Chapter 40 Hygiene Copyright 2017 Elsevier Inc All

Scientific Knowledge Base Apply knowledge of pathophysiology to provide preventive hygiene care. Recognize disease

Case Study Mrs. Winkler is a 58 -year-old white woman admitted recently to an

The Skin Functions include Ø Protection, secretion, excretion, temperature regulation, and sensation Primary layers

The Feet, Hands, and Nails Feet, hands, and nails require special attention to prevent

The Oral Cavity The oral cavity is lined with mucous membranes. Normal oral mucosa

Case Study (Cont. ) Jamie Johnson is a 20 -year-old nursing student assigned to

Hair Growth, distribution, and pattern indicate general health status. Hormonal changes, nutrition, emotional stress,

Eyes, Ears, and Nose When hygiene care is provided, the eyes, ears, and nose

Case Study (Cont. ) Jamie needs to review the effect of dependency on the

Nursing Knowledge Base Many factors influence personal hygiene. Use communication skills to promote therapeutic

Factors Influencing Hygiene Social practices Personal preferences Body image Socioeconomic status Health beliefs and

Critical Thinking Integrate nursing knowledge. Consider developmental and cultural influences. Think creatively. Be nonjudgmental

Quick Quiz! 1. You are caring for a non–English-speaking male patient. When preparing to

Case Study (Cont. ) Before entering Mrs. Winkler’s room, Jamie reviews knowledge about the

Nursing Process: Assessment Through the patient’s eyes Ø Assess patient expectations about hygiene Assess:

Nursing Assessment (Cont. ) Copyright © 2017, Elsevier Inc. All Rights Reserved. 17

Case Study (Cont. ) Jamie learns that Mrs. Winkler likes to have her face

Nursing Diagnosis Common diagnoses associated with hygiene: Activity intolerance Ø Bathing self-care deficit Ø

Case Study (Cont. ) Mrs. Winkler states that she wants to be able to

Nursing Process: Planning Goals and outcomes Partner with the patient and family Ø Measurable,

Case Study (Cont. ) Goals: Ø Knowledge: illness care • Mrs. Winkler will verbalize

Implementation Use caring to reduce anxiety, promote comfort. Administer meds for symptoms before hygiene.

Implementation (Cont. ) Health promotion Make instructions relevant. Ø Adapt instruction to patient’s facilities

Implementation (Cont. ) Consider normal grooming routines, and individualize care Bathing and skin care

Implementation (Cont. ) Bath Guidelines Provide privacy. Maintain safety. Maintain warmth. Promote independence. Anticipate

Implementation (Cont. ) Back rub Foot and nail care Oral hygiene Brushing removes particles,

Implementation (Cont. ) Denture care Keep dentures covered in water when they are not

Implementation (Cont. ) Hair and scalp care Ø Brushing and combing • • Distributes

Implementation (Cont. ) Shampooing Ø Frequency depends on patient routines and hair condition Copyright

Implementation (Cont. ) Shaving Mustache and beard care Copyright © 2017, Elsevier Inc. All

Quick Quiz! 2. A young girl with long hair is experiencing a problem with

Implementation (Cont. ) Care of the eyes, ears, and nose: Medical devices Ø Basic

Implementation (Cont. ) Care of the eyes, ears, and nose (cont. ): Ear care

Implementation (Cont. ) Patient’s room environment Ø Maintaining comfort • Temperature, noise, lighting, ventilation,

Implementation (Cont. ) Foot boots Special mattresses Copyright © 2017, Elsevier Inc. All Rights

Implementation (Cont. ) Beds Bed making Copyright © 2017, Elsevier Inc. All Rights Reserved.

Implementation (Cont. ) Surgical or recovery Bed Linens Copyright © 2017, Elsevier Inc. All

Case Study (Cont. ) What interventions are appropriate for restoration of oral health? What

Evaluation Through the patient’s eyes Ø Were the patient’s expectations met? Patient outcomes Evaluate

Case Study (Cont. ) Jamie asks Mrs. Winkler about reporting of symptoms. Mrs. Winkler

Safety Guidelines for Nursing Skills Identify the patient with two identifiers. Move from the

Slides: 42

Download presentation

Scientific Knowledge Base Apply knowledge of pathophysiology to provide preventive hygiene care. Recognize disease states that create changes in the integument, oral cavity, and sensory organs. Use time spent providing hygiene care to identify abnormalities and initiate appropriate actions to prevent further injury to sensitive tissues. Copyright © 2017, Elsevier Inc. All Rights Reserved. 2

Case Study Mrs. Winkler is a 58 -year-old white woman admitted recently to an assisted-living nursing facility. She has a medical history of multiple sclerosis (MS) and diabetes mellitus plus a family history of coronary artery disease. Mrs. Winkler uses a wheelchair for mobility. She has recently become weaker (in both upper and lower extremities), is unable to push the chair herself, and requires assistance in transferring to and from the chair. Copyright © 2017, Elsevier Inc. All Rights Reserved. 3

