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Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Chapter 15 Personal Care.

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Presentation on theme: "Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Chapter 15 Personal Care."— Presentation transcript:

1 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Chapter 15 Personal Care

2 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Activities of Daily Living (ADLs) Related to Personal Care  Bathing  Washing and styling hair  Brushing and flossing teeth  Dressing  Shaving

3 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Routine Care  Who’s job is it?  Delegate?  Responsibility

4 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Scheduled Care  A.M. Care  Before or after breakfast  ADL’s  Linen’s

5 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Scheduled Care  P.M. Care  Address any needs—hourly rounding  Straighten sheets  Back rub?

6 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Scheduled Care  Bedtime (hs) Care  Prepare for sleep  Brush teeth, remove dentures  Remove glasses, remove hearing aid  Back rub?  Extra blanket  Dim lights

7 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Benefits of Bathing Patients  Patient  Cleansing the skin  Increasing circulation and sensation  Providing comfort and relaxation  Improving self-esteem  Nurse  Opportunity for skin assessment  Nurse–patient relationship

8 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Benefits of Bathing  Skin assessment  Look for redness, cracking, and maceration  Crevices, under breasts and scrotum, axilla and groin, between toes, and between buttocks  Excoriation or scrapes on skin  Temperature  Breakdown

9 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Benefits of Bathing  Gain your patient’s trust and respect  Respect  Preserve modesty  Demonstrate care and compassion  More time spent with patient=ability of patient to confide in you

10 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Factors to Consider When Planning Patient Care and Bathing  Patient preferences  Patient’s culture  Timing of the care  Patient’s abilities  Understands directions  Moves and turns enough to assist  Tolerates physical demands of a bath

11 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Preparing  Ability to turn  Follow directions  Need for assistance  Is patient in pain? Experiencing fatigue? SOB?  Determine appropriate bath

12 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Supplies  Basin or bag  Several towels, washcloths, bath blanket  Linens  Laundry bag or somewhere to place dirty linen

13 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Bath  Test water temperature  Provide privacy  Position bed to appropriate height  Lower siderail nearest you  Place bath blanket  Remove gown

14 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Approach is Important  Positive attitude  Do not rush patient  Do not make their care seem like a chore to you  How would you like to be treated or your family member

15 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Three Categories of Personal Care  Self-care: patients who are able to perform ADLs without assistance  Assisted care: patients who need some assistance with ADLs  Total care: patients who are able to do very little or nothing for themselves

16 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Types of Baths  Complete bed bath  Assisted or help bath  Partial bath  Tub bath*  Shower*  Therapeutic bath  Towel or blanket bath*  Bag bath*

17 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Complete Bed Bath  View video  Skill 15-1 pg. 294

18 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Assisted Bath  Bed or chair  Patient participates as much as possible  Nurse completes what patient can not reach or if becomes fatigued

19 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Special Considerations  Older adults  Sebaceous and sweat glands produce less oil and sweat  Optional daily full bath—cleanse areas of necessity  Prevent dryness  Keep patient warm

20 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Partial Bath  Only selected areas are washed  Patient condition  Post-op  Dryness  Face, hands, axilla, buttocks, and perineal area, or parts of the patient that would cause odor if not washed

21 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Tub Bath  Sits in tub  Whirlpool  Disadvantages—difficult to get in and out of tub, risk of falls

22 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Shower  Shower chair  Monitor temperature of water  Wash hair

23 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Key Points  Tub baths, showers, or therapeutic baths  Monitor water temperature  Warm water dilates blood vessels (vasodilatation)  Lowers blood pressure  Possible dizziness or fainting  Stay with patient or in close proximity  Inform patient of emergency call system

24 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Bag Bath  washcloths saturated with no-rinse skin cleanser  Heat bag in microwave  Each washcloth washed one part of body— then discard

25 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Guidelines  Use of bath blanket  Fold washcloth into a mitt  Move cleanest to dirtiest areas—prevent transferring bacteria  Extremities—distal to proximal  Start with extremity farthest away from you— prevent contamination

26 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Guidelines  Change water  Dirty  Soapy  Cool  After bathing buttocks and rectal area  Perform perineal care during bath and anytime patient is incontinent

27 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Nurse Responsibilities When Bathing Patients  Assess the skin for rashes, bruises, and lesions  Complete the bathing process in timely manner  Be alert to signs of patient fatigue  Intervene in ways to conserve patient energy during the bath

28 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Oral Care  Freshens mouth  Decrease bacterial count  Assess mouth for problems  Teeth—decaying, broken, or missing  Reddened or bleeding gums  Ulcerations  Coating on the tongue

29 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Examples of Patients Needing Special Mouth Care  Patients who are NPO  Patients receiving oxygen by cannula or mask  Patients having a nasogastric or feeding tube in place  Patients who are unconscious

