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HYGIENE MODULE Dr. Anita Catlin Sonoma State University N205.

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Presentation on theme: "HYGIENE MODULE Dr. Anita Catlin Sonoma State University N205."— Presentation transcript:

1 HYGIENE MODULE Dr. Anita Catlin Sonoma State University N205

2 Hyg iene involves cleansing of the: zSkin zMouth zTeeth zHair zNails z Eyes z Ears z Nose z Perineal Area z Feet

3 HYGIENE zCleansing by nurse is part of historical giving of care zThe more ill the patient, the more skill needed in providing the hygiene care zCleansing skin is first line of defense against organisms yMucous membranes also defend yGastric secretions as well

4 WHY A NURSING FUNCTION? zAssessment zTeaching zComfort zTouch zRelaxation zPain Relief zCaring

5 ATTENTION TO BODY IMAGE ISSUES zBody image is the meaning that the person attaches to body part zPerson may have radical changes in body image zYou may be one of first to see this zHow nurse responds to body image changes sets tone to last a lifetime

6 HYGIENE includes: zCleansing of patient zBedmaking zRoom straightening zEmptying garbage zRemoval of used supplies, dishes, flowers, newspapers, etc. zAssessing patency of and cleansing equipment zPlacement of necessary supplies

7 SOCIOCULTURAL FACTORS zAmericans bathe daily; not all cultures do zEconomics is an influence zDifferent cultures shave different body parts and hair on head differently zSome cultures wear items not to be removed in bath yexamples: wigs, headdressings, amulets, turbans, religious medals or shawls zMale nurse only or female nurse only may be necessary in some cultures

8 SOCIOCULTURAL FACTORS zIn some cultures, male relative may not allow male nurse alone with woman patient zIn some cultures, autonomy of patient is paramount; in others, family makes decisions for care zLevel of education may influence care zLegal and presumptive relationships yGay and lesbian partners yTeen friends of emancipated minors zNurse accepts all who lovingly participate

9 POVERTY OR HOMELESSNESS zInfluences hygiene zMay have body parasites zMay have unhealed/untreated wounds zDental caries zClotting problems from alcohol zDrug entry sites, abscesses zNeed to use standard precautions

10 KNOWLEDGE LEVEL zMay need teaching regarding: yFront to back perineal care yBrushing gum line, not teeth ySpecial foot care for circulatory problems ySkin inspections by dermatologist

11 DEVELOPMENTAL LEVEL: NEWBORNS zDo not place under running faucet zDo not submerge until umbilical cord drops off zDry carefully, especially the head zPlace cap after bath

12 DEVELOPMENTAL LEVEL: YOUNG CHILDREN zChildren can drown in 2 inches of water; never leave alone during bathing zTeach parents about fluoride zNo milk or juice bottles in bed zWipe off teeth after eating with soft cloth zDemonstrate on teddy bear

13 DEVELOPMENTAL ISSUES: CHILDREN zChildren may have natural parents, stepparents, four sets of grandparents, all involved in care zFor decision making, some cultures must ask father, some must ask grandmother

14 DEVELOPMENTAL LEVEL: ADOLESCENTS zModesty essential zNormal clothes, not gowns zBed pans not acceptable zAllow decision making zNo tampons in the hospital

15 DEVELOPMENTAL LEVEL: OLDER ADULTS zHeat insensitivity; can burn easily zFoot care zSkin very fragile

16 CONFIDENTIALITY zIn providing hygiene, may find very personal details zReport on “need to know” basis zTell instructor; decide together on what to take further zMust break confidentiality if signs of abuse

17 STUDENT NURSE ISSUES zPersonal space of patient yUndress, examine, wash and groom stranger yIncontinence can cause discomfort ySexuality may be an issue xPatient really asking “Am I still desirable despite my illness?” xTake a break if uncomfortable; tell instructor xAttraction? Ask for patient change

18 STUDENT NURSE ISSUES zYour safety and well being is our job zCare of your back zLifting and bending appropriately zProtected against infection transmission zTell instructor if pregnant or immunosuppressed zAsk for help (physical and emotional) zLearn assessment skills

19 PATIENT PREFERENCES zTry to involve patient in care zIf too ill, we must do all zGive control over soap, deodorant, mouthwash, nail length, water temperature zMust work within time constraints zBe very cautious with delegation of care to others zMust carefully assess refusal of bathing; speak to instructor

20 BATH REFUSAL What is real problem? zPower issue? zFatigue? zVisitors? Assessment zPatient continent? zSkin care? zLevel of exertion? Comfort education and negotiation

21 PURPOSE OF NURSE PROVIDED HYGIENE zRemove microorganisms zDo physical assessment zIncrease circulation yDistal to proximal yReturn to heart zImprove self image zProvide comfort

