Oral Hygiene

1. Oral Hygiene Benefits of Oral Hygiene

2. Benefits of Oral Hygiene • Provides comfort • Stimulates the appetite • Prevents disease and dental caries • Helps to prevent bad breath (halitosis) • Stimulates saliva production which contains digestive enzymes and promotes digestion

3. Routine Oral Hygiene • Involves tooth brushing and flossing. • Should be done at least 3 times a day. • Provide necessary equipment such as toothbrush, toothpaste, dental floss, mouthwash, emesis, basin, cup and water. • Assist the patient as needed.

4. Denture Care • Provide privacy for the patient. • Have patient remove dentures if able. • Place dentures in a denture cup to carry to sink. • Use warm water to clean dentures. • Hold dentures securely. Let patient rinse mouth and brush gums. • Store dentures in a denture cup labeled with the patient's name.

5. Special Oral Hygiene • Usually given to unconscious or semiconscious patients. • Tell the patient what you are doing. • Turn the patient's head toward you • Use a very small amount of liquid • Clean all areas of the mouth: Teeth Gum Tongue Roof of mouth • Apply lubricant to tongue and lips.

6. Bathing Types of baths • Complete Bed bath (CBB) • Patient is usually confined to bed and the health care worker must bathe all parts of the patient’s body.

7. Use standard precautions Provide privacy comfort, and safety. Fill basin 2/3 full with warm water at a temperature of 1050 – 1100 F Form a mitten around your hand with the cloth Wash body parts in this order: Face, ears, and neck → axilla, arms, and hands (apply deodorant) →chest, breast, and abdomen → thighs, legs, and feet (change water) → back, buttock, and back of perineum (give back rub) → perineal area. Change water when it becomes too cool, dirty or soapy. Complete Bed Baths

8. Bathing Partial Bed Bath • Patient washes some of the parts of their body and the health care worker washes the parts of the body the patient cannot reach. Tub bath or shower • Health care worker prepares the tub or shower area and assists patient as needed.

9. Tub Baths and Showers • Usually require a physician’s order. • Make sure tub or shower is clean. • Put a rubber mat in tub or shower • Fill tubs half full with water at 1050 F • Help the patient into the tub or shower (use the shower chair for patient who cannot stand) • Assist patient as needed • Stay with patient or make sure patient can use the emergency call system • After bath or shower cover patient with a towel or bath blanket • Clean the tub or shower with a disinfectant after each use.

10. Amount of fluid taken into the body should equal the amount of fluid lost from the body. Excessive fluid retained by body= edema (swelling) Excessive fluid lost by body=dehydration What do you measure? Intake – Oral (P.O.) --Intravenous (IV) --Irrigation Output --Bowel Movement (BM) --Emesis --Urine --Irrigation Measuring and Recording Intake and Output

11. INTAKE • Oral • Includes liquids taken by mouth • Also includes foods that are liquid at room temperature such as soup, Jell-O, ice cream, pudding, and Popsicles. • Fluids are measured in metric units • 1 Cubic Centimeter (cc) = 1 milliliter (ml)

12. INTAKE • 1 ml or cc = 15 gtt (drops) • 5 ml or cc = 1 tsp (teaspoon) • 15 ml or cc = 1 tbsp (tablespoon) • 30 ml or cc = 1 (oz) ounce • 240 ml or cc = 1 cup (8 oz) • 500 ml or cc = 1 pint (16 oz) • 1000 ml or cc = 1 quart (32 oz)

13. MEASURING INTAKE PRACTICE Fred is on intake and output. When you go into his room after lunch, you examine his lunch tray and find he consumed the following: 1 hamburger ½ bowl of chicken broth (1 soup bowl = 200 cc) 4 soda crackers 1 cup of tea ¾ carton of milk ( 1 carton = 8 oz) ½ bowl of Jell-O ( 1 small bowl = 120 cc) What was Fred’s fluid intake?

