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Unit fiveUnit five

Mr. Ahmad AtaMr. Ahmad AtaRN,CNS,MSNRN,CNS,MSN

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Lecture Objectives Lecture Objectives

At the end of this lecture At the end of this lecture the student will able to:the student will able to:

1.1. Know about hygiene, hygiene measure.Know about hygiene, hygiene measure.2.2. Know about common problem of the skin.Know about common problem of the skin.3.3. Describe common kind of hygiene.Describe common kind of hygiene.4.4. Ability to identify patients with self care deficit Ability to identify patients with self care deficit

related hygiene.related hygiene.5.5. Ability to communicate and interact effectively with Ability to communicate and interact effectively with

patients patients 6.6. Commitment to safety and quality Commitment to safety and quality

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Introduction Introduction Personal hygiene practices well vary Personal hygiene practices well vary

widely among persons.widely among persons.Well people are ordinarily responsible Well people are ordinarily responsible

for their own hygiene.for their own hygiene. In some cases the nurse assist well In some cases the nurse assist well

person through teaching to develop person through teaching to develop personal habits the person may lack.personal habits the person may lack.

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Definition: Definition:

HygieneHygiene:: is self care by which people is self care by which people attended to such function as bathing, attended to such function as bathing, oral care, grooming hair, cleaning oral care, grooming hair, cleaning fingernails, genital area, ear and eye fingernails, genital area, ear and eye care.care.

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HygHygiene involves cleansing of iene involves cleansing of the:the:

SkinSkinMouthMouthTeethTeethHairHairNailsNails

EyesEyesEarsEarsNoseNosePerineal AreaPerineal AreaFeetFeet

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HygieneHygieneCleansing by nurse is part of historical Cleansing by nurse is part of historical

giving of caregiving of careThe more ill patient, the more skill The more ill patient, the more skill

needed in providing the hygiene care.needed in providing the hygiene care.Cleansing skin is first line of defense Cleansing skin is first line of defense

against organismsagainst organisms

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Kinds of hygiene may nurses described:Kinds of hygiene may nurses described:

1. Early morning care:1. Early morning care: Assist patient with toileting.Assist patient with toileting. Provide comfort measure to refresh patient to prepare for day.Provide comfort measure to refresh patient to prepare for day. Wash face and hands.Wash face and hands. Provide mouth care.Provide mouth care.2. Morning care:2. Morning care:After breakfast, nurse completes morning care:After breakfast, nurse completes morning care: ToiletingToileting Oral careOral care BathingBathing Back massageBack massage Hair care, cosmeticsHair care, cosmetics DressingDressing Positioning for comfortPositioning for comfort Refreshing or changing bed linensRefreshing or changing bed linens Tidying up bedsideTidying up bedside

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Kinds of hygiene may nurses described:Kinds of hygiene may nurses described:

3. After noon care:3. After noon care:Ensure patient’s comfort after lunch:Ensure patient’s comfort after lunch: Offer assistance with toileting, hand washing, oral careOffer assistance with toileting, hand washing, oral care Straighten bed linens Straighten bed linens Help patients with mobility to reposition themselvesHelp patients with mobility to reposition themselves

4. Hours of sleep care:4. Hours of sleep care:Before patient retires:Before patient retires: Offer assistance with toileting, washing, and oral careOffer assistance with toileting, washing, and oral care Offer a back massageOffer a back massage Change any soiled bed linens or clothingChange any soiled bed linens or clothing Position patient comfortablyPosition patient comfortably Ensure that call light and other objects patient requires are within reachEnsure that call light and other objects patient requires are within reach

5. As needed care:5. As needed care: is provided required by client. is provided required by client.

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Factor influencing individual Factor influencing individual hygiene:hygiene:

culture.culture. Religion.Religion. Environment.Environment. Development level.Development level. Health status.Health status. Personal preferences Personal preferences

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Etiologies of self care deficitEtiologies of self care deficit Visual impairment.Visual impairment.Activity intolerance or weakness.Activity intolerance or weakness.Pain or discomfort.Pain or discomfort.Mental impairment.Mental impairment.Therapeutic procedures.Therapeutic procedures.Skeletal impairment. Skeletal impairment.

