kebersihan diri.ppt
TRANSCRIPT
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CURRICULUM VITAE Name : Tina Handayani Nasution Place of Birth : Tanjungpandan Belitung Marital Status : Married Address : Jl. MT Haryono, Gg. 6,
No.868, Dinoyo, Malang Mobile Phone : 081334395093
E-mail :[email protected] Lulusan : FIK UI Tahun 2004
mailto:[email protected]:[email protected] -
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Personal ygieneBy :
Ns. Tina HandayaniNasution, S.Kep
Jurusan KeperawatanFakultas Kedokteran Universitas Brawijaya
April 2010
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What is it???
Hygiene : Health
Personal hygiene :the self caremeasures people useto maintain theirhealth
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PURPOSE OF NURSEPROVIDED HYGIENE
Removemicroorganisms
Do physicalassessment
Increase circulation Distal to proximal Return to heart
Improve self image Provide comfort
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Factor AffectingPersonal Hygiene
???
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Continue Male relative may not allow male
nurse alone with woman patient
Autonomy of patient is paramount;in others, family makes decisions forcare
Level of education Nurse accepts all who lovingly
participate
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2. KNOWLEDGE
May need teaching regarding: Front to back perineal care Special foot care for circulatory
problems Skin inspections by dermatologist
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3. DEVELOPMENTAL LEVELNEWBORNS
Do not place underrunning faucet
Do not submergeuntil umbilical corddrops off
Dry carefully,especially the head
Place cap after bath
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YOUNG CHILDREN Children can drown in 2 inches
of water; never leave alone
during bathing No milk or juice bottles in bed Wipe off teeth after eating and
before sleep Demonstrate on teddy bear
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CHILDREN Children may have
natural parents,stepparents, four sets
of grandparents For decision making,
some cultures mustask father, somemust askgrandmother
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ADOLESCENTS Modesty essential Normal clothes, not
gowns Bed pans notacceptable
Allow decisionmaking
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OLDER ADULTS
Heat insensitivity;can burn easily
Foot care
Skin very fragile
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5. Physical Condition Patient receiving chemotherapy
Patient receiving radiation therapy
Unconscious patient
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Hygiene Care Schedule Early morning 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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HYGIENE includes: Care of the skin Care of the feet and
nails
Oral hygiene Hair care Care of the eyes, ears,
and nose Clients room
environment
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1. Care of Skin
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SKIN Regulates body temperature First line of defense against harm
Antibacterial and antifungal Transmits sensations Signs of problems
Redness Wet or damp Not intact
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PATIENTS AT RISK FOR SKINPROBLEMS
Altered level of consciousness Altered nutrition
Immobility Dehydration Altered sensation Secretions on skin Mechanical devices, restraints Altered venous circulation
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Nursing Diagnosis Impaired skin integrity related to
immobilization, exposure to chemical
irritants Hygiene self care deficit : bathing related
to pain in hands, forced immobilization,musculoskeletal weakness
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NURSING INTERVENTIONS Goals :
- Client will have intact skin- Client will be free of odors
Expected outcomes :- Skin will be without redness- Skin will be warm, soft, smooth, and
well hydrated- Odors will be reduced or eliminated
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Continue Intervention :
Bathe client daily
Dry skin thoroughlyafter each cleansing
Apply lotion to skinafter bathing
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NURSING ASSESSMENTWHILE BATHING
Color and condition ofskin
Pain on movement Level of consciousness Injuries Scars Skin turgor Weight loss or gain
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2. PERINEAL CARE Professionalism always Female
Always sterile to contaminated (urethra torectum) Male
Assess for circumcision If not, cleanse under foreskin and replace
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3. Care of the feet and nails
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Common Foot Nail ProblemsCallus (kulit tebal)Warts (kutil)Ingrown nails (tdktumbuh nyeri)Rams horn nails(tumbuh lambat,dasar kuku rusak)Paronychia (radangjaringan)Foot odors
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Nursing Diagnosis Pain related to callus formation, ingrown
toenails
Impaired physical mobility related to painfulfoot lesion
Impaired skin integrity related to impropernail-cutting practices, friction of shoes, injuryto nail
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FOOT CARE Soak feet as part of bath Clean toes and toenails
Range of motion of legs Feet of diabetic patients and patients
with vascular disease are inspected
carefully; Never cut toenails of thesepatients
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NAIL CARE Observe circulation; color, capillary
refill time
Observe color, sensation, andmovement (CSM) Cut nails straight across and file
smooth; Do not go down into corners Assess for rings too tight or too loose
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4. Oral hygiene
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Oral HygieneCommon oral problems :
Dental caries (radang gigi)
Periodontal diseases (gusi berdarah ataubengkak)
Nursing Diagnosis :Altered oral mucous membrane related toradiation of oral cavity
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MOUTH CARE
Examine with gloves and light,especially smokers
Use only water soluble lubricants Unconscious patient has no gagreflex, position on side for care
Teach about brushing and flossing
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5. Hair care
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Nursing Diagnosis Impaired skin integrity related to scalp
laceration Pain related to scalp lesion, accumulated
secretions in hair Body image disturbance related to
unkempt physical appearance
Risk for infection related to scalplaceration
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6. Care of the eyes, ears, and nose
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Nursing Diagnosis Sensory perceptual alterations (visual,
auditory, or olfactory) related toobstruction in ear canal, nasalobstruction, inflammation of eyes orlocal eye infection
Risk injury related to decrease of visual,auditory, or olfactory function
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EYE CARE Contact lenses usually removed Stored in saline liquid; case labeled Also label and safeguard glasses in drawer Clean inner to outer canthus Patient must be able to blink to protect cornea 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
dont lose Label case Cerumen in ears may need softeningand removing
Speak directly to patients face
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Clients room environment
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BEDMAKING
Make bed for patientcomfort
If incontinent, wash,rinse, dry, changelinen
Position as ordered
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NURSE SAFETY INBEDMAKING
Raise bed to workingheight
Face patient
Bend knees Conserve steps Dont lift alone
Side rails as ordered Lower bed and placecall bell when leaving
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Any Questions ???