HYGIENE MODULE

1. HYGIENE MODULE Dr. Anita Catlin Sonoma State University N205

2. Skin Mouth Teeth Hair Nails Eyes Ears Nose Perineal Area Feet Hygiene involves cleansing of the:

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 defense against organisms • Mucous membranes also defend • Gastric secretions as well

4. WHY A NURSING FUNCTION? • Assessment • Teaching • Comfort • Touch • Relaxation • Pain Relief • Caring

5. ATTENTION TO BODY IMAGE ISSUES • Body image is the meaning that the person attaches to body part • Person may have radical changes in body image • You may be one of first to see this • How nurse responds to body image changes sets tone to last a lifetime

6. HYGIENE includes: • Cleansing of patient • Bedmaking • Room straightening • Emptying garbage • Removal of used supplies, dishes, flowers, newspapers, etc. • Assessing patency of and cleansing equipment • Placement of necessary supplies

7. SOCIOCULTURAL FACTORS • Americans 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, headdressings, amulets, turbans, religious medals or shawls • Male nurse only or female nurse only may be necessary in some cultures

8. SOCIOCULTURAL FACTORS • In some cultures, male relative may not allow male nurse alone with woman patient • In some cultures, autonomy of patient is paramount; in others, family makes decisions for care • Level of education may influence care • Legal and presumptive relationships • Gay and lesbian partners • Teen friends of emancipated minors • Nurse accepts all who lovingly participate

9. POVERTY OR HOMELESSNESS • Influences hygiene • May have body parasites • May have unhealed/untreated wounds • Dental caries • Clotting problems from alcohol • Drug entry sites, abscesses • Need to use standard precautions

10. KNOWLEDGE LEVEL • May need teaching regarding: • Front to back perineal care • Brushing gum line, not teeth • Special foot care for circulatory problems • Skin inspections by dermatologist

11. DEVELOPMENTAL LEVEL:NEWBORNS • Do not place under running faucet • Do not submerge until umbilical cord drops off • Dry carefully, especially the head • Place cap after bath

12. DEVELOPMENTAL LEVEL:YOUNG CHILDREN • Children can drown in 2 inches of water; never leave alone during bathing • Teach parents about fluoride • No milk or juice bottles in bed • Wipe off teeth after eating with soft cloth • Demonstrate on teddy bear

13. 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

14. DEVELOPMENTAL LEVEL:ADOLESCENTS • Modesty essential • Normal clothes, not gowns • Bed pans not acceptable • Allow decision making • No tampons in the hospital

15. DEVELOPMENTAL LEVEL:OLDER ADULTS • Heat insensitivity; can burn easily • Foot care • Skin very fragile

16. CONFIDENTIALITY • In providing hygiene, may find very personal details • Report on “need to know” basis • Tell instructor; decide together on what to take further • Must break confidentiality if signs of abuse

17. STUDENT NURSE ISSUES • Personal space of patient • Undress, examine, wash and groom stranger • Incontinence can cause discomfort • Sexuality may be an issue • Patient really asking “Am I still desirable despite my illness?” • Take a break if uncomfortable; tell instructor • Attraction? Ask for patient change

18. STUDENT NURSE ISSUES • Your safety and well being is our job • Care of your back • Lifting and bending appropriately • Protected against infection transmission • Tell instructor if pregnant or immunosuppressed • Ask for help (physical and emotional) • Learn assessment skills

19. 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 instructor

20. BATH REFUSAL What is real problem? • Power issue? • Fatigue? • Visitors? Assessment • Patient continent? • Skin care? • Level of exertion? Comfort education and negotiation

21. PURPOSE OF NURSE PROVIDED HYGIENE • Remove microorganisms • Do physical assessment • Increase circulation • Distal to proximal • Return to heart • Improve self image • Provide comfort

22. NOSOCOMIAL INFECTION • Also called iatrogenic • Patient illness brought on simply by being in the hospital and being exposed to organisms not found outside the health care setting • 5% of all hospital deaths (90,000 in 2000) • 4th largest cause of death in US (heart disease, cancer, stroke, infection) • More than 4 billion dollars annually • Often hands of health care providers

23. NOSOCOMIAL INFECTION • Hands washed with antiseptic soap and friction • Short fingernails; artificial nails now being forbidden • Soiled linen kept off uniform • Gloves • if client has open or draining wound or is incontinent • if nurse has skin breaks on hands • No sharing supplies without proper sanitation

24. SAFETY • Electrical supplies must be checked by engineering department prior to use; and not left near pan of water • hair dryers • electric shavers • Bed raised to working height and lowered when finished • Side rails up for patients requiring • All spilled water immediately wiped • Caution with use of powder • Caution with use of latex