22 NOSOCOMIAL INFECTION zAlso called iatrogenic zPatient illness brought on simply by being in the hospital and being exposed to organisms not found outside the health care setting z5% of all hospital deaths (90,000 in 2000) z4 th largest cause of death in US (heart disease, cancer, stroke, infection) zMore than 4 billion dollars annually zOften hands of health care providers

23 NOSOCOMIAL INFECTION zHands washed with antiseptic soap and friction zShort fingernails; artificial nails now being forbidden zSoiled linen kept off uniform zGloves yif client has open or draining wound or is incontinent yif nurse has skin breaks on hands zNo sharing supplies without proper sanitation

24 SAFETY zElectrical supplies must be checked by engineering department prior to use; and not left near pan of water yhair dryers yelectric shavers zBed raised to working height and lowered when finished zSide rails up for patients requiring zAll spilled water immediately wiped zCaution with use of powder zCaution with use of latex

25 SHAVING zShaving reflects level of caring zSafety razor not used on certain patients yThose on anticoagulant drugs yThose with liver disease causing clotting disorders yConfused patients ySuicidal patients zUse electric razor after engineer check zIf using hair depilatory, always test area first

26 SAFETY zAll patients will need attention to water temperature zPatients with impaired level of consciousness will need special care ygentle eye care, possibly patching yfrequent mouth care yproper positioning ycare to bed linen ywater temperature

27 PATIENTS RECEIVING CHEMOTHERAPY zSpecial mouth care ynausea yoral thrush or stomatitis zSpecial hair care zRest periods

28 PATIENTS RECEIVING RADIATION THERAPY zDo not wash off markings zNo bath salts zNo heating pads or hot water bottles

29 UNCONSCIOUS PATIENT zMove during bath zROM frequently zMouth care in lateral position, with head lower zChange frequently zDo not roll down if tube feeding running

30 FATIGUE AS A FACTOR zNurse’s job to monitor patient tolerance yRespiratory response yHeart rate yCan patient tolerate being flat? Does he need orthopnea position? yConfusion level yShower less taxing than bed bath yMay be easier on patient to be up in chair than rolled side to side

31 TYPES OF HYGIENE zEarly a.m. care: Urinal/bedpan, wash hands and face, brush teeth, roll up zMorning care: After breakfast, complete bath or shower, hair care, nail care, oral care, back rub, linen change zAfternoon care: straighten linen, offer urinal/bedpan/commode, wash hands/face zHS care: Elimination, wash hands and face, oral care, linen straightening, back rub

32 SKIN zRegulates body temperature zFirst line of defense against harm zAntibacterial and antifungal zTransmits sensations zSigns of problems xRedness (erythema) xWet or damp xNot intact

33 PATIENTS AT RISK FOR SKIN PROBLEMS zAltered level of consciousness zAltered nutrition zImmobility zDehydration zAltered sensation zSecretions on skin zMechanical devices, casts, restraints zAltered venous circulation

34 NURSING INTERVENTIONS zGeneral health important zIntact skin yCaution in movement yDon’t overbathe elderly zProtein in diet zAvoid periods of moisture yChange frequently yDry carefully yRinse soap zSun screen important yEspecially with certain medications

35 NURSING ASSESSMENT WHILE BATHING zHistory zRelationship zColor and condition of skin zPain on movement zLevel of consciousness zInjuries zScars zSkin turgor zNevi zWt loss or gain

36 THERAPEUTIC BATHING zPhysician ordered; nurse suggestion zWater temperature usually 100-115 F zMedications are ordered to be put in water zTime usually 20 minutes zDon’t leave patients alone yBe very clear delegating

37 TYPES OF THERAPEUTIC BATHS zSaline y0.9% NaCl Normal body consistency for wound care and irrigations zOatmeal, cornstarch, Aveeno for itching zIodine, Dakin’s, KMNO4 for antibacterial action (Ask about allergies)

38 SHOWERING zCheck orders and get report zOrganize your supplies first zKeep covered when moving in hallway zKeep heels from dragging on floor zKeep curtains/doors closed zDry carefully zInclude oral care, shampoo, and shave zDon’t leave alone in shower

39 ORGANIZATION SKILLS yCheck orders (schedule; positioning) yCheck arm band yObtain report on patient yDiscuss plan with team yCheck availability of water, linen, hamper, gloves if needed yOrganize supplies prior to entering room yAssess patient condition xDoes patient need pain medication? xWill any treatments need to be done? yBegin!

