1. Chapter 17 Hygiene

2. OBJECTIVES
1. Define hygiene. 2. Name five hygiene practices that most people perform regularly. 3. Give two reasons why a partial bath is more appropriate than a daily bath for older adults. 4. List at least three advantages of towel or bag baths. 5. Name two situations in which shaving with a safety razor is contraindicated. 6. Name three items recommended for oral hygiene. 7. Identify two methods to prevent the chief hazard when providing oral hygiene to an unconscious client. 8. Describe two techniques for preventing damage to dentures during cleaning. 9. Describe two methods for removing hair tangles. 10. Name two types of clients for whom nail care is provided with extreme caution. 11. Name four visual and hearing devices. 12. List two alternatives for clients who cannot insert or care for their own contact lenses. 13. Discuss four reasons for sound disturbances experienced by people who wear hearing aids. 14. Describe an infrared-listening device.

3. Hygiene
Hygiene: practices that promote health through personal cleanliness
Activities that foster hygiene
Bathing; cleaning and maintaining fingernails and toenails
Performing oral care
Shampooing and grooming hair
Maintaining hearing aids and eyeglasses

4. Integumentary System Components
Skin Mucous membrane Hair Fingernails, toenails Teeth

5. Skin
Epidermis: Outermost layer, contains dead skin cells forming a tough protein called keratin. Cells shed continuously & are replaced by the dermis. Dermis: True skin, contain most of the secretory glands

6. Skin
Subcutaneous layer: Separate the skin from skeletal muscles, contains fat cells, blood vessels, nerves and roots of the hair follicles and glands

7. Cross-Section of the Skin

8. Skin carries out the following functions:
Protect inner body structures from injury & infection
Regulate body temperature
Maintain fluid and chemical balance
Provide sensory information such as pain, temperature, touch and pressure
Assist in converting precursors to Vitamin D when exposed to sunlight

9. Skin
Common Benign Skin Lesions in Older Adults Seborrheic keratoses: tan to black raised areas on the trunk Senile lentigines: brown, flat patches on the face, hands, and forearms (liver spots)

10. Skin GLAND LOCATION SECRETION PURPOSE Sudoriferous
Throughout dermis and subcutaneous layers, especially in axilla and groin
Sweat
Regulate body temperature.
Excrete body waste
Ceruminous
Ear canals
Cerumen
Protective functions; has antimicrobial properties
Sebaceous
Throughout the dermis
Sebum
Lubricate skin and hair
Ciliary
Eyelids
Sweat and sebum
Protect lid margin and lubricate eyelash follicles

11. Mucous Membrane
Line body passages such as the: digestive, respiratory, urinary, and reproductive systems Mucous membrane also lines the conjunctiva of the eye Goblet cells in the mucous membranes secrete mucus, a slimy substance that keeps the membranes soft and moist

12. Hair
Each hair is a thread of keratin Forms from cells at the base of a single follicle Helps to prevent heat loss by trapping heat in the air between the hairs Sebaceous glands in the hair follicles release sebum Basic genetically inherited structure can be altered by chemicals used to curl, relax or lubricate the hair

13. Nails
Fingernails and toenails are made of keratin, which in concentrated amounts gives them their tough texture Normal nails are thin, pink, and smooth Fingernails and toenails provide some protection to the digits

14. Teeth
Present beneath the gums at birth Contain the outer covering, enamel, a keratin structure Exposed portion of each tooth: crown Portion within the gum: root Adults: 28 to 32 permanent teeth Saliva: keeps the teeth clean and inhibits bacterial growth

15. Teeth
Discoloration occurs from chronic consumption of coffee or tea, tobacco use, certain drugs such as tetracycline antibiotics taken during childhood. Integrity of teeth largely depend on the person’s oral hygiene practices, diet and general health.

16. Common Dental Problems
Sugar, plaque, and bacteria may eventually erode the tooth enamel, causing caries Tartar leads to gingivitis, while gum inflammation may cause periodontal disease Tooth loss is common in older adults as a result of periodontal disease

17. Hygiene
Integument contains many secretory glands that produce odors and attract debris Hygiene measures are beneficial for maintaining personal cleanliness and healthy integumentary structures Hygiene practices vary widely, most Americans routinely perform bathing, shaving, brushing teeth, hair care and nail care

18. Bathing
Uses a cleansing agent such as soap and water to remove sweat, oil, dirt, and microorganisms from the skin
Advantages of bathing
Eliminates body odor; reduces the potential for infection
Stimulates circulation; provides a refreshed and relaxed feeling; improves self-image

19. Types of Bathing
Most bathing is done in a tub or shower, at a sink or at the bedside Partial bathing: washing only those body areas that are subject to greatest or sources of body odor: generally, the face, hands, axillae and perineal area. This is done at a sink or with a basin at the bedside.

