Bed Bath, Oral Care, and Serving Bed Pan and Urinal

BED BATH, ORAL CARE AND SERVING BED PAN AND URINAL NCM 103 (LAB): FUNDAMENTALS OF NURSING BY: JUDY N. VASQUEZ, M.A.N. GENERAL OBJECTIVES After 6 hours of lecture-demonstration the BSN level 1 students will be able to develop positive attitude, acquire basic knowledge and skills in the conce...

BED BATH, ORAL CARE AND SERVING BED PAN AND URINAL NCM 103 (LAB): FUNDAMENTALS OF NURSING BY: JUDY N. VASQUEZ, M.A.N. GENERAL OBJECTIVES After 6 hours of lecture-demonstration the BSN level 1 students will be able to develop positive attitude, acquire basic knowledge and skills in the concept of hygienic care. Specifically the student nurses will be able to: 1. Appreciate the nursing process in the performance of hygienic care procedures such as: a. offering a bedpan/ urinal b. Providing oral care (brushing and flossing the teeth) c. Bathing an adult client. d. Changing an occupied bed. 2. Describe hygienic care that nurses provides to clients. 3. Identify factors influencing personal hygiene. 4. List the materials/equipment needed in providing hygienic care. 5. State the purposes of bathing 6. Enumerate various types of baths. 7. Describe guidelines for bathing adult patients. 8. Discuss safety and comfort measures underlying bed- making procedure. 9. Perform the steps in the following procedures: A. Offering a bedpan/ urinal B. Providing oral care (brushing and flossing the teeth) C. Bathing an adult client. D. Changing an occupied bed.  PERSONAL HYGIENE Is the self-care by which people attend to such functions as bathing, toileting, general body hygiene, & grooming Hygiene is a highly personal matter determined by individual values and practices It involves care of the skin, feet, nails, oral & nasal cavities, teeth, hair, eyes, ears, & perineal-genital areas  PERSONAL HYGIENE ❑ Provides opportunity to develop a meaningful nurse-patient relationship ❑ Provides opportunity for assessment of the patient including condition of patient, psychosocial and learning needs OFFERING A BED PAN  PROVIDING BEDPAN ❑ Offering a bedpan to meet the elimination need of a bedridden patient PURPOSE: ❑ To facilitate bowel and bladder elimination of a bedridden patient ❑ To collect specimen ❑ To give perineal wash ❑ To perform bowel and bladder training ❑ To obtain accurate measurement of urine output  VOCABULARY INCONTINENCE ---the inability to control urine or feces VOID --- to urinate. MICTURATE ---to urinate. DYSURIA---painful urination/ difficult urination URINARY FREQUENCY – voiding at frequent intervals URINARY URGENCY – the need to void at once HEMATURIA – blood in the urine NOCTURIA – frequent urination at night POLYURIA – large amounts of urine  NURSING RESPONSIBILITIES 1. Make sure the bed pan is clean 2. Keep it warm 3. Provide privacy 4. Discard the waste immediately Anatomy of the Urinary System ❑ Normal Urine output per hour is 30ml/hr  Do not withhold fluids Follow the person’s routines Assist the person to the bathroom as needed. Provide the bedpan or urinal if needed Assist the person to assume a normal voiding position Provide for privacy Allow time to void Run water to help start urination Provide perineal care if needed Allow person to wash hands after toileting Allow the patient to be as independent as possible Provide assistive equipment if needed (crutches, walker, cane)  FACTORS THAT AFFECT ELIMINATION ❑ Lack of privacy ❑ Lack of physical movement ❑ Position ❑ Medications ❑ Use of bedpan  HOME CARE BEDPAN AND URINALS Bed pan – shallow vessel used for urination or defecation by a patient confined in bed. Urinal – receptacle for urine VINTAGE BEDPAN AND URINAL SET ENAMELWARE  BED PAN and URINAL WITH LID COVER BED PAN AND URINAL RACK  BEDSIDE COMMODE May be placed in bathroom over the toilet. May be placed in the bedroom or wherever the patient will be located. Should be cleaned after each use.  REGULAR BEDPAN FRACTURE PAN ❑ Women use the bedpan for ❑ More comfortable both urine and bowel ❑ Holds less urine movement ❑ More easily spilled ❑ Men use the bedpan for bowel movement only ❑ Used by male patients for urination ❑ Has a handle to hold onto ❑ A lid will cover the top ❑ Has calibrations on side ✔ Ask the patient to flex the knees and raise the buttocks. ✔ You may need to slide your hand under the patient’s back to help raise the buttocks. ✔ Slide the bedpan under the patient. ✔ Make sure the bedpan is properly positioned. ✔ Turn the person onto their side ✔ Place the bedpan firmly Against the buttocks ✔ Push the bedpan down And toward the patient ✔ Hold the bedpan and turn the person onto Their back  GUIDELINES FOR USING A URINAL ❑ Do not put the urinal on the overbed table or on the floor ❑ Empty and clean the urinal promptly after it has been used ❑ Urinals that are not emptied promptly can be tipped and spilled  ABNORMAL URINE FINDINGS: Blood or mucus, stones, gravel, or sediment in the urine. Dark colored or concentrated urine Unusual urine odor Complaints of pain, burning, or itching on urination Inability to void ORAL HYGIENE CARE  DEFINITION OF TERMS: ❑ Oral Hygiene measures that maintain the healthy state of mouth, teeth, gums and lips. ❑ Tooth brushing is using a small brush and chemical agent that promotes lather that cleanses the teeth and all over the oral cavity. ❑ Flossing mechanical cleansing of teeth surface with string like floss.  