MJ11004 Fundamental of Nursing PDF

MJ11004FUNDAMENTAL OF NURSING Hygiene: Bath Care, Hair Care, Oral Care, Nail care, Perineal Care Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care Learning objectives At the end of the lecture, student will be able to 1. Understanding the impor...

MJ11004FUNDAMENTAL OF NURSING Hygiene: Bath Care, Hair Care, Oral Care, Nail care, Perineal Care Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care Learning objectives At the end of the lecture, student will be able to 1. Understanding the importance of personal hygiene for maintaining overall health and well-being. 2. Knowing the different types of bathing techniques, such as bed baths, partial baths, and complete baths, and how to choose the appropriate technique based on the patient's condition and preferences. 3. Understanding the principles of skin care, including identifying common skin conditions and selecting appropriate skin care products. 4. Knowing the different types of hair care techniques and how to choose the appropriate technique based on the patient's condition and preferences. 5. Understanding the importance of infection control practices during hygiene procedures and how to prevent the spread of infectious diseases. 6. Being able to effectively communicate with patients and families about hygiene practices and the importance of maintaining good hygiene. 7. Understanding the legal and ethical considerations related to hygiene care, such as informed consent and patient privacy. Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 2 What personal hygiene is important? Essential for skin health Maintaining self-esteem Maintaining quality of life Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 3 Personal hygiene includes.. Mouth, eyes, Perineal Hair Skin Nails ear and areas nose Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 4 Factors that negatively affect skin health Poor nutrition and hydration Poor mobility Advancing age Surgical interventions, Incontinence wounds and drains Medical Concurrent or interventions, such underlying skin as radiotherapy and conditions chemotherapy Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 5 Who is responsible to perform bath care? Junior nurses? Whether the nurse performs the bath or delegates Senior nurses? the activity to another HCP, the nurse remains responsible for ensuring that the hygienic needs of the client are met or not Diploma nurses? (Koirala, 2023) Degree nurses? Matron U41/U44/U48? ALL NURSES are responsible to ensure Sister U32/U36/KUP? smooth delivery of care Student year 1 bachelor? Student final year diploma? Helping patients to wash and dress is frequently delegated to junior staff, but time spent attending to a Family member patient’s hygiene needs is a valuable opportunity for nurses to carry out a holistic assessment. Caregiver (Dougherty and Lister, 2015; Burns and Day, 2012, Lawton, 2019) Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 6 Bed bathing a patient Bed bathing is not as effective as showering or bathing and should only be undertaken when there is no alternative (Dougherty and Lister, 2015) If a bed bath is required, it is important to offer patients the opportunity to participate in their own care, which helps to maintain their.. Independence Self-esteem, and Dignity Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 7  Types of cleaning bath Shower For ambulatory patient, limited mobility but able to Partial bath accommodate by placing water-proof chair in the shower Cleaning only body areas that would cause Minimal assistance required, pre-caution – fall discomfort / odor (e.g face, axilla, hands and perineal area) Based on patient’s self care ability (either Tub bath self-help / complete) Not common in Malaysia setting, for patient with limited ability Called a therapeutic bath Complete bed bath Assistance to enter and exiting tub, pre-caution – fall, drown Highly dependent client, confined to bed Involves washing the entire body Self-help bath For patient who is confined to bed Nurse prepare the equipment, and provide minimal assistance Assistance limited to wash at difficult-to-reach body area (e.g feet and back) Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 8 Indication of bath care Bed ridden patients Coma patients Major surgery Orthopedic patients with surgery Severe ill patient Patients with amputation surgery Unconscious or semi-conscious patient Paralyzed patient Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 9 Purpose of bed bath To clean the skin surface. To promote blood circulation. To refresh the patient To promote sleep To prevent bacteria spreading on skin To improve the patient self image To prevent bed sore To reduce body temperature Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 10 Principles of bed bathing Keep the patient warm at all times Position a linen skip near the patient and dispose of used linen