NURS1162 Promoting Hygiene Lecture Notes PDF

NURS1162 Promoting hygiene 22.01.25 | Lecture | Marques Ng  Learning Objectives At the end of the lecture, students will be able to: Discuss the importance of promoting personal hygiene; Describe and demonstrate the nursing skills in promoting personal hygiene;...

NURS1162 Promoting hygiene 22.01.25 | Lecture | Marques Ng  Learning Objectives At the end of the lecture, students will be able to: Discuss the importance of promoting personal hygiene; Describe and demonstrate the nursing skills in promoting personal hygiene; Describe the signs and symptoms, treatment and related care of parasitic infestation: scabies, pediculosis capitis; Describe the contributing factors and characteristics of pressure injury; and Discuss the prevention and management of pressure injury. 2  Hair Care 3  Pediculosis Capitis (Head Lice) Infestation caused by Pediculus humanus capitis Found on scalp and in the hairs 3 stages: eggs  nymphs  adults Both nymphs and adults suck blood Adult louse (size of a sesame seed) is greyish white colour that moves fast among hair Lice eggs (oval shape, yellow to white colour) are easily found Common sites of infestation: occiput, ears, neck 4  Life Cycle Eggs hatch in 7-10 days Nymphs takes 7-13 days to become adult Once mature, they reproduce and increase in number rapidly Lifespan lasts for ~28-30 days, but they usually die 2 days after falling off from the host 5  Route of Transmission Direct head-to-head contact Sharing articles (e.g., comb) harboring lice Upholstered furniture used by a person with head lice 6  Signs & Symptoms Oval particles clinging to the hair Frequent scratching caused by allergic reaction to bites Haemorrhagic spots on skin where lice has sucked blood Itching skin excoriation in affected area On pillow Fine black powders (louse feces) Pale coloured materials (cast lice skin) On scalp Tiny oval shaped white or clear dots (lice eggs) Tickling feeling ‘something moving in the hair’ 7 8  Diagnosis Dry-combing with a closed-set tooth comb Wet-combing after applying conditioner Direct scalp inspection by parting the hair Scalp inspection by using a magnifying glass Small haemorrhagic areas Scratches Insect-type bites behind ears or hairline Small dandruff-like particles 9  Treatments Topical pediculicides (e.g., malathion 5% solution) Decontamination 10  Malathion 5% Solution Directions for use Shake well and rub onto dry hairs until they are thoroughly moistened All hair to dry naturally and remain uncovered Wash hair with shampoo with conditioner 12 hours after Comb hair thoroughly from the hair roots Repeat combing every 2-3 days for 2-3 weeks Precautions Treat all family members Cover pillow during treatment to avoid staining 11  Decontamination Wash all clothes and beddings used by the infested client separately in hot water (60°C or above) for not less than 20 minutes Disinfect combs in a mixture of bleaching agent and water (in ratio 1:1) for 30 minutes Seal stuffed toys and other non-washable articles in a plastic bag for 2 weeks Thoroughly vacuum all rugs, mattresses, pillows, and furniture 12 Skin care Bathing Remove accumulated oil, perspiration, dead skin cells, some bacteria and unpleasant odour Restore cleanliness and promote comfort Stimulate circulation Promote sense of well-being, morale, appearance, self- respect, and body image Reduce risk of infection Provide mild exercise Allow assessment of skin condition, joint mobility, and muscle strength  Types of Bath Cleansing bath (43°C - 46°C) Complete / self-help bed bath Bag Bath Tub bath / shower Commercial products containing Bag bath no-rinse cleansing solution Towel bath Packet can be warmed in Therapeutic bath microwave to promote comfort Medicated bath 15  Assessment Physical and emotional factors Condition of skin Texture, turgor, temperature, lesions, bruises… Presence of pain Range of motion Level of cooperation Other aspect of health Mobility, strength, cognition, vital signs… 16  Planning General considerations Equipment Location Basin with warm water Timing Bath mitt and towels Assistance needed Soap or bathing gel Toileting before bathing Gloves and apron Protection of casts or IV sites Bed linen Environment Personal care items (lotion, Temperature topical medication etc.) Privacy Laundry bag Shaving equipment 17  Implementation Prepare the bed, position the client, lower bed side rail, assist client to move near you Cover client with bath blanket, remove client’s clothes Make a bath mitt with washcloth 18  Perineal & Face Back genitalia area Buttock & Ears & neck Legs & feet anal area Arms & Chest & hands abdomen 19  Precautions Inspect for any abnormality Provide relevant health education Perform assisted ROM during bed bath Clean and dry skin-fold areas carefully Groin, skin under breasts, skin between fingers and toes Dress the injured or immobilised side first For clients with deep vein thrombosis or blood clotting disorder, should not wash with long firm strokes for lower extremities 20  Scabies Skin infestation of itch mite Sarcopte sscabiei A small arthropod burrows just below the surface of the skin Adult female mites lay 2-3 eggs a day at the end of a tunnel Eggs take about 10-17 days to develop into adult mites Mites will die within 48-72 hours