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Hygiene. Chapter 38. Objectives. Define key terms Describe factors that influence hygiene Explain importance of foot care in the diabetic client Successfully perform hygiene procedures. Assessments. Skin/Hair Feet and nails Oral cavity Eye, Ear and Nose.

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hygiene

Hygiene

Chapter 38

objectives
Objectives
  • Define key terms
  • Describe factors that influence hygiene
  • Explain importance of foot care in the diabetic client
  • Successfully perform hygiene procedures
assessments
Assessments
  • Skin/Hair
  • Feet and nails
  • Oral cavity
  • Eye, Ear and Nose
risk factors for skin impairment
Risk Factors for Skin Impairment
  • Immobilization
  • Reduced Sensation
  • Secretions & excretions
  • Vascular insufficiency
  • External devices
developmental changes
Developmental Changes
  • Skin
  • Feet & Nails
  • The mouth
  • Eye, ear, & nose
  • Self-care Ability
assessment of hygienic practices
Assessment of Hygienic Practices
  • Preferred routine
  • Preferred products
  • Preferred method
  • Dental care
cultural factors
CULTURAL FACTORS
  • Chinese Americans
  • Vietnamese Americans
  • “What would make them feel most comfortable during a bath?”
at risk for hygiene problems
At Risk for Hygiene Problems
  • Oral Problems
  • Skin Problems
  • Foot Problems
  • Eye Care Problems
special considerations
Special Considerations
  • Footwear
  • Eating Patterns
  • Sensory Aids
nursing diagnosis
Nursing Diagnosis
  • Self-care deficit, bathing/hygiene
  • Dentition, altered
  • Fatigue
planning
Planning
  • Individual for each client & each nursing diagnosis
  • Client’s condition influences care plan
  • Plan around client’s schedule, needs
  • Include family
  • Community resources
interventions implementation
Interventions/Implementation
  • Pre-medicate if needed
  • Health promotion
  • Acute & restorative care, e.g.:
    • Bathing & skin care
    • Perineal Care
    • Foot & nail care
    • Oral hygiene
bathing times
Bathing Times
  • Am Care – before breakfast
  • Complete AM Care – after breakfast
  • Afternoon Care - afternoon
  • PM Care – at bedtime, backrub
bathing
Bathing
  • Complete Bed Bath
  • Partial Bed Bath
  • Bag Baths
  • Perineal Care
  • Back Rub
  • Infant
foot nail care
Foot & Nail Care
  • Soaking feet
  • Teach proper technique, inspection
  • High risk clients
    • Diabetes
    • PVD
  • Peripheral neuropathy
  • Vascular insufficiency
peripheral neuropathy
Peripheral neuropathy
  • Muscle wasting
  • Absent DTR’s
  • Foot deformities
  • Abnormal gait
  • Decreased sensation
vascular insufficiency
Vascular insufficiency
  • Decreased hair growth
  • Absent or decreased pulses
  • Infection
  • Shiny skin
  • Blanching on elevation
  • Thickened nails
ada guidelines for foot nail care
ADA Guidelines for Foot & Nail care
  • Inspect & wash daily (check temp)
  • Do not soak
  • Podiatrist to TX corns/calluses
  • Unscented powder
  • File toenails straight across, do not cut
  • Annual foot exam
  • Do not walk barefoot
  • Proper fitting shoes
  • Break in new shoes
  • Exercise regularly
  • Avid hot water bottles
  • TX minor cuts
oral hygiene
Oral Hygiene
  • Brushing 4 x a day
  • Fluoride paste
  • Soft brush
  • Electrical
  • Replace q 3 months
  • Replace after a cold
  • Soft rubber ball on handle
  • Foam rubber brush
  • (Lemon-glycerin swabs not recommended)
  • Rinsing
  • Mouthwash
  • Don’t share brush
  • Don’t drink from bottle
  • Disclosure tabs/drops
  • Flossing 1 x a day
oral care for unconscious clients
Oral Care for Unconscious Clients
  • Mouth care at least q 2 h
  • Assess for aspiration
  • Suction secretions
  • Do not use fingers to hold mouth open
clients with cancer ngt infection diabetes
Clients with Cancer, NGT, Infection & Diabetes
  • Stomatitis (chemo,radiation,NGT, infection)
    • gentle brushing & flossing
    • avoid alcohol, mouthwash, stop smoking
    • NS rinses 4x a day - q 2h
    • Oral analgesic
  • Diabetes- frequent periodontal disease
    • Dentist q 3-4 months
    • good oral hygiene
denture care
Denture Care
  • Remove at night
  • Keep covered in water when not worn
  • Enclosed labeled cup in bedside stand
  • Don’t place in napkin or tissue
hair scalp care
Hair & Scalp Care
  • Brushing & combing
    • preferred hair practices
    • braiding
    • brush in sections
    • Lice
shampooing
Shampooing
  • Shower/bath
  • Shower or tub chair
  • Sink/washbasin
  • Stretcher to shower or sink
  • In bed
  • Dry shampoo
grooming
Grooming
  • Shaving
    • warm washcloth, shaving cream
    • pull skin taught
    • use short, firm strokes in direction of hair growth
    • electric razors if risk for bleeding
  • Mustache & beard
care of eyes
Care of Eyes
  • Clean wet washcloth - no soap
  • Eyeglasses - cool water, soft cloth
  • Contact lenses
    • rigid (hard)
    • soft
    • rigid gas permeable (RGP)
    • daily wear, extended wear, disposable
    • At risk for infection, corneal ulceration
artificial eye prosthesis
Artificial Eye/prosthesis
  • Enucleation
  • Permanent implant or temporary
  • To remove prosthesis:
    • retract lower lip & put pressure below eye
    • or use small bulb syringe or medicine dropper
    • clean with NS, assess socket for infection
  • Replace - retract upper & lower lids
care of ear
Care of Ear
  • End of wet washcloth
  • Gentle downward retraction at entrance to ear canal to remove visible cerumen
  • No sharp objects
  • No cotton tipped applicators
hearing aids
Hearing Aids
  • Three types:
    • in the canal (ITC)
    • in the ear (ITE)
    • behind the ear (BTE)
irrigation of ear
Irrigation of Ear
  • To remove impacted cerumen
  • Glycerin ( 3 gtts) at bedtime
  • H2O2 BID
  • 250ml. Of warm water into ear canal
  • Client sit or lies on side
  • Water pik or bulb syringe
  • Do not occlude canal
care of nose
Care of Nose
  • Teach client to blow nose gently
  • Gentle suctioning
  • Wet washcloth or cotton tipped applicator
  • Only insert cotton tip of applicator
  • NGT or endotracheal tubes through nose
    • change tape QD
    • hold tube & clean & dry nasal surface
maintaining comfort
Maintaining Comfort
  • Temperature
  • Good ventilation
  • Noise level
  • Proper lighting
  • Room equipment
  • Beds/bed making/linens
evaluation
Evaluation
  • Reassess condition of client’s skin
  • Determine if comfort improves
  • Ask client to demonstrate self-care skills
  • Ask client if expectations are being met