME,
YOUR SATISFACTORY AND YOUR UNSATISFACTORY.
YOU WANT TO STAY WITHIN THAT.
THE KEY TO DOING THIS IS IN WASHING, TALKING,
WASHING, TALKING.
YOU GOT TO WASH AND TALK, WASH AND TALK, WASH AND TALK TO GET IT DONE
BECAUSE AS YOU WASH THAT'S THE WHOLE POINT.
YOU'RE WASHING AND OBSERVING AND FEELING.
AND JUST GET USED TO DOING THAT. OKAY?
SO HERE WE GO. YOU CAN PUT ME ON THE CLOCK.
IT'S 20 TILL, WE'LL SEE WHEN I GET DONE.
ALRIGHT, I'VE CHECKED MY DOCTOR'S ORDERS.
DOES THE DOCTOR ORDER A BED BATH?
- NO. - NO, NOT USUALLY, BUT AN ACTIVITY LEVEL
AND IF YOU KNOW THEY'RE BED RIDDEN AND THEY CAN'T GET UP, THEN IT'S YOUR CALL.
AND SO CARE PLAN WILL TELL YOU BED BATH.
GATHERING UP OF YOUR EQUIPMENT, I HAVE A BATH BLANKET.
I'VE ALREADY GATHERED MY BASIN. YOU'RE GOING TO HAVE WATER IN IT.
YOU ONLY NEED TO PUT IN A COUPLE INCHES OF WATER,
BUT WE ARE GOING TO DO REAL BATHS WITH REAL WATER.
IT'S WARM, I'VE ALREADY CHECKED IT
BECAUSE THIS IS THEIR EATING TABLE I WANT TO GO AHEAD
AND HAVE A CHUX AND A BARRIER DOWN FOR SLOP AND WATER AND MY WASH CLOTH AND SO FORTH.
BABY POWDER, IF YOU CAN USE IT
AND THIS IS JUST A PROP TO REMIND ME ON FEMALES
AND I'LL TALK ABOUT FOR PUTTING UNDER BREASTS
OR MAYBE UNDER THE ARMS, DEODORANT, THAT KIND OF THING.
NO RINSE SOAP. THAT'S YOUR BEST OPTION WHEN POSSIBLE.
THAT'S A ONE BASIN METHOD.
IF I WAS USING BAR SOAP, THAT'S ALL THEY HAD
THEN I WOULD HAVE TWO BASINS, ONE FOR RINSING AND ONE FOR THE SOAP.
COS IT GETS SO MURKY AND FILMY WITH BAR SOAP.
LOTION FOR DOING THE BACK RUB AND I'M JUST GOING TO TOSS IT INTO THE WATER
SO THAT IT GETS WARM AND IT'S NOT COLD WHEN I GO TO GIVE THE BED BATH.
ALRIGHT. SUPPLY-WISE, ALL I WANT YOU GUYS TO GATHER
IS TWO WASH CLOTHS AND TWO TOWELS.
BUT WHAT I REALLY GATHER IF I AM DOING A BED BATH
IS ABOUT SIX TO TEN WASHCLOTHS
BECAUSE I DON'T KNOW WHAT I'M GOING TO FIND IN THE PERI CARE ARENA.
SO I WANT PLENTY OF WASHCLOTHS AND I USUALLY MESS THEM UP.
SO, I USUALLY GET MORE TOWELS.
I JUST DON'T HAVE ENOUGH OF THIS LINEN FOR US
-- EVERYONE TO SNARF IT ALL OUT.
SO JUST TWO AND TWO AND IF YOU NEED A NEW WASHCLOTH SAY,
I'D GET ANOTHER ONE AND WE GO, "OKAY." YOU KNOW, KIND OF, A DEAL.
THE OTHER THING IS I'VE GOT A FRESH GOWN
BECAUSE I'M GOING TO CHANGE MY CLIENT'S GOWN AFTERWARDS
AND I'VE ALSO GOT A LINEN HAMPER FOR MY CLIENT.
OKAY, I'VE WASHED MY HANDS. I'M GOING TO IDENTIFY MY CLIENT.
GOOD MORNING MR SPADE, IT'S TIME FOR YOUR BED BATH.
YOU'RE READY? GREAT. AND PROVIDE PRIVACY.
OKAY, I'M GOING TO PUT MY CLIENT UP IN A NICE HIGH POSITION
JUST LIKE YOU DID BEFORE.
- IS IT BEST LYING DOWN? - YES.
I DO. IF THEY'RE IN BED, THEY'RE IN BED FOR A REASON. AND, YEAH.
IS IT ALRIGHT IF I PUT YOU FLAT?
IT'LL BE EASIER FOR US TO MOVE AROUND
AND ROLL OVER AND GET YOU CLEANED UP.
THEY DON'T REALLY HAVE TO BE, YOU KNOW,
FOR THE FIRST PART, BUT I JUST WANT HIM FLAT.
OKAY, HOW IS THAT? GREAT.
OKAY.
I'M GOING TO GET THE GLOVES.
FOR SOME REASON THIS MANNEQUIN, THIS CLIENT, IS REALLY CLOSE TO ME.
BUT IF THEY WEREN'T CLOSE YOU CAN MOVE THEM CLOSER
SO THAT YOU'RE NOT LEANING TO DO ALL OF YOUR CARE.
BUT HE'S JUST REALLY CLOSE HERE.
AND I'M GOING TO GO AHEAD AND PUT A BATH BLANKET ON
BECAUSE MY LINEN IS CLEAN.
IT WOULD HAVE BEEN A BETTER SCENARIO
IF I'D HAVE DONE MY BATH FIRST AND CHANGED MY LINEN,
BUT, YOU KNOW, MAYBE HE WENT TO X-RAY OR SOMETHING
AND IT'S EASIER TO CHANGE THE BED
WHEN THEY'RE OUT OF IT THAN IN IT.
SO.
AGAIN PRESERVING PRIVACY,
COVER HIM UP AND FANFOLD YOUR LINEN, DON'T GET IT ON THE FLOOR.
SO WE FAN FOLD.
SO THAT IT DOESN'T GET WET.
AND I HAVE TO GET YOUR GOWN OFF HERE.
SO HOW ARE YOU DOING TODAY?
ARE YOU HAVING ANY PAIN ANYWHERE? NO.
FAMILY BEEN IN TO VISIT?
ARE THEY COMING? HOW IS YOUR APPETITE?
HAVE YOU HAD A BOWEL MOVEMENT TODAY?
I ASK A LOT OF VERY PURPOSEFUL QUESTIONS.
THINGS I NEED TO KNOW ABOUT THEM.
I HAVE VERY LITTLE WASTED CONVERSATION.
AND EVERYTHING I ASK HAS A MEANING TO IT.
ONE, SOCIALIZATION, ONE --
I MEAN, IS YOUR FAMILY HERE. IS THAT JUST A CHIT-CHAT?
NOT REALLY, IT HELPS, BUT NOT REALLY.
I NEED TO KNOW IF THERE'S PEOPLE THAT CARE FOR HIM.
IF HE'S GOT PEOPLE TO GO HOME TO, IF HE'S SOCIALIZING,
WHAT'S GOING ON HERE WITH THIS GUY?
HOW IS HE DOING PAIN-WISE? DO I HAVE ISSUES HERE? IS HE EATING?