14. MEASURING OUTPUT • Output = all fluids eliminated by the patient • Bowel movements (BM) Liquid BMs are measured and recorded Solid or formed BM is usually noted under feces on the remarks column

15. EMESIS • Measure anything that is vomited. • Also note color, type, and other facts in the remarks column Urine • Measure all urine voided or drained via a catheter • Men can collect their urine in a urinal and women can collect their urine in a bedpan or a special urine collector that can be placed under the seat of the toilet. Irrigation • Measure any drainage from nasogastric tubes, hemo-vacs, chest tubes or other drainage tubes • These measurements are usually done by the nurse.

16. MEASURING OUTPUT PRACTICE Jennifer is on intake and output. At the end of an 8 hour shift, you note the following: 0800 (8:00 am) she voided 400 cc of urine 1000 (10:00 am) she vomited 200 cc of thick yellow emesis with food particles in it 1130 (11:30 am) she had one formed green BM 1315 (1:15 PM) she voided 350 cc of urine What was Jennifer’s output for the 7-3 shift?

17. Feeding the Patient Prior to the meal Provide privacy Help patient use the bedpan or urinal if needed Provide oral hygiene if desired Remove emesis basins or bedpans from sight Position patient in a sitting position if allowed Wash patient’s hands and face Put overbed table in position Check to make sure the patient is not NPO Make sure the diet is correct for the patient Place a towel or napkin under patient’s chin Open packages and cartons, season and cut foods if necessary.

18. FEEDING A PATIENT • Steps for feeding a patient • Test the temperature of hot foods by placing small amount on wrist • Feed patient slowly and give them time to chew • Use separate straw for each liquid • Hold utensil at a 900 to the patients mouth • Give small bites • Alternate foods and liquids • Allow patient to help as much as they are able • Offer choices to the patient • Wipe patient’s mouth as needed • Encourage patient to eat as much as possible.

19. AFTER THE MEAL • Allow patient to wash their face and hands • Provide oral hygiene • Position patient in correct body alignment • Clean area • Note how much food was eaten • Calculated I&O if this is ordered for patient.

20. BEDPANS AND URINALS • Urinate, micturate, or void – terms for emptying of the bladder, which stores urine. • Urinals are used by male patient when they need to micturate • A bedpan is used by females when they need to micturate

21. Defecate • Having a bowel movement (BM) • Both men and women must use a bedpan when they need to defecate. • Two main types of bedpans • 1. Fracture or orthopedic bedpan • 2. Standard bedpan • Many patients are sensitive about using the bedpan. Always provide privacy and make them as comfortable as possible.

22. Assisting with a Bedpan • Use standard precautions and wear gloves • Provide privacy for the patient • Warm bedpan by running warm water over it • There are two positions to place the pan under the patients 1. Patient flexes knees and puts weight on heels. They then lift their hips up. 2. Patient is turned to one side and the pan is placed against the buttock and then the patient is rolled back in the pan.

23. Bedpan Cont. • The patient's buttock should rest on the rounded portion of the pan • Place call bell and tissue within patient’s reach • Raise siderail before leaving the patient • All done………… • Answer call bell immediately • Use the same positions to get the patient off the pan, but hold onto the pan firmly • Cover the bedpan and place on nearby chair or table • Make sure perineum is clean and dry • Assist patient in washing hands • Clean bedpan and note any abnormalities of urine or BM

24. ASSISTING WITH A URINAL Never empty a bedpan or an urinal until you check to see if a specimen is needed!! Use standard precautions and wear gloves Provide privacy for the patient Assist patient with placement of the urinal if needed Leave the call bell and toilet tissue near the patient Answer patient’s call bell immediately All finished………….. Avoid exposing the patient Have patient hand you the urinal if they are able Close the lid or cover the top of the urinal Assist patient with washing perineal area if needed Assist patient with washing his hands Measure contents if patient is on I&O Empty urinal and clean with warm soapy water Report any abnormalities to the urine