Hygiene

Creating a Plan

Hygiene and Functional Ability

• Hygiene is a broad concept of cleanliness and grooming that actively improves self-image and decreases infection risk

• Activities of Daily Living (ADLs); Fundamental self-care tasks

  • Ex: bathing, dressings, toileting, eating, transferring

  • Clinical: pt’s level of independence performing ADLs can influence nursing workload

• Instrumental ADLs (IADLs): cx tasks needed for independent community living

  • Ex: cooking, cleaning, finances, managing medications

  • Clinical: influences discharge planning and home safety

• Clinical concern: a sudden decline in a pt’s ability to perform ADLs/IADLs can indicate a change in health status and warrants further investigation to determine safety

Recognizing Cues - Assessing Influences on Hygiene

• Pt-centered (subjective factors)

  • Ex: personal preferences, culture, religion, spirituality

• Clinical (objective factors)

  • Ex: health status, pain level, physical mobility limitations, sensory deficits (vision/hearing loss), cognitive abilities, mental health

Recognizing Cues - Case Study

• Health Status

  • Pneumonia and Exacerbation of COPD: excess movement may worsen respiratory symptoms

• Mobility

  • Osteoarthritis: client may experience pain and limited ROM while trying to complete ADLs

• Cognitive Abilities

  • Moderate Dementia: client may become confused during care and can refuse or become combative if not approached correctly

Recognize Cues/Assessment Clinical Tools

• Clinical tools such as the Katz Index of Independence in ADLSs to further your assessment of our patient’s ability to provide hygiene for themselves

• 6 points - independent

• 0 points - very dependent

Neglect vs Deficit - Why does Distinction Matter?

• Self-Neglect: the client is able to provide self-care but fails to maintain social standards of hygiene

  • Nursing role: Psychosocial Assessment and Ethical/Legal Advocacy

  • Ex: Mental Health, Substance Abuse, Abuse/Neglect

• Self-Care Deficit: the client lacks the ability to complete independently

  • Nursing Role: Supportive

  • Ex: physical assistance, adaptive equipment

Case Study - Neglect vs Deficit

• The nurse is analyzing the client’s presentations to plan morning hygiene care

• For each clinical cue from the case profile, specify if the finding support the nursing concept of self-care deficit or self-neglect

• Clinical cue (supports self-care deficit/supports self-neglect)

  • Exertional dyspnea and severe fatigue from pneumonia and COPD (self-care deficit)

  • Cognitive disorientation and memory impairment from moderate dementia (self-care deficit)

  • Grimacing and joint stiffness from severe osteoarthritis during movement (self-care deficit)

  • Active refusal/intentional choice (self-neglect)

Analyze Cues - Formulating a Nursing Diagnosis

• Nursing Dx = Actual/Potential Problem = related to (pathophysiology/etiology) + as evidenced by (subjective/objective cues)

• Nursing Dx help us recognize priority problems and how to care for our clients

• Actual Problems

  • Bathing/Hygiene Deficit

  • Toileting Deficit

  • Feeding Deficit

• Potential Problems

  • Risk for impaired skin integrity

  • Risk for aspiration

• Case study ex: bathing/hygiene deficit related to exertional fatigue and joint stiffness as evidenced by body odor and dyspnea upon minor movement

Understanding Cause and Effect (Potential Risks)

• Dampness/Moisture - Prolonged exposure to (sweat, urine, or wound drainage) softens the tissue, making it highly vulnerable to breakdown

• Dehydration & Nutrition Status - Dry skin and Tear Risk: Poor hydration and malnutrition compromise skin turgor and structural integrity

• Clinical Considerations:

  • High-risk areas for moisture: under the breasts, skin folds, groin

  • Infants and Geriatrics may have compromised skin

  • Reduce friction and shearing

Solutions & Actions - Nursing Interventions

• Individualize nursing activities and care activities - always promote independence when appropriate

  • Special Considerations

    • Dementia, obesity, age, patient preferences

  • Bathing

    • Levels of Assistance: independent, assist, complete, partial

    • Type of Bathing: prepackaged bathing products*, bag bath, bath & basin/bathwater*

    • Privacy and Timing of Bathing

  • Morning Care: hand & face washing, oral hygiene, toileting, environmental tidying, patient positioning

