Skin and Skin Layers

The skin is one of the largest organs in the body in surface area and weight.

Skin protects body from external factors,

There are three main layers of the skin.

Epidermis is the top layer of the skin, the part of the skin you see.

Dermis is the second layer of skin. It's much thicker and does a lot for your body.

Subcutaneous fat is the bottom layer.

Function of the SkinThe main functions of the skin include:

Protection of the human body

Sensation (Pressure/touch, heat/cold, pain)

Temperature regulation

Immunity (the role of the skin within the immune system)

Enables movement and growth without injury

Excretion from the body of certain types of waste materials(Excretion of water, urea, ammonia and uric acid)

Endocrine function (Synthesis of Vitamin D)

Skin structure differs according to individual development periods.

This difference is a factor that must be considered in skin care.

Skin integrity assessment

Skin integrity assessment

Inspection and palpation methods are used in skinassessment.

Turgor: The elasticity and filling of the skin.

Edema: fluid accumulation in cells and tissues. When the skin is pressed, it moves in.

Causes of deterioration of skin integrity

immobility

Sensory changes

Change in nutrition and fluid intake

The presence of body wastes and

secretions on the skin

Change in Blood Circulation

Mechanical Tools

Skin problems

dry skin

acne

erythema

pubescence

Contactdermatitis

graze

Skin cleaning The bath provides cleaning by removing sweat, dead

skin cells and some microorganisms.

It stimulates the circulation and relaxes the client(patient).

The bath reduces body odors.

The bath increases muscle tone and provides joint movements.

The bathing process allows the patient to be evaluated.

It is a good opportunity to observe the condition of the patient's body as well as communicate with thepatient.

What should be attention during bathing?

Protecting the privacy of the patient

Providing patient safety

Do not chill the patient

The development of the patient's sense of independence

Attention should be paid to the physical and psychosocial aspects of the patient.

The baths are divided according to the purpose of the application:Cleaner baths;

* Full baths in the bed

*Partial baths

*Bathtub baths

Therapeutic baths;

* Hot baths

* Medicated baths

Indications of full baths

Unconscious patients

Paralyzed patients

Babies and old people

Patients with bed rest

If the post-operative patient is bed-dependent (eg, Abdomenic surgery)

If the patient is dependent on the bed after acute illnesses,

Partial baths;

Partial baths are given if the patient can not tolerate full bed baths or the whole body needs no cleaning.

In this bath; the face, neck, hands, back, armpit and perineal region of the patient are cleaned.

Bathtub baths;

Bathtub baths are done for patients who move independently or need a little help.

FULL BED BATH

1. Gather necessary equipment.

2. Wash your hands. Put on gloves.

3. Explain what you are going to do.

4. Provide privacy.

5. Offer bedpan/urinal then empty, clean, and put it away.

6. Remove gloves and discard in appropriate container. Wash hands. Put on clean

gloves.

7. Place client in supine position near the side of the bed nearest you.

8. Un-tuck bed linens.

9. Remove bedspread and blanket; fold and place on chair if reusing; otherwise,

place in laundry basket.

10. Cover top sheet with a large towel. Ask the client to hold the towel in place; if

unable, tuck under client's shoulders.

11. Remove top sheet without disturbing the towel and place in laundry basket at

bedside.

12. Remove client's gown or pajamas.

13. Fill bath basin 2/3 (two over tree) full of warm water (43- 46°C). Check temperature with inner aspect of arm.

14. Place a towel across the client's chest.

15. Wet washcloth and squeeze out excess water. Make a washcloth mitt.

16. Wash eyes first. Start at inner corner and work out. Use different area of

washcloth for each eye. Don't dangle the ends of the washcloth.

NOTE: DO NOT USE SOAP ON OR NEAR THE CLIENT'S EYES.

17. Wash, rinse, and dry face, ears, nose, and mouth.

NOTE: ASK THE CLIENT IF HE/SHE WANTS SOAP USED ON HIS FACE.

