1. Assisting with hygiene L / Hanaa Eisa 2015-2016

2. Course out Line 1.Introduction 2.Purpose of hygiene 3.Hygiene. 4.Kinds of hygiene may nurses described. 5.2. Morning care. 6.3. After noon care 7.4. Hours of sleep care

3. Course out Line 8.Etiologies of self care deficit. 9.Functions of the skin 10.Nursing management 11.Patients at risk for skin problems 12.Practices related skin care 13.Tube Bath 14.Bed sore

4. At the end of this lecture the student will able to: 1.Describe hygienic care that nurses provide to client. 2.Identify factors influencing personal hygiene 3.Know about common problem of the skin. 4.Describe common kind of hygiene. 5.Ability to identify patients with self care deficit related hygiene. 6.Identify the purposes of bathing. 7.Describe various types of baths. 8.Identify safety and comfort measures underlying bed- making procedure. Learning outcome

5. Personal hygiene practices well vary widely among persons. 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. Introduction

6. 1.To remove microorganisms. 2.To do physical assessment. 3.To improve circulation. 4.To improve self image. 5.To provide comfort. Purpose of hygiene

7. Cleansing by nurse is part of nursing care Cleansing skin is first line of defense against organisms. Nurses commonly use the following terms to describe types of hygienic care Hygiene

8. Nurses commonly use the following terms to describe types of hygienic care: 1)Early morning care. 2)Morning care. 3)After noon care. 4)Hours of sleep care.. 5)As needed (prn) care. Kinds of hygiene may nurses described

9. Provide comfort measure to refresh patient to prepare for day by: a.Assist patient with toileting (providing a urinal or bedpan). b.Wash face and hands. c.Provide oral care 9 Purposes of early morning care

10. After breakfast, nurse completes morning care 1.Elimination needs 2.A bath or shower 3.Perineal care 4.Back massage 5.Oral care 2. Morning care 6.Hair care 7.Making the client’s bed is part of morning care 8.Dressing 9.Positioning for comfort 10.Tidying up bedside

11. Ensure patient’s comfort after lunch: Offer assistance with toileting, hand washing, oral care Straighten bed linens Help patients with mobility to reposition themselves 3. After noon care

12. Before patient retires: Providing for elimination needs, washing, and oral care,offer a back massage and change any soiled bed linens or clothing, position patient comfortably Ensure that call light & other objects patient requires are within reach : 5. As needed care: is provided as required by the client. 12 4. Hours of sleep care

13. 1.Culture. E.g. have a bath once or twice a day 2.Religion. 3.Environment. 4.Development level. 5.Health and energy. 6.Personal preferences 13 Factor influencing individual hygiene

14. 1.Visual impairment. 2.Activity intolerance or weakness. 3.Pain or discomfort. 4.Mental impairment. 5.Therapeutic procedures. 6.Skeletal impairment. 14 Etiologies of self care deficit

15. Functional level of the patient may described as following: 1.Total dependent. 2.Partial dependent. 3.Independent. 15 Functional level of the patient

16. Definition Skin define as is the largest organ that cover all surface of the body. The skin contains: Epidermis. Dermis. Subcutaneous layer. 16 Skin

17. : 1)Protection: a)From micro organism. b)From dehydration. c)From ultraviolet. d)Mechanical trauma. e)Pain f)Heat and cold 17 Functions of the skin

18. 2) Sensation: different somatic sensory receptors that detect stimuli. 3) Excretion by regulating the volume & chemical content of sweat. 4) Vitamin D production. 6) Regulation of body temperature. 18 Functions of the skin cont’d

19. Assessment: Assessment of the client’s skin & hygienic practices includes: a.A nursing health history to determine the client’s skin care practices. b.physical assessment of the skin. c.Identification of client at risk for developing skin impairments. 19 Nursing management

20. 1.History, skin color and condition, uniformity, texture. turgor, temperature, intact and lesions. Moisture, sensation, Pain on movement, level of consciousness,injuries, scars,wt loss or gain Nursing assessment while bathing

21. 1.Immobility 2.Dehydration 3.Altered nutrition 4.Altered sensation 5.Secretions on skin 6.Altered venous circulation 7.Altered level of consciousness 8.Mechanical devices, casts, restraints Patients at risk for skin problems

22. 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. Practices related skin care

23. For all clients who are independent and there no safely risk. Nurse should encourage clients to take shower independent. Most bath room are equipped with rails and handle to promote client safety. 23 1. Tube Bath

24. o Washing only body area that are directly cause odor ( face, hand, axillae, perineal area). o Partial bathing done at sink or with basin at bed side.e.g Perineum: o Area around the genital and rectum, its required special cleaning technique. When perineal care: o After vaginal delivery. o Gynecological or rectal surgery. o After elimination (urine or stool) 2. Partial bath

