Nursing: Hygiene, Activity, and Movement & Alignment (Video Notes)

A comprehensive set of Question-and-Answer flashcards covering hygiene, activity, movement, ROM, positioning, safety, and patient education based on the provided nursing lecture notes.

What is included in Hygiene Practices in nursing according to the notes?

Bathing and care of the skin and specific body areas; practices vary among people; strong links between hygiene and health; nurses should respect patient preferences and provide care only what patients cannot or should not provide for themselves.

What guiding principle should nurses follow when assisting patients with basic hygiene?

Respect individual patient preferences and provide only the care that patients cannot or should not provide for themselves.

Name the factors that affect personal hygiene.

Culture; Socioeconomic class; Spiritual practices; Developmental level; Health state; Personal preference.

How can culture influence personal hygiene practices?

It can affect bathing frequency, privacy (private vs communal bathing), and ceremonial or religious washings.

Which conditions in a patient indicate high risk during Nursing History?

Seriously ill, comatose, dehydrated, confused, depressed, or paralyzed.

In nursing history, what skin-related aspects are documented?

Rashes, lumps, itching, dryness, and lesions.

What oral cavity factors are important in the Nursing History?

Poor nutrition or high refined sugar intake, family history of periodontal disease, and chemotherapy agents that produce oral lesions.

What is a key focus for Eyes, Ears, & Nose during physical assessment?

Use and care of visual aids/prosthetics and hearing aids.

What hair-related issues should be considered in assessment?

Malnutrition, treatments or medical conditions that lead to hair loss.

What are common concerns in the Perineal & Vaginal Areas assessment?

Incontinence, catheters, childbirth, surgery, UTIs, diabetes, STIs.

What skin assessment parameters are evaluated?

Cleanliness, texture, temperature, turgor, moisture, sensation, vascularity, and lesions.

What should be assessed under Eyes, Ears, & Nose during physical assessment?

Care and use of visual aids/prosthetics and hearing aids.

What are common nails & feet assessment findings?

Deficient self-care abilities, vascular disease, arthritis, diabetes, ill-fitting shoes, obesity.

What are common concerns in the Anal area assessment?

Fissures, nodules, distended veins, masses, polyps.

What items are listed in the Nursing History for the integumentary system?

Daily skin assessments (skin, nails, feet), and related risk factors such as poor self-care abilities and chronic conditions.

What is the Actual or Potential Problem List in the Nursing Process?

Self-Care Deficit (bathing, dressing, feeding, toileting); Impaired Oral Mucous; Risk for Impaired Oral Mucous Membrane Integrity; Impaired Social Interaction; Readiness for Enhanced Self-Care.

What does Outcome Identification & Planning (B PLAN) entail in hygiene care?

Setting patient-centered outcomes such as comfort/cleanliness, participation in hygiene, intact skin/mucous membranes, proper skin/dental care, and use of aids.

Give two example outcomes from the Hygiene B PLAN.

The patient will verbalize feeling comfortable and clean; participate in hygiene measures.

What are the purposes of Bathing & Skin Care?

Cleansing the skin, relaxing the patient, promoting circulation, providing musculoskeletal exercise, aiding respiration, promoting comfort, offering sensory input, improving self-image, and strengthening nurse–patient rapport.

What safety measures are recommended for Shower & Tub Baths?

Mats or nonskid strips; provide a shower chair; assist with in/out; check water temperature; ensure a call device is available; maintain privacy with door openable.

What are General Skin Care Principles?

Assess skin daily and after incontinence; avoid excessive friction; minimize moisture; use a skin barrier; apply emollients; assess skin folds in bariatric patients twice daily.

What tasks comprise Morning Care (AM Care)?

Assist with toileting; refresh/comfort measures; wash face and hands; mouth care; bathing; linen change; back massage; skin care; hair care; dressing.

What tasks comprise Afternoon Care (PM Care)?

Ensure comfort after lunch; assist with toileting, handwashing, and oral care; straighten bed linens; assist mobility to reposition self.

What tasks comprise Hour of Sleep Care (HS Care)?

Assist with toileting, washing, oral care; back massage; change soiled linens/clothing; position the patient; keep call light within reach.

What are key teaching points about skin care for patients?

Expensive soaps are not more effective; keeping body and clothes clean prevents odor; discard cosmetics after 2–4 months and keep applicators clean; use sun protection.

What are Outcome Achievement Indicators for hygiene care?

Level of patient participation; reduction/elimination of factors hindering independence; improvement in skin problems and patient management of treatment.

What is the basic physiology of movement & alignment?

Articulation and joints; synovial joints contain lubricating fluid and are freely moving; nerve impulses stimulate muscles to contract; movement results from muscle contraction pulling on a tendon that moves a bone.

Name factors that affect movement & alignment.

Developmental considerations; Physical health (posture, bone/muscle issues, trauma, CNS problems); Mental health; Lifestyle; Attitude/Values; Fatigue/Stress; External factors (resources, environment, access to equipment, support).

What are the cardiovascular effects of immobility?

Increased cardiac workload, orthostatic hypotension, venous stasis and thrombosis.

What are the respiratory effects of immobility?

Decreased ventilatory effort and increased respiratory secretions.

What are the musculoskeletal (MSK) effects of immobility?

Decreased muscle size, tone, and strength; reduced joint mobility; bone demineralization; limited endurance.

What metabolic changes occur with immobility?

Muscle wasting and altered metabolic processes.

What GI effects arise from immobility?

Disturbances in appetite, altered protein metabolism, poor digestion; slowed GI motility leading to constipation.

What GU effects are linked to immobility?

Urinary stasis and kidney stones.

What skin and psychosocial effects can immobility cause?

Skin breakdown; feelings of worthlessness and diminished self-esteem.

What should be included in a Nursing History for movement assessment?

Daily activity level; type, frequency, and duration of activity; endurance; dizziness; dyspnea; exercise goals; mobility problems; health alterations; external factors.

What is ROM and its two forms?

ROM is the range of motion; Active ROM is when the patient moves joints independently; Passive ROM is when the nurse moves each joint.

What are key guidelines for performing ROM?

Move slowly; stop at resistance but not pain; return joint to neutral; perform 2–5 repetitions, twice daily.

What are Safe Patient Transfer considerations?

Assess the patient; use assistive devices if any caregiver will lift more than 35 lb; ensure enough staff; assess area; choose equipment; treat pain if present; elevate bed and lock wheels; avoid friction.

What are common assistive devices for transfers and their uses?

Gait belts (avoid on abdominal/thoracic incisions); lateral-assist devices (roller/transfer boards, inflatable mattresses) to reduce friction; friction-reducing sheets; powered full-body lifts with slings.

What positioning aids help maintain alignment?

Foam wedges/pillows, adjustable beds, trapeze bar, foot supports, trochanter/hands rolls; follow a turn schedule (2-3 staff under 200 lb; at least 3 staff if over 200 lb).

Describe common positions: Fowler’s, Side-lying, Prone, Supine.

Fowler’s: head of bed 45–60 degrees; Side-lying: use supporting pillows; Prone: lying on abdomen (avoid with spinal problems); Supine: flat with head/shoulders elevated.

What is the ROM guideline regarding movement repetition and frequency?

2–5 times per joint, twice a day.

What are ergonomics guidelines for lifting and moving objects?

Maintain erect posture; use longest/strongest muscles; work close to the object; face movement direction; use body weight to pull/push; broaden base of support; ensure dry, smooth surfaces; bend knees and stay low; break heavy loads into smaller parts.