Hygienic Care PDF

Hygienic Care  Learning Outcomes 1. Discuss hygienic care that nurse provides to clients (hair, mouth, perineal-genital care, feet and nail care). 2. Identify the factors influencing personal hygiene. 3. Identify normal and abnormal assessment findings while providing hygienic c...

Hygienic Care  Learning Outcomes 1. Discuss hygienic care that nurse provides to clients (hair, mouth, perineal-genital care, feet and nail care). 2. Identify the factors influencing personal hygiene. 3. Identify normal and abnormal assessment findings while providing hygienic care.  Hygienic Care Hygiene The science of health and maintenance Personal Hygiene Self-care by which people attend to such functions as bathing, toileting and general body hygiene and grooming  Cleansing by nurse is part of historical giving of care. The more ill patient, the more skill needed in providing the hygiene care. Cleansing the skin is the first line of defense against organisms.  A highly personal matter determined by individual values and practices. Involves care of the skin, hair, nails, teeth, oral and nasal care, eyes, ears and perineal-genital areas. Essential for the nurse to assess the level of assistance a client needs for hygienic care. Common terms used to describe types of hygienic care: 1. Early Morning Care care provided to client’s as they awaken in the morning consist of providing a urinal or bedpan to the client confined on the bed washing the face and hands giving oral care 2. Morning Care often provided after the client had breakfast or before breakfast provides elimination needs, a bath or shower, perineal care, back massages and oral, nail and hair care 3. Afternoon Care often includes providing a bedpan or urinal, washing the hands and face and assisting with oral care 4. As needed (PRN) care: provided only if necessary Factor influencing individual hygiene: Culture Religion Environment Development level Health and energy Personal preferences Functional Level of the Client: 1. Totally dependent 2. Partially dependent 3. Independent Guidelines for Skin Care: intact healthy skin is the body’s first line of defense all skin care measures prevent injury and irritation avoid scratching the skin with jewelry or sharp nails  harsh rubbing or use of rough towels can damage the skin bottom sheets are kept wrinkle-free prevent undue pressure on toes with top sheets  skin that is poorly nourished and dry is less able to protect and more vulnerable to injury use of lotions or creams can be encouraged the greater the subcutaneous tissue, the more padding over bony prominences Assessment of the skin: 1.cleanliness (clean or dirty) 2. uniformity of skin color 3.hyperpigmentation or hypopigmentation Skin color: – Erythema: Redness – Cyanosis: Blue – Jaundice: Yellow – Pallor: White 4. Edema: collection of fluids inside the tissue. 5. Skin moisture: a. Excessive moisture (hyperthermia) b. Excessive loss of moisture (dehydration) 6. Skin temperature: Generalized hyperthermia and hypothermia 7. Skin mobility & turgor: – elasticity by lifting and pulling the skin at the back of forearm – Skin moves back slowly in dehydration 8. Sensation: decrease sensation in extremities due to nerves system disease 9. Skin lesions Abrasion: superficial layers of skin are scraped. Sore: damage in skin layers Scar: fibrous tissue 10. Scabies Scabies Mite contagious skin infestation by the itch mite burrow lesion in the upper layers of the skin burrows are short, wavy, brown and black, threadlike lesions ( webs of the fingers and folds of the wrist and elbows) causes intense itching especially at night Treatment: thorough cleansing of the body with soap and water application of scabicide lotion all linens should be washed in very hot or boiling water  Bathing The Client Bathing removes accumulated oil, perspiration, dead skin cells and bacteria stimulates circulation Excessive Bathing interfere intended lubricating effect of the sebum, causing dryness of the skin  rubbing with long smooth strokes from the distal to proximal parts of extremities (farthest to the point closest) facilitates well-being refreshing and relaxing, improves morale, appearance and self-respect  offers nurse excellent opportunity to assess the client Categories: Two (2) 1. Cleansing baths 2. Therapeutic baths Cleansing Baths 1.Complete bed bath Nurse washes the entire body of a dependent client on bed 2. Self-help bath Clients confined to bed are able to bath themselves with help from nurse (washing back and feet) 3. Partial bath only some parts of the client’s body is washed like face, hands, axilla, perineal area and back 4. Tub bath Tub bath are preferred because it is easier to wash and rinse in a tub used for therapeutic baths amount of assistance the nurse offers depends on the abilities of the client 