40 GENERAL PRINCIPLES zClient safety zNurse safety zWork in time constraints zAllow privacy and dignity yOnly body part being washed is uncovered yCurtain is closed zChange water, washclothes, towels, linen as needed zUse absorbent cotton bath blanket (heated best) zCall bell available

41 PERINEAL CARE zProfessionalism always zNot deferred in cases needing nursing assessment zFemale yAlways sterile to contaminated (urethra to rectum) yOften have menses in hospital xUse peripads - tampons forbidden in hospital yIf large breasts, need to dry underneath carefully, may use cornstarch zMale yAssess for circumcision xIf not, cleanse under foreskin and replace

42 BACK RUB zPurpose yRelaxation yCirculation yPain relief zAssess skin integrity on back zAssess all bony prominences zAlways done as part of good nursing care

43 BACK OR BODY MASSAGE zWarm lotion first zUse continuous strokes zDoes not include back of calves zDon’t gatch knees or put pillows under calves

44 FOOT CARE zSoak feet as part of bath zClean toes and toenails zTeach as you go zRange of motion of legs zFeet of diabetic patients and patients with vascular disease are inspected carefully; Never cut toenails of these patients zMany facilities have podiatrist visits

45 NAIL CARE zObserve circulation; color, capillary refill time zObserve color, sensation, and movement (CSM) zPolish removed to observe color and use pulse oximeter zAssess for clubbing sign of long term lack of oxygen zCut nails straight across and file smooth; Do not go down into corners zAssess for rings too tight or too loose

46 MOUTH CARE zExamine with gloves and light, especially smokers zUse only water soluble lubricants zIf feeding tubes present, assess for parotitis zUnconscious patient has no gag reflex, position on side for care zMay have gum hyperplasia from meds zMay have teeth staining from meds zMay have accumulated debris in mouth called sordes zTeach about brushing and flossing

47 CARE OF DENTURES zAssess for fit zIf removed, keep in covered cup with water zLabel cup with patient’s name zKeep in bedside table zPad sink when cleaning zUse cool water

48 HAIR CARE zCulture may influence care yHmong – do not touch without permission yMuslim and Orthodox Jew – May keep covered, wear wig ySikh – Does not cut yDifferent parts of body have hair shaved

49 HAIR CARE zHair is combed daily and shampooed prn zCorn rows, dreds, braids not undone to shampoo yPatients may use hair oil on these zBoth wet and dry shampoo available zSend to operating room or surgical procedure with clean hair and shaven

50 EYE CARE zContact lenses usually removed zStored in saline liquid; case labeled zAlso label and safeguard glasses in drawer zClean inner to outer canthus zPatient must be able to blink to protect cornea zNever use cotton near eyes zTreat each eye separately zEyes considered sterile zCare of artificial eye similar to dentures

51 EARS zAllow nothing sharp in ears zHearing aids now miniscule in size – don’t lose! Label case zCerumen in ears may need softening and removing zSpeak directly to patient’s face if HOH

52 BEDBATH zWash head to toe, front to back, distal to proximal zPhysical assessment as you are washing; must also loosen and secure lines as moving and turning patient zChange washclothes for different areas zChange water if cold or soiled or very soapy zSome put oil in bath water of elderly zUse powder in your hand, very sparingly ynot with respiratory patients or those with allergies

53 BEDBATH zChange linen as needed zDo range of motion as needed zDo oral care, hair care, and give back rub zLeave bed in low position, rails up, and call light in place. Straighten room. zReport and chart findings

54 WHO BATHES PATIENT? zMore complexly ill, higher level of caregiver yIn ICU, registered nurse yIn OB, nurse yIn intensive care nursery, nurse yIn nursing home, may be nursing assistant, but nurse is responsible for training and delegating

55 ASSESSING TUBES AND LINES zOxygen – stays on during bath, check connections, liters per minute, cleanliness of prongs or mask, water if used, plugged in if concentrator zIV lines – use special gown, don’t open lines to change gown, look at IV site, rate and solution zUrinary catheter – draining, unkinked, bag below bladder zEnteral tubes – in place, running or draining properly, or clamped properly zDressings – Clean and dry, drains properly working zDoes anything need to be emptied, changed or cleaned?

56 BEDMAKING zMake bed for patient comfort zIf incontinent, wash, rinse, dry, change linen zUse aids to relieve pressure points yheel, elbow protectors ybed frame with trapeze yframe to keep covers off feet yspecial beds and mattresses zPosition as ordered

57 NURSE SAFETY IN BEDMAKING zRaise bed to working height zFace patient zBend knees zConserve steps zDon’t lift alone zSide rails as ordered zLower bed and place call bell when leaving

58 CHARTING zHow patient tolerated bath zAny unusual findings zWhat was done about findings zComparative progress

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