2Hygiene and Care of the Patient’s Environment Personal HygieneThe self-care measures persons use to maintain their healthHygieneThe science of healthIncludes care of the skin, hair, hands, feet, eyes, ears, nose, mouth, back, and perineumConscientious personal hygienic practices are essential for the nurse; nurses are role models.Why are nurses role models regarding hygiene?What personal hygiene practices should nurses practice every day?
3Hygiene and Care of the Patient’s Environment Factors Influencing Personal HygieneSocial practicesBody imageSocioeconomic statusKnowledgePersonal preferencePhysical conditionCultural variablesWhat factors influence personal hygiene?How does culture affect personal hygiene?
4Patient’s Room Environment Maintaining ComfortRoom temperature: 68° to 74° FGood ventilationBedpans and urinals that are emptied and rinsed promptlyMonitored noise levelProper lightingWhy is it important to consider the room temperature?Why is it important to rinse bedpans and urinals?How does proper lighting affect the patient’s comfort?
6Patient’s Room Environment Room EquipmentBedside standUsed to store the patient’s personal articles and hygienic equipmentOverbed tableOn wheels; is adjustable to various heights over the bed or a chairChairsStraight chairs and lounge chairsWhat items might you expect to find in the patient’s bedside table? What items would you hope not to find? Wallets, large sums of money.What is the purpose of the overbed table?Why is it beneficial to have straight chairs available at the bedside?
7Patient’s Room Environment Room Equipment (continued)LightsLights provide comfort, safety, and ease.Call light signal indicates that a patient needs assistance.BedBed is designed for comfort, safety, and adaptability to position changes.It has a number of safety features.What is the purpose of the call light?How should nursing staff respond to the patient’s call light?Why is it important to make sure the patient’s call light is within reach?What safety features would you find on a hospital bed?
8Bathing Sitz Bath Cool Water Tub Bath Cleanses and aids in reducing inflammation of the perineal and anal areas of the patient who has undergone rectal or vaginal surgery or childbirthWater temperature 98° to 102° FCool Water Tub BathMay be given to relieve tension or lower body temperatureWater temperature tepid, not cold—98.6° FWhy would a tub bath be less desirable than a sitz bath?How long should the patient sit in the sitz bath?How can the nurse prevent hypothermia when the patient is taking a tepid bath?
9Figure 18-2(From Potter, P.A., Perry, A.G. . Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)The sitz bath.
10Bathing Warm Water Tub Bath Hot Water Tub Bath Given to reduce muscle tensionWater temperature 109.4° FObserve s/s of dizziness/faintingHot Water Tub BathGiven to assist in relieving muscle soreness and muscle spasmsWater temperature 113° to 115° FHow does a warm water tub bath relieve muscle tension?How does a hot water tub bath relieve muscle soreness and spasm?
12Bathing Other Baths Complete bed bath Tepid sponge bath Medicated bath For patients who are totally dependent and require total assistanceTepid sponge bathAdministered to reduce an elevated temperatureMedicated bathMay include agents such as oatmeal, cornstarch, Burow’s solution, and soda bicarbonateTo reduce tension and relax the patient and to relieve pruritus caused by certain skin disordersWhat is the difference between a complete bed bath and a tepid sponge bath?What is the benefit to a medicated bath?
13Skill 18-1: Steps 8h & 8i Bed bath. (From Potter, P.A., Perry, A.G. . Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)Bed bath.
14Skill 18-1: Steps 8r & 8u Bed bath. (From Potter, P.A., Perry, A.G. . Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)Bed bath.
17Bathing Back Care/Back Rub Usually administered after the patient’s bathPromotes relaxation, relieves muscular tension, and stimulates circulationNurse massages for 3 to 5 minutesContraindicated if the patient has such conditions as fractures of the ribs or vertebral column, burns, pulmonary embolism, or open woundsWhat is an assessment benefit for the nurse when giving a massage?Why are massages contraindicated in patients with pulmonary embolism?
18Skill 18-1: Steps 14e & 14f Back rub. (From Potter, P.A., Perry, A.G. . Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)Back rub.
19Components of the Patient’s Hygiene Care of the SkinWhen a person’s physical condition changes, the skin often reflects this through alterations in color, thickness, texture, turgor, temperature, and hydration.As long as the skin remains intact and healthy, its physiological function remains optimal.Describe how the skin might appear when the patient is dehydrated, cyanotic, and hyperthermic.What is the skin’s physiologic function?
