Chapter 33-Hygiene PDF

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Learning Outcomes - Chapter 33: Hygiene 1) Describe hygienic care that nurses provide to clients. ● Early morning care - Right as the patient awakens, the nurse provides urinal or bedpan care, face and hand washing, and oral care. ● Morning care - Usually after the patient has his/her breakfast but can also be provided before breakfast the nurse provides a bath/shower, perineal care, back massages, and oral, nail, and hair care. ● Hour of sleep or PM care - PM is provided right before the patient retires for the night. Same as morning care, the care consists of face and hand washing, oral care, and possible back massages. ● As needed (PRN) care - For patients that require extra hygiene care. 2) Identify factors influencing personal hygiene. ● Culture ● Religion ● Environment ● Developmental Level ● Health and Energy ● Personal Preferences

3) Identify normal and abnormal assessment findings while providing hygiene care. ● Abnormal findings: a) Skin - Abrasion, dryness, ammonia dermatitis (diaper rash), acne, erythema, hirsutism. b) Feet - Excessive dryness, areas of inflammation or swelling, fissures, scaling and cracking of skin, plantar warts, swelling or pitted edema, weak or absent pulses, cool skin temperature in one or both feet. c) Nails - Infected cuticle, inflammation of the tissue around the nail, discoloration of the nail beds. d) Mouth - Bad breath, inflammation of the tongue, inflammation of the gums, gums appear spongy and bleeding, excessive dryness of the buccal mucosa, redness or excoriated mucosa, cracking lips, teeth have darkened areas/may be painful, accumulation of foul matter(food, microorganisms, and epithelial elements) in the mouth, inflammation of the oral mucosa, inflammation of the parotid salivary glands. e) Hair - Dandruff, hair loss, ticks, pediculosis(lice), scabies, hirsutism. f) Eyes - Signs of inflammation, excessive drainage, encrustations, secretions of the eyelids. g) Ears - Excessive earwax, inflammation, drainage, discomfort in the external ear. h) Nose - Discharge, tenderness, redness. ● Normal Findings - intact skin, clean hair and body, brushed teeth, fresh breath, well

maintained nail beds and toe nails.

4) Apply the nursing process to common problems related to hygienic care of the: ● Skin ● Feet ● Nails ● Mouth ● Hair ● Eyes ● Ears 5) Identify the purposes of bathing. Bathing removes accumulated oils, perspiration, dead skin cells and some bacteria, stimulates circulation, and also produces a sense of well-being. 6) Describe various types of baths. ● Cleansing baths a) Complete bed baths - Nurse cleans the entire body of a dependent patient. b) Self-help bed baths - Patients that are somewhat independent, but still need help from a nurse with certain body parts. c) Partial bath - Only parts of the patient's body that experience discomfort or odor are washed. Nurses provide help to the dependent patients. d) Bag baths - A commercially prepared product that contains about 10-12 disposable washcloths that contain a no-rinse cleansing solution. e) Towel bath - Same as a bag bath but instead of disposable washcloths, towels are used with the no-rinse cleansing solution. This bath is usually used for patients with dementia or who are bedridden. f) Tub baths - Baths that are often prepared to bed baths since it is typically easier to wash and rinse in a tub. The amount of assistance a nurse may provide all depends on how independent the patient may be. g) Shower - Patients that need minimal assistance will take showers. Patients in long-term care facilities may be offered a shower chair. h) Therapeutic baths - Given for physical effects, usually to soothe irritated skin or to treat an area.

7) Compare and contrast the task-centered approach and the person-centered approach to bathing. ● Task-centered approach to bathing - routine and depersonalized, more about tasks and less about the patient and relationship. ● Person-centered approach to bathing - Therapeutic, satisfying for the patient, nurses are able to focus on the patients needs, the opportunity to gain a

relationship with the patient. 8) Describe guidelines for bathing individuals with dementia. ● Focus on the person rather than the task. ● Be flexible. Adapt your approach to meet the needs of the person. ● Use persuasion, not coercion. ● Be prepared. (Gather everything that you may need for the bath.) ● Stop when the person experiences any distress. The person being cared for shouldn’t be crying, screaming, or protecting while bathing. ● Talk to others who may have experience dealing with other persons with dementia. It is OK to ask for help. 9) Discuss different types of contact lenses. ● Hard contact lenses - Rigid, unwettable, airtight plastic that does not absorb water or saline solutions. These lenses usually can not be worn for more than 12 to 14 hours. ● Soft contact lenses - Covers the entire cornea, more pliable and softer than hard contact lenses, and they mold to the eye for a firmer fit. These lenses can be typically worn anywhere from 1-30 days, depending on the brand. ● Gas-permeable lenses - Rigid enough to provide clear vision but more flexible than the traditional hard lenses. They permit oxygen to reach the cornea, which creates a greater comfort and will not cause any severe damage to the eye if left in place for several days. 10) Discuss different types of hearing aids. ● Behind the ear (BTE) open fit - Has no earmold and is barely visible with a clear tube that runs down the ear canal. ● Behind the ear (BTE) with earmold - Fits snugly behind the ear and contains a hearing aid case, which holds the microphone, amplifier, and receiver which are all attached to the earmold by the plastic tube. ● In the ear (ITE) aid - A one piece hearing aid that has all its components housed in the ear mold. ● In the canal (ITC) aid - Fits completely into the ear canal. ● Completely in the canal (CIC) aid - Has to be customly designed to fit a person's ear. ● Eyeglasses aid - Quite similar to the “BTE” aid, the components of this aid are housed in the temple of the eyeglasses. ● Body hearing aid - Used for more severe hearing losses, this aid contains a case that consists of a microphone and amplifier and is completely connected by a cord to the receiver, which snaps into the earpiece. 11) Discuss factors that support a positive and safe environment for the client. Some factors to keep a positive and safe environment for a patient are, keeping their environment clean and well maintained, good ventilation so the room doesn’t contain any

foul odors, keeping the room at a temperature between 68 °F and 74 °F, limiting the noise inserting the room, and dimming lights.

12) Identify safety and comfort measures underlying bed-making procedures. ● Wear gloves while handling used bed linens and keep the soiled bed linens away from uniform. ● Soiled linens from one patient should never be used for another patient. ● Do not shake soiled linens in the air. ● Once bed if made, make a cuff on the top of the linens to make it easier for the patient to pull the covers. 13) Verbalize the steps used in: a) Bathing an adult client. b) Providing perineal-genital care. c) Providing foot care. d) Brushing and flossing the teeth. e) Providing special oral care. f) Providing hair care. g) Removing, cleaning, and inserting a hearing aid. h) Changing an unoccupied bed. i) Changing an occupied bed. 14) Recognize when it is appropriate to delegate hygiene skills for clients to unlicensed assistive personnel. 15) Demonstrate appropriate documentation and reporting of hygiene skills....