1 principles of hygiene. 2 hygiene involves: skin mouth teeth hair nails eyes ears nose perineal...
DESCRIPTION
3 HYGIENE Cleansing by nurse is part of historical giving of care The more ill the patient, the more skill needed in providing the hygiene care Cleansing skin is first line of defence against organisms Mucous membranes and gastric secretions also defendTRANSCRIPT
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PRINCIPLES of HYGIENE
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HYGIENE INVOLVES:
Skin Mouth Teeth Hair Nails
Eyes Ears Nose Perineal Area Feet
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HYGIENE
Cleansing by nurse is part of historical giving of care
The more ill the patient, the more skill needed in providing the hygiene care
Cleansing skin is first line of defence against organisms Mucous membranes and gastric secretions also
defend
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WHY A NURSING FUNCTION? Assessment Teaching Comfort Touch Relaxation Pain Relief Caring
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HYGIENE also includes: Cleansing of patient Bed making Room straightening Emptying garbage Removal of used supplies, dishes, flowers,
newspapers, etc. Assessing patency of and cleansing equipment Placement of necessary supplies
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SOCIOCULTURAL FACTORS It is common to bathe daily; not all cultures do Economics is an influence Different cultures shave different body parts and
hair on head differently Some cultures wear items not to be removed in
bath examples: wigs, head-dressings, amulets, turbans,
religious medals or shawls Male nurse only or female nurse only may be
necessary for some cultures
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KNOWLEDGE LEVEL May need teaching regarding:
Front to back perineal care Brushing gum line, not just teeth Special foot care for circulatory problems Skin inspections by dermatologist
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DEVELOPMENTAL LEVEL:YOUNG CHILDREN
Children can drown in very little water
NEVER LEAVE CHILDREN ALONE DURING BATHING
NEVER ALLOW CHILDREN TO TURN THE TAPS
ALWAYS CHECK TEMPERATURE OF BATH WATER BEFORE PUTTING CHILD IN
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DEVELOPMENTAL ISSUES: CHILDREN
Children may have natural parents, stepparents, four sets of grandparents, all involved in care
For decision making, some cultures must ask father, some must ask grandmother
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DEVELOPMENTAL LEVEL:ADOLESCENTS
Modesty essential Normal clothes, not gowns Involve patients in decision making
when appropriate No tampons in the hospital
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DEVELOPMENTAL LEVEL:OLDER ADULTS Heat insensitivity; can burn easily Foot care Skin very fragile Decreased strength Decreased stamina
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ISSUES YOU MAY FACE Personal space of patient
Undress, examine, wash and groom stranger Incontinence can cause discomfort/embarrassment Sexuality may be an issue
• Take a break if uncomfortable; tell facilitator, preceptor
• Attraction? Ask for patient change
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PATIENT PREFERENCES
Try to involve patient in care If too ill, we must do all Give control over soap, deodorant, mouthwash,
nail length, water temperature Must work within time constraints Be very cautious with delegation of care to others Must carefully assess refusal of bathing; speak to
facilitator, preceptor
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BATH REFUSALWhat is real problem? Power issue? Fatigue? Visitors?Assessment Patient continent? Skin care? Level of exertion?Comfort education and negotiation
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PURPOSE OF NURSE PROVIDED HYGIENE
Remove microorganisms Do physical assessment Improve circulation Improve self image/esteem Provide comfort
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NOSOCOMIAL INFECTION Also called iatrogenic Patient illness brought on simply by being in hospital 4,000,000 cases reported annually. That’s:
76,923 per week 10,958 per day 8 per minute
Statistics from http://aje.oxfordjournals.org/cgi/content/abstract/121/2/159 viewed 8/2/2010
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REDUCING NOSOCOMIAL INFECTION
Hands washed with antiseptic soap or friction or approved alcohol gel
Short fingernails; artificial nails now being banned at a lot of sites
Soiled linen kept off uniform Gloves
If your are going to come into contact with blood or body fluid (e.g.if client has open or draining wound or is incontinent
if nurse has skin breaks on hands No sharing supplies without proper sanitation
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SAFETY Electrical supplies must be checked by
engineering department prior to use hair dryers electric shavers
Bed raised to working height and lowered when finished
Side rails up for patients requiring All spilled water immediately wiped up
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SHAVING
Safety razor not used on certain patients
Those on anticoagulant drugs Those with liver disease causing clotting
disorders Confused patients Suicidal patients
Use electric razor after engineer check
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SAFETY All patients will need attention to water
temperature Patients with impaired level of
consciousness will need special care gentle eye care frequent mouth care proper positioning care to bed linen
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FATIGUE AS A FACTOR Nurse’s job to monitor patient tolerance
Respiratory response Heart rate Can patient tolerate being flat? Do they need
orthopnea position? Confusion level Shower less taxing than bed bath May be easier on patient to be up in chair
than rolled side to side
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TYPES OF HYGIENE Early a.m. care: Urinal/bedpan, wash hands and
face, brush teeth Morning care: After breakfast, complete bath or
shower, hair care, nail care, oral care, back rub, linen change
Afternoon care: straighten linen, offer urinal/bedpan/commode, wash hands/face
Evening care: Elimination, wash hands and face, oral care, linen straightening, back rub
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SKIN
Regulates body temperature First line of defense against harm Antibacterial and antifungal Transmits sensations Signs of problems
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PATIENTS AT RISK FOR SKIN PROBLEMS Altered level of consciousness Altered nutrition Immobility Dehydration Altered sensation Secretions on skin Mechanical devices, casts, restraints Altered venous circulation
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NURSING INTERVENTIONS General health important Intact skin
Caution in movement Don’t over bathe elderly
Protein in diet Avoid periods of moisture
Change frequently Dry carefully (pat do not rub) Rinse off soap well, or use shower gel
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NURSING ASSESSMENT WHILE BATHING Relationship Color and condition of skin Pain on movement Level of consciousness Injuries Scars Skin turgor Weight loss or gain
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SHOWERING Check orders and get report Organize your supplies first Keep covered when moving in hallway Keep heels from dragging on floor Keep curtains/doors closed Dry carefully Include oral care, shampoo, and shave Don’t leave alone in shower
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BED BATH Check orders (schedule; positioning) Check arm band Obtain report on patient Discuss plan with team Check availability of water, linen, hamper, gloves if
needed Organize supplies prior to entering room Assess patient condition
• Does patient need pain medication?• Will any treatments need to be done?
