Chapter 17 Hygiene

OBJECTIVES 1. Define hygiene. 2. Name five hygiene practices that most people perform regularly. 3. Give two reasons why a partial bath is more appropriate than a daily bath for older adults. 4. List at least three advantages of towel or bag baths. 5. Name two situations in which shaving with a safety razor is contraindicated. 6. Name three items recommended for oral hygiene. 7. Identify two methods to prevent the chief hazard when providing oral hygiene to an unconscious client. 8. Describe two techniques for preventing damage to dentures during cleaning. 9. Describe two methods for removing hair tangles. 10. Name two types of clients for whom nail care is provided with extreme caution. 11. Name four visual and hearing devices. 12. List two alternatives for clients who cannot insert or care for their own contact lenses. 13. Discuss four reasons for sound disturbances experienced by people who wear hearing aids. 14. Describe an infrared-listening device.

Hygiene Hygiene: practices that promote health through personal cleanliness Activities that foster hygiene Bathing; cleaning and maintaining fingernails and toenails Performing oral care Shampooing and grooming hair Maintaining hearing aids and eyeglasses

Integumentary System Components Skin Mucous membrane Hair Fingernails, toenails Teeth

Skin Epidermis: Outermost layer, contains dead skin cells forming a tough protein called keratin. Cells shed continuously & are replaced by the dermis. Dermis: True skin, contain most of the secretory glands

Skin Subcutaneous layer: Separate the skin from skeletal muscles, contains fat cells, blood vessels, nerves and roots of the hair follicles and glands

Cross-Section of the Skin

Skin carries out the following functions: Protect inner body structures from injury & infection Regulate body temperature Maintain fluid and chemical balance Provide sensory information such as pain, temperature, touch and pressure Assist in converting precursors to Vitamin D when exposed to sunlight

Skin Common Benign Skin Lesions in Older Adults Seborrheic keratoses: tan to black raised areas on the trunk Senile lentigines: brown, flat patches on the face, hands, and forearms (liver spots)

Skin GLAND LOCATION SECRETION PURPOSE Sudoriferous Throughout dermis and subcutaneous layers, especially in axilla and groin Sweat Regulate body temperature. Excrete body waste Ceruminous Ear canals Cerumen Protective functions; has antimicrobial properties Sebaceous Throughout the dermis Sebum Lubricate skin and hair Ciliary Eyelids Sweat and sebum Protect lid margin and lubricate eyelash follicles

Mucous Membrane Line body passages such as the: digestive, respiratory, urinary, and reproductive systems Mucous membrane also lines the conjunctiva of the eye Goblet cells in the mucous membranes secrete mucus, a slimy substance that keeps the membranes soft and moist

Hair Each hair is a thread of keratin Forms from cells at the base of a single follicle Helps to prevent heat loss by trapping heat in the air between the hairs Sebaceous glands in the hair follicles release sebum Basic genetically inherited structure can be altered by chemicals used to curl, relax or lubricate the hair

Nails Fingernails and toenails are made of keratin, which in concentrated amounts gives them their tough texture Normal nails are thin, pink, and smooth Fingernails and toenails provide some protection to the digits

Teeth Present beneath the gums at birth Contain the outer covering, enamel, a keratin structure Exposed portion of each tooth: crown Portion within the gum: root Adults: 28 to 32 permanent teeth Saliva: keeps the teeth clean and inhibits bacterial growth

Teeth Discoloration occurs from chronic consumption of coffee or tea, tobacco use, certain drugs such as tetracycline antibiotics taken during childhood. Integrity of teeth largely depend on the person’s oral hygiene practices, diet and general health.

Common Dental Problems Sugar, plaque, and bacteria may eventually erode the tooth enamel, causing caries Tartar leads to gingivitis, while gum inflammation may cause periodontal disease Tooth loss is common in older adults as a result of periodontal disease

Hygiene Integument contains many secretory glands that produce odors and attract debris Hygiene measures are beneficial for maintaining personal cleanliness and healthy integumentary structures Hygiene practices vary widely, most Americans routinely perform bathing, shaving, brushing teeth, hair care and nail care

Bathing Uses a cleansing agent such as soap and water to remove sweat, oil, dirt, and microorganisms from the skin Advantages of bathing Eliminates body odor; reduces the potential for infection Stimulates circulation; provides a refreshed and relaxed feeling; improves self-image

Types of Bathing Most bathing is done in a tub or shower, at a sink or at the bedside Partial bathing: washing only those body areas that are subject to greatest or sources of body odor: generally, the face, hands, axillae and perineal area. This is done at a sink or with a basin at the bedside.