5. Shower ambulatory clients clients in long-term care settings are often given showers with aid of a shower chair (wheels) Therapeutic Baths given for physical effects (sooth irritated skin or treat the area) medications maybe placed in water taken in a tub 1/3 or ½ full client remains in the tub for 20- 30 minutes temperature should be 100- 115’F ( 37.7- 46’C) Types of Therapeutic Bath Bath Solution Directions Uses Saline 4 ml to 500 ml of Cleans, cooling water effect, reduces irritation. Sodium 4 ml to 500 ml of Cleans, cooling bicarbonate water effect, reduces irritation Nursing Assessment while Bathing: Color and condition of skin Pain on movement Level of consciousness Injuries Scars Skin turgor Wt loss or gain Patient’s At Risk for Skin Problems Altered level of consciousness Altered nutrition Immobility Dehydration Altered sensation Secretions on skin Mechanical devices, casts, restraints Altered venous circulation Possible Diagnoses: Self care deficit (bathing, grooming, and dressing) R/T pain, decreased level of consciousness……. Knowledge deficit R/T lack of experience……… Self esteem disturbance R/T body odor, visible skin problem Nursing Responsibilities Room should be comfortably warm. Use cotton bath blankets to cover the patient. Temperature of the water should be 105°F. Patient should be assisted in all transfer activities related to bath. Provide a bath mat, tub floor maybe slippery. Remain with the patient at all times  Protect tubes and lines attached to the patient: o Oxygen – stays on during bath, check connections, liters per minute, cleanliness of mask, water if used o IV lines –look at IV site, rate and solution o Urinary catheter – draining, urine bag o Enteral tubes – in place, running or draining properly, or clamped properly o Dressings – Clean and dry, drains properly working o Does anything need to be emptied, changed or cleaned?  HAIR appearance of hair often reflects a person’s feeling of self-concept and sociocultural wellbeing hair can reflect the state of health ( excessive coarseness and dryness maybe associated with hypothyroidism) Purposes: cleanse the hair and scalp maintain or improve self esteem treat conditions of the scalp with topical applications of medications Assessment of the hair & scalp: 1. Dandruff accompanied by itching diffuse scaling of the scalp treated effectively with a commercial shampoo 2. Hair Loss hair loss and growth are continual process some permanent thinning of hair normally occurs with aging (Baldness) common in men 3. Pediculosis Parasitic insects that infect mammals Pediculosis (infestation) 3 common kinds: 1. Pediculus capitis (head louse) 2. Pediculus corposis (body louse) 3. Pediculus pubis ( crab louse) Pediculosis capitis stays on the scalp and hidden in the hairs Pediculosis pubis stays in the pubic hair Pediculosis corposis tends to cling on clothes Signs includes: ✓frequent scratching ✓hemorrhagic spots on the skin  lice are very small, grayish white and difficult to see may be contracted from infested clothes and direct contact Treatment: topical pediculicides Pyrethrins (RID, Pyrinate) Permethrin (Nix)- recommended one Lindane (Kwell) use of fine-tooth combs to remove the eggs Burrow formation 4. Hirsutism growth of excessive body hair Hair Care Brushing & Combing Hair Shampooing Hair Treatment of Hair With Infestation Brushing & Combing Hair: Purposes: stimulate circulation of blood in the scalp distributes the oil along the hair shaft helps to arrange the hair hair needs to be brushed daily neat and well groomed hair gives a sense of well-being Shampooing Hair: keep hair clean and healthy promote growth of hair prevent hair loss prevent itching and infection prevent accumulation of dirt, dandruff and oil  prevent tangles stimulate circulation clean hair after pediculosis observe the scalp Assessment before shampoo in bed: determine the risk that might contraindicate shampooing determine if there are restrictions for positioning client review physician’s order to determine whether to use medicated shampoo  assess client’s routine hair care practices: preferred style, type of hair care products used assess hair and scalp condition  clients who must remain on bed can be given shampoo with water brought to the bedside pail or large washbasin can be used as receptacle for the shampoo water water for the shampoo should be 40.5°C (105°F) for an adult ORAL CARE Mouth oral cavity takes in food, chews it, secretes mucus to moisten and lubricate the food and secretes a digestive enzyme  good oral hygiene involves cleanliness, comfort and moisturizing of mouth structures daily oral care is vital to maintain the integrity of the mucous membranes, gums, teeth and lips Purposes: prevent oral infection and diseases Maintain health and cleanliness of lips, teeth, tongue, and mucous membranes