immediately to reduce dispersal of microorganisms and dead skin cells into the environment Clean body part from the cleanest → less clean area Only expose the area of the body being washed (Fig 1) Change water if it becomes dirty or cold and always after washing the genitalia and sacrum Change wash cloths if they become soiled and after washing the genitalia and sacral area Check skin for pressure damage Avoid contaminating dressings and drains with water Pat the skin dry to reduce the risk of friction damage Separate skin folds, and wash and pat them dry Use the correct manual handling procedures and equipment to avoid injury to yourself and the patient If the patient is unconscious, remember to talk them through what you are doing; nurses should not talk over the patient Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 11 Principles of bed bathing Clean patient according to the following order : 1) Oral care 2) Eye (use cotton balls) inner → outer canthus 3) Neck → ears (for male patient shaving can be carried out here) 4) Arm → forearms → hands (firm stroke from distal to proximal) 5) Hand (soak 3 – 5 min) → interdigit area → finger → nails 6) Chest → Abdomen → Skin fold under women breast → umbilicus 7) Legs → feet (start with farthest from you, distal to proximal) → foot soaked for 3 – 5 min 8) Clean soles → interdigit → toes 9) Put patient in lateral position → clean back → buttock → give back rub → apply lotion / skin barrier 10)Perineal area→ clean front → anus Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 12  Principles of bed bathing Make a bath mitten using clean washcloth (watch this :) 1) Grasp the edge of the washcloth with the thumb; Washcloth mitten folding video : 2) Fold a third over the palm of the hand; https://youtu.be/6UUZOEdKOr4 3) Wrap remainder of cloth around hand and across palm 4) Grasp the second edge under the thumb; 5) Fold the extended end of the washcloth onto the palm 6) Tuck under the palmar surface of the cloth. Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 13 Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 14 Hair care Hair affects a client’s personal appearance and body image It maintain body temperature and as a receptor for the sense of touch Hair care includes: Brushing and combing Shampooing, Shaving, mustache and beard care Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 15  Common hair and scalp conditions Common hair and scalp condition Dandruff Dandruff Small pieces of dry skin flake off of the scalp accompanied by itching Pediculosis Pediculosis Lice infection Alopecia Alopecia Hair loss Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 16 Purpose of hair care To keep hair clean, healthy and tidy To provide the sense of well being To observe the scalp To increase circulation to the scalp and hair To prevent accumulation of dirt, dandruff and oil To promote growth of hair To prevent itching, infection and lice To prevent loss of hair To promote mental relaxation Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 17 General principles in hair washing Maintain privacy Empty the bladder before washing Combing hair should be done first before doing hair washing Hair must be kept free from snarls, combed and brushed without hurting the patient Prevent the eyes and ears from soapy water Water temperature should be around 37°C, check the temperature by placing a small amount of water on the inner aspect of forearm Special precaution should be taken in positioning the patient, if central venous lines are present Teeth of the comb should be ‘blunt’ to prevent scratching of the scalp Cover ear to prevent water from entering the ear Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 18  *If shampoo basin not available → improvise using macintosh Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 19 Oral care Definition Oral Hygiene is the practice of keeping the mouth clean and healthy The scientific care of the teeth and mouth Purpose Prevent odors, infections, tooth decay and loss of teeth, gum disease Increase comfort Enhance taste of food, appetite Indication Highly dependent patient / unconscious Seriously ill patient Patient on ventilator support / under anaesthesia Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 20 Principle of oral care Self-care patient → assist in preparing articles for flossing & brushing teeth Position → High fowler / in sitting position unless contraindicated Avoid flossing for patient at risk of bleeding Full-care patient → assemble articles for flossing and brush teeth Position → semi-fowler / lateral position with head tilt toward side Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 21 Principle of oral care Unconscious patient → perform oral suction first After brush teeth & flossing, rinse mouth using syringe → perform oral suction Do not force water into the mouth Patient to remain in a lateral position with head tilt to the