1. Hygiene B260: Fundamentals of Nursing

2. Scientific Knowledge Base Physical hygiene is necessary for comfort, safety, and well-being. Ill patients require assistance with personal hygiene. Several factors influence a patient’s hygiene practices, such as culture and age. Good hygiene techniques promote normal structure and function of tissues. Apply knowledge of pathophysiology to provide preventive hygiene care.

3. The Skin Functions include – Protection, secretion, excretion, temperature regulation, and sensation Two layers – Epidermis: shields underlying tissue – Dermis: contains bundles of collagen, nerve fibers, blood vessels, sweat glands, sebaceous glands, and hair follicles  Subcutaneous: tissue lies just beneath the skin; contains blood vessels, nerves, lymph, and loose connective tissue filled with fat cells

6. The Feet, Hands, and Nails Feet, hands, and nails require special attention to prevent infection. The hand in contrast to the foot is used for manipulation rather than for support. The condition of a patient’s hands and feet influences his or her ability to perform hygiene care. The normal nail is transparent, smooth, and convex, with a pink nail bed and a white tip.

8. The Oral Cavity Cavity is lined with mucous membranes. Normal oral mucosa is light pink, soft, moist, smooth, and without lesions. Medications, exposure to radiation, and mouth breathing can impair salivary secretion. Xerostomia—dry mouth Gingivitis—inflammation of the gums Dental caries—tooth decay

10. Hair Growth, distribution, and pattern indicate general health status. Hormonal changes, nutrition, emotional stress, physical stress, aging, infection, and other illnesses can affect the hair. Sun, chemicals, hair products, permanents, and straightening and coloring agents can also affect the hair.

12. Eyes, Ears, and Nose When hygiene care is provided, the eyes, ears, and nose require careful attention. Clean the sensitive sensory tissues in a way that prevents injury and discomfort for a patient, such as by taking care to not get soap in his or her eyes. The sense of smell is an important aid to appetite.

14. Peri-care Male – Circumcised vs. uncircumcised Female – Front to back

15. Nursing Knowledge Base Factors influence a patient’s personal hygiene. Use communication skills to promote the therapeutic relationship. During hygiene, assess: – Emotional status – Health promotion practices – Health care education needs

16. Factors Influencing Hygiene Social patterns Ethnic, social, and family influences on hygiene patterns Personal preferences Dictate hygiene practices Body image A person’s subjective concept of his or her body appearance Socioeconomic status Influences the type and extent of hygiene practices used

17. Factors Influencing Hygiene Health beliefs and motivation Motivation is the key factor in hygiene. Cultural variables People from diverse cultures practice different hygiene rituals. Developmental stage Affects the patient’s ability to perform hygiene care Physical condition May lack physical energy and dexterity to perform self-care

18. https://www.youtube.com/watch?v=_e_cH3Ot 0Ck

19. Factors Influencing Hygiene Developmental stage – Skin (sensitive neonate skin, active glands in puberty, thinning and drying with age) – Feet and nails (dry skin, systemic disease footwear problems, chronic foot problems) – Mouth Teeth (teething, caries, gum disease, edentulous) – Hair (shaving, puberty, aging) – Eyes, ears, nose

20. Critical Thinking Integrate nursing knowledge. Consider developmental and cultural influences. Think creatively. Be nonjudgmental and confident. Draw on your own experiences. Rely on professional standards.

21. Nursing Process: Assessment Explore the patient’s viewpoint. Assess: Patients at risk for hygiene problems Self-Care AbilitySkinFeet and Nails Oral cavityHair and hair careEyes, ears, and nose Use of sensory aidsHygiene care practices Cultural influences

22. Nursing Assessment

23. Nursing Process: Diagnosis Common diagnoses associated with hygiene: – Activity intolerance – Bathing self-care deficit – Dressing self-care deficit – Impaired physical mobility – Impaired oral mucous membrane – Ineffective health maintenance – Risk for infection Use the patients’ actual alteration or the alteration for which they are at risk.

24. Nursing Process: Planning Goals and outcomes – Partner with the patient and family – Measurable, achievable, individualized Set priorities based on assistance required, extent of problems, nature of diagnoses Teamwork and collaboration – Health care team members – Family – Community agencies

25. Implementation Use caring to reduce anxiety, promote comfort. Administer meds for symptoms before hygiene. Be alert for patient’s anxiety or fear Assist and prepare patients to perform hygiene as independently as possible. Teach techniques and signs of problems. Inform patients about community resources.

