NURS 344: Hygiene (slides)

What is HYGIENE?

actions and practices that decrease the spread or transmission of pathogens

Why is HYGIENE practiced?

to lessen the occurrence of illness

What are PHYSICAL BARRIERS?

serve as the first line of defense in preventing pathogens from entering the body

What does the INTEGUMENTARY SYSTEM consist of?

skin, hair, nails, sebaceous glands, and sweat glands

What is the function of the INTEGUMENTARY SYSTEM?

to block pathogens found from entering the immune system from the outside environment

Where are MUCOUS MEMBRANES found?

in the mouth, respiratory tract, gastrointestinal tract, and the urinary tract

What is the function of MUCOUS MEMBRANES?

line the body passages that are open to the exterior environment and act as a barrier to pathogens

What do MUCOUS MEMBRANES line?

all body cavities "open" to exterior

What are the characteristics of MUCOUS MEMBRANES?

wet and moist, great for absorption, layered, secretion of mucous

What is the SKIN?

Largest organ in the body, covering the majority of the

outer surfaces of the body

What is the first line of defense against pathogens?

Skin

What is the function of SKIN?

Serves as a physical barrier to offer protection to the

internal parts of the body

What are LANGERHANS CELLS?

found in skin; sense and kill pathogens that are found on the skin trying to enter the body

What THREE STEPS should be taken to prevent HEALTHCARE-ASSOCIATED INFECTIONS (HAIS)?

1. Effective handwashing

2. Patients and family caregivers encouraged to perform hand hygiene.

3. Education and access to soap/water and alcohol-based hand rub

Why is addressing a patient's CULTURE important for hygiene?

some cultures have unique hygiene practices, must be respectful and observant of each client's specific cultural needs

What must be considered for a patient's CULTURAL & SOCIAL PRACTICES?

personal preferences

How can socioeconomic status affect clients' hygiene status?

If a client is without housing, alter discharge instructions and follow-up care accordingly

What adjustments can be made to a unhoused patient?

for wound care, provide spray and wipes for bandaging and advice for cleaning in a park bathroom

Why is it important to respect clients' dignity in hygiene care? How would you provide respect and dignity as a nurse?

Many clients are dealing with a loss of control when others must provide their hygiene care

- Reassure clients, and allow them to have as much control as possible.

What is HEALTH PROMOTION?

facilitating the client's control over and improving their general health

What are EIGHT WAYS to support HEALTH PROMOTION?

1.) EDUCATE about the importance of hygiene in HEALING

2.) EDUCATE about the importance of hygiene in PREVENTING INFECTION

3.) Establish a RAPPORT with patient and family

4.) Assess patient's ability to perform ACTIVITIES OF DAILY LIVING (ADLs).

5.) Encourage family/caregiver's PARTICIPATION

6.) Provide SUPPLIES AND ASSISTANCE based on assessment findings

7.) Provide PRIVACY

8.) RESPECT cultural, spiritual, and ethnic practices and beliefs

What are ADLS?

activities of daily living

What are examples of ADLs?

washing, toileting, dressing, feeding, mobility, transferring

Why might a patient struggle with being assisted with ADLs?

ADLs are a big change, they may feel a loss of autonomy aka control over their life

TRUE OR FALSE: Assisting patients with ADLs are "CNA duties"

FALSE; nurses can help

What are SIX types of patients that have DIFFICULTY PERFORMING PERSONAL HYGIENE?

1. Patients with neurological deficits that affect movement or coordination (stroke, ALS, Parkinsons)

2. Patients with shortness of breath (SOB) caused by COPD, pneumonia, Cystic Fibrosis

3. Visual Impairment

4. Amputations

5. Cognitive Impairment

6. Older adults

What are THREE kinds of SPECIAL CONSIDERATIONS?

1.) Social or cultural beliefs about bathing when ill

2.) Spiritual beliefs about who should assist with hygiene

3.) History of physical or sexual abuse

What consideration should be taken for patients with a HISTORY OF PHYSICAL OR SEXUAL ABUSE?