Types of Bathing Bed bath: washing with basin of water at the bedside. Towel bath: single large towel to cover and wash a client Bag bath: commercially packaged kit (p. 359) Any one of these three types of baths would be suitable for the client who is unable to take a tub bath or shower independently

Therapeutic Baths TYPE DESCRIPTION PURPOSE Sitz bath Immersion of the buttocks & perineum in a small basin of continuously circulating water Removes blood, serum, stool or urine. Reduces local swelling. Relieves discomfort. Sponge bath Applications of tepid water to the skin Reduces a fever Medicated bath Soaking/immersing in a mixture of water & other substance, such as baking soda, oatmeal, or cornstarch Relieves itching or a rash Whirlpool bath Warm water that is continuously agitated within a tub or tank Improves circulation Increases joint mobility Relieves discomfort Removes dead tissue

Question Is the following statement true or false? Partial bathing is most common in young adults.

Answer False. Partial bathing is most common in older clients.

Advantages of Bed Bath

Partial bathing Partial bathing is more appropriate for older adults than a tub bath or shower because they do not perspire as much as young adults and soap tends to dry their skin.

Giving a Towel Bath

Question Is the following statement true or false? Towel bath is very expensive.

Answer False. Towel bath saves expense. (CS: 88yr)

Shaving Removes unwanted body hair Accomplished with an electric or a safety razor The use of safety razor may not be possible in the following situations: If the client has a face injury If the client cannot shave

Shaving a Client’s Face

Contraindications to Using a Safety Razor Receiving anticoagulants (drugs that interfere with clotting) Ex. Coumadin, Heparin Treatment of DVT (Deep-Vein Thrombosis), PE (Pulmonary Embolism), Prosthetic Heart Valves Receiving thrombolytic agents (drugs that dissolve blood clots) Ex. Alteplase, Streptokinase Treatment of PE, MI, stroke

Contraindications to Using a Safety Razor Taking high doses of aspirin Blood disorder such as hemophilia Liver disease who have impaired clotting Rashes or elevated or inflamed skin lesions on or near the face Those who are suicidal

Oral Hygiene Practices used to clean the mouth, especially brushing and flossing the teeth Most dentists recommend twice daily brushing Dentures and bridges require special cleaning and care To prevent damage during cleaning, hold dentures over a plastic or towel-lined container and uses cold or tepid water.

Oral Care for Unconscious Clients Because unconscious clients are not salivating in response to seeing, smelling, and eating food, they need oral care even more frequently than conscious clients. Sordes (dried crusts containing mucus, microorganisms, and epithelial cells shed from the mucous membranes) are common on the lips and teeth of unconscious clients.

Oral Care for Unconscious Clients The chief hazard in providing oral hygiene for unconscious clients is aspiration (inhaling) of liquid into the lungs. To prevent aspiration, nurses position unconscious clients on the side with the head lower than the body. They use oral suction equipment to remove liquid from the mouth.

Oral Care for Unconscious Clients Aspirated liquids predispose clients to pneumonia. Tooth brushing is the preferred technique for providing oral hygiene Oral swabs are also used to moisten and refresh the mouth

Advantages of Electric Toothbrushes

Question Is the following statement true or false? Dentures are best washed with hot water.

Answer False. Dentures are best washed with cold or tepid water.

Hair Care Apply a conditioner to loosen tangles Use oil on the hair if it is dry Braid the hair to help prevent tangles Brush the hair slowly to increase circulation of sebum Use a wide-toothed comb, combing from end to crown Use shampoo to clean hair

Nail Care Keeping the fingernails and toenails clean and trimmed Nail care should be provided with extreme caution for the following clients: Clients with diabetes Clients with impaired circulation Client with thick nails

Nail Care Clients with diabetes, impaired circulation or thick nails are at risk for vascular complications secondary to trauma. Podiatrist (person with special training in caring for feet) services are often indicated It is best to check with the client’s MD before cutting fingernails or toenails

Question Is the following statement true or false? Applying alcohol to tangled hair helps remove the tangles.

