Seven

Week 7 N221 Lab Lecture (October 13-17, 2025)

  • Focus: Promotion of skin integrity, hygiene care, elimination, and continence care

Key Question

  • What is the largest organ in the human body?

    • Answer: The skin!

Main Topics Covered

## 1. Learning Objectives

  • Apply clinical reasoning and judgment in patient exemplars related to hygiene care.

  • Discuss the role that hygiene and bathing practices play in maintaining health and well-being of clients.

  • Discuss functional ability and independence concerning hygiene and bathing.

  • Discuss expected and unexpected findings related to skin integrity and elimination.

2. Clinical Judgment vs. Clinical Reasoning

  • Clinical Judgment:

    • Definition: The decision-making process in nursing that entails applying knowledge, experience, and expertise to assess patient situations, prioritize needs, and select appropriate interventions.

    • Involves intuition and evaluating outcomes of chosen actions.

    • Takes into account the patient’s medical history, environment, and personal preferences.

  • Critical Thinking:

    • Definition: The ability to analyze, evaluate, and synthesize information to make informed decisions.

    • Involves questioning assumptions, considering different perspectives, and applying logic to solve problems.

    • Example: A nurse may review a patient’s medical history, lab results, and symptoms to determine necessary assessments or interventions.

3. Hygiene

  • Definition: Conditions or practices of cleanliness and body care conducive to health and wellness (Tellier & How, 2020, p. 801).

  • Self-Care:

    • Definition: The person's ability to perform care functions in bathing, feeding, toileting, and dressing without help (Tellier & How, 2020, p. 801).

4. Hygiene & Bathing Practices

  • Very personal and individualized.

  • Regular bathing is essential for maintaining healthy skin integrity.

  • Hygiene practices vary from person to person.

5. Importance of Assessment in Hygiene

  • Hygiene begins with a comprehensive assessment of the patient’s needs.

6. Scheduling Hygiene Care

  • Types of Care:

    • Early Morning Care: Urinal assistance, washing hands and face, oral care.

    • Morning Care: Bathing (shower or bed bath), hair care, shaving, foot/nail care, dressing, bed linen change.

    • Afternoon Care: Refreshing, elimination needs, bed linen checks.

    • HS or Evening Care: Face/washing, oral care, changing into nightwear, back massage.

7. Bed Baths

  • Types: Partial or complete.

  • Opportunity for multitasking, assessments can be incorporated.

  • Must follow a structured approach.

8. Considerations When Bathing

  • Promote independence.

  • Anticipate patient's needs.

  • Ensure safety through risk assessments and infection control practices.

  • Provide privacy and maintain warmth during bathing.

  • Rinse and pat dry skin thoroughly.

  • Maintain communication throughout the bath (Tellier & How, 2020).

9. Alternative Bathing Methods

  • Bath in a bag, hair wash in a bag, sprays.

10. Perineal Care

  • An essential aspect of hygiene during complete or partial baths.

  • Highly personal; patients are encouraged to perform their own care when able.

  • Ensure routine practices and PPE (Personal Protective Equipment) are applied (Tellier & Lee, 2020).

11. Safe Temperature for Bathing

  • AHS policy PS-47 outlines safe bathing temperatures and frequency guidelines.

12. Hygiene Care Products

  • Commonly used products include moisturizers, moisture barrier creams, cleansers, wipes, and pharmaceutical creams/powders.

13. Importance of Moisturizers

  • They are critical for treating dry skin (xerosis).

  • Functions include:

    • Repairing the skin barrier

    • Increasing skin water content

    • Reducing water loss

  • Different types of moisturizers may be required based on individual patient needs.

14. Handling Refusal of Bathing

  • Strategies should include respectful communication and understanding the patient's concerns.

15. Skin Integrity & Elimination

  • Key questions:

    • What is expected?

    • What is unexpected?

    • What strategies can be implemented?

    • When is monitoring and evaluation urgent?

16. Considerations for Older Adults

  • Challenges:

    • Decreased kidney ability to concentrate urine or reabsorb water

    • Reduced Glomerular Filtration Rate (GFR)

    • Decreased functional capacity of the bladder

    • Reduced bladder contractility

    • Diminished sensation of thirst

    • Possible decline in perineal floor and anal sphincter muscle tone (Hunter & Thompson, 2019, p. 1172).

17. Urinary Assessment

  • Components include:

    • Health history

    • Physical assessment

    • Urine analysis

    • Lab tests

    • Additional diagnostic exams

18. Bowel Assessment

  • Components include:

    • Health history

    • Physical assessment

    • Stool analysis

    • Lab tests

    • Other diagnostic data

19. Bristol Stool Chart

  • Categorizes stool types to assess bowel function:

    1. Type 1: Separate hard lumps - Severe constipation

    2. Type 2: Lumpy and sausage-like - Mild constipation

    3. Type 3: Sausage shape with cracks - Normal

    4. Type 4: Smooth, soft sausage or snake - Normal

    5. Type 5: Soft blobs with clear-cut edges - Lacking fiber

    6. Type 6: Mushy with ragged edges - Mild diarrhea

    7. Type 7: Liquid with no solid pieces - Severe diarrhea

20. Indicators for Further Assessments

  • Changes in urine output

  • New or increased pain/distension

  • Signs of infection

  • Presence of bloody stool or urine

  • Absence of bowel sounds

  • Lack of bowel movements or flatulence

  • Occurrence of diarrhea

21. Incontinence

  • Discussion on managing involuntary loss of urine or feces and the importance of skin integrity during care.

22. Skin Integrity Assessment

  • Documentation practices:

    • Where and when to chart assessments.

23. Braden Scale for Predicting Pressure Sore Risk

  • SENSORY PERCEPTION:

    1. Completely Limited

    2. Very Limited

    3. Slightly Limited

    4. No Impairment

  • MOISTURE:

    1. Constantly Moist

    2. Very Moist

    3. Occasionally Moist

    4. Rarely Moist

  • ACTIVITY:

    1. Bedfast

    2. Chairfast

    3. Walks Occasionally

    4. Walks Frequently

  • NUTRITION:

    1. Very Poor

    2. Very Limited

    3. Adequate

    4. Excellent

  • FRICTION & SHEAR considerations.

  • Total score calculation may indicate risk level for pressure sores.

24. Patient Assessment Checklist

  • Comprehensive checklist for neurological, cardiovascular, gastrointestinal, and musculoskