N203_Hygiene_2024.pptx

N 2 0 3 Fu n d a m e n t a l s o f Nursing I N203.1&2: Unit 1 Hygiene BAHRAIN OF UNIVERSITY Click to edit master title style Ms. Eman Fateel Fateel MEDICAL Revised Date: August 2024 RCSI...

N 2 0 3 Fu n d a m e n t a l s o f Nursing I N203.1&2: Unit 1 Hygiene BAHRAIN OF UNIVERSITY Click to edit master title style Ms. Eman Fateel Fateel MEDICAL Revised Date: August 2024 RCSI M s. Em an Fat e e l FH EA, M S c , P G D i p. H P E, BS c , R N N2 Director & Lecturer in Nursing, SoN&M, RCSI Medical University of Bahrain Learning Outcomes 1. Describe hygienic care that nurses provide to clients. 2. Identify factors influencing personal hygiene. 3. Identify normal and abnormal assessment findings while providing hygiene care. 4. Apply the nursing process to common problems related to hygienic care of the skin, feet, nails, mouth, hair, eyes, ears and nose. 5. Identify the purpose of bathing. 6. Describe various types of bathing. 7. Identify specific ways in which nurses help hospitalized clients with hygiene. 8. Describe steps for identified hygienic-care procedures. 9. Identify safety and comfort measures underlying bed- making procedures. What is Hygiene? Hygiene is the science of health and its maintenance. Personal hygiene is the self-care by which people attend to such functions as bathing, toileting, general body hygiene, and grooming. Hygiene is a highly personal matter determined by individual values and practices. It involves care of the skin, feet, nails, oral and nasal cavities, teeth, hair, eyes, ears, and perineal-genital areas.  Table: Factors Influencing Individual Hygienic Practices Functional level: in need for assistance? Independent vs. dependent. Functional Level Hygienic Care Early morning care – Urinal or bedpan – Washing face and hands – Oral care Morning care – Usually after breakfast – Elimination – Bath or shower – Perineal care – Back massage – Oral, nail, and hair care Hygienic Care Hour of sleep or PM care – Elimination – Washing face and hands – Oral care – Back massage As-needed (prn) care – As required by client need More frequent bathing Changes of clothes Skin Protects underlying tissue Regulates body temperature Secretes sebum – Oily substance that softens and lubricates hair and skin – Maintains moisture – Bactericidal action Transmits sensation Produces and absorbs vitamin D Skin Sudoriferous (sweat) glands – All surfaces except lips and parts of the genitals Apocrine glands – Axillae, anogenital areas – Begin to function at puberty Eccrine glands – Palms of hands, soles of feet, forehead – Cool the body through evaporation  Skin Care Assessment of skin Nursing history – Determine: Client's skin care practices Self-care abilities – Client's functional, cognitive levels and motivation Presence of past or current skin problems Physical assessment of the skin Identification of clients at risk for altered skin integrity. Table: Common Skin Problems Nursing Diagnosing Self-Care Deficit (examples) – Bathing Self-Care Deficit – Dressing Self-Care Deficit – Toileting Self-Care Deficit Examples of associated diagnosis Deficient Knowledge R/T: a. Lack of experience with skin condition (acne) and need to prevent secondary infection b. New therapeutic regimen to manage skin problems c. Lack of experience in providing hygiene care to dependent person d. Unfamiliarity with devices available to facilitate sitting on or rising from toilet. Situational Low Self-Esteem R/T: a. Visible skin problem (e.g., acne or alopecia) b. Body odor. Risk for impaired skin integrity Skin integrity impaired General guidelines for skin care Intact, healthy skin: the body's first line of defense. Protection afforded by skin depends on general health of skin cells, amount of subcutaneous tissue, and dryness of skin. Moisture in contact with the skin: increase bacterial growth, irritation and infection. Body odors are caused by resident skin bacteria acting on body secretions. Skin sensitivity varies among individuals and in accordance with their health. Skin care agents have selective actions and purposes. Planning, Implementing, and Evaluating