1. Oral Hygiene Benefits of Oral Hygiene

2. Provides comfort Provides comfort Stimulates the appetite Stimulates the appetite Prevents disease and dental caries Prevents disease and dental caries Helps to prevent bad breath (halitosis) Helps to prevent bad breath (halitosis) Stimulates saliva production which contains digestive enzymes and promotes digestion Stimulates saliva production which contains digestive enzymes and promotes digestion

3. Routine Oral Hygiene Involves tooth brushing and flossing. Should be done at least 3 times a day. Provide necessary equipment such as toothbrush, toothpaste, dental floss, mouthwash, emesis, basin, cup and water. Assist the patient as needed.

4. Denture Care Provide privacy for the patient. Provide privacy for the patient. Have patient remove dentures if able. Have patient remove dentures if able. Place dentures in a denture cup to carry to sink. Place dentures in a denture cup to carry to sink. Use warm water to clean dentures. Use warm water to clean dentures. Hold dentures securely. Let patient rinse mouth and brush gums. Hold dentures securely. Let patient rinse mouth and brush gums. Store dentures in a denture cup labeled with the patient's name. Store dentures in a denture cup labeled with the patient's name.

5. Special Oral Hygiene Usually given to unconscious or semiconscious patients. Usually given to unconscious or semiconscious patients. Tell the patient what you are doing. Tell the patient what you are doing. Turn the patient's head toward you Turn the patient's head toward you Use a very small amount of liquid Use a very small amount of liquid Clean all areas of the mouth: Clean all areas of the mouth:TeethGumTongue Roof of mouth Apply lubricant to tongue and lips. Apply lubricant to tongue and lips.

6. Bathing Types of baths Complete Bed bath (CBB) Patient is usually confined to bed and the health care worker must bathe all parts of the patient’s body.

7. Complete Bed Baths Use standard precautions Use standard precautions Provide privacy comfort, and safety. Provide privacy comfort, and safety. Fill basin 2/3 full with warm water at a temperature of 105 0 – 110 0 F Fill basin 2/3 full with warm water at a temperature of 105 0 – 110 0 F Form a mitten around your hand with the cloth Form a mitten around your hand with the cloth Wash body parts in this order: Face, ears, and neck → axilla, arms, and hands (apply deodorant) →chest, breast, and abdomen → thighs, legs, and feet (change water) → back, buttock, and back of perineum (give back rub) → perineal area. Change water when it becomes too cool, dirty or soapy.

8. Bathing Partial Bed Bath Patient washes some of the parts of their body and the health care worker washes the parts of the body the patient cannot reach. Tub bath or shower Health care worker prepares the tub or shower area and assists patient as needed.

9. Tub Baths and Showers Usually require a physician’s order. Usually require a physician’s order. Make sure tub or shower is clean. Make sure tub or shower is clean. Put a rubber mat in tub or shower Put a rubber mat in tub or shower Fill tubs half full with water at 105 0 F Fill tubs half full with water at 105 0 F Help the patient into the tub or shower (use the shower chair for patient who cannot stand) Help the patient into the tub or shower (use the shower chair for patient who cannot stand) Assist patient as needed Assist patient as needed Stay with patient or make sure patient can use the emergency call system Stay with patient or make sure patient can use the emergency call system After bath or shower cover patient with a towel or bath blanket After bath or shower cover patient with a towel or bath blanket Clean the tub or shower with a disinfectant after each use. Clean the tub or shower with a disinfectant after each use.

10. Measuring and Recording Intake and Output Amount of fluid taken into the body should equal the amount of fluid lost from the body. Amount of fluid taken into the body should equal the amount of fluid lost from the body. Excessive fluid retained by body= edema (swelling) Excessive fluid retained by body= edema (swelling) Excessive fluid lost by body=dehydration Excessive fluid lost by body=dehydration What do you measure? Intake – Oral (P.O.) --Intravenous (IV) --Irrigation Output--Bowel Movement (BM) --Emesis --Urine --Irrigation

11. INTAKE Oral Oral Includes liquids taken by mouth Includes liquids taken by mouth Also includes foods that are liquid at room temperature such as soup, Jell-O, ice cream, pudding, and Popsicles. Also includes foods that are liquid at room temperature such as soup, Jell-O, ice cream, pudding, and Popsicles. Fluids are measured in metric units Fluids are measured in metric units 1 Cubic Centimeter (cc) = 1 milliliter (ml) 1 Cubic Centimeter (cc) = 1 milliliter (ml)

12. INTAKE 1 ml or cc=15 gtt (drops) 1 ml or cc=15 gtt (drops) 5 ml or cc=1 tsp (teaspoon) 5 ml or cc=1 tsp (teaspoon) 15 ml or cc=1 tbsp (tablespoon) 15 ml or cc=1 tbsp (tablespoon) 30 ml or cc=1 (oz) ounce 30 ml or cc=1 (oz) ounce 240 ml or cc=1 cup (8 oz) 240 ml or cc=1 cup (8 oz) 500 ml or cc=1 pint (16 oz) 500 ml or cc=1 pint (16 oz) 1000 ml or cc=1 quart (32 oz) 1000 ml or cc=1 quart (32 oz)

13. MEASURING INTAKE PRACTICE Fred is on intake and output. When you go into his room after lunch, you examine his lunch tray and find he consumed the following: 1 hamburger ½ bowl of chicken broth (1 soup bowl = 200 cc) 4 soda crackers 1 cup of tea ¾ carton of milk ( 1 carton = 8 oz) ½ bowl of Jell-O ( 1 small bowl = 120 cc) What was Fred’s fluid intake?

