HYGIENE MODULE

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HYGIENE MODULE

• Dr. Anita Catlin
• Sonoma State University
• N205

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Hygiene involves cleansing of the

• Skin
• Mouth
• Teeth
• Hair
• Nails

• Eyes
• Ears
• Nose
• Perineal Area
• Feet

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HYGIENE

• Cleansing by nurse is part of historical giving
  of care
• The more ill the patient, the more skill needed
  in providing the hygiene care
• Cleansing skin is first line of defense against
  organisms
• Mucous membranes also defend
• Gastric secretions as well

4
WHY A NURSING FUNCTION?

• Assessment
• Teaching
• Comfort
• Touch
• Relaxation
• Pain Relief
• Caring

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ATTENTION TO BODY IMAGE ISSUES

• Body image is the meaning that the person
  attaches to body part
• Person may have radical changes in body image
• You may be one of first to see this
• How nurse responds to body image changes sets
  tone to last a lifetime

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HYGIENE includes

• Cleansing of patient
• Bedmaking
• Room straightening
• Emptying garbage
• Removal of used supplies, dishes, flowers,
  newspapers, etc.
• Assessing patency of and cleansing equipment
• Placement of necessary supplies

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SOCIOCULTURAL FACTORS

• Americans bathe daily not all cultures do
• Economics is an influence
• Different cultures shave different body parts and
  hair on head differently
• Some cultures wear items not to be removed in
  bath
• examples wigs, headdressings, amulets, turbans,
  religious medals or shawls
• Male nurse only or female nurse only may be
  necessary in some cultures

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SOCIOCULTURAL FACTORS

• In some cultures, male relative may not allow
  male nurse alone with woman patient
• In some cultures, autonomy of patient is
  paramount in others, family makes decisions for
  care
• Level of education may influence care
• Legal and presumptive relationships
• Gay and lesbian partners
• Teen friends of emancipated minors
• Nurse accepts all who lovingly participate

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POVERTY OR HOMELESSNESS

• Influences hygiene
• May have body parasites
• May have unhealed/untreated wounds
• Dental caries
• Clotting problems from alcohol
• Drug entry sites, abscesses
• Need to use standard precautions

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KNOWLEDGE LEVEL

• May need teaching regarding
• Front to back perineal care
• Brushing gum line, not teeth
• Special foot care for circulatory problems
• Skin inspections by dermatologist

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DEVELOPMENTAL LEVELNEWBORNS

• Do not place under running faucet
• Do not submerge until umbilical cord drops off
• Dry carefully, especially the head
• Place cap after bath

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DEVELOPMENTAL LEVELYOUNG CHILDREN

• Children can drown in 2 inches of water never
  leave alone during bathing
• Teach parents about fluoride
• No milk or juice bottles in bed
• Wipe off teeth after eating with soft cloth
• Demonstrate on teddy bear

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DEVELOPMENTAL ISSUES CHILDREN

• Children may have natural parents, stepparents,
  four sets of grandparents, all involved in care
• For decision making, some cultures must ask
  father, some must ask grandmother

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DEVELOPMENTAL LEVELADOLESCENTS

• Modesty essential
• Normal clothes, not gowns
• Bed pans not acceptable
• Allow decision making
• No tampons in the hospital

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DEVELOPMENTAL LEVELOLDER ADULTS

• Heat insensitivity can burn easily
• Foot care
• Skin very fragile

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CONFIDENTIALITY

• In providing hygiene, may find very personal
  details
• Report on need to know basis
• Tell instructor decide together on what to take
  further
• Must break confidentiality if signs of abuse

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STUDENT NURSE ISSUES

• Personal space of patient
• Undress, examine, wash and groom stranger
• Incontinence can cause discomfort
• Sexuality may be an issue
• Patient really asking Am I still desirable
  despite my illness?
• Take a break if uncomfortable tell instructor
• Attraction? Ask for patient change

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STUDENT NURSE ISSUES

• Your safety and well being is our job
• Care of your back
• Lifting and bending appropriately
• Protected against infection transmission
• Tell instructor if pregnant or immunosuppressed
• Ask for help (physical and emotional)
• Learn assessment skills

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PATIENT PREFERENCES

• Try to involve patient in care
• If too ill, we must do all
• Give control over soap, deodorant, mouthwash,
  nail length, water temperature
• Must work within time constraints
• Be very cautious with delegation of care to
  others
• Must carefully assess refusal of bathing speak
  to instructor

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BATH REFUSAL

• What is real problem?
• Power issue?
• Fatigue?
• Visitors?
• Assessment
• Patient continent?
• Skin care?
• Level of exertion?
• Comfort education and negotiation

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PURPOSE OF NURSE PROVIDED HYGIENE

• Remove microorganisms
• Do physical assessment
• Increase circulation
• Distal to proximal
• Return to heart
• Improve self image
• Provide comfort

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NOSOCOMIAL INFECTION

• Also called iatrogenic
• Patient illness brought on simply by being in the
  hospital and being exposed to organisms not found
  outside the health care setting
• 5 of all hospital deaths (90,000 in 2000)
• 4th largest cause of death in US (heart disease,
  cancer, stroke, infection)
• More than 4 billion dollars annually
• Often hands of health care providers

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NOSOCOMIAL INFECTION

• Hands washed with antiseptic soap and friction
• Short fingernails artificial nails now being
  forbidden
• Soiled linen kept off uniform
• Gloves
• if client has open or draining wound or is
  incontinent
• if nurse has skin breaks on hands
• No sharing supplies without proper sanitation

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SAFETY

• Electrical supplies must be checked by
  engineering department prior to use and not left
  near pan of water
• hair dryers
• electric shavers
• Bed raised to working height and lowered when
  finished
• Side rails up for patients requiring
• All spilled water immediately wiped
• Caution with use of powder
• Caution with use of latex

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SHAVING

• Shaving reflects level of caring
• Safety razor not used on certain patients
• Those on anticoagulant drugs
• Those with liver disease causing clotting
  disorders
• Confused patients
• Suicidal patients
• Use electric razor after engineer check
• If using hair depilatory, always test area first

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SAFETY

• All patients will need attention to water
  temperature
• Patients with impaired level of consciousness
  will need special care
• gentle eye care, possibly patching
• frequent mouth care
• proper positioning
• care to bed linen
• water temperature

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PATIENTS RECEIVING CHEMOTHERAPY

• Special mouth care
• nausea
• oral thrush or stomatitis
• Special hair care
• Rest periods

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PATIENTS RECEIVING RADIATION THERAPY

• Do not wash off markings
• No bath salts
• No heating pads or hot water bottles

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UNCONSCIOUS PATIENT

• Move during bath
• ROM frequently
• Mouth care in lateral position, with head lower
• Change frequently
• Do not roll down if tube feeding running

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FATIGUE AS A FACTOR

• Nurses job to monitor patient tolerance
• Respiratory response
• Heart rate
• Can patient tolerate being flat? Does he need
  orthopnea position?
• Confusion level
• Shower less taxing than bed bath
• May be easier on patient to be up in chair than
  rolled side to side

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TYPES OF HYGIENE

• Early a.m. care Urinal/bedpan, wash hands and
  face, brush teeth, roll up
• Morning care After breakfast, complete bath or
  shower, hair care, nail care, oral care, back
  rub, linen change
• Afternoon care straighten linen, offer
  urinal/bedpan/commode, wash hands/face
• HS care Elimination, wash hands and face, oral
  care, linen straightening, back rub

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SKIN

• Regulates body temperature
• First line of defense against harm
• Antibacterial and antifungal
• Transmits sensations
• Signs of problems
• Redness (erythema)
• Wet or damp
• Not intact

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PATIENTS AT RISK FOR SKIN PROBLEMS

• Altered level of consciousness
• Altered nutrition
• Immobility
• Dehydration
• Altered sensation
• Secretions on skin
• Mechanical devices, casts, restraints
• Altered venous circulation

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NURSING INTERVENTIONS

• General health important
• Intact skin
• Caution in movement
• Dont overbathe elderly
• Protein in diet
• Avoid periods of moisture
• Change frequently
• Dry carefully
• Rinse soap
• Sun screen important
• Especially with certain medications

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NURSING ASSESSMENT WHILE BATHING

• History
• Relationship
• Color and condition of skin
• Pain on movement
• Level of consciousness
• Injuries
• Scars
• Skin turgor
• Nevi
• Wt loss or gain

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THERAPEUTIC BATHING

• Physician ordered nurse suggestion
• Water temperature usually 100-115 F
• Medications are ordered to be put in water
• Time usually 20 minutes
• Dont leave patients alone
• Be very clear delegating

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TYPES OF THERAPEUTIC BATHS

• Saline
• 0.9 NaCl Normal body consistency for wound care
  and irrigations
• Oatmeal, cornstarch, Aveeno for itching
• Iodine, Dakins, KMNO4 for antibacterial action
  (Ask about allergies)

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SHOWERING

• Check orders and get report
• Organize your supplies first
• Keep covered when moving in hallway
• Keep heels from dragging on floor
• Keep curtains/doors closed
• Dry carefully
• Include oral care, shampoo, and shave
• Dont leave alone in shower

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ORGANIZATION SKILLS

• Check orders (schedule positioning)
• Check arm band
• Obtain report on patient
• Discuss plan with team
• Check availability of water, linen, hamper,
  gloves if needed
• Organize supplies prior to entering room
• Assess patient condition
• Does patient need pain medication?
• Will any treatments need to be done?
• Begin!