Begin!
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GENERAL PRINCIPLES Nurse safety Patient safety Work within time constraints Allow privacy and dignity
Only body part being washed is uncovered Curtain is closed
Change water, washcloths, towels, linen as needed
Call bell available
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PERINEAL CARE Professionalism always Not deferred in cases needing nursing assessment Female
Always wipe front to back (urethra to rectum) Often have menses in hospital
• Use peripads - tampons are not ideal in hospital If large breasts, need to dry underneath carefully, may
use powders to keep area dry Male
Assess for circumcision• If not, cleanse under foreskin and replace
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BACK RUB Purpose
Relaxation Circulation Pain relief
Assess skin integrity on back Assess all bony prominences Always done as part of good nursing care
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FOOT CARE Soak feet as part of bath Clean toes and toenails Teach as you go Range of motion of legs Feet of diabetic patients and patients with
vascular disease are inspected carefully; Never cut toenails of these patients
Many facilities have podiatrist visits
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NAIL CARE
Observe circulation; color, capillary refill time
Observe color, sensation, and movement (CSM)
Assess for rings too tight or too loose
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MOUTH CARE
Examine with gloves and light Use only water soluble lubricants Unconscious patient has no gag reflex,
position on side for care May have accumulated debris in mouth
called sordes Teach about brushing and flossing
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CARE OF DENTURES Assess for fit - loose, causing ulcers If removed, keep in covered cup with
water Label cup with patient’s name Keep in bedside table Pad sink when cleaning (they break when
dropped - trust me, I know!!) Use cool water
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HAIR CARE
Hair is combed daily and shampooed as required (prn)
Both wet and dry shampoo available Send to operating room or surgical
procedure room with clean hair and body hair shaven when applicable
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EYE CARE Contact lenses usually stored in saline
liquid; case labeled Also label and safeguard glasses in
drawer Clean inner to outer canthus Never use cotton near eyes Treat each eye separately Eyes considered sterile
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EARS
Allow nothing sharp in ears Hearing aids now miniscule in size
– don’t lose! Label case Speak directly to patient’s face if
hard of hearing
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BEDBATH
Wash head to toe, front to back Physical assessment as you are washing;
must also loosen and secure lines as moving and turning patient
Change washcloths for different areas Change water if cold or soiled or very soapy Some put oil in bath water of elderly
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BEDBATH Change linen as needed Do range of motion as needed Do oral care, hair care, and give back
rub Leave bed in low position, rails up,
and call bell in place. Straighten room. Report and chart findings
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ASSESSING TUBES AND LINES Oxygen – stays on during bath, check
connections, litres per minute, cleanliness of prongs or mask, water if humidified etc
IV lines – look at IV site, rate and solution
Urinary catheter – draining, unkinked, bag below bladder
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ASSESSING TUBES AND LINES
Enteral tubes – in place, running or draining properly, or clamped properly
Dressings – Clean and dry, drains properly working
Does anything need to be emptied, changed or cleaned?
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BEDMAKING Make bed for patient comfort If incontinent, wash, rinse, dry and change
linen Use aids to relieve pressure points
heel, elbow protectors bed frame with trapeze frame to keep covers off feet special beds and mattresses
Position as ordered
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NURSE SAFETY IN BEDMAKING
Raise bed to working height Face patient Bend knees Conserve steps Don’t lift alone Side rails as ordered Lower bed and place call bell when
leaving
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CHARTING How patient tolerated bath Any unusual findings What was done about findings Comparative progress Nursing care plan updated?