14. MEASURING OUTPUT Output = all fluids eliminated by the patient Output = all fluids eliminated by the patient Bowel movements (BM) Bowel movements (BM) Liquid BMs are measured and recorded Solid or formed BM is usually noted under feces on the remarks column

15. EMESIS Measure anything that is vomited. Measure anything that is vomited. Also note color, type, and other facts in the remarks column Also note color, type, and other facts in the remarks columnUrine Measure all urine voided or drained via a catheter Measure all urine voided or drained via a catheter Men can collect their urine in a urinal and women can collect their urine in a bedpan or a special urine collector that can be placed under the seat of the toilet. Men can collect their urine in a urinal and women can collect their urine in a bedpan or a special urine collector that can be placed under the seat of the toilet.Irrigation Measure any drainage from nasogastric tubes, hemo-vacs, chest tubes or other drainage tubes Measure any drainage from nasogastric tubes, hemo-vacs, chest tubes or other drainage tubes These measurements are usually done by the nurse. These measurements are usually done by the nurse.

16. MEASURING OUTPUT PRACTICE Jennifer is on intake and output. At the end of an 8 hour shift, you note the following: 0800 (8:00 am) she voided 400 cc of urine 1000 (10:00 am) she vomited 200 cc of thick yellow emesis with food particles in it 1130 (11:30 am) she had one formed green BM 1315 (1:15 PM) she voided 350 cc of urine What was Jennifer’s output for the 7-3 shift?

17. Feeding the Patient Prior to the meal Provide privacy Help patient use the bedpan or urinal if needed Provide oral hygiene if desired Remove emesis basins or bedpans from sight Position patient in a sitting position if allowed Wash patient’s hands and face Put overbed table in position Check to make sure the patient is not NPO Make sure the diet is correct for the patient Place a towel or napkin under patient’s chin Open packages and cartons, season and cut foods if necessary.

18. FEEDING A PATIENT Steps for feeding a patient Steps for feeding a patient Test the temperature of hot foods by placing small amount on wrist Feed patient slowly and give them time to chew Use separate straw for each liquid Hold utensil at a 90 0 to the patients mouth Give small bites Alternate foods and liquids Allow patient to help as much as they are able Offer choices to the patient Wipe patient’s mouth as needed Encourage patient to eat as much as possible.

19. AFTER THE MEAL Allow patient to wash their face and hands Allow patient to wash their face and hands Provide oral hygiene Provide oral hygiene Position patient in correct body alignment Position patient in correct body alignment Clean area Clean area Note how much food was eaten Note how much food was eaten Calculated I&O if this is ordered for patient. Calculated I&O if this is ordered for patient.

20. BEDPANS AND URINALS Urinate, micturate, or void – terms for emptying of the bladder, which stores urine. Urinate, micturate, or void – terms for emptying of the bladder, which stores urine. Urinals are used by male patient when they need to micturate Urinals are used by male patient when they need to micturate A bedpan is used by females when they need to micturate A bedpan is used by females when they need to micturate

21. Defecate Having a bowel movement (BM) Having a bowel movement (BM) Both men and women must use a bedpan when they need to defecate. Both men and women must use a bedpan when they need to defecate. Two main types of bedpans Two main types of bedpans 1. Fracture or orthopedic bedpan 1. Fracture or orthopedic bedpan 2. Standard bedpan 2. Standard bedpan Many patients are sensitive about using the bedpan. Always provide privacy and make them as comfortable as possible. Many patients are sensitive about using the bedpan. Always provide privacy and make them as comfortable as possible.

22. Assisting with a Bedpan Use standard precautions and wear gloves Use standard precautions and wear gloves Provide privacy for the patient Provide privacy for the patient Warm bedpan by running warm water over it Warm bedpan by running warm water over it There are two positions to place the pan under the patients There are two positions to place the pan under the patients 1. Patient flexes knees and puts weight on heels. They then lift their hips up. 2. Patient is turned to one side and the pan is placed against the buttock and then the patient is rolled back in the pan.

23. Bedpan Cont. The patient's buttock should rest on the rounded portion of the pan The patient's buttock should rest on the rounded portion of the pan Place call bell and tissue within patient’s reach Place call bell and tissue within patient’s reach Raise siderail before leaving the patient Raise siderail before leaving the patient All done………… All done………… Answer call bell immediately Answer call bell immediately Use the same positions to get the patient off the pan, but hold onto the pan firmly Use the same positions to get the patient off the pan, but hold onto the pan firmly Cover the bedpan and place on nearby chair or table Cover the bedpan and place on nearby chair or table Make sure perineum is clean and dry Make sure perineum is clean and dry Assist patient in washing hands Assist patient in washing hands Clean bedpan and note any abnormalities of urine or BM Clean bedpan and note any abnormalities of urine or BM

24. ASSISTING WITH A URINAL Use standard precautions and wear gloves Provide privacy for the patient Assist patient with placement of the urinal if needed Leave the call bell and toilet tissue near the patient Answer patient’s call bell immediately All finished………….. Avoid exposing the patient Have patient hand you the urinal if they are able Close the lid or cover the top of the urinal Assist patient with washing perineal area if needed Assist patient with washing his hands Measure contents if patient is on I&O Empty urinal and clean with warm soapy water Report any abnormalities to the urine Never empty a bedpan or an urinal until you check to see if a specimen is needed!!