PURPOSES OF ORAL HYGIENE 1. AESTHETIC VALUE OF CLEAN 3. GUSTATORY PLEASURE IS AND HEALTHY MOUTH ENHANCE–INCREASE APPETITE 2. BOOST SELF ESTEEM 4.COMFORT  PURPOSES OF ORAL HYGIENE 5. PREVENT INFECTION AND ORAL PROBLEMS 6. PROMOTES DIGESTION 7. MAINTAIN INTEGRITY OF ORAL STRUCTURES  INDICATIONS FOR ORAL HYGIENE 1. Every after meal 2. Before a meal 3. After waking up 4. Those with dentures or oral inflammations 5. Symptoms of oral problems PRINCIPLES OF ORAL HYGIENE 1. Have all materials within patient’s easy reach 2. Use the appropriate materials or toothbrush 3. Use enough pressure during brushing procedure 4. Regular dental exams with a dentist should be encouraged every 6 months  COMMON ORAL HEALTH PROBLEMS DENTAL CARIES – Decaying of teeth with formation of cavities. HALITOSIS – Offensive bad breath resulting from poor oral hygiene and possible dental or oral infection. Pyorrhea – marked inflammation of the gums with copious amount of pus.  COMMON ORAL HEALTH PROBLEMS PLAQUE – Invisible soft film of bacteria, saliva, epithelial cells and leukocytes that adhere to the enamel surface of the teeth. TARTAR - Visible, hard deposit of plaque and bacteria that forms the gum lines  COMMON ORAL HEALTH PROBLEMS GLOSSITIS – Inflammation of tongue GINGIVITIS – Inflammation of the gums  COMMON ORAL HEALTH PROBLEMS Stomatitis– inflammation of the oral mucosa/small ulcers covered by exudates. Parotitis – inflammation of the salivary glands (mumps)  COMMON ORAL HEALTH PROBLEMS SORDES– Accumulation of foul matter on gums and teeth, brown/black crust like collection with dehydration associated with chronic debilitating disease. CHEILOSIS – Cracking of the lips TOOTHBRUSHING MATERIALS  PROPER BRUSHING TECHNIQUE 1. Front up and down 2. Sides 3. Inner sides 4. Tongue 5. 45 degree angle between teeth and gums 6. Vibrating motion should be 15 seconds per area ORAL CARE FOR UNCONSCIOUS PATIENT  BED BATH PROCEDURE NCM 103 (LAB): FUNDAMENTALS OF NURSING BY: JUDY N. VASQUEZ, M.A.N  BATHING/ BED BATH ❑The action or process of bathing a bedridden or a person confined in bed, the result of which is the removal of accumulated oil, perspiration, dead skin cells and some bacteria PURPOSE OF BATHING Cleanses the skin, Removes transient microorganisms, body secretions and dead skin cells Stimulation of circulation Promote a senses of well-being, Improve self-image Reduction of body odors Promotion of Range of Motion, Produce relaxation and comfort  GENERAL GUIDELINES FOR SKIN CARE 1. Intact, healthy skin is the body’s first line of defense. 2. The degree to which the skin protects the underlying tissues from injury depends on the general health of the cells, the amount of subcutaneous tissue, and the dryness of the skin. 3. Moisture in contact with the skin for more than a short time can result in increased bacterial growth and irritation. 4. Body odors are caused by resident skin bacteria acting on body secretions. 5. Skin sensitivity to irritation and injury varies among individuals and in accordance with their health. 6. Agents used for skin care have selective actions and purpose  AGENTS COMMONLY USED ON THE SKIN ❑ SOAP – Lowers surface tension and helps in cleaning, some have antimicrobial agents ❑ CHLORHEXIDINE GLUCONATE (CHG) – A disposable cloth saturated with 2% CHG and skin- moisturizing substances, has antimicrobial activity after application, used in critical settings ❑ BATH OIL – Used in bathwater, provides an oily film on the skin that softens and prevents chapping ❑ SKIN CREAM, LOTION – provides a film on the skin that prevents evaporation and therefore chapping ❑ POWDER – can be used to absorb water and prevent friction, some are anti bacterial ❑ DEODORANT – masks or diminishes body odors ❑ ANTIPERSPIRANT – reduces the amount of perspiration  2 TYPES OF BATH CLEANSING BATH THERAPEUTIC BATH Given to a patient in bed, for Given for physical effects, the purpose of cleaning the patient and also refreshing the such as to soothe irritated patient. skin or to treat an area Medications may be placed in the water  TYPES OF CLEANSING BATHS Complete bed bath – nurse washes the entire body of a comatose or dependent client in bed  TYPES OF CLEANSING BATHS SELF-HELP BED BATH – Client confined to bed are able to bathe themselves with help from the nurse for washing the back and perhaps the feet. PARTIAL BATH – Only the parts of the client’s body that might cause discomfort or odor, if neglected, are washed; face, axilla, back, hands, perineal area, omitted; arms , abdomen, feet, chest, legs.  