HIS STRENGTH, BOWEL MOVEMENTS, IT'S JUST THINGS WE ASK EVERYDAY.
SO USE THAT TIME FOR YOURSELF.
ALRIGHT, WHEN YOU SET UP YOUR AREA,
SET UP YOUR AREA SO THAT IF YOU'RE RIGHT-HANDED,
YOU'RE ALWAYS WORKING ON THIS RIGHT HAND SIDE OF THE BED.
AND THAT YOUR TABLE IS RIGHT HERE.
THAT IT'S NOT BEHIND YOU AND YOU'RE SPINNING THE WHOLE TIME.
TURNING BACK HERE AND THEN DOING AND DOING.
THERE'S, LIKE, NO MOVEMENT HERE. IT WILL SAVE ME LOTS OF TIME.
ALRIGHT, FIRST THING I WANT TO DO
COS YOU'RE NICE AND CLOSE HERE IS I JUST WANT TO WASH YOUR FACE.
DO YOU WANT SOAP ON YOUR FACE OR JUST PLAIN WATER?
WE JUST...
SOAP? ALRIGHT. WELL, I'M GOING TO DO YOUR EYES FIRST.
SO, EYES OBVIOUSLY, NO SOAP.
OKAY. SOMEONE, YOU KNOW, THEY HAD TO THINK THROUGH BED MAKING
WHILE THERE WAS ALSO SOME BATH THEORIST OUT THERE,
FIGURED OUT HOW WE'RE SUPPOSED TO GIVE A BED BATH.
SO, THEY DECIDED WE SHOULD DO A MITT. I DON'T KNOW IF YOU'VE READ ABOUT THE MITT.
SO, I'LL SHOW YOU HOW THE MITT IS IN THE BOOK AND THEN I'LL SHOW YOU MINE.
YOU TAKE IT LIKE THIS ON THE SIDE EDGE,
YOU WRAP IT AND YOU FOLD IT AND YOU TUCK IT
AND IT'S GOOD TO GO AND SO YOU COME IN HERE
AND YOU CLEAN THE EYES FROM THE INNER CAMPUS OUT,
A NEW PIECE OF THE WASHCLOTH FROM THE INNER CAMPUS OUT.
AND THEN IF YOU NEED TO WIPE MORE, WHATEVER.
AND IF THEY INSIST, THEY DON'T WANT SOAP YOU CAN CONTINUE ON THE FACE.
BUT IF THEY DO WANT SOAP, YOU CAN CONTINUE ON.
ALRIGHT, THIS IS HOW I DO IT.
THAT FOLDING THING JUST TAKES WAY TOO LONG IN MY OPINION.
SO WHAT I DO IS I GRAB THE WASHCLOTH FROM THE CORNER
SO THAT IT LOOKS LIKE THIS.
THEN I TAKE THE OTHER CORNER AND I JUST WRAP IT AROUND.
AND SO NOW I HAVE NO SLOPPY ENDS.
THAT'S THE THING, THEY DON'T WANT THE COLD, WET END SLOPPING ALL OVER.
SO I REALLY DON'T CARE IF YOU DO THAT NICE, PROPER LITTLE FOLDING THING
OR IF YOU DO THE LITTLE WRAPPY THING.
IT DOESN'T MATTER AS LONG AS YOU DON'T HAVE SLOPPY WASHCLOTHES GOING ALL OVER.
I DON'T WANT TO SEE THIS KIND OF STUFF, YOU KNOW, GOING OVER THEIR FACE.
ALRIGHT. WELL, HE WANTED SOAP,
SO I'LL GIVE HIM A LITTLE SQUIRT OF MY NO RINSE SOAP IN THERE.
I DON'T KNOW IF THERE IS SOAP IN THERE OR NOT,
WE'VE USED THESE FOR SO MANY YEARS.
IT'S PROBABLY WATER. I MAY HAVE EVEN PUT JOY DISHWASHING SOAP IN IT.
I DON'T KNOW. THIS IS THE ONE BATH THE MANNEQUINS GET ALL YEAR, SO.
YOU KNOW, DO IT GOOD. IF YOU SEE ANYTHING, SCRUB IT OFF.
ALRIGHT, SO WE'RE GOING TO CLEAN THEIR FACE AND ALL THE WHILE
I'M DOING MY NURSING ASSESSMENT.
AND THERE'S TWO THINGS I'M DOING
AND THEY'RE, KIND OF, SIMULTANEOUS, IF YOU WILL.
I AM INSPECTING, WHICH IS JUST LOOKING.
YOU ALWAYS LOOK FIRST.
AND I AM PALPATING. SO I AM INSPECTING FOR PIGMENT,
BRUISES, COLOR,
TEXTURE, REDNESS, HAIR DISTRIBUTION.
AND AGAIN, THAT'S KIND OF LOOKING AT THEIR FACE AND EVEN THEIR HEAD.
I HAVEN'T GOT TO THE BACK OF THE HEAD TO NOTICE,
YOU KNOW, IF THEY HAVE BED HEAD OR MATTING OR THAT KIND OF THING.
I'M LOOKING AT HIDE, I'M JUST LOOKING TO SEE
ARE THEY REALLY SOILED? IS THEIR HAIR OILY?
IS THEIR BREATH ODOR BAD? YOU'RE TAKING IN HYGIENE ISSUES.
AS YOU'RE SAYING THESE, WE'RE CHECKING THEM OFF.
BUT I'M LISTENING FOR - YOU'LL SEE IN THE MIDDLE OF YOUR BATH
THAT IS SAYS THAT YOU DID IT THROUGHOUT.
THAT YOU DID ALL OF THIS KIND OF STUFF,
SO I AM LISTENING THAT YOU SAY EACH WORD AT LEAST ONCE IN THE BED BATH.
AND I AM LISTENING THAT YOU DO IT THROUGHOUT THE BED BATH.
ALRIGHT, WELL, YOUR FACE LOOKS GREAT HERE.
I'M GOING TO MOVE THIS TOWEL HERE FROM YOUR HEAD.
WE TRY TO PUT A TOWEL UNDER EACH EXTREMITY THAT YOU WASH
SO THAT IT PROTECTS THE LINEN.
ALRIGHT, IN BED THEORY SOMEONE DECIDED
THAT IT WOULD BE BETTER
IF YOU WASHED FROM AWAY FROM YOU IN.
SO THAT YOU'RE NOT LEANING YOUR DIRTY SELF OVER WHAT'S CLEANEST.
THAT WAS THE THEORY.
I DON'T REALLY CARE.
YOU'RE JUST WASHING THEM AND I DON'T THINK
IT'S THAT HUGE OF A DEAL IN THE SCHEME OF LIFE,
BUT IN KEEPING WITH BATH THEORY WE'LL START HERE.
THE OTHER THING ABOUT A BATH IS THAT YOU'RE GOING
FROM WHAT YOU WANT TO BE CLEANEST TO DIRTIEST AREAS.
SO WE START FROM THE HEAD,
WHICH WE WANT TO HAVE THE CLEANEST WATER FOR
AND THEN WE'RE GOING TO WORK OURSELVES DOWN HAVING PERI-ED AREA BE LAST,
WHICH WILL BE THE FRONT AND THEN THE BUTTOCKS IS THE LAST,
LAST ANUS OF CLEANING.
OKAY, THE OTHER THING IS
I COULD WASH THIS -- IF SOMEONE IS REALLY LARGE,
AND YOU CAN'T REACH VERY WELL,
YOU COULD WASH THIS WHOLE SIDE OF THE BODY.