20. Types of Bathing
Bed bath: washing with basin of water at the bedside. Towel bath: single large towel to cover and wash a client Bag bath: commercially packaged kit (p. 359) Any one of these three types of baths would be suitable for the client who is unable to take a tub bath or shower independently

21. Therapeutic Baths TYPE DESCRIPTION PURPOSE Sitz bath
Immersion of the buttocks & perineum in a small basin of continuously circulating water
Removes blood, serum, stool or urine.
Reduces local swelling.
Relieves discomfort.
Sponge bath
Applications of tepid water to the skin
Reduces a fever
Medicated bath
Soaking/immersing in a mixture of water & other substance, such as baking soda, oatmeal, or cornstarch
Relieves itching or a rash
Whirlpool bath
Warm water that is continuously agitated within a tub or tank
Improves circulation
Increases joint mobility
Relieves discomfort
Removes dead tissue

22. Question
Is the following statement true or false? Partial bathing is most common in young adults.

23. Answer
False. Partial bathing is most common in older clients.

24. Advantages of Bed Bath

25. Partial bathing
Partial bathing is more appropriate for older adults than a tub bath or shower because they do not perspire as much as young adults and soap tends to dry their skin.

26. Giving a Towel Bath

27. Question
Is the following statement true or false? Towel bath is very expensive.

28. Answer
False.
Towel bath saves expense.
(CS: 88yr)

29. Shaving Removes unwanted body hair
Accomplished with an electric or a safety razor
The use of safety razor may not be possible in the following situations:
If the client has a face injury
If the client cannot shave

30. Shaving a Client’s Face

31. Contraindications to Using a Safety Razor
Receiving anticoagulants (drugs that interfere with clotting) Ex. Coumadin, Heparin
Treatment of DVT (Deep-Vein Thrombosis), PE
(Pulmonary Embolism), Prosthetic Heart Valves
Receiving thrombolytic agents (drugs that dissolve blood clots) Ex. Alteplase, Streptokinase
Treatment of PE, MI, stroke

32. Contraindications to Using a Safety Razor
Taking high doses of aspirin Blood disorder such as hemophilia Liver disease who have impaired clotting Rashes or elevated or inflamed skin lesions on or near the face Those who are suicidal

33. Oral Hygiene
Practices used to clean the mouth, especially brushing and flossing the teeth Most dentists recommend twice daily brushing Dentures and bridges require special cleaning and care To prevent damage during cleaning, hold dentures over a plastic or towel-lined container and uses cold or tepid water.

34. Oral Care for Unconscious Clients
Because unconscious clients are not salivating in response to seeing, smelling, and eating food, they need oral care even more frequently than conscious clients. Sordes (dried crusts containing mucus, microorganisms, and epithelial cells shed from the mucous membranes) are common on the lips and teeth of unconscious clients.

35. Oral Care for Unconscious Clients
The chief hazard in providing oral hygiene for unconscious clients is aspiration (inhaling) of liquid into the lungs. To prevent aspiration, nurses position unconscious clients on the side with the head lower than the body. They use oral suction equipment to remove liquid from the mouth.

36. Oral Care for Unconscious Clients
Aspirated liquids predispose clients to pneumonia. Tooth brushing is the preferred technique for providing oral hygiene Oral swabs are also used to moisten and refresh the mouth

37. Advantages of Electric Toothbrushes

38. Question
Is the following statement true or false? Dentures are best washed with hot water.

39. Answer
False. Dentures are best washed with cold or tepid water.

40. Hair Care
Apply a conditioner to loosen tangles Use oil on the hair if it is dry Braid the hair to help prevent tangles Brush the hair slowly to increase circulation of sebum Use a wide-toothed comb, combing from end to crown Use shampoo to clean hair

41. Nail Care Keeping the fingernails and toenails clean and trimmed
Nail care should be provided with extreme caution for the following clients:
Clients with diabetes
Clients with impaired circulation
Client with thick nails

42. Nail Care
Clients with diabetes, impaired circulation or thick nails are at risk for vascular complications secondary to trauma. Podiatrist (person with special training in caring for feet) services are often indicated It is best to check with the client’s MD before cutting fingernails or toenails

