Review

• Reduce infection, removes pathogens, helps make them comfortable. Pay attention to cultural needs.
• Assessing skin/body. this is why we turn paitent’s bc of skin/breathing. Called pulomonary cleansing- to prevent pneuomonia.
HYGIENE
• Personal hygiene affects patients’ comfort, safety, and well-being.
• When ill, people may need self-care assistance
• Personal, social, and cultural factors influence hygiene practices.
• Integrate other nursing activities during hygiene care (assessment, ROM, dressings changes.
• Preserve as much of patient’s independence as possible
• Ensure privacy & convey respect
Skin Function
• Sensation: skin contains sensory organs for touch, pain, heat, cold, and pressure.
• Heat (temp) regulation: radiation, evaporation, conduction, and convection control body temperature.
• Absorption (book doesn’t list this one) – topical medications
• Protection: prevents entrance of microorganisms; sebum removes bacteria from hair follicles; acidic pH of skin slows bacterial growth
• Dryness = cracks (moisturize skin)
• Moisture (sweat) causes maceration – keep linens smooth & dry
• Alkaline soap disrupts pH
• Excretion: sweat promotes heat loss by evaporation.
• Secretion: sebum lubricates skin and hair, slows water loss, antibacterial
• Vitamin D synthesis (not in book)
THE SKIN
• Two layers
• The epidermis:
• Shields underlying tissues against water loss and injury
• Prevents entry of disease-producing microorganisms
• Generates new cells to replace the dead cells that are continuously shed from the outer surface of the skin.
• The dermis:
• Provides support for the epidermis
• Contains nerve fibers, blood vessels, sebaceous & sweat glands, and hair follicles.
• Subcutaneous tissue:
• Heat insulator
• Supports upper skin layers to withstand stresses and pressure
• Anchors the skin loosely to underlying structures (muscle).
• The skin reflects change in person’s physical condition (color, thickness, texture, turgor, temperature, moisture)
• Hygiene influences skin status, both beneficial and negative effects
FEET, HANDS, & NAILS
• Require special attention to prevent infection, odor and injury.
• The condition of patient’s hands and feet influences ability to perform hygiene care.
• Without the ability to bear weight, ambulate, or manipulate the hands a patient at risk for losing self-care ability.
• A normal healthy nail appears transparent, smooth, and convex, with a pink nail bed and translucent white tip
• Nails:
• Grow from root of nail bed, hidden by cuticle
• Inadequate nutrition and disease can cause changes in shape, thickness, and curvature of the nail.
ORAL CAVITY & TEETH
• The oral cavity: lips, cheeks, tongue and its muscles, hard & soft palates.
• The effects of medications, exposure to radiation, dehydration, mouth breathing may impair salivary secretion
• Difficulty in chewing develops when gums surrounding teeth become inflamed or infected or when teeth are lost or become loosened.
• Normal oral mucosa glistens and is pink, soft, moist, smooth, and without lesions.
• Saliva cleanses mouth, dissolves food chemicals to promote taste, moistens food to facilitate bolus formation, contains enzymes that start
breakdown of starch
• Healthy teeth appear white, smooth, shiny, and aligned.
• Regular oral hygiene helps to prevent gingivitis and dental caries
• Affect of oral cavity on nutrition?
EYES, EARS, NOSE, & THROAT
• When hygiene care is provided, eyes, ears, and nose require careful attention.
• Clean sensitive sensory tissues in a way that prevents injury and discomfort (take care not get soap in eyes)
• Patients sensory often need help to meet hygiene needs.
• Specialized glands in the auditory canal secrete cerumen (traps foreign bodies, repels insects) can build up and become impacted.
• The eyes secrete tears (contain substances that cleanse and lubricate eye, protect from bacteria).
• During hygiene: excellent opportunity to ask if any changes in vision, hearing, or sense of smell are occurring.
NURSING KNOWLEDGE BASE
• Individualize hygiene care
• Use communication skills to promote the therapeutic relationship.
• Use this time to convey caring
• Complete assessment & determine patient needs.
• Patient care individualized on basis of unique hygiene practices and preferences.
• Personal hygiene activities promote comfort, foster a positive self-image, and help prevent infection and disease.

FACTORS INFLUENCING HYGIENE

 • Patients with limitations or disabilities associated with disease and injury often lack the physical energy and dexterity to perform hygiene self-
care safely.
