Introduction

Hygiene is the practice of cleanliness Various studies have confirmed that improved personal hygiene practices reduce illness rates, 2001). Vary among people

Factors affecting hygiene Economic status Culture Ability to perform self-care Personal preference Time/Frequency Age and Illness Physical function– Poor vision– Decreased sense of touch– Limitation with mobility

Nursing Process for Skin Care and Personal Hygiene

What is the Nursing Process? I will begin that process by _______ the following areas?– Skin– Eyes, Ears, Nose– Hair– Nails and Feet– Perineal and Vaginal areas----Yes you must assess this area!

Interview Questions/Skin Alterations How long have you had this problem? Does it bother you? How does it bother you (itching)? Have you found anything helpful in relieving these symptoms?

Skin

Head to toe fashion, good lighting, compare for symmetry Intact skin is the body’s first line of defense, prevents microbes from entering the body and causing infection. Mucous membranes must also be clean and intact

Factors to Consider When Examining Skin Cleanliness Color Temperature Turgor Moisture Sensation Vascularity Evidence of lesionsEyes, Ears, Nose

Specific care the client performs. Specific care measures r/t use and care of visual aids prosthetics History of problemsCare of Eyes Clean from inner to outer canthus with wet, warm cloth, cotton ball, or compress Use artificial tear solution or normal saline every 4 hours if blink reflex is absent Care for contact lensesEar and Nose Care Wash external ear with washcloth-covered finger; do not use cotton-tipped swabs Perform hearing aid teaching and care if indicated Clean nose by having patient blow it if both nares are patent If indicated, use nasal suctioning with bulb syringe Remove crusted secretions around nose and apply petroleum jelly

The Oral Cavity Observe for oral problems

– Dental caries-decay of teeth, cavities (diet)– Periodontal disease-inflammation of gums– Other oral problems-stomatitis, glossitis, cheilosis Identify actual or potential oral problems that nurses can treat Identify appropriate nursing measures Carry out the plan of careAdministering Oral Hygiene Moistening the mouth Cleaning the mouth Caring for dentures Toothbrushing and flossing Using mouthwashesHearing Aids Batteries must be checked routinely. Ear pieces or molds must be cleaned daily with mild soap and water.

Contact Lens Care

Small disc worn directly on the eyeball May be hard or soft, disposable. Keep them free of microorganisms Irritated with smoke or noxious vaporsProviding Hair Care Identify patient’s usual hair and scalp care practices and styling preferences Note any history of hair or scalp problems, such as dandruff, hair loss, or baldness Treat any infestations, such as pediculosis and ticks Groom and shampoo hair Care for beards and mustaches

Shaving

Follow agency policy

Safety razors can cause nicks or cutsBe careful when shaving a confused patient

Nail and Foot Care Assess nails for color and shape, intactness and cleanness, and tenderness Check for history of nail or foot problems Soak nails and feet and assist with cleaning and trimming nails (if not contraindicated) Provide diabetic foot care if indicatedPerineal and Vaginal Care Assess for perineal or vaginal problems and related treatments Perform a physical assessment of male and female genitalia Cleanse vaginal area with plain soap and waterDiagnosing Careful assessment Each diagnosis statement identifies a patient problem and suggests expected patient outcomes. The etiology of the problem directs nursing interventions P.1135Nursing Diagnosis for Hygiene Problems Self care deficit diagnoses address four specific activities necessary to meet daily needs: Feeding Bathing Dressing Grooming ToiletingOutcome Identification and Planning Nursing measures to assist the patient to develop or maintain hygiene practices .

They begin with The Patient Will Demonstrate proper use and care of visual or auditory aids Exhibit clean hair

Implementing Providing schedule hygiene care

Early morning careMorning Care (a.m. care)Afternoon Care (p.m.)

Hour of Sleep Care (h.s. care)As Needed Care (p.r.n. care)

Early Morning Care Assist patient with toileting Provide comfort measure to refresh patient to prepare for day Wash face and hands Provide mouth careMorning Care (AM Care)After breakfast, nurse completes morning care: Toileting Oral care Bathing Back massage Special skin measures Hair care, cosmeticsMorning Care (AM Care) (cont.) Dressing Positioning for comfort Refreshing or changing bed linens Tidying up bedside

Afternoon Care (PM Care)Ensure patient’s comfort after lunch: Offer assistance with toileting, handwashing, oral care Straighten bed linens Help patient with mobility to reposition selfHours of Sleep Care (hs Care)Before patient retires: Offer assistance with toileting, washing, and oral care

Offer a back massage Change any soiled bed linens or clothing Position patient comfortably Ensure that call light and other objects patient requires are within reachAs Needed Care (prn Care) Offer individual hygiene measure as needed Change clothing and bed linens of diaphoretic patients Provide oral care every two hours if indicated Reasons for Providing Back Massage Acts as a general body conditioner Relieves muscle tension and promotes relaxation Provides opportunity for nurse to observe skin for signs of breakdowns Improves circulation May decrease pain, distress, and anxiety May improve sleep qualityPurposes of Bathing Cleanses the skin Acts as a skin conditioner Helps to relax a person Promotes circulation Serves as musculoskeletal exercise Stimulates the rate and depth of respirationsPurposes of Bathing (cont.) Promotes comfort through muscle relaxation and skin stimulation Provides person with sensory input Helps improve self-image Strengthens nurse–patient relationship

Bathing Bathing Types of bathes– Tub or shower– Partial bath

– Perineum- the area around the genitals and rectum– Perineal care (peri-care) techniques used to cleanse the perineum– Bed bath

Bathing Cleans the skin, mucous membranes of the genitals and anal areas Refreshing and relaxing Observations are made, talk to client Method of bathing depends on the patients conditions, self-care abilities and personal choice Ask choice of bath time if possible

Providing a Bed Bath Provide articles for bathing on over-bed table or bedside stand Provide privacy for patient Remove top linens and replace with bath blanket Place cosmetics in convenient place Assist patients who cannot bathe themselves completelyComplete bed bath Involves washing the person’s entire body in bed To persons who cannot bathe themselves Explain how the bath is given Explain how you cover the body for privacy Use a new washcloth for each body part– Cleaner areas to more soiled

The Elderly and bathing Dry skin occurs with aging Soap also dries the skin; skin is easily damaged Older persons usually need a complete bath or shower two/three times a week Partial baths are taken the other days Some older persons have dementia– Bathing may scare them and frighten them– They resist care and become agitated and combative– Shout and cry for help

General Gerontologic Considerations

– Do not rush the person– Use a calm, pleasant voice– Divert the person’s attention– Be gentle– Calm the person– Try bathing at a later time if indicated

Changing gowns and clothing

Changed after the bath and when wet or soiled– Provide privacy. Do not expose the person– Encourage them to do much as possible, allow to choose– Remove clothing from the good side first– Put on weaker side first– Support arm or leg when putting on garment

Bedmaking

Beds are made everyday A clean, dry and wrinkle-free bed– Increase comfort– Helps prevent skin breakdown and pressure ulcers

Bedmaking Straighten linens when loose or wrinkled Check linens for dentures, eyeglasses, hearing aids, sharp objects and other items Clear food and crumbs Change when wet, soiled or dampTypes of Bedmaking

Closed bed is not in use.– Top linens are not folded back, awaiting new patient Open bed is in use.

– Top linens are folded back Occupied bed is made with person in it Surgical bed is made to transfer a person from a stretcher to the bed

Linens Practice medical asepsis when handling linens Your uniform is considered dirty Never shake linens in the air Clean linens on clean surfaces– Never place dirty linen on floor Only bring linen needed to room Collect in order you will useDrawsheets It is a small sheet placed over the middle of the bottom sheet– Helps keep the mattress and bottom linens clean and dry– Lifting or turning sheets Some are precut (ideally) but if not fold in halfNeeded items Bottom sheet Drawsheet Pad Top sheet Blanket Bedspread Two pillowcases

Bath towels Hand towels Washcloths Hospital gown Bath blanket Gloves

Use one arm to hold linen away from body and the other to pick linen up– Item you will use first will be on bottom of stack until complete then turn over

Place on clean surface in room

Guidelines for Applying Antiembolism Stockings Measure patient’s leg for size of stocking Apply stocking in morning before patient is out of bed and while patient is supine Do not massage the legs Check legs regularly for redness, blistering, swelling, and pain Launder the stockings as necessaryApplying Intermittent Pneumatic Compression Stockings May be used in conjunction with antiembolism stockings Require a physician’s order Are prescribed for high-risk surgical patients and patients with chronic venous disease or at risk for deep-vein disorders Are knee-length or thigh-high cuff connected to hoses and a pump Stimulate normal muscle-pumping action in the legs

Ensuring Bedside Safety Patient call light is functioning and within reach Bed is positioned properly, at appropriate height, wheels locked Side rails are safely used when indicated Principles of medical asepsis are followed Electrical equipment is safely grounded Walk space is unclutteredPatient Outcome Achievement Level of patient participation in hygiene program Elimination of, reduction in, or compensation for factors interfering with independent execution of hygiene measures Changes related to specific skin problemsLinens Practice medical asepsis when handling linens Your uniform is considered dirty Never shake linens in the air Clean linens on clean surfaces

– Never place dirty linen on floor Only bring linen needed to room Collect in order you will useEvaluating Patient participation in hygiene Changes related to specific skin problems, for example healing of skin lesions, elimination or reduction in causative factors, and independent patient management of the prescribed treatment Did you see improvement, if not revise your interventions----increase frequency of oral care

Compare and contrast oral hygiene for clients with natural teeth and dentures.Demonstrate safety awareness when providing oral care for unconscious clients.Discuss the rationale for cutting the nails straight across.Describe the steps in providing perineal care for male and female clients.Describe the necessary actions to care for clients with prosthetic eye or contact lens.Describe how to perform care to hearing aids, and ways to facilitate communication with clients that have difficulty hearing.State at least two nursing diagnosis pertinent to clients requiring assistance with personal hygiene.