The Skin Functions include Ø Protection, secretion, excretion, temperature regulation, and sensation Primary layers Epidermis: shields underlying tissue Ø Dermis: contains bundles of collagen, nerve fibers, blood vessels, sweat glands, sebaceous glands, and hair follicles Ø Subcutaneous tissue Ø • Lies just beneath the skin; contains blood vessels, nerves, lymph, and loose connective tissue filled with fat cells Copyright © 2017, Elsevier Inc. All Rights Reserved. 4

The Feet, Hands, and Nails Feet, hands, and nails require special attention to prevent infection, odor, and injury. The condition of a patient’s hands and feet influences his or her ability to perform hygiene care. The normal nail is transparent, smooth, and convex, with a pink nail bed and a translucent white tip. Copyright © 2017, Elsevier Inc. All Rights Reserved. 5

The Oral Cavity The oral cavity is lined with mucous membranes. Normal oral mucosa is light pink, soft, moist, smooth, and without lesions. Medications, exposure to radiation, and mouth breathing can impair salivary secretion. Xerostomia—dry mouth. Gingivitis—inflammation of the gums. Dental caries—tooth decay. Copyright © 2017, Elsevier Inc. All Rights Reserved. 6

Case Study (Cont. ) Jamie Johnson is a 20 -year-old nursing student assigned to the nursing facility. She is single and works part-time in a skilled nursing facility near her home. Jamie knows how important it is for patients to feel comfortable and to have their basic needs met. To provide basic hygiene, Jamie needs to learn about what is important for Mrs. Winkler’s comfort. When hygiene needs are not fulfilled, patients experience complications such as oral lesions and infections. Copyright © 2017, Elsevier Inc. All Rights Reserved. 7

Hair Growth, distribution, and pattern indicate general health status. Hormonal changes, nutrition, emotional stress, physical stress, aging, infection, and other illnesses can affect hair characteristics. The shaft itself is lifeless, and physiological factors do not directly affect it. Ø However, hormonal and nutrient deficiencies of the hair follicle cause changes in hair color or condition. Copyright © 2017, Elsevier Inc. All Rights Reserved. 8

Eyes, Ears, and Nose When hygiene care is provided, the eyes, ears, and nose require careful attention. Clean the sensitive sensory tissues in a way that prevents injury and discomfort for a patient, such as by taking care to not get soap in his or her eyes. The sense of smell is an important aid to appetite. Copyright © 2017, Elsevier Inc. All Rights Reserved. 9

Case Study (Cont. ) Jamie needs to review the effect of dependency on the patient’s self-esteem and to review ways to give patients opportunities to maintain selfcare needs. At an optimal level of functioning with assistance, Mrs. Winkler is at risk for potential self-care deficits, impaired skin integrity, impaired oral mucosa, and altered health maintenance. During hygiene care, Jamie interacts with Mrs. Winkler to assess her readiness to learn and to teach health promotion practices. Copyright © 2017, Elsevier Inc. All Rights Reserved. 10

Nursing Knowledge Base Many factors influence personal hygiene. Use communication skills to promote therapeutic relationship. Hygiene care is never routine. During hygiene, assess: Emotional status Ø Health promotion practices Ø Health care education needs Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 11

Factors Influencing Hygiene Social practices Personal preferences Body image Socioeconomic status Health beliefs and motivation Cultural variables Developmental stage Physical condition Copyright © 2017, Elsevier Inc. All Rights Reserved. 12

Critical Thinking Integrate nursing knowledge. Consider developmental and cultural influences. Think creatively. Be nonjudgmental and confident. Draw on your own experiences. Rely on professional standards. Copyright © 2017, Elsevier Inc. All Rights Reserved. 13

Quick Quiz! 1. You are caring for a non–English-speaking male patient. When preparing to assist him with personal hygiene, you should: 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. Copyright © 2017, Elsevier Inc. All Rights Reserved. 14

Case Study (Cont. ) Before entering Mrs. Winkler’s room, Jamie reviews knowledge about the effects of chronic illness on body image and independence, principles of communication and the pathophysiology for MS, diabetes, and oral lesions. Previous clinical experience has taught Jamie that patients need to have an opportunity to determine how nurses implement nursing care. Copyright © 2017, Elsevier Inc. All Rights Reserved. 15

Nursing Process: Assessment Through the patient’s eyes Ø Assess patient expectations about hygiene Assess: Self-care ability Oral cavity Skin Hair and hair care Use of sensory aids Hygiene care practices Feet and nails Eyes, ears, and nose Cultural influences Patients at risk for hygiene problems Copyright © 2017, Elsevier Inc. All Rights Reserved. 16

Case Study (Cont. ) Jamie learns that Mrs. Winkler likes to have her face and hands washed first and then her teeth brushed before breakfast. But then, she tells Jamie that it is really not important. Mrs. Winkler says, “I am not going to have breakfast today because my mouth is sore. I took my dentures out yesterday. They hurt my mouth too much. I guess I just can’t wear them anymore. ” Jamie determines that assisting Mrs. Winkler with oral care is a priority. Copyright © 2017, Elsevier Inc. All Rights Reserved. 18