Nurse and, if appropriate, client and/or family set outcomes for each nursing diagnosis. Planning for home care – Client's and family's abilities to provide self-care/care – Need for referrals and home health services – Learning needs Related nursing procedures: – Bathing – Perineal-genital care Bathing – Removes accumulated oil, perspiration, dead skin cells, and some bacteria – Stimulates circulation – Produces a sense of well-being – Offers opportunity for assessment Bathing Categories Cleansing baths – Chiefly for hygiene purposes – Complete bed bath – Self-help bed bath – Partial bath (abbreviated bath) – Bag bath – Towel bath – Tub bath – Shower Figure–3 A shower chair. Bathing Categories Cleansing baths – Therapeutic baths » Given for physical effects » Soothe irritated skin » Treat a certain area (e.g., the perineum) » Medication may be placed in the water  Feet Care Assessment Nursing history – Determine: Normal nail and foot care practices Type of footwear worn Self-care abilities Presence of risk factors for foot problems Any foot discomfort Any perceived foot problems with foot mobility Identifying clients at risk – Diabetes – Peripheral vascular disease – Long-term steroid therapy Developmental variations (baby – elderly) Assessment Physical assessment – Calluses Thickened portion of epidermis – Corns Keratosis caused by friction, pressure from a shoe – Unpleasant odors Resulting from perspiration – Plantar warts Sole of foot – Fissures Between the toes – Athlete's foot (tinea pedis) – Ingrown toenails Assessment Nursing Diagnosing Bathing Self-Care Deficit (foot care) Risk for Impaired Skin Integrity Risk for Infection Deficient Knowledge (diabetic foot care) Planning, implementing, and evaluating Nursing interventions to help client maintain or restore healthy foot care practices Desired outcomes for each client Self-care ability and participation Teach the client about correct nail and foot care Prevent tissue injury and infection Demonstrate optimal foot hygiene Refer to this table Nails Care Assessment – Nursing history Determine: – Normal nail care practices – Self-care abilities – Any problems associated with them – Physical assessment Inspection of the nails Nursing diagnosis – Bathing Self-Care Deficit – Risk for Infection around the nail bed Planning & implementation – Measures to assist client to develop or maintain healthy nail care practices Evaluation Figure–4 Fingernails are trimmed straight across.  Mouth Care Assessing Nursing history – Determine: Oral hygiene practices Dental visits Self-care abilities Past or current mouth problems Physical assessment – Plaque – Tartar – Gingivitis – Advanced periodontal disease (pyorrhea) Table: Common Problems of the Mouth Assessing Identifying clients at risk – Serious illness – Confusion – Coma – Depression – Dehydration – Deficient knowledge – Inadequate nutrition – Lack of money or insurance – Radiation treatment Diagnosing Impaired Oral Mucous Membrane Deficient Knowledge Planning The nurse and, if appropriate, client and/or family set outcomes for each nursing diagnosis. The nurse performs nursing interventions and activities to achieve client outcomes. Implementing Daily stimulation of gums Mechanical brushing and flossing – Removes food particles – Stimulates circulation in gums – Sulcular technique Removes plaque Cleans under gingival margins – Fluoride toothpaste recommended Flushing of the mouth Promoting oral health throughout the life span Assisting clients with oral care Implementing Caring for artificial dentures – Lower, upper plate or both – Like natural teeth, need to be cleaned regularly, at least once a day – Ill-fitting prostheses can cause discomfort, chewing difficulties, and contribute to oral problems, poor nutrition and enjoyment of food Clients with special oral hygiene needs – Xerostomia (dry mouth) Can be caused by medications, being unconscious Irritated, dry soft tissues – Removal of plaque and microorganisms as well as comfort – Water-soluble moisturizer – Saliva substitute Hair Care Reflects person's feeling or self-concept, well-being, state of health