HYGIENE Nur 102 Fall semester 2014/2015 Dr Khulood Shattnawi

HYGIENE hygiene: is the science of health & maintenance Personal hygiene: is the self-care by which people attend to such functions such as bathing, toileting, general body hygiene, & grooming Hygiene is highly personal matter determined by: Individual values Individual practices Purpose : promote cleanliness, provide comfort and relaxation, improves self images, and promote healthy skin Involves care of the skin, hair, nail, teeth, mouth, eye, ear, and perineal area

HYGIENEIC CARE The type of hygienic care provided depends on the client’s ability, needs, and practices Nurses commonly use the following terms to describe types of hygienic care Early morning care: is provided to clients as they awaken in the morning. (e.g., providing urinal or bedpan, washing the face& hands, & giving oral care)

Morning care: is often provided after clients have breakfast, although it may be provided before breakfast( e.g., providing for elimination needs, a bath or shower, perineal care, back massages,& oral, nail, & hair care Making client's bed is part of morning care Hour of sleep (HS OR Afternoon care) care: is provided to clients before they retire for the night. It usually involves providing for elimination needs, washing face& hands, giving oral care,& giving back massage As-needed care (prn): care is provided as required by the client E.g., a client who is diaphoretic( sweating profusely) may need more frequent bathing& change of clothes & linen.

Factor Influencing Hygiene Read table (33-1) P.742 Culture Religion Environment and socioeconomic status Developmental level Health and energy Personal references ( tub or shower, time of bathing)

Functions of the Skin Protection Body temperature regulation Sensation Excretion Maintenance of water and electrolyte balance Vitamin D production and absorption

ASSESSING Assessment of the clients skin & hygiene practices includes: Nursing health history: to determine The client’s skin care practices: it enable the nurse to incorporate the client’s needs & preferences as much as possible in the plan of care self care abilities: it determines the amount of nursing assistance & type of bath( e.g., bed, tub, shower) best suited for the client Important considerations include: The client balance for tub & shower Activity tolerance (fatigue, pain) Coordination

4) vision Appropriate joint range of motion Adequate muscle strength The client’s preferences 8) cognition & motivation The client’s functional level (0→completely independent +4 →totally dependent) read table (33-2) page (744) (definitions & descriptors for functional level)

Presence of past or current skin problems: (abrasion, excessive dryness, ammonia dermatitis, acne, erythema, hirsutism) alerts the nurse to specific nursing interventions or referrals the client may require B- Physical Assessment: It involves inspection & palpation Preferable done when assisting in bathing& other hygienic care The nurses collect data about (skin color, uniformity of color, texture, turgor, temperature, intactness, & lesions)

Common skin problems Abrasion: superficial layers of the skin are scraped or rubbed away, area is reddened and may have localized bleeding or serous discharge Excessive Dryness: skin may appear rough Ammonia Dermatitis( Diaper rash): reacting of skin bacteria with urea in the urine. Skin become reddened and is sore Acne: inflammatory condition with papules and pustules Erythema: redness associated with a variety of conditions, such as rashes, exposure to sun and fever Hirsutism: Excessive hair growth on face particularly in women

C- At risk client: Limited joint mobility Dehydration On chemo or radio therapy Immunosuppressant Reduce sensation Chronic disease Excessive secreration Malnourished Limited sensory ability

Nursing diagnosis Self care deficit ( for pt have problem performing hygienic care) Bathing/hygiene Dressing/grooming Toileting R\T weakness or tiredness pain cognitive and perceptual impairment therapeutic procedure restraining mobility( cast, IVF)

Associated Diagnosis Deficit knowledge related to lack of experience with skin condition( acne)& need to prevent 2nd infection New therapeutic regimen to manage skin problems Lack of experience in providing hygiene care to dependent person Unfamiliarity with devices available to facilitate sitting on or rising from toilet Situational low Self-Esteem related to Visible skin problem( acne or alopecia) Body odor Risk for impaired skin integrity & impaired skin integrity

PLANNING: In planning care, the nurse, if appropriate, the client and/or family set outcomes for each nursing diagnosis. Goals: To increase self care ability To increase pt knowledge To promote self esteem To prevent complications associated with immobility ( bed ulcer) The nurse then performs interventions & activities to achieve the client outcomes, such activities may includes: Assisting dependent client with bathing, skin care, perineal care Providing back massages to promote circulation Instructing clients/families about appropriate hygienic practices & alternative methods of dressing Demonstrating use of assistive equipment & adaptive activities

Planning in assisting client with personal hygiene includes consideration: Client’s personal preferences( when & how to bath) Client’s health Limitations The best time to give the care The equipment, facilities, & personnel available Assess client comfort with the gender of the care giver ( bathing is embarrassing and stressful to modest individuals ).

Implementation General guidelines for skin care: An intact skin is the body’s first line defense The degree to which the skin protect the underlying tissuees from injury depend on the general health of cells, the amount of Sc tissue and skin dryness Moisture can result in increase bacterial growth and irritation Body odors are caused by resident skin bacteria which acting in body secreration Skin sensitivity to irritation and injury varies among individuals and in accordance with their health Agent used for skin care have selective actions and purpose

IMPLEMENTING Bathing The purpose of bathing To Remove accumulated oils, perspirations, dead skin cells, & some bacteria To stimulate circulation It produce sense of well-being (refreshing & relaxing& frequently improves morale, appearance,& self respect It offers an excellent opportunity for the nurse to assess all clients

Two categories of baths are given to clients Cleaning baths Complete bed bath: the nurse washes the entire body of a dependent client in the bed Self-help bed bath: clients confined to bed are able to bath themselves with help from the nurse for washing the back & perhaps the feet Partial bath (abbreviated bath): only the parts of the client's body that might cause discomfort or odor, if neglected are washed ( the face, hands, axillae, perineal area,& back Bag bath: is an in-bed bath that use a presoaked disposable washcloths that contain no-rinse cleanser solution. The washcloths warmed up into the microwave before applying the bath.

Tub bath: are often preferred to bed baths because it is easier to wash &rinse in a tub also it is used for therapeutic baths . The amount of assistance the nurse offers depends on the abilities of the client Sponge baths: are suggested for the newborn Shower: for ambulatory clients Temp. for bathing should be comfortably warm (43-46Cº)

Therapeutic baths: Requires a physician’s order. Temperature of water Body surface to be treated Type of medicated solutions to use They are given for physical effects, such as to soothe irritated skin or to treat an area (e.g., perineum) Medications may be placed in water Generally taken in a tub one-third or one-half full (specific time 20-30min.) (temp 37.7-46C adults, 40.5C for infants)

Client teaching Dry skin: Use cleansing cream to clean skin rather than soap Use bath oil Remove, rinse soap immediately from skin if used Bath less frequently Increase fluid intake Humidify water Use moisturizing cream that contain lanoline or petroleum jell

Skin rashes: Keep area clean and dry Relive itching by using lotion with careful Avoid scratching the rash Choose cotton clothes Acne: Wash face frequently with soap and hot water to remove oil and dirt Avoid using oily cream Avoid using cosmetics that block the sebaceous gland Never squeeze the lesion