21Components of the Patient’s Hygiene Care of the Skin (continued)Collection of dataNormal skin has the following characteristics:Intact without abrasionsWarm and moistLocalized changes in texture across surfaceGood turgor; generally smooth and softSkin color variations from body part to body partHow does having “normal skin” (meeting the normal skin characteristics listed) keep the patient healthy?What are skin color variations, and where are these variations located on the body?
22Components of the Patient’s Hygiene Care of the Skin (continued)Impaired skin integrityA patient who stays in one position without relief of pressure can develop a pressure sore.Patients especially at risk are the chronically ill, debilitated, older, disabled, or incontinent patient and the patient with spinal cord injuries, limited mobility, or poor overall nutrition.How does lying in one position increase a patient’s chances to develop a pressure sore?What is the rationale that supports that these patients are at increased risk for pressure sores?Why is the incontinent patient at an increased risk of developing a pressure sore?
24Thirty-degree lateral position to avoid pressure points. Figure 18-5(From Potter, P.A., Perry, A.G. . Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)Thirty-degree lateral position to avoid pressure points.
25Using a rolled bath blanket as a pressure-reducing device. Figure 18-6Using a rolled bath blanket as a pressure-reducing device.
26Components of the Patient’s Hygiene Care of the Skin (continued)Impaired skin integrityPressure ulcers occur when there is sufficient pressure on the skin to cause the blood vessels in an area to collapse.The flow of blood and fluid to the cells is impaired, resulting in ischemia to the cells.When the external pressure against the skin is greater than the pressure in the capillary bed, blood flow decreases to the adjacent tissue.If the pressure continues for longer than 2 hours, cell necrosis may occur.What causes blood vessels to collapse when a patient is lying in the same position for a prolonged period of time?Why is decreased blood flow to the area a concern?Where is pressure most severe on the patient’s body?
28Components of the Patient’s Hygiene Care of the Skin (continued)Impaired skin integrityShearing forceThe tissue layers of skin slide onto each other, resulting in kinking or stretching of subcutaneous blood vessels; this results in an interruption of blood flow to the skin.FrictionRubbing of skin over a surface produces friction, which may remove layers of tissue.What mechanical factors can result in pressure ulcers?When might friction occur?
30Diagram of shearing force exerted against sacral area. Figure 18-3(From Potter, P.A., Perry, A.G. . Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)Diagram of shearing force exerted against sacral area.
31Components of the Patient’s Hygiene Care of the Skin (continued)Stages of pressure ulcersStage I: nonblanchable erythema of the skinStage II: partial-thickness skin loss; epidermisStage III: full-thickness skin loss, damage or necrosis of subcutaneous tissueStage IV: full-thickness skin loss withextensive destruction, tissue necrosis,or damage to muscle, bone, orsupporting structuresWhat is erythema?What is partial-thickness skin loss?What is full-thickness skin loss?What is necrosis?
32A, Stage I pressure ulcer. Figure 18-4, A(From Potter, P.A., Perry, A.G. . Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)A, Stage I pressure ulcer.
33B, Stage II pressure ulcer. Figure 18-4, B(From Potter, P.A., Perry, A.G. . Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)B, Stage II pressure ulcer.
34C, Stage III pressure ulcer . Figure 18-4, C(From Potter, P.A., Perry, A.G. . Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)C, Stage III pressure ulcer .
35D, Stage IV pressure ulcer . Figure 18-4, D(From Potter, P.A., Perry, A.G. . Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)D, Stage IV pressure ulcer .
37Components of the Patient’s Hygiene Care of the Skin (continued)Nursing interventionsAssess improvement.Assess size and depth of the ulcer, the amount and color of any exudate, the presence of pain or odor, and the color of the exposed tissue.Specific interventions are determined by the stage of the ulcer.Why is healing a long-term process?What nursing interventions would be appropriate for the care of a pressure ulcer?What nutritional support promotes healing of pressure ulcers?What other devices might a nurse utilize to relieve pressure on ulcerated areas?
38Components of the Patient’s Hygiene Oral HygieneCare of the oral cavityHelps maintain a healthy state of the mouth, teeth, gums, and lipsBrushing the teeth removes food particles, plaque, and bacteria; massages the gums; and relieves discomfort resulting from unpleasant odors and tastes.What types of patients are at risk for oral disorders?Why is it important to maintain a healthy mouth?How does proper oral hygiene stimulate appetite?
40Components of the Patient’s Hygiene Oral Hygiene (continued)DenturesA set of artificial teeth not permanently fixed.Should be stored in an enclosed, labeled cup for soaking or when they are not wornShould be cleaned as often as for natural teeth to prevent infection and irritationOral care provided on a regular basisWhy should dentures not be worn during surgery and other procedures?Why is it important to provide oral care on a regular basis?
42Components of the Patient’s Hygiene Hair CareCombing, brushing, and shampooing are basic hygiene measures for all patients.Patient may shampoo in the shower or tub, use a portable chair in front of a sink, or in bed.Shaving the PatientPatient may prefer to shave at the time of bathing.Patients who have a bleeding disorder or are taking anticoagulants should use electric razors.Do not allow a disoriented or depressed patient to use a razor with a blade.How might hair care be important to the patient?How often should hair care be performed?Why is it important to use an electric razor when shaving a patient prone to bleeding?Why is it important for the nurse to shave, or not allow a depressed or disoriented patient to shave, with a razor blade?
43Care of the hair, nails, and feet. Skill 18-3: Steps 9a & 10e(From Potter, P.A., Perry, A.G. . Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)(From Elkin, M.K., Perry, A.G., Potter, P.A. . Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)Care of the hair, nails, and feet.
44Components of the Patient’s Hygiene Hand, Foot, and Nail CareHands and feet often require special attention to prevent infection, odors, and injury.AssessmentExamine all skin surfaces.Carefully assess between the toes.Observe for adequate circulation.Why should patients with diabetes and/or peripheral vascular disease be observed for circulation of the feet?Why are the elderly at risk for foot disorders?
45Components of the Patient’s Hygiene Eye, Ear, and Nose Care (continued)Care of the eyesCleansing of the circumorbital area of the eyes is usually performed during the bath.Case involves washing with a clean washcloth moistened with clear water.The use of soap is omitted because it may cause burning and irritation.The eye is cleansed from the inner to the outer canthus.Patient may need assistance with care of eyeglasses or contact lenses.What is the circumorbital area?Why is the eye cleansed from the inner to outer canthus?Why is a separate section of the washcloth used to clean the other eye?
47Components of the Patient’s Hygiene Eye, Ear, and Nose Care (continued)Care of the earsThe ears are cleansed by the nurse during the bed bath.A clean corner of a moistened washcloth rotated gently into the ear canal works best for cleaning.A cotton-tipped applicator is useful for cleansing the pinna.The nurse should teach patients never to use bobby pins, toothpicks, or cotton-tipped applicators to clean the internal auditory canal.Why is the patient instructed not to use items such as bobby pins, toothpicks, or other sharp objects?What is cerumen?
48Components of the Patient’s Hygiene Eye, Ear, and Nose Care (continued)Care of the ears (continued)Hearing aidsThis involves routine cleaning, battery care, and proper insertion technique.When not in use, the hearing aid should be stored where it will not become damaged.Why is it important for the nurse to talk clearly and slowly to a patient who wears hearing aids?
49Figure 18-8(From Elkin, M.K., Perry, A.G., Potter, P.A. . Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)Hearing aid.
50Components of the Patient’s Hygiene Eye, Ear, and Nose Care (continued)Care of the noseThe patient can usually remove secretions from the nose by gently blowing into a soft tissue.Teach the patient that harsh blowing causes pressure capable of injuring the tympanic membrane, nasal mucosa, and even sensitive eye structures.If the patient is not able to clean the nose, the nurse will assist, using a saline-moistened washcloth or cotton-tipped applicator; for excessive secretions, suctioning may be required.How can the nurse assist the patient with excessive nasal secretions?How often should the nurse cleanse the nares of the patient?
51Components of the Patient’s Hygiene Perineal CareCare of the genitaliaPart of the complete bed bathAssess for signs of vaginal or urethral exudate, skin impairment, unpleasant odors, complaints of burning during urination, or localized tenderness or pain of the perineum.Catheter care is to be performed twice daily on all patients with indwelling catheters.Includes cleansing of the meatal-catheter junction with a mild soap and water and sometimes application of a water-soluble microbial ointmentWhy is a patient with an indwelling catheter at risk for infection?What signs and symptoms indicate infection of the perineum, vagina, or urethra?Why is catheter care required twice a day?
53Skill 18-4: Steps 9e & 9g Female perineal care. (From Potter, P.A., Perry, A.G. . Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)Female perineal care.
54Skill 18-4: Step 10c/10d Male perineal care. (From Potter, P.A., Perry, A.G. . Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)Male perineal care.
55Components of the Patient’s Hygiene Bed MakingThe patient’s bed is usually made in the morning after the bath.When possible, the bed is made while it is not occupied; when the patient is unable to be out of bed, the nurse will make an occupied bed.The patient’s safety is always foremost in the nurse’s mind; comfort and privacy are also important.Use side rails, keep the call light within easy reach, and maintain the bed in the proper position.How does the nurse make an occupied bed?How does the nurse maintain safety when changing the linen of an occupied bed?How does the nurse maintain privacy while changing the bed linen on an occupied bed?
62Components of the Patient’s Hygiene Bed Making (continued)It is the nurse’s responsibility to keep the bed as clean and comfortable as possible.This may require frequent inspections to make sure the bedding is clean, dry, and wrinkle free.Check the linens for food particles after meals and for urine incontinence or involuntary stool.Use proper body mechanics; raise bed to a working level.Why is it important to inspect the patient’s bed linen frequently?Describe methods to maintain medical asepsis when changing bed linen.How does raising the level of the bed to a working position limit injury to the nurse?
63Figure 18-9 The postoperative bed. (From Elkin, M.K., Perry, A.G., Potter, P.A. . Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)The postoperative bed.
64Selected equipment and supplies for elimination. Figure 18-10(From Potter, P.A., Perry, A.G. . Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)Selected equipment and supplies for elimination.
65The bedside commode has a toilet seat with a container underneath. Figure 18-11The bedside commode has a toilet seat with a container underneath.
66Components of the Patient’s Hygiene Assisting the Patient with EliminationBedpanA device for receiving feces or urine from either male or female patients confined to the bedUrinalA device for collecting urine from male patients; urinals for females also availableBedpans or urinals are used when a patient is unable to get up to go to the bathroom for the purpose of urination or defecation.How do you place a patient on a bedpan?What can assist in removing the bedpan from a patient? Prior to placing a patient on a bedpan, the application of powder to the flat surface will assist in removing the bedpan by reducing friction. Note: do not apply powder to the bedpan when obtaining a urine or stool specimen.
67Components of the Patient’s Hygiene Assisting the Patient with Elimination (continued)The nurse should offer the bedpan or urinal frequently, because patients may accidentally soil bedclothes if their elimination needs are not met.Report any abnormalities and record in the nurse’s notes.Flow sheets are usually provided for documentation of normal voidings and stools.What might hinder a patient from using a bedpan? The patient might procrastinate from requesting a bedpan because of discomfort and embarrassment issues.Describe a flow sheet that would record elimination.
68Positioning the bedpan. Skill 18-6: Steps 11b & 11c(From Elkin, M.K., Perry, A.G., Potter, P.A. . Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)Positioning the bedpan.
69Components of the Patient’s Hygiene Care of the Incontinent PatientIncontinence is a very common problem, especially among older adults.Incontinence occurs because pressure in the bladder is too great, sphincters are weak, or the innervation has been compromised due to illness or injury.Incontinence may involve a small leakage of urine when the person laughs, coughs, or lifts something heavy.How might the nurse manage this patient?What nursing staff might assist the nurse in assessing incontinence?Why would coughing, laughing, or lifting cause incontinence in the female patient?What type of exercises might help in minimizing incontinence in the female patient?
70Components of the Patient’s Hygiene Care of the Incontinent Patient (continued)Care requires the use of disposable adult undergarments or underpads.Cleansing the skin thoroughly after each episode of incontinence with warm soapy water and drying it thoroughly help to prevent skin impairment.When urinary incontinence results from decreased perception of bladder fullness or impaired voluntary motor control, bladder training can be helpful.What happens to the patient’s skin that is exposed to urine for a long time?What is bladder training?
71Nursing Process Nursing Diagnoses Oral mucous membranes, impaired Mobility, impaired physicalSkin integrity, impairedSelf-care deficit—bathing/hygiene, dressing/groomingProvide an example of a patient situation in which these nursing diagnoses would be appropriate.Provide a goal for each of the nursing diagnoses.