26. Implementation Health promotion – Make instructions relevant. – Adapt instruction to patient’s facilities and resources. – Teach the patient ways to avoid injury. – Reinforce infection control practices. Acute, restorative, and continuing care – Hygiene measures vary by patient needs and health care setting.

27. Implementation Consider normal grooming routines, and individualize care. Bathing and skin care – Therapeutic: sitz, medicated – Complete bed bath, shower – Partial bed bath Bag baths Perineal care Back rub Foot and nail care

28. Bath Guidelines Provide privacy. Maintain safety. Maintain warmth. Promote independence. Anticipate needs.

29. Implementation Oral hygiene – Brushing removes particles, plaque, and bacteria; massages the gums; and relieves unpleasant odors and tastes. – Flossing removes tartar at the gum line. – Rinsing removes particles and excess toothpaste. Patients with special needs: diabetes, artificial airways, unconscious, chemotherapy

30. Care of Dentures

31. Implementation Oral hygiene – Unconscious Patient – Turn patient’s head towards you – Place patient in semi- fowler’s – Oral air way can be used to hold mouth open – Use a small brush or swab to clean the mucous membranes and teeth – Use suctions to remove secretions and fluid – Use chap stick or lip moisturizer

32. Implementation Hair and scalp care – Brushing and combing Distributes oil Prevents tangling, as does braiding Obtain permission before braiding or cutting. Procedures for head lice – Shampooing – Shaving – Mustache and beard care

33. Shampooing Hair of Patient Who Is Bed-Bound

34. Shaving

35. Implementation Care of the genitalia: Can be embarrassing for the nurse and the patient. Should not be overlooked because of embarrassment. If the patient can do it themselves—let them. – Hand them the washcloth and ask if they would like to “finish their bath.”

36. Peri-care Those patients who may need the nurses assistance: – Vaginal or urethral discharge – Skin irritation – Catheter – Surgical dressings – Incontinent of urine or feces

37. Peri-care: Female Wipe labia majora (outer) from front to back in downward motion using clean surface of wash cloth for each swipe. Wipe labia minora (inner) from front to back in downward motion using clean surface of wash cloth for each swipe Wipe down the center of the meatus from front to back. If catheter in place, clean around catheter in circular fashion, using clean surface of wash cloth for each swipe. Wash inner thighs from proximal to distal

38. Peri-care: Female Rinse with warm to tepid water using pour from peri-bottle if available. Pat dry using clean towel in same order as wash Remove bedpan if one is used Verbalize turning patient on side to wash anal area from front to back and dry

39. Peri-care: Male Retract foreskin of penis if uncircumcised Wash around the urinary meatus in a circular motion, using clean surface of washcloth for each stroke and around the head of penis in circular motion Wash down shaft of penis toward the thighs changing washcloth position with each stroke Wash scrotum – front to back Wash inner thighs

40. Peri-care: Male Rinse with clean wash cloth or peri- bottle using warm water in same sequence as the wash Dry with clean towel in the same sequence Replace foreskin, as appropriate Turn patient on side to wash anus from front to back and dry

41. Implementation Care of the eyes, ears, and nose: – Basic eye care – Eyeglasses – Contact lenses – Artificial eyes – Ear care – Hearing aid care – Nasal care

42. Hearing Aids: In the Canal

43. Hearing Aids: In the Ear

44. Hearing Aids: Behind the Ear

45. Implementation Patient’s room environment – Maintaining comfort: temperature, noise, lighting, ventilation, odors – Beds Features: raising, adjusting, side rails Clean, comfortable, and safe – Bed making Occupied Unoccupied

46. Room Equipment

47. Foot Boots

48. Communication

49. Linen Care

50. Evaluation Evaluate during and after each intervention. Observe for changes in patient’s behavior. Consider the patient’s perspective. Often it takes time, repeated measures, and a combination of interventions for improvement. Expected outcomes met? Patient’s expectations met? Ask questions to determine appropriate changes to interventions.

51. Safety Guidelines Communicate clearly with team members. Incorporate patient’s priorities. Move from the cleanest to less clean areas. Use clean gloves for contact with nonintact skin, mucous membranes, secretions, excretions, or blood. Test the temperature of water or solutions. Use principles of body mechanics and safe patient handling. Be sensitive to the invasion of privacy.