Personal Hygiene, bathing And backrubs, SkinCare and pressure ulcers

1. Personal Hygiene, bathing And backrubs, SkinCare and pressure ulcers PN 103

2. Personal Hygiene • The self-care measures people use to maintain the health • Hygiene • -The science of health • -Includes care of the skin, hair, hands, feet, eyes, ears, nose, • mouth , back, and perineum • -Conscientious personal hygienic practices are essential for • the nurse; nurses are role models

3. Personal Hygiene • Factors influencing personal hygiene • -Social practices • -Body image • -Socioeconomic status • -Knowledge • -Personal preferences • -Physical condition • -Cultural variables

4. Personal Hygiene • Gerontological considerations • -Older individuals have less subcutaneous tissue making • them more susceptible to becoming chilled during bathing • -Impaired circulation or neurological changes may decrease • ability to sense temperature changes of water • -Skin is often dry –no harsh soaps, no frequent bathing, use • lotions and creams

5. Bath Administration • Preparing the patient • -Provide privacy (pull the curtain) • -Drape as needed • -Ask if he/she needs the bedpan of urinal • -Arrange needed supplies • -Adjust room temperature • -Raise the bed to a comfortable position

6. Bath Administration • Partial bed bath • -Nurse assists the patient to bathe inaccessible body parts • Complete bed bath • -Reserved for patients who are completely dependent and • require total assistance • Shower • -May be allowed if the patient is ambulatory and the MD • approves • Hair care • -Brush or comb daily • -Wash as needed

7. Bath Administration • http://mcom.alexanderstreet.com/view/1665506

8. Back Rubs • -Usually administered after a patient’s bath • -Promotes relaxation, relieves muscular tension, and • stimulates circulation • -Nurse massages for 3 to 5 minutes • -Contraindicated if the patient has such conditions as • fractures of the ribs or vertebral column, burns, pulmonary • embolism, or open wounds

9. Back Rubs • -Begin the massage by starting in sacral area using circular • motions • -Stroke upward to the shoulders • -Massaging over bony prominences is no longer • recommended • -Evidence suggests that massage may result in decreased • blood flow and tissue damage in some patients

10. Skin Care • When a person’s physical condition changes, the skin often reflects this through alterations in: • -color • -thickness • -texture • -turgor • -temperature • -hydration • As long as the skin remains intact and healthy, its physiological function remains optimal

11. Skin Care • Collection of data • -Normal skin has the following characteristics: • -Intact without abrasions • -Warm and dry • -Localized changes in texture across the surface • -Good turgor • -Generally warm and soft • -Skin color variations from body part to body part

12. Skin Care • Impaired skin integrity • -A patient who stays in one position without relief of • pressure can develop a wound • -also known as a pressure ulcer, PrU, decubitus ulcer or • bed sore • Patients at risk • -chronically ill • -debilitated • -older • -disabled • -incontinent • -patients with spinal cord injuries • -limited mobility • -poor overall nutrition

13. Pressure Ulcers • Pressure Ulcer Risk Assessment Tools • -Braden Scale and Norton Scale • -the lower the score on both tools, the higher the pressure • ulcer risk • -the total annual cost of treating a pressure ulcer in the • US is approximately $8.5 billion • -1.7 million people develop pressure ulcers each year

14. Braden Scale

15. Norton scale

16. Pressure Ulcers • Pressure ulcers occur when there is sufficient pressure on the skin to cause the blood vessels in an area to collapse • The flow of blood and fluid to the cells is impaired, resulting in ischemia to the cells • When external pressure against the skin is greater than the pressure in the capillary bed, blood flow decreases to the adjacent tissue • If the pressure continues for longer than 2 hours, cell necrosis occurs

17. Pressure Ulcers • Shearing force -An internal, opposing motion of tissue layers and bone. Shearing forces stretch or tear the blood vessels which reduces the amount of pressure needed to occlude them • Friction -Rubbing of skin over a surface produces friction, which may remove layers of skin

18. Pressure Ulcers • Maceration/Incontinence • -Continued exposure of skin to moisture, causing tissue • softening which leaves the skin more susceptible to the • forces of shear and friction • Epidermal stripping • -Removal of the top layer of skin by mechanical forces • -tape burns

19. Shearing force

20. Skin structure

21. Stage of Pressure ulcers • Stage I • -nonblachable erythema of the skin • Stage II • -partial skin loss of the epidermis • Stage III • -full thickness skin loss, damage or necrosis of the • subcutaneous tissue • Stage IV • -full thickness skin loss with extensive destruction, tissue • necrosis or damage to muscle, bone, or supporting • structures

22. Pressure Ulcers • Nursing Interventions • -Assess improvement • -Assess size and depth of the ulcer • -the amount and color of the exudate • -the presence of pain or odor • -the color of the wound • -the appearance of the surrounding tissue • -Specific interventions are determined by the stage of the • ulcer

23. Stage I pressure ulcer

24. Stage I pressure ulcer • Treatment: • -Relieve pressure • -Monitor closely as may progress to another stage even • after pressure is remove

25. Stage ii Pressure ulcer

26. Stage ii Pressure ulcer • Treatment: • -Remove pressure • -Clean with facility approved wound cleanser or normal • saline • -Debride any necrotic tissue (chemically, mechanically or • surgically) • -Keep moist healing environment by covering with alginate, • gel or hydrocolloid dressing • -Change dressing 1-2 times a day.

27. Stage III pressure ulcer

28. Stage iv pressure ulcer

29. Stage III & iv pressure ulcer • Treatment: • -Remove pressure • -Cleanse wound with facility approved wound cleanser or • irrigate with normal saline • -Debride any necrotic tissue • -Fill any dead space (pack lightly with moist gauze), use • wound gel and/or moist dressings • -May consider wound vac when the necrotic tissue is • debrided and granulating tissue has filled the wound

30. Pressure Ulcers • Support surfaces • -Pressure relieving mattresses or chair cushions should be • used with patients who are at risk for skin impairment • -alternating air mattresses • -silicone mattresses

31. Pressure Ulcers • http://mcom.alexanderstreet.com/view/1665674/play/true/

32. Prevention of Pressure Ulcers • Positioning • -use positioning devices (pillows, foam wedges) to prevent • bony prominence from direct contact with any other surface • -turn and reposition bedbound patients at least every 2 • hours • Seating interventions • -Shift weight every 15 minutes • -if unable to shift weight, reposition every hour • -wheelchair cushion

33. Prevention of Pressure Ulcers • Moisture reduction • -Incontinent patients should be checked for incontinence • every 2 hours and changed as soon as incontinence has • occurred • -use barrier ointment to skin at perineum • Range of motion • -Helps keep the blood circulating and keeps the • patient from being in one position

34. Prevention of Pressure Ulcers • Prevent shear and friction • -Nutrition • -All at risk patients should be referred to a dietician for • nutritional interventions • -Vitamin and mineral supplements as ordered by the • patient’s HCP