hygiene and self-care craven ch. 23 2/5/2016nrs 320 collings1
DESCRIPTION
Bathing & Hygiene How did it feel to be the ‘patient’? To be the provider? It is difficult for most people to adjust to the level of dependence to have another person perform routine hygiene care It is difficult for most people to adjust to the level of dependence to have another person perform routine hygiene care It is also difficult to forgo basic hygiene! It is also difficult to forgo basic hygiene! 2/5/2016NRS 320 Collings3TRANSCRIPT
HYGIENEHYGIENEand Self-Careand Self-Care
Craven Ch. 23 Craven Ch. 23
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ImportanceImportance Self – CareSelf – Care: ability to independently perform : ability to independently perform
functions of:functions of: BathingBathing DressingDressing FeedingFeeding ToiletingToileting
Independence in these basic areas enhances Independence in these basic areas enhances health and emotional well-being, dignityhealth and emotional well-being, dignity
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Bathing & HygieneBathing & Hygiene How did it feel to be the ‘patient’?How did it feel to be the ‘patient’? To be the provider?To be the provider?
It is difficult for most people to adjust to the It is difficult for most people to adjust to the level of dependence to have another person level of dependence to have another person perform routine hygiene careperform routine hygiene care
It is also difficult to forgo basic hygiene!It is also difficult to forgo basic hygiene!
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BathingBathing
Intact skin is first line of defense against Intact skin is first line of defense against infectioninfection
Regular bathing removes perspiration, Regular bathing removes perspiration, bacteria, oil from the skinbacteria, oil from the skin Increases circulationIncreases circulation Maintains muscle & joint mobilityMaintains muscle & joint mobility Promotes relaxationPromotes relaxation Provides a sense of well-being & comfortProvides a sense of well-being & comfort Time for assessment & interactionTime for assessment & interaction
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Basic PrinciplesBasic Principles Wash from Wash from clean to dirtyclean to dirty Maintain Maintain privacyprivacy, dignity, dignity Incorporate Incorporate patientpatient preferencespreferences & values & values Distal to proximal Distal to proximal motion increases venous motion increases venous
returnreturn EBPEBP: :
Basin bath Basin bath is associated with increase in infection is associated with increase in infection ratesrates
Peri-carePeri-care is often omitted; associated with UTI is often omitted; associated with UTI Turn Turn unconsciousunconscious pt to side for oral care pt to side for oral care
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Oral CareOral Care
Helps maintain strong healthy teeth & Helps maintain strong healthy teeth & gumsgums
Prevent tooth lossPrevent tooth loss Increase saliva, taste, comfortIncrease saliva, taste, comfort Prevent Prevent pneumoniapneumonia
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Types of bathsTypes of baths
Tub, shower, sit-down showerTub, shower, sit-down shower Bed bath [partial/complete]Bed bath [partial/complete] Bag bath or towel bathBag bath or towel bath Partial bath [sink bath]Partial bath [sink bath]
Consider energy, ability of ptConsider energy, ability of pt Choose bath type that enhances Choose bath type that enhances
independence while providing benefitsindependence while providing benefits Provide supplies, assist as neededProvide supplies, assist as needed
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Foot CareFoot Care Disease state, ROM, perfusion affect needs Disease state, ROM, perfusion affect needs
and abilities R/T foot careand abilities R/T foot care Good foot care and education essentialGood foot care and education essential Diabetes, PVDDiabetes, PVD Do not soak feet [dryness - cracking – skin Do not soak feet [dryness - cracking – skin
breakdown and infection riskbreakdown and infection risk AssessAssess for temperature, circulation, sensation, for temperature, circulation, sensation,
woundswounds EducationEducation – daily VSE, good shoes, report – daily VSE, good shoes, report
changeschanges
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Other hygiene needsOther hygiene needs
ShavingShaving in direction of hair growthin direction of hair growth Electric shaver if on anticoagulant TXElectric shaver if on anticoagulant TX
Glasses & contactsGlasses & contacts Clean dailyClean daily
Hearing AidsHearing Aids Check battery, clean per policy, replaceCheck battery, clean per policy, replace
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FeedingFeeding
DysphagiaDysphagia: difficulty swallowing: difficulty swallowing Assess patients for dysphagia before feedingAssess patients for dysphagia before feeding SupervisionSupervision Assistive devicesAssistive devices ConsistencyConsistency
• Thickened liquids easier to swallowThickened liquids easier to swallow Separate flavors, do not mixSeparate flavors, do not mix
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ToiletingToileting
