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.