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Functional level of the patient may Functional level of the patient may described as following:described as following:

Total dependent.Total dependent.Partial dependent.Partial dependent. Independent.Independent.

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PURPOSE OF NURSE PROVIDED PURPOSE OF NURSE PROVIDED HYGIENEHYGIENE

Remove microorganismsRemove microorganismsDo physical assessmentDo physical assessment Increase circulationIncrease circulation Improve self imageImprove self imageProvide comfortProvide comfort

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Skin:Skin:DefinitionDefinition: is the largest organ that cover : is the largest organ that cover

all surface of the body.all surface of the body.

The skin contains:The skin contains:Epidermis.Epidermis.Dermis.Dermis.Subcutaneous layer.Subcutaneous layer.

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1) Epidermis 1) Epidermis

1. 1. KeratinocyteKeratinocyte the most important cell in the the most important cell in the epidermis become filled with a tough fibrous epidermis become filled with a tough fibrous protien called keratin.protien called keratin.

They make up more than 90% of the epidermal They make up more than 90% of the epidermal cellscells

2. 2. MelanocyteMelanocyte contribute color to the skin and contribute color to the skin and serve to decrease the amount of ultraviolet light serve to decrease the amount of ultraviolet light that can penetrate into deeper layers of the skin.that can penetrate into deeper layers of the skin.

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Cell TypesCell Types

3. Langerhans cell3. Langerhans cell : : it plays limited role in it plays limited role in immunological reaction that effect the immunological reaction that effect the skin and may serve defense mechanismskin and may serve defense mechanism for the body.for the body.

4. 4. Merkel cellsMerkel cells - - combines with disclike combines with disclike sensory nerve endings to make Merkel’s sensory nerve endings to make Merkel’s discsdiscs

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2) Dermis2) Dermis

It is some time called true skin , it is It is some time called true skin , it is composed of a thin papillary and thicker composed of a thin papillary and thicker reticular layer.reticular layer.

It may exceed 4mm on the soles and palms It may exceed 4mm on the soles and palms ..

At various level in the dermis , there are At various level in the dermis , there are muscle fibers, sweet gland, hair follicles and muscle fibers, sweet gland, hair follicles and many blood vessels.many blood vessels.

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Functions of the skin Functions of the skin

1) Protection: 1) Protection: A) from micro organism.A) from micro organism.B) from dehydration.B) from dehydration.C) from ultraviolet.C) from ultraviolet.D) mechanical trauma.D) mechanical trauma.E) painE) painF) heat and coldF) heat and cold

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Functions of the skinFunctions of the skin

2) Sensation: the widespread of the millions 2) Sensation: the widespread of the millions of different somatic sensory receptors that of different somatic sensory receptors that detect stimuli.detect stimuli.

3) Excretion by regulating the volume and 3) Excretion by regulating the volume and chemical content of sweat.chemical content of sweat.

4) Vitamin D production .4) Vitamin D production .5) Immunity (langerhan’s cell).5) Immunity (langerhan’s cell).6) Regulation of body temperature. 6) Regulation of body temperature.

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Assessment:Assessment:Cleanliness. Cleanliness. Color.Color.Temperature.Temperature.Moisture.Moisture.Sensation.Sensation.TurgorTurgorTexture.Texture.

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NURSING ASSESSMENT WHILE NURSING ASSESSMENT WHILE BATHINGBATHING

HistoryHistory RelationshipRelationship Color and condition of skinColor and condition of skin Pain on movementPain on movement Level of consciousnessLevel of consciousness InjuriesInjuries ScarsScars Skin turgorSkin turgor NeviNevi Wt loss or gainWt loss or gain

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PATIENTS AT RISK FOR SKIN PATIENTS AT RISK FOR SKIN PROBLEMSPROBLEMS

Altered level of consciousnessAltered level of consciousnessAltered nutritionAltered nutrition ImmobilityImmobilityDehydrationDehydrationAltered sensationAltered sensationSecretions on skinSecretions on skinMechanical devices, casts, restraintsMechanical devices, casts, restraintsAltered venous circulationAltered venous circulation

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Practices related skin care:Practices related skin care: 1) Bathing: practice that use soap and 1) Bathing: practice that use soap and

water to remove sweet, oil, dirt, and water to remove sweet, oil, dirt, and microorganism from skin. microorganism from skin.

