Post on 18-Jan-2016
Assisting with hygiene
L / Hanaa Eisa
2015-2016
Course out Line
1. Introduction
2. Purpose of hygiene
3. Hygiene.
4. Kinds of hygiene may nurses described.
5. 2. Morning care.
6. 3. After noon care
7. 4. Hours of sleep care
Course out Line
8. Etiologies of self care deficit.
9. Functions of the skin
10. Nursing management
11. Patients at risk for skin problems
12. Practices related skin care
13. Tube Bath
14. Bed sore
At the end of this lecture the student will able to:
1. Describe hygienic care that nurses provide to client.
2. Identify factors influencing personal hygiene
3. Know about common problem of the skin.
4. Describe common kind of hygiene.
5. Ability to identify patients with self care deficit related hygiene.
6. Identify the purposes of bathing.
7. Describe various types of baths.
8. Identify safety and comfort measures underlying bed- making procedure.
Learning outcome
Personal hygiene practices well vary widely among
persons. Well people are ordinarily responsible for
their own hygiene. In some cases the nurse assist
well person through teaching to develop personal
habits the person may lack.
Introduction
1. To remove microorganisms.
2. To do physical assessment.
3. To improve circulation.
4. To improve self image.
5. To provide comfort.
Purpose of hygiene
• Cleansing by nurse is part of nursing care• Cleansing skin is first line of defense against
organisms.• Nurses commonly use the following terms to describe
types of hygienic care
Hygiene
Nurses commonly use the following terms to describe types of hygienic care:
1) Early morning care.
2) Morning care.
3) After noon care.
4) Hours of sleep care.
5) As needed (prn) care.
Kinds of hygiene may nurses described
Provide comfort measure to refresh patient to prepare for day by:
a. Assist patient with toileting (providing a urinal or
bedpan).
b. Wash face and hands.
c. Provide oral care
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Purposes of early morning care
After breakfast, nurse
completes morning care
1. Elimination needs
2. A bath or shower
3. Perineal care
4. Back massage
5. Oral care
2. Morning care
6. Hair care
7. Making the client’s bed
is part of morning care
8. Dressing
9. Positioning for comfort
10. Tidying up bedside
Ensure patient’s comfort after lunch:
• Offer assistance with toileting, hand washing, oral care
• Straighten bed linens
• Help patients with mobility to reposition themselves
3. After noon care
Before patient retires:
• Providing for elimination needs, washing, and oral
care ,offer a back massage and change any soiled
bed linens or clothing, position patient comfortably
• Ensure that call light & other objects patient
requires are within reach
5. As needed care: is provided as required by the client.
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4. Hours of sleep care
1. Culture. E.g. have a bath once or twice a day
2. Religion.
3. Environment.
4. Development level.
5. Health and energy.
6. Personal preferences
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Factor influencing individual hygiene
1. Visual impairment.
2. Activity intolerance or weakness.
3. Pain or discomfort.
4. Mental impairment.
5. Therapeutic procedures.
6. Skeletal impairment.
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Etiologies of self care deficit
Functional level of the patient may described as following:
1. Total dependent.
2. Partial dependent.
3. Independent.
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Functional level of the patient
Definition
Skin define as is the largest organ that cover all surface of the body.
The skin contains:
• Epidermis.• Dermis.
• Subcutaneous layer.
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Skin
1) Protection:
a) From micro organism.
b) From dehydration.
c) From ultraviolet.
d) Mechanical trauma.
e) Pain
f) Heat and cold
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Functions of the skin
2) Sensation: different somatic sensory receptors that detect stimuli.
3) Excretion by regulating the volume & chemical
content of sweat.
4) Vitamin D production .
6) Regulation of body temperature.
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Functions of the skin cont’d
Assessment:
Assessment of the client’s skin & hygienic practices includes:
a. A nursing health history to determine the client’s skin care practices.
b. physical assessment of the skin.
c. Identification of client at risk for developing skin impairments.
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Nursing management
1. History, skin color and condition , uniformity, texture.
turgor , temperature, intact and lesions. Moisture,
sensation, Pain on movement , level of
consciousness ,injuries, scars ,wt loss or gain
Nursing assessment while bathing
1. Immobility
2. Dehydration
3. Altered nutrition
4. Altered sensation
5. Secretions on skin
6. Altered venous circulation
7. Altered level of consciousness
8. Mechanical devices, casts, restraints
Patients at risk for skin problems
1) Bathing: practice that use soap and water to remove
sweet, oil, dirt, and microorganism from skin.
Type of bathing:
1. Tube bath.
2. Partial bath.
3. Bed bath.
Practices related skin care
• For all clients who are independent and there no
safely risk.
• Nurse should encourage clients to take shower
independent.
• Most bath room are equipped with rails and handle to
promote client safety.
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1. Tube Bath
oWashing only body area that are directly cause odor ( face, hand, axillae, perineal area).
o Partial bathing done at sink or with basin at bed side .e.g
Perineum: oArea around the genital and rectum, its required
special cleaning technique.
When perineal care:o After vaginal delivery.o Gynecological or rectal surgery.o After elimination (urine or stool)
2. Partial bath
oWashing with a basin of water at the bed side.
oFor client who cannot take shower independently.
Types of patients needing bed bath
1. Unconscious patient.
2. Operated patient.
3. Orthopedics patient.
4. Seriously ill patients.
3. Bed bath:
2) Shaving:• To remove unwanted body hair.
3) Oral hygiene:• Practice used to clean the mouth includes:• Tooth brushes and flossing.• Denture care.
4) Hair care:
hair grooming, shampooing and identify patient usual hair practice and styling preferences
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5) Bed making:
Make bed for patient comfort• If incontinent, wash, rinse, dry, change linen• Use aids to relieve pressure points• heel, elbow protectors• bed frame with trapeze• special beds and mattresses• Position as ordered
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1. Self care deficit (bathing, grooming, and dressing) R/T pain.
2. Knowledge deficit R/T lack of experience.
3. Self esteem disturbance R/T body odor.
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Diagnosis
1. Thin and obese people.
2. Fluid loss.
3. Excessive perspiration
4. jaundice.
5. Age.
6. Poor circulation.
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Causes of skin alteration
Decubitus ulcers
Description:
Decubitus ulcers (pressure sores) are localized areas of cellular necrosis on the skin & subcutaneous tissue
Etiology
Decubitus ulcers or pressure sores result from excessive
pressure on body areas, particularly over bony
prominences. &old adult patients
Major risk factors:
1. Include decreased or limited activity
2. Immobility
3. Malnutrition
4. Incontinence
5. Impaired circulation & sensation.
Assessment findings
Clinical manifestations:• vary according to the stage in which the ulcer is
classified. • The appearance of purulent drainage or foul odor
suggests an infection.
Stages of Pressure Sores
In stage one: The area is red ,edema & congestion, & the client
complains of discomfort.
How to recognize: Skin is not broken but is red or discolored.
Stage Two
The reddened area is break in the skin through the epidermis or dermis; an abrasion, blister, may be seen How to recognize: The epidermis or topmost layer of the skin is broken, creating a shallow open sore. Drainage may or may not be present.
The ulcer extends into the subcutaneous tissue with necrotic tissue , & exudates.
How to recognize:
The break in the skin extends through the dermis (second skin layer) into the subcutaneous and fat tissue. The wound is deeper than in Stage Two.
Stage Three
Stage IV
• The ulcer extends into the underlying structures, including the muscle & possible the bone.
• How to recognize: The breakdown extends into the muscle and can extend as far down as the bone. Usually lots of dead tissue and drainage are present.
Nursing Assessment:
1. Assess for risk factors for pressure sore development & alter those factors if possible.
2. Assess skin of the older adult frequently for the development of pressure sores.
3. Stage the ulcer so appropriate treatment can be started.
Nursing & Patient Care Considerations
Prevent Pressure Sore Development
1. Provide meticulous care & positioning for immobilized patients.
2. Inspect skin several times daily.
3. Wash skin with mild soap, rinse, and dry with a soft towel.
4. Lubricate skin with lotion.
5. Avoid mattress that is covered with plastic.
6. prevent incontinence.7. Encourage ambulation & exercise. 8. Promote nutritious diet with optimal protein,
vitamins, and iron.9. Teach older adult & family the importance of good
nutrition, hydration, activity, positioning, and avoidance of pressure, shearing, friction, and moisture
Nursing & Patient Care Considerations
Relieve the Pressure
• Avoid elevation of head of bed grate than 30 degrees.• Reposition every 2 hours.• Use special devices to cushion specific areas, • Use an alternating-pressure mattress for patients at high
risk to prevent or treat pressure sores.• Provide for activity and ambulation .• Advise frequent shifting of weight and occasional
raising of bottom off chair while sitting.
Clean and Debride the Wound
• Use normal saline for cleaning & disinfecting wounds.
• Apply wet-to-dry dressings or enzyme ointments for debridement as directed; or assist with surgical debridement.
Treat Local Infection• Apply topical antibiotics to locally infected pressure
ulcer as prescribed.
Cover the Wound With a Protective Dressing
Bed Sore cont’d
Elbow
Hips HeelEars
Inner Knees
Lower backScapula
OcciputElbow
1. Bed-ridden patients
2. Obese patients
3. Very thin patient
4. Patients in traction
5. Patients in complete bed rest
6. Diabetic patients
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Patients prone to pressure sores
1. Redness, heat, and discomfort in the area.
2. Area become cold to touch
3. Area become blue
4. Gangrene formation
5. Sloughing and infection
Causes of bed sore:
6. Pressure
7. Friction
8. Moisture
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Signs and symptoms of bed sore
1) Find out and detect the patients who are
2) Daily observation of the pressure point
3) Stimulate circulation
4) Relive pressure by:
a. Moving the patient in bed
b. Changing position every 2 hours
c. Use a bed cradle to take the weight off the linen
d. Use pillows between legs
e. Early ambulation of the patient
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Prevention of bed sore