4Purpose of Bathing Cleansing the skin Removes perspiration, bacteria, which minimizes skin irritation and reduces chance of infectionStimulation of circulationWarm water and gentle strokes from distal to proximal increase circulation and promote venous returnImprove self-imagePromotes feeling of being refreshed, relaxed
5Purpose of Bathing Reduction of body odors Especially in axillae and pubic areasPromotion of Range of MotionMovement of extremities while bathingCleansing removes perspiration, some bacteria, and dead skin cells which minimizes skin irritation and reduces the chance of infection.
6Nurse’s AdvantageProvides opportunity to develop a meaningful nurse-patient relationshipProvides opportunity for assessment of the patient including condition of patient, psychosocial and learning needs.Assessment:of the skin, hair, nails, feet,Psychosocial data collection – where live, family members, occupation, what is on their mind—some will open up at this timeLearning needs
7Before You Begin Bathing It is the Nurses Role to:Assess Your PatientAssess:preference for bathing, types of hygiene products usedcurrent condition of patient– movement, positions, up, bedridden,dizzy, confused
8Factors Affecting Personal Hygiene Cultural / ReligiousDevelopmental StageMobilityEmotionalPhysical IllnessPersonal PreferenceNorth American culture places a high value on cleanliness bathing once or twice a day, whereas other cultures bathe once a week.Body odors may be offensive in some cultures and accepted an normal in other cultures.Some religious beliefs do not allow bathing for certain days and ceremonial washings are practiced by some religions.Develop – the very young and elderly have needs for assistanceMobility – some patients have limited mobility due to weakness or a complete loss of mobility . Determine if the patient can sit without support, stand and amount of range of motion.Emotional – stress and emotional disturbances can cause disruptions in ability to perform self-carePhysical – ill patient may not have motivation( not a hierarchy of need) or energy to bath. Consider poor visionPersonal preference – each pt. has individual desires and preferences when they want to bath. Consider. Although, realize that it is the “day shift” that bathes pt’s.
9Critical Thinking Situation: The Nurse enters Mrs. G’s room to do a complete bed bath and she says “I do not want my bath now, I just want to rest”.What should the nurse do now?
10Critical Thinking Situation: The nurse enters Mr. C’s room to do a complete bed bath and he says “I do not want my bath now, I just want to rest”. You notice that his bed is wet and he was incontinent of urine.Now what should the nurse do?
11Used to clean the patient Types of BathsCleansing BathsUsed to clean the patient
12Cleansing Baths Complete Bed Bath Nurse baths entire body of dependent patient in bedSelf-Help BathPatients confined to bed are able to bathe themselves with some helpPartial BathParts of the body are washed by the patient and some by the nurse
13Cleansing BathsTub BathMuch easier for bathing and rinsing than in a bedVaries in style
14types of bathsShowerUsed by ambulatory patients who require only minimal assistanceCan be used with a shower chair
15Bath used for treatment Usually requires a doctor’s order Types of BathsTherapeutic BathsBath used for treatmentUsually requires a doctor’s order
16Therapeutic BathsMedicated solutions may be used in bathingRange from warm water baths, cool water baths, cornstarch, oatmeal, Aveno, alcohol
17Back Rub May be performed after drying off the back during the bath. Position of Patient: Prone or side-lyingExpose only the back, shoulders, upper arms. Cover remainder of bodyLay towel alongside backWarm lotion in your hands—still explain that it may be cool and wet.
18Back Rub Start in the sacral area, moving up the back. Massage in a circular motion over the scapula.Move upward to shoulders, massage over the scapulaContinue in one smooth stroke to upper arms and laterally along side of back down to iliac crests.Do NOT allow your hands to leave the patient’s skinEnd by telling your patient that you are finished
19Guidelines for Bathing Provide PrivacyMaintain SafetyMaintain warmthPromote the patient’s independence as much as possible
20Procedure for Bathing Bed Bath Harkreader p. 799-803 Tub Bath or ShowerHarkreader p
21Hygienic measures related to the care of the genitalia. Part B: Perineal CareHygienic measuresrelated to thecare of the genitalia.
22Perineal Care Can be embarrassing for the nurse and the patient. Should not be overlooked because of embarrassment.If the patient can do it themselves—let them.Hand them the washcloth and ask if they would like to “finish their bath.”
