personal hygiene it is the nurses responsibility to provide the patient with the opportunity for...
TRANSCRIPT
Personal Hygiene
It is the nurses responsibility to provide the patient with the opportunity for hygiene
HYGIENE
PART 6-A
Purpose of Bathing Cleansing the skin
Removes perspiration, bacteria, which minimizes skin irritation and reduces chance of infection
Stimulation of circulation Warm water and gentle strokes from
distal to proximal increase circulation and promote venous return
Improve self-image Promotes feeling of being refreshed,
relaxed
Purpose of Bathing
Reduction of body odors Especially in axillae and pubic
areas Promotion of Range of Motion
Movement of extremities while bathing
Nurse’s Advantage
Provides opportunity to develop a meaningful nurse-patient relationship
Provides opportunity for assessment of the patient including condition of patient, psychosocial and learning needs.
Before You Begin Bathing
It is the Nurses Role to:
Assess Your Patient
Factors Affecting Personal Hygiene
1. Cultural / Religious
2. Developmental Stage
3. Mobility
4. Emotional
5. Physical Illness
6. Personal Preference
Critical Thinking
Situation: The Nurse enters Mrs. G’s room to
do a complete bed bath and she says “I do not want my bath now, I just want to rest”.
What should the nurse do now?
Critical Thinking
Situation: The nurse enters Mr. C’s room to
do a complete bed bath and he says “I do not want my bath now, I just want to rest”. You notice that his bed is wet and he was incontinent of urine.
Now what should the nurse do?
Types of Baths
Cleansing Baths Used to clean the patient
Cleansing Baths Complete Bed Bath
Nurse baths entire body of dependent patient in bed
Self-Help Bath Patients confined to bed are able to bathe
themselves with some help
Partial Bath Parts of the body are washed by the
patient and some by the nurse
Cleansing Baths
Tub Bath Much easier for bathing and rinsing than in a bed
Varies in style
types of baths
Shower Used by ambulatory patients who require only minimal assistance
Can be used with a shower chair
Types of Baths
Therapeutic Baths Bath used for treatment Usually requires a doctor’s order
Therapeutic Baths
Medicated solutions may be used in bathing
Range from warm water baths, cool water baths, cornstarch, oatmeal, Aveno, alcohol
Back Rub May be performed after drying off the back during the bath.
Position of Patient: Prone or side-lying
Expose only the back, shoulders, upper arms. Cover remainder of body
Lay towel alongside back
Warm lotion in your hands—still explain that it may be cool and wet.
Back Rub Start in the sacral area, moving up the
back. Massage in a circular motion over the
scapula. Move upward to shoulders, massage over
the scapula Continue in one smooth stroke to upper
arms and laterally along side of back down to iliac crests.
Do NOT allow your hands to leave the patient’s skin
End by telling your patient that you are finished
Guidelines for Bathing
1.Provide Privacy
2.Maintain Safety
3.Maintain warmth
4.Promote the patient’s independence as much as possible
Procedure for Bathing
Bed Bath Harkreader p. 799-803
Tub Bath or Shower Harkreader p. 806-807
Part B: Perineal Care
Hygienic measures
related to the care of the genitalia.
Perineal Care 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.”
Perineal Care
Those patients who may need the nurses assistance: Vaginal or urethral discharge Skin irritation Catheter Surgical dressings Incontinent of urine or feces
Perineal Care ProcedureNormal conditions, Discharge, Menses
Women 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
Cont. Female Perineal Care 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
Perineal 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 continued
Cont. Perineal 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
Procedure 31-2Procedure 31-2: Harkreader, p. 804-805
Perineal Care with Catheter
Follow similar procedure in the male patient.
Start at the urethra opening and clean outward.
Part C: Oral Hygiene
Maintains the healthy state of the mouth Cleanses teeth of food particles, plaque, and
bacteria Massages the gums Relieves discomfort from unpleasant odors
and tastes. Refreshes the mouth and gives a
sense of well-being and thus can stimulate appetite.
