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

Hygiene & Activity

Ch. 32

• Hygiene definitions and scope

  • Hygiene practices = bathing and care of the skin and specific body areas.
  • Practices vary widely among people.
  • Strong links exist between good hygiene practices and a person’s health.
  • Nurses assisting patients with basic hygiene must respect individual patient preferences, providing only the care that patients cannot, or should not, provide for themselves.
  • Social factors (religion, culture), educational perspectives, financial issues, and their impact on hygiene are important to consider when providing hygiene care.

• Factors Affecting Personal Hygiene

  • Culture: some individuals bathe weekly or do not use deodorant; private vs communal bathing.
  • Socioeconomic Class: lack of funds for toiletries or clean clothing.
  • Spiritual Practices: ceremonial washings and purifications before prayer, eating, etc.
  • Developmental Level: family practices often dictate hygiene routines.
  • Health State: disease, surgery, or injury affect hygiene needs.
  • Personal Preference: individual likes/dislikes influence hygiene care.

Nursing Process

Assessing

• Nursing History (Skin, Oral Cavity, Eyes/Ears/Nose, Hair, Nails/Feet, Perineal & Vaginal Areas)

  • Skin: rashes, lumps, itching, dryness, lesions.
  • Recent surgeries, wounds, tattoos, piercings.
  • Oral Cavity: nutrition status, refined sugar intake, periodontal history, chemo-induced oral lesions.
  • Seriously ill, comatose, dehydrated, confused, depressed, paralyzed = high risk.
  • Eyes, Ears, & Nose: use and care of visual aids/prosthetics and hearing aids.
  • Hair: malnutrition, treatments or medical conditions causing hair loss.
  • Nails & Feet: accessing for deficient self-care abilities; vascular disease, arthritis, diabetes, ill-fitting shoes, obesity.
  • Perineal & Vaginal Areas: incontinence, catheters, childbirth, surgery, UTIs, diabetes, STIs.

• Box 32-1 P.1093: Focused Assessment Guide

  • Nails & Feet details above.
  • Perineal & Vaginal Areas details above.

• Physical Assessment

  • Musculoskeletal System: muscle weakness, decreased ROM, impaired balance, fatigue, lack of coordination.
  • Skin: cleanliness, texture, temperature, turgor, moisture, sensation, vascularity, lesions.
  • Oral Cavity: lips, buccal mucosa, teeth, tongue, hard/soft palates, oropharynx; dental caries, periodontal disease, stomatitis, glossitis, cheilosis, dry mucosa, lumps/ulcers.
  • Eyes, Ears, & Nose: dryness, crusting, discharge, foreign body.

• Hair, Nails & Feet; Perineal & Vaginal Areas (detailed above)

Actual or Potential Problem List

• Common problems include:
  • 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.

Outcome Identification & Planning (B PLAN)

• The patient will:
  • Verbalize feeling comfortable and clean.
  • Participate in hygiene measures.
  • Maintain intact skin and mucous membranes.
  • Demonstrate correct skin care measures.
  • Verbalize importance of good teeth-brushing habits, fluoride use, and regular dental examinations.
  • Demonstrate proper use and care of visual or auditory aids.
  • Participate in hair and scalp care as able.

Implementing

• Bathing & Skin Care

  • Serves purposes: cleansing skin; relaxing restless patients; promoting circulation; musculoskeletal exercise; stimulating respiration; promoting comfort; providing sensory input; improving self-image; strengthening nurse-patient relationship.

• Shower & Tub Baths

  • Mats or nonskid strips; provide shower chair for weak patients; assist in getting in/out.
  • Check water temperature; ensure a call device is handy; ensure privacy but door remains unlocked.

• General Skin Care Principles

  • Assess skin at least daily and after incontinence episodes.
  • Avoid excessive friction and scrubbing.
  • Minimize skin exposure to moisture (incontinence, wound leakage); use a skin barrier.
  • Use skin emollients after bathing and as needed for dry skin.
  • Assess bariatric inpatients’ skin twice a day; lift and separate skin folds.