Type of bathing:Type of bathing:1.1. Tube bath.Tube bath.2.2. Partial bath.Partial bath.3.3. Bed bath.Bed bath.

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1. Tube Bath:1. Tube Bath: For all clients who are independent and there no For all clients who are independent and there no

safly risk.safly risk. Nurse should encourage clients to take shower Nurse should encourage clients to take shower

independent.independent. Most bath room are equipped with rails and Most bath room are equipped with rails and

handle to promote client safety.handle to promote client safety.2. Partial bath:2. Partial bath: Washing only body area that are directly cause Washing only body area that are directly cause

odor ( face, hand, axillae, perineal area).odor ( face, hand, axillae, perineal area). Partial bathing done at sink or with basin at bed Partial bathing done at sink or with basin at bed

side.side.

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PerineumPerineum: area around the genital and : area around the genital and rectum, its required special cleaning rectum, its required special cleaning technique.technique.

When perineal care:When perineal care:After vaginal delivery.After vaginal delivery.Gynecological or rectal surgery.Gynecological or rectal surgery.Urine, stool.Urine, stool.

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3. Bed bath:3. Bed bath:Washing with a basin of water at the bed Washing with a basin of water at the bed

side.side.For client who cannot take shower For client who cannot take shower

independently. independently.

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3. Bed bath 3. Bed bath Wash head to toe, front to back, distal to Wash head to toe, front to back, distal to

proximalproximal Physical assessment as you are washing; Physical assessment as you are washing;

must also loosen and secure lines as moving must also loosen and secure lines as moving and turning patient and turning patient

Change wash clothes for different areasChange wash clothes for different areas Change water if cold or soiled or very soapyChange water if cold or soiled or very soapy Some put oil in bath water of elderlySome put oil in bath water of elderly Use powder in your hand, very sparinglyUse powder in your hand, very sparingly

not with respiratory patients or those with not with respiratory patients or those with allergiesallergies

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Change linen as needed Change linen as needed Do range of motion as neededDo range of motion as neededDo oral care, hair care, and give back Do oral care, hair care, and give back

rubrubLeave bed in low position, rails up, and Leave bed in low position, rails up, and

call light in place. Straighten room. call light in place. Straighten room. Report and chart findingsReport and chart findings

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ASSESSING TUBES AND LINESASSESSING TUBES AND LINES Oxygen – stays on during bath, check Oxygen – stays on during bath, check

connections, liters per minute, cleanliness of connections, liters per minute, cleanliness of prongs or mask, water if used, plugged in if prongs or mask, water if used, plugged in if concentratorconcentrator

IV lines – use special gown, don’t open lines to IV lines – use special gown, don’t open lines to change gown, look at IV site, rate and solution change gown, look at IV site, rate and solution

Urinary catheter – draining, unkinked, bag below Urinary catheter – draining, unkinked, bag below bladderbladder

Enteral tubes – in place, running or draining Enteral tubes – in place, running or draining properly, or clamped properlyproperly, or clamped properly

Dressings – Clean and dry, drains properly Dressings – Clean and dry, drains properly working working

Does anything need to be emptied, changed or Does anything need to be emptied, changed or cleaned?cleaned?

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Purposes of bathing:Purposes of bathing:

Provides Cleanse of skin.Provides Cleanse of skin. Acts as skin conditioner.Acts as skin conditioner. Helping in relaxation patient.Helping in relaxation patient. Promote circulation.Promote circulation. Serve as musculoskeletal exercise.Serve as musculoskeletal exercise. Promote comfort.Promote comfort. Improve body image.Improve body image.