Assessment: Oral Hygienea. Frequency
Depends on the condition of the patient’s mouth. Some patient’s with dry mouth or lips need
care every 2 hours. Usually done twice a day or after each meal
b. Assistance Needed Does the patient need assistance to do oral care
*The nurse can help patients maintain good oral hygiene by:
1. Teaching them correct techniques 2. Actually performing for weakened or disabled patients.
Oral Hygiene Assessment
c. Abnormalities Loose or missing teeth Swelling and bleeding of gums Unusual mouth odor Pain or stinging in mouth structures
Brushing
Major concerns are: Thoroughness in cleansing Maintaining the condition of the oral
mucosa.
Procedure for Conscious Patient: Upright position Get out your textbook--Harkreader: p. 813-814
Brushing: Unconscious Patient
See performance checklist in syllabus Safety is of utmost importance Prevent aspiration
1. Positioning—lateral position with head turned to the side or side-lying. Position back of head on a pillow so that the face tips forward and fluid/ secretions will flow out of the mouth, not back into the throat.
2. Place a bulb syringe or suction machine with suction equipment nearby. Yankuer end on suction device.
Oral Hygiene: Unconscious Patient
Keeping the mouth open1.Use a padded tongue blade to open the
patients mouth and separate the upper and lower teeth
2.Never place your hand in the patient’s mouth or open with your fingers. Oral stimulation often causes the biting –down reflex and serious injuries can occur.
Harkreader p. 814-815
Denture Care Clean dentures as frequently as natural teeth
Dentures are the patient’s personal property and should be handled with care because they can be easily broken.
Care: Remove before going to bed – allows gums
to rest and prevents buildup of bacteria. Store in a labeled container covered with
water or denture cleaner if available
Denture Care Procedure: Harkreader p. 815 Tips to remember:
Use gauze squares or washcloth to grasp front of dentures to prevent from slipping
Place wash cloth or paper towel in sink to line it while you are cleaning the dentures
Work close to the bottom of the sink in case you drop them.
Use tepid water
Part D: Hair Care
A person’s appearance and feeling of well-being often depends on the way their hair looks and feels
Major Goals in Hair Care
Stimulate Circulation
Prevents Matting
Brushing and Combing
Keeps hair clean and distributes oil evenly along the hair shaft
Combing styles hair and prevents from tangling
Assessment while brushing Scalp lesions, abrasions Dandruff Parasitic infestations Quality of hair Appearance
Hair Care: Shampooing Depends on:
Personal preference of the patient, does not have to occur every day with hygiene
Condition of the hair
Ways to Shampoo If patient can get up and into a shower or sink,
use a hand held nozzle If patient can not get up, place on stretcher and
roll to a shower area If patient is unable to be moved, may shampoo
in the bed – see procedure in Harkreader p. 817-818.
“Shampoo in a Bag” or dry shampoos are available
Part E: Shaving
Improves self-esteem and emotional needs of the patient
Usually done after the bath or shampoo
Assessment: Skin for elevated moles, warts,
Rashes, patchy skin lesions, or pustules
Shaving Provide SafetyProvide Safety
When using a razor blade, the skin must be softened to prevent pulling, scraping, or cutting
Place a warm wash cloth over area and then apply some gel, cream, foam.
Hold the razor at a 450 angle
Pull the skin taut Shave in the direction of
hair growth
Shaving
Safety Precautions
Electric razors must be used in patients who are at risk for bleeding, confused, or depressed
Part F: Foot and Nail Care Usually part of the bath
Purpose: Eliminate sources of infection and
decrease odors
Assessment: Color, shape length, texture of nails Condition of skin around nails and
between toes and fingers – swollen, inflamed, callused, lesions, temperature
Foot and Nail Care Soak the hand or foot to
soften the cuticles
Thoroughly cleanse and dry
Trim the nails ONLY if you have permission or it is allowed at that institution. Most institutions do not allow nurses to trim the nails.
Foot and Nail Care
Teach patient and family that nails should be cut – straight across. May need to get a referral if no one available to cut nails.