Ask what is best for them and provide privacy, consent, and communication

What are BARIATRIC PATIENTS?

patients of increased weight or BMI

What does INCREASED BMI in BARIATRIC PATIENTS cause?

distinctive physiological changes that affect skin integrity,

such as extremely deep skin folds, especially in the abdominal region

Where do most physiological changes that affect SKIN INTEGRITY located for BARIATRIC PATIENTS?

abdominal region

What FIVE reasons might a BARIATRIC PATIENT have difficulty with hygiene?

1.) May be unable to reach areas of their body that require bathing.

2.) Increased sweating causing skin breakdown.

3.) Increased physical effort to perform ADLs

4.) Shame and embarrassment

5.) Alterations in anatomy that decrease their ability to perform adequate hygiene after toileting

What considerations should be taken for OLDER ADULTS for SKIN?

Skin is drier, thinner, will not tolerate as much bathing as younger adults' skin

TRUE OR FALSE: Old people sweat more than younger people

FALSE; decreased perspiration for older adults

Amount of hair (INCREASES/DECREASES) in ears, nose, and eyebrows for OLDER ADULTS.

increases

What is the result of WEAKENING PERIODONTAL MEMBRANE in older adults?

higher incidences of infection/periodontal disease

Why might older adults experience DRY MOUTH?

increased saliva production & side effects of some

meds

Is it okay if a OLDER PATIENT'S dentures are loose or too tight fitting?

No, dentures must fit correctly or they can cause problems

Why does POOR NUTRITIONAL STATUS occur in OLDER ADULTS?

dental problems, socioeconomic status, or a limited ability to prepare healthful foods

What necessary PRECAUTION should be taken before STARTING ANY CARE?

Understand how to complete each task to avoid injuring the client, be familiar with the equipment

What should NEVER be done when providing HYGIENE CARE?

Never leave clients in a position where injury could occur

What position should the bed be left in?

lowest position

What if you need to walk to the other side of the bed while the bed is elevated?

the side rail must be raised; never leave a side rail down if you walk away from the elevated bed

How many side rails should be up at one time?

only 3/4 are raised in the lowest position

When working with a patient, how can the bed be adjusted?

comfortable working height; lower the bed upon completion of the task

What is a COMPLETE BED BATH?

nurse or another designated health care provider giving

the client a bath IN the bed

What is a PARTIAL BED BATH?

bath given in bed by the nurse or other designated health

care provider in which the client COMPLETES PART of the bath THEMSELVES

What does AM CARE include?

toileting, washing hands/face, and oral care

What BATHING PRODUCTS are used MOST FREQUENTLY?

Pre-moistened wipes with non rinse soap and lubricants

What BATHING PRODUCTS are used LESS FREQUENTLY?

Soap and water with a basin

What is CHLORHEXIDINE BATHING?

routine clinical practice that uses a broad-spectrum antiseptic washcloth or liquid to reduce the number of germs on the skin

When is CHLORHEXIDINE BATHING performed?

before surgery and for patients with indwelling medical devices

How is EYE AND EAR CARE provided to patients?

Use a clean, moist washcloth without any soap to wipe gently across the eyelids from the inner to the outer canthus

- Rotate the end of a clean, moist washcloth gently into the ear canal

What can INADEQUATE ORAL HYGIENE cause?

tooth decay and periodontal disease that has been linked to heart disease, cancer, and diabetes

How does INADEQUATE ORAL HYGIENE cause other problems to far parts of the body?

Bacteria can travel via the blood to the heart and cause an infection in the heart

How often should oral hygiene be performed?

twice daily

What should be ASSESSED in relation to a patients ORAL HYGIENE?

patient's ability to perform independently and assist or

provide supplies as needed

How should ORAL HYGIENE be PERFORMED?

Brush teeth and tongue, rinse oral cavity

How should DENTURES be taken care of in ORAL HYGIENE?

Dentures should be removed, cleaned, and replaced in a clean oral cavity

How is ORAL HYGIENE performed on UNCONSCIOUS PATIENTS?