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2) Shaving:2) Shaving:To remove unwanted body hair.To remove unwanted body hair.3) Oral hygiene:3) Oral hygiene:Practice used to clean the mouth includes:Practice used to clean the mouth includes:Tooth brushes and flossing.Tooth brushes and flossing.Denture care.Denture care.4) Hair care:4) Hair care: hair grooming, shampooing and hair grooming, shampooing and

identify patient usual hair practice and styling identify patient usual hair practice and styling preferences preferences

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5) Bed making: 5) Bed making: Make bed for patient Make bed for patient comfortcomfort

If incontinent, wash, rinse, dry, change If incontinent, wash, rinse, dry, change linenlinen

Use aids to relieve pressure pointsUse aids to relieve pressure pointsheel, elbow protectorsheel, elbow protectorsbed frame with trapezebed frame with trapeze frame to keep covers off feetframe to keep covers off feetspecial beds and mattressesspecial beds and mattresses

Position as orderedPosition as ordered

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Diagnosis: Diagnosis:

Self care deficit (bathing, grooming, and Self care deficit (bathing, grooming, and dressing) R/T pain.dressing) R/T pain.

Knowledge deficit R/T lack of experience.Knowledge deficit R/T lack of experience.Self esteem disturbance R/T body odor.Self esteem disturbance R/T body odor.

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Implementation:Implementation:

Avoid long shape finger nails, jewelry may Avoid long shape finger nails, jewelry may be irritant skin.be irritant skin.

Maintain nutrition to prevent skin dryness.Maintain nutrition to prevent skin dryness.Reduce moisturing in the irritant area such Reduce moisturing in the irritant area such

as axilla and between toes by apply corn as axilla and between toes by apply corn starch.starch.

Maintain level of cleanliness.Maintain level of cleanliness.

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Causes of skin alteration:Causes of skin alteration:

Thin and obese people.Thin and obese people.Fluid loss.Fluid loss.Excessive perspiration Excessive perspiration jaundice.jaundice.Age.Age.Poor circulation.Poor circulation.

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Hair:Hair: Hair is composed of column of dead keratinized.Hair is composed of column of dead keratinized. Its consists of shaft and root.Its consists of shaft and root.

Hair covers the whole body part but its distribution, Hair covers the whole body part but its distribution, color, texture, differ according to:color, texture, differ according to:

1.1. Location. Location. 2.2. Age .Age .3.3. Gender. Gender.

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Hair Hair Hair color is determined by the amount Hair color is determined by the amount

and type of melanin present.and type of melanin present.Melanocytes become less active with age. Melanocytes become less active with age.

Gray hair is a mixture of pigmented and Gray hair is a mixture of pigmented and non-pigmented hairs.non-pigmented hairs.

Red hair results from a a modified type of Red hair results from a a modified type of melanin that contains iron.melanin that contains iron.

AlopeciaAlopecia is the term for hair loss. is the term for hair loss.

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Culture may influence HAIR care:Culture may influence HAIR care:

Hmong – do not touch without permissionHmong – do not touch without permissionMuslim – May keep covered, wear wigMuslim – May keep covered, wear wigSikh – Does not cutSikh – Does not cut

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Importance of hair:Importance of hair:

Appearance.Appearance. Prevent heat loss.Prevent heat loss. Protection.Protection.Assessment:Assessment:

Alopecia, dandruff, lice, scabies, hirsutism.Alopecia, dandruff, lice, scabies, hirsutism.Diagnosis:Diagnosis:

Self care deficit grooming R/T activity intolerance.Self care deficit grooming R/T activity intolerance. Risk for infection R/T scalp laceration.Risk for infection R/T scalp laceration.

Implementation:Implementation:

Brushing, shampooing that stimulate circulation and distribute Brushing, shampooing that stimulate circulation and distribute the oil.the oil.

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Nail :Nail :Nails made of keratin.Nails made of keratin.

Parts of nail:Parts of nail:Nail root.Nail root.Nail body.Nail body.Nail bed.Nail bed.Clupping fingers: Clupping fingers: is condition in which the angle between the nail is condition in which the angle between the nail

and nail bed is 180 degree may cause by long and nail bed is 180 degree may cause by long term lack of oxygen.term lack of oxygen.

Koilonychias:Koilonychias: is condition of nails which is like spoon shape is condition of nails which is like spoon shape

may be caused by iron deficiency anemia. may be caused by iron deficiency anemia.

