Week 7: Promotion of Skin Integrity, Hygiene Care, Elimination and Continence Care

Define hygiene

Conditions/practices of cleanliness or care of the body that are conducive to health and wellness and fundamental to comfort

Define self-care

The person's ability to perform care functions in the following four areas independently: bathing, feeding, toileting, and dressing

What things can affect self-care?

-Illness

-Age

-Culture

-Mental health

-Condition

-Functional ability

Why is regular bathing essential?

To promote healthy skin integrity

True or False: Hygiene care should be individualized to the patient?

True

1 multiple choice option

When providing hygiene begin with ________

Assessment

What does early morning care entail?

-Bathroom: Urinal or assistance to the bathroom

-Washing hands and face, oral care

-Prepare for breakfast

What does morning care entail?

-Bath: Shower or bed bath

-Hair care, shaving, oral care, foot/nail care

-Dressing in clothes or changing gown

-Bed linen change

What does afternoon care entail?

-Washing hands and face (to refresh)

-Oral care

-Elimination needs

-Checking bed linens

What does HS or evening care entail?

-Washing face and hands

-Oral care

-Elimination needs

-Changing into a new gown or bed clothes

-Back massage

-Straightening up area to reduce clutter

Bed baths may be partial or complete depending on what?

Depending on the timing, needs, and ability of the patient

What do bed baths give us an opportunity to assess?

Skin integrity and other systems (E.g. MSK)

What steps are taken when preforming a bed bath?

-Provide privacy (curtains closed, cover up any areas that are not being bathed)

-Maintain safety (side rails up)

-Maintain warmth (only expose areas being washed)

-Promote independence (encourage and assist where needed)

-Anticipate needs (be organized and have supplies ready)

-Ensure you are working safely (i.e. IYM principles)

-Do a risk assessment and apply routine practices and infection control principles

-Explain and communicate well throughout with the patient and family

What is the proper method for cleansing limbs during a bed bath?

Use long strokes on the limbs, moving from the distal to the proximal areas (E.g. Fingers to axial and toes to hips). Once finished, rinse thoroughly and gently pat the areas dry

Should you cleanse from front to back or back to front?

Front to back (Clean to dirty)

1 multiple choice option

What are the benefits of bed baths?

-Disposable

-Convenient

-No drying needed

-No cleaning of equipment or basins

-Requires warming

-Helps with infection control

What is the AHS approved bathing temperature for an adult?

38°-43° celsius

What bath temperature should not be exceeded for patients 12 years old and younger?

Never over 38°, 36.7°-38° celsius is best practice

When should safe bathing temperature be identified?

Prior to the patient entering the bath or shower

What should you encourage patients to do prior to preforming a bed bath?

Encourage the patient to void

When preforming a bed bath what side should you begin if the patient has an intravenous line, injury, or reduced mobility on one side?

Begin from the unaffected side

How should the head of the bed be positioned when preforming a bed bath?

Remove the patient's pillow and raise the head of the bed to 30-45 degrees (If the patient's condition allows)

How should you wash the eye area when preforming a bed bath?

Fold the washcloth to form a mitt and wash the patient's eyes with plain warm water, bathing the eye from the inner to the outer canthus and using a new section of the cloth for each eye

How should you clean eyelid crusts when preforming a bed bath?

Soak any eyelid crusts for 2-3 minutes if necessary, before you try to remove them

How should the breasts be lifted when cleaning them during a bed bath?

Lift each breast with the back of your hand

When performing a bed bath who's feet should you never soak?

Patient's with diabetes or impaired sensation

What should you do when fecal material is present during a bed bath?

Enclose it in a folded underpad or toilet tissue and clean the area with disposable wipes

In which direction should you cleanse the patient's buttocks during a bed bath?

Cleanse the buttocks and anus moving from front to back and paying special attention to the folds in that area

What is a commercial bag bath or cleansing pack?

A cleansing pack that provide a quick cleanup, each cleansing pack contains eight to ten pre-moistened towels

What products aid in maintaining skin integrity and hygiene care?

-Moisturizers

-Moisture barrier creams

-Cleansers and wipes

-Pharmaceutical creams and powders

-Incontinence products

MOA of moisturizers

Cornerstone for dry skin. They exert their effect by repairing the skin barrier, increasing water content of the skin, reducing water loss

MOA of emollients

Fatty acid containing lotions that replenish the oils on the skin surface

MOA of humectants

Additives (i.e. alpha hydroxy acids, urea) that draw water from the deeper layers to the skin surface

MOA of occlusives

Prevent water loss from the skin

Define xerosis

Dry skin

What urinary changes occur in older adults?

-Decrease in the kidney's ability to concentrate urine or reabsorb water

-Reduced GFR

-Changes in vasopressin secretion --> may experience nocturia

-Functional capacity of bladder decreases

-Bladder contractility decreases causing less efficient emptying

-Decreased sensation of thirst

-May experiences decreased muscle tone in perineal floor and anal sphincter

Define nocturia

Frequent urination at night

Define oliguria

Decreased production and elimination of urine

Define hematuria

Blood in the urine

Define polyuria

Increase in urine production and elimination not associated with increased fluid consumption

Define anuria

Absence of urine

Define urgency

Feelings associated with having to empty your bladder immediately

Define hesitancy

Difficulty starting urination

Define retention

Incomplete emptying of the bladder

Define dysuria

Painful or difficult urination

What stool types on the bristol stool chart are considered normal? Define each type.

Type 3: Sausage like with cracks in the surface

Type 4: Smooth, soft sausage or snake like

List the elimination red flags

-Increase or decrease in urine output

-Increase or change of pain, distention

-Signs of infection and or septicemia (pathogen in blood)

-Bloody stool or urine

-Reduced or no bowel sounds

-No bowel movements or movement of gas

-Diarrhea

What urine output levels should you report?

Less than 30 ml over an hour

How should a patients skin be kept?

Clean and dry

True or False: Dignity and privacy do not need to be maintained at all times?

False

1 multiple choice option

Should we encourage patients to do their own care if they're able to?

Yes

1 multiple choice option

When using incontinence products what should you ensure?

Ensure the patient(s):

-Is comfortable and has the right size (Day and night products)

-Skin is kept dry and protected

-Dignity and privacy is maintained

What possible nursing interventions can you take to promote skin integrity, hygiene, elimination and continence care?

-Report and document findings

-Encourage fluids (non caffeinated)

-Increase fiber in diet

-Pain management

-Increase mobility and exercise

-Ensure appropriate position for bowel movement with privacy

-Monitor intake and output of urine and stool

-Patient teaching on fluids, pain management, diet and fiber

-Teach on the importance of mobility and exercise to reduce constipation

Which body area should you not apply soap to during bathing?

The eye area