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CHAPTER 37 UNIT 4 PHYSIOLOGICAL INTEGRITY Eye and ear care SECTION: BASIC CARE AND COMFORT Use a clean, moist washcloth without any soap to Hyg...

CHAPTER 37 UNIT 4 PHYSIOLOGICAL INTEGRITY Eye and ear care SECTION: BASIC CARE AND COMFORT Use a clean, moist washcloth without any soap to Hygiene wipe gently across the eyelids from the inner to the CHAPTER 37 outer canthus. Rotate the end of a clean, moist washcloth gently into the ear canal. Personal hygiene needs vary with clients’ health Oral hygiene status, social and cultural practices, and the Proper oral hygiene helps decrease the risk of infection for daily routines they follow at home. For most clients living in long‑term care facilities, especially from clients, personal hygiene includes bathing, oral the transmission of pathogens that can cause pneumonia. Other populations who require meticulous oral hygiene care, nail and foot care, perineal care, hair care, include those who are seriously ill, injured, unconscious, and shaving (especially for men). dehydrated, or have an altered mental status or limited upper body mobility. Because personal hygiene has a profound effect Foot care on overall health, comfort, and well‑being, it Foot care prevents skin breakdown, pain, and infection. is an integral component of individualized Foot care is extremely important for clients who have nursing care plans. When clients become ill, diabetes mellitus, and a qualified professional must perform it. have surgery, or are injured and are unable to manage their own personal hygiene needs, it Perineal care becomes the nurse’s responsibility to meet Perineal care helps maintain skin integrity, relieve discomfort, and prevent transmission of micro‑organisms those needs. (catheter care). Before beginning any personal care delivery, it is important to evaluate the client’s ability to CULTURAL AND SOCIAL PRACTICES Clients vary in their hygiene preferences and practices. participate in personal hygiene. Encourage These include bathing routines, oral care, grooming clients to participate in any way they can. preferences, and health beliefs. Culture also plays an important role, because some Integrate assessment, range-of-motion cultures have unique hygiene practices. Be sure to exercises, and dressing changes while providing be respectful and observant of each client’s specific cultural needs. hygiene care. Consider the client’s personal preference regarding hygiene practices. Socioeconomic status can affect clients’ hygiene status. HYGIENE CARE If a client is homeless, alter discharge instructions and follow‑up care accordingly. Bathing Respect each client’s dignity. Many clients are dealing Bathe clients to cleanse the body, stimulate circulation, with a loss of control when others must provide their provide relaxation, and enhance healing. hygiene care. Reassure clients and allow them to have Bathing clients is often delegated to the assistive as much control as possible. personnel. However, the nurse is responsible for data collection and client care. Bathe clients whose health problems have exhausted SAFETY them or limited their mobility. Before starting any care, understand how to complete ◯ Give a complete bath to clients who can tolerate it and each task to avoid injuring the client. This includes whose hygiene needs warrant it. knowing the equipment and what the proper techniques ◯ Allow rest periods for clients who become tired are for each hygiene procedure. during bathing. Never leave clients in a position where injury could ◯ Partial baths are useful when clients cannot tolerate occur during routine hygiene care. For example, avoid a complete bath, need particular cleansing of odorous leaving a client who is at risk for aspiration alone with or uncomfortable areas, or can perform part of the oral hygiene supplies. bath independently. Adjust the bed to a comfortable working height and ◯ Therapeutic baths are used to promote comfort and lower the bed upon completion of the task. provide treatment (soothing itchy skin). FUNDAMENTALS FOR NURSING CHAPTER 37 Hygiene 211  CONSIDERATIONS FOR OLDER ADULTS PATIENT‑CENTERED CARE Older adults’ skin is drier, thinner, and will not tolerate as much bathing as younger adults’ skin. NURSING CONSIDERATIONS Older adults have higher incidences of infection and periodontal disease due to the weakening of the Giving a bed bath periodontal membrane. Collect supplies, provide for privacy, and explain the Dentures must fit correctly, or they can cause digestive procedure to the client. issues, pain, and discomfort. Dentures are a client’s Apply gloves. personal property. Never leave them on a meal tray or in Lock the wheels on the bed. a place where they could be damaged or lost. Adjust the bed to a comfortable working position. Dry mouth is common in older adults due to decreased Place a bath blanket over the client, and remove the saliva production and the use