Answer True. Applying alcohol to tangled hair helps remove the tangles.

Visual and Hearing Devices Eyeglasses and hearing aids improve communication and socialization Eyeglasses Contact lenses Artificial eyes Hearing aids Infrared listening devices

Types of Contact Lenses

Eyeglass Care The nurse cleans glass and plastic lenses as follows: Hold eyeglasses by the nose or ear braces Run tepid water over both sides of the lenses (hot water damages plastic lenses) Wash lenses with soap or detergent Rinse with running tap water Dry with a clean, soft cloth. Do not use paper tissues because can scratch lenses.

Contact Lens Care Never assume that someone who wears eyeglasses does not use a contact lens, and vice versa. For conscious clients, the nurse asks them to remove and insert the lenses. Care for the contact lenses is according to the client’s established routines.

Contact Lens Care For clients who cannot remove contact lenses, the nurse may assist with their removal or should consult the client’s ophthalmologist (medical MD who treats eye disorders) or optometrist (person who prescribes corrective lenses) about alternatives to promote adequate vision and safety.

Contact Lens Care For the unconscious client: Obtain an appropriate storage container, label it Left & Right Elevate client’s head and place towel over the chest to prevent loss or damage to contact lenses Soft Lenses p. 366, also see Figure 17-12, 17-13 Hard Lenses p. 366, also see Figure 17-15, 17-16

Examples of Hearing Aids In the ear (A) Behind the ear (B) Remote controlled (C) Refer to Figure 17-18 in the textbook. Refer to Client and Family Teaching Maintaining a Hearing Aid 17-2 p. 368

Hearing Aids Four types of hearing aids: In-the-ear devices: small self-contained aids that fit in the outer ear Canal aids: fit deep within the ear canal and are largely concealed. Because of their size, may be difficult to remove and adjust

Hearing Aids Behind-the-ear devices: microphone and an amplifier worn behind the ear that delivers sound to an internal receiver. Body-aid devices: use electrical components enclosed in a case carried somewhere on the body to deliver sound through a wire connected to an ear mold receiver. Most clients insert and remove their own hearing aids, but the nurse may need to assess and troubleshoot problems that develop.

Infrared Listening Devices Infrared Listening Devices (IRLDs) resemble earphones attached to a handheld receiver. They are an alternative to conventional hearing aids. Converts sound into infrared light & sends it through a wall- or ceiling mounted receiver to the person wearing the device. The light is converted into an auditory stimulus.

Infrared Hearing Devices Advantage: IRLD reduces background noise Disadvantage: Cannot be used outdoors, in rooms that contain many windows, brightly lit rooms because infrared light jams the signal which causes audio interference

Infrared Hearing Device Some geriatric centers are installing IRLDs in rooms used for social and recreational activities. People who need help hearing lectures, TV, live performance may use an IRLD.

Question Is the following statement true or false? Infrared listening devices (IRLDs) are used by clients with hearing impairment to hear sounds outdoors.

Answer False. IRLDs cannot be used outdoors or in rooms that contain many windows or in well-lit rooms.

General Gerontologic Considerations Poor hygiene and grooming in older adults: signs of visual impairments, functional changes, dementia, depression, abuse, or neglect Older adults do not need to bathe as frequently as younger adults Use mild, superfatted, nonperfumed soap Oils are not used in showers or bathtubs due to increased risk for falls

General Gerontologic Considerations (cont’d) For older adults with limited range of motion or mobility, provide: Long-handled bath sponges or hand-held shower attachments Nonskid strips on the floor of bathtubs Showers with strategically placed handles and grab bars; a tub/shower seat

General Gerontologic Considerations (cont’d) Due to increased susceptibility to dry skin, tears and scratches: Avoid skin care products containing alcohol, perfumes that aggravate dry skin Nails: keep trimmed and smooth Feet: regularly inspect condition Modify clothing to promote independence Tooth loss: periodontal disease

Question Is the following statement true or false? Older adults need to bathe frequently because they perspire a lot.

Answer False. Older adults do not need to bathe frequently because they have diminished perspiration and sebum production.