NUR 112 Functional Ability

Hygiene & Activities of Daily Living Notes

Overview

  • Course Code: NUR 112

  • Date: 8/21/24

  • Focus: Functional Ability related to Hygiene and Activities of Daily Living (ADLs).

Concept of Functional Ability

  • Exemplars: Various examples of hygiene and basic skills that contribute to functional ability. Includes:

    • Oral Care

    • Compression Socks

    • Bed Pan

    • Urinal

    • Bedmaking

    • Bathing

    • Personal Protective Equipment (PPE)

    • Hand Hygiene

Course Objectives

  • Importance of Good Hygiene: Discuss how good hygiene affects overall health.

  • Identifying Factors Affecting Hygiene: Understanding personal and external factors that influence hygiene practices.

  • Demonstrating Hygiene Techniques:

    • Assisting patients with hygiene measures.

    • Performing occupied-bed linen change safely.

    • Performing unconscious oral care.

    • Proper handwashing techniques.

    • Proper donning and doffing of PPE.

General Concepts Related to Hygiene

  • Activities of Daily Living (ADLs): Refers to personal grooming and cleanliness tasks.

    • Includes activities such as:

    • Bathing

    • Ambulation

    • Toileting

    • Transfers

    • Eating

    • Dressing

Instrumental Activities of Daily Living (IADLs)

  • Definition: Measure a person’s ability to live independently through more complex activities such as:

    • Shopping

    • Cleaning/Cooking

    • Using telephone or transportation

    • Managing money or medications

Benefits of Good Hygiene

  • Promotes both physical and mental health by:

    • Preventing infections through skin cleansing.

    • Conditioning the skin.

    • Providing relaxation and improving circulation (distal to proximal).

    • Serving as a form of exercise.

    • Enhancing self-image and strengthening nurse-client relationships.

Framework for Patient Independence in Hygiene

  • Emphasize promoting independence by providing care only for tasks patients cannot perform themselves.

Components of Hygiene

  • Includes:

    • Cleansing of the patient.

    • Maintaining a clean environment.

    • Bedmaking practices.

    • Oral care provisions.

    • Ensuring safety during care processes.

Personnel Responsible for Bathing Patients

  • Who Bathes Patients?:

    • Unlicensed Assistive Personnel

    • Nurses

Nursing Functions in Hygiene

  • Role of Nursing in Hygiene:

    • Assessment of patient needs.

    • Teaching patients about hygiene.

    • Providing comfort during hygiene practices.

    • Engaging in therapeutic touch.

    • Facilitating relaxation and pain relief.

    • Demonstrating care and compassion.

Factors Affecting Personal Hygiene

  • Cultural Factors: Variations in hygiene practices based on cultural beliefs regarding frequency, type of assistance, and gender preferences.

  • Financial Resources: Access to water and personal hygiene supplies.

  • Spiritual Practices: Rituals that involve specific cleansing practices (like pre-prayer washing).

  • Developmental Level: Differences in hygiene needs among children, teenagers, and the elderly.

  • Health State: Influence of diseases, surgeries, and injuries on hygiene capabilities.

  • Personal Preferences: Preferences regarding shower vs. bath, time of day for hygiene, and frequency of cleansing.

Encouraging Patient Involvement in Hygiene

  • Involve patients in their hygiene care when possible to give them a sense of control.

  • Consider time constraints, delegation options and ensure refusals are reported appropriately.

Assessment Before Bathing

  • Nurse Responsibilities:

    • Monitoring patient tolerance through:

    • Observing respiratory responses.

    • Tracking heart rate.

    • Evaluating patient's position requirements (e.g., need for orthopnea).

    • Assessing confusion and endurance levels before selecting the bath type (shower vs. bed bath).

Assessment During Bathing

  • Areas to Monitor:

    • Skin condition.

    • Activity tolerance and musculoskeletal function.

    • Oral cavity health.

    • Condition of eyes, ears, nose, hair, nails, and feet.

    • Perineal and vaginal areas.

Assessing Tubes and Lines

  • Tubes and Lines to Assess:

    • Oxygen.

    • Intravenous (IV) lines.

    • Urinary catheters.

    • Enteral feeding tubes.

    • Jackson Pratt drains.

Skin Characteristics Assessment

  • Assessment Factors:

    • Identifying wounds, rashes, and abnormalities.

    • Checking skin temperature, color, elasticity, and texture.

Common Skin Alterations

  • Alterations Include:

    • Cyanosis: blue discoloration due to lack of oxygen.

    • Clubbing: deformity of fingers and nails related to chronic respiratory or cardiovascular conditions.

    • Dry Skin: lack of moisture in the skin.

    • Impetigo: bacterial skin infection.

    • Eczema: chronic skin condition causing inflammation.

    • Jaundice: yellowing of skin due to liver issues.

Foot Assessment

  • Conditions to Note:

    • Athlete’s foot.

    • Diabetic ulcers.

    • Plantar warts.

    • Edema.

Nail Assessment

  • Nail Issues:

    • Fungal infections.

    • Cancerous lesions.

    • Protocols for cleaning dirty fingernails.

  • Trimming Guidelines:

    • Nails should be trimmed straight across; avoid cutting too closely or down the corners.

Oral Care Importance

  • Connection Between Oral and Systemic Health:

    • Poor oral health can lead to systemic diseases (diabetes, cardiovascular issues).

    • Bacteria can enter the bloodstream through the gums, causing both localized and systemic inflammation.

