CHAPTER 17 Hygiene All items and derived items

CHAPTER 17 Hygiene All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved.

Hygiene ■ Hygiene promotes comfort, safety, and health. ■ Intact skin: – Is the body’s first line of defense against disease – Prevents microbes from entering the body and causing an infection ■ Good hygiene: – Cleanses the body – Prevents body and breath odors – Is relaxing and increases circulation All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 2

Factors That Affect Hygiene ■ Culture and personal choice affect hygiene. ■ Many factors affect hygiene needs—perspiration, elimination, vomiting, drainage from wounds or body openings, bedrest, and activity. ■ The nurse uses the nursing process to meet the person’s hygiene needs. – Follow the nurse’s directions and the care plan. ■ Some older persons resist your efforts to assist with hygiene. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 3

Daily Care ■ You must: – Assist with hygiene whenever it is needed. – Protect the person’s right to privacy and to personal choice. ■ Daily care is given at these times: – Before breakfast (early morning care, or AM care) – After breakfast (morning care) – Afternoon care – Evening care (PM care) All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 4

Oral Hygiene ■ Oral hygiene (mouth care) does the following: – Keeps the mouth and teeth clean – Prevents mouth odors and infections – Increases comfort – Makes food taste better – Reduces the risk for cavities (dental caries) and periodontal disease All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 5

Oral Hygiene (Cont’d) ■ Flossing: – Removes plaque and tartar from the teeth ■ Plaque is a thin film that sticks to teeth and causes tooth decay (cavities). When plaque hardens, it is called tartar. Tartar builds up at the gum line and causes periodontal disease. – Removes food from between the teeth – Is usually done after brushing – You need to floss for persons who cannot do so themselves. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 6

Oral Hygiene (Cont’d) ■ Most people perform oral hygiene themselves. ■ You may need to brush the teeth for persons who: – Are very weak – Cannot move or use their arms – Are too confused to brush their teeth ■ Some people need help gathering and setting up equipment. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 7

Oral Hygiene Supplies • A toothbrush, toothpaste, dental floss, and mouthwash are needed. • Persons with dentures need a denture cleaner, denture cup, and denture brush or toothbrush. Use only denture cleaning products to avoid damaging dentures. • Sponge swabs are used for persons with sore, tender mouths and for unconscious persons. • You also need a kidney basin, water glass or cup, straw, tissues, towels, and gloves. Many persons bring oral hygiene equipment from home. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 8

Oral Hygiene for the Unconscious Person ■ Mouth care for the unconscious person – The care plan tells you what cleaning agent to use. – Protect unconscious persons from choking and aspiration. – Keep the person’s mouth open with a padded tongue blade. – Always assume that unconscious persons can hear. – Mouth care is given at least every 2 hours. – Follow the nurse’s directions and the care plan. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 9

Dentures ■ Denture care – Mouth care is given and dentures cleaned as often as natural teeth. – Dentures are slippery when wet. – Dentures easily break or chip if dropped onto a hard surface. – To use a cleaning agent, follow the manufacturer’s instructions. – Hot water causes dentures to lose their shape (warp). – Remind residents not to wrap dentures in tissues or napkins. – You clean dentures for those who cannot do so. Many people clean their own dentures. Some need help All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 10

Bathing ■ Bathing does the following: – It cleans the skin. – It cleans the mucous membranes of the genital and anal areas. – It is refreshing and relaxing. – Circulation is stimulated and body parts are exercised. – Observations are made. – You have time to talk to the person. ■ Complete or partial baths, tub baths, or showers are given. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 11

Bathing Factors ■ The bathing method depends on: – The person’s condition – Self-care abilities – Personal choice ■ Bathing frequency is a personal matter. ■ Older persons usually need a complete bath or shower twice a week. ■ Dry skin occurs with aging and is easily damaged. Soap also dries the skin. ■ Bathing procedures can threaten persons with dementia. ■ The complete bed bath involves washing the person’s entire body in bed. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 12

Towel, Bag, and Partial Baths ■ Towel baths – The nurse and care plan tell you when to use a towel bath. – To give a towel bath, follow center policy. ■ Bag baths – Use a new washcloth for each body part. – Let the skin air-dry. You do not need towels. ■ The partial bath involves bathing the face, hands, axillae, back, buttocks, and perineal area. – You give partial baths to persons who cannot bathe themselves. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 13

Tubs and Showers ■ Tub baths and showers – Falls, burns, and chilling from water are risks. – Safety is important. – The person’s privacy must be protected. ■ A tub bath can make a person feel faint, weak, or tired. – These are great risks for persons who are on bedrest. – A tub bath lasts no longer than 20 minutes. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 14

The Back Massage ■ Back massages (back rubs): – Relax muscles and stimulate circulation – Are given after the bath and with evening care – Can be given after repositioning or to help the person relax – Last 3 to 5 minutes ■ Be sure to request a person’s consent before performing a back massage. ■ Observe the skin before the massage. ■ Lotion reduces friction during the massage. – Lotion is warmed before being applied. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 15

Perineal Care ■ Perineal care (pericare) involves cleaning the genital and anal areas. These areas provide a warm, moist, and dark place for microbes to grow. ■ Cleaning prevents infection and odors, and it promotes comfort. ■ Perineal care is done: – Daily during the bath – Whenever the area is soiled with urine or feces ■ The person does perineal care if able. – Otherwise, it is given by the nursing staff All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 16

Basics of Perineal Care ■ Standard Precautions, medical asepsis, and the Bloodborne Pathogen Standard are followed. – Work from the cleanest area to the dirtiest. ■ The perineal area is delicate and easily injured. – Use warm water, not hot. – Rinse thoroughly. – Pat dry after rinsing. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 17

Reporting and Recording ■ You make many observations while assisting with hygiene. ■ Report and record the care given. – If care is not recorded, it is assumed that care was not given. All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 18

Quality of Life ■ Provide hygiene in a way that maintains or improves the person’s quality of life, health, and safety. ■ Protect the person’s rights when giving care. – Residents have the right to ■ Privacy and personal choice ■ Freedom from restraint ■ Keep and use personal items All items and derived items © 2015, 2011 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 19