GO CHANGE YOUR WATER AND THEN GO TO THAT SIDE
AND DO THAT WHOLE SIDE
AND CHANGE YOUR WATER AND THEN DO THE BACK.
BUT BECAUSE I CAN REACH FAIRLY DECENTLY
AND I CAN EVEN MOVE HIM OVER A LITTLE CLOSER IF I FELT SO INCLINED HERE,
I'M JUST GOING TO REACH OVER.
NOW I THINK AS MUCH AS YOU CAN,
YOU NEED TO DIP A BODY PART IN WATER AND SOAK IT.
AND TWO PLACES THAT NEED TO BE SOAKED ARE HANDS AND FEET.
IT'S BEEN MY EXPERIENCE WITH BED BATHS
ESPECIALLY PEOPLE THAT ARE A LITTLE CONFUSED
THAT YOU'RE HAVING TO HELP BATHE, THEY SCRATCH THEMSELVES.
JUST COS THEY DO.
AND THEIR NAILS ARE JUST FULL OF STOOL,
AND SO YOU NEED TO GET THEM CLEANED UP.
SO GET THEM SOAKED AND PLUS,
I DON'T KNOW, A SPONGE BATH JUST DOESN'T FEEL LIKE A REAL BATH
UNLESS I'VE SOAKED A BODY PART.
SO IT JUST FEELS LIKE YOU'VE HAD A REAL BATH
IF YOU CAN GET SOMETHING SOAKED, SO.
THERE YOU GO. WHAT WE'RE GOING TO DO,
BATH THEORY IS WE'RE GOING TO CLEAN
AND WIPE TOWARDS THE HEART RATHER THAN DOWN.
IT HELPS CIRCULATION OR SOMETHING.
HEY, WHAT'S UP?
WE'RE GOING TO COME DOWN HERE AND WE'RE GOING TO WASH THEIR ARMS.
ALL THE WHILE I'M NOT ONLY JUST LOOKING AND NOTICING.
BE CAREFUL, THE MANNEQUINS DON'T FIT SO WELL IN THERE.
I'M NOTICING THE TEMPERATURE OF MY CLIENT,
WHICH I COULD HAVE NOTICED ON THEIR HEAD FOR A GENERAL BODY TEMPERATURE,
PUTTING THE BACK OF MY HAND TO THEIR HEAD TO FEEL FOR TEMPERATURE.
BUT I'M NOTING THE TEMPERATURE OF THE BODY,
I'M NOTICING THE SKIN FOR MOISTURE, THICKNESS,
TEXTURE, AS WITH THE PALMS OF MY HANDS.
THAT'S HOW I AM GOING TO BE ABLE TO TELL AS I DRY HERE.
AND I'M GOING TO DRY UNDER THEIR ARMS.
AND THEN I GOT TO DO CHEST HAIR AND YOU HAVE TO EXPOSE BODY.
I MEAN, YOU CAN'T JUST TOTALLY LEAVE HIM UNDER.
BUT COME OVER HERE.
ALL THESE TOWELS GO IN.
ALRIGHT.
I'M AGAIN INSPECTING AND NOTICING HYGIENE ISSUES.
LIKE ARE THEY ODOROUS WHEN I COME OVER HERE,
PIGMENT, I'M LOOKING IF THE SKIN'S INTACT.
AND I'M CLEANING CHEST AREA
AND I'M GOING TO CLEAN ALL THE WAY DOWN INTO ABDOMEN
BECAUSE IT'S RELATIVELY CLEAN AND UMBILICUS.
ALRIGHT, IF THIS IS A GUY IT'S A PRETTY EASY, JUST STRAIGHT DOWN CLEAN.
IF IT'S A LADY, AND YOU HAVE BREASTS
THAT ARE LARGE HERE, YOU WANT TO LIFT THE BREAST
AND CLEAN UNDER THE BREAST
AND LOOK FOR SIGNS AND SYMPTOMS OF SKIN BREAKDOWN.
SOMETIMES THE BREASTS RUB TOGETHER
AND THEY GET SOME FRICTION AND CRACKING UNDERNEATH HERE
AND SO YOU WANT TO GET THAT CLEANED REALLY WELL AND DRIED REALLY WELL.
AND THEN THAT'S WHERE I MAY PUT SOME BABY POWDER,
SO THAT THERE'S NOT SO MUCH RUBBING AND STICKING.
JUST DEPENDS AGAIN ON CLIENT PREFERENCE AND SO FORTH.
ALRIGHT, SO I AM GOING TO CLEAN AND DRY.
AND LAST BUT NOT LEAST, I'M GOING TO COME OVER HERE
AND MOVE HIM JUST A LITTLE BIT THERE.
AND DO THIS LAST ARM.
INSPECTING FOR PIGMENT,
HYGIENE, COLOR, TEXTURE.
A COUPLE OF THINGS I WANTED TO NOTE
WAS ON BOTH HANDS, I WANT TO LOOK
FOR THE NAIL CONTOUR AND WHAT WAS THE OTHER ONE?
- COLOR - COLOR, THANK YOU.
WE HAVEN'T TALKED ABOUT THAT. BUT I WANT TO FEEL FOR CONSISTENCY.
I WANT TO FEEL THAT THE NAILS ARE THICK, THIN, BRITTLE
AND JUST ROUNDED OR WHATEVER AS FAR AS THE NAIL GOES AND HYGIENE ISSUES.
AND LOOK FOR CAPILLARY REFILL.
I ALSO WANT TO COME WHEN I AM AT THE CHEST,
AND I WANT TO PINCH UNDERNEATH THE CLAVICLE FOR SKIN TURGOR.
IT'S REALLY THE ONLY TIME YOU'RE GOING TO CHECK FOR SKIN TURGORY.
AND YOU CAN PINCH YOUR OWN. IF I PINCH UNDER HERE
SEE HOW MY SKIN JUST RECOILS AND PINK, IT GOES RIGHT BACK.
BUT IF I AM DEHYDRATED, IT'S GOING TO TENT.
IT'S GOING TO STAY PINCHED UP.
AND SO WE COUNT THE NUMBER OF SECONDS IT STAYS PINCHED UP.
SO THAT WE'LL KNOW, WE'LL REFLEX HOW DEHYDRATED THEY ARE.
OTHER AREAS THAT YOU CAN CHECK ARE THE ARM
AND WE TRY TO AVOID THE HAND, ESPECIALLY IN THE GERIATRIC POPULATION
BECAUSE THEIR SKIN IS OLDER AND IT JUST STAYS THERE BECAUSE IT'S OLD SKIN.
IT DOESN'T HAVE ANYTHING TO DO WITH HYDRATION.
SO THAT'S WHY THE BEST PLACE TO CHECK IS UNDER THE CLAVICLE.
SO, I'VE DONE THAT, I'M GOING TO COME OVER HERE
AND MOVE THIS CLOSER.
LIKE A SPILL WAITING TO HAPPEN HERE.
SO, I WOULD JUST SAY, CAN YOU GET YOUR HANDS IN THAT?
IT'S NOT GOING TO FIT ON THE BED TOO WELL
AND REAL PEOPLE DIP A LITTLE BETTER.
SO, COMING IN HERE, NOTICING AGAIN
THE NAILS, THE COLOR, THE CONTOUR, THE CONSISTENCY.