23Perineal Care Those patients who may need the nurses assistance: Vaginal or urethral dischargeSkin irritationCatheterSurgical dressingsIncontinent of urine or feces
24Perineal Care Procedure Normal conditions, Discharge, Menses WomenWipe labia majora (outer) from front to back in downward motion using clean surface of wash cloth for each swipe.Wipe labia minora (inner) from front to back in downward motion using clean surface of wash cloth for each swipeWipe down the center of the meatus from front to back. If catheter in place, clean around catheter in circular fashion, using clean surface of wash cloth for each swipe.Wash inner thighs from proximal to distal
25Cont. Female Perineal Care Rinse with warm to tepid water using pour from peri-bottle if available.Pat dry using clean towel in same order as washRemove bedpan if one is usedVerbalize turning patient on side to wash anal area from front to back and dry
26Perineal Care - Male Retract foreskin of penis if uncircumcised Wash around the urinary meatus in a circular motion, using clean surface of washcloth for each stroke and around the head of penis in circular motionWash down shaft of penis toward the thighs changing washcloth position with each strokeWash scrotum – front to backWash inner thighscontinued
27Cont. Perineal Care - Male Rinse with clean wash cloth or peri-bottle using warm water in same sequence as the washDry with clean towel in the same sequenceReplace foreskin, as appropriateTurn patient on side to wash anus from front to back and dryProcedure 31-2: Harkreader, p
28Perineal Care with Catheter Follow similar procedure in the male patient.Start at the urethra opening and clean outward.
29Part C: Oral Hygiene Why do oral hygiene? Maintains the healthy state of the mouthCleanses teeth of food particles, plaque, and bacteriaMassages the gumsRelieves discomfort from unpleasant odors and tastes.Refreshes the mouth and gives a sense of well-being and thus can stimulate appetite.
30Assessment: Oral Hygiene a. FrequencyDepends on the condition of the patient’s mouth.Some patient’s with dry mouth or lips need care every 2 hours.Usually done twice a day or after each mealb. Assistance NeededDoes the patient need assistance to do oral care*The nurse can help patients maintain good oral hygiene by:1. Teaching them correct techniques2. Actually performing for weakened or disabledpatients.
31Oral Hygiene Assessment c. AbnormalitiesLoose or missing teethSwelling and bleeding of gumsUnusual mouth odorPain or stinging in mouth structures
32Brushing Major concerns are: Thoroughness in cleansing Maintaining the condition of the oral mucosa.Procedure for Conscious Patient:Upright positionGet out your textbook--Harkreader:p
33Brushing: Unconscious Patient See performance checklist in syllabusSafety is of utmost importancePrevent aspirationPositioning—lateral position with head turned to the side or side-lying. Position back of head on a pillow so that the face tips forward and fluid/ secretions will flow out of the mouth, not back into the throat.Place a bulb syringe or suction machine with suction equipment nearby. Yankuer end on suction device.
34Oral Hygiene: Unconscious Patient Keeping the mouth openUse a padded tongue blade to open the patients mouth and separate the upper and lower teethNever place your hand in the patient’s mouth or open with your fingers. Oral stimulation often causes the biting –down reflex and serious injuries can occur.Harkreader p
35Denture Care Clean dentures as frequently as natural teeth Dentures are the patient’s personal property and should be handled with care because they can be easily broken.Care:Remove before going to bed – allows gums to rest and prevents buildup of bacteria.Store in a labeled container covered with water or denture cleaner if available
36Denture Care Procedure: Harkreader p. 815 Tips to remember: Use gauze squares or washcloth to grasp front of dentures to prevent from slippingPlace wash cloth or paper towel in sink to line it while you are cleaning the denturesWork close to the bottom of the sink in case you drop them.Use tepid water
37Part D: Hair CareA person’s appearance and feeling of well-being often depends on the way their hair looks and feels
38Major Goals in Hair Care Stimulate CirculationPrevents Matting
39Brushing and CombingKeeps hair clean and distributes oil evenly along the hair shaftCombing styles hair and prevents from tanglingAssessment while brushingScalp lesions, abrasionsDandruffParasitic infestationsQuality of hairAppearance
40Hair Care: Shampooing Depends on: Personal preference of the patient, does not have to occur every day with hygieneCondition of the hairWays to ShampooIf patient can get up and into a shower or sink, use a hand held nozzleIf patient can not get up, place on stretcher and roll to a shower areaIf patient is unable to be moved, may shampoo in the bed – see procedure in Harkreader p“Shampoo in a Bag” or dry shampoos are available
41Part E: ShavingImproves self-esteem and emotional needs of the patientUsually done after the bath or shampooAssessment:Skin for elevated moles, warts, Rashes, patchy skin lesions, or pustules
42Shaving Provide Safety When using a razor blade, the skin must be softened to prevent pulling, scraping, or cuttingPlace a warm wash cloth over area and then apply some gel, cream, foam.Hold the razor at a 450 anglePull the skin tautShave in the direction of hair growth
43ShavingSafety PrecautionsElectric razors must be used in patients who are at risk for bleeding, confused, or depressed
44Part F: Foot and Nail Care Usually part of the bathPurpose:Eliminate sources of infection and decrease odorsAssessment:Color, shape length, texture of nailsCondition of skin around nails and between toes and fingers – swollen, inflamed, callused, lesions, temperature
45Foot and Nail Care Soak the hand or foot to soften the cuticles Thoroughly cleanse and dryTrim the nails ONLY if you have permission or it is allowed at that institution. Most institutions do not allow nurses to trim the nails.