Nursing Diagnosis Common diagnoses associated with hygiene: Activity intolerance Ø Bathing self-care deficit Ø Dressing self-care deficit Ø Impaired physical mobility Ø Impaired oral mucous membrane Ø Ineffective health maintenance Ø Risk for infection Ø Use the patients’ actual alteration or the alteration for which they are at risk. Copyright © 2017, Elsevier Inc. All Rights Reserved. 19

Case Study (Cont. ) Mrs. Winkler states that she wants to be able to wear her teeth and to feel clean. Mrs. Winkler reports mouth pain and sores. Jamie’s examination reveals reddened oral mucosa, red sores and patchy white lesions, a thick coating on the gums and tongue, and some bleeding from swollen tissues. Mrs. Winkler states that she has trouble holding her arms above her waist and trouble holding small things because her muscles are so weak. Copyright © 2017, Elsevier Inc. All Rights Reserved. 20

Nursing Process: Planning Goals and outcomes Partner with the patient and family Ø Measurable, achievable, individualized Ø Set priorities based on assistance required, extent of problems, nature of diagnoses Teamwork and collaboration Health care team members Ø Family Ø Community agencies Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 21

Case Study (Cont. ) Goals: Ø Knowledge: illness care • Mrs. Winkler will verbalize preventive and routine oral and denture care by the time of discharge. Ø Oral hygiene • Mrs. Winkler will have return of intact oral mucosa within 1 week. Copyright © 2017, Elsevier Inc. All Rights Reserved. 22

Implementation Use caring to reduce anxiety, promote comfort. Administer meds for symptoms before hygiene. Be alert for patient’s anxiety or fear. Assist and prepare patients to perform hygiene as independently as possible. Discuss signs and symptoms of problems. Inform patients about community resources. Copyright © 2017, Elsevier Inc. All Rights Reserved. 23

Implementation (Cont. ) Health promotion Make instructions relevant. Ø Adapt instruction to patient’s facilities and resources. Ø Teach the patient ways to avoid injury. Ø Reinforce infection control practices. Ø Acute, restorative, and continuing care Ø Hygiene measures vary by patient needs and health care setting. Copyright © 2017, Elsevier Inc. All Rights Reserved. 24

Implementation (Cont. ) Consider normal grooming routines, and individualize care Bathing and skin care Therapeutic: sitz, medicated Ø Complete bed bath, shower Ø Partial bed bath Ø Soap and water vs. Chlorhexidine Gluconate (CHG) Ø Perineal care Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 25

Implementation (Cont. ) Back rub Foot and nail care Oral hygiene Brushing removes particles, plaque, and bacteria; massages the gums; and relieves unpleasant odors and tastes. Ø Flossing removes tartar at the gum line. Ø Rinsing removes particles and excess toothpaste. Ø Patients with special needs: diabetes, artificial airways, unconscious, chemotherapy Copyright © 2017, Elsevier Inc. All Rights Reserved. 27

Implementation (Cont. ) Denture care Keep dentures covered in water when they are not worn Ø Store in an enclosed, labeled cup with the cup placed on patient’s bedside stand Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 28

Implementation (Cont. ) Hair and scalp care Ø Brushing and combing • • Distributes oil Prevents tangling, as does braiding Obtain permission before braiding or cutting. Combing is more effective than use of pediculicidal shampoos in the case of head lice Copyright © 2017, Elsevier Inc. All Rights Reserved. 29

Quick Quiz! 2. A young girl with long hair is experiencing a problem with matting. The most appropriate action to take would be: 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. Copyright © 2017, Elsevier Inc. All Rights Reserved. 32

Case Study (Cont. ) What interventions are appropriate for restoration of oral health? What is the rationale supporting each intervention? Example intervention: Remove, clean, and do not replace dentures except for meals (if desired). Ø Rationale: This promotes healing during cases of mild to moderate stomatitis. Copyright © 2017, Elsevier Inc. All Rights Reserved. 39

Evaluation Through the patient’s eyes Ø Were the patient’s expectations met? Patient outcomes Evaluate after each hygiene intervention Ø Use teach back Ø If outcomes were not met, revise the care plan Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 40

Case Study (Cont. ) Jamie asks Mrs. Winkler about reporting of symptoms. Mrs. Winkler states she now knows that her oral discomfort and sores are related to how she cares for her dentures, and that she will report these symptoms if they reoccur. Achievement of outcome is shown because Mrs. Winkler is able to participate in prevention of oral problems by reporting symptoms indicating a problem. Copyright © 2017, Elsevier Inc. All Rights Reserved. 41

Safety Guidelines for Nursing Skills Identify the patient with two identifiers. Move from the cleanest to less clean areas. Use clean gloves for contact with nonintact skin, mucous membranes, secretions, excretions, or blood. Test the temperature of water or solutions. Use principles of body mechanics and safe patient handling. Give proper direction to NAP when delegating. Copyright © 2017, Elsevier Inc. All Rights Reserved. 42