25. SHAVING • Shaving reflects level of caring • 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 • If using hair depilatory, always test area first

26. SAFETY • All patients will need attention to water temperature • Patients with impaired level of consciousness will need special care • gentle eye care, possibly patching • frequent mouth care • proper positioning • care to bed linen • water temperature

27. PATIENTS RECEIVING CHEMOTHERAPY • Special mouth care • nausea • oral thrush or stomatitis • Special hair care • Rest periods

28. PATIENTS RECEIVING RADIATION THERAPY • Do not wash off markings • No bath salts • No heating pads or hot water bottles

29. UNCONSCIOUS PATIENT • Move during bath • ROM frequently • Mouth care in lateral position, with head lower • Change frequently • Do not roll down if tube feeding running

30. FATIGUE AS A FACTOR • Nurse’s job to monitor patient tolerance • Respiratory response • Heart rate • Can patient tolerate being flat? Does he 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

31. TYPES OF HYGIENE • Early a.m. care: Urinal/bedpan, wash hands and face, brush teeth, roll up • 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 • HS care: Elimination, wash hands and face, oral care, linen straightening, back rub

32. SKIN • Regulates body temperature • First line of defense against harm • Antibacterial and antifungal • Transmits sensations • Signs of problems • Redness (erythema) • Wet or damp • Not intact

33. 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

34. NURSING INTERVENTIONS • General health important • Intact skin • Caution in movement • Don’t overbathe elderly • Protein in diet • Avoid periods of moisture • Change frequently • Dry carefully • Rinse soap • Sun screen important • Especially with certain medications

35. NURSING ASSESSMENT WHILE BATHING • History • Relationship • Color and condition of skin • Pain on movement • Level of consciousness • Injuries • Scars • Skin turgor • Nevi • Wt loss or gain

36. THERAPEUTIC BATHING • Physician ordered; nurse suggestion • Water temperature usually 100-115 F • Medications are ordered to be put in water • Time usually 20 minutes • Don’t leave patients alone • Be very clear delegating

37. TYPES OF THERAPEUTIC BATHS • Saline • 0.9% NaCl Normal body consistency for wound care and irrigations • Oatmeal, cornstarch, Aveeno for itching • Iodine, Dakin’s, KMNO4 for antibacterial action (Ask about allergies)

38. 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

39. ORGANIZATION SKILLS • 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!

40. GENERAL PRINCIPLES • Client safety • Nurse safety • Work in time constraints • Allow privacy and dignity • Only body part being washed is uncovered • Curtain is closed • Change water, washclothes, towels, linen as needed • Use absorbent cotton bath blanket (heated best) • Call bell available

41. PERINEAL CARE • Professionalism always • Not deferred in cases needing nursing assessment • Female • Always sterile to contaminated (urethra to rectum) • Often have menses in hospital • Use peripads - tampons forbidden in hospital • If large breasts, need to dry underneath carefully, may use cornstarch • Male • Assess for circumcision • If not, cleanse under foreskin and replace

42. BACK RUB • Purpose • Relaxation • Circulation • Pain relief • Assess skin integrity on back • Assess all bony prominences • Always done as part of good nursing care

43. BACK OR BODY MASSAGE • Warm lotion first • Use continuous strokes • Does not include back of calves • Don’t gatch knees or put pillows under calves

44. 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

45. NAIL CARE • Observe circulation; color, capillary refill time • Observe color, sensation, and movement (CSM) • Polish removed to observe color and use pulse oximeter • Assess for clubbing sign of long term lack of oxygen • Cut nails straight across and file smooth; Do not go down into corners • Assess for rings too tight or too loose

46. MOUTH CARE • Examine with gloves and light, especially smokers • Use only water soluble lubricants • If feeding tubes present, assess for parotitis • Unconscious patient has no gag reflex, position on side for care • May have gum hyperplasia from meds • May have teeth staining from meds • May have accumulated debris in mouth called sordes • Teach about brushing and flossing

47. CARE OF DENTURES • Assess for fit • If removed, keep in covered cup with water • Label cup with patient’s name • Keep in bedside table • Pad sink when cleaning • Use cool water

48. HAIR CARE • Culture may influence care • Hmong – do not touch without permission • Muslim and Orthodox Jew – May keep covered, wear wig • Sikh – Does not cut • Different parts of body have hair shaved

49. HAIR CARE • Hair is combed daily and shampooed prn • Corn rows, dreds, braids not undone to shampoo • Patients may use hair oil on these • Both wet and dry shampoo available • Send to operating room or surgical procedure with clean hair and shaven

50. 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 • Care of artificial eye similar to dentures