• Morning Care (AM Care)

  • Early morning care: after awakening. Tasks include toileting, comfort measures, wash face/hands, mouth care.
  • AM Care after breakfast: toileting, oral care, bathing, linen change, back massage, special skin measures, hair care, cosmetics, dressing.

• Afternoon Care (PM Care)

  • After lunch: ensure comfort; assist with toileting, handwashing, oral care; straighten bed linens; assist with mobility to reposition self.

• Hour of Sleep Care (HS Care)

  • Before retiring: assist with toileting, washing, oral care; back massage; change soiled linens/clothing; position for comfort; ensure call light within reach.
  • PRN care: individual hygiene measures as needed; change clothing and bed linens; oral care every 2 hours if indicated.

• Teaching Patients About Skin Care

  • Expensive soaps are not more effective than cheaper options.
  • Keeping body and clothing clean prevents body odors.
  • Do not share cosmetics; discard after 2–4 months; keep applicators/brushes clean.
  • Use sun protection measures.

• Evaluating

  • Outcome Achievement Indicators: level of patient participation in hygiene; reduction/elimination/compensation for factors interfering with independent hygiene; changes in skin problems (healing of lesions, reducing causative factors); patient management of prescribed treatment program.

Activity (Ch. 34)

Physiology of Movement & Alignment

• Articulation and joint definitions: where a bone meets another bone.
• Synovial joints: contain lubricating fluid between articulating bones; freely moving.
• Nerve impulses stimulate muscles to contract.
• Movement results from a skeletal muscle contracting and exerting force on a tendon, which pulls on a bone.

Factors Affecting Movement & Alignment

• Developmental Considerations: age, neuromuscular development.
• Physical Health: postural abnormalities, bone formation/muscle development problems, joint mobility problems, trauma to MSK system, CNS issues, other body systems.
• Mental Health & Lifestyle: daily living patterns; many occupations are sedentary.
• Attitude & Values; Fatigue & Stress; External Factors: finances, access to equipment, safe parks, support people.

Effects of Immobility on the Body

• Cardiovascular: increased cardiac workload, orthostatic hypotension, venous stasis and thrombosis.
• Respiratory: decreased ventilatory effort and increased secretions.
• MSK: decreased muscle size (atrophy), tone, strength; decreased joint mobility and flexibility; bone demineralization; limited endurance.
• Metabolic Process: muscle wasting.
• GI: appetite disturbances, altered protein metabolism, poor digestion; slowed normal GI activity → constipation and poor reflexes.
• GU: urinary stasis, kidney stones.
• Skin: breakdown.
• Psychosocial: feelings of worthlessness, diminished self-esteem.

Nursing Process: Assessing

• Nursing History

  • Daily activity level: type, frequency, duration.
  • Endurance: dizziness, dyspnea, frequent pauses to rest; pounding heart; increased respiratory rate.
  • Exercise/fitness goals.
  • Mobility problems; physical or mental health alterations; decrease in strength; neuromuscular, MSK, perceptional or cognitive impairment; pain or discomfort; depression or anxiety.
  • External factors: environment, finances.

• Physical Assessment

  • General ease of movement and gait; involuntary movements; poor posture or balance; assistive devices.
  • Alignment; joint structure dysfunction; masses, deformities, ROM limitations, strength, swelling, heat, tenderness, pain, nodules, crepitus.
  • Muscle mass, tone, and strength; muscle wasting.
  • Endurance: increased pulse, respirations, blood pressure; SOB, dyspnea; pallor; confusion; vertigo.

Actual or Potential Problem List

• See slide on Actual/Potential Problems (e.g., Activity Intolerance, Impaired Transfer Mobility, Risk for Injury, Risk for Constipation, Toileting Self-Care Deficit, Risk for Ineffective Peripheral Tissue Perfusion).

Nursing Diagnoses

• Activity Intolerance
• Impaired Transfer Mobility
• Risk for Injury
• Risk for Constipation
• Toileting Self-Care Deficit
• Risk for Ineffective Peripheral Tissue Perfusion

Outcome Identification & Planning

• The patient will:
  • Identify personal benefits of regular exercise.
  • List support systems that reinforce exercise efforts.
  • Follow a program of regular physical exercise.
  • Demonstrate correct body alignment.
  • Demonstrate full ROM.
  • Demonstrate adequate muscle mass, tone, and strength to perform functional ADLs.
  • Be free from alterations in skin integrity.
  • Show signs of adequate venous return.
  • Be free of contractures.