TYPES OF CLEANSING BATHS BAG BATH – 10 to 12 presoaked disposable washcloths that contain no-rinse cleanser solution, the package is warm in a microwave (1 min), each area of the body is cleaned with a different cloth and then air dried, the emollient in the solution remains on the skin TUB BATH – Bed bath performed in the tub , also used for therapeutic baths  TYPES OF CLEANSING BATHS TOWEL BATH – Similar to bag bath but uses regular towels, client is covered and kept warmth with a bath blanket then slowly replaces with a large towel soaked with warm water and no-rinse soap and massage towel on client, then wet towel is replace with dry towel for drying the client’s skin. SHOWER- Require only minimal assistance from the nurse, for ambulatory patients.  THERAPEUTIC BATH - Ordered by a physician - Given for physical effect such as to soothe irritated skin or to treat an area. - Medication may be placed in the water. - Generally taken in a tub 1/3 or 2/3 full, or about 114 liter - client remains in a bath for 20-30 min. - Bath temperature: Adults is 37.7 C to 46 C Infants and Children 37-38 degrees celsius THERAPEUTIC BATH PURPOSE: 1. To soothe irritated skin areas 2. To treat areas with bed sores 3. Condition the skin 4. Cleanse the skin 5. Help relax a restless person 6. Promotes blood circulation , stimulate body’s peripheral nerve endings 7. Serve as exercise  DIFFERENT TYPES OF THERAPEUTIC BATH SOLUTIONS ❑Colloidal oatmeal (oatmeal that has been ground into a fine powder, e.G. Aveeno) coats, soothes, and stops itching without drying out the skin. ❑Potassium permanganate—a dark purple salt—makes a good disinfectant. ❑Bath oils are used as an emollient to ease itchy skin and eczema. Robathol and cottonseed oil are recommended for younger children. ❑ Cornstarch is a soothing, drying bath for itchy skin. ❑ Sodium bicarbonate can be cooling for sunburn or other hot, dry skin conditions. ❑ Saline (salt) water baths can be used to treat eczema in children. The recommended amount is one cup to a tubful of warm water. ❑ Chlorine bleach can be added to bath water for children who develop recurrent skin infections with eczema. The recommended amount is two teaspoons per gallon of water  THERAPEUTIC BATHS Hydrotherapy hot bath ( arthritis, relieving muscle soreness and muscle spasms, muscle tension) Medicated Soak Bath for Kidney Disease or Kidney Failure  THERAPEUTIC BATHS Cool water tub bath – relieves tension and lower body temperature (not recommended for infants) Hot sitz bath – Decrease inflammation of the perineal and anal area to patients who have undergone rectal or vaginal surgery or child birth and hemorrhoids. Duration: 10-15 mins. Water temperature 98° to 102° F  THERAPEUTIC BATHS Tepid sponge bath-administered to reduce an elevated temperature THERAPEUTIC MASSAGE ❑ Is the application of pressure and motion by the hands with the intent of improving the recipient’s well-being. It involves kneading, rubbing and using friction. ❑ To enhance or induced relaxation before sleep or stimulate skin circulation in association with hygienic measures. ❑ Body conditioning – means of communicating through therapeutic touch SIGNIFICANCE OF MASSAGE 1. General body conditioning 2. Stimulation and relaxation 3. Improves circulation 4. Communication through touch 5. Improves muscle tone 6. Observe sign and symptom of skin breakdown TYPES OF MASSAGE  Effleurage – stroking, gliding and smooth long rhythmic strokes Petrissage – pressing, squeezing, kneading and rolling movements by both hands on large quick pinches of the skin, subcutaneous tissue and muscle Tapotement – brisk, vigorous, rhythmic, percussive, tapping movements are used FRICTION – THUMB PADS, HEEL OF HAND OR VIBRATION – VERY FINGERTIPS, FOCUSED FINE RAPID, RAPID, DEEP CIRCULAR MOTION SHAKING MOVEMENT ARE USED USING ENTIRE HAND FACTORS INFLUENCING HYGIENE Health beliefs and Cultural variables motivation People from diverse Motivation is the key cultures practice factor in hygiene. different hygiene rituals. Developmental stage Physical condition Affects the patient’s May lack physical energy ability to perform and dexterity to perform hygiene care self-care BATH GUIDELINES Provide privacy. Maintain safety. Maintain warmth. Promote independence. Anticipate needs. SAFETY GUIDELINES Communicate clearly with team members. Incorporate patient’s priorities. Move from the cleanest to less clean areas. Use clean gloves for contact with non-intact skin, mucous membranes, secretions, excretions, or blood. Test the temperature of water or solutions. Use principles of body mechanics and safe patient handling. Be sensitive to the invasion of privacy. GUIDE FOR BED BATHING PROCEDURE