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Purposes of Hygienic care
- Maintenance of personal hygiene: psychological well being, bacterial elimination,
- Protection: against skin breakdown
- To improve Circulation: ↑ Activity leads to ↑circulation; wash distal to proximal with long, strong strokes to improve venous return.
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FActor that influence hygien and self care practices
- Psychosocial factors: routines, habits, personality quibbles.
- Personal preferences
- Culture and religion: privacy issues, timing, taboos against animal products, hair care, etc.
- Economic status: homeless? running water? power?
- Developmental level: infants, elderly, adults will have different motor skills and special needs related to skin care, mobility, etc.
- Knowledge level: will be doing tons of teaching.
- Physical factors: health status, mobility, can pt assist?
- Cognative: Depressed, ALOC,
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Nursing Roles
- Assess self-care abilities: Encourage as mucindependence as possible. Your pt is the 4th of July! Bathing is one of the best opportunities to assess your pt. ROM? Exersion tolerance? Skin integrity? LOC?
- Provide assistance with ADLs (as needed)
- Promote self-care in ADLs
- Delegate appropriate parts of hygiene care
- Always remember confidentiality!
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Things you might not think about that can affect skin condition
- Illness: All the symptoms of the illness.
- Changes in weather
- Changes in lifestyle: smoking, drugs, hiegyne
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Risk factors for alteration in skin integrity
- Immobility: bed sores
- Limited activity levels
- Incontinence: urine/feces break down skin.
- Impaired nutritional status
- Infection
- Anemia
- Diminished sensations
- Altered level of consciousness
- Cachexia (emaciation)
- Friction and shear injury
- Obesity
- Hydration
- Aging skin
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Nursing Intervensions to reduse risk to skin.
- Use soap sparingly: will dry skin.
- Rinse well
- Use only light friction
- Bathe less frequently: Not daily. Pt. is in a "sterile" enviroment so not necessary.
- Use moisturizing lotions and creams
- Increase fluid intake: to replace lost fluids.
- Reposition patient q2h
- TED/SCD (Sequential Compression Device) Hose: Compression stockings. SCDs actually inflate and massage. Decreases DVTs. Makes sure they fit, and fit can change espeically if edema decreases.
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Identifying Level of Impairment in Skin Integrity
- Tissue ischemia: lack of blood flow
- Blanching: lack of refill
- Normal reactive hyperemia: normal erythema which will blanch and return to normal normal color < 1hr.
- Abnormal reactive hyperemia: Skin will not blanch, erythema doesn't go away.
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Diagnosis
- Nurse's clinical judgement about the response to actual or ptoential health conditons or needs.
- Self-Care Deficit Bathing/Hygiene
- Ineffective Health Maintenance
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Scheduling
- Early morning care: on awakening – wash face and hands, mouth care
A.M. care: after breakfast – bathing, toileting, hair, skin, bedmaking
- P.M. care: afternoon – toileting, hand washing, oral care, readying for visitors
- H.S. (before bed) care: prior to sleep – relaxation activities, readying environment to facilitate sleep
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Hygiene planing
- Privacy: door open, bed pointing in inopportune position
- Safety: bed rails/locks
- Warmth
- Independence: Bed rest? ambulatory?
- Supplies
- Anticipate patient needs
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Delegating Hygiene Care
- Assess prior to delegating
- Instruct UAP (Unlicensed Assisstive Personel) regarding...
- Client’s limitations
- Amount of assistance needed
- Use of assistive devices
- Presence and care of tubes
- Observations to make during hygiene care, ie what are we looking for here?
Must reassess after delegated activities have been performed.
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Types of Baths
- Assist bath: Bathe areas hard to reach, ie nooks and crannies.
- Partial bath: only the good parts. The "bear" necessities.
- Bathe only those areas absolutely necessary, including perineum
- Bed bath
- CompletePartial
- Help bath
- Towel Bath
- Bag Bath
- Shower: usually in a chair.
- Tub: Pretty rare now.
- Therapeutic bath: OT, PT
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Considerations Prior to Bath
- Review orders
- Explain procedure
- Prepare room
- Assemble equipment
- Offer a bedpan: Warm water makes you pee. It will make your pt pee too.
- Water or bag bath temperature: ~100.5. No microwaves.
- Privacy
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The Bed Bath
- Maintain Comfort
- Temp -105 degrees F
- Use soap/oil: Move clean --> dirty. Save the butt/groin for last.
- Proper lighting
- Eliminate odors
- Maintain Distal to Proximal: Remember we're trying to improve venous return.
- Support extremities
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Eyes, Ears, Nose, Mouth
- Inner to outer canthus.
- Remove artificial eye (depress on lower lid to pop out
- Remove hearing aids.
- Reposition nasal tubes to wash around. Use water soluble lubricant. No Vaseline! Will ignite with O2.
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Oral Care
- Oral care facilitates:
- Removal of food particles and secretions
- Improved appetite
- Assessment of client’s oral status: Especially for pt on vent, inspect at least twice daily to prevent VAP (Ventilator Assisted Pneumonia). Also, if pt has dentures, remove and look at oral cavity.
- Care of dentures
- Assessment of the oral cavity
- If pt is unconscious, position pt on side (to prevent aspiration) and use mouth swabs with suction.
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Other Areas of Hygienic needs
- Care of the feet: Usually will not clip nails, especially with diabetic pts. Will not be able to feel their feet.
- Special considerations for care of the diabetic client
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Care of the nails
: File only.
- Hair care: Can use dry shampoo if necessary.
- Special considerations for cultural variations in hair
- Care for mustaches and beards
- Backrubs: Slow, sliding strokes up the back = efflourage
- Perineal Care: Encourage self care, remember privacy.
- Contact lenses? Use their cleaner.
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Bed Making
- Linens : clean, dry, wrinkle free (do not through used linens on floor). Do not fluff! Do not tuck under chin.
- Medical asepsis
- Proper body mechanics
- Privacy, comfort and safety
- Avoid the floor
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Evaluation
- How did the patient tolerate the procedure?
- Documentation:
- Type of bath
- Patient’s level of assistance
- Any assessment findings
- Tolerance to procedure
- Patient status
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