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Parts of NailParts of Nail

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Assessment :Assessment : Observe circulation; color, capillary refill Observe circulation; color, capillary refill

timetime Observe color, sensation, and movement Observe color, sensation, and movement

(CSM)(CSM) Polish removed to observe color and use Polish removed to observe color and use

pulse oximeterpulse oximeter Assess for clubbing sign of long term lack of Assess for clubbing sign of long term lack of

oxygenoxygen Cut nails straight across and file smooth; Do Cut nails straight across and file smooth; Do

not go down into cornersnot go down into corners Assess for rings too tight or too looseAssess for rings too tight or too loose

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Teeth Teeth Each tooth has three parts:Each tooth has three parts:1.1. Crown: is exposed parts of the tooth which is Crown: is exposed parts of the tooth which is

out side of gum.out side of gum.2.2. Root: is embedded in the jaw and covered by Root: is embedded in the jaw and covered by

bony tissue called cementum. bony tissue called cementum. 3.3. Pulp: is the center of the tooth contains the Pulp: is the center of the tooth contains the

blood vessels and nerves.blood vessels and nerves. Teeth begin to erupt at six month to two year.Teeth begin to erupt at six month to two year. Deciduous teeth (temporary teeth).Deciduous teeth (temporary teeth). Permanent teeth.Permanent teeth. Adults have 28 – 32 permanent teeth Adults have 28 – 32 permanent teeth

depending on wisdom teeth.depending on wisdom teeth.

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Assessment Assessment 1.1. Caries:Caries: erode tooth enamel because of erode tooth enamel because of

accumulation of sugur, bacteria.accumulation of sugur, bacteria.2.2. Tartar: Tartar: is avisible, hard deposite of is avisible, hard deposite of

plague and dead bactria.plague and dead bactria.3.3. Pyorrhea:Pyorrhea: the teeth are loose and pus is the teeth are loose and pus is

evident when the gums are pressed.evident when the gums are pressed.4.4. Periodontal disease:Periodontal disease: gums appear gums appear

spongy and bleeding.spongy and bleeding.5.5. Halitosis:Halitosis: bad breathing. bad breathing.

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Diagnosis:Diagnosis:Self care deficit.Self care deficit.Altered oral mucosa.Altered oral mucosa.Implementation:Implementation:Good oral hygiene.Good oral hygiene.Brushing and flossing the teeth.Brushing and flossing the teeth.Caring of artificial denture.Caring of artificial denture.

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Mouth care Mouth care Examine with gloves and light, especially Examine with gloves and light, especially

smokerssmokers Use only water soluble lubricantsUse only water soluble lubricants If feeding tubes present, assess for parotitisIf feeding tubes present, assess for parotitis Unconscious patient has no gag reflex, Unconscious patient has no gag reflex,

position on side for careposition on side for care May have gum hyperplasia from medsMay have gum hyperplasia from meds May have teeth staining from medsMay have teeth staining from meds May have accumulated debris in mouth May have accumulated debris in mouth

called sordescalled sordes Teach about brushing and flossingTeach about brushing and flossing

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Care of eyes:Care of eyes:Clean from inner to outer conthus with Clean from inner to outer conthus with

wet, warm cotton ball or compress.wet, warm cotton ball or compress.Use artificial tear solution or normal saline Use artificial tear solution or normal saline

every four hour, if blink reflex is absent.every four hour, if blink reflex is absent.Care for eye glass, contact lens.Care for eye glass, contact lens.

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Eye care Eye care Contact lenses usually removedContact lenses usually removed Stored in saline liquid; case labeledStored in saline liquid; case labeled Also label and safeguard glasses in drawerAlso label and safeguard glasses in drawer Clean inner to outer canthus Clean inner to outer canthus Patient must be able to blink to protect Patient must be able to blink to protect

corneacornea Never use cotton near eyesNever use cotton near eyes Treat each eye separatelyTreat each eye separately Eyes considered sterileEyes considered sterile Care of artificial eye similar to denturesCare of artificial eye similar to dentures

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Ear and nose: Ear and nose: Wash external ear with wash cloth - Wash external ear with wash cloth -

covered finger .covered finger .Clean nose by having patient blow.Clean nose by having patient blow. If indicated use nasal suction with bulb If indicated use nasal suction with bulb

syringe.syringe.Remove crusted secretion around nose Remove crusted secretion around nose

and apply moisturing gill.and apply moisturing gill.

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