Nursing 215 Chapter 22: Facilitating Hygiene

Learning Outcomes

• Understand the connection between personal hygiene and overall health and well-being.
• Recognize various factors that influence personal hygiene practices, including preferences, culture, economic status, and developmental levels.
• Discuss the role of nurses in assessing patients' self-care abilities and delegating hygiene tasks to unlicensed assistive personnel (UAPs).
• Identify nursing diagnoses related to hygiene and self-care deficits.

Key Concepts

• Hygiene is crucial for maintaining cleanliness and preventing infections.
• Activities of Daily Living (ADLs) encompass routine hygiene tasks that promote personal comfort and self-image.
• Self-Care Ability refers to a patient's capacity to perform personal hygiene activities independently or with assistance.

Patient Case Studies

• Mrs. Williams: 76-year-old woman post-CVA, experiences paralysis on the right side, struggles with communication but is culturally proud of her hygiene habits and requires assistance.
• Mr. Gold: 68-year-old man post-heart attack, unresponsive, has dry mucous membranes and hygiene deficits, with specific cultural and spiritual considerations due to Orthodox Jewish beliefs.

Factors Influencing Hygiene Practices

• Personal Preferences: Individual choices regarding types of baths or use of products can vary significantly.
• Cultural and Religious Beliefs: Specific guidelines and practices can dictate hygiene routines, such as frequency of bathing.
• Economic and Environmental Factors: Limited access to facilities or hygiene products can severely impact personal hygiene.
• Developmental Level: Influences change from dependence in infancy to independent practices in adulthood.

Health Status and Self-Care Ability

• Factors such as pain, limited mobility, sensory deficits, and cognitive impairments can dramatically affect a person's ability to maintain hygiene.
• Emotional health, such as depression, can lead to neglect of personal grooming and hygiene tasks.

Assessment and Nursing Diagnosis

• Regular assessment of functional status regarding hygiene practices is essential.
• Nursing diagnoses for self-care deficits include:
  • Bathing/Hygiene Deficit
  • Dressing/Grooming Deficit
  • Feeding Deficit
  • Toileting Deficit
  • Self-Neglect

Planning Interventions

• Individualized Care: Create tailored hygiene plans based on patients' specific needs and capabilities.
• Use assistive devices when necessary and encourage the maximum possible independence in hygiene routines.

Practical Knowledge: Self-Care Assessment

• Routinely assess patient functionality in ADLs using tools like the Katz ADL Index.
• Collect both subjective and objective data related to skin, feet, nails, and oral hygiene to determine the patient's self-care abilities.

Importance of Hand Hygiene

• Hand hygiene is essential in preventing infection; patient engagement in this practice increases the compliance of healthcare workers.

Routine Hygiene Assessments

• Assess various body parts such as skin, feet, nails, mouth, hair, eyes, ears, and nose to ensure comprehensive hygiene care.

Types of Baths

• Complete Bath: Full body wash.
• Assisted Bath: Helped by personnel.
• Partial Bath: Only certain areas washed.
• Towel Bath: Wet towel used for cleaning.
• Bag Bath: Pre-moistened cloths for convenience.
• Shower Bath: Standing wash.
• Tub Bath: Immersive bathing.
• Therapeutic Bath: Treatment-focused soaking.

Goals for Self-Care Deficits

• Outcomes should focus on promoting patient independence and capability in hygiene practices.

Key Takeaway

• Maintaining hygiene is vital for physical and mental health; nurses play a crucial role in assessing, planning, and implementing care strategies that respect patient individuality and promote self-sufficiency.### Feet and Nails Assessment
• Inspect skin between toes for cracks or fungal infections; observe color and temperature for bilateral comparison.
• Cold, dusky feet may indicate impaired circulation or peripheral vascular disease.
• Check capillary refill time; a slower return indicates circulation issues.
• Note any foot odors, as they can signify infection or hygiene issues.
• For nail assessment, inquire about nail care practices and history of problems.
• Objective assessments include examining nail shape, cleanliness, presence of hangnails, and condition at nail bases.

Oral Cavity Health

• Subjective data includes usual oral hygiene practices, history of periodontal issues, and financial constraints affecting dental care.
• Objective observations include inspecting lips, oral mucosa, gums, and tongue for color, lesions, and overall cleanliness.
• Healthy gums should show defined margins and no bleeding; the tongue should be symmetrical and pink.
• Note any bad breath or unusual mouth odors as indicators of oral health.

Hair and Scalp Care

• Gather subjective data regarding hair care products, history of hair disorders, and conditions affecting hair.
• Inspect hair for cleanliness, texture, oiliness, and scalp conditions such as dandruff or lice.

Eye Assessment

• Inquire about eyeglass or contact lens usage, types, and cleaning habits to assess eye health.
• Inspect for redness, lesions, or discharge in the eyes and evaluate the conjunctivae color.

Scheduled Hygiene Care

• Hourly rounds promote patient comfort by addressing self-care needs and reducing call light usage.
• Early morning care involves assisting with personal hygiene before breakfast and any required preparations.
• A.M. (morning) care entails comprehensive hygiene activities including bathing and oral care.
• P.M. (afternoon) care centers on patient readiness for rest or visitors, focusing on comfort measures.
• H.S. (hour-of-sleep) care provides routine hygiene with additional comfort measures, like back massages.

