Module 8

1. Module 8 Personal Hygiene

2. Personal Hygiene • It is the nurses responsibility to provide the patient with the opportunity for hygiene

3. HYGIENE PART 6-A Bathing

4. Purpose of Bathing • Cleansing the skin • Removes perspiration, bacteria, which minimizes skin irritation and reduces chance of infection • Stimulation of circulation • Warm water and gentle strokes from distal to proximal increase circulation and promote venous return • Improve self-image • Promotes feeling of being refreshed, relaxed

5. Purpose of Bathing • Reduction of body odors • Especially in axillae and pubic areas • Promotion of Range of Motion • Movement of extremities while bathing

6. Nurse’s Advantage • Provides opportunity to develop a meaningful nurse-patient relationship • Provides opportunity for assessment of the patient including condition of patient, psychosocial and learning needs.

7. Before You Begin Bathing It is the Nurses Role to: • Assess Your Patient

8. Factors Affecting Personal Hygiene • Cultural / Religious • Developmental Stage • Mobility • Emotional • Physical Illness • Personal Preference

9. Critical Thinking • Situation: The Nurse enters Mrs. G’s room to do a complete bed bath and she says “I do not want my bath now, I just want to rest”. What should the nurse do now?

10. Critical Thinking • Situation: The nurse enters Mr. C’s room to do a complete bed bath and he says “I do not want my bath now, I just want to rest”. You notice that his bed is wet and he was incontinent of urine. Now what should the nurse do?

11. Types of Baths • Cleansing Baths • Used to clean the patient

12. Cleansing Baths • Complete Bed Bath • Nurse baths entire body of dependent patient in bed • Self-Help Bath • Patients confined to bed are able to bathe themselves with some help • Partial Bath • Parts of the body are washed by the patient and some by the nurse

13. Cleansing Baths • Tub Bath • Much easier for bathing and rinsing than in a bed • Varies in style

14. types of baths • Shower • Used by ambulatory patients who require only minimal assistance • Can be used with a shower chair

15. Types of Baths • Therapeutic Baths • Bath used for treatment • Usually requires a doctor’s order

16. Therapeutic Baths • Medicated solutions may be used in bathing • Range from warm water baths, cool water baths, cornstarch, oatmeal, Aveno, alcohol

17. Back Rub • May be performed after drying off the back during the bath. • Position of Patient: Prone or side-lying • Expose only the back, shoulders, upper arms. Cover remainder of body • Lay towel alongside back • Warm lotion in your hands—still explain that it may be cool and wet.

18. Back Rub • Start in the sacral area, moving up the back. • Massage in a circular motion over the scapula. • Move upward to shoulders, massage over the scapula • Continue in one smooth stroke to upper arms and laterally along side of back down to iliac crests. • Do NOT allow your hands to leave the patient’s skin • End by telling your patient that you are finished

19. Guidelines for Bathing • Provide Privacy • Maintain Safety • Maintain warmth • Promote the patient’s independence as much as possible

20. Procedure for Bathing • Bed Bath • Harkreader p. 799-803 • Tub Bath or Shower • Harkreader p. 806-807

21. Part B: Perineal Care • Hygienic measures related to the care of the genitalia.

22. Perineal Care • Can be embarrassing for the nurse and the patient. • Should not be overlooked because of embarrassment. • If the patient can do it themselves—let them. • Hand them the washcloth and ask if they would like to “finish their bath.”

23. Perineal Care • Those patients who may need the nurses assistance: • Vaginal or urethral discharge • Skin irritation • Catheter • Surgical dressings • Incontinent of urine or feces

24. Perineal Care ProcedureNormal conditions, Discharge, Menses Women • Wipe labia majora (outer) from front to back in downward motion using clean surface of wash cloth for each swipe. • Wipe labia minora (inner) from front to back in downward motion using clean surface of wash cloth for each swipe • Wipe down the center of the meatus from front to back. If catheter in place, clean around catheter in circular fashion, using clean surface of wash cloth for each swipe. • Wash inner thighs from proximal to distal

25. Cont. Female Perineal Care • Rinse with warm to tepid water using pour from peri-bottle if available. • Pat dry using clean towel in same order as wash • Remove bedpan if one is used • Verbalize turning patient on side to wash anal area from front to back and dry

26. Perineal Care - Male • Retract foreskin of penis if uncircumcised • Wash around the urinary meatus in a circular motion, using clean surface of washcloth for each stroke and around the head of penis in circular motion • Wash down shaft of penis toward the thighs changing washcloth position with each stroke • Wash scrotum – front to back • Wash inner thighs continued

27. Cont. Perineal Care - Male • Rinse with clean wash cloth or peri-bottle using warm water in same sequence as the wash • Dry with clean towel in the same sequence • Replace foreskin, as appropriate • Turn patient on side to wash anus from front to back and dry • Procedure 31-2: Harkreader, p. 804-805

28. Perineal Care with Catheter • Follow similar procedure in the male patient. • Start at the urethra opening and clean outward.

29. Part C: Oral Hygiene • Maintains the healthy state of the mouth • Cleanses teeth of food particles, plaque, and bacteria • Massages the gums • Relieves discomfort from unpleasant odors and tastes. • Refreshes the mouth and gives a sense of well-being and thus can stimulate appetite. Why do oral hygiene?

30. Assessment: Oral Hygiene a. Frequency • Depends on the condition of the patient’s mouth. • Some patient’s with dry mouth or lips need care every 2 hours. • Usually done twice a day or after each meal b. Assistance Needed • Does the patient need assistance to do oral care *The nurse can help patients maintain good oral hygiene by: 1. Teaching them correct techniques 2. Actually performing for weakened or disabled patients.

31. Oral Hygiene Assessment c. Abnormalities • Loose or missing teeth • Swelling and bleeding of gums • Unusual mouth odor • Pain or stinging in mouth structures

32. Brushing • Major concerns are: • Thoroughness in cleansing • Maintaining the condition of the oral mucosa. • Procedure for Conscious Patient: • Upright position • Get out your textbook--Harkreader: p. 813-814

33. Brushing: Unconscious Patient See performance checklist in syllabus Safety is of utmost importance • Prevent aspiration • Positioning—lateral position with head turned to the side or side-lying. Position back of head on a pillow so that the face tips forward and fluid/ secretions will flow out of the mouth, not back into the throat. • Place a bulb syringe or suction machine with suction equipment nearby. Yankuer end on suction device.

34. Oral Hygiene: Unconscious Patient • Keeping the mouth open • Use a padded tongue blade to open the patients mouth and separate the upper and lower teeth • Never place your hand in the patient’s mouth or open with your fingers. Oral stimulation often causes the biting –down reflex and serious injuries can occur. Harkreader p. 814-815

35. Denture Care • Clean dentures as frequently as natural teeth • Dentures are the patient’s personal property and should be handled with care because they can be easily broken. • Care: • Remove before going to bed – allows gums to rest and prevents buildup of bacteria. • Store in a labeled container covered with water or denture cleaner if available

36. Denture Care • Procedure: Harkreader p. 815 • Tips to remember: • Use gauze squares or washcloth to grasp front of dentures to prevent from slipping • Place wash cloth or paper towel in sink to line it while you are cleaning the dentures • Work close to the bottom of the sink in case you drop them. • Use tepid water

37. Part D: Hair Care • A person’s appearance and feeling of well-being often depends on the way their hair looks and feels

38. Major Goals in Hair Care Stimulate Circulation Prevents Matting

39. Brushing and Combing • Keeps hair clean and distributes oil evenly along the hair shaft • Combing styles hair and prevents from tangling • Assessment while brushing • Scalp lesions, abrasions • Dandruff • Parasitic infestations • Quality of hair • Appearance

40. Hair Care: Shampooing • Depends on: • Personal preference of the patient, does not have to occur every day with hygiene • Condition of the hair • Ways to Shampoo • If patient can get up and into a shower or sink, use a hand held nozzle • If patient can not get up, place on stretcher and roll to a shower area • If patient is unable to be moved, may shampoo in the bed – see procedure in Harkreader p. 817-818. • “Shampoo in a Bag” or dry shampoos are available

41. Part E: Shaving • Improves self-esteem and emotional needs of the patient • Usually done after the bath or shampoo • Assessment: • Skin for elevated moles, warts, Rashes, patchy skin lesions, or pustules

42. Shaving • Provide Safety • When using a razor blade, the skin must be softened to prevent pulling, scraping, or cutting • Place a warm wash cloth over area and then apply some gel, cream, foam. • Hold the razor at a 450 angle • Pull the skin taut • Shave in the direction of hair growth

43. Shaving • Safety Precautions • Electric razors must be used in patients who are at risk for bleeding, confused, or depressed

44. Part F: Foot and Nail Care • Usually part of the bath • Purpose: • Eliminate sources of infection and decrease odors • Assessment: • Color, shape length, texture of nails • Condition of skin around nails and between toes and fingers – swollen, inflamed, callused, lesions, temperature

45. Foot and Nail Care • Soak the hand or foot to soften the cuticles • Thoroughly cleanse and dry • Trim the nails ONLY if you have permission or it is allowed at that institution. Most institutions do not allow nurses to trim the nails.

46. Foot and Nail Care • Teach patient and family that nails should be cut – straight across. May need to get a referral if no one available to cut nails. • Show close attention to the feet and nails of the diabetic patient and the elderly ** If feet and nails are in bad condition– notify doctor so a consult can be ordered with a podiatrist

47. Part G: Ear Care • Usually requires minimal care • Cleanse the external auricle with washcloth when bathing • Avoid insertion of objects into the ear

48. Hearing Aids • Check that the device is functioning correctly and clean any body oils or cerumen from the hearing aid • Make sure the hearing aid is off and volume is down before insertion • Insert hearing aid in ear by pulling earlobe downward while pressing the hearing aid inward • Turn on and adjust volume • Ask the patient if comfortable and can they hear!

49. Part G: Eye Care • Assessment: • Abnormal lesions • Discharge • Tearing • Presence of any infection • Use of Visual Aids (contacts, glasses) • Ask when patient needs to use these devices

50. Eye Care • Wash around the eyes with a warm moist washcloth with warm water—NO SOAP! • Clean from the inner canthus to the outer canthus of the eye. Pay special attention to the inner canthus. • Provide special care for the eyes of unconscious patients. • May need to tape the eye lids shut if unable to blink and protect own eyes