• Sensory deficits alter ability to perform care & place at risk for injury (inability to feel water is hot)
• Chronic illnesses may exhaust patient
• Pain limits motion; analgesics may sedate (fall risk)
• A person’s economic resources influence the type and extent of hygiene practices used. Be sensitive to the patient’s situation. May not afford
deodorant, shampoo, toothpaste
• Developmental stage affects ability to perform hygiene care; cognitive impairment may be unaware of hygiene needs.
• Dementia: fearful & agitated during care
• Safe and effective patient-centered nursing care elicits individual preferences, promotes patient involvement and independence.
• People from diverse cultural backgrounds follow different self-care practices.
• Do not force changes in hygiene practices unless the practices affect a patient’s health - be tactful
QUICK QUIZ
1. The nurse is caring for a non–English-speaking male patient. How should the nurse assist him with personal hygiene?
A. Use soap and water on all types of skin.
B. Ensure that culture and ethnicity influence hygiene practices.
C. Shave facial hair to make the patient more comfortable.
D. Know that all patients need to be bathed daily.
ASSESS:
• Skin: note color, texture, thickness, turgor, temperature, and hydration.
• Attentive to problems influenced by hygiene measures & alterations caused by condition.
• Examine surfaces of feet, including between toes and entire sole of foot.
• Before performing hygiene care, assess the condition of the hair and scalp
• Proper technique for cleaning artificial eye & hearing aids
• For patients who wear eyeglasses, contact lenses, artificial eyes, or hearing aids, assess knowledge regarding methods used to care for the
aids.
• Older adults: observe for xerosis (abnormal dryness of the skin) and skin tears (traumatic wounds in which the epidermis separates from the
dermis).
• Older adults may not have strength, dexterity, or vision to care for feet.
• Nails – hard, brittle – may need podiatrist to cut (diabetic)
• Calluses, bunions, hammertoe – painful
• As age gums lose vascularity & elasticity – dentures may not fit
•
GINGIVITIS, THRUSH, ORAL CANCER
DRY SKIN
• Flaky, rough texture on exposed areas
• Skin may become infected if epidermal layer cracks.
• Bathing daily for limited time (10 minutes or less) can help with hydration.
• To minimize drying use warm water and superfatted soap (e.g., Dove) for cleansing.
• Rinse body of all soap well (residue can cause irritation and breakdown).
• Increase fluid intake when skin is dry.
• Use moisturizing lotion to aid healing process & form protective barrier to help maintain fluid within skin.
SKIN RASHES
• Skin eruption may result from overexposure to sun or moisture or from allergic reaction
• Appears flat or raised, localized or systemic, pruritic or nonpruritic
• If patient scratches, inflammation & infection occur.
• Wash thoroughly and apply antiseptic spray or lotion to prevent further itching and aid healing process.
• Warm or cold soaks may relieve inflammation and promote comfort.
CONTACT DERMATITIS (bath should be with tepid water)
• Inflammation of skin; abrupt onset (erythema, pruritus, pain, appearance of scaly, oozing lesions
• Seen on face, neck, hands, forearms, trunk, genitalia
• Often difficult to eliminate because person usually in continual contact with substance causing skin reaction.
• Substance is sometimes hard to identify.
• Identify and avoid contributing agents
• Treatment: remove contributing agent and apply OTC topical steroids or calamine lotion.
• Prescription steroids may be ordered.
ABRASION
• Scraping or rubbing away of epidermis; results in localized bleeding and weeping of serous fluid
• Predisposed to infection
• Be careful not to scratch patients with your jewelry or fingernails.
• Wash abrasions with mild soap and water.
• Dressing or bandage could increase risk for infection because of retained moisture.
CALLUS (Use of orthotic devices (e.g., foam insoles, metatarsal pads, and various cushioning devices) redistributes weight and pressure away from
callused area.
• Thickened portion of epidermis, consisting of mass of horny, keratotic cells; usually flat and painless
• Found on undersurface of foot or palm of hand; caused by local friction or pressure
• Can cause discomfort when walking
• Soak in warm water and Epsom salts to soften
• Contraindicated in patients with diabetes and peripheral vascular disease.
• Use pumice stone to remove callus after softens.
 • Apply creams or lotions to reduce recurrence.
CORN
• Keratosis caused by friction and pressure over bony prominence; usually cone shaped, round, and raised; with painful core
• Tissue attaches to bone if allowed to grow.
• Pain may alter gait
• Surgical removal is sometimes necessary, depending on location and severity of pain and size of corn.
• Use oval corn pads carefully because they increase pressure on toes and reduce circulation.
• Do not use corn pads for patients with diabetes or impaired circulation.
PLANTAR WARTS
• Fungating lesion that appears on sole of foot; caused by papillomavirus
• Sometimes contagious
• Painful and make walking difficult.
