FUNDAMENTALS OF NURSING LESSON 8 HYGIENE AND CARE OF THE PATIENT’S ENVIRONMENT

VOCABULARY ALOPECIA ASPIRATION AXILLA BEDPAN CANTHUS CERUMEN CHUX CIRCUMORBITAL DANDRUFF DENTURE DRAWSHEET ERYTHEMA FLATUS GAG REFLEX GINGIVITIS HALITOSIS HYGIENE LABIA MAJORA LABIA MINORA MEDICAL ASEPSIS MITERED CORNER ORAL HYGEINE PEDICULOSIS PERINEAL CARE PERIODONTITIS PRONE SANGUINEOUS SYNCOPE UMBILICUS URINAL VERTIGO

FACTORS THAT INFLUENCE HYGIENE HYGIENE: – Science of the preservation of health & healthy living INFLUENCING FACTORS: – SOCIAL PRACTICE – BODY IMAGE – SOCIOECONOMIC STATUS – KNOWLEDGE – PERSONAL PREFERENCE – PHYSICAL CONDITION – CULTURAL VARIABLES – AGE

FACTORS THAT INFLUENCE HYGIENE DAILY CARE: – SELF HYGIENE AS A ROLE MODEL – RESPECT OF PRIVACY – ATTITUDE OF ACCEPTANCE – ENCOURAGEMENT TOWARD SELF CARE – INSTRUCTION ON TEACHING – SENSITIVITY FOR PERSONAL BELIEFS

FACTORS THAT INFLUENCE HYGIENE ROOM ENVIRONMENT EQUIPMENT HYGIENE CARE SCHEDULE

FACTORS THAT INFLUENCE HYGIENE EQUIPMENT: – Safety factors – Bedside stand – Bed – Over table – Chairs – Lights

FACTORS THAT INFLUENCE HYGIENE HYGIENE CARE SCHEDULE: – Early AM – After breakfast – Afternoon – PM care

PURPOSE OF HYGIENE MAINTAIN SKIN INTEGRITY PREVENT SKIN IMPAIRMENT PROMOTE ADEQUATE CIRCULATION PROMOTE HYDRATION PROMOTES COMMUNICATION

INTACT SKIN DEFINITION – DEFENSE AGAINST INFECTION – DEFENSE OF AWARENESS – CONTROLS BODY TEMPERATURE

MEDICAL ASEPSIS REVIEW KNOWN AS CLEAN TECHNIQUE INHIBITS GROWTH & SPREAD OF PATHOGENIC MICROBES

INTACT SKIN ASSESSMENT – COLOR – TEXTURE – THICKNESS – TURGOR – TEMPERATURE – HYDRATION NURSING GOAL – PREVENT COMPLICATIONS OR SKIN IMPAIRMENT

GOOD TO KNOW THE PATIENT SHOULD BE ENCOURAGED TO ASSIST IN PERSONAL HYGIENE IF POSSIBLE TO PROMOTE INDEPENDENCE AND SELF-ESTEEM. DAILY SKIN INSPECTION AND DOCUMENTATION IS AN IMPORTANT PART OF SKIN CARE AND PREVENTION OF DECUBITUS ULCERS.

FRICTION SHEARING FORCE PRESSURE PRESSURE SORES: CAUSES

PRESSURE SORES PROLONGED PRESSURE OVER BONY PROMINENCES IS #1 FACTOR IN CAUSING A DECUBITUS ULCER. THE BEST TREATMENT FOR PRESSURE ULCERS IN THE INITIAL STAGE IS FREQUENT TURNING.

PRESSURE SORES: RISK FACTORS POOR NUTRITION IMMOBILITY AGE INCONTINENCE IMPAIRED CIRCULATION SENSORY DEFICIT UNDER OR OVER WEIGHT

FIGURE 18-4 A, Stage I pressure ulcer. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.) PRESSURE SORES:STAGE 1

FIGURE 18-4 B, Stage II pressure ulcer. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.) PRESSURE SORES: STAGE 2

FIGURE 18-4 C, Stage III pressure ulcer. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.) PRESSURE SORES: STAGE 3

FIGURE 18-4 D, Stage IV pressure ulcer. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.) PRESSURE SORES: STAGE 4

PRESSURE SORES: TREATMENT ASSESSMENT – SIZE – DEPTH – COLOR – EXUDATE – PAIN SURGICAL ASEPSIS DURING WOUND CARE PROMOTE NUTRITION AND HYDRATION REPOSITIONING USE PRESSURE RELIEVING DEVICES

COMMON SKIN PROBLEMS DRY SKIN ACNE HIRSUTISM RASHES ABRASIONS I am a female

COMMON SKIN PROBLEMS CONTACT DERMATITIS

BATHING & HYGIENE PURPOSE – CLEANSE THE SKIN – STIMULATE CIRCULATION – PROMOTE ROM – DECREASE BODY ODORS – INCREASE SELF IMAGE AND COMFORT

BATHING THE PATIENT BATHING SHOULD BE INCREASED WHEN: – Pt is incontinent – Excessive wound drainage – Pt is diaphoretic ELDERLY CONSIDERATIONS: – Frequency is decreased because Thinner and drier skin Less vascular Fragile Age related changes

BATHING THE PATIENT

Skill 18-1 Step 8e(1) Bathing the Patient/Administering a Back Rub,Step 8e(1): Bed bath—Remove patient’s gown, all undergarments, and jewelry. (Facilitates a more effective bed bath.) If an extremity is injured or has reduced mobility begin removal of the gown from the unaffected side. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.)

Skill 18-1 Step 8e(2) Bathing the Patient/Administering a Back Rub, Step 8e(2): Bed bath—If the patient has intravenous (IV) tube, remove gown from the arm without IV first, then lower IV container or remove tubing from pump. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.)

Skill 18-1 Step 8e(3) Bathing the Patient/Administering a Back Rub, Step 8e(2): Bed bath—Remove gown from the arm without IV first, then lower IV container or remove tubing from pump and slide gown covering down over the affected arm, over tubing and container. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.)

Skill 18-1 Step 8e(4) Bathing the Patient/Administering a Back Rub, Step 8e(4): Bed bath—Rehang IV container and check flow rate or reset pump. Do not disconnect tubing. (Undressing the unaffected side first allows for easier manipulating of gown over body part with reduced range of motion [ROM] [normal movement that any given joint is capable of making.]) (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.)

Skill 18-1 Step 8h Bathing the Patient/Administering a Back Rub, Step 8h: Bed bath—Form mitt with bath cloth around your hand; dip mitt and hand into bath water. Squeeze out excess water. (Facilitates handling of bath cloth and prevents corners from brushing against patient. Do not place soap in bath water—too many suds will prevent adequate rinsing.) (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.) BATHING THE PATIENT

FEMALE BATH Front Back

MALE BATH Always replace foreskin

PHLEBITIS: Inflammation of vein Do Not Massage OUCH!

TOWEL BATH Towel bath. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

METHODS OF BATHING Shower Tub Bath Tepid Sponge Bath Medicated Bath Sitz Bath

ORAL HYGEINE Administering oral hygiene. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

ORAL PROBLEMS Dental Caries Gingivitis

ORAL PROBLEMS Halitosis Periodontitis

DENTURE CARE Administering oral hygiene. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.)

HAIR CARE AND SHAVING (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.)

HAIR CARE AND SHAVING Dandruff

HAIR CARE AND SHAVING Pediculosis (tinea capitus)

HAIR CARE AND SHAVING Pediculosis Corporis

HAIR CARE AND SHAVING Pediculosis Pubis

FOOT & NAIL CARE Risk Factors: – Poor foot care – Poor fitting shoes – Biting nails Pt’s with peripheral vascular disease Joint Mobility Elderly

Palpate pulses Assess color and warmth Assess cap refill Assess for edema – in feet and ankles Assess between toes FOOT & NAIL CARE

Problems: – Callus – Corns – Planter warts – Athletes foot – Ingrown toenails – Ram’s horn nails – Fungal Infection FOOT & NAIL CARE

BACKRUBS PURPOSE: – Increase relaxation – Increase circulation – Decrease muscle tension Not for pt’s w fx of ribs or vertebra, burns, open wounds, or pulmonary embolism

CATHETER CARE

Avoid tension or pulling & perform care BID Cleanse from urinary meatus down tube Never raise catheter bag above bladder

BEDMAKING: OCCUPIED BED (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

BEDMAKING—OCCUPIED BED (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

BEDMAKING—OCCUPIED BED (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

POST-OP BED (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

BEDMAKING—MITERED CORNER (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

BEDMAKING—MITERED CORNER (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

BEDPAN/URINAL Selected equipment and supplies for elimination. (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6 th ed.]. St. Louis: Mosby.)

BEDSIDE COMMODE The bedside commode has a toilet seat with a container underneath.

ASSISTING WITH BEDPAN Positioning the bedpan. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3 rd ed.]. St. Louis: Mosby.)

THE END