Developmental variations – Lanugo Fine hair on body of fetus – Puberty Pubic hair Sebaceous glands – Thinning hair in older adults Assessing Nursing history – Determine: Usual hair care Self-care abilities History of hair or scalp problems Conditions known to affect the hair – Alopecia (hair loss) Physical assessment – Dandruff – Hair loss – Ticks – Pediculosis (lice) Removal of nits – Scabies – Hirsutism Nursing Diagnosing Dressing Self-Care Deficit Impaired Skin Integrity Risk for Infection Disturbed Body Image Planning The nurse and, if appropriate, client and/or family sets outcomes for each nursing diagnosis. The nurse performs nursing interventions and activities to achieve client outcomes. Implementing Brushing and combing hair Shampooing the hair Beard and mustache care  Eyes Care Assessing Require no special hygiene Lacrimal fluid washes the eye. Eyelids and eyelashes prevent entrance of foreign particles. Nursing history – Determine: Client's eyeglasses or contact lenses Recent examinations by ophthalmologist Any history of eye problems and related treatments Physical assessment – External eye structures Nursing Diagnosing Risk for Infection Risk for Injury Planning Identify nursing activities that will assist the client to maintain integrity of eye structures Prevent eye injury and infection Implementing Eye care – Wipe away dried secretions – Prevent drying and irritation of the cornea Eyeglass care – Clean with warm water and dry with soft tissue that will not scratch lens Contact lens care – Teach clients how to clean, insert, and remove contact lenses – Types Hard contact lenses Soft contact lenses Gas-permeable lenses General eye care – Avoid home remedies – If dirt or dust gets into eyes, clean them copiously with clean, tepid water – Take measures to guard against eyestrain and to protect vision – Schedule regular eye examinations to detect problems Ears Care Cleaning the ears – Minimal hygiene – Clean auricles and excessive cerumen (earwax) during bed bath – Hearing aids may require nursing assistance. – Hearing aids are usually removed before surgery. Ears Care Care of hearing aids – Behind-the-ear (BTE) open fit – Behind-the-ear (BTE) with earmold – In-the-ear (ITE) aid – In-the-canal (ITE) aid – Completely-in-the-canal (CIC) aid – Eyeglasses aid – Body hearing aid Figure–9 A, A behind-the-ear (BTE) open-fit hearing aid; B, a BTE open-fit hearing aid in place. A B Figure–10 A, A behind-the-ear (BTE) hearing aid with earmold; B, a BTE hearing aid attached to glasses. A B Figure–11 An in-the ear (ITE) hearing aid. Figure–12 An in-the canal (ITC) hearing aid. Figure–13 A completely-in-the-canal (CIC) hearing aid in place. Nose Care Usually cared for by client blowing into tissue Clean with cotton-tipped applicator (not inserted farther than cotton tip) or saline Supporting a Hygienic Environment Environment – Room temperature – Ventilation – Noise Hospital beds – Mattresses – Side rails – Intravenous stands Making beds: unoccupied, occupied, pot-operative References  Berman, A. and Snyder, S. J. (2021). Kozier & Erb's fundamentals of nursing: concepts, process, and practice. 10th ed., Global edition. Harlow, Essex: Pearson Education Limited  Dougherty, L. and Lister, S. (2011). The Royal Marsden Hospital Manual of Clinical Nursing Procedures: Student Edition, 8th ed., Chichester, West Sussex: Wiley-Blackwell.  Gulanick, M. and Myers, J.L. (2013). Nursing Care Plans: diagnoses, interventions, and outcomes. 8th ed. Oxford: Mosby.  Skidmore-Roth, L. (2017). Mosby's 2018 Nursing Drug Reference. St. Louis: Mosby.  Hinkle, J.L. and Cheever, K.H. (2014) Brunner & Suddarth's Textbook of Medical-Surgical Nursing. 13th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins  August,2024 Thank you BAHRAIN OF UNIVERSITY Ms. Eman Fateel Fateel FHEA, MSc, PG Dip.HPE, BSc, RN N2 Director and Lecturer SoN&M, Click to RCSI edit Medical master University title styleof Bahrain MEDICAL RCSI M s. Em an Fat e e l FH EA, M S c , P G D i p. H P E, BS c , R N N2 Director & Lecturer in Nursing, SoN&M, RCSI Medical University of Bahrain Leading the world to better health