Basic Nursing: Foundations of

Skills & Concepts Chapter 20

SAFETY/HYGIENE

Safety

The number one priority in providing client care.

Prevention is the key to safety.

Factors Affecting Safety

Age. Lifestyle. Sensory and Perceptual Alterations. Mobility. Emotional State.

Causes of Accidents in the Health Care Setting

Client behavior accidents (e.g. poisoning, burns, self-inflicted cuts and bruises).

Therapeutic procedure accidents (medication errors, falls during transfers, contamination of sterile instruments or wounds, etc.).

Equipment accidents (malfunctioning or improper use of medical equipment).

Hygiene

The science of health.

Promotes cleanliness, provides for comfort and relaxation, improves self-image, promotes healthy skin.

Factors Influencing Hygiene

Body Image. Social and Cultural Practices. Personal Preferences. Socioeconomic Status. Knowledge.

Cultural Considerations and Hygiene

Some cultures do not permit women to immerse their bodies in water during menstruation for fear they will drown.

In North America, people typically bathe daily and use deodorants.

In Europe, many people do not bathe daily or use deodorants.

Nursing Process: Assessment

What things do you do to stay healthy?

Do you need assistance with bathing and dressing?

Do you regularly visit the eye doctor and dentist?

Do you floss regularly?

Do you wash your hands before preparing food?

Do you keep meats and dairy products refrigerated before using?

Is there a smoke detector or fire extinguisher in your home?

Assessment: Appraisals

Nurses will assess clients for risk with two main tools:

Skin Integrity Risk Appraisal.

Fall Risk Appraisal.

Nursing Diagnosis

After data collection and analysis, the main nursing diagnoses that relate to safety and hygiene deficits are: Injury, Risk for. Risk for. Self-Care Deficits.

7 Subcategories of Risk

Aspiration, Risk for.

Disuse Syndrome, Risk for.

Poisoning, Risk for.

Suffocation, Risk for.

Trauma, Risk for.

Latex Allergy Response.

Latex Allergy Response, Risk for.

Self-Care Deficit

A condition that exists when an individual is not able to perform one or more activities of daily living.

Implementation and Hygiene

Implementation involves continual assessment of client health risks and prioritization of such nursing interventions as: Administration of prescribed medications. Provision of balanced nutritional intake. Promotion of adequate rest and exercise. Teaching client about health hazards.

Reducing the Risk for Client Falls

Orienting the client to the environment and the call system.

Providing ambulatory aids (e.g. wheelchair or walker).

Placing personal belongings and call light within easy reach.

Proper supervision. Keeping hospital beds

in the lowest position and side rails up.

Using nonslip mats and rugs.

Illuminating the environment.

Nursing Interventions and Prevention of Falls

Specific nursing interventions aimed at preventing falls include: Wiping up spills. Encouraging use of side rails. Applying restraints. Encouraging use of assistive devices for walking. Using proper body mechanics. Ensure adequate lighting. Removing obstacles.

Restraints

Protective devices used to limit the physical activity of a client or to immobilize a client or extremity.

Types of Restraints

Physical (reduces the client’s movement through the application of a device).

Chemical (medications used to control a client’s behavior).

Acceptable Reasons for Restraints

They are a legitimate part of the medical treatment.

All other interventions have been tried first. Other disciplines have been consulted for

assistance with the problem. Supporting documentation has been

provided.

Key Elements of Restraint Documentation

Reason for the restraint. Method of restraint. Explanation given to

client and family. Date and time of and

client’s response. Duration.

Frequency of observation and client’s response.

Safety. Assessment of continued

need. Client outcome.

Assistive Devices for Walking

Canes. Crutches. Walkers. Wheelchairs.

Using Proper Body Mechanics

The safest way of lifting and moving things is to use these principles of body mechanics: Center of gravity (pelvic area).

Base of support (the feet).

Body alignment.

Fire Prevention

Nursing interventions aimed at preventing or reducing risk of fire include: Clearly marking fire exits. Knowing locations and operation of fire extinguishers. Practicing fire evacuation procedures. Posting emergency phone numbers. Keeping open spaces and hallways clear of clutter. Checking wiring. Educating clients about fire hazards.

Reducing Exposure to Radiation

Minimizing the time spent in contact with radiation source.

Maximizing distance from radiation source. Using appropriate radiation shields. Monitoring radiation exposure with a film badge. Labeling all potentially radioactive material. Never touching dislodged implants or body fluids of

person receiving radiation therapy.

Nursing Interventions and Hygiene

Providing clean bed linen.

Reducing noise pollution. Providing for client’s

bathing needs. Offering back rubs. Providing perineal care.

Providing foot and toenail care.

Oral care. Hair care. Eye, ear and nose care.

Bathing Clients

Bathing of clients is an essential component of nursing care that falls into two general categories:

Cleansing baths (Shower bath, tub bath).

Therapeutic baths (hot, warm, cool, tepid; soak or sitz; oatmeal, cornstarch, or sodium bicarbonate).

Providing Oral Care

Common problems occurring in the oral cavity include: Bad breath (halitosis). Cavities (dental caries). Plaque. Periodontal disease (pyorrhea). Inflammation of the gums (gingivitis). Inflammation of the oral mucosa (stomatitis).