Show close attention to the feet and nails
of the diabetic patient and the elderly
** If feet and nails are in bad condition– notify doctor so a consult can be ordered with a podiatrist
Part G: Ear Care
Usually requires minimal care
Cleanse the external auricle with washcloth when bathing
Avoid insertion of objects into the ear
Hearing Aidsa. Check that the device is functioning correctly and
clean any body oils or cerumen from the hearing aid
b. Make sure the hearing aid is off and volume is down before insertion
c. Insert hearing aid in ear by pulling earlobe downward while pressing the hearing aid inward
d. Turn on and adjust volume
e. Ask the patient if comfortable and can they hear!
Part G: Eye Care
Assessment: Abnormal lesions Discharge Tearing Presence of any infection Use of Visual Aids (contacts, glasses)
Ask when patient needs to use these devices
Eye Care Wash around the eyes with a warm moist
washcloth with warm water—NO SOAP!
Clean from the inner canthus to the outer canthus of the eye. Pay special attention to the inner canthus.
Provide special care for the eyes of unconscious patients. May need to tape the eye lids shut if
unable to blink and protect own eyes
Part H: Elimination Care
Optimum elimination occurs when the patient can use a toilet and eliminate in private.
Elimination Hygiene
There are various circumstances when a patient will have to use a bedpan or urinal for elimination
Elimination Hygiene
Assist patient’s in a respectful way
Assist to be comfortable especially when using a bed pan
Provide privacy
Do not hurry
Elimination Hygiene Types of Devices
Bedside commode
Urinal
Bedpan Regular Orthopedic / fracture
Elimination HygieneProcedure for Using Bedpan / Urinal
1. Bring to the bedside2. Warm the bedpan if it is metal3. Place bed in appropriate position4. Fold the top linen back to allow for
placement of bedpan or urinal5. Have patient assist by bending knees
and lifting up, place hand under lower back and slip into place.
or
Use of Bedpan
6. Turn to the side and roll back onto the bedpan
7. Check placement Bedpan - when the buttocks rest on
the rounded edge of the pan Urinal – penis is inside, urinal rests on
the bed
Procedure for using bedpan / urinal
8. Raise head of bed to upright sitting position
9. Place call light and toilet within reach. Leave the patient if safe to do so, with side rails up
10. Removal• Same manner as offered; hold
steady• Cover the pan
8. May need to clean up the patient
9. Note character of contents, chart
10. Clean the pan or urinal
11. Unglove and Wash hands
Assisting with a Condom Catheter
Purpose: Control incontinence in a male patient
without the risk of urinary tract infection Greater comfort to the patient than an
indwelling catheter
Equipment Needed Condom catheter Soap and water, washcloth, towel Disposable gloves Drainage bag and tubing
Condom Catheter - Procedure
Wash hands Place patient in supine position, provide
privacy, close door and drape with only penis exposed
Apply gloves, Cleanse area with soap and water, dry
Assess for any skin breakdown, redness Wrap adhesive spirally around the shaft of
the penis Place rolled condom over the penis and
unroll over the penis and adhesive, press condom to the strip
Attach drainage bag and tubing to the catheter Check that tubing is not twisted and lies over top of leg. Cover the patient, return bed to
low position Assess later to be sure that it is
secure and not leaking. Empty bag as necessary Remove condom daily to clean
the area and assess the skin integrity.
Part I: Antiembolic Prevention
Patients who are immobile are at risk for stasis of blood in the lower extremities and development of thrombophlebitis.
Contraction and relaxation of skeletal muscles helps to move blood through veins toward the heart
Valves within the veins prevent the blood from slipping back toward the feet under the influence of gravity.
When circulation slows, clots (thrombi) are more likely to form in those patients with limited activity or incompetent valves.
A blood clot can break loose and travel through the blood stream as an embolus leading to potential severe complications.