They should be turned on their side before performing oral care

What is HAP?

hospital associated pneumonia

What patients are at risk for HAP?

intubated patients, NGT placement, going to surgery, impaired swallowing, artifical airways

What are patients who have IMPAIRED SWALLOWING at risk for?

aspiration

What are patients who have ARTIFICIAL AIRWAYS at risk for?

ventilator-associated pneumonia (VAP)

What is CHLORHEXIDINE GLUCONATE?

"swish and spit"; may be ordered to decrease bacterial load in the oral cavity

When should a nurse TAKE OVER DENTURE CARE?

when patients are unable to do so themselves

How are DENTURES cleaned?

1.) REMOVE the dentures with a GLOVED HAND, and a GAUZE over the hand.

- Pull down and out at the front of the upper denture, and lift up and out at the front of the lower denture.

2.) PLACE the dentures in a denture cup, emesis basin, or on a washcloth in the sink

3.) BRUSH in a horizontal back and forth motion with a soft brush and denture cleaner

4.) RINSE dentures in tepid water

5.) STORE the dentures in a denture cup—LABEL THE CUP

6.) Place the dentures in the cup with water to keep them moist and to HELP the client REINSERT the dentures

Why is PERINEAL CARE performed?

to avoid infections, odors, and irritation or skin breakdown in the perineum or buttocks

What is PERINEAL CARE?

"peri care"; gentle, routine cleansing of the genital and anal areas

What FIVE types of patients do nurses and CNAs perform peri care for?

1.) indwelling urinary CATHETERS (foley catheters)

2.) INCONTINENT of urine and/or stool

3.) NEED ASSISTANCE with toileting

4.) women who have RECENTLY DELIVERED BABIES

5.) UNABLE to perform it INDEPENDENTLY

How is PERINEAL CARE performed?

Gently cleanse and dry the area THEN apply moisture barrier cream as needed to prevent breakdown and dermatitis

What should the nurse ASSESS for PERINEAL CARE patients?

breakdown around urethra when catheter is present

When providing PERINEAL CARE, always move from (CLEAN/DIRTY) to (CLEAN/DIRTY) areas.

clean; dirty

When should hand hygiene and change gloves be performed during PERINEAL CARE?

as needed

What is MEATAL CARE?

gently cleaning the external urinary opening (meatus) and the surrounding catheter tubing to prevent irritation and infection; USE DESIGNATED WIPES

What is MOISTURIZER CREAM used for?

to reduce dryness

What is BARRIER CREAM used for?

rash to stay dry

Patients who are at a HIGHER RISK FOR INFECTION should have what more CLOSELY MONITORED? Why?

feet more closely monitored as infections can cause serious foot problems

Why is NAIL TRIMMING important?

Longer nail length has been shown to conceal a greater

number of germs as compared to shorter nail length

What should be reviewed before TRIMMING FINGER OR TOENAILS?

Refer to the facility's policies

What should be done before trimming nails?

Use a basin of warm water to soak feet or hands to clean

nails

What THREE precautions should be taken for patients with PERIPHERAL VASCULAR DISEASE or DIABETES?

1.) DO NOT soak the feet; risk for infection

2.) DO NOT cut the nails; risk for infection

3.) DO NOT apply lotion between the fingers or toes; moisture causes skin irritation and breakdown

What is UAP?

unlicensed assistive personnel

When can nail care be delegated to UAP?

if the patient is healthy

How should nails be cut?

Cut nails strait across; Never round nails with clippers

When SHAVING, what PRECAUTION should be taken for patients PRONE TO BLEEDING/ON ANTICOAGULANT/LOW PLATELET COUNT?

use electric razor instead of blade

How do you perform SHAVE CARE?

1.) Soften the skin with warm water

2. Apply liquid soap or shaving cream

3. Hold the skin taut

4. Move the razor over the skin in the direction of hair growth using long strokes on large areas of the face and short strokes around the chin and lips

What is important to address and communicate with clients while providing SHAVE CARE?

personal shaving preferences

What precaution should be taken for patients on OXYGEN when providing SHAVE CARE?

use manual razor, no electricity should be around oxygen