Lesson 2 Hygiene

Activities of Daily Living (ADLs)

Bathing, ambulation, toileting, transferring, eating, dressing

Instrumental Activities of Daily Living (IADLs)

Higher level of functioning required; impacted by sensory, motor (gross or fine), or neurological impairments

Principles for providing hygiene - preferences

Determine patient preferences; ask before doing

Principles for providing hygiene - independence

Maintain highest level of function; encourage independence; NEVER assume

Principles for providing hygiene - activity tolerance

Assess activity tolerance; tailor activities to patient response

Principles for providing hygiene - respect

Be respectful of personal space and ways of doing things; if patient does things differently and it's not harmful, let them do it their way

Factors affecting self-care

Health state, developmental level, socioeconomic status, culture, personal preferences

Early morning care steps

1. Assist patient with toileting 2. Provide comfort measures to refresh patient for day 3. Wash face and hands 4. Provide mouth care

Morning care timing

After breakfast, nurse completes morning care

Morning care activities

Toileting, oral care, bathing, back massage, special skin measures, hair care/cosmetics, dressing, positioning, changing linens

Afternoon care

Offer assistance with toileting, handwashing, oral care; straighten bed linens; help patient with mobility to reposition self

Hour of Sleep (HS) care

Toileting, washing, and oral care; back massage; change soiled bed linens or clothing; position patient comfortably; ensure call light and objects within reach

PRN care

1. Offer individual hygiene measures as needed 2. Change clothing and bed linens of diaphoretic patients 3. Provide oral care every 2 hours if indicated

Safety awareness for independence

Call bell, shower seat, check water temp, stay nearby

General skin care principles - assessment

Assess skin daily

General skin care principles - cleansing

Use pH balanced no-rinse cleanser; avoid soap and hot water; avoid excessive friction and scrubbing

General skin care principles - moisture

Minimize skin exposure to moisture (incontinence, wound leakage); use moisturizers

General skin care principles - powders

If patient has powders ordered for intertriginous areas, apply afterwards as ordered

Therapeutic effects of bathing

Removes dirt and bacteria, stimulates circulation, improves joint mobility, provides opportunity to assess integument, provides positive client-nurse interaction, provides relaxation and comfort, fosters sense of wellbeing

No-rinse bathing wipe areas

Face/neck/chest, left arm, right arm, perineum, left leg, right leg, back, buttocks (8 WIPES FOR ONE COMPLETE BATH)

No-rinse bathing technique

No rinsing after; let air dry

Bathing types

Bed bath (partial or complete), shower (sitting or standing)

Bed bath considerations - privacy

Privacy, comfort, bath blanket, expose 1 body part at a time, cover wet area

Bed bath considerations - technique

Wash extremities distal to proximally for circulatory support (stimulate venous return)

Bed bath considerations - nursing

Use time for assessment and rapport development

Hair care types

Two types of in-bed hair care; therapeutic touch

Eye care technique

Use one side of wash cloth, wipe, then fold wash cloth to use clean corner to maintain hygienic practice

Oral care - NPO dependent patient

Use mouth swab every 2 hours

Oral care types

Dentures, permanent teeth, mouth swab

Shaving technique

Always shave downwards

Nail care tools

Orange sticks for finger nails

Nail care technique

Soaking; typically only file nails (no clippers)

Nose care PPE

Gloves, using standard precautions for bodily fluids

Ear care cleaning

Cleanse pinna or auricle of the ear

Cerumen removal

Removed via capillary action (ear candling)

Ear care restrictions

No Q-tips

Impacted cerumen treatment

Medications such as Debrox; ear irrigation

Hearing aids vs normal hearing

Hearing is not the same as normal hearing; amplifies sound but does not affect discrimination

Hearing aid pearls - adjustment

Wear at intervals first to adjust; adjust volume to lowest level needed

Hearing aid pearls - maintenance

Check batteries daily; clean ear piece daily

Hearing aid normal function test

Whistling sound when aid is held in hand on "high" = normal, means battery is working

Hearing aid feedback noise cause

Occurs when sounds leave ear and find way back into microphone where it is re-amplified

Hearing aid feedback consequences

Can lead to emotional distress, isolation (to avoid embarrassment), and even depression

Hearing aid feedback solutions

Often due to poor fit - take out and re-insert or have refit; can use feedback canceller; check for excessive earwax buildup, cracked tubing, or dislodged microphones

Perineal care - female

Front to back and cleanest to dirtiest

Perineal care - male

Tip from center out and then down

Unresponsive patient mouth care

Mouth care with swabs every 2 hours

Unresponsive patient lip care

Vaseline or lubricant to lips

Unresponsive patient skin care

Lotion to skin

Unresponsive patient circulation

Backrub to stimulate circulation

Unresponsive patient hair care

Dry shampoo the hair

Unresponsive patient shaving

Use electric razor

Unresponsive patient mobility

Joint range of motion to prevent contractures and promote circulation

Unresponsive patient communication

Talk to patient while providing care

Eating complexity

Eating is complex activity requiring energy, muscle coordination, and ability to swallow and chew

Set up assistance

Assist as needed with tray setup, open cartons, cut food into small pieces if appropriate, position food choices per patient preference

Vision impaired patient feeding

Use clock location for food placement

Feeding a patient - preparation

Position upright, mouth care before meal, toilet before meals, provide pain med PRN, place napkin/bib for clothing protection, dentures/hearing aids/glasses in place

Feeding a patient - technique

Sit at eye level, encourage conversation, keep patient preferences in mind

Feeding a patient - assessment

Observe for pocketing of food; watch for drooling in patients with history of stroke or dementia

Dressing a patient requirements

Requires mobility, dexterity (fine motor skills), and balance

Dressing a patient principles

Strive to maintain independence

Dressing a patient considerations

Dress painful side first; dress weak or paralyzed side first

Feet vulnerable populations

Older adults and patients with diabetes mellitus

Diabetic foot vulnerability causes

Structural changes, decreased peripheral circulation, peripheral neuropathy

Diabetic foot and nail care - inspection

Inspect feet regularly

Diabetic foot and nail care - nails

File nails straight across; no nail clippers

Diabetic foot and nail care - restrictions

Do not soak feet; do not rub vigorously

Diabetic foot and nail care - moisture

Moisturize skin but not between toes

Diabetic foot and nail care - prevention

Avoid anything that can cause skin breakdown

Antiembolism stockings (TEDS)

Type of compression stocking

TEDS purpose

Prevents DVT or VTE, prevents venous stasis, prevents edema formation

TEDS pressure

Exerts 15 mmHg of pressure

TEDS care considerations

Correct fit, avoid wrinkles, put on in AM, remove for 30 minutes every 8 hours