Implementing

• Safe Patient Transfer

  • Assess the patient.
  • If any caregiver will lift more than 35 ext{ lb} of a patient’s weight, use assistive devices.
  • Ensure there are enough staff.
  • Assess the area; decide which equipment to use.
  • If the patient is in pain, administer prescribed analgesic.
  • Elevate the bed and lock the wheels; avoid friction.

• Equipment & Assistive Devices

  • Gait Belts: around the waist; do not use on patients with abdominal or thoracic incisions.
  • Lateral-Assist Devices: reduce patient-surface friction during side-to-side transfers (roller boards, slide boards, transfer boards, inflatable mattresses).
  • Friction-Reducing Sheets (Drawsheet).
  • Powered Full-Body Lifts: for patients who cannot bear any weight; sling under body; head to torso; sling attached to lift.

• Positioning

  • Maintain correct body alignment; use foam wedges and pillows; adjustable beds; trapeze bar; foot support to prevent “footdrop”; trochanter rolls & hand rolls; turn schedule.
  • < 200 lb: 2-3 staff; > 200 lb: at least 3 staff.

• Positioning Techniques

  • Fowler’s: head of bed elevated 45-60°, semi-sitting; promotes cardiac/respiratory function; good for eating, conversation, urinary/intestinal elimination; buttocks bear main weight.
  • High-Fowler’s: head elevated to 90°.
  • Low-Fowler’s / Semi-Fowler’s: head elevated to 30°.
  • Supine: flat on back with head/shoulders slightly elevated.
  • Side-lying / Lateral: use support pillows; variations.
  • Prone: patient lies on abdomen; head turned to side; helps prevent flexion contractures of hips/knees; contraindicated for spinal problems; careful positioning of feet to avoid plantar flexion.

• ROM (Range of Motion)

  • ROM = complete extent of movement of a joint.
  • Active ROM: patient independently moves joints.
  • Passive ROM: nurse moves each joint.
  • Move slowly; move to resistance but not pain; return to neutral.
  • Exercise each joint 2-5 times, twice a day.

• Helping Patients Ambulate

  • Early mobilization is safe, reduces hospital length of stay, and improves muscle strength and functional independence.
  • Provide assistance with walking; use mechanical aids (canes, crutches, walkers, braces).

• Promoting Exercise

  • Exercise improves health and quality of life across ages.
  • Helps prevent chronic diseases (hypertension, type 2 diabetes, cardiovascular disease).
  • Children/Adolescents: aim for 60 minutes or more of physical activity daily.
  • Adults: moderate activity for at least 2.5\text{ hours} per week.
  • Older adults at risk for falling should include balance-maintaining exercises.

• Starting a New Exercise Program

  • Medical exam before starting if: heart disease, asthma, lung disease, diabetes, kidney disease, or arthritis.
  • OR if 2+ of the following:
  • Men > 45 or Women > 55.
  • Family history of heart disease before 55 (men) or 65 (women).
  • Currently smoke or quit in past 6 months.
  • Have not exercised for at least 30\text{ minutes}, 3 days a week for 3+ months.
  • Overweight.
  • High blood pressure or high cholesterol.
  • Impaired glucose tolerance.

Nursing Process: Evaluating

• Outcome Achievement Indicators

  • General ease of movement and gait.
  • Body alignment; joint structure and function.
  • Muscle mass, tone, and strength; endurance.

• Preventing Injury for the Nurse

  • CPR readiness and other safety measures.

• Application of Ergonomics

  • Develop a habit of erect posture.
  • Use the longest and strongest muscles of arms/legs.
  • Work close to the object being moved; face direction of movement; avoid twisting.
  • Use body weight to pull/push; begin lifting with a broad base of support.
  • Ensure surface is dry and smooth; flex knees; get close to object to lift.
  • Break up heavy loads into smaller loads.