    • Prior to breakfast to promote appetite

Solutions & Actions - Nursing Interventions

• Toileting Assistance

  • Levels of assistance: independent, assistance, dependent

  • Common equipment: toilet, bedside commode, external urinary catheters, indwelling catheters, urinal, bedpans

  • Privacy: Always provide clients with appropriate privacy during elimination

  • Positioning: Upright position (fowler’s/high-fowler’s) when appropriate

  • Frequent assessment of toileting needs

IMPLEMENTATION - Nursing Interventions (pt 1)

• Assess for allergies related to products

  • Soaps and fragrances

  • Use hospital approved products

• Always provide care from “clean” to “dirty”

  • Ex: front to back during perineal care, inner canthus to out using a different portion of washcloth

IMPLEMENTATION - Nursing Interventions (pt 2)

• Foot Care & Nail

  • Ex: diabetes, corns, calluses, Tinea Pedis, ingrown toenails, foot odor, plantar warts, pressure injuries (PI), Bunions

  • Assess for alterations in sensory

    • Diabetes, neuropathy, etc

  • Never place a client’s extremities in HOT water

    • Never clip a client’s nails, always file

      • Infection risk especially with chronic diseases

    • Apply lotion on dry areas but never entrap moisture

• Hair Care

  • Hair can be sensitive and clients can have cultural preferences—always ask!

  • Dandruff, Pediculosis, Alopecia

  • Be aware of contact transmission in special consideration

IMPLEMENTATION - Nursing Interventions (pt 3)

• Oral Care

  • Dental hx, dental coverage, nutrition, medications, and medical conditions

  • Aspiration precautions!!

    • Pt should be sitting upright and have suction available

  • Denture Care - very fragile

    • Follow specific instructions

  • Soft toothbrushes

    • Be aware that patients with bleeding risk can sustain injuries from oral care

IMPLEMENTATION - Nursing Interventions (pt 4)

• Eye care

  • Assess for visual aids

  • Gentle care

  • Infection risk

• Ear Care

  • Assess for hearing aids

  • Avoid cotton tip

    • Never insert something into client’s ear

• Nose Care

  • Avoid trauma to nares

• Perineal Care

  • Privacy!

  • Clean to dirty

Solutions & Actions - Nursing Interventions

• Assisting with Feeding

  • Assess for dietary order and NPO status

  • Positioning: upright position (fowler’s or high-fowler’s) and have the patient remain upright minimum of 30 min after meal

  • Offer small, controlled bites

  • Assess for pocketing of food

  • Promote Independence

    • The Clock Face Method: describing where items are in relation to a clock

  • Abnormal findings

    • Aspiration (choking)

      • Frequent coughing, clearing throat, wheezing, gurgling noises, waving hands, absence of noises but panicked movements and expressions

IMPLEMENTATION - DELEGATION

• Primary Nurses Responsibility

• Safety of patient and knowledge of UAP’s scope and experience

• Assistive devices

• Safety Concerns

  • Gait belt

  • Fall risk

  • Skin condition

• Remember that you can assess patient while providing care

Delegation Model (ADLs)

Intervention—>Registered Nurse—>Unlicensed Assistive Personnel (UAP)

• Bed bath—>performs baseline head-to-toe skin integrity assessment. Evaluates tolerance.—>performs standard bathing task on stable clients. Reports reddened/broken skin.

• Perineal & Catheter Care—>Assess for signs of infection, bleedings, or anatomical/surgical complications—>performs daily hygiene (cleans front-to-back, clean to dirty). Secures device

• Foot & Nail Care—>Assess for wounds and sensory deficits. Files nails straight across. Cleanses and dries feet completely. DO NOT CLIP NAILS. Reports skin breaks

• Denture & Oral Care—>Assesses swallow/gag reflex, oral mucosa, and aspiration (choking) precautions—>assists with performing oral care for stable patients

Introduction

• Introductions

• Check Identity/Order

• Check for Allergies

• Get Permission for Bath and Hygiene Care

Preparing for Care

• Do you have all supplies

• Didi you provide privacy

• Adjust bed height

• Check side rails

• Assess for Lines, Drains, Airways (LDAs)

• Encourage Independence

Evaluate Outcomes/Evaluation

• How do we know our actions worked?

  • Improved hygiene

  • Improved self-image

  • Free of actual/potential harm factors

• Pt Education

  • Did we educated our patient during the process of implementation"?

  • Teach-back method