• Treatment ordered by HCP: topical applications of acids, cryotherapy, or laser therapy.
• Wart = veruca
TINEA PEDIS
• Fungal infection of foot
• Scaliness and cracking of skin between toes and on soles of feet; small blisters containing fluid
• Can spread to other body parts, especially hands.
• Contagious and frequently recurs.
• Make sure that feet are well ventilated.
• Drying feet well after bathing and applying powder help prevent infection.
• Clean socks or stockings reduces incidence.
• HCP may order griseofulvin, miconazole nitrate, or tolnaftate.
PEDICULOSIS CORPORIS
• Pediculosis corporis (body lice)
• Cling to clothing, difficult to see
• Suck blood & lay eggs on clothing and furniture
• Patient itches constantly; scratches on skin become infected; hemorrhagic spots appear on skin where lice are sucking blood.
• Have patient bathe or shower thoroughly; after drying skin, apply lotion for eliminating lice; after 12 to 24 hours have patient take another
bath or shower; bag infested clothing or linen until laundered.
PEDICULOSIS PUBIS
• Found in pubic hair
• Grayish-white with red legs
• Spread through bed linen, clothing, furniture, or sexual contact.
• Shave hair off affected areas; cleanse as for body lice
• If lice were sexually transmitted, patient needs to notify partner.
INGROWN TOENAIL
• Toenail or fingernail growing inward into soft tissue around nail; results from improper nail trimming, poor shoe fit, or heredity
• Cause localized pain with pressure; some become infected.
• Treatment: frequent warm soaks in antiseptic solution and removal of portion of nail that has grown into skin.
• May need podiatry
PARONYCHIA
• Inflammation of tissue surrounding nail after hangnail or other injury
• Common in people who frequently have their hands in water or in patients with diabetes
• Area sometimes becomes infected.
• Treatment: warm compresses or soaks (contraindicated with diabetes) and local application of antibiotic ointments.
TOENAIL FUNGUS
• Results from excess moisture, use of artificial nails
• Infection requires treatment with fungicide.
• Wear clean, dry footwear
CLUBBING OF NAILS
• Change in the structure of fingernails or toenails in which the finger and nail takes on the appearance of an upside-down spoon, and become
red and sponge-like.
• Possible causes: lung diseases, heart disease, and digestive tract conditions
HAIR (Consider ethnic hair variations.
• Growth, distribution, and pattern indicate general health status.
• Hormonal changes, altered nutrition, emotional and physical stress, aging, infection, and certain illnesses can affect hair characteristics.
• Sun, chemicals, hair products, permanents, and straightening and coloring agents can also affect the hair.
ASSESS HAIR
 If you suspect pediculosis capitis, use gloves or tongue blades to inspect the patient’s hair.
 Alopecia present with many disorders – report if not previously noted.
 Lice:
 Check hair for nits and comb with a nit comb for 2 to 3 days until all lice and nits have been removed.
 Caution against use of products containing lindane because the ingredient is a neurotoxin known to cause adverse reactions
 Vacuum infested areas of home and car
TICKS
• Small gray-brown parasites that burrow into skin and suck blood
• May transmit Rocky Mountain spotted fever, Lyme disease, and tularemia.
• Using fine-tipped tweezers, grasp tick as close to surface of skin as possible and pull upward with steady, even pressure. Hold until tick pulls
out, usually for about 3-4 minutes.
 • Avoid twisting or jerking (can cause mouth parts to break off)
• After removing the tick, clean the area and perform hand hygiene.
• If rash or fever develops within next several weeks see HCP, (inform of recent tick bite)
RISK FOR HYGIENE PROBLEMS (Diabetes: Prone to dryness of mouth, gingivitis, periodontal disease, and loss of teeth)
• Lack dexterity
• Dehydrated, NPO, unable to eat
• Presence of NG tube or O2
• On chemotherapy or radiation: kills rapidly multiplying cells (includes cells of oral cavity)
• On broad-spectrum antibiotics (destroys normal flora, opportunistic infections)
• Meds or diseases that alter blood clotting
• Cardiovascular disease: linked to periodontal disease
AT RISK FOR SKIN PROBLEMS
• Immobile
• Reduced skin sensation (stroke, spinal cord injury, diabetes, nerve damage)
• Limited protein or caloric intake
• Excess perspiration or drainage on skin
• Cast or restraints
• Vascular insufficiency
ORAL CARE
• Oral hygiene
• Brushing removes particles, plaque, & bacteria; massages the gums; relieves unpleasant odors & tastes.
• Flossing removes tartar at the gum line.
• Rinsing removes particles and excess toothpaste.