25. o Washing with a basin of water at the bed side. o For client who cannot take shower independently. Types of patients needing bed bath 1.Unconscious patient. 2.Operated patient. 3.Orthopedics patient. 4.Seriously ill patients. 3. Bed bath:

26. 2) Shaving: To remove unwanted body hair. 3) Oral hygiene: Practice used to clean the mouth includes: Tooth brushes and flossing. Denture care. 4) Hair care: hair grooming, shampooing and identify patient usual hair practice and styling preferences 26

27. 5) Bed making: Make bed for patient comfort If incontinent, wash, rinse, dry, change linen Use aids to relieve pressure points heel, elbow protectors bed frame with trapeze special beds and mattresses Position as ordered 27

28. 1.Self care deficit (bathing, grooming, and dressing) R/T pain. 2.Knowledge deficit R/T lack of experience. 3.Self esteem disturbance R/T body odor. 28 Diagnosis

29. 1.Thin and obese people. 2.Fluid loss. 3.Excessive perspiration 4.jaundice. 5.Age. 6.Poor circulation. 29 Causes of skin alteration

30. Decubitus ulcers Description: Decubitus ulcers (pressure sores) are localized areas of cellular necrosis on the skin & subcutaneous tissue

31. Etiology Decubitus ulcers or pressure sores result from excessive pressure on body areas, particularly over bony prominences. &old adult patients Major risk factors: 1. Include decreased or limited activity 2. Immobility 3. Malnutrition 4. Incontinence 5. Impaired circulation & sensation.

32. Assessment findings Clinical manifestations: vary according to the stage in which the ulcer is classified. The appearance of purulent drainage or foul odor suggests an infection.

33. Stages of Pressure Sores In stage one: The area is red,edema & congestion, & the client complains of discomfort. How to recognize: Skin is not broken but is red or discolored.

34. Stage Two The reddened area is break in the skin through the epidermis or dermis; an abrasion, blister, may be seen How to recognize: The epidermis or topmost layer of the skin is broken, creating a shallow open sore. Drainage may or may not be present.

35. The ulcer extends into the subcutaneous tissue with necrotic tissue, & exudates. How to recognize: The break in the skin extends through the dermis (second skin layer) into the subcutaneous and fat tissue. The wound is deeper than in Stage Two. Stage Three

36. Stage IV The ulcer extends into the underlying structures, including the muscle & possible the bone. How to recognize: The breakdown extends into the muscle and can extend as far down as the bone. Usually lots of dead tissue and drainage are present.

40. Nursing Assessment: 1.Assess for risk factors for pressure sore development & alter those factors if possible. 2.Assess skin of the older adult frequently for the development of pressure sores. 3.Stage the ulcer so appropriate treatment can be started.

41. Nursing & Patient Care Considerations Prevent Pressure Sore Development 1.Provide meticulous care & positioning for immobilized patients. 2.Inspect skin several times daily. 3.Wash skin with mild soap, rinse, and dry with a soft towel. 4.Lubricate skin with lotion. 5.Avoid mattress that is covered with plastic.

42. 6.prevent incontinence. 7.Encourage ambulation & exercise. 8.Promote nutritious diet with optimal protein, vitamins, and iron. 9.Teach older adult & family the importance of good nutrition, hydration, activity, positioning, and avoidance of pressure, shearing, friction, and moisture Nursing & Patient Care Considerations

43. Relieve the Pressure Avoid elevation of head of bed grate than 30 degrees. Reposition every 2 hours. Use special devices to cushion specific areas, Use an alternating-pressure mattress for patients at high risk to prevent or treat pressure sores. Provide for activity and ambulation. Advise frequent shifting of weight and occasional raising of bottom off chair while sitting.

44. Clean and Debride the Wound Use normal saline for cleaning & disinfecting wounds. Apply wet-to-dry dressings or enzyme ointments for debridement as directed; or assist with surgical debridement. Treat Local Infection Apply topical antibiotics to locally infected pressure ulcer as prescribed.

45. Cover the Wound With a Protective Dressing

46. Bed Sore cont’d Elbow Hips Heel Ears Inner Knees Lower back Scapula Occiput Elbow

48. 1.Bed-ridden patients 2.Obese patients 3.Very thin patient 4.Patients in traction 5.Patients in complete bed rest 6.Diabetic patients 48 Patients prone to pressure sores

49. 1.Redness, heat, and discomfort in the area. 2.Area become cold to touch 3.Area become blue 4.Gangrene formation 5.Sloughing and infection Causes of bed sore: 1.Pressure 2.Friction 3.Moisture 49 Signs and symptoms of bed sore

50. 1)Find out and detect the patients who are 2)Daily observation of the pressure point 3)Stimulate circulation 4)Relive pressure by: a. Moving the patient in bed b. Changing position every 2 hours c. Use a bed cradle to take the weight off the linen d. Use pillows between legs e. Early ambulation of the patient 50 Prevention of bed sore