Week 1: Hygiene and Comfort Measures

How should the patient be positioned when using a bedpan? (Potter and Perry 1214)

Patient head should be raised 30 degrees to prevent hyperextension of the back

When is a bedpan used for patient defecation? (Potter and Perry 1214)

Patients that are restricted to the bed

What 6 steps should nurses perform in aiding an immobile pt with defecation with a bed pan? (Potter and Perry 1215)

1. Lower head of bed flat and assist pt to role onto one side, backside towards you

2. Place bedpan firmly against buttocks

3. Keep one hand against bedpan, place another hand around pt's far hip

4. When pt is positioned comfortably, raise head of bed to 30 degrees

5. Place a rolled towel or pillow under lumbar curve of pt's back for comfort

6. Ask pt to bend knees and assume squatting position unless unable to

What is the correct position for defecation using a toilet? (Potter and Perry 1214)

Knees higher than hips

Lean forward

Putting elbows on knees

Bulge out abdomen

Straighten spine

Cuticle (Potter and Perry 902)

Fold of skin that hides the root of the nail bed

Buccal glands (Potter and Perry 903)

Located in mucous membrane lining cheek of mouth, produce small amount of saliva, normally light pink and moist

Gingivitis (Potter and Perry 903)

Inflammation of gum, resulting in difficulties with chewing

Dermis (Potter and Perry 903)

Skin layer deeper than epidermis, where hair follicles are located

What are 9 factors that influence patient's personal hygienic practices? (Pottery and Perry 903, Lec)

Social practices - type of hygiene products, nature+freq of care, age and influences (childhood-family customs, adolescent-peers, interest in personal hygiene, adult-friends and work, older persons- changes in living conditions, health status, available resources)

Personal Preferences - when, products, individualized care, developing new hygiene practices when necessary

Body Image - ( a pt's subjective concept of their physical appearance) changes frequently, promoting pt hygienic comfort and appearance, affects how hygiene is maintained, individualized care

Socioeconomic status - economic resources, influences ability to maintain hygiene, considering alternatives

Health Beliefs and Motivation - Knowledge of importance of hygiene, personal factors, what is important to pt

Cultural variables - cultural beliefs and personal values differ regarding self-care practices (nurse should be culturally aware/accommodating)

Physical condition - physical limitations, disabilities, pain, chronic illnesses

Growth and Development - Children should learn hygiene practices and be encouraged to practice them

Health and Energy - Illness affects desire and ability to perform hygiene practices, motivation = key factor, physical limitations, disabilities, pain

What areas of the body should be examined before a complete bed bath? (Potter and Perry 905)

Skin - colour, texture, thickness, mobility/turgor, temperature, hydration/moisture, presence of edemas, presence of bruising and vascularity

Feet and nails - all skin surfaces on foot, gait, adequate circulation, condition of nails (inclu nailbends+ cuticles)

Oral Cavity- colour, hydration, texture, and lesions

Hair - condition of hair and scalp

Eyes, Ears and Nose - condition and function, contact lens, external ear structures (cerumen), nares

Acne (Potter and Perry 906)

inflammatory, papulopustular skin eruption, usually involving bacterial breakdown of sebum, can spread and result in scarring if squeezed

Dermatitis (Potter and Perry 906)

Inflammation of skin characterized by abrupt onset with erythema, pruritus, pain, and appearance of scaly oozing lesions, difficult to eliminate due to continual contact with substance

Halitosis (Potter and Perry 908)

Bad breath, common sign of bad oral hygiene

Cerumen (Potter and Perry 910)

Accumulated drainage in ear canal (aka ear wax)

What are 7 risks that could put a pt at risk for poor oral mucous membranes/hygiene? (Potter and Perry 912)

1. Inability to use upper extremities due to paralysis, weakness, or restriction

2. Dehydration

3. Nasogastric or oxygen tubes, mouth breathers, chemotherapeutic drugs, and other medications

4. Lozenges, cough drops, antacids, and chewable vitamins

5. Radiation therapy in head or neck

6. Oral surgery, trauma to mouth, oral airway

7. Immunosuppression, altered blood clotting, diabetes mellitus

What are 12 risks that could put a pt at risk for poor skin integrity/hygiene? (Potter and Perry 912, Lec)

1. Immobilization/ Impaired mobility

2. Reduced sensation due to medical conditions

3. Limited protein or caloric intake and reduced hydration (nutrition)

4. Excessive secretions or excretions on the skin from perspiration, urine, watery fecal material, and wound drainage (Moisture)

5. Prescence of external devices

6. Vascular insufficiency

7. Tissue perfusion

8. Alterations in LOC

9. Infections

10. Shear/Friction (moving pt up in bed, damage to skin)

11. Pain

12. Age

What is a health risk that could put a pt at risk for poor foot integrity/hygiene? (Potter and Perry 912)

Inability to bend over or see clearly

Complete bed bath (Potter and Perry 917, Lec)

Used for patients who are totally dependent and require total hygiene care, can be exhausting for pt, complete cleaning of pt

Partial bed bath (Potter and Perry 917, Lec)

Only bathing body parts that would cause discomfort or odor if not cleaned, and areas where the pt would not be able to reach

What are the 11 steps to performing a complete bed bath (Potter and Perry 918, Lec)?