• Patients with artificial airways or unconscious may not have gag reflex
• On chemotherapy, immunosuppressive agents, head or neck radiation therapy susceptible to mucositis
• Some patients require oral hygiene as often as every 1 to 2 hours.
• Mucositis causes burning, pain, and a change in a person’s food and fluid tolerance.
• If in bed – on side, HOB elevated (if permitted)
CARE OF DENTURES
• Patient’s personal property
• Need to be handled with care because they break easily
• Brush at least once daily with denture cleanser and a denture brush
• Avoid stiff-bristled brushes, strong cleansers, or regular toothpaste.
• Toothpastes with whitening agents are particularly abrasive and should not be used on dentures.
• Store in label cup at bedside
• Do not place in napkin or tissue – could be thrown away
• Put towel in sink when cleaning, won’t break if drop
• See text for proper technique in removing dentures from mouth
TYPES OF BATHS
• Complete bed bath: administered to totally dependent patient in bed.
• Cleansing patients’ genital, anal areas = perineal care.
• Part of complete bed bath & performed at additional times as needed. Encourage to do themselves if able.
• Partial bed bath: bathing only body parts that would cause discomfort if left unbathed (hands, face, axillae, and perineal area; includes
washing back and providing a backrub.
• Sponge bath at the sink: patient sitting in a chair, able to perform part of the bath independently. You help patient with hard-to-reach areas.
• Tub bath: Involves immersion in a tub of water that allows more thorough washing and rinsing than a bed bath. Some institutions have tubs
equipped with lifting devices
• Most facilities use no rinse disposable cleaning cloths. Bath basins – bacterial contaminants – increased HAI
• Shower: Patient sits or stands under a continuous stream of water. The shower provides more thorough cleansing than a bed bath but can be
fatiguing.
• Bag bath/travel bath: soft, nonwoven cotton cloths, premoistened in no-rinse surfactant cleanser and emollient.
BATH GUIDELINES
• Provide privacy. Close the door & pull room curtains around the bathing area.
• Expose only the areas being bathed by using proper draping.
• Maintain safety. Keep side rails up and the bed in low position when away from the bedside.
• Protect patients from injury by assessing and controlling the bath water temperature.
• Use assistive devices such as bath chairs when indicated.
• Maintain warmth and comfort. Keep room warm to prevent chilling. Control drafts and keep windows closed.
• Cover your patient, exposing only the body part being washed.
• Promote independence. Encourage your patient to participate with bathing as much as he or she is able.
• Anticipate needs. Implement actions to address a patient’s pain or nausea relief before hygiene care.
• Currently health care–associated infections (HAIs) loom as one of the most common adverse events occurring during hospitalization,
• Large financial burden (prolonged hospitalization, high incidence of fatalities).
• High rate of central line–associated bloodstream infections (mortality of up to 25%), studies to test the effect of daily bathing
with impregnated Hibiclens
BACKRUB (Contraindications to a massage such as spinal cord injury, rib fractures, or other painful conditions.)
• A backrub:
• Promotes relaxation, relieves muscular tension, and decreases pain perception
• May reduce anxiety, heart rate, respiratory rate
• Improves physiological and psychological indicators of relaxation in older adults
 • Before initiating a backrub:
• Assess patient preferences.
• Consult record for any contraindications.
CARE OF EYES, EARS, NOSE
• Basic eye care
• Eyeglasses
• Contact lenses
• Ear care
• Nasal care
• Cleaning the eyes involves simply washing with a clean washcloth moistened in water from inner canthus to outer
• Because of the cost, be careful when cleaning glasses, and protect them from breakage or other damage when they are not worn.
• Care of contact lenses includes proper cleaning, insertion and removal, and storage.
• Routine ear care involves cleaning the ear with the end of a moistened washcloth rotated gently into the ear canal. No q-tips
• Irrigation requires a health care provider’s order.
• If the patient is unable to remove nasal secretions, help by using wet washcloth or a cotton-tipped applicator moistened in water or saline or
by gentle suctioning.
• When nasogastric, feeding, or endotracheal tubes are inserted through a patient’s nose, change the tape anchoring the tube at least once a
day.
NAIL AND FOOT CARE
• Soaking
• Cleaning
• Drying
• Nail trimming
• Diabetic considerations
• Risk factors
• Soak to soften cuticles and layers of horny cells (unless diabetic or pvd); thorough cleaning, drying
• Clip nails straight across - need a HCP’s order to trim toenails.
• Provide foot and nail care in bed for an immobilized patient or have the patient sit in a chair.