of certain medications client’s gown. (antihypertensives, diuretics, anti‑inflammatory Obtain warm bath water. agents, antidepressants). Wash the client’s face first. Allow the client to perform Poor nutritional status is often due to dental problems, this task if able. socioeconomic status, or a limited ability to prepare Perform the bath systematically by starting with the healthful foods. client’s trunk and upper extremities and continuing to the client’s lower extremities. Keep cleaned areas covered with a blanket or towel. ASSESSMENT/DATA COLLECTION Wash with long, firm strokes from distal to proximal. Inspect the skin for color, hydration, texture, turgor, Use light strokes over lower extremities for clients who and any lesions or other impaired integrity. have a history of deep vein thrombosis. Check the condition of the gums and teeth for dryness Apply lotion and powder (if the client has no or inflammation of the oral mucosa. Does the client contraindications for these products), and a clean gown. report any pain? Replace the water if it becomes cool, and use fresh water Assess the skin surfaces, including the feet and to perform perineal care. nails, and note the shape and size of each foot, any Document skin assessment, type of bath, and the lesions, and areas of dryness or inflammation. client’s response. Significant alterations can indicate neuropathy and/or TO CHANGE LINENS ON AN OCCUPIED BED vascular insufficiency. Are all pulses palpable and Adjust the bed to a comfortable working height. equal bilaterally? Don gloves. Identify hygiene preferences to understand how clients Roll the bottom linens up in the bottom sheet or perform hygiene at home and what additional education mattress pad under the client who is turned to one side, and care to provide. facing the opposite direction. For safety purposes, adjust Monitor for safety issues (altered positioning, decreased and lower side rails accordingly. mobility) and the ability to participate in self‑care. Alter Apply clean bottom linens to the bed (draw sheets are the plan of care according to the client’s capabilities. optional), and extend them to the middle of the bed with the remainder of the linen fan‑folded underneath the client. Have the client roll over the linens and face the opposite direction, then remove the used linens (keep them away from your uniform) and apply the clean linens. Make sure the linens are free from wrinkles. Apply the upper sheet and blanket. To remove the pillowcase, insert one hand into the opening, grab the pillow, and turn the pillowcase inside‑out. Apply the clean pillowcase by grasping the center of the closed end, turning the case inside‑out, fitting the pillow into the corner of the case, and pulling the case until it is right‑side out over the pillow. 212 CHAPTER 37 Hygiene CONTENT MASTERY SERIES  Foot care Oral hygiene It is important to prevent any infection or pain that Check for aspiration risk, impaired swallowing, and a can interfere with gait. A qualified professional should decreased gag reflex. perform foot care for clients who have diabetes mellitus, Clients who have fragile oral mucosa require gentle peripheral vascular disease, or immunosuppression to brushing and flossing. evaluate the feet and prevent injury. Have suction apparatus ready at the bedside when Instruct clients at risk for injury to do the following. providing oral hygiene to clients who are unconscious to ◯ Inspect the feet daily, paying specific attention to the help prevent aspiration. Do not place your fingers into area between the toes. an unconscious client’s mouth because the client could ◯ Use lukewarm water, and dry the feet thoroughly. bite down on your fingers. Position the client on one ◯ Apply moisturizer to the feet, but avoid applying it side with the head turned toward you in either a between the toes. semi‑Fowler’s position, or with the head of the bed flat. ◯ Avoid over‑the‑counter products that contain alcohol This will allow fluid and oral secretions to collect in the or other strong chemicals. dependent side of the client’s mouth and drain out. ◯ Wear clean cotton socks daily. Perform denture care for clients who are unable to do so ◯ Check shoes for any objects, rough seams, or edges themselves. Dentures are very fragile, so handle them that can cause injury. with care. ◯ Cut the nails straight across, and use an emery board ◯ Remove the dentures with a gloved hand, pulling to file nail edges. down and out at the front of the upper denture, and ◯ Avoid self‑treating corns or calluses. lifting up and out at the front of the lower denture. ◯ Wear comfortable shoes that do not ◯ Place the dentures in a denture cup, emesis basin, or restrict circulation. on a washcloth in the sink. ◯ Do not apply heat unless prescribed. ◯ Brush in a horizontal back-and-forth motion with a ◯ Contact the provider if any indications of infection or soft brush and denture cleaner. inflammation appear. ◯ Rinse