GET BETWEEN THEIR FINGERS REALLY GOOD,
ESPECIALLY PEOPLE THAT CLENCH UP THEIR HANDS.
IT STINKS IN THERE FROM SWEATING.
SO GET THEIR HANDS CLEANED UP
AND THEN AGAIN, YOU'RE GOING TO WASH...
..UP TOWARDS THEIR HEART NOTICING THE COLOR, THE CONTOUR.
TAPE STUCK ON THEIR SKIN, BETADINE, WHATEVER,
FROM TREATMENTS AND STUFF. IT'S THE SAME ON THEIRS.
I'M LOOKING FOR HAIR DISTRIBUTION ON THEIR BALDING SPOTS.
I'M NOTICING THE TEXTURE OF HAIR, FEELING HAIR.
I'LL DO THAT A LITTLE MORE WHEN I GO TO THE BACK OF THE NECK
AND SEE THEIR HAIR AND REALLY FOCUS ON HAIR DISTRIBUTION AND MATTING,
BUT GET UNDER THEIR ARM.
TOWELS EVERYWHERE.
COME BACK HERE AND DRY.
HOW ARE YOU DOING? WAS THE WATER WARM ENOUGH? DID I GET EVERY PLACE?
ASK HIM, YOU MIGHT MISS AND YOU DON'T EVEN KNOW BECAUSE IT'S NOT YOUR BODY.
SO JUST TALK TO HIM ALL ABOUT STUFF.
AND THEN IF THEY'RE TOTALLY OUT OF IT,
AND NOT GIVING YOU ANY INFORMATION,
I TELL THEM ABOUT THE WEATHER, I TALK TO THEM ABOUT MY KIDS
BECAUSE THEY SAY HEARING IS THE LAST THING TO GO.
SO WHAT IF NO ONE EVER TALKED TO YOU
THE WHOLE TIME YOU WERE IN JUST BECAUSE YOU DIDN'T TALK BACK?
THAT'S A CRIME. WE NEED TO TALK TO OUR CLIENTS, SO, I JUST TALK.
ALRIGHT, WE'RE GOING TO GO TO LEGS NOW.
I DIDN'T MENTION BUT I NOTICED ALL ALONG
JUST IN THE NICK OF TIME. I'M LOOKING FOR PRESSURE AREAS AS WELL.
AND THERE ARE AREAS THAT ARE AT RISK FOR PRESSURE SORES
AND THOSE ARE ELBOWS AND I NOTICED ON BOTH ELBOWS
THAT THE SKIN IS INTACT AND GOOD TO GO.
SO NOT TOO LATE TO GET ALL MY POINTS.
ALRIGHT, SO LOOK FOR PRESSURE SORES AND BREAKDOWN ON SKIN.
OKAY, IF YOU COULD JUST LIFT YOUR LEG HERE NOW.
THINK OF THIS AS A REAL PERSON AND I DON'T WANT TO SEE THIS KIND OF STUFF,
YOU KNOW, PEOPLE DON'T DO THAT.
SO JUST BE, KIND OF, GENTLE AND LIFT
AND WE'RE GOING TO START AGAIN AWAY FROM THEM.
WHEN POSSIBLE, PUT THE FEET IN AND...
..DIP THEM IN AND SOAK THEM THERE.
AGAIN WE HAVE NAILS THAT WE WANT TO BE LOOKING AT,
SO I'M INSPECTING FOR LESIONS AND BRUISES
AND PIGMENTS AND HYGIENE, NAIL COLOR,
CONSISTENCY, HAIR DISTRIBUTION,
TEXTURE, I'M GOING TO FEEL FOR.
AND THEN I AM GOING TO SCRUB AGAIN TOWARDS, HARD.
SCRUB.
KNEES, I SUPPOSE COULD HAVE BREAKDOWN
BUT YOUR REALLY HIGH RISK AREA HERE.
OKAY, GET IT OFF. IS THE HEELS.
HEELS ARE A HIGH RISK PRESSURE SORE AREA SO YOU REALLY WANT TO NOTE THAT.
THE OTHER THING YOU WANT TO BE CONSCIOUS OF IS EDEMA.
IF THEY'RE HAVING EDEMA,
YOU'RE MOST LIKELY GOING TO HAVE IT IN A DEPENDENT AREA.
FOR PEOPLE THAT ARE WALKING AND UPRIGHT, THAT'S USUALLY THE FEET.
THEY DEPEND ON THE HEART TO PULL THE BLOOD BACK UP, SO IT'S DEPENDENT.
LOWER THAN THE HEART.
SOMEONE THAT'S BEDRIDDEN MAY HAVE EDEMA ON THEIR UNDERNEATH SIDE,
THEIR BEDSIDE, SO WHEN YOU ROLL THEM OVER
THEY'VE GOT FULLNESS IN THEIR BUTT,
IN THE BACK OF THEIR LEGS, WHATEVER DIRECTION THEY'VE BEEN LAYING.
YOU CAN FEEL IT BY PUSHING DOWN AND SEEING IF IT INDENTS.
SO IF THE SKIN INDENTS AND STAYS INDENTED,
IT'S EDEMA AND YOU WANT TO COUNT THE NUMBER OF SECONDS IT STAYS PITTED,
IF IT'S PITTING EDEMA, OR YOU MAY JUST NOTICE FULLNESS.
ONE OF THE THINGS THAT'S IMPORTANT
THAT WE DO IS COMPARE ONE SIDE TO THE OTHER.
FOR EXAMPLE, TEMPERATURE.
I WOULD COMPARE THAT ONE LEG.
IF ONE LEG LOOKS REDDER THAN THE OTHER
THEN I WANT TO COMPARE TEMPERATURE AS WELL.
MAYBE THEY'VE GOT A PHLEBITIS GOING ON,
A THROMBO-PHLEBITIS, A BLOOD CLOT.
AND SO THEY'VE GOT SOMETHING BREWING.
COMPARE TO SEE, THIS LEG IS WARMER, IT'S REDDER IN YOUR COMPARISON.
ALRIGHT.
CLEAN GOOD BETWEEN THE TOES AND THEY CAN GET, KIND OF, SMELLY AS WELL.
ALRIGHT, GET YOUR OTHER FOOT IN HERE.
THIS IS DANGEROUS. I'VE SPILLED A BUCKET OR TWO IN MY DAY.
YOU WILL TOO.
IT'S NOT THE END OF THE WORLD. IT'S NOT LIFE OR DEATH.
IT'S A MESS, THAT'S ALL IT IS,
AN INCONVENIENCE. SO I TRY NOT TO SPILL.
ALRIGHT, NOTICING THE SAME THINGS. BRUISES, LESIONS,
PIGMENT, COLOR, HYGIENE, TEXTURES, MOISTURES, THICKNESS,
HAIR DISTRIBUTION.
I'M CLEANING STUFF OFF.
ANOTHER AREA THAT IS AT RISK FOR PRESSURE SORES...
..IS THE HIPS.
SO YOU WANT TO LOOK AT BOTH HIPS.
SOMETIMES IT'S EASIER TO SEE FROM THE SIDES,
BUT YOU WANT TO SEE IF OVER HERE ON THE ILIAC PRESS AREA,
THE BONEY PROMINENCES, IF THERE'S ANY PRESSURE SORES.
GET THEIR FEET DRY BETWEEN THEIR TOES.
