1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 18 Hygiene

2. Slide 2 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Hygiene promotes comfort, safety, and health.  Intact skin: Is the body’s first line of defense against disease Is the body’s first line of defense against disease Prevents microbes from entering the body and causing an infection Prevents microbes from entering the body and causing an infection  Good hygiene: Cleanses the body Cleanses the body Prevents body and breath odors Prevents body and breath odors Is relaxing and increases circulation Is relaxing and increases circulation

3. Slide 3 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Culture and personal choice affect hygiene.  The nurse uses the nursing process to meet the person’s hygiene needs. Follow the nurse’s directions and the care plan. Follow the nurse’s directions and the care plan.  Some older persons resist your efforts to assist with hygiene. Follow the care plan to meet the person’s needs. Follow the care plan to meet the person’s needs.

4. Slide 4 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  DAILY CARE  You must: Assist with hygiene whenever it is needed. Assist with hygiene whenever it is needed. Protect the person’s right to privacy and to personal choice. Protect the person’s right to privacy and to personal choice.  Daily care is given at these times: Before breakfast (early morning care, or AM care) Before breakfast (early morning care, or AM care) After breakfast (morning care) After breakfast (morning care) Afternoon care Afternoon care Evening care (PM care) Evening care (PM care)

5. Slide 5 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  ORAL HYGIENE  Oral hygiene does the following: Keeps the mouth and teeth clean Keeps the mouth and teeth clean Prevents mouth odors and infections Prevents mouth odors and infections Increases comfort Increases comfort Makes food taste better Makes food taste better Reduces the risk for cavities (dental caries) and periodontal disease Reduces the risk for cavities (dental caries) and periodontal disease  Flossing: Removes plaque and tartar from the teeth Removes plaque and tartar from the teeth Removes food from between the teeth Removes food from between the teeth Is usually done after brushing Is usually done after brushing You need to floss for persons who cannot do so themselves. You need to floss for persons who cannot do so themselves.

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Most people perform oral hygiene themselves.  Some people need help gathering and setting up equipment.  You may need to brush the teeth for persons who: Are very weak Are very weak Cannot move or use their arms Cannot move or use their arms Are too confused to brush their teeth Are too confused to brush their teeth

9. Slide 9 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Mouth care for the unconscious person The care plan tells you what cleaning agent to use. The care plan tells you what cleaning agent to use. Protect unconscious persons from choking and aspiration. Protect unconscious persons from choking and aspiration. Keep the person’s mouth open with a padded tongue blade. Keep the person’s mouth open with a padded tongue blade. Always assume that unconscious persons can hear. Always assume that unconscious persons can hear. Mouth care is given at least every 2 hours. Mouth care is given at least every 2 hours. Follow the nurse’s directions and the care plan. Follow the nurse’s directions and the care plan.

12. Slide 12 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Denture care Mouth care is given and dentures cleaned as often as natural teeth. Mouth care is given and dentures cleaned as often as natural teeth. Dentures are slippery when wet. Dentures are slippery when wet. Dentures easily break or chip if dropped onto a hard surface. Dentures easily break or chip if dropped onto a hard surface. To use a cleaning agent, follow the manufacturer’s instructions. To use a cleaning agent, follow the manufacturer’s instructions. Hot water causes dentures to lose their shape (warp). Hot water causes dentures to lose their shape (warp). Remind residents not to wrap dentures in tissues or napkins. Remind residents not to wrap dentures in tissues or napkins. You clean dentures for those who cannot do so. You clean dentures for those who cannot do so.

15. Slide 15 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  BATHING  Bathing does the following: It cleans the skin. It cleans the skin. It cleans the mucous membranes of the genital and anal areas. It cleans the mucous membranes of the genital and anal areas. It is refreshing and relaxing. It is refreshing and relaxing. Circulation is stimulated and body parts are exercised. Circulation is stimulated and body parts are exercised. Observations are made. Observations are made. You have time to talk to the person. You have time to talk to the person.  Complete or partial baths, tub baths, or showers are given.

16. Slide 16 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  The bathing method depends on: The person’s condition The person’s condition Self-care abilities Self-care abilities Personal choice Personal choice  Bathing frequency is a personal matter.  Older persons usually need a complete bath or shower twice a week.  Bathing procedures can threaten persons with dementia.  The complete bed bath involves washing the person’s entire body in bed.

24. Slide 24 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Towel baths  Bag baths  The partial bath involves bathing the face, hands, axillae, back, buttocks, and perineal area.  Tub baths and showers Falls, burns, and chilling from water are risks. Falls, burns, and chilling from water are risks. Safety is important. Safety is important. The person’s privacy must be protected. The person’s privacy must be protected.

30. Slide 30 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  THE BACK MASSAGE  Back massages (back rubs): Relax muscles and stimulate circulation Relax muscles and stimulate circulation Are given after the bath and with evening care Are given after the bath and with evening care Can be given after repositioning or to help the person relax Can be given after repositioning or to help the person relax Last 3 to 5 minutes Last 3 to 5 minutes  Observe the skin before the massage.  Lotion reduces friction during the massage.

34. Slide 34 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  PERINEAL CARE  Cleaning prevents infection and odors, and it promotes comfort.  Perineal care is done: Daily during the bath Daily during the bath Whenever the area is soiled with urine or feces Whenever the area is soiled with urine or feces  The person does perineal care if able. Otherwise, it is given by the nursing staff. Otherwise, it is given by the nursing staff.

35. Slide 35 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Standard Precautions, medical asepsis, and the Bloodborne Pathogen Standard are followed. Work from the cleanest area to the dirtiest. Work from the cleanest area to the dirtiest.  The perineal area is delicate and easily injured. Use warm water, not hot. Use warm water, not hot. Rinse thoroughly. Rinse thoroughly. Pat dry after rinsing. Pat dry after rinsing.

40. Slide 40 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  REPORTING AND RECORDING  Report the following observations at once: Bleeding Bleeding Signs of skin breakdown Signs of skin breakdown Changes from prior observations Changes from prior observations  Report and record the care given. If care is not recorded, it is assumed that care was not given. If care is not recorded, it is assumed that care was not given.

41. Slide 41 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  QUALITY OF LIFE  Provide hygiene in a way that maintains or improves the person’s quality of life, health, and safety.  Protect the person’s rights when giving care.