AssessAssess level & type of assistance needed level & type of assistance needed Assist to BRAssist to BR Raised seat/grab bars/commode chairRaised seat/grab bars/commode chair BSCBSC Urinal/bedpanUrinal/bedpan
Provide Provide privacyprivacy while maintaining safety while maintaining safety Provide Provide hand hygiene hand hygiene for patientfor patient AssessAssess need for assistance with peri-care need for assistance with peri-care
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DressingDressing AssessAssess needs, abilities, energy level needs, abilities, energy level AnalgesiaAnalgesia if indicated if indicated Allow Allow timetime Provide Provide choiceschoices when possible when possible RoutineRoutine for cognitive deficits for cognitive deficits AidsAids [shoehorn, zipper pull, Velcro] help [shoehorn, zipper pull, Velcro] help
maintain independencemaintain independence PrivacyPrivacy
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Other considerationsOther considerations
Personal itemsPersonal items:: Overbed table s/b clean, neatOverbed table s/b clean, neat Personal items, call light within easy reachPersonal items, call light within easy reach Trash nearby and/or bag taped to bedrailTrash nearby and/or bag taped to bedrail
BedBed placed in position of comfort, placed in position of comfort, appropriate for activity & pt needsappropriate for activity & pt needs
LinensLinens s/b changed in conjunction with s/b changed in conjunction with bathingbathing Medical asepsisMedical asepsis
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CRITICAL EVALUATIONCRITICAL EVALUATION WHAT IS THE ABILITY OF THIS WHAT IS THE ABILITY OF THIS
PERSON TO CARE FOR THEMSELVES?PERSON TO CARE FOR THEMSELVES? PHYSICAL DisabilityPHYSICAL Disability MENTAL DisabilityMENTAL Disability Lack of KnowledgeLack of Knowledge Lack of resourcesLack of resources → → Self-care deficitsSelf-care deficits
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CRITICAL EVALUATIONCRITICAL EVALUATION ARE THERE ANY ARE THERE ANY CULTURALCULTURAL ISSUES ISSUES
THAT NEED TO BE ADDRESSED PRIOR THAT NEED TO BE ADDRESSED PRIOR TO BATHING? TO BATHING? Privacy, Gender, OtherPrivacy, Gender, Other
WHAT DO YOU DO WITH THIS WHAT DO YOU DO WITH THIS INFORMATION ABOUT THE PATIENT?INFORMATION ABOUT THE PATIENT? CARE PLANCARE PLAN
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NURSING NURSING DIAGNOSISDIAGNOSIS SELF-CARE DEFICIT: (BATHING) R/T SELF-CARE DEFICIT: (BATHING) R/T
confusion, fatigue: AEB unwashed hair, confusion, fatigue: AEB unwashed hair, body odor, incontinent episodebody odor, incontinent episode
SELF-CARE DEFICIT: feeding R/T SELF-CARE DEFICIT: feeding R/T unilateral weakness, difficulty (2* to unilateral weakness, difficulty (2* to RECENT CVA) AEB Right sided weakness, RECENT CVA) AEB Right sided weakness, inability to feed self, weight loss of 1 lb. in 5 inability to feed self, weight loss of 1 lb. in 5 daysdays
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Self-Care Deficit Self-Care Deficit PlanningPlanning
Goal/Outcome:Goal/Outcome: Overall goals are increased Overall goals are increased independenceindependence
and and safetysafety1.1. Pt will participate in hygiene routine this Pt will participate in hygiene routine this
morningmorning2.2. Pt will demonstrate ability to feed himself Pt will demonstrate ability to feed himself
using assistive devices [large-handled using assistive devices [large-handled utensils] within 24 hoursutensils] within 24 hours
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ImplementationImplementation
AssessAssess functional abilities/ areas of deficit functional abilities/ areas of deficit Assess Assess resourcesresources available available
Is patient aware of/using available aids?Is patient aware of/using available aids? EducationEducation, referrals, encouragement, referrals, encouragement
Provide appropriate education, assistive Provide appropriate education, assistive devicesdevices, help, , help, referral referral [OT/PT, home health, Meals on Wheels…][OT/PT, home health, Meals on Wheels…] Provide Provide encouragementencouragement EvaluateEvaluate results of interventions results of interventions
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EvaluationEvaluation
Was the goal metWas the goal met??1.1. Was Pt able to assist in a.m. hygiene?Was Pt able to assist in a.m. hygiene?
• If If yesyes, move to higher-level goal [more , move to higher-level goal [more independence]independence]
• If not, reassess patient needs, methods, goal…If not, reassess patient needs, methods, goal… Revise plan; provide shower chair at sink this p.mRevise plan; provide shower chair at sink this p.m..
2.2. Goal met; patient demonstrated ability to feed self Goal met; patient demonstrated ability to feed self >75% of all meals today using assistive utensils. >75% of all meals today using assistive utensils. Continue with plan; OT to assess food preparation Continue with plan; OT to assess food preparation needs/abilities prior to discharge in 48 hoursneeds/abilities prior to discharge in 48 hours
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Questions?Questions?
Discussion?Discussion?
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