ALRIGHT. WELL, I'VE CLEANED THE WHOLE BODY
FROM HEAD TO TOE AND I'VE GOT TOE JAM IN MY WATER.
NOW DO YOU WANT THAT ALL OVER YOUR BACK OR IN BETWEEN YOUR LEGS? NO, NOT REALLY.
AND WHEN YOU THINK ABOUT IT, IT'S ONLY TWO INCHES OF WATER
FOR THIS LITTLE SPIT BATH HERE.
SO, WE'RE GOING TO PUT THE CLIENT IN A LOW POSITION
AND WE'RE GOING TO CHANGE THE WATER AT LEAST ONCE FOR ANY CLIENT.
FOR ONE, IT'S GETTING COOL. IT'S NOT WARM ANY MORE.
JUST FROM ALL THE ACTIVITY IN IT, SO.
SO WE'RE GOING TO PUT THE BED DOWN HERE FOR A SECOND
AND GET YOU SOME FRESH WATER. SO WE CAN GET YOUR BACK AND BETWEEN YOUR LEGS.
I THINK THIS IS GREAT, SO.
YOU'RE ON THE CLOCK, YOU NEED TO GO REALLY CHANGE.
ALRIGHT, MR SPADE,
I'M GOING TO GO AHEAD AND WASH YOUR BACK.
CAN YOU ROLL OVER ON YOUR SIDE FOR ME?
AND HE SAYS, "SURE."
VERY HELPFUL.
ROLL ON OVER, NOW.
THIS ISN'T PERFECT IN MANNEQUIN WORLD BECAUSE THEY, KIND OF, FALL OVER.
BUT DON'T WORRY ABOUT MANNEQUINS BECAUSE PEOPLE WOULDN'T DO THAT.
ALRIGHT, WE NEED A LITTLE SOAP IN THERE.
SO GIVE YOURSELF A HIT
AND NOW WE'RE GOING TO GO DO THE BACK.
AND WHEN I LAY MY TOWEL DOWN, I KNOW I AM GOING TO DO PERI CARE AS WELL SO,
I'M GOING TO LAY MY TOWEL DOWN SO THAT IT COMES BELOW BUTTOCKS,
SO THAT I CAN CLEAN BETWEEN THE LEGS AND NOT HAVE TO RE-LAY THE TOWEL.
WHEN I HAVE THE CLIENT TURNED, I CAN CHECK A LOT MORE BONEY PROMINENCES
FROM BACK HERE THAN I COULD WHEN THEY WERE ON THEIR FRONT.
SO, I WANT TO CHECK AGAIN THE HAIR DISTRIBUTION ON THEIR HEAD,
I'M NOTICING BACK HERE IF THEY GOT BALDING OR MATTING.
I'M LOOKING AT THE EARS TO SEE IF THEY HAVE ANY SKIN BREAKDOWN.
THEY CAN GET SORES ON THE SIDES AND THE BACK OF THEIR YEARS
AND NOT ONLY FROM LAYING,
BUT YOUR CLIENTS THAT HAVE OXYGEN.
GET IN THE HABIT OF LOOKING BEHIND THEIR EARS
TO SEE IF THEY'RE GETTING RUBBED BY THE OXYGEN TUBING THAT COMES AROUND.
I'M LOOKING FOR BREAKDOWNS.
THIS IS A GOOD TIME TO DOUBLE CHECK ELBOWS
IF YOU, KIND OF, FORGOT ABOUT IT DURING THE ARM PART.
SCAPULA, AND THE SACRUM HERE.
SO, I AM LOOKING FOR BONEY PLACES
AND PLACES WHERE I MIGHT SEE SKIN BREAKDOWN.
AND THEN AGAIN THIS IS A GOOD PLACE, YOU SEE THE HEELS.
EVERYTHING IS JUST POINTING UP TO YOU
THAT MIGHT HAVE SKIN BREAKDOWN ON IT.
ALRIGHT, I'M NOTICING AGAIN THE SAME THINGS I DID BEFORE.
I AM INSPECTING FOR THE PIGMENT, THE COLOR, HYGIENE,
HAIR DISTRIBUTION, LESIONS, BRUISES.
AND I AM PALPATING THE SKIN FOR MOISTURE, TEXTURE AND THICKNESS.
AND I'M CLEANING HERE, REALLY WELL.
OKAY, IF I DIDN'T FEEL LIKE I GOT THE BACK OF THIGHS TOO GOOD,
THIS MIGHT BE A GOOD PLACE TO, KIND OF, MAKE UP FOR IT,
WHICH YOU THOUGHT YOU MIGHT HAVE MISSED.
ALRIGHT, AND THEN I AM GOING TO DRY THE BACK
AND I TRY TO BE FAIRLY VIGOROUS WITH BACK CARE.
IF YOU'VE BEEN IN BED FOR ANY TIME AT ALL, IT'S MISERABLE.
SO, AT THIS POINT YOU CAN GIVE A BACK RUB IF YOU WANT
OR YOU CAN WAIT AND DO IT AT THE END.
BUT I JUST FOUND THAT IT'S JUST FASTER AND EASIER TO DO.
SO, THIS IS WHEN I WOULD GRAB MY LOTION.
PUT A LITTLE LOTION ON MY HANDS WITH GLOVES.
IT'S VERY SLIPPERY WITH GLOVES. IT WORKS FINE.
GET A LOT OF LOTION ON HERE AND I'M GOING TO PUT LOTION ON THEIR BACK
AND GIVE THEM A BACK RUB.
DON'T WASTE YOUR TIME ON THE MANNEQUIN,
BUT JUST TELL ME HOW YOU GIVE A BACK RUB.
I'M GOING TO TELL YOU THE THREE KINDS OF STROKES
THAT YOU COULD USE FOR YOUR BACK RUB.
THEY ARE EFFLEURAGE,
WHICH IS LONG, SMOOTH STROKES IN A FIGURE EIGHT.
SO, THEY GO UP THE SPINE, AROUND THE SHOULDERS,
DOWN TOWARDS BUTTOCKS AREA BACK UP,
FIGURE EIGHT, THE WHOLE ENTIRE BACK.
OKAY. OH, THIS FEELS GOOD ALREADY AND I'M WASTING THIS ON A MANNEQUIN.
OKAY, THE SECOND ONE, PETROSAGE.
PETROSAGE IS A PINCHING OR KNEADING.
SO PINCHING ALONG THE SPINE.
PINCH, PINCH, PINCH AROUND THE NECK.
IT'S THAT RUBBING, PINCHING OF THE SKIN.
AND THEN FINALLY, TOPOTEMENT. T-O-P-O-T-E-M-E-N-T, TOPOTEMENT,
AND IT'S...
IT'S, KIND OF, A STIMULATING BACK RUB.
IT JUST, KIND OF, WAKES UP THE SKIN
THAT'S BEEN LAYING ON THIS BED FOR HOURS AND HOURS.
IF YOU CAN, IF YOU HAVE TIME, IF THE CLIENT SAYS
"YES, I'D LIKE A BACK RUB."
GO FOR ALL THREE, IF YOU CAN. IT FEELS GOOD.
PEOPLE THAT ARE STUCK IN BED NEED A BACK RUB EVERY SHIFT.
THEY JUST -- I MEAN, YOU DON'T HAVE TO STAY THERE FOR AN HOUR.