30 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Unconscious Patient  Oral care needs to be provided  Highest priority—Prevent aspiration of fluids  Proper positioning  Availability of suction  Assess for lesions and sordes (dried mouth secretions)  Skill 15-4, pg. 298

31 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Conscious Patient  Independent—help with necessary supplies  Assistance needed—use small amount of toothpaste, circular motion on inner and outer surface of teeth, and back and forth motion on chewing surfaces  Possible swallowing difficulties*--stay with patient and position patient properly

32 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Denture Care  Be careful!  Expensive  Interfere with nutrition  Pad cleaning surface  Use cool rather than hot water  Follow policy or patient’s preference

33 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Dressing  Underwear?  Intravenous line?  Size of patient  Don’t forget their HAIR!

34 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company  Let them select outfit  Any limitations?  Style hair  Apply makeup if desired Dressing

35 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Hair Care  Keep patient well groomed  Improves self-esteem  Comb or brush—eliminate bed head—style age appropriate  Shampoo if needed or desired  Shower or no rinse shampoo  Shampoo board

36 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Shaving  Shave in direction of hair growth  Electric razor—circular motion—clean razor when finished to prevent clogging  Safety: DO NOT USE a razor blade for any patient on anticoagulation therapy (blood thinning medication) A cut can cause excessive, difficult to control bleeding

37 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Contraindications  Thrombolytic agents  High doses of aspirin  Blood disorders  Liver disease  Rashes, lesions, inflamed lesions  Suicidal patients

38 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Nail Care  Follow facility policy  Do not cut nails on diabetics or patients with circulatory problems—Podiatrist  Clip nails straight then file—stay away from skin

39 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Observations Made During Nail Care  Discoloration  Ridges  Redness  Infections  Thick yellow toenails (fungal infection)

40 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Care of Piercings  New piercings  Keep clean—soap, water, and alcohol  S/S of infection—redness, swelling, pain, or drainage

41 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Situations Requiring Removal of Jewelry From Piercings  Surgery  Intubation  Diagnostic testing  Catheterization  Table 15-1, pg. 289

42 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Eye Care  Glassess  Clean with warm water and soft cloth  Inform patient of placement of glasses  Safe but accessible site

43 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Removing Contact Lenses  Wash hands; put on gloves  Pull down on lower lid; place finger across upper lid; apply gentle pressure  Ask patient to blink  Grasp lens with fingers  Hold lens carefully and put in well  Fill the well with saline or soaking solution

44 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Contact Lenses  Properly labeled containers (R and L)  Place in correctly  Saline or special soaking solution

45 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Procedure for Removing a Prosthetic Eye  Wash your hands and put on gloves  Dip the end of the suction cup in saline  Lift the upper eyelid  Squeeze the suction cup and place it on the iris of the prosthesis  Stop squeezing  Use the handle of the suction cup to lift the prosthesis out of the socket

46 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Cleansing Prosthesis  Cleanse prosthesis with sterile water or saline  Irrigate the eye socket with eye irrigating solution  Small amounts of mucus may accumulate  Observe for thick yellow or green mucus

47 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Removing a Hearing Aid  Turn off the hearing aid  Turn the earmold slightly toward the nose and lift out  Store the aid in its case or moisture-control container

48 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Inserting a Hearing Aid  Check the battery by turning the hearing aid on to full volume and listening for it to whistle, which indicates that it is working  If you do not hear a whistle, check the battery and replace as needed  Turn off the hearing aid and lower the volume  Insert the hearing aid into the ear and adjust the volume as needed

49 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Types of Unoccupied Beds  Open bed: made with top linens fan folded to foot of bed  Surgical bed: made with top linens fan folded to side of bed  Closed bed: only used when patient is discharged; top linens are spread to the head of the bed

50 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Nurse Responsibility in Bed Making  Often delegated to a CNA or UAP  Must be made tightly without wrinkles  Number one concern is patient safety  Use side rails appropriately  Apply drawsheet according to policy  Miter corners

51 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Common Bed Positions  Flat  Fowler’s—45 to 60°  Semi-Fowler’s or low-fowler’s—30°  High Fowler’s—sitting upright in bed  Trendelenburg  Reverse Trendelenburg

52 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Controlling the Patient Environment  Provide for privacy  Arrange furniture  Keep patient door closed to block noise  Control odors by removing bed pans  Remove clutter from room  Keep pathway to bed clear of equipment

53 Fundamentals of Nursing Care: Concepts, Connections, & Skills Copyright © 2011 F.A. Davis Company Orient Patient to Surroundings  Use of bed controls  Importance of siderails  Call light and television controls  Over bed table—compartments  Importance of cleanliness and order  Bedside stand  Closet


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