1. Personal Hygiene, bathing And backrubs, SkinCare and pressure ulcers
PN 103

2. Personal Hygiene
The self-care measures people use to maintain the health
Hygiene
-The science of health
-Includes care of the skin, hair, hands, feet, eyes, ears, nose,
mouth , back, and perineum
-Conscientious personal hygienic practices are essential for
the nurse; nurses are role models

3. Personal Hygiene Factors influencing personal hygiene
-Social practices
-Body image
-Socioeconomic status
-Knowledge
-Personal preferences
-Physical condition
-Cultural variables

4. Personal Hygiene Gerontological considerations
-Older individuals have less subcutaneous tissue making
them more susceptible to becoming chilled during bathing
-Impaired circulation or neurological changes may decrease
ability to sense temperature changes of water
-Skin is often dry –no harsh soaps, no frequent bathing, use
lotions and creams

5. Bath Administration Preparing the patient
-Provide privacy (pull the curtain)
-Drape as needed
-Ask if he/she needs the bedpan of urinal
-Arrange needed supplies
-Adjust room temperature
-Raise the bed to a comfortable position

6. Bath Administration Partial bed bath
-Nurse assists the patient to bathe inaccessible body parts
Complete bed bath
-Reserved for patients who are completely dependent and
require total assistance
Shower
-May be allowed if the patient is ambulatory and the MD
approves
Hair care
-Brush or comb daily
-Wash as needed

7. Bath Administration

8. Back Rubs -Usually administered after a patient’s bath
-Promotes relaxation, relieves muscular tension, and
stimulates circulation
-Nurse massages for 3 to 5 minutes
-Contraindicated if the patient has such conditions as
fractures of the ribs or vertebral column, burns, pulmonary
embolism, or open wounds

9. Back Rubs -Begin the massage by starting in sacral area using circular
motions
-Stroke upward to the shoulders
-Massaging over bony prominences is no longer
recommended
-Evidence suggests that massage may result in decreased
blood flow and tissue damage in some patients

10. Skin Care
When a person’s physical condition changes, the skin often reflects this through alterations in:
-color
-thickness
-texture
-turgor
-temperature
-hydration
As long as the skin remains intact and healthy, its physiological function remains optimal

11. Skin Care Collection of data
-Normal skin has the following characteristics:
-Intact without abrasions
-Warm and dry
-Localized changes in texture across the surface
-Good turgor
-Generally warm and soft
-Skin color variations from body part to body part

12. Skin Care Impaired skin integrity
-A patient who stays in one position without relief of
pressure can develop a wound
-also known as a pressure ulcer, PrU, decubitus ulcer or
bed sore
Patients at risk
-chronically ill
-debilitated
-older
-disabled
-incontinent
-patients with spinal cord injuries
-limited mobility
-poor overall nutrition

13. Pressure Ulcers Pressure Ulcer Risk Assessment Tools
-Braden Scale and Norton Scale
-the lower the score on both tools, the higher the pressure
ulcer risk
-the total annual cost of treating a pressure ulcer in the
US is approximately $8.5 billion
-1.7 million people develop pressure ulcers each year

14. Braden Scale

15. Norton scale

16. Pressure Ulcers
Pressure 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 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 occurs

17. Pressure Ulcers Shearing force
-An internal, opposing motion of tissue layers and bone.
Shearing forces stretch or tear the blood vessels which
reduces the amount of pressure needed to occlude them
Friction
-Rubbing of skin over a surface produces friction, which may
remove layers of skin

18. Pressure Ulcers Maceration/Incontinence
-Continued exposure of skin to moisture, causing tissue
softening which leaves the skin more susceptible to the
forces of shear and friction
Epidermal stripping
-Removal of the top layer of skin by mechanical forces
-tape burns

19. Shearing force

20. Skin structure

21. Stage of Pressure ulcers
Stage I
-nonblachable erythema of the skin
Stage II
-partial skin loss of the epidermis
Stage III
-full thickness skin loss, damage or necrosis of the
subcutaneous tissue
Stage IV
-full thickness skin loss with extensive destruction, tissue
necrosis or damage to muscle, bone, or supporting
structures

22. Pressure Ulcers Nursing Interventions -Assess improvement
-Assess size and depth of the ulcer
-the amount and color of the exudate
-the presence of pain or odor
-the color of the wound
-the appearance of the surrounding tissue
-Specific interventions are determined by the stage of the
ulcer

23. Stage I pressure ulcer

24. Stage I pressure ulcer Treatment: -Relieve pressure
-Monitor closely as may progress to another stage even
after pressure is remove

25. Stage ii Pressure ulcer

26. Stage ii Pressure ulcer
Treatment:
-Remove pressure
-Clean with facility approved wound cleanser or normal
saline
-Debride any necrotic tissue (chemically, mechanically or
surgically)
-Keep moist healing environment by covering with alginate,
gel or hydrocolloid dressing
-Change dressing 1-2 times a day.

27. Stage III pressure ulcer

28. Stage iv pressure ulcer

29. Stage III & iv pressure ulcer
Treatment:
-Remove pressure
-Cleanse wound with facility approved wound cleanser or
irrigate with normal saline
-Debride any necrotic tissue
-Fill any dead space (pack lightly with moist gauze), use
wound gel and/or moist dressings
-May consider wound vac when the necrotic tissue is
debrided and granulating tissue has filled the wound

30. Pressure Ulcers Support surfaces
-Pressure relieving mattresses or chair cushions should be
used with patients who are at risk for skin impairment
-alternating air mattresses
-silicone mattresses

31. Pressure Ulcers

32. Prevention of Pressure Ulcers
Positioning
-use positioning devices (pillows, foam wedges) to prevent
bony prominence from direct contact with any other surface
-turn and reposition bedbound patients at least every 2
hours
Seating interventions
-Shift weight every 15 minutes
-if unable to shift weight, reposition every hour
-wheelchair cushion

33. Prevention of Pressure Ulcers
Moisture reduction
-Incontinent patients should be checked for incontinence
every 2 hours and changed as soon as incontinence has
occurred
-use barrier ointment to skin at perineum
Range of motion
-Helps keep the blood circulating and keeps the
patient from being in one position

34. Prevention of Pressure Ulcers
Prevent shear and friction
-Nutrition
-All at risk patients should be referred to a dietician for
nutritional interventions
-Vitamin and mineral supplements as ordered by the
patient’s HCP