1. Prepare room, equipment, hand hygiene, and wear PPE if necessary

2. Place hospital bed at appropriate level, lower side rail closest to you

3. Remove bedspread and fold if still clean, place bath blanket over top sheet, remove top sheet and discard in laundry hamper, ensure that pt is kept warm

4. Perform oral hygiene

5. Fill basin with warm bathwater

6. Wash client from head to toe (Face, arms, chest, abdomen, leg, back, buttocks)

7. Use long firm strokes from distal to proximal areas (towards the heart)

8.Allow patients to soak hands and feet in basin once finished rinsing arms and legs

9. Perform perineal care

10. Assist patient with donning clean gown, returning to room and into comfortable position in bed

11. Clean equipment, remove and replace soiled linen, perform hand hygiene and place side rails back up

Perineal care (Potter and Perry 926)

Cleaning of the perineal region (genitalia and anal area)

What are the 8 steps to performing oral hygiene? (Potter and Perry 932, Lec)

1. Prepare equipment, perform hand hygiene and wear disposable gloves

3. Raise bed to comfortable working conditions, raise head of bed, and lower side rail, move patient closer to you

4. Brush the pt's teeth, pt may aid if able, holding toothbrush at 45 degree angle to gum line

5. Allow pt to rinse mouth

6. Allow pt to floss

7. Assist pt to comfortable position, raise side rail, and lower bed to original position

8. Remove gloves, perform hand hygiene

(Note: position unconscious pt in side lying position on dependent side, use mouths swabs instead of toothbrush + toothpaste

What are the 6 steps to performing perineal care? (Potter and Perry 922, Performing Perineal Care)

1. Put on disposable gloves, lower side rails

2. assist pt to dorsal recumbent position (f) or supine position (m)

3. Cover extremities, exposing only genitalia

4. Wash all parts of genitalia using smooth but firm strokes

Females - clean upper thighs, labia majora, urethral meatus, and vaginal orifice

Males - clean upper thighs, penis starting at tip (urethral meatus), shaft of penis, and scrotum

5. Assist pt back to comfortable position and cover with bath blanket

6. Perform hand hygiene and remove disposable gloves

When should perineal care be provided? (Lec)

Provided to patients wearing briefs, with fecal or urinary incontinence, with a urinary catheter, recovering from rectal/genital surgery, and postbirth pts

What assessment activities should be performed of the skin while performing a complete bed bath (Assessing Skin, Hair, and Nails)

Inspection

-Inspect skin colour, uniformity, thickness, symmetry, hygiene, and lesions

Palpation

-Palpate skin to determine moisture, temperature, texture, turgor and mobility

- Fully palpate any lesions and it's characteristics, note exudate characteristics of lesions, determine malignancy of moles

Exudate (Assessing Skin, Hair and Nails)

Fluid that has seeped out of bvs or organs

What are the 16 steps to providing a bedpan to pt (Providing a bedpan)

1. Perform hand hygiene

2. Raise side rail of opposite side of bed

3. Raise bed to working height

4. Have patient assume supine position

5. Apply clean gloves, raise head of pt bed to ~30 degrees

6. Remove bed linens without exposing pt

7. Instruct pt to flex knees and life hips upward

8. Place bedpan under pt with one hand, assist pt with lifting with other hand

9. Maintain pt comfort, safety, warmth, and place pillow+towel to support back

10. Have call light and toilet tissue within pt reach, place bed in lowest position as pt uses bedpan

11. Perform hand hygiene, replace gloves

12. Remove bedpan

13. Allow pt to perform hand hygiene, change soiled linens, remove gloves, and return pt to comfortable position

14. Place bed in lowest position

15. Wear gloves when emptying bedpan, rinse with spray faucet and disinfectant if required

16. Remove gloves and perform hand hygiene

What are the 9 steps to aiding a pt with using a urinal? (Assisting with a Urinal)

