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2. 2 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.

3. 3 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

4. 4 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

5. 5 Kinds of hygiene may nurses described: Early morning care: washing face, hands, oral care and bed making. Early morning care: washing face, hands, oral care and bed making. Morning care: is providing after client has breakfast such as baths, back massage, oral and nails care. Morning care: is providing after client has breakfast such as baths, back massage, oral and nails care. After noon care: includes provide bed ban, urinal, hand washing and face. After noon care: includes provide bed ban, urinal, hand washing and face. Hours of sleep care: they provide to client before they relative for night, elimination need and oral care. Hours of sleep care: they provide to client before they relative for night, elimination need and oral care. As needed care: is provided required by client. As needed care: is provided required by client.

6. 6 Factor influencing individual hygiene: culture. culture. Religion. Religion. Environment. Environment. Development level. Development level. Health status. Health status. Personal prefernces Personal prefernces

7. 7 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.

8. 8 Functional level of the patient may described as following: Total dependent. Total dependent. Partial dependent. Partial dependent. Independent. Independent.

9. 9 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

10. 10 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.

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12. 12 Function of the skin: Its protect under lying tissues from injury by preventing passage microorganism. Its protect under lying tissues from injury by preventing passage microorganism. Its regulate body temperature. Its regulate body temperature. Sensation. Sensation. Excretion. Excretion. Production of vitamin D. Production of vitamin D.

13. 13 Assessment: Cleanliness. Cleanliness. Color. Color. Temperature. Temperature. Moisture. Moisture. Sensation. Sensation. Turgor Turgor Texture. Texture.

14. 14 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

15. 15 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

16. 16 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.

17. 17 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.

18. 18 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.

19. 19 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.

20. 20 BATH REFUSAL What is real problem? Power issue? Power issue? Fatigue? Fatigue? Visitors? Visitors?Assessment Patient continent? Patient continent? Skin care? Skin care? Level of exertion? Level of exertion? Comfort education and negotiation

21. 21 SHOWERING Check orders and get report Check orders and get report Organize your supplies first Organize your supplies first Keep covered when moving in hallway Keep covered when moving in hallway Keep heels from dragging on floor Keep heels from dragging on floor Keep curtains/doors closed Keep curtains/doors closed Dry carefully Dry carefully Include oral care, shampoo, and shave Include oral care, shampoo, and shave Don’t leave alone in shower Don’t leave alone in shower

22. 22 ORGANIZATION SKILLS Check orders (schedule; positioning) Check orders (schedule; positioning) Check arm band Check arm band Obtain report on patient Obtain report on patient Discuss plan with team Discuss plan with team Check availability of water, linen, hamper, gloves if needed Check availability of water, linen, hamper, gloves if needed Organize supplies prior to entering room Organize supplies prior to entering room Assess patient condition Assess patient condition Does patient need pain medication? Does patient need pain medication? Will any treatments need to be done? Will any treatments need to be done? Begin! Begin!

23. 23 GENERAL PRINCIPLES Client safety Client safety Nurse safety Nurse safety Work in time constraints Work in time constraints Allow privacy and dignity Allow privacy and dignity Only body part being washed is uncovered Only body part being washed is uncovered Curtain is closed Curtain is closed Change water, washclothes, towels, linen as needed Change water, washclothes, towels, linen as needed Use absorbent cotton bath blanket (heated best) Use absorbent cotton bath blanket (heated best) Call bell available Call bell available

24. 24 Hair: Hair is composed of column of dead keratinized. 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: Hair covers the whole body part but its distribution, color, texture, differ according to: 1. Location. 2. Age. 3. Gender.

25. 25 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

26. 26 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.

27. 27 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.

28. 28 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

29. 29 Teeth 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. vessels and nerve. vessels and nerve. 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.

30. 30 Assessment Assessment Caries: erode tooth enamel because of accumulation of sugur, bacteria. Caries: erode tooth enamel because of accumulation of sugur, bacteria. Tartar: is avisible, hard deposite of plague and dead bactria. Tartar: is avisible, hard deposite of plague and dead bactria. Pyorrhea: the teeth are loose and pus is evident when the gums are pressed. Pyorrhea: the teeth are loose and pus is evident when the gums are pressed. Periodontal disease: gums appear spongy and bleeding. Periodontal disease: gums appear spongy and bleeding. Halitosis: bad breathing. Halitosis: bad breathing.

31. 31 Diagnosis: Diagnosis: Self care deficit. Self care deficit. Altered oral mucosa. Altered oral mucosa. Implementation: 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.

32. 32 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

33. 33 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.

34. 34 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

35. 35 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.

36. 36 Hygiene: Hygiene: 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: Type of bathing: Tube bath. Tube bath. Partial bath. Partial bath. Bed bath. Bed bath.

37. 37 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. 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.

38. 38 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.

39. 39 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.

40. 40 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

41. 41 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

42. 42 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?

43. 43 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 stylling preferences

44. 44 5) Bed making. Make bed for patient comfort 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

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