1. HYGIENE and Self-Care Craven Ch. 23 2/5/2016NRS 320 Collings1

2. Importance  Self – Care: ability to independently perform functions of: Bathing Bathing Dressing Dressing Feeding Feeding Toileting Toileting  Independence in these basic areas enhances health and emotional well-being, dignity 2/5/2016NRS 320 Collings2

3. Bathing & Hygiene  How did it feel to be the ‘patient’?  To be the provider? It is difficult for most people to adjust to the level of dependence to have another person perform routine hygiene care It is difficult for most people to adjust to the level of dependence to have another person perform routine hygiene care It is also difficult to forgo basic hygiene! It is also difficult to forgo basic hygiene! 2/5/2016NRS 320 Collings3

4. Bathing  Intact skin is first line of defense against infection  Regular bathing removes perspiration, bacteria, oil from the skin Increases circulation Increases circulation Maintains muscle & joint mobility Maintains muscle & joint mobility Promotes relaxation Promotes relaxation Provides a sense of well-being & comfort Provides a sense of well-being & comfort Time for assessment & interaction Time for assessment & interaction 2/5/2016NRS 320 Collings4

5. Basic Principles  Wash from clean to dirty  Maintain privacy, dignity  Incorporate patient preferences & values  Distal to proximal motion increases venous return  EBP: Basin bath is associated with increase in infection rates Basin bath is associated with increase in infection rates Peri-care is often omitted; associated with UTI Peri-care is often omitted; associated with UTI Turn unconscious pt to side for oral care Turn unconscious pt to side for oral care 2/5/2016NRS 320 Collings5

6. Oral Care  Helps maintain strong healthy teeth & gums  Prevent tooth loss  Increase saliva, taste, comfort  Prevent pneumonia 2/5/2016NRS 320 Collings6

7. Types of baths  Tub, shower, sit-down shower  Bed bath [partial/complete]  Bag bath or towel bath  Partial bath [sink bath] Consider energy, ability of pt Consider energy, ability of pt Choose bath type that enhances independence while providing benefits Choose bath type that enhances independence while providing benefits  Provide supplies, assist as needed 2/5/2016NRS 320 Collings7

8. Foot Care  Disease state, ROM, perfusion affect needs and abilities R/T foot care Good foot care and education essential Good foot care and education essential Diabetes, PVD Diabetes, PVD Do not soak feet [dryness - cracking – skin breakdown and infection risk Do not soak feet [dryness - cracking – skin breakdown and infection risk Assess for temperature, circulation, sensation, wounds Assess for temperature, circulation, sensation, wounds Education – daily VSE, good shoes, report changes Education – daily VSE, good shoes, report changes 2/5/2016NRS 320 Collings8

9. Other hygiene needs  Shaving in direction of hair growth in direction of hair growth Electric shaver if on anticoagulant TX Electric shaver if on anticoagulant TX  Glasses & contacts Clean daily Clean daily  Hearing Aids Check battery, clean per policy, replace Check battery, clean per policy, replace 2/5/2016NRS 320 Collings9

10. Feeding  Dysphagia: difficulty swallowing Assess patients for dysphagia before feeding Assess patients for dysphagia before feeding Supervision Supervision Assistive devices Assistive devices Consistency Consistency Thickened liquids easier to swallowThickened liquids easier to swallow Separate flavors, do not mix Separate flavors, do not mix 2/5/2016NRS 320 Collings10

11. Toileting  Assess level & type of assistance needed Assist to BR Assist to BR Raised seat/grab bars/commode chair Raised seat/grab bars/commode chair BSC BSC Urinal/bedpan Urinal/bedpan  Provide privacy while maintaining safety  Provide hand hygiene for patient  Assess need for assistance with peri-care 2/5/2016NRS 320 Collings11

12. Dressing  Assess needs, abilities, energy level  Analgesia if indicated  Allow time  Provide choices when possible  Routine for cognitive deficits  Aids [shoehorn, zipper pull, Velcro] help maintain independence  Privacy 2/5/2016NRS 320 Collings12

13. Other considerations  Personal items: Overbed table s/b clean, neat Overbed table s/b clean, neat Personal items, call light within easy reach Personal items, call light within easy reach Trash nearby and/or bag taped to bedrail Trash nearby and/or bag taped to bedrail  Bed placed in position of comfort, appropriate for activity & pt needs  Linens s/b changed in conjunction with bathing Medical asepsis Medical asepsis 2/5/2016NRS 320 Collings13

14. CRITICAL EVALUATION  WHAT IS THE ABILITY OF THIS PERSON TO CARE FOR THEMSELVES? PHYSICAL Disability PHYSICAL Disability MENTAL Disability MENTAL Disability Lack of Knowledge Lack of Knowledge Lack of resources Lack of resources → Self-care deficits → Self-care deficits 2/5/2016NRS 320 Collings14

15. CRITICAL EVALUATION  ARE THERE ANY CULTURAL ISSUES THAT NEED TO BE ADDRESSED PRIOR TO BATHING? Privacy, Gender, Other Privacy, Gender, Other  WHAT DO YOU DO WITH THIS INFORMATION ABOUT THE PATIENT? CARE PLAN CARE PLAN 2/5/2016NRS 320 Collings15

16. NURSING DIAGNOSIS  SELF-CARE DEFICIT: (BATHING) R/T confusion, fatigue: AEB unwashed hair, body odor, incontinent episode  SELF-CARE DEFICIT: feeding R/T unilateral weakness, difficulty (2* to RECENT CVA) AEB Right sided weakness, inability to feed self, weight loss of 1 lb. in 5 days 2/5/2016NRS 320 Collings16

17. Self-Care Deficit Planning  Goal/Outcome:  Overall goals are increased independence and safety 1. Pt will participate in hygiene routine this morning 2. Pt will demonstrate ability to feed himself using assistive devices [large-handled utensils] within 24 hours 2/5/2016NRS 320 Collings17

18. Implementation  Assess functional abilities/ areas of deficit  Assess resources available Is patient aware of/using available aids? Is patient aware of/using available aids? Education, referrals, encouragement Education, referrals, encouragement  Provide appropriate education, assistive devices, help, referral [OT/PT, home health, Meals on Wheels…] [OT/PT, home health, Meals on Wheels…] Provide encouragement Provide encouragement Evaluate results of interventions Evaluate results of interventions 2/5/2016NRS 320 Collings18

19. Evaluation  Was the goal met? 1. Was Pt able to assist in a.m. hygiene? If yes, move to higher-level goal [more independence]If yes, move to higher-level goal [more independence] If not, reassess patient needs, methods, goal…If not, reassess patient needs, methods, goal… Revise plan; provide shower chair at sink this p.m. Revise plan; provide shower chair at sink this p.m. 2. Goal met; patient demonstrated ability to feed self >75% of all meals today using assistive utensils. Continue with plan; OT to assess food preparation needs/abilities prior to discharge in 48 hours 2/5/2016NRS 320 Collings19

20. Questions? Discussion? 2/5/2016NRS 320 Collings20