once away from the body 21  Route of Transmission Spread by skin-to-skin contact in crowded conditions, especially in hospitals, old age homes, and child care centres Easily infected sex partners and household members Sharing clothes, towels, and beddings can also spread scabies Incubation period is 2-6 weeks 22  Signs and Symptoms Burrows Greyish-white or pink threadlike lines (0.5-1 cm) long found between fingers, on palm and sides of wrist Intense itching Worsens at night Papules Small elevated reddish papules and some with tiny vesicles on the top seen on skin surface Common sites webs between fingers, around nipples, backs of elbows, wrists, sides and backs of feet, knees, around waist and umbilicus, genital area, axillary folds, buttocks 23 24  Norwegian Scabies Highly contagious as it associates with hundreds to thousands of mites present on the body Marked scales and thick crust are present particularly on palms and soles Often occurs in frail elderly, history of steroid treatment and immunocompromised patients. Itching may be severe or absent 25  Diagnosis Examining the burrows or rash Ink test Ink is applied on an itchy spot and then wiped off with an alcohol pad Remaining ink will track into the burrows and dark lines will be shown Microscopic examination of skin scraping Identification of mites/ their eggs or fecal pallets Skin specimen should be collected from multiple sites Non-excoriated, non-scratched, non-inflamed areas (burrows and papules) should be chosen 26  Treatments Classic scabies Norwegian scabies Permethrin 5% cream Ivermectin (oral drug) Crotamiton 10% Permethrin 5% cream lotion/cream Benzyl benzoate 25% Sulfur ointment ointment Lindane 1% lotion Keratolytic cream Ivermectin (oral drug) 27  Topical Scabicides Implement contact precautions Apply medication from neck to toes, except for lips and eyelids Pay particular attention to skin folds, webs between fingers and toes, and nails Reapply the scabicide if it is washed off during the treatment period Leave the scabicide for the recommended period and then take a bath to rinse off medication 28  Permethrin 5% Cream Approved for the treatment of scabies in person who are at least 2 months of age Kills both the scabies mite and eggs Two (or more) applications, each about a week apart, may be necessary to eliminate all mites 29  Infection Control Infested patients should be isolated before treatment, a single room or isolated area is recommended Number of visitors should be limited, and visitors should wear personal protective equipment during the defined treatment period Patients should avoid close body contact with others until the treatment is completed Contact precaution can be discontinued after bathing to remove the scabicide 30  Simultaneously (within 24 hours) treat all members of household, close contacts and sexual partners with tropical scabicide (even without symptoms) Separate belongings of infested persons and close contacts for decontamination Decontaminate clothes, towels, and beddings (used during 3 days before the treatment) by machines wash in hot water at 60°C for >10 min and then dry in dryer for 20 min Non-washable items of infested persons should be placed in plastic bags and sealed up for >14 days before use 31  Pressure Injury A pressure injury is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. 32  Aetiology Compression of soft tissue over bony prominence for a prolonged period of time Prolonged compression occluding blood flow Tissue ischaemia Skin discoloration Continued tissue breakdown resulting in pressure injuries 33  Risk Factors Tissue Mobility Skin status Blood results perfusion Moisture Temperature Nutrition Age Mental General Quality of status health status care 34 35 36  NPIAP Pressure Injury Staging A pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue. 37  Stage 1 Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. Presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes. Color changes do not include purple or maroon discoloration; these may indicate deep tissue pressure injury. 38  Stage 2 Partial-thickness loss of skin with exposed dermis. The wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister. Adipose (fat) is not visible and deeper tissues are not visible. Granulation tissue, slough and eschar are not present. 39  Stage 3 Full-thickness loss of skin, in which adipose (fat) is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present. Slough and/or eschar may be visible. The depth of tissue damage varies by anatomical location; areas of significant adiposity can develop deep wounds. Undermining and tunneling may occur. 40  Stage 4 Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer. Slough and/or eschar may be visible. Epibole (rolled edges), undermining and/or tunneling often occur. Depth varies by anatomical location. 41  Unstageable Pressure Injury Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar. 42  Deep Tissue Pressure Injury Intact or non-intact skin with localized area of persistent non- blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood- filled blister. Pain and temperature change often precede skin color changes. Discoloration may appear differently in darkly pigmented skin. 43  Risk Assessment Norton Scale Braden Scale Indicator for risk: