1. 1 Unit five Mr. Ahmad Ata RN,CNS,MSN

2. 2 Lecture Objectives At the end of this lecture the student will able to: 1. Know about hygiene, hygiene measure. 2. Know about common problem of the skin. 3. Describe common kind of hygiene. 4. Ability to identify patients with self care deficit related hygiene. 5. Ability to communicate and interact effectively with patients 6. Commitment to safety and quality

3. 3 Introduction Personal hygiene practices well vary widely among persons. Personal hygiene practices well vary widely among persons. Well people are ordinarily responsible for their own hygiene. Well people are ordinarily responsible for their own hygiene. In some cases the nurse assist well person through teaching to develop personal habits the person may lack. In some cases the nurse assist well person through teaching to develop personal habits the person may lack.

4. 4 Definition: Hygiene: is self care by which people attended to such function as bathing, oral care, grooming hair, cleaning fingernails, genital area, ear and eye care. Hygiene: is self care by which people attended to such function as bathing, oral care, grooming hair, cleaning fingernails, genital area, ear and eye care.

5. 5 Hyg iene involves cleansing of the: Skin Skin Mouth Mouth Teeth Teeth Hair Hair Nails Nails Eyes Eyes Ears Ears Nose Nose Perineal Area Perineal Area Feet Feet

6. 6 Hygiene Hygiene Cleansing by nurse is part of historical giving of care Cleansing by nurse is part of historical giving of care The more ill patient, the more skill needed in providing the hygiene care. The more ill patient, the more skill needed in providing the hygiene care. Cleansing skin is first line of defense against organisms Cleansing skin is first line of defense against organisms

7. 7 Kinds of hygiene may nurses described: 1. Early morning care: Assist patient with toileting. Assist patient with toileting. Provide comfort measure to refresh patient to prepare for day. Provide comfort measure to refresh patient to prepare for day. Wash face and hands. Wash face and hands. Provide mouth care. Provide mouth care. 2. Morning care: After breakfast, nurse completes morning care: Toileting Toileting Oral care Oral care Bathing Bathing Back massage Back massage Hair care, cosmetics Hair care, cosmetics Dressing Dressing Positioning for comfort Positioning for comfort Refreshing or changing bed linens Refreshing or changing bed linens Tidying up bedside Tidying up bedside

8. 8 Kinds of hygiene may nurses described: 3. After noon care: Ensure patient’s comfort after lunch: Offer assistance with toileting, hand washing, oral care Offer assistance with toileting, hand washing, oral care Straighten bed linens Straighten bed linens Help patients with mobility to reposition themselves Help patients with mobility to reposition themselves 4. Hours of sleep care: Before patient retires: Offer assistance with toileting, washing, and oral care Offer assistance with toileting, washing, and oral care Offer a back massage Offer a back massage Change any soiled bed linens or clothing Change any soiled bed linens or clothing Position patient comfortably Position patient comfortably Ensure that call light and other objects patient requires are within reach Ensure that call light and other objects patient requires are within reach 5. As needed care: is provided required by client.

9. 9 Factor influencing individual hygiene: culture. culture. Religion. Religion. Environment. Environment. Development level. Development level. Health status. Health status. Personal preferences Personal preferences

10. 10 Etiologies of self care deficit Visual impairment. Visual impairment. Activity intolerance or weakness. Activity intolerance or weakness. Pain or discomfort. Pain or discomfort. Mental impairment. Mental impairment. Therapeutic procedures. Therapeutic procedures. Skeletal impairment. Skeletal impairment.

11. 11 Functional level of the patient may described as following: Total dependent. Total dependent. Partial dependent. Partial dependent. Independent. Independent.

12. 12 PURPOSE OF NURSE PROVIDED HYGIENE Remove microorganisms Remove microorganisms Do physical assessment Do physical assessment Increase circulation Increase circulation Improve self image Improve self image Provide comfort Provide comfort

13. 13 Skin: Definition: is the largest organ that cover all surface of the body. Definition: is the largest organ that cover all surface of the body. The skin contains: Epidermis. Epidermis. Dermis. Dermis. Subcutaneous layer. Subcutaneous layer.

14. 14

15. 15 1) Epidermis 1. Keratinocyte the most important cell in the epidermis become filled with a tough fibrous protien called keratin. They make up more than 90% of the epidermal cells They make up more than 90% of the epidermal cells 2. Melanocyte contribute color to the skin and serve to decrease the amount of ultraviolet light that can penetrate into deeper layers of the skin.

16. 16 Cell Types 3. Langerhans cell : it plays limited role in immunological reaction that effect the skin and may serve defense mechanism for the body. 4. Merkel cells - combines with disclike sensory nerve endings to make Merkel’s discs

17. 17 2) Dermis It is some time called true skin, it is composed of a thin papillary and thicker reticular layer. It is some time called true skin, it is composed of a thin papillary and thicker reticular layer. It may exceed 4mm on the soles and palms. It may exceed 4mm on the soles and palms. At various level in the dermis, there are muscle fibers, sweet gland, hair follicles and many blood vessels. At various level in the dermis, there are muscle fibers, sweet gland, hair follicles and many blood vessels.

18. 18 Functions of the skin 1) Protection: A) from micro organism. B) from dehydration. C) from ultraviolet. D) mechanical trauma. E) pain F) heat and cold

19. 19 Functions of the skin 2) Sensation: the widespread of the millions of different somatic sensory receptors that detect stimuli. 3) Excretion by regulating the volume and chemical content of sweat. 4) Vitamin D production. 5) Immunity (langerhan’s cell). 6) Regulation of body temperature.

20. 20 Assessment: Cleanliness. Cleanliness. Color. Color. Temperature. Temperature. Moisture. Moisture. Sensation. Sensation. Turgor Turgor Texture. Texture.

21. 21 NURSING ASSESSMENT WHILE BATHING History History Relationship Relationship Color and condition of skin Color and condition of skin Pain on movement Pain on movement Level of consciousness Level of consciousness Injuries Injuries Scars Scars Skin turgor Skin turgor Nevi Nevi Wt loss or gain Wt loss or gain

22. 22 PATIENTS AT RISK FOR SKIN PROBLEMS Altered level of consciousness Altered level of consciousness Altered nutrition Altered nutrition Immobility Immobility Dehydration Dehydration Altered sensation Altered sensation Secretions on skin Secretions on skin Mechanical devices, casts, restraints Mechanical devices, casts, restraints Altered venous circulation Altered venous circulation

23. 23 Practices related skin care: 1) Bathing: practice that use soap and water to remove sweet, oil, dirt, and microorganism from skin. 1) Bathing: practice that use soap and water to remove sweet, oil, dirt, and microorganism from skin. Type of bathing: 1. Tube bath. 2. Partial bath. 3. Bed bath.

24. 24 1. Tube Bath: For all clients who are independent and there no safly risk. For all clients who are independent and there no safly risk. Nurse should encourage clients to take shower independent. Nurse should encourage clients to take shower independent. Most bath room are equipped with rails and handle to promote client safety. Most bath room are equipped with rails and handle to promote client safety. 2. Partial bath: Washing only body area that are directly cause odor ( face, hand, axillae, perineal area). Washing only body area that are directly cause odor ( face, hand, axillae, perineal area). Partial bathing done at sink or with basin at bed side. Partial bathing done at sink or with basin at bed side.

25. 25 Perineum: area around the genital and rectum, its required special cleaning technique. When perineal care: After vaginal delivery. After vaginal delivery. Gynecological or rectal surgery. Gynecological or rectal surgery. Urine, stool. Urine, stool.

26. 26 3. Bed bath: Washing with a basin of water at the bed side. Washing with a basin of water at the bed side. For client who cannot take shower independently. For client who cannot take shower independently.

27. 27 3. Bed bath Wash head to toe, front to back, distal to proximal Wash head to toe, front to back, distal to proximal Physical assessment as you are washing; must also loosen and secure lines as moving and turning patient Physical assessment as you are washing; must also loosen and secure lines as moving and turning patient Change wash clothes for different areas Change wash clothes for different areas Change water if cold or soiled or very soapy Change water if cold or soiled or very soapy Some put oil in bath water of elderly Some put oil in bath water of elderly Use powder in your hand, very sparingly Use powder in your hand, very sparingly not with respiratory patients or those with allergies not with respiratory patients or those with allergies

28. 28 Change linen as needed Change linen as needed Do range of motion as needed Do range of motion as needed Do oral care, hair care, and give back rub Do oral care, hair care, and give back rub Leave bed in low position, rails up, and call light in place. Straighten room. Leave bed in low position, rails up, and call light in place. Straighten room. Report and chart findings Report and chart findings

29. 29 ASSESSING TUBES AND LINES Oxygen – stays on during bath, check connections, liters per minute, cleanliness of prongs or mask, water if used, plugged in if concentrator Oxygen – stays on during bath, check connections, liters per minute, cleanliness of prongs or mask, water if used, plugged in if concentrator IV lines – use special gown, don’t open lines to change gown, look at IV site, rate and solution IV lines – use special gown, don’t open lines to change gown, look at IV site, rate and solution Urinary catheter – draining, unkinked, bag below bladder Urinary catheter – draining, unkinked, bag below bladder Enteral tubes – in place, running or draining properly, or clamped properly Enteral tubes – in place, running or draining properly, or clamped properly Dressings – Clean and dry, drains properly working Dressings – Clean and dry, drains properly working Does anything need to be emptied, changed or cleaned? Does anything need to be emptied, changed or cleaned?

30. 30 Purposes of bathing: Provides Cleanse of skin. Provides Cleanse of skin. Acts as skin conditioner. Acts as skin conditioner. Helping in relaxation patient. Helping in relaxation patient. Promote circulation. Promote circulation. Serve as musculoskeletal exercise. Serve as musculoskeletal exercise. Promote comfort. Promote comfort. Improve body image. Improve body image.

31. 31 2) Shaving: To remove unwanted body hair. To remove unwanted body hair. 3) Oral hygiene: Practice used to clean the mouth includes: Practice used to clean the mouth includes: Tooth brushes and flossing. Tooth brushes and flossing. Denture care. Denture care. 4) Hair care: hair grooming, shampooing and identify patient usual hair practice and styling preferences

32. 32 5) Bed making: Make bed for patient comfort If incontinent, wash, rinse, dry, change linen If incontinent, wash, rinse, dry, change linen Use aids to relieve pressure points Use aids to relieve pressure points heel, elbow protectors heel, elbow protectors bed frame with trapeze bed frame with trapeze frame to keep covers off feet frame to keep covers off feet special beds and mattresses special beds and mattresses Position as ordered Position as ordered

33. 33 Diagnosis: Self care deficit (bathing, grooming, and dressing) R/T pain. Self care deficit (bathing, grooming, and dressing) R/T pain. Knowledge deficit R/T lack of experience. Knowledge deficit R/T lack of experience. Self esteem disturbance R/T body odor. Self esteem disturbance R/T body odor.

34. 34 Implementation: Avoid long shape finger nails, jewelry may be irritant skin. Avoid long shape finger nails, jewelry may be irritant skin. Maintain nutrition to prevent skin dryness. Maintain nutrition to prevent skin dryness. Reduce moisturing in the irritant area such as axilla and between toes by apply corn starch. Reduce moisturing in the irritant area such as axilla and between toes by apply corn starch. Maintain level of cleanliness. Maintain level of cleanliness.

35. 35 Causes of skin alteration: Thin and obese people. Thin and obese people. Fluid loss. Fluid loss. Excessive perspiration Excessive perspiration jaundice. jaundice. Age. Age. Poor circulation. Poor circulation.

36. 36 Hair: Hair is composed of column of dead keratinized. Its consists of shaft and root. Its consists of shaft and root. Hair covers the whole body part but its distribution, color, texture, differ according to: 1. Location. 2. Age. 3. Gender.

37. 37 Hair Hair color is determined by the amount and type of melanin present. Hair color is determined by the amount and type of melanin present. Melanocytes become less active with age. Gray hair is a mixture of pigmented and non-pigmented hairs. Melanocytes become less active with age. Gray hair is a mixture of pigmented and non-pigmented hairs. Red hair results from a a modified type of melanin that contains iron. Red hair results from a a modified type of melanin that contains iron. Alopecia is the term for hair loss. Alopecia is the term for hair loss.

38. 38 Culture may influence HAIR care: Culture may influence HAIR care: Hmong – do not touch without permission Hmong – do not touch without permission Muslim – May keep covered, wear wig Muslim – May keep covered, wear wig Sikh – Does not cut Sikh – Does not cut

39. 39 Importance of hair: Appearance. Appearance. Prevent heat loss. Prevent heat loss. Protection. Protection.Assessment: Alopecia, dandruff, lice, scabies, hirsutism. Alopecia, dandruff, lice, scabies, hirsutism.Diagnosis: Self care deficit grooming R/T activity intolerance. Self care deficit grooming R/T activity intolerance. Risk for infection R/T scalp laceration. Risk for infection R/T scalp laceration.Implementation: Brushing, shampooing that stimulate circulation and distribute the oil. Brushing, shampooing that stimulate circulation and distribute the oil.

40. 40 Nail : Nails made of keratin. Nails made of keratin. Parts of nail: Nail root. Nail root. Nail body. Nail body. Nail bed. Nail bed. Clupping fingers: Clupping fingers: is condition in which the angle between the nail and nail bed is 180 degree may cause by long term lack of oxygen. is condition in which the angle between the nail and nail bed is 180 degree may cause by long term lack of oxygen. Koilonychias: Koilonychias: is condition of nails which is like spoon shape may be caused by iron deficiency anemia. is condition of nails which is like spoon shape may be caused by iron deficiency anemia.

41. 41 Parts of Nail

42. 42 Assessment : Assessment : Observe circulation; color, capillary refill time Observe circulation; color, capillary refill time Observe color, sensation, and movement (CSM) Observe color, sensation, and movement (CSM) Polish removed to observe color and use pulse oximeter Polish removed to observe color and use pulse oximeter Assess for clubbing sign of long term lack of oxygen Assess for clubbing sign of long term lack of oxygen Cut nails straight across and file smooth; Do not go down into corners Cut nails straight across and file smooth; Do not go down into corners Assess for rings too tight or too loose Assess for rings too tight or too loose

43. 43 Teeth Each tooth has three parts: 1. Crown: is exposed parts of the tooth which is out side of gum. 2. Root: is embedded in the jaw and covered by bony tissue called cementum. 3. Pulp: is the center of the tooth contains the blood vessels and nerves. Teeth begin to erupt at six month to two year. Teeth begin to erupt at six month to two year. Deciduous teeth (temporary teeth). Deciduous teeth (temporary teeth). Permanent teeth. Permanent teeth. Adults have 28 – 32 permanent teeth depending on wisdom teeth. Adults have 28 – 32 permanent teeth depending on wisdom teeth.

44. 44 Assessment 1. Caries: erode tooth enamel because of accumulation of sugur, bacteria. 2. Tartar: is avisible, hard deposite of plague and dead bactria. 3. Pyorrhea: the teeth are loose and pus is evident when the gums are pressed. 4. Periodontal disease: gums appear spongy and bleeding. 5. Halitosis: bad breathing.

45. 45 Diagnosis: Self care deficit. Self care deficit. Altered oral mucosa. Altered oral mucosa.Implementation: Good oral hygiene. Good oral hygiene. Brushing and flossing the teeth. Brushing and flossing the teeth. Caring of artificial denture. Caring of artificial denture.

46. 46 Mouth care Examine with gloves and light, especially smokers Examine with gloves and light, especially smokers Use only water soluble lubricants Use only water soluble lubricants If feeding tubes present, assess for parotitis If feeding tubes present, assess for parotitis Unconscious patient has no gag reflex, position on side for care Unconscious patient has no gag reflex, position on side for care May have gum hyperplasia from meds May have gum hyperplasia from meds May have teeth staining from meds May have teeth staining from meds May have accumulated debris in mouth called sordes May have accumulated debris in mouth called sordes Teach about brushing and flossing Teach about brushing and flossing

47. 47 Care of eyes: Clean from inner to outer conthus with wet, warm cotton ball or compress. Clean from inner to outer conthus with wet, warm cotton ball or compress. Use artificial tear solution or normal saline every four hour, if blink reflex is absent. Use artificial tear solution or normal saline every four hour, if blink reflex is absent. Care for eye glass, contact lens. Care for eye glass, contact lens.

48. 48 Eye care Contact lenses usually removed Contact lenses usually removed Stored in saline liquid; case labeled Stored in saline liquid; case labeled Also label and safeguard glasses in drawer Also label and safeguard glasses in drawer Clean inner to outer canthus Clean inner to outer canthus Patient must be able to blink to protect cornea Patient must be able to blink to protect cornea Never use cotton near eyes Never use cotton near eyes Treat each eye separately Treat each eye separately Eyes considered sterile Eyes considered sterile Care of artificial eye similar to dentures Care of artificial eye similar to dentures

49. 49 Ear and nose: Wash external ear with wash cloth - covered finger. Wash external ear with wash cloth - covered finger. Clean nose by having patient blow. Clean nose by having patient blow. If indicated use nasal suction with bulb syringe. If indicated use nasal suction with bulb syringe. Remove crusted secretion around nose and apply moisturing gill. Remove crusted secretion around nose and apply moisturing gill.

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