NSE111 - Week #7 Supporting Personal Hygiene & Grooming - DM - Fall 23.pptx

NSE111 WEEK #7 Supporting Personal Hygiene & Grooming © NSE 111 Centennial College Teaching Reminders:  This is a heavy slide deck – take your time and read through it in chunks – lots of valuable information that will help you in your practice – we may not get through it all in class!!  Mosb...

NSE111 WEEK #7 Supporting Personal Hygiene & Grooming © NSE 111 Centennial College Teaching Reminders:  This is a heavy slide deck – take your time and read through it in chunks – lots of valuable information that will help you in your practice – we may not get through it all in class!!  Mosby Videos are AWESEOME !!!!!! Learning Objectives 1. Identify factors that influence personal hygiene practices. 2. Relate the conditions (physical/cognitive impairment) that place clients at risk for impaired hygiene to specific nursing interventions. 3. Describe the various approaches to providing hygiene care for clients such as showers, bed baths and "bag baths". 4. Relate safe and effective hygiene care to clients with special needs (e.g. cognitive impairment, the unconscious client, or those with diabetes). Please refer to your Weekly Outline for all LOs for this week including lab learning outcomes and activities!! Recall readings…  Potter & Perry Chapter 38 pp.902-929; 937-938  Personal Care Assistant OER: a. Assisting with personal grooming and hygiene b. General guidelines for dressing and undressing a client c. Dressing and undressing a client in bed Please refer back to your LOs to streamline your reading… Mosby Basic Skills Video (available through Centennial Library)  Performing a complete or partial bed bath  Assisting with a tub bath or shower  Performing a back massage  Performing hair care and shampooing in bed  Shaving a male patient  Performing nail and foot care  Assisting with gown change  Performing oral hygiene for an unconscious patient.  Cleaning dentures Nursing Process and Clinical Judgement Model Why is hygiene important to a person? What are the risks of not performing hygiene? What kind of situations make hygiene maintenance challenging? How does the nurse enable and assist a client’s hygiene? 7 What are some factors affecting personal hygiene? Factors Influencing Personal Hygiene (P&P, p.904905) • Social practices • Personal preferences o Physical limitations and expectations o Ability/Disability • Body image o Pain • Eating habits/diet o Lack of physical energy • Socioeconomic status o Dexterity • Health beliefs and o ROM motivation o Medical • Cultural variables • Physical conditions devices/equipment • Cognitive ability What else do we need to consider when thinking about personal care and hygiene? Important Considerations for Assessment • • Self care ability • How much assistance does the client require? • Balance, coordination, strength, ROM, tolerance Use of sensory aids • • Hygiene practices • • Does the client require sensory aids during care? What specific grooming practices does the client prefer? Or special considerations? Cultural factors Potter & Perry, 2019, p.906, 911-912 Risks for unmet hygiene needs – what so we need to think about?  Tracheostomies,  Skin drains, dressings integrity  Chewing and swallowing difficulty  Language deficits  Sedation, mental illness, dementia  Reduced physical energy, ROM, diminished vision  Hands-inflammation, decreased dexterity,  Feet-ability to walk/weight bear, poor fitting shoes  Environment-bathing obstacles Universal nursing approaches to providing hygiene care  Take the opportunity to build and develop the therapeutic nurse-client relationship (TNCR) during assistance with the client’s hygiene needs  Seek and support the personal choice and preferences of the client  Assess the physical, psycho-social, spiritual, cultural needs of the client through the nursing process  Provide privacy and confidentiality.  Physical safety: Proper use of infection control body mechanics, and temperature. 13 Developing the TNCR  Remember, bathing is an intimate activity. You are entering their very personal space. You need to be sensitive, respectful and professional.  It is a quiet time and many clients will want to talk. Use this time to honor your client and further develop your therapeutic relationship. 