CNA · Activities of Daily Living · 6 min read
Mouth Care, Dentures and Grooming
- Demonstrate proper techniques for providing oral hygiene to alert residents, unconscious residents, and residents with dentures.
- Identify safe practices for hair care and facial shaving, including critical precautions regarding oxygen and anticoagulant use.
- Explain standard procedures and role limitations regarding fingernail and foot care, specifically for residents with diabetes or poor circulation.
Routine Oral Hygiene and Mouth Care for the Unconscious Resident
Oral hygiene is a fundamental activity of daily living that maintains comfort and general health. Nurse aides must wear gloves when providing mouth care because of contact with mucous membranes and saliva. Oral hygiene should be offered at least twice daily, typically in the morning and before bed, and after meals. Brushing teeth stimulates gums, removes food particles and plaque, and prevents halitosis. To brush effectively, the toothbrush should be held at a 45-degree angle to the gum line. The nurse aide should gently brush all surfaces of the teeth, the gums, and the tongue. For a resident who can rinse and spit, hold an emesis basin under the chin to catch rinse water and spit.
Providing mouth care for an unconscious resident requires specific safety measures to prevent complications. Unconscious residents need frequent mouth care because their mouths can dry quickly, so the nurse aide must follow the care plan for how often to provide it. During mouth care for an unconscious resident, follow the care plan and position the resident on their side when possible to help fluids drain and reduce the risk of aspiration. The head of an unconscious resident should be turned to the side to allow fluids to drain out of the mouth.
When performing mouth care for an unconscious resident, follow the care plan for using a soft toothbrush or a moistened sponge-tipped swab, and avoid putting excess liquid in the mouth. Swabs used for unconscious mouth care must be squeezed to remove excess liquid before entering the mouth to prevent aspiration. If permitted by the care plan, a padded tongue blade may be used to help hold an unconscious resident's mouth open during oral care; never force the mouth open. Nurse aides must never insert their fingers into the mouth of an unconscious or confused resident.
After oral care is completed, apply an approved lip moisturizer as directed by the care plan. Use a water-based product rather than petroleum jelly if the resident receives oxygen. Throughout the procedure, the nurse aide must observe the mouth and report bleeding gums, sores, white patches, cracked lips, or loose teeth to the nurse.
Common mistakes
- Placing fingers inside the mouth of an unconscious or confused resident during oral hygiene.
- Using hot water to wash or store dentures, which causes them to warp, crack, and ruin.
- Cutting a resident's toenails instead of reporting toenail-care needs to the nurse.
- Applying lotion between the toes or using an electric razor when oxygen therapy is present.
Key points
- Wear gloves during mouth care, brush teeth at a 45-degree angle, and provide mouth care to unconscious residents turned on their side using squeezed swabs.
- Denture care requires cool or tepid water, a sink lined with a washcloth or paper towels and partially filled with water, and storage in a covered, labeled cup.
- Brush hair from ends upward to remove tangles, never share equipment, and never cut hair without specific authorization and consent.
- Shave in the direction of hair growth with taut skin; never use a safety razor if the resident is on anticoagulants, and never use an electric razor near oxygen.
- Soak hands five to ten minutes before nail care, file nails in one direction, clean with an orangewood stick, and never cut or push back cuticles.
- Never cut toenails, avoid applying lotion between toes, and report all sores, bleeding, loose teeth, or inflamed nail beds to the nurse.
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