1. Perform hand hygiene

2. Wear clean gloves

3. Help pt into appropriate position (male/female)

4. Cover pt with bed linens, place call light within reach and provide privacy while pt voids, aid pt if necessary

5. Remove gloves and perform hand hygiene

6. Remove urinal, assist pt with washing and drying genitalia

7. Empty and clean urinal

8. Help pt perform hand hygiene

9. Remove gloves, perform hand hygiene

How does age influence personal hygiene practices? (Potter and Perry 910)

Skin

Careful handling as newborn

Parents providing thorough hygiene and teaching hygiene practices as toddler

Use of deodorant and more frequent bathing and shampooing as adolescent,

Avoiding daily baths and using very hot water + harsh soaps due to aging skin as elder

Feet and Nails

Wearing comfortable footwear

Chronic foot conditions as a result of aging

Dry feet as elder

Fungal infections, and nail problems

Oral cavity

Regular dental care, brushing and flossing to prevent caries and periodontal diseases from infancy to adolescence

Age related changes of the mouth, chronic diseases, physical disabilities, lack of attention to oral care, prescribed medications resulting in poor oral care

Wearing edentulous and dentures as an older adult

Decubitus ulcer

aka bedsores, injuries to the skin and the tissue below the skin that are due to pressure on the skin for a long time

Alopecia

aka baldspots, loss of hair in one or several regions

AM Care (Lec)

Care given during the morning, includes offering bedpan/urinal, washing hands+face, assisting w/ oral care + hygiene, providing bath/shower, perineal care, foot + nail + hair care, change gown, change bed linens, organize pt's room

HS Care (Lec)

Care given during the evening, includes changing soiled bed linen, changing gown, washing hands and face, oral hygiene, back massage, offering bedpan/urinal

Diaphoresis

Excessive sweating for no apparent reason

Integumentary

Skin

Pruritus

Itching/ Itchy sensation (on skin)

Febrile

Fever

Tepid

Warm/Lukewarm (ex: water)

What is the nurse's role in providing personal hygienic measures? (Lec)

- Provide therapeutic communication skills to build therapeutic relationship

- Pt assessment and interventions can occur during provision of personal hygiene (head to toe)

-Encourage and promote independence of pt (pt who is well can meet own hygiene needs, pt who is ill may need various levels of assisstane)

-Ensure privacy, respect, and pt's physical comfort is fostered during provision of care

What 11 assessments should be performed regarding the pt while providing hygienic care? (Lec)

- Sensory alteration history

- Mental status

- Ability to perform self-care/ physical limitations

-Health promotion habits

-Hazards

-Communication methods

-Social support

-Use of assistive devices

-Other factors affecting perception

-Emotional/psychosocial needs

-Physical assessment (ex:skin assessment)

How should pt's with darker skin tones be assessed for cyanosis/hyperemia? (Lec)

Note of areas that are darker than surrounding skin, note of taut, shiny skin, and examine areas with less melanin for underlying tone (ex: soles of feet, palms of hands, mucous membranes, conjunctiva below eyelids)

What is the Braden scale? (Lec)

Risk assessment tool used to predict risk of pressure injuries using 6 subscales

-Sensory perception

-Moisture

-Activity

-Mobility

-Nutrition

-Friction and Shear

(Lower score = greater risk for pressure injury, score range from 6-23, below 18= onset of pressure injury)

What are 7 guiding principles for providing personal hygiene? (Lec)

- Provide privacy

- Maintain safety

- Maintain warmth

- Promote independence

- Anticipate needs

- Wash body parts from clean to dirty (From face -> perineum)

- Wear PPE as necessary

What are 5 factors that affect bowel elimination in patients? (Lec)

1. Diet (fiber)

2. Fluid intake (adequate fluid intake)

3. Physical activity (increases peristalsis, more muscle tone for elimination)

4. Personal bowel habits (home comforts, scheduling)

5. Privacy (avoids embarrassment)

What is the Bristol Stool Chart? (Potter and Perry 1217, Lec) - istg if they test us on this

Used to describe different stool patterns (without having to say it looks like a sausage)

Type 1 - Hard nut shaped

Type 2 - Lumpy sausage shaped

Type 3 - Cracked sausage shaped

Type 4 - Smooth soft snake shaped

Type 5 - Soft bolbs with clear-cut edge

Type 6 - Mushy fluffy pieces with ragged edges

Type 7 - Entirely liquid

What are 9 risk factors for poor oral hygiene? (Lec)

- Tobacco and alcohol use

-HPV

-More prevalent in Males

-Older age

-Poor nutrition

-Weakened immune system

-Irritation from dentures

-SDOH (access to resources - dentist/products)

-Patients with special needs (stomatitis, use of o2 therapy, unconscious state)