IT'S NOT LIKE YOU'RE PAYING FOR THE ULTRA MASSAGE CARE,
BUT JUST RELAX THOSE MUSCLES AND HELP THEM REST BETTER.
SO,
DRY HIS BACK. SOMETIMES PEOPLE SAY,
"I COULDN'T DO IT ALL THE WAY DOWN TO THE BUTTOCKS.
THAT'S JUST TOO MUCH FOR ME." WELL, OKAY.
YOU KNOW, KNOW YOUR CLIENTS WELL AND IF YOU SENSE THEIR SEXUAL TENSION OR SOMETHING
THEN DON'T DO IT.
BUT MOST OF THE TIME, THERE'S NOT --
IT'S A CLIENT THAT'S JUST IN BED THAT JUST --
YOUR BUTTOCKS IS YOUR BIGGEST MUSCLE.
AND SO YOU JUST WANT TO MASSAGE THAT WHOLE THING
AND YOU'D BE AMAZED AT HOW RELAXED
AND COMFORTABLE A CLIENT CAN BE IF YOU DO THAT.
MY NURSE FRIEND THAT HAD ME WASHING HAIR WAS ALSO A BACK RUB FANATIC.
AND WHEN I STARTED INTRODUCING THOSE TWO LITTLE KINDNESSES TO CLIENTS,
WHAT A DIFFERENCE IT MADE IN MY PRACTICE
AND IN THEIR HOSPITAL STAY. IT'S HUGE, IT'S REALLY HUGE.
ALRIGHT, FINALLY WE'RE GOING TO DO PERI CARE.
THAT'S ALWAYS SAVED FOR LAST.
YOU MAY WANT TO CHANGE WASHCLOTHES AT THIS POINT
DEPENDING ON WHAT YOU'VE CLEANED, YOU'LL KNOW.
BUT IT'S THEIR FLORA SO DON'T WORRY TOO MUCH ABOUT IT.
AND LET'S SEE WHAT WE'VE GOT HERE. WELL, WE DO HAVE A GUY.
YOU NEVER KNOW IN THE LAB WHAT WE'VE CHANGED THEIR PARTS TO BE.
OKAY. REMIND ME, I'LL TALK ABOUT BOTH AGAIN,
BUT FOR THE MALE PERI CARE, WHAT YOU WANT TO DO --
WHEN YOU'RE DOING PERI CARE IS YOU WANT TO BE SURE
AND TOUCH THE THIGH FIRST AND SAY, "I'M GOING TO CLEAN BETWEEN YOUR LEGS."
DON'T JUST GRAB AND CLEAN.
THEY JUMP, YOU KNOW, SO TOUCH
AND THAT GIVES ENOUGH WARNING SO THERE'S NO JUMPING.
ON THE MALE YOU WANT TO CLEAN AND -- BOY, THESE ARE SOILED WITH BETADINE.
YOU WANT TO CLEAN FROM THE MEATUS DOWN, CLEAN THE SHAFT,
AND THEN CLEAN GOOD BETWEEN THE LEGS,
AND YOU WANT TO CLEAN THE SCROTUM AS BEST YOU CAN FROM THIS ANGLE.
I ACTUALLY CLEAN SCROTUM BETTER FROM BEHIND.
AND THIS IS THE REASON. FROM THE FRONT, THE SCROTUM CAN BE CLEANED,
BUT THE SCROTUM HAS WHAT'S CALLED RUGAE.
IT'S THE WRINKLY TISSUE AND IT'S SENSITIVE TO HEAT AND COLD
AND IT PULLS UP AND DOWN ACCORDINGLY.
THE FRONT DOESN'T USUALLY GET AS SOILED AS THE BACK DOES WITH STOOL.
AND PEOPLE DON'T CLEAN IT AS WELL.
SO, YOU'RE GOING TO WANT TO CLEAN THAT REALLY WELL.
AND IF YOU SENSE THAT IT'S REALLY SOILED AND DRIED UP,
THEN I TAKE A WASHCLOTH AND I JUST, KIND OF, LEAVE IT THERE TO KIND OF SOAK THAT UP
BECAUSE THE SCROTUM IS VERY SENSITIVE
AND YOU JUST CAN'T GET IN THERE AND SCRUB WITH VIM AND VIGOR.
YOU GOT TO GET THE STUFF OFF OF THERE FAIRLY GENTLY, SO.
YOU WANT TO SOAK IT OFF
ON THE SCROTUM IF IT'S SOILED.
OKAY AND DRY, BUT AGAIN CLEANING FROM THE MEATUS BACK ON SCROTUM.
ON A FEMALE.
I SHOULD HAVE GRABBED A BODY PART.
IT'S, KIND OF, LIKE, WHAT WE TALKED ABOUT
BEFORE WHEN YOU WERE CLEANING FOR URINE SPECIMEN.
YOU'RE GOING TO GET YOUR WASHCLOTH, THE SAME.
AGAIN TOUCH ON THE THIGH.
I'M GOING TO CLEAN BETWEEN YOUR LEGS AND I USUALLY START FROM THE TOP.
AND THEN I SPREAD THE LABIA, I CLEAN FROM FRONT TO BACK.
GET A NEW PIECE OF WASHCLOTH, FRONT TO BACK,
NEW PIECE OF WASHCLOTH, FRONT TO BACK.
IF IT'S REALLY SOILED AND THEY'VE BEEN INCONTINENT OF STOOL,
I'LL GET A LOT OF WASHCLOTHES.
THIS IS WHERE I REALLY USE A LOT OF WASHCLOTHES.
SO THAT I AM NOT SCRUBBING BACK UP AND GETTING THE STOOL,
THE E.COLI UP IN THE VAGINA.
ALRIGHT, AND THEN MAKE SURE THEY'RE NICE AND DRY. - OKAY.
WHEN WAS YOUR LAST PERIOD, WHEN ARE YOU DUE? YOU KNOW, THAT KIND OF THING.
WASHING EXTREMITIES AND STUFF, WHEN YOU'RE LEANING OVER, AS FAR AS BODY PARTS GO, IT'S EASIER ON THE BACK.
- CAN BE. - THAN THE OTHER SIDE.
- IS THAT OKAY IF WE DO THAT? - YOU CAN DO IT ANY WAY YOU WANT.
IT'S TOTALLY YOUR CALL.
THE REASON I STAY ON SIDE OF THE BED IS IT'S EASIER.
AND THE TRUTH US, WHEN YOU'VE GOT TWO PEOPLE IN ONE ROOM,
AND EVEN SOMETIMES IN SOME ROOMS,
THERE IS JUST NOT ENOUGH ROOM AND I AM BUMPING AND SPLASHING WATER ALL OVER THE PLACE.
AND JUST DON'T DO IT. SO IT'S YOUR CALL.
IF THE BED'S HIGH AND YOU FEEL OKAY ABOUT IT,
BUT IF YOU DON'T, GO TO THE OTHER SIDE.
YEAH. THIS IS A BATH. YOU'RE TAKING CARE OF YOU.
- I HAVE THREE QUESTIONS.
- IS THAT ALL? OKAY. I'M READY.
- HOW LONG DOES IT TAKE FOR SKIN TO REGROW IF THEY'RE DEHYDRATED? WHAT KIND OF TIME PERIOD --
- IT VARIES DEPENDING ON HOW DEHYDRATED THEY ARE
AND SO YOU'RE COUNTING THE SECONDS OF HOW LONG THAT SKIN STAYS PINCHED.