18. Wash, rinse, and dry neck.

19. Expose arm farther from you; place towel under arm up to axilla.

20. If the client is able, place a basin of water on the bed and immerse client's hand in water and wash.

21. Wash and rinse far shoulder, axilla, arm, and hand.

22. Remove the basin and dry the client's arm, shoulder, and hand.

23. Repeat steps 21-23 with arm closer to you.

24. The In-Home Aide may perform fingernail care at this time.

25. Place towel across chest.

26. Wash and rinse chest and breasts while lifting towel.

27. Dry skin thoroughly.

28. Keep chest covered with towel.

29. Wash, rinse, and dry abdomen.

30. Change bath water in basin. Obtain a clean washcloth.

31. Expose the farther leg; flex (bend) leg and place bath towel lengthwise under the leg up to the buttocks.

32. Wash and rinse leg and foot.

33. Dry leg, foot, and in between toes.

34. Repeat steps 32-34 on leg nearer you; cover client with bath blanket.

35. May perform toenail care at this time.

36. Place the towel and washcloth in a laundry basket and get clean ones.

37. Change bath water in basin. Obtain a clean washcloth.

38. Ask or assist the client to turn on his side with back towards you.

39. Fold a towel over the client's side to expose his back and buttocks; place clean towel parallel to client's back.

40. Wash, rinse, and dry the client's back and buttocks.

41. Give backrub using warmed lotion.

42. Turn client to back; place clean towel under buttocks.

43. If client is able, provide wash cloth, soap, and towel and instruct him to wash and dry peri area.

44. If the client is unable, wash peri area from front to back.

45. Place dirty linen in appropriate container.

46. Remove and dispose of gloves. Wash hands.

47. If client did own peri care, provide fresh water for client to wash hands.

48. Apply warmed lotion and deodorant as needed.

49. Put clean clothing on client without exposing him.

50. Remove, clean, and store equipment.

51. Wash your hands.

52. Make the client comfortable.

53. Record observations and report anything unusual to nurse/supervisor.

NOTE: LINENS ARE USUALLY CHANGED WHEN THE BED BATH IS COMPLETED, USING THE PROCEDURE FOR OCCUPIED BED MAKING.

Bed baths must be made towards from the head to the foot, from the clean area to the

dirty area.

For this reason, the cleaning process begins at the eyes of the face and ends with

the cleansing of the anal region.

MASSAGE

Massage reduces tension in the muscles, allows relaxation and stimulates blood circulation in tissues.

1. Effleurage: An effleurage movement is a relatively slow and smoothly continuous stroke using the flat of the hand.

2. Petrissage:

Petrissage movement is made to subcutaneous tissues and muscles

3. Frictions:

Circular frictions are applied using the tips of fingers or thumbs using some pressure and some circular stationary manipulation

4. Tapotement:

It is a rhythmic percussion, most frequently administered with the edge of the hand, a cupped hand or the tips of the fingers

5. Vibration:

Vibration massage technique is a trembling movement performed with hands or fingers.

Daily Self Care Applications

Pre-breakfast Care

Morning Care

Night Care

Oral (Mouth) Care

Cleans the inside of the mouth structure

Prevents oral infection

Gets sense of cleanliness and comfort

The most commonly used oral care solution is SODIUM BICARBONATE.

Ready-made oral care solutions are also available.

Oral Care Process

•Gather necessary equipment.

•Wash your hands

•Explain what you are going to do.

• Provide privacy.

•Give the patient lateral, supine or semi-

fowler position.

•Put on clean gloves.

•Open the mouth of the patient if the mouth is closed

•Evaluate tooth, gingival and oral mucosa.

Aspirate the accumulated spit.

•Place the kidney tub under the patient's chin.

Place face towel

If the patient is using a prosthesis, remove the prosthesis first

and clean the prosthesis

∞ Make every

cleaning with

different material

Apply a moisturizer to prevent drying of the lips.

Remove and dispose of gloves. Wash

hands.

Remove and throw the equipment

Record observations and report anything unusual

to nurse/supervisor.

if it is suitable for the

patient, teeth can be

brushed and dental floss

can be used.

Hair bath

Today, with the developing technology, the hair bath in the bed has become more

practical.

Hair bath in bed

Lay out all your supplies so you know you have everything you’ll need

Protect the bed to keep it from getting wetFill one bucket with warm water

place patient's head into the inflatable basinMake sure the basin is set up to drain into the empty bucketScoop warm water from the full bucket to wet their hair

Use a small amount of shampoo to wash their hair – using too much will make it difficult to rinse out

Scoop warm water to rinse hair completelyIf hair is very dirty, shampoo and rinse againWhen hair is clean, gently remove your

senior’s head from the basinWrap their head in a dry towel to keep them

warm and comfortableMake sure the basin is fully drained

FOOT CARE

Place the patient's feet in hot water.

Place towel under the feet of the feet.

Foot care must be made towards from the clean area to the dirty area.

If the fingernails are long; cut straight

Apply moisturizer if necessary.

1. Gather necessary equipment.

2. Wash your hands. Put on gloves.

3. Explain what you are going to do.

4. Provide privacy (very important)

5. Female patients should be given dorsal recumbent and male patients should be given supine position.

Female Clients;

•Clean perineum from the

midline outward in

following order

a. The vulva

b. The labia

c. Inside of labia on both

sides.

d. Outside of labia on both

sides.

Clean the perineal region

and anus thoroughly.

Male Clients;

the penis is held from its

body and wiped from

urethral meatus to pubis

with circular motion.

Anal region cleaning;

Clean anal region from the pubis to the anus.

Repeat the process until the area is cleared.

Record the procedure with date and the observations made.

Clean or throw all equipments

Wash hands

Change bed linen and dress if necessary

Make patient comfortable.

Patient Education

a health professional should explain to patients;

What are these???

the importance of individual hygiene

How, how often and what materials hygiene practices should be done?

Why skin integrity is important?

Health personnel should teach the use of assistive devices to protect the patient from falling and trauma.