Personal Hygiene: Nursing Knowledge, Care, and Procedures PDF

 Personal Hygiene It is the nurses responsibility to provide the patient with the opportunity for hygiene The skill may be delegated but not always. Scientific Knowledge Base Physical hygiene is necessary for comfort, safety, and well-being. Ill patients requ...

 Personal Hygiene It is the nurses responsibility to provide the patient with the opportunity for hygiene The skill may be delegated but not always. Scientific Knowledge Base Physical hygiene is necessary for comfort, safety, and well-being. Ill patients require assistance with personal hygiene. Several factors influence a patient’s hygiene practices, such as culture and age. Good hygiene techniques promote normal structure and function of tissues. Apply knowledge of pathophysiology to provide preventive hygiene care. Benefits of Bathing Patients  Patient  Cleansing the skin  Increasing circulation and sensation  Providing comfort and relaxation  Improving self-esteem  Nurse  Opportunity for skin assessment  Nurse-patient relationship  Nursing Knowledge Base  Explore the patient’s viewpoint.  Use communication skills to promote the therapeutic relationship.  During hygiene, assess:  Emotional status  Health promotion practices  Health care education needs Self-Care Skin Feet and Nails Ability Oral cavity Hair and hair Eyes, ears, care and nose Use of sensory Hygiene care Cultural aids practices influences  Patients at risk for hygiene problems Factors Influencing Hygiene Social patterns Personal Ethnic, social, and preferences family influences on Dictate hygiene hygiene patterns practices Body image Socioeconomic A person’s subjective status concept of his or her Influences the type body appearance and extent of hygiene practices used 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 Physical condition stage May lack physical Affects the patient’s energy and dexterity ability to perform to perform self-care hygiene care Critical Thinking Integrate nursing knowledge. Consider developmental and cultural influences. Think creatively. Be nonjudgmental and confident. Draw on your own experiences. Rely on professional standards. Use caring to reduce anxiety, promote comfort. Administer meds for symptoms before hygiene. Be alert for patient’s anxiety or fear Assist and prepare patients to perform hygiene as independently as possible. Teach techniques and signs of problems. Inform patients about community resources. Implementation  Consider normal grooming routines, and individualize care.  Bathing and skin care  Therapeutic: sitz, medicated  Complete bed bath, shower  Partial bed bath  Bag baths  Perineal care  Back rub  Foot and nail care  Three Categories of Personal Care  Self-care:  Patients who are able to perform ADLs without assistance  Assisted care:  Patients who need some assistance with ADLs  Total care:  Patients who are able to do very little or nothing for themselves Bath Guidelines Provide privacy. Maintain safety. Maintain warmth. Promote independence. Anticipate needs. Nurse Responsibilities When Bathing Patients  Assess the skin for rashes, bruises, and lesions  Complete the bathing process in a timely manner  Be alert to signs of patient fatigue  Intervene in ways to conserve the patient’s energy during the bath  Assessment: Oral Hygiene a. 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  Oral hygiene  Brushing removes particles, plaque, and bacteria; massages the gums; and relieves unpleasant odors and tastes.  Flossing removes tartar at the gum line.  Rinsing removes particles and excess toothpaste.  Patients with special needs: diabetes, artificial airways, unconscious, chemotherapy  Patients who are NPO  Patients receiving oxygen by cannula or mask  Patients having a nasogastric or feeding tube in place  Patients who are unconscious  Assess for Abnormalities  Loose or missing teeth  Swelling and bleeding of gums  Unusual mouth odor  Pain or stinging in mouth structures Care of Dentures Tips to remember: – Use gauze squares or washcloth to grasp front of dentures to prevent from slipping – Place wash cloth or paper towel in the sink to line it while you are cleaning the dentures Work close to the bottom of the sink in case you drop them! 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  Oral hygiene – Unconscious Patient 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.  Keeping the mouth open 1. 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.  Oral air way can be used to hold mouth open  Use a small brush or swab to clean the mucous membranes and teeth  Use suctions to remove secretions and fluid  Use chap stick or lip moisturizer Implementation  Hair and scalp care  Brushing and combing  Distributes oil  Prevents tangling, as does braiding  Obtain permission before braiding or cutting.  Shampooing  Shaving  Mustache and beard care A person’s appearance and feeling of well-being often depends on the way their hair looks and feels  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 Potter and Perry – “Shampoo in a Bag” or dry shampoos are available  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 Safety Precautions Electric razors must be used in patients who are at risk for bleeding, confused, or depressed  Shaving ◼ Provide 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 Implementation  Care of the genitalia:  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.” Peri-care Those patients who may need the nurses assistance: Vaginal or urethral discharge Skin irritation Catheter Surgical dressings Incontinent of urine or feces  Peri-care: Female  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  Peri-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  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  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 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 nonintact 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. 34 Quick Quiz 2 (1 of 2) 2. A young girl with long hair is experiencing a problem with matting. The most appropriate action to take would be: A. cutting the matted hair away. B. braiding the hair to reduce tangles. C. using a grease-type product to tame the hair. D. keeping the hair oil free by applying powder every morning. Copyright © 2021, Elsevier Inc. All Rights Reserved. 35 Quick Quiz 2 (2 of 2) Answer: B. braiding the hair to reduce tangles. Copyright © 2021, Elsevier Inc. All Rights Reserved. 36 Quick Quiz 1 (1 of 2) 1. You are caring for a non–English-speaking male patient. When preparing to assist him with personal hygiene, you should: A. use soap and water on all types of skin. B. ensure that culture and ethnicity influence hygiene practices. C. shave facial hair to make the patient more comfortable. D. know that all patients need to be bathed daily. Copyright © 2021, Elsevier Inc. All Rights Reserved. 37 Quick Quiz 1 (2 of 2) Answer: B. ensure that culture and ethnicity influence hygiene practices. Copyright © 2021, Elsevier Inc. All Rights Reserved.