FUNDAMENTALS OF NURSING

LESSON 8HYGIENE 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. [6th 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. [6th 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. [6th 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. [6th 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. [6th 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. [6th 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. [6th 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. [6th 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. [6th ed.]. St. Louis: Mosby.)

BATHING THE PATIENT

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. [3rd 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. [3rd 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. [6th ed.]. St. Louis: Mosby.)

HAIR CARE AND SHAVING

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th 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

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. [3rd ed.]. St. Louis: Mosby.)

BEDMAKING—OCCUPIED BED

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

BEDMAKING—OCCUPIED BED

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

POST-OP BED

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

BEDMAKING—MITERED CORNER

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

BEDMAKING—MITERED CORNER

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

BEDPAN/URINAL

Selected equipment and supplies for elimination.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th 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. [3rd ed.]. St. Louis: Mosby.)

THE END