Delegating Hygiene Care

• UAPs often perform hygiene tasks, but patient safety and UAP experience must be assessed before delegation.
• Nurses must evaluate patients' conditions to determine the appropriateness of delegation.

Nursing Care Plan Example

• Case study of Fred Williams highlights a total self-care deficit due to decreased consciousness post-cerebral hemorrhage.
• Emphasis on oral care with specific goals aimed at reducing mouth odor and improving moisture.
• Research-backed interventions include regular mouth assessments and hygiene measures at least every 2-4 hours.

Skin Care Basics

• The skin's two layers: epidermis (outer, protective) and dermis (contains blood vessels and glands).
• Functions of skin include protection against infections, sensation, thermoregulation, secretion/excretion, and Vitamin D synthesis.
• Common skin problems to monitor: pruritus, dryness, maceration, excoriation, abrasions, and pressure injuries.

Risk Factors Affecting Skin Integrity

• Risk factors for skin issues include dampness from excessive perspiration or fecal incontinence, dehydration, and poor circulation.
• Nutritional status impacts skin health; obesity or being underweight can lead to skin problems.
• Lifestyle choices, aging, and developmental stages (from fragile infant skin to mature, resilient adult skin) affect skin conditions.

Practical Assessment Guidelines

• Conduct assessments respectfully, ensuring patient privacy and comfort during examinations.
• Be aware of room temperature to prevent chilling during skin examinations.### Subjective Data Collection
• Assess patient’s regular bathing and skin care habits, preferences, and history of current or past skin issues and their impact.
• Inquire about the use of prescription, over-the-counter, or herbal skin remedies.
• Identify any allergic reactions to food, medications, plants, or skin care products.
• Gather medical history related to conditions affecting skin health, like decreased mobility, circulation issues, incontinence, or poor nutrition.

Objective Data Inspection

• Perform a head-to-toe skin assessment noting cleanliness, condition, color, texture, hydration, and temperature.
• Look for rashes, lumps, lesions, cracks, and drainage from wounds or tubes.
• Document changes in skin color indicative of various conditions:
  • Pallor: Pale skin in light-skinned individuals; ashen or yellow tones in dark-skinned individuals.
  • Erythema: Redness due to vasodilation and inflammation; palpate for warmth in dark-skinned individuals.
  • Jaundice: Yellow discoloration noted in the sclera of the eyes due to liver impairment.
  • Cyanosis: Bluish skin color from oxygen deprivation; seen in conjunctiva, tongue, and palms in dark-skinned individuals.

Normal Skin Changes in Older Adults

• Epidermis: Thinner skin, slower healing; appears pale and translucent.
• Subcutaneous tissue: Less fat, reduced thermoregulation, leading to fragile protection over bony areas.
• Dermis: Weakened collagen and elastin fibers cause wrinkling.
• Glands: Reduced sebaceous and sweat gland activity results in dry, scaly, itchy skin; difficulty regulating temperature.
• Melanocytes: Decrease in number leads to graying hair and uneven pigmentation.
• Nails: Thickening and slower growth, with higher susceptibility to tears.
• Skin growths: Increased benign growths due to sun exposure; skin cancers are more prevalent.

Nursing Diagnoses

• Impaired Skin Integrity: Focus on treatment/prevention of skin conditions.
• Risk Factors: Conditions such as moisture, dehydration, immobility, nutritional deficiency, and systemic diseases increase risks.
• Characteristics of Impaired Integrity: Interruptions in skin layers can lead to infection risk and affect self-esteem.

Planning and Outcomes

• NOC Standardized Outcomes: Include outcomes related to tissue integrity, wound healing, self-care, and self-esteem.
• Patient Goals: Maintain intact skin, remain free of lesions and secretions, and adhere to dryness-improving regimens.

Nursing Interventions for Skin Care

• For Impaired Integrity: Bathing, cutaneous stimulation, pressure management, skin surveillance, wound care.
• Risk Prevention: Add bed rest care, circulatory precautions, and positioning strategies.

Techniques for Patient Bathing

• Bath Types: Choose based on patient's needs and preferences, including assist, complete, or partial baths.
• Bed Baths: Use prepackaged products for consistency and reduced infection risk.
• Towel Bath: Efficient, with quick application, beneficial for patients with skin integrity issues or dementia.
• Shower and Tub Baths: Preferred for ambulatory patients, providing relaxation and cleansing.
• Therapeutic Baths: Prescribed to alleviate specific skin conditions or discomfort.

Perineal Care Importance

• Crucial for preventing odor, skin irritation, and infection, particularly for incontinent patients.
• Approach with professionalism, ensuring privacy and comfort during care.

Bathing Patients with Dementia

• Adjust bathing techniques to reduce agitation and fear; employ towel or bag baths for comfort.
• Use distraction methods, maintain routine, and focus on patient comfort to enhance experience.

Considerations for Morbidly Obese Patients

• Thorough skin assessments are vital; reposition patients carefully.
• Address hygiene challenges with adaptive equipment for effective cleaning.
• Manage moisture in skinfolds to prevent infections; utilize barrier creams when necessary.
• Frequent repositioning helps alleviate pressure and friction concerns associated with obesity.

Key Considerations

• Maintaining patient dignity and comfort during all skin and bathing interventions is paramount.
• Continuous assessment should inform care adjustments based on patient-specific needs.