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GENERAL PRINCIPLES

• Client safety
• Nurse safety
• Work in time constraints
• Allow privacy and dignity
• Only body part being washed is uncovered
• Curtain is closed
• Change water, washclothes, towels, linen as
  needed
• Use absorbent cotton bath blanket (heated best)
• Call bell available

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PERINEAL CARE

• Professionalism always
• Not deferred in cases needing nursing assessment
• Female
• Always sterile to contaminated (urethra to
  rectum)
• Often have menses in hospital
• Use peripads - tampons forbidden in hospital
• If large breasts, need to dry underneath
  carefully, may use cornstarch
• Male
• Assess for circumcision
• If not, cleanse under foreskin and replace

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BACK RUB

• Purpose
• Relaxation
• Circulation
• Pain relief
• Assess skin integrity on back
• Assess all bony prominences
• Always done as part of good nursing care

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BACK OR BODY MASSAGE

• Warm lotion first
• Use continuous strokes
• Does not include back of calves
• Dont gatch knees or put pillows under calves

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FOOT CARE

• Soak feet as part of bath
• Clean toes and toenails
• Teach as you go
• Range of motion of legs
• Feet of diabetic patients and patients with
  vascular disease are inspected carefully Never
  cut toenails of these patients
• Many facilities have podiatrist visits

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NAIL CARE

• Observe circulation color, capillary refill time
• Observe color, sensation, and movement (CSM)
• Polish removed to observe color and use pulse
  oximeter
• Assess for clubbing sign of long term lack of
  oxygen
• Cut nails straight across and file smooth Do not
  go down into corners
• Assess for rings too tight or too loose

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MOUTH CARE

• Examine with gloves and light, especially smokers
• Use only water soluble lubricants
• If feeding tubes present, assess for parotitis
• Unconscious patient has no gag reflex, position
  on side for care
• May have gum hyperplasia from meds
• May have teeth staining from meds
• May have accumulated debris in mouth called
  sordes
• Teach about brushing and flossing

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CARE OF DENTURES

• Assess for fit
• If removed, keep in covered cup with water
• Label cup with patients name
• Keep in bedside table
• Pad sink when cleaning
• Use cool water

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HAIR CARE

• Culture may influence care
• Hmong do not touch without permission
• Muslim and Orthodox Jew May keep covered, wear
  wig
• Sikh Does not cut
• Different parts of body have hair shaved

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HAIR CARE

• Hair is combed daily and shampooed prn
• Corn rows, dreds, braids not undone to shampoo
• Patients may use hair oil on these
• Both wet and dry shampoo available
• Send to operating room or surgical procedure with
  clean hair and shaven

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EYE CARE

• Contact lenses usually removed
• Stored in saline liquid case labeled
• Also label and safeguard glasses in drawer
• Clean inner to outer canthus
• Patient must be able to blink to protect cornea
• Never use cotton near eyes
• Treat each eye separately
• Eyes considered sterile
• Care of artificial eye similar to dentures

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EARS

• Allow nothing sharp in ears
• Hearing aids now miniscule in size dont lose!
  Label case
• Cerumen in ears may need softening and removing
• Speak directly to patients face if HOH

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BEDBATH

• Wash head to toe, front to back, distal to
  proximal
• Physical assessment as you are washing must also
  loosen and secure lines as moving and turning
  patient
• Change washclothes for different areas
• Change water if cold or soiled or very soapy
• Some put oil in bath water of elderly
• Use powder in your hand, very sparingly
• not with respiratory patients or those with
  allergies

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BEDBATH

• Change linen as needed
• Do range of motion as needed
• Do oral care, hair care, and give back rub
• Leave bed in low position, rails up, and call
  light in place. Straighten room.
• Report and chart findings

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WHO BATHES PATIENT?

• More complexly ill, higher level of caregiver
• In ICU, registered nurse
• In OB, nurse
• In intensive care nursery, nurse
• In nursing home, may be nursing assistant, but
  nurse is responsible for training and delegating

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ASSESSING TUBES AND LINES

• Oxygen stays on during bath, check connections,
  liters per minute, cleanliness of prongs or mask,
  water if used, plugged in if concentrator
• IV lines use special gown, dont open lines to
  change gown, look at IV site, rate and solution
• Urinary catheter draining, unkinked, bag below
  bladder
• Enteral tubes in place, running or draining
  properly, or clamped properly
• Dressings Clean and dry, drains properly
  working
• Does anything need to be emptied, changed or
  cleaned?

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BEDMAKING

• 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
• frame to keep covers off feet
• special beds and mattresses
• Position as ordered

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NURSE SAFETY IN BEDMAKING

• Raise bed to working height
• Face patient
• Bend knees
• Conserve steps
• Dont lift alone
• Side rails as ordered
• Lower bed and place call bell when leaving

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CHARTING

• How patient tolerated bath
• Any unusual findings
• What was done about findings
• Comparative progress