• Increased risk for amputation: uncontrolled diabetes, peripheral neuropathy, limited joint mobility, bony deformity, peripheral vascular
disease, history of skin ulcers or previous amputation.
HAIR CARE
• Brushing and combing
• Shampooing
• Shaving
• Mustache and beard care
• Long hair easily matted when patient confined to bed, even for a short period.
• When lacerations or incisions involve scalp, blood and topical medications also cause tangling.
• Braiding helps to avoid repeated tangles. Ask permission before braiding
• Shave facial hair after a bath or shampoo. Use electric if on anticoagulants or diabetic
• Mustaches or beards require daily grooming.
• Frequency of shampooing depends on a person’s daily routines and the condition of the hair.
• HCP order to shampoo hair of patients with neck injuries. Dry shampoo products and shampoo in a cap.
• Another option is to wash a patient’s hair in the bed.
• Equipment: Bath towels (two or more), washcloths, shampoo, water pitcher and warm water supply, shampoo trough, wash basin, bath
blanket, waterproof pad, clean comb and brush, hair dryer
QUICK QUIZ
2. A young girl with long hair is experiencing a problem with matting. What would be the most appropriate action to take?
A. Cutting the matted hair away.
B. Braiding the hair to reduce tangles.
C. Using a grease-type product to tame the hair.
D. Keeping the hair oil free by applying powder every morning.
ROOM ENVIRONMENT
• Maintaining comfort
• Temperature, noise, lighting, ventilation, odors
• Basic room equipment
• Over-bed table, bedside stand, chairs, lamp, and bed
• Keeping the room neat and orderly contributes to the patient’s sense of well-being.
• Control room temperature, ventilation, noise, and odors.
• What are some sources of unpleasant odors in patient rooms? How can they be managed?
• Draining wounds, emesis, bowel movements, and used bedpans and urinals.
• Clean the top of the over-bed table with an antiseptic cleaner before using it for meals.
• Do not place the bed pan or urinal on the over-bed table.
•
ROOM ENVIRONMENT
• Beds
• Features: raising, adjusting, side rails
• Clean, comfortable, and safe
• Bed making
• Occupied
• Unoccupied
 • Surgical, recovery, postoperative
• Use different bed positions to promote patient comfort, minimize symptoms, promote lung expansion, and improve access during
procedures.
• All beds contain safety features:
• Lock wheels when a bed is stationary to prevent accidental movement.
• Side rails allow patients to move more efficiently in bed and prevent accidents.
• Do not use side rails to restrict a patient from moving in bed.
• When using side rails as a restraint, you need a health care provider’s order.
• Make sure that linen is clean, dry, and free of wrinkles.
When changing bed linen, keep soiled linen away from your uniform.
• Place soiled linen in linen bags before placing in the linen hamper - do not place soiled linen or linen bags on the floor
• Never shake linen.
• Once you bring linen into a patient’s room, even if the linen is not used, it must be laundered before being used by another
patient.
• Always raise the bed to the appropriate height before changing linen
• Move back and forth to opposite sides of the bed while applying new linen.
• Body mechanics, safe handling important when turning or repositioning the patient in bed.
• Use side rails to aid positioning & turning, keep call lights within reach
• After making a bed, return it to the lowest horizontal position
BED POSITIONS
• Fowler’s
• Semi-Fowler’s
• Trendelenburg’s
• Reverse Trendelenburg’s
• Flat
SAFETY GUIDELINES
• To reduce the risk of infection always perform hygiene measures moving from cleanest to less clean or dirty areas.
• May require changing gloves and performing hand hygiene during care activities.
• Use clean gloves when anticipate contact with nonintact skin or mucous membranes or when there is or may likely be contact with drainage,
secretions, excretions, or blood during hygiene care.
SAFETY GUIDELINES
• When using water or solutions, be sure to test the temperature to prevent burn injury.
• To avoid injury, use principles of body mechanics and safe patient handling.
• Remember that you are responsible and accountable for assessing and evaluating a patient both before and after care to detect unexpected
outcomes and give proper direction to UAP when delegating hygiene care.
SIGNS OF NEUROPATHY OR VASCULAR INSUFFICIENCY
• Peripheral Neuropathy
•Muscle wasting of lower extremities
•Foot deformities
•Soft tissue infection of lower extremities
•Abnormal gait
•Decreased or absent vibratory, touch, temperature, or painful stimuli
• Vascular Insufficiency
•Decreased hair growth on legs and feet
•Absent or decreased pulses
•Infection of the foot
•Poor wound healing
•Thickened nails
•Shiny appearance of the skin
•Blanching of the skin on elevation