Purpose of Antiembolic Measures
1. Promote the circulation of blood from the legs back to the heart- increase venous return; decrease venous stasis
2. Support valves within peripheral leg veins so that blood is less likely to pool in a dependent position- decreases dependent edema
3. Prevent thrombus formation
Assessment
1. Identify conditions that increase the potential for poor circulation and clot formation• Post-operative• Varicose veins• Thrombophlebitis• Dehydration• Pregnancy
2. Examine lower extremities for poor circulation (Cold, cyanosis), intact skin or ulcerations, distended leg veins, peripheral pulses
3. Assess past history for developing blood clots
Interventions / Preventive Measures
1. Leg and Foot Exercises
2. Antiembolism stockings
3. Sequential Compression Devices
4. Avoiding compression of leg vessels
Leg and Foot Exercises Alternately flex and extend the foot five times. Make circular movement with the feet five times
to the left and then repeat to the right. A leg exercise is to bend the knee and draw the
foot up to the thigh, and then extend the leg.
These exercises can be active – just have the patient do these ever so often on their own;
Or passive. It is common to include these range of motion exercises as part of the bath for the immobile patient and at least every 2 hours for the post-operative patient.
Antiembolism Hose Antiembolism stockings are elasticized stockings
that provide varying degrees of pressure at different areas of the legs.
To provide the optimum amount of pressure, the stockings should fit properly and be free of wrinkles. To ensure a proper fit, the patients leg is
measured in length and circumference and then refer to the manufacturer’s chart to obtain the correct hose size.
Length Circumference
Procedure for Applying TED Hose Do not follow procedure in book
Place patient in supine position in bed with leg horizontal for 15 minutes
Turn the stocking inside out by placing one hand into sock, holding the toe with the other hand, and pull inside out
Place patient’s toe into foot of elastic stocking
Application of TED Hose Slide remaining stocking
over foot, Now the stocking will be right side out
Never allow to make a tight band around the leg.
Be sure to smooth stocking having no wrinkles.
Antiembolism Hose
Nursing Care:1. Assess the lower extremities EVERY SHIFT. Toe area should have an opening that can be
pulled back and the toes and feet assessed for function and any neuro-circulatory problems.
Toes should be warm, pink, good capillary refill, can wiggle toes, has feeling in toes with no tingling.
2. Remove ONCE EACH DAY and inspect the feet and toes.
TED Hose Document
0830 -- Calf length TED hose applied, skin warm and pink with no lesions. Instructed patient in use, verbalized understanding. Stated they felt good
--------------------------------------J. Ward R.N.
Sequential Compression Devices SCD’s
Purpose: Enhance venous return
by applying intermittent external compression to the tissues and veins similar to the normal physiologic pumping mechanisms of the muscles.
Sequential Compression Device
Disposable plastic sleeve wrapped around the patients leg and secured with velcro.
The sleeves are then connected to an air pump that alternately
inflates and deflates the air tubes in the sleeves. The sleeves are inflated in sequence from the bottom of the leg to the top, helping to move venous blood out of the leg veins and toward the heart.
Sequential Compression Devices
Place patient in supine position with legs horizontal for 15 minutes.
Apply antiembolism hose, if desired Measure circumference of upper thigh Open inflatable sleeve on the flat bed,
cotton side up, and place the patients leg on the sleeve Wrap sleeve snugly around the leg, fasten with velcro
Sequential Compression Devices
Connect tubing on sleeve to compression controller
Turn on ordered settings
Remove three times daily and inspect skin
Sequential Compression Devices
Document:
0900 – sequential compression devices placed on both legs set on low. Skin on lower extremities warm, dry, pink. Explained use to patient, verbalized understanding. -----------J. Ward R.N.
0900 – SCD’s in place on both lower extremities. Toes warm and pink, pedal pulses present---------------------------------------------------J. Ward R.N.
Avoid Compression of Legs
Watch positioning of the patient’s lower extremities. Do not allow the tubes, equipment to be placed under the legs to compress circulation
Place lower extremities on pillows to position correctly.
Encourage patient to not cross legs or feet.