TYPICALLY, NOT USUALLY MORE THAN ABOUT FIVE SECONDS, BUT --
- SO ANYTHING BEYOND PRETTY MUCH --
- A SECOND, YEAH. AND YOU CAN LOOK AT YOURSELF AND GO, THAT'S NORMAL.
IT JUST, PHEW, GOES BACK. SO ANYTHING THAT STAYS UP, YOU'RE COUNTING.
- AND THEN WHILE WASHING EXTREMITIES,
ABOUT HOW MANY TIMES WERE YOU CHANGING CLOTHS?
- I DIDN'T UNTIL I GOT TO PERI CARE .
- OKAY, SO YOU JUST DO YOUR BASELINE, IF YOU THINK IT'S GOTTEN ALL DIRTY --
- YEAH. LIKE FOR INSTANCE, I HAVE GONE TO DO CLIENTS AND I'M ALWAYS SURPRISED
BECAUSE THEY LOOK FAIRLY CLEAN AND THEN I GO TO DO THEIR NAILS
AND THERE'S JUST SOLID STOOL.
SO I AM SOAKING THEM, I'VE GOT MY WASHCLOTH IN THERE.
AND I GOT AN ORANGE STICK AND I CLEAN THEM ALL OUT.
THAT WASHCLOTH I AM NOT GOING TO REALLY TAKE DOWN TO PERI.
I AM GOING TO GET RID OF IT.
IT JUST DEPENDS BUT IT'S THEIR FLORA AND THEIR BODY
SO THEY ARE NOT GOING TO HAVE REACTION TO THEIR OWN BODY.
I AM MORE CONCERNED ABOUT PROTECTING ME,
THAT'S WHY I WEAR GLOVES FOR THE WHOLE THING.
- OKAY, THEN COULD YOU DO STOOL YOURSELF?
- WE SHOULD HAVE THAT OLD VIDEO, SHOULDN'T WE? WHERE I TOTALLY DID...
THE WHOLE THING. YOU GO GET MORE WATER.
YEAH AND THEN I CHANGE THE SHEET. - YOU CHANGE THE SHEET,
FINISH ALL YOUR CLEANING AND THEN JUST CHANGE THE SHEET AFTERWARDS.
- YEAH. UH HUH, BECAUSE, WHO KNOWS? I MIGHT SPILL IT AGAIN.
I MEAN, YOU KNOW, IF YOU'RE HAVING A KLUTZ DAY.
YEAH, I WAIT TILL THE END. I JUST PUT A COUPLE OF TOWELS OVER IT
AND SAY, "SORRY." MOVE ON.
- WHERE DO YOU FIND PRESSURE SORES?
- WE ARE GOING TO GET TO PRESSURE SORES, WHAT TO DO.
IT'S, KIND OF, THE LAST LINE OF THE ASSESSMENT SHEET.
AND WE ARE GOING TO ACTUALLY DO PRESSURE SORES AT THE END OF THE SEMESTER
AND THE FIRST OF NEXT SEMESTER TO REALLY CARE FOR THEM.
BUT IF YOU FIND THEM, YOU'RE GOING TO MEASURE THEM
IS THE MAIN THING, LENGTH BY WIDTH BY DEPTH.
- I HAVE GOT ONE QUESTION ON THE PERI CARE.
THE VIDEO SHOWS THEM, KIND OF, CLEANING THE SKIN FOLDS FIRST
ON THE WOMAN AND THEN ACTUALLY CLEANING
THE LABIA AND ALL OF THAT.
- IT'S ACTUALLY BACKWARDS. WHAT THEY SAY IS THAT
YOU SHOULD GO FROM WHAT YOU WANT TO BE CLEANING
SO I DON'T WANT TO BE TAKING ANYTHING IN TO THE VAGINA AREA OR THE MEATUS.
SO YEAH YOU GO CENTER AND YOU GO OUT. - OKAY.
- SO AGAIN THAT'S THEIR OWN FLORA, BUT IF THERE IS STOOL AND STUFF,
IT'S GOING TO BE IN THE GROIN AREA
SO I AM NOT GOING TO WANT TO TAKE IT TO CENTER.
SO I CLEAN CENTER WITH WHAT'S CLEANEST AND THEN MOVE OUT AND SCRUB IT.
IT DOESN'T MATTER THAT YOU GET STOOL IN THE BUTT
BECAUSE IT'S FROM THERE. YEAH.
ANYTHING ELSE? OKAY.
HOW DO I KNOW WHERE AM I? OH, I DID PERI, OKAY.
LAST BUT NOT THE LEAST. THIS IS, KIND OF, AEROBIC FOR THE CLIENT.
I MEAN, THIS MIGHT BE ALL THE EXERCISE THEY'RE GETTING SO ROLL THEM BACK OVER.
I'M GOING TO CLEAN THE BUTTOCKS, WELL, HANG ON THERE.
MR SPADE, OKAY.
CLEAN WASHCLOTH
AND AGAIN, IN GENITALIA YOU'RE INSPECTING,
PALPATING, I DON'T NEED SO MUCH PALPATION.
BUT I AM LOOKING FOR REDNESS,
ODOR, SORES, YOU KNOW, IT'S VERY SIMILAR THINGS.
I AM GOING TO CLEAN HERE FROM BUTTOCKS AND YOU'RE COMING ANUS BACK,
BACK, THIS IS WHERE I REALLY HAVE FOUND THAT SCROTUMS GET NEGLECTED.
IT'S FROM THE BACKSIDE AND YOU WANT TO GET BACK THERE
AND LOOK AND GET THAT DRIED STOOL OFF THERE
BECAUSE IF YOU DON'T GET THE STOOL OFF, THAT'S WHERE SKIN BREAKDOWN HAPPENS.
SO IT'S JUST A MISSION I AM ON. PEOPLE JUST NEED TO CLEAN BETTER DOWN THERE.
IF YOU'RE GOING TO CLEAN, WHY NOT CLEAN IT ALL AND CLEAN IT WELL.
IT AGGRAVATES ME THAT I CAN FOLLOW A NURSE AID, FOR EXAMPLE,
AND DO PERI CARE AND GO, "THEY DIDN'T CLEAN."
THERE'S NO WAY THAT IF THEY JUST TOOK HIM OFF THE PAN, YOU KNOW, 15 MINUTES AGO
THEY CAN BE THIS DRIED UP AND THIS SOILED.
THERE IS NO WAY, THEY'RE NOT CLEANING.
SO I CALL THEM IN AND I SAY,
"HE'S NOT GETTING CLEANED RIGHT HERE, BE CAREFUL AND WATCH THAT."
YOU DON'T HAVE TO BE SCOLDING ABOUT IT,
BUT YOU NEED TO POINT IT OUT SO IT GETS DONE.
ALRIGHT. GET RID OF MY TOWEL HERE,
STRAIGHTEN OUT THIS POOR BED, IT'S FALLING APART.
WITH GLOVES AND THEN IT'S STICKING AND IT'S TERRIBLE.
ALRIGHT.
OKAY.
DEPENDING ON HOW SOILED THESE GLOVES ARE, I'VE JUST CLEANED THE BUTTOCKS,
IT'S HOW MUCH DO I WANT TO DO WITH THIS, SO. I THINK I MIGHT GET RID OF IT HERE.
BECAUSE I WANTED TO DO A COUPLE OF THINGS THAT I HAVEN'T DONE YET.