46Foot and Nail CareTeach patient and family that nails should be cut – straight across. May need to get a referral if no one available to cut nails.Show close attention to the feet and nails of the diabetic patient and the elderly** If feet and nails are in bad condition– notify doctor so a consult can be ordered with a podiatrist
47Part G: Ear Care Usually requires minimal care Cleanse the external auricle with washcloth when bathingAvoid insertion of objects into the ear
48Hearing AidsCheck that the device is functioning correctly and clean any body oils or cerumen from the hearing aidMake sure the hearing aid is off and volume is down before insertionInsert hearing aid in ear by pulling earlobe downward while pressing the hearing aid inwardTurn on and adjust volumeAsk the patient if comfortable and can they hear!
49Part G: Eye Care Assessment: Abnormal lesions Discharge Tearing Presence of any infectionUse of Visual Aids (contacts, glasses)Ask when patient needs to use these devices
50Eye CareWash around the eyes with a warm moist washcloth with warm water—NO SOAP!Clean from the inner canthus to the outer canthus of the eye. Pay special attention to the inner canthus.Provide special care for the eyes of unconscious patients.May need to tape the eye lids shut if unable to blink and protect own eyes
51Part H: Elimination Care Optimum elimination occurs when the patient can use a toilet and eliminate in private.
52Elimination HygieneThere are various circumstances when a patient will have to use a bedpan or urinal for elimination
53Elimination Hygiene Assist patient’s in a respectful way Assist to be comfortable especially when using a bed panProvide privacyDo not hurry
54Elimination Hygiene Types of Devices Bedside commodeUrinalBedpanRegularOrthopedic / fracture
55Elimination Hygiene Procedure for Using Bedpan / Urinal Bring to the bedsideWarm the bedpan if it is metalPlace bed in appropriate positionFold the top linen back to allow for placement of bedpan or urinalHave patient assist by bending knees and lifting up, place hand under lower back and slip into place.or
56Use of Bedpan Turn to the side and roll back onto the bedpan Check placementBedpan - when the buttocks rest on the rounded edge of the panUrinal – penis is inside, urinal rests on the bed
57Procedure for using bedpan / urinal Raise head of bed to upright sitting positionPlace call light and toilet within reach. Leave the patient if safe to do so, with side rails upRemovalSame manner as offered; hold steadyCover the pan
58May need to clean up the patient Note character of contents, chartClean the pan or urinalUnglove and Wash hands
59Assisting with a Condom Catheter Purpose:Control incontinence in a male patient without the risk of urinary tract infectionGreater comfort to the patient than an indwelling catheterEquipment NeededCondom catheterSoap and water, washcloth, towelDisposable glovesDrainage bag and tubing
60Condom Catheter - Procedure Wash handsPlace patient in supine position, provide privacy, close door and drape with only penis exposedApply gloves, Cleanse area with soap and water, dryAssess for any skin breakdown, rednessWrap adhesive spirally around the shaft of the penisPlace rolled condom over the penis and unroll over the penis and adhesive, press condom to the strip
61Attach drainage bag and tubing to the catheterCheck that tubing is nottwisted and lies over top of leg.Cover the patient, return bed to low positionAssess later to be sure that it is secure and not leaking.Empty bag as necessaryRemove condom daily to clean the area and assess the skin integrity.