14 Privacy & Confidentiality   Close curtains Maintain dignity of client  Minimize the time the patient is unclothed and only expose part of the body that is being washed.  Use a Do Not Disturb sign if available 15 Infection Control  Determine PPE required (or additional precautions when required)  Ensure wash basin belongs to client, is sanitized [sanitize the basin after each use]  Eyes-use different part of wash cloth and move from inner to outer canthus of eyes  Always move from cleanest part of body to dirtiest (face first, peri-care last)  Move front to back and cleanse meatus first when beginning peri-care 16 Safety  Raise bed to appropriate level for you to work  (elbow height of tallest helper)  Get assistance if you need help moving/positioning client in bed  Remember 16kg lifting rule  Keep side rails up on the opposite side not being washed  Check water temperature before use  Securely support parts being washed  Protect drains, tubes, etc  Do not use long firm strokes on lower limbs if history of Deep Vein Thrombosis 17 General types of baths… oComplete bed bath (nurse washes entire body) oSelf-help bed bath (clients able to bathe themselves, with assistance for washing back) oPartial bed bath (face, hands, axillae, perineal area, and back) oTub bath or shower oBag bath 18 Shower chairs for more ambulatory clients 19 Preparing for the Bath 1. Determine type of bath 2. Determine patient’s tolerance for activity, comfort level and cognitive ability, patient preferences 3. Perform hand hygiene (4 moments of HH) 4. Provide client privacy-curtains and draping 5. Offer a bedpan, urinal or commode before bath 6. Motivate client to perform as much personal self-care as possible to promote independence, exercise, and self-esteem 7. 20 Gather supplies; ensure comfort and warmth: Anticipate personal products and clothing, Usual order of bathing the client’s body: Consider infection control, safe and efficient use of body mechanics and energy, and client comfort Start at the cleanest (face), work downward towards the feet 1. Freshly sanitized wash basin, clean, unused linens, facecloths and towels 2. Eyes then Face 3. Arms and hands 4. Chest and abdomen (axillae and area under women’s breasts may require cleaning) 5. Legs and feet 6. Back-may be done after peri care with fresh water Obtain fresh water 7. Peri care 8. Buttocks, anus/rectum 21 Bathing Patients Diagnosed with Dementia • Obtain a bathing history of what works and what does not work • Identify bathing preferences • Determine method that is least distressing • If patient fears water, try a bubble bath • Prepare bath environment in advance • Minimize time patient is unclothed • Use distraction and negotiations instead of demands • Minimize noise during bathing time • Set priorities regarding body parts • Assess communication needs: glasses, hearing aid • Praise patient for accomplishment Potter & Perry, 2019, p.918 Bottom Line…Bathing & Skin Care Basic Principles • Assess skin integrity and condition throughout bath • Provide privacy and maintain warmth • Promote independence • Infection control • Hand washing and gloves • Consider body mechanics • Check water temperature • Clean body from head to toe, clean to dirty, distal to proximal supporting limbs • Change water as necessary, prior to back, and prior to perineum • Dry areas well, apply protective moisturizers, • Do not massage reddened areas • Ensure safety at all times Potter & Perry, 2019, p.919926 Assessments – always on the lookout for “cues” Bath time is a great time to complete a variety of assessments: • Skin • Nose • Hair • Mouth • Eyes • Nails • Ears • Feet • Mobility • Cognition Using clinical judgement and ongoing assessment… o Assisting with bathing/supporting grooming is an excellent opportunity to assess the client’s physical status: ROM, strength, grasp, coordination o Include ROM when possible – note any discomfort, pain, or limitations o Need for partial or complete bath o Emotional response to bathing o Document any changes from baseline Hair & Shaving Care • Shampoo depending on client’s routine and hair condition • Bathing at sink or in bed • Brush and comb hair daily • Shaving done usually after bath • Wear gloves and obtain equipment • Hold skin taut & blade at a 45 degree • Short, firm strokes in direction of hair growth Potter & Perry, 2019, p.937-938 Eyes • Use clean washcloth