of mouth clean and moisten the membranes of mouth and lips maintain cleanliness of dentures Indication: client who has not eaten for a period of time client who are on restricted diet dehydrated or malnourished client client suffering from nausea or vomiting client on oxygen therapy  client with high temperature unconscious client seriously ill client client having radiotherapy/ cytotoxic medication Assessment: Dry Mouth poor fluid intake heavy smoking alcohol use anxiety high salt intake medications ( Diuretics) Common Oral Problems: Dental Carries decay of teeth with formation of cavities Halitosis strong mouth odor/ Bad breath Glossitis - inflammation of the tongue Gingivitis - inflammation of the gums Stomatitis - inflammation of the oral mucosa Cheilosis - cracking and ulceration of the lips Plaque - invisible soft film that adheres to the enamel surface of the teeth contain bacteria ,cells and saliva Tartar - visible hard deposit of plaque and dead bacteria that forms at the gum lines Pyorrhea - pus formation in the socket of the teeth Glossitis Gingivitis  Cheilosis Stomatitis Plaque  good oral care includes daily brushing and flossing of the teeth, flushing of the mouth, and regular check ups by a dentist Brushing and Flossing Teeth Purposes: remove food particles. remove dental plaque. enhance the client’s feeling of well being. prevent sores and infection of the oral tissues Denture Care Denture Care  needs care like normal teeth use soft tooth brush to clean the denture clean it under tap water never use hot water to clean the denture  if not in use, store it in the denture container with water label the box with client’s name store in the client’s bed side discourage client placing it on napkin or tissue because it could be easily thrown away  unconscious client: dentures should be removed protect client from choking and aspiration perform mouth care frequently Expected Outcomes: buccal mucosa and tongue are pink, moist and intact gums are moist and intact teeth clean, tongue pink and without coat lips moist and without cracks client express feeling of cleanliness Preventive Measures for Tooth Decay brush the teeth after meals and at bed time floss the teeth daily ensure an adequate intake of nutrients eat fresh fruits and more vegetable visit the dentist every 6 months Possible Nursing Diagnosis: 1. Self care deficit (oral) hygiene R/T (Inability to brush or floss teeth or clean dentures) 2. Altered oral mucous membrane. (The state in which an individual experience disruptions in the tissue layer of the oral cavity)  Perineal Care A professional, dignified and sensitive approach can reduce embarrassment  involves cleaning the external genitalia and the surrounding area remove normal perineal secretions and odor promote client comfort reduce and prevent infection Assessment irritation inflammation excessive discharge pain /discomfort swelling /Odor  Urinary / Fecal incontinence Rectal / Perineal surgery Indwelling catheters Hygienic practices Self care abilities FOOT CARE Procedure: wash hands identify the patient provide privacy assemble equipment: ✓ Basin with water, Soap, Lotion ✓ Plastic protector, Nail Cutter ✓ Orange Stick, Towel  Nail Care elevate head end of bed adjust over bed table in front of patient place plastic protector over the bed side table fill basin with warm water place basin on over bed table instruct patient to put hands in basin soak for about 20 minutes  wash the patient hands lift hands out of basin and dry use nail cutter to cut finger nails cut nails straight across do not cut below tips of fingers shape and smooth nails with nail file apply some lotion to hands avoid trimming or digging into nails at the lateral corners  Foot Care Purposes: maintain foot function prevent foot odors prevent foot infections maintain the skin integrity of the feet Equipment: ✓Basin with water ✓Towel ✓Soap. lotion ✓Washcloth ✓Plastic protector ✓Nail cutter and orange stick  Foot Care Procedure: assist client in to the chair place plastic cover on floor in front of client fill basin with warm water(105’F) put basin on plastic cover place the feet in to the basin cover with towel to retain heat soak for 20 minutes  Foot Care wash feet with soap rinse and dry remove the basin covering the feet with towel clean the nails with orange stick dry feet with towel apply lotion to feet, not between the toes  wash the feet daily and dry well, especially between toes check the skin for redness, break or swollen areas check the water temperature before immersing the feet into water soak the feet in warm water apply lotion wear clean socks daily  Foot Care wear correct fitting shoes avoid walking barefoot avoid sitting crossed legs for prolonged time exercise the feet regularly. Point the feet upward, downward, and move them in circles Thank You!