62Part I: Antiembolic Prevention Patients who are immobile are at risk for stasis of blood in the lower extremities and development of thrombophlebitis.Contraction and relaxation of skeletal muscles helps to move blood through veins toward the heartValves within the veins prevent the blood from slipping back toward the feet under the influence of gravity.
63When circulation slows, clots (thrombi) are more likely to form in those patients with limited activity or incompetent valves.A blood clot can break loose and travel through the blood stream as an embolus leading to potential severe complications.
64Purpose of Antiembolic Measures Promote the circulation of blood from the legs back to the heart- increase venous return; decrease venous stasisSupport valves within peripheral leg veins so that blood is less likely to pool in a dependent position- decreases dependent edemaPrevent thrombus formation
65AssessmentIdentify conditions that increase the potential for poor circulation and clot formationPost-operativeVaricose veinsThrombophlebitisDehydrationPregnancyExamine lower extremities for poor circulation (Cold, cyanosis), intact skin or ulcerations, distended leg veins, peripheral pulsesAssess past history for developing blood clots
66Interventions / Preventive Measures 1. Leg and Foot Exercises2. Antiembolism stockings3. Sequential Compression Devices4. Avoiding compression of leg vessels
67Leg and Foot ExercisesAlternately flex and extend the foot five times.Make circular movement with the feet five times to the left and then repeat to the right.A leg exercise is to bend the knee and draw the foot up to the thigh, and then extend the leg.These exercises can be active – just have the patient do these ever so often on their own;Or passive. It is common to include these range of motion exercises as part of the bath for the immobile patient and at least every 2 hours for the post-operative patient.
68Antiembolism HoseAntiembolism stockings are elasticized stockings that provide varying degrees of pressure at different areas of the legs.To provide the optimum amount of pressure, the stockings should fit properly and be free of wrinkles.To ensure a proper fit, the patients leg is measured in length and circumference and then refer to the manufacturer’s chart to obtain the correct hose size.Length Circumference
69Procedure for Applying TED Hose Do not follow procedure in book Place patient in supine position in bed with leg horizontal for 15 minutesTurn the stocking inside out by placing one hand into sock, holding the toe with the other hand, and pull inside outPlace patient’s toe into foot of elastic stocking
70Application of TED Hose Slide remaining stocking over foot, Now the stocking will be right side outNever allow to make a tight band around the leg.Be sure to smooth stocking having no wrinkles.
71Antiembolism Hose Nursing Care: 1. Assess the lower extremities EVERY SHIFT.Toe area should have an opening that can be pulled back and the toes and feet assessed for function and any neuro-circulatory problems.Toes should be warm, pink, good capillary refill, can wiggle toes, has feeling in toes with no tingling.2. Remove ONCE EACH DAY and inspect the feet and toes.
72TED HoseDocumentCalf length TED hose applied, skin warm and pink with no lesions. Instructed patient in use, verbalized understanding. Stated they felt goodJ. Ward R.N.
73Sequential Compression Devices SCD’s Purpose:Enhance venous return by applying intermittent external compression to the tissues and veins similar to the normal physiologic pumping mechanisms of the muscles.
74Sequential Compression Device Disposable plastic sleeve wrappedaround the patients leg and secured with velcro.The sleeves are then connectedto an air pump that alternately inflates and deflates the air tubes in the sleeves. The sleeves are inflated in sequence from the bottom of the leg to the top, helping to move venous blood out of the leg veins and toward the heart.
75Sequential Compression Devices Place patient in supine position with legs horizontal for 15 minutes.Apply antiembolism hose, if desiredMeasure circumference of upper thighOpen inflatable sleeve on the flat bed, cotton side up, and placethe patients leg on the sleeveWrap sleeve snugly aroundthe leg, fasten with velcro
76Sequential Compression Devices Connect tubing on sleeveto compression controllerTurn on ordered settingsRemove three timesdaily and inspect skin
77Sequential Compression Devices Document:0900 – sequential compression devices placed on both legs set on low. Skin on lower extremities warm, dry, pink. Explained use to patient, verbalized understanding J. Ward R.N.0900 – SCD’s in place on both lower extremities. Toes warm and pink, pedal pulses present J. Ward R.N.
78Avoid Compression of Legs Watch positioning of the patient’s lower extremities. Do not allow the tubes, equipment to be placed under the legs to compress circulationPlace lower extremities on pillows to position correctly.Encourage patient to not cross legs or feet.