side for at least 30 minutes Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 22 Back rubs (alternative / complementary intervention) To be carried out when providing partial/complete bed bath unless contraindicated Purpose Massages stimulate the client’s circulation Relax muscles, Relieve muscle tension Opportunity for skin assessment Emollient / creams / lotions → to facilitate back rub care Patient position : Lateral / prone Pre-caution : Massaging lower limb may dislodge a thrombus (blood clot) creating embolus (circulating blood clot) Bony prominence should be massage lightly Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 23 Perineal care Cleansing of the external genitalia, perineum, and surrounding area Also called as perineal genital care, involves cleaning the private areas of a patient Must be cleaned every day and more frequent for incontinence patient Indication → highly dependent patient Genito-urinary infection Incontinence or urine / stool With indwelling catheter Post-partum Pressure injury Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 24 Principles of perineal care Ensure empty bowel and bladder prior to perineal care. Offer urinal / bedpan for patient with limited mobility Provide privacy, and only expose when performing perineal care Place patient in dorsal recumbent position with knees bend Recommended to wear non-sterile glove when performing perineal care Swab clean mons pubis and high folds in “7 shape” manner each side Clean from thigh folds towards thigh Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 25  Principles of perineal care One swab per stroke in the following order: 1. Labia majora from upward to downward each side 2. Labia minora from upward to downward each side 3. Urethra towards anus 4. Separate vestibule using non- dominant hand, clean vestibule Posterior start from clitoris → fourchette fourchette 5. Clean anus in a circular manner Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 26 Foot and Nail Care It is essential for ambulation and standing Purpose To prevent infection and soft tissue trauma from ingrown or jagged nails To eliminate odor Hygienic care of foot and nail includes Regular trimming of nails, cleaning under nails, cleaning, rinsing, drying feet and nails Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 27 Principles of Foot and Nail Care Dirty nail need to be soaked with cleanser Clean under nails using orange stick wood Trim nails using nail clipper Nail should be filed straight across Never cut calluses, repeated soaking facilitate callus removal After soaking, pat all areas with clean towel and dry Soak feet with warm water Apply an emollient Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 28  Selection appropriate skin care product & equipment Equipment / skin care products Explanation / Information Use single-use disposable / stainless steel / use - Avoid plastic wash bowls patient own toiletries (no sharing) - Routinely used in hospitals for bed bathing but easily become contaminated with microorganisms responsible for healthcare acquired infections (HAI) Skin-cleansing emollient creams (Cowdell et al, - Avoid soap, as it will alter skin pH → dryness and skin breakdown 2014) Clean washcloth - Avoid reusable washcloths as they can harbour bacteria New development :- pre- packaged cloth for bed - This is particularly important in patients who are immunocompromised bathing, no water required or critically ill, skin integrity is compromised (e.g. patients with burns) Comb/brush - Use patient own toiletries Oral/denture care - Use patient own oral care equipment Disposable wash bowls Linen skip - Clean linen, patient attire Non-sterile glove (for perineal care) - Prevent cross contamination Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 29 Prevention of spread of infectious diseases The World Health Organization (2009) stated that non-sterile gloves are not required routinely for washing and dressing patients Nurses need to assess individual patients for risk of exposure to blood and body fluids Be aware of local policies for glove use Wear gloves to provide intimate care for example, washing genitalia. When gloves are required they must be single-use and be disposed of in accordance with local policy Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 30 Patient education : Hygiene practices Encourage movement Perform range of motion exercises Support walking Use compression stockings Administer prescribed medications Educate patients and families Prevent falls Collaborate with the healthcare team Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 31 Legal and ethical considerations related to hygiene care Legal Ethic Consent Dignity and respect Confidentiality Autonomy Documentation Beneficence and non- Standard of Care maleficence Abuse / Neglect Equity Honesty and Integrity Hygiene: Bath Care, Hair Care, Oral Care, nail Care, Perineal Care 32