43. Question
Is the following statement true or false? Applying alcohol to tangled hair helps remove the tangles.

44. Answer
True. Applying alcohol to tangled hair helps remove the tangles.

45. Visual and Hearing Devices
Eyeglasses and hearing aids improve communication and socialization
Eyeglasses
Contact lenses
Artificial eyes
Hearing aids
Infrared listening devices

46. Types of Contact Lenses

47. Eyeglass Care
The nurse cleans glass and plastic lenses as follows: Hold eyeglasses by the nose or ear braces Run tepid water over both sides of the lenses (hot water damages plastic lenses) Wash lenses with soap or detergent Rinse with running tap water Dry with a clean, soft cloth. Do not use paper tissues because can scratch lenses.

48. Contact Lens Care
Never assume that someone who wears eyeglasses does not use a contact lens, and vice versa. For conscious clients, the nurse asks them to remove and insert the lenses. Care for the contact lenses is according to the client’s established routines.

49. Contact Lens Care
For clients who cannot remove contact lenses, the nurse may assist with their removal or should consult the client’s ophthalmologist (medical MD who treats eye disorders) or optometrist (person who prescribes corrective lenses) about alternatives to promote adequate vision and safety.

50. Contact Lens Care
For the unconscious client: Obtain an appropriate storage container, label it Left & Right Elevate client’s head and place towel over the chest to prevent loss or damage to contact lenses Soft Lenses p. 366, also see Figure 17-12, Hard Lenses p. 366, also see Figure 17-15, 17-16

51. Examples of Hearing Aids
In the ear (A) Behind the ear (B) Remote controlled (C) Refer to Figure in the textbook. Refer to Client and Family Teaching Maintaining a Hearing Aid 17-2 p. 368

52. Hearing Aids Four types of hearing aids:
In-the-ear devices: small self-contained aids that fit in the outer ear
Canal aids: fit deep within the ear canal and are largely concealed. Because of their size, may be difficult to remove and adjust

53. Hearing Aids
Behind-the-ear devices: microphone and an amplifier worn behind the ear that delivers sound to an internal receiver. Body-aid devices: use electrical components enclosed in a case carried somewhere on the body to deliver sound through a wire connected to an ear mold receiver. Most clients insert and remove their own hearing aids, but the nurse may need to assess and troubleshoot problems that develop.

54. Infrared Listening Devices
Infrared Listening Devices (IRLDs) resemble earphones attached to a handheld receiver. They are an alternative to conventional hearing aids. Converts sound into infrared light & sends it through a wall- or ceiling mounted receiver to the person wearing the device. The light is converted into an auditory stimulus.

55. Infrared Hearing Devices
Advantage: IRLD reduces background noise Disadvantage: Cannot be used outdoors, in rooms that contain many windows, brightly lit rooms because infrared light jams the signal which causes audio interference

56. Infrared Hearing Device
Some geriatric centers are installing IRLDs in rooms used for social and recreational activities. People who need help hearing lectures, TV, live performance may use an IRLD.

57. Question
Is the following statement true or false? Infrared listening devices (IRLDs) are used by clients with hearing impairment to hear sounds outdoors.

58. Answer
False. IRLDs cannot be used outdoors or in rooms that contain many windows or in well-lit rooms.

59. General Gerontologic Considerations
Poor hygiene and grooming in older adults: signs of visual impairments, functional changes, dementia, depression, abuse, or neglect Older adults do not need to bathe as frequently as younger adults Use mild, superfatted, nonperfumed soap Oils are not used in showers or bathtubs due to increased risk for falls

60. General Gerontologic Considerations (cont’d)
For older adults with limited range of motion or mobility, provide:
Long-handled bath sponges or hand-held shower attachments
Nonskid strips on the floor of bathtubs
Showers with strategically placed handles and grab bars; a tub/shower seat

61. General Gerontologic Considerations (cont’d)
Due to increased susceptibility to dry skin, tears and scratches:
Avoid skin care products containing alcohol, perfumes that aggravate dry skin
Nails: keep trimmed and smooth
Feet: regularly inspect condition
Modify clothing to promote independence
Tooth loss: periodontal disease

62. Question
Is the following statement true or false? Older adults need to bathe frequently because they perspire a lot.

63. Answer
False. Older adults do not need to bathe frequently because they have diminished perspiration and sebum production.