hygeine powerpoint

Kozier & Erb's Fundamentals of Nursing, 8eBerman, Snyder, Kozier, ErbCopyright 2008 by Pearson Education, Inc.

Chapter 33Hygiene

Copyright 2008 by Pearson Education, Inc.

Learning Outcomes

1. Describe hygienic care that nurses provide to clients.

2. Identify factors influencing personal hygiene.3. Identify normal and abnormal assessment

findings while providing hygiene care.4. Apply the nursing process to common problems

related to hygienic care of the skin, feet, nails, mouth, hair, eyes, ears, and nose.

5. Identify the purposes of bathing.6. Describe various types of baths.


Learning Outcomes

7. Explain specific ways in which nurses help hospitalized clients with hygiene.

8. Describe steps for identified hygienic-care procedures.

9. Identify steps in removing contact lenses and inserting and removing artificial eyes.

10. Describe steps for removing, cleaning, and inserting hearing aids.

11. Identify safety and comfort measures underlying bed-making procedures.


Pretest

• Use your clickers to complete the following pretest.


Question 1

The client is unresponsive and requires total care. Prior to providing oral care, the nurse should assess for which of the following?

1. Presence of pain2. Condition of the skin3. Gag reflex4. Range of motion


Rationales 1

1. More appropriate prior to bathing the client.2. More appropriate prior to bathing the client.3. Correct. The client will be positioned in a

sidelying position with the head of the bed lowered because the client is at risk for aspiration. The absence of gag reflex lets the nurse know that the client has no natural defense (cough) and is at a higher risk for aspiration.

4. More appropriate prior to bathing the client.


Question 2

The client is in surgery and will be returning to his bed via a stretcher. The nurse plans ahead by making which type of bed and placing the bed in which position?

1. An open bed in low position2. An occupied bed in low position3. A closed bed in high position4. A surgical bed in high position


Rationales 2

1. Incorrect.2. Incorrect.3. Incorrect. 4. Correct. Both the placement of

the linens for a surgical bed and placing the bed in a high position facilitate the client’s transfer from a stretcher into the bed.


Question 3

The nurse is observed the UAP perform perineal care for a client. Which of the following actions indicates that further teaching is required?

1. Uses a clean portion of the washcloth for each stroke.

2. Wipes from the pubis to the rectum.3. Uses clean gloves.4. Does not retract the foreskin.


Rationales 3

1. This is appropriate.2. This is appropriate.3. This is appropriate.4. Correct. It is important to retract

the foreskin to remove the smegma that collects under the foreskin and can cause bacterial growth.


Question 4

The nurse is discussing foot care with a client who was recently diagnosed with diabetes. Which of the following statements indicates a need for further teaching?

1. “I am going to use a mirror to check my feet.”2. “I enjoy walking barefoot around the house.”3. “I will file my nails.”4. “I will increase the time that I wear new shoes

each day.”


Rationales 4

1. This is appropriate.2. Correct. The client needs to avoid

walking barefoot as that could cause injury which may result in an infection. Also, neurological impairment is likely which may result in decreased sensation. The client would be unaware of an injury.

3. This is appropriate.4. This is appropriate.


Question 5

The client experiencing labored, shortness of breath has a respiratory rate of 28. The bed is currently in the flat position. The best nursing intervention includes putting the bed in which of the following positions?

1. Fowler’s2. Semi-Fowler’s3. Trendelenburg4. Reverse Trendelenburg


Rationales 5

1. Correct. Fowler’s is a semi-sitting position which should ease the client’s breathing.

2. The HOB in semi-Fowler’s is lower. 3. The HOB is lowered in the Trendelenburg

position. 4. The HOB is raised in the reverse

Trendelenburg position, it is a straight tilt and may not be as comfortable as Fowler’s.


Hygienic Care

• Involves care of:– Skin– Hair– Nails– Teeth– Oral and nasal cavities– Eyes– Ears– Perineal-genital area


Types of Hygienic Care

• Early morning-offer urinal/bedpan, wash face & hands, & give oral care.

• Morning – after breakfast, bedpan/urinal, bath/shw, perineal care, back massage & oral, nail & hair care.

• Hours of sleep (HS) or PM-bedpan/urinal, washing hands & face, oral care, & backrub.

• As needed (prn)- care as needed


Factors Influencing Personal Hygiene

• Culture-some bath daily, some weekly. Body odor accepted in some cultures, privacy vs communal

• Religion-ceremonial washings• Environment-financial limitations


Factors Influencing Personal Hygiene

• Developmental level-children learn at their ability

• Health and energy-illness, motivation

• Personal preference- shower vs bath, AM vs PM


Figure 33-9 An African American’s hair styled with braids.


Figure 33-10 Shaving in the direction of hair growth.


Bed-Making

• Provide smooth, wrinkle-free bed foundation

• Place the bedside table/overbed table within reach

• Leave the bed in the high position if returning by stretcher

• Leave in the low position if returning to bed after being up


Bed-Making

• When turning the client to the side while making an occupied bed, raise the side rail nearest the client

• To ensure continued safety of the client after making an occupied bed:– Raise the side rails– Place the bed in the low position– Put items used by the client within easy

reach– Attach the signal cord


Figure 33-18 Mitering the corner of a bed.