moistened with plain water. • Soak crust on eyelids 2-3 minutes to soften. • Use different section of mitt for each eye. • Wash from inner to outer canthus. Potter & Perry, 2019, p.937-940 Ears • Use moistened washcloth to clean auricles of ears. • Never use sharp objects to remove ear wax (cerumen) or put cotton-tipped applicators into canal. • Visible wax can be loosened and removed. Potter & Perry, 2019, p.940 Nose • Encourage client to remove secretions from nose by blowing into a tissue. • May use a wet cloth or cotton-tipped applicator moistened in water or normal saline to cleanse. • Never insert the applicator beyond the length of the cotton tip. Potter & Perry, 2019, p.940 Risk Factors for Impaired Skin Integrity • Immobilization • Reduced sensation • Nutrition and hydration alterations • Secretions and excretions on the skin • Vascular insufficiency • External devices Potter & Perry, 2019, p. 907 Box 38- Oral Care is a very important part of personal hygiene and grooming but will be addressed during Week 9…stay tuned!! Foot Care • Wash and soak feet daily with warm water. • Dry thoroughly especially between toes. • Apply lotion if feet are dry. • Clean under toenails • Trim toenails PRN straight across and even with toes. • Check doctors orders for special care i.e. podiatrist. Potter & Perry, 2019, p.926-927 Nail Care • Soak fingers in basin of warm water. • Clean under nails • Trim nails straight across and even with fingers. • Use file to shape nails. Push cuticles back gently. Potter & Perry, 2019, p.926-927 Risk Factors for Feet and Nails • Patients with peripheral vascular disease, diabetes mellitus (DM), and other diseases that affect peripheral circulation and sensation should be assessed for adequacy of circulation to the feet Potter & Perry, 2019, p. 906-908, 928-930 Risk Factors for Feet and Nails • Inspection and daily foot care can help prevent the development of a foot ulcer • Foot ulcerations are a predisposing factor for lower extremity amputation in individuals with DM Potter & Perry, 2019, p. 906-908, 928-930 Diabetes Mellitus • Assess for neuropathy • Degeneration of the peripheral nerves characterized by a loss of sensation, which can lead to injury • Assess sensation to light touch, pain, and temperature Potter & Perry, 2019, p. 906-908, 928-930 Back Rub Potter & Perry, 2019, p.926 • Promotes relaxation • Relieves muscular tension • Stimulates circulation • Improves sleep • Reduction in blood pressure • Reduction in pain • Decrease anxiety & depression • Enhance comfort • Determine preference of deep or gentle massage What else should you consider during a back rub? Guidelines for Changing Clothing Sorrentino Reading, p.669-672 • Provide hand hygiene and privacy not exposing client. • Encourage the client to do as much as possible. • Allow the client to choose what to wear. Make sure the right undergarments are chosen. • Support the limbs when removing or putting on a garment. • Put clothing on the affected side first. Case Study: Ms. Perinic [adapted from Kozier&Erb (2018) Fundamentals of Canadian Nursing, Case Study 31] It is the 4th day after abdominal surgery and Ms is progressing well, is ambulating several times each day, has been providing for her own hygiene needs, and is planning to go home in 2 days. In the a.m you note that her hair is oily and she emits an unpleasant odour. Her dentures are also in a container in need of cleaning. You inquire about her ability to take care of her own hygiene needs and you offer to assist her. She replies that she had a bath yesterday, does not feel that she needs another one today, and requests to omit her care for today. Using clinical judgement that reflects critical thinking, discuss the following questions: 1. Explain why it would be in Ms Perinic’s best interest for you to assist her with hygiene care, even though she does not feel she needs a bath. 2. What factors should you consider before you attempt to encourage Ms Perinic to attend to her personal care? 3. What approaches might you use to ensure Ms Perinic is agreeable before assisting her hygiene? 4. What approaches might you use if you feel that Ms Perinic does not need her hair shampooed, but needs to have her personal care attended to? Done!!  Next week – we continue with Supporting Elimination  Keep up on your skills  PRACTICE!!!