Patient Care Technician Exam

This chapter covers types of baths, safe water temperature, eye and perineal care, and how bath time doubles as the PCT's best chance to observe the skin.

Bath water should be about 105 to 110 F (40.5 to 43.3 C). Measure it with a bath thermometer, or, if policy allows, test it on the inner wrist. Ask the patient whether it feels comfortable. Older adults, patients with diabetes and patients with nerve damage may not feel heat well and can be burned by water that seems only warm to them.

Change the water when it becomes cool, soapy or dirty, and always after perineal care before washing any other area.

Bathing moves from cleanest to dirtiest areas so germs are not carried to clean skin.

1. Eyes, using water only and no soap; wipe from the inner corner (inner canthus) to the outer corner, using a different part of the washcloth for each eye.
2. Face, ears and neck.
3. Arms, hands and underarms, starting with the arm farthest from you; soak hands in the basin if possible.
4. Chest and abdomen, keeping the rest of the body covered; wash and dry under the breasts.
5. Legs and feet; dry carefully between the toes.
6. Back and buttocks, with the patient turned to the side; offer a back rub if allowed.
7. Perineal area last, with fresh water and clean gloves.

Use long, firm strokes from distal to proximal (from the hands toward the shoulders and from the feet toward the hips) to help venous return. Rinse well and pat dry; moisture left in skin folds causes irritation and fungal infection.

Bathing is the PCT's best opportunity to see the whole body. Look for and report:

• Redness that does not fade, especially over bony areas
• Blisters, open areas, rashes or skin tears
• Bruises, especially bruises in different stages of healing or in unusual places
• Swelling, very dry or cracked skin, or skin that is cool, hot, pale or bluish
• Drainage, odor or changes around wounds, tubes or drains

On the Unit: During a morning bed bath on the med-surg floor, the PCT notices a reddened area on the patient's right heel that stays red after the pressure is removed. The PCT should float the heel off the bed with a pillow under the calf, finish care, and report the finding to the nurse promptly. The PCT should not label it as a stage or apply any cream; describing and reporting are within scope, while assessing and treating are the nurse's role.

Perineal (peri) care cleans the genital and anal area. It prevents odor, skin breakdown and infection, especially urinary tract infections.

• Always wear gloves and provide full privacy.
• For a female patient, separate the labia and wash from front to back (from the urethra toward the anus), using a clean part of the washcloth for each stroke.
• For a male patient, wash the tip of the penis in a circular motion starting at the urethral opening and moving outward, then the shaft and scrotum. If the patient is uncircumcised, gently pull back the foreskin, clean the tip, then return the foreskin to its normal position to prevent swelling and restricted blood flow.
• Clean the anal area last, wiping from front to back, with the patient turned to the side.
• For a patient with an indwelling urinary catheter, clean the catheter tubing starting at the urethral opening and wiping away from the body about 4 inches, holding the catheter so it is not pulled.

Oral care prevents tooth decay, gum disease, bad breath and pneumonia caused by breathing in mouth bacteria.

For a conscious patient who needs help, raise the head of the bed, place a towel under the chin, provide a soft toothbrush and toothpaste, and let the patient brush as much as possible. Floss if allowed. Offer mouthwash diluted per facility policy.

For an unconscious patient:

1. Position the patient on the side with the head turned, so fluid drains out of the mouth instead of into the airway.
2. Place a towel and an emesis basin under the chin.
3. Use a suction toothbrush or soft swabs moistened with a small amount of solution; never pour liquid into the mouth.
4. Do not put your fingers in the patient's mouth; use a padded tongue blade to hold it open if needed.
5. Clean the teeth, gums, tongue and inside of the cheeks, then apply lip moisturizer.
6. Explain each step, because hearing may remain even when the patient cannot respond.

Unconscious patients often need oral care about every 2 hours, or as the care plan states.

Denture care:

1. Wear gloves and line the sink with a towel or partly fill it with water, so a dropped denture does not break.
2. Remove the upper denture first by gently breaking the seal, then the lower.
3. Brush all surfaces with a denture brush and cleaner, and rinse with cool water. Hot water can warp dentures.
4. Clean the patient's gums and tongue with a soft brush or swab.
5. Return the dentures to the patient or store them in a labeled denture cup with cool water or solution.

Brush or comb hair daily, starting at the ends and working toward the scalp for tangles. Respect cultural preferences for hair products and styles, and ask the patient or family. Shampoo in bed with a shampoo tray or a no-rinse shampoo cap if allowed. Report lice, sores, flaking or hair loss to the nurse.

Use an electric razor for patients who take anticoagulants (blood thinners), have bleeding disorders or have low platelet counts, because a blade razor can cause bleeding. When a safety razor is allowed, soften the beard with a warm washcloth, shave in the direction of hair growth, and discard the razor in a sharps container. Never share razors. Do not shave a patient's beard or mustache without permission.

Soak and clean the nails, push back the cuticles gently and file fingernails if allowed. Many facilities do not allow assistive staff to cut nails at all.

Do not cut the nails of patients with diabetes, poor circulation or thick, fungal nails. These patients heal poorly and a small cut can become a serious infection or lead to amputation. Report long or thick nails so a podiatrist or nurse can provide care.

Diabetic foot care that is within scope:

• Wash the feet daily with warm (not hot) water and dry thoroughly, especially between the toes
• Apply lotion to the tops and soles if ordered, but not between the toes
• Inspect the feet and report cuts, blisters, calluses, color changes or sores
• Make sure the patient wears clean socks and well-fitting shoes or nonskid footwear, and never walks barefoot

• Bath water is about 105 to 110 F; check it with a bath thermometer.
• Wash from clean to dirty: eyes (inner to outer, no soap) first and perineal area last with fresh water.
• Peri care goes front to back; return the foreskin after cleaning an uncircumcised penis.
• Unconscious patients receive oral care side-lying with minimal liquid.
• Use an electric razor for anticoagulated patients and do not cut diabetic patients' nails.