    • Important nutrients for dental health include Vitamin D, calcium, and phosphorus.

Oral Cavity Assessment

  • Conditions to Identify:

    • Cavities: necessitate fillings from a dentist.

    • Gingivitis: inflammation of gums indicating poor dental hygiene.

    • Stomatitis: sores inside the mouth.

    • Glossitis: inflammation of the tongue.

    • Oral lesions or malignancies: require thorough examination for appropriate diagnosis.

Comprehensive Oral Care Steps

  • Key Practices:

    • Moistening the mouth, cleaning, caring for dentures, and brushing teeth. Ideally after each meal and before bed.

    • Using toothpaste and mouth rinses for effective cleaning.

  • Unconscious Oral Care Specifics:

    • Test for gag reflex before working, have suction ready.

    • Position patient appropriately (on their side) for safety.

    • Use a swab or toothette for cleaning; ensure to suction secretions.

Hair and Scalp Assessment

  • Key Factors to Examine:

    • Texture, color, cleanliness, loss, or infestation of hair.

Shaving Techniques

  • With Standard Razor:

    • Apply warm, wet washcloth to soften hair; use shaving cream and shave in the direction of hair growth (face) or against for legs.

  • With Electric Razor:

    • Recommended for patients on anticoagulant therapy; minimizes risk of cuts.

Assessing Eye Care Needs

  • Points to Consider:

    • Use of corrective lenses, check sclera, eyelids, pupils, and signs of inflammation.

    • Care considerations for contact lenses and artificial eyes.

Care of Dentures and Eyeglasses

  • Dental Hygiene Practices:

    • Clean dentures as frequently as natural teeth; use care to avoid breaking.

    • Store dentures properly overnight in water.

    • Use gauze or washcloth to hold dentures during cleaning, and line the sink to catch any dropped items.

Ear and Nose Assessment

  • Ears:

    • Inspect outer structures, cerumen buildup, presence of hearing aids, and piercings.

  • Nose:

    • Inspect for inflammation, discharge, lesions, edema, and deformities.

Shampooing Hair Preferences

  • Options for Shampooing: Involve patient preference in deciding whether to use:

    • Sink, tub/shower, shampoo in a bag, or dry shampoo methods.

Perineal and Vaginal Care

  • Assessment and Care:

    • Conduct assessments and procedures respectfully and with dignity.

    • Use appropriate cleansing methods.

Perineal Care Procedure - Women

  • Steps for cleansing:

    • Wipe labia majora from front to back; use clean surface for each swipe.

    • Similar techniques for labia minora and around the meatus; ensure to wash inner thighs as directed.

Perineal Care Procedure - Male

  • Steps for cleansing:

    • Retract foreskin if uncircumcised; wash urinary meatus in a circular motion and continue down the shaft of the penis, scrotum, and inner thighs.

Care with Catheter

  • Similar cleaning methods as perineal care in a woman; remember to clean catheter area cautiously.

Types of Baths

  • Various Bathing Techniques: Includes:

    • Shower

    • Tub Bath

    • Bed Bath

    • Disposable Bath

Providing a Bed Bath

  • Types:

    • Complete Bed Bath: caretaker washes the entire body.

    • Partial Bed Bath: some areas washed by the healthcare worker, others by the patient.

    • Maintain warmth, privacy, and safety throughout the procedure.

CHG Bath Benefits

  • Chlorhexidine gluconate (CHG) 2%:

    • Reduces skin bacteria, decreases healthcare-associated infections (HAIs), more effective than soap & water.

    • Must avoid contact with eyes and perineal area.

Special Considerations for Confused or Dementia Patients

  • Individualized care must consider patient comfort and needs. May involve alternative bathing methods such as towel baths to enhance dignity.

Back Massage Benefits

  • Relieves muscle tension, promotes relaxation, and allows skin observation. Can improve circulation and decrease distress or anxiety.

Delegating Hygiene Care

  • Assess the patient before delegating hygiene tasks; ensure proper instructions are given to assistants regarding patient limitations and required observations.

Bath Refusal Considerations

  • Investigate underlying issues (power dynamics, fatigue, visitor presence) when a patient refuses bathing; understand effective communication strategies.

Ensuring Bedside Safety

  • Safety Protocols:

    • Ensure bed is at lowest position, side rails up, and call light accessible. Confirm bed controls are functioning and wheels are locked.

Bedpans & Urinals Usage

  • Applicable Conditions:

    • Male patients tend to prefer urinals; female patients usually opt for bedpans unless alternatives like PureWick are available. Fracture pan usage should be noted for specific patient populations.

Types of Precautions in Nursing

  • Categories:

    • Standard: hand hygiene & gloves.

    • Contact: gown & gloves.

    • Droplet: surgical mask, gown, gloves.

    • Airborne: N95 masks, gloves.

    • Reverse or Neutropenic: gloves and masks as necessary.

Ted vs. SCD

  • Purpose: Both are utilized for preventing Deep Vein Thrombosis (DVT).

  • Differences:

    • Thrombo-Embolic Deterrent (TED) hose are graduated stockings designed to promote circulation.

    • Sequential Compression Device (SCD) inflates in sequence to mimic ambulation and enhance blood flow.

  • Similarities: Both should be removed before bathing to ensure safety and effectiveness.

References

  • Textbook: Taylor, et al. Fundamentals of Nursing, 2023, Wolters Kluwer, Philadelphia.