A


Figure 33-18 (continued) Mitering the corner of a bed.

B



C



D



E


Abnormal Findings of the Skin K744

• Abrasion- • Excessive dryness -• Ammonia dermatitis - • Acne -• Erythema• Hirsutism


Abnormal Findings of the Feet

• Excessive dryness• Areas of inflammation or swelling• Fissures• Scaling and cracking of skin• Plantar warts• Swelling and pitting edema• Weak or absent pulses • Cool skin temperature in one or both

feet


Abnormal Findings of the Nails

• Spoon nails• Excessive thickness or clubbing• Grooves or furrows• Beau’s lines• Discolored or detached• Bluish or purplish tint or pallor• Hangnails or paronychia• Delayed capillary refilling time


Figure 33-4 Fingernails are trimmed straight across.


Abnormal Findings of the Mouth K765

• Halitosis• Glossitis• Gingivitis• Periodontal

disease• Reddened or

excoriated mucosa• Excessive dryness

of the buccal mucosa

• Cheilosis (cracked lips)

• Dental caries• Sordes

(accumulation of foul matter on teeth & lips)

• Stomatitis• Parotitis


Abnormal Findings of the Hair

• Dandruff• Hair loss• Ticks• Pediculosis• Scabies

• Hirsutism


Abnormal Findings of Eyes

• Loss of hair, scaling, flaky eyebrows• Redness, swelling, flaking, crusting,

discharge, asymmetrical closing, ptosis of eyelids

• Jaundiced sclera• Unequal pupils• Pupils fail to dilate or constrict• Inability to see


Abnormal Findings of Ears

• Asymmetrical, excessively red or tender auricles

• Lesions, flaky, scaly skin over auricles

• Normal voice tones not heard


Abnormal Findings of the Nose

• Asymmetrical • Discharge• Localized redness, tenderness or

lesions


Nursing Process: Assessment

• Nursing history to determine:– Self care practices– Self-care abilities– Past or current problems– Identification of clients at risk for

developing impairment

• Physical assessment


Nursing Process: Nursing Diagnoses

• Deficient knowledge• Situational low self-esteem• Risk for impaired skin integrity• Impaired skin integrity• Self-care deficit• Risk for infection• Impaired oral mucous membrane• Disturbed body image• Risk for injury


Nursing Process: Planning

• Nurse and, if appropriate, the client and/or family set goals/desired outcomes

• Nurse identifies interventions to assist the client to achieve the designated outcomes


Nursing Process: Interventions

• Assisting dependent clients with hygiene activities

• Educating clients and/or family about appropriate hygienic practices

• Demonstrating use of assistive equipment and adaptive activities

• Assessing and monitoring physical and psychological responses


Purposes of Bathing

• Remove transient microorganisms, body secretions and excretions, and dead skin cells

• Stimulate circulation• Produce a sense of well-being• Promote relaxation and comfort• Prevent or eliminate unpleasant body

odors


Categories of Baths

• Cleansing baths• Therapeutic baths


Types of Baths

• Complete bed• Self-help • Partial • Bag• Tub • Sponge • Shower


Bath Equipment


Hospitalized Client

• Early morning care – Urinal or bedpan– Washing face and

hands– Oral care

• Morning care– Usually after

breakfast– Elimination– Bath or shower– Perineal care– Back massage– Oral, nail, and hair

care


Hospitalized Client

• Hour of sleep (HS) or P.M.– Elimination– Washing face and

hands– Oral care– Back massage

• As needed (prn)– As required by

client need• More frequent

bathing• Changes of clothes


Bathing an Adult or Pediatric Client: Skill 33-1


Providing Perineal-Genital Care

Skill 33-2


Figure 33-5 The anatomic parts of a tooth.


Figure 33-8 Example of a foam swab used to clean the mouth of a dependent client.


Brushing and Flossing TeethSkill 33-4


Artificial DenturesSkill 33-4


Oral Care for the Unconscious Client: Skill 33-5


Shampooing Hair of Client Confined to Bed: Skill 33-7


Removing Contact Lenses


Inserting and Removing Artificial Eye


Figure 33-17 (continued) A, An in-the-ear hearing aid. B, Small hearing aid in ear canal. C, Large hearing aid in ear canal. (Source: Jane Schemilt; Science Photo Library/Photo Researcher’s, Inc.)

B


Figure 33-17 (continued) A, An in-the-ear hearing aid. B, Small hearing aid in ear canal. C, Large hearing aid in ear canal. (Source: Jane Schemilt; Science Photo Library/Photo Researcher’s, Inc.)

C


Figure 33-16 (continued) A, A behind-the-ear hearing aid. B, A behind-the-ear hearing aid attached to glasses.

B


Figure 33-17 A, An in-the-ear hearing aid. B, Small hearing aid in ear canal. C, Large hearing aid in ear canal. (Source: Jane Schemilt; Science Photo Library/Photo Researcher’s, Inc.)

A


Removing, Cleaning, and Inserting Hearing Aids


Post Test

• Use your clickers to complete the following post test.