1. Chapter 37 Hygiene

2. Six Functions of the Skin Protection Body temperature regulation Sensation Excretion Maintenance of water and electrolyte balance Vitamin D production and absorption

3. Factors affecting the Skin Unbroken and healthy skin and mucous membranes defend against harmful agents. Resistance to injury is affected by age, amount of underlying tissues, and illness. Adequately nourished and hydrated body cells are resistant to injury. Adequate circulation is necessary to maintain cell life.

4. Developmental Considerations Infant’s skin and mucous membranes are easily injured and subject to infection. Child’s skin becomes increasingly resistant to injury and infection. –Requires special care because of toilet and play habits Adolescent has enlarged sebaceous glands and increased secretions. Adult’s tissue becomes thinner and wrinkles appear; liver spots occur.

5. Causes of Skin Alterations Very thin and very obese people are more susceptible to skin injury. –Fluid loss during illness causes dehydration. –Skin appears loose and flabby. Excessive perspiration during illness predisposes skin to breakdown. Jaundice causes yellowish, itchy skin. Diseases of the skin cause lesions that require care.

6. Factors Influencing Personal Hygiene Culture Socioeconomic class Spiritual practices Developmental and knowledge level Health state Personal preference

7. Interview Questions/Skin Alterations How long have you had this problem? Does it bother you? How does it bother you (itching)? Have you found anything helpful in relieving these symptoms?

8. Factors to Consider When Examining Skin Cleanliness Color Temperature Turgor Moisture Sensation Vascularity Evidence of lesions

9. At Risk for Skin Alteration Lifestyle variables Changes in health state Illness Diagnostic measures Therapeutic measures

10. Focus of Self-Care Deficit Diagnoses Feeding Bathing and hygiene Dressing and grooming Toileting

11. Early Morning Care Assist patient with toileting. Provide comfort measure to refresh patient to prepare for day. Wash face and hands. Provide mouth care.

12. Morning Care (AM Care) After breakfast, nurse completes morning care: Toileting Oral care Bathing Back massage Special skin measures Hair care, cosmetics

13. Morning Care (AM Care) (continued) Dressing Positioning for comfort Refreshing or changing bed linens Tidying up bedside

14. Afternoon Care (PM Care) Ensure patient’s comfort after lunch: Offer assistance with toileting, handwashing, oral care Straighten bed linens Help patients with mobility to reposition themselves

15. Hours of Sleep Care (hs Care) Before patient retires: Offer assistance with toileting, washing, and oral care Offer a back massage Change any soiled bed linens or clothing Position patient comfortably Ensure that call light and other objects patient requires are within reach

16. As Needed Care (prn Care) Offer individual hygiene measure as needed Change clothing and bed linens of diaphoretic patients Provide oral care every two hours if indicated

17. Reasons for Providing Back Massage Acts as a general body conditioner Relieves muscle tension and promotes relaxation Provides opportunity for nurse to observe skin for signs of breakdowns Improves circulation May decrease pain, distress, and anxiety May improve sleep quality

18. Purposes of Bathing Cleanses the skin Acts as a skin conditioner Helps to relax a person Promotes circulation Serves as musculoskeletal exercise Stimulates the rate and depth of respirations

19. Purposes of Bathing (continued) Promotes comfort through muscle relaxation and skin stimulation Provides person with sensory input Helps improve self-image Strengthens nurse patient relationship

20. Providing a Bed Bath Provide articles for bathing on over-bed table or bedside stand. Provide privacy for patient. Remove top linens and replace with bath blanket. Place cosmetics in convenient place. Assist patients who cannot bathe themselves completely.

21. Physical Assessment of Oral Cavity Observe for oral problems. –Dental caries –Periodontal disease –Other oral problems Identify actual or potential oral problems that nurses can treat. Identify appropriate nursing measures. Carry out the plan of care.

22. Administering Oral Hygiene Moistening the mouth Cleaning the mouth Caring for dentures Toothbrushing and flossing Using mouthwashes

23. Care of Eyes Clean from inner to outer canthus with wet, warm cloth, cotton ball or compress. Use artificial tear solution or normal saline every 4 hours if blink reflex is absent. Care for eyeglasses, contact lens, or artificial eye if indicated.

24. Ear and Nose Care Wash external ear with washcloth-covered finger; do not use cotton-tipped swabs. Perform hearing aid teaching and care if indicated. Clean nose by having patient blow it if both nares are patent. If indicated, use nasal suctioning with bulb syringe. Remove crusted secretions around nose and apply petroleum jelly.

25. Providing Hair Care Identify patient’s usual hair and scalp care practices and styling preferences. Note any history of hair or scalp problems, such as dandruff, hair loss, or baldness. Treat any infestations, such as pediculosis and ticks. Groom and shampoo hair. Care for beards and mustaches. Assist with unwanted hair removal.

26. Nail and Foot Care Assess nails for color and shape, intactness and cleanness, and tenderness. Check for history of nail or foot problems. Soak nails and feet and assist with cleaning and trimming nails (if not contraindicated). Massage the feet to promote relaxation and comfort. Provide diabetic foot care if indicated.

27. Perineal and Vaginal Care Assess for perineal or vaginal problems and related treatments. Perform a physical assessment of male and female genitalia. Perform perineal in matter-of-fact and dignified manner according to procedure. Cleanse vaginal area with plain soap and water.

28. Guidelines for Applying Antiembolism Stockings Measure patient’s leg for size of stocking. Apply stocking in morning before patient is out of bed and while patient is supine. Do not massage the legs. Check legs regularly for redness, blistering, swelling, and pain. Launder the stockings as necessary.

29. Applying Intermittent Pneumatic Compression Stockings May be used in conjunction with antiembolism stockings Require a physician’s order Are prescribed for high-risk surgical patients and patients with chronic venous disease or at risk for deep-vein disorders Are knee-length or thigh-high cuff connected to hoses and a pump Stimulate normal muscle-pumping action in the legs

30. Ensuring Bedside Safety Patient call light is functioning and within reach Bed is positioned properly, at appropriate height, wheels locked Side rails are safely used when indicated Principle of medical asepsis are followed Electrical equipment is safely grounded Walk space is uncluttered

31. Patient Outcome Achievement Level of patient participation in hygiene program Elimination of, reduction in, or compensation for factors interfering with independent execution of hygiene measures Changes related to specific skin problems