AND THAT IS I HAVEN'T OFFERED HIM ANY LOTIONS FOR HANDS
FOR -- OR DEODORANT FOR UNDERARMS OR ANY OF THAT KIND OF STUFF.
SO I WANT TO OFFER THAT.
I'M NOT GOING TO DO ORAL HYGIENE YET,
I SUPPOSE I COULD HAVE DONE IT FIRST.
BUT I USUALLY SAVE IT FOR LAST, I DON'T KNOW WHY.
OH, MAN, MY HANDS ARE SWEATY THESE ARE LIKE NARLY TO GET ON.
THIS IS BAD.
AND THAT'S JUST PLAIN HOT AND SWEATY HANDS FROM BEING IN WATER.
SO THE OTHER THING IS I WANT GLOVES TO DISPOSE OF ALL MY STUFF
BECAUSE IT'S BODY FLUIDS AND SOIL. SO DON'T TAKE YOUR GLOVES OFF,
AND CLEAN UP YOUR AREA, IT'S OUT OF SEQUENCE, YOU GOT TO HAVE GLOVES ON.
OH, THIS WAS A BAD IDEA.
DO AS MUCH AS YOU CAN WITH THESE NON-COVERED GLOVES.
OKAY, FIVE MINUTES FOR YOUR GLOVING.
OKAY. I THINK EVERYTHING'S DONE.
HE NEEDS A CLEAN GOWN.
AND REALLY...
..YOU JUST HAVE TO SAY THAT YOU'RE GOING TO OFFER ORAL HYGIENE
BECAUSE WE'RE NOT GOING TO, THEY CAN'T DO IT.
AND I WOULD COMB THEIR HAIR, ANY OTHER PERSONAL HYGIENE ISSUES.
IF YOU HAVEN'T DONE A BACK RUB
THIS WOULD BE AGAIN THE TIME TO OFFER IT IF YOU WANT TO DO IT WITHOUT GLOVES,
WHICH IS FINE. THERE IS NO BODY FLUIDS BACK THERE AND HE'LL FEEL NICE.
ALRIGHT, HOW'D YOU DO THERE MR SPADE, DID I GET EVERYTHING?
YOU FEEL CLEAN? ALRIGHT.
IF I FOUND ANY PRESSURE SORES ON HIS BODY
I'M GOING TO WANT TO MEASURE THEM.
THAT'S YOUR MAIN PRIORITY RIGHT NOW WOULD BE TO MEASURE THEM
AND YOU ARE GOING TO MEASURE LENGTH BY WIDTH BY DEPTH.
LENGTH IS ALWAYS HEAD TO TOE.
IT'S NOT THE LONGEST PLACE, IT'S THE LONGEST PLACE
PERPENDICULAR, HEAD TO TOE.
YOU DON'T DO ANYTHING, LIKE, DIAGONALLY.
WIDTH IS ALWAYS THE HORIZONTAL PLAIN, THE LONGEST PLACE.
AND THEN DEPTH, YOU PROBE FOR THE DEEPEST PLACE.
AND WE'LL REVIEW THAT AGAIN WHEN WE DO ROOM CARE.
LENGTH, HEAD TO TOE, WIDTH, HORIZONTAL
AND DEPTH, WHEREVER THE DEEPEST PLACE IS.
AND YOU ALWAYS DOCUMENT IN CENTIMETERS, NOT IN INCHES, ALWAYS.
ALRIGHT.
WELL, THAT TOOK ME FOREVER. 35 MINUTES.
I'M GOING TO CLEAN UP MY AREA,
PUT ALL MY STUFF IN THE HAMPER.
NOW WHAT I'M GOING TO DO HERE, DROP MY WATER.
- DO YOUM, KIND OF, EYE YOUR MEASUREMENTS?
- NO, IT HAS TO BE WITH A MEASURING DEVICE
AND WE'LL TREACH YOU HOW TO DO THAT IN THE NEXT SEMESTER.
MAKE SURE YOU DRY OUT YOUR BASIN,
PUT ALL YOUR SUPPLIES BACK IN IT
AND THEN IT GOES BACK INTO THE SECOND DRAWER.
IF YOUR CLIENT NEEDS TO SCOOT OVER MORE, YOU CAN RE-CENTER HIM IN THE BED.
LOOKS BEAUTIFUL.
ALL OF THIS GOES IN THE TRASH.
LINENS.
THERE YOU GO.
WASH YOUR HANDS AND DOCUMENT THAT A BATH WAS GIVEN.
AND ANY PARTICULARS THAT YOU FOUND ALONG THE WAY, OKAY.
- COULD WE HAVE EXTRA LINEN THAT WE COULD USE?
- ONCE IT GETS TAKEN TO THE CLIENT'S ROOM,
IT CAN'T BE TAKEN BACK TO THE LINEN CART. SO, YEAH, IT WOULD HAVE TO BE.
SO WHAT WE'LL DO IS BECAUSE WE ARE ALL REUSING THAT STUFF,
WHAT WE'LL TRY TO DO IS BRING YOUR WET WASHCLOTHES
AND PUT THEM IN THE DRYER, WHICH IS THE TOP ONE RIGHT HERE.
AND THEN WHAT WE WILL DO IS RUN IT DRY AROUND 10 O'CLOCK
SO PEOPLE WILL HAVE STUFF AND IF WE DON'T -- IF WE RUN OUT,
AND WE'LL JUST GRAB A WET ONE AGAIN, AND PRETEND IT'S DRY.
I MEAN, NOTHING SOILED OR REALLY DIRTY, BUT WE'LL SEND YOU DOWN HERE
WITH IT RATHER THAN JUST PILE UP A BUNCH OF WET LINEN IN OUR HAMPERS.
BUT YEAH, ANYTHING THAT COMES TO THE ROOMS IS OUT.
- YOU SAID CLEAN AND RINSE OUT THE BASIN AND DRY IT OUT? - WITH A TOWEL.
- WITH ONE OF THE TOWELS THAT WE BROUGHT IN?
- TOWEL, PAPER TOWEL, SOMETHING.
- PAPER TOWELS? FROM THE BATHROOM OR SOMETHING?
- THAT'S WHY THOSE FILTERS DIDN'T COME OUT SO GREAT
BECAUSE WE JUST GIVE IT A TOKEN RINSE, WIPE IT.
NOW, IF THEY HAVE SOME KIND OF DISINFECTANT SPRAY THAT YOU CAN SPRAY IN,
THAT'S GREAT TOO BEFORE YOU PUT IT IN THE DRAWER.
AND IT GETS ITS OWN DRAWER, NOT THE BED PAN DRAWER.
OKAY.
ALRIGHT, ANY OTHER QUESTIONS?
DID I DO EVERYTHING? DID I FORGET ANYTHING?
OKAY.
WHAT WE NEED TO DO NOW IS MATH.
SO DID EVERYONE GET THE PRACTICE MED MATH TWO?
WHAT I WANT TO DO IS GO THROUGH A FEW OF THE PROBLEMS FROM LAST WEEK.
I WANT TO GO OVER FRACTIONS, THAT'S USUALLY A BIG, HUGE DEAL.
AND A COUPLE OTHER CONVERSIONS
AND MAKE SURE YOU GOT THEM STRAIGHT IN YOUR MIND
AND THEN WE WILL HIT, JUST SOME PROBLEMS.