dentures in tepid water. ◯ Store the dentures in a denture cup. Label the cup Perineal care with the client’s name. ◯ Place the dentures in the cup with water to keep them It is important to maintain skin integrity to relieve moist, or to help the client reinsert the dentures. discomfort and prevent transmission of infection (catheter care). Nail care PRINCIPLES OF PERINEAL CARE Observe the size, shape, and condition of the nails and Provide privacy. nail beds. Maintain a professional demeanor. Check for cracking, clubbing, and fungus. Remove any fecal material from the skin. Before cutting any client’s nails, check the facility’s Cleanse the perineal area from front to back (perineum policy. Some require a prescription from the provider, to rectum). while others allow only a podiatrist or other qualified Dry thoroughly. professional to cut some or all clients’ nails. Retract the foreskin of male clients to wash the tip of Foot and nail care vary from the standard when caring the penis, clean from the meatus outward in a circular for a client who has diabetes mellitus or peripheral motion, then replace the foreskin. vascular disease. Do not soak the feet due to the risk of infection, and do not cut the nails. Instead, file nails using a nail file. Do not apply lotion between the fingers or toes because the moisture can cause skin irritation and breakdown. FUNDAMENTALS FOR NURSING CHAPTER 37 Hygiene 213  Hair care Shaving Caring for the hair and scalp is important for clients’ Safety is important. Clients who are prone to bleeding, appearance and sense of well‑being, and is an essential are receiving anticoagulants, or have low platelet counts component of personal hygiene. Take into consideration should use an electric razor. the client’s cultural and personal preferences. Soften the skin with warm water. Brush or comb the hair daily to remove tangles, Apply liquid soap or shaving cream. massage the scalp, stimulate circulation to the scalp, Hold the skin taut. and distribute natural oils along the shaft of the hair. Move the razor over the skin in the direction of hair Use a soft‑bristled brush to prevent injury or trauma to growth using long strokes on large areas of the face and the scalp and a wide‑toothed comb or hair pick to comb short strokes around the chin and lips. through tightly curled hair. Be sure to communicate with clients about personal For clients who cannot shower but can sit in a chair and shaving preferences. lean back, shampoo the hair at the sink. For clients who require bed rest, use a plastic shampoo trough. Dry or no‑rinse shampoos and shampoo caps are also options Active Learning Scenario for clients who require bed rest. Start shampooing the hair at the hairline and work A nurse is about to perform perineal care for a client whose toward the neck. To wash the hair on the back of the ability to assist with care is limited. Use the ATI Active head, gently lift the head with one hand and shampoo Learning Template: Nursing Skill to complete this item. with the other. Place a folded or rolled towel behind the neck to pad the DESCRIPTION OF SKILL: List the steps the nurse edge of the sink. Then rinse, comb, and dry the hair. should take to perform this procedure. Application Exercises 1. A nurse is performing mouth care for a 4. A nurse is beginning a complete bed bath for client who is unconscious. Which of the a client. After removing the client’s gown and following actions should the nurse take? placing a bath blanket over the body, which of the A. Turn the client’s head to the side. following areas should the nurse wash first? B. Place two fingers in the client’s mouth to open it. A. Face C. Brush the client’s teeth once per day. B. Feet D. Inject a mouth rinse into the center C. Chest of the client’s mouth. D. Arms 2. A nurse is instructing a client who has diabetes mellitus 5. A nurse is preparing to perform denture about foot care. Which of the following guidelines care for a client. Which of the following should the nurse include? (Select all that apply.) actions should the nurse plan to take? A. Inspect the feet daily. A. Pull down and out at the back of the B. Use moisturizing lotion on the feet. upper denture to remove. C. Wash the feet with warm water and let them air dry. B. Brush the dentures with a toothbrush and denture cleaner. D. Use over‑the‑counter products to treat abrasions. C. Rinse the dentures with hot water E. Wear cotton socks. after cleaning them. D. Place the dentures in a clean, dry storage 3. A nurse is planning care for a client who develops container after cleaning them. dyspnea and feels tired after completing morning care. Which of the following actions should the nurse include in the client’s plan of care? A. Schedule rest periods during morning care. B. Discontinue morning care for 2 days. C. Perform all care as quickly as possible. D. Ask a family member to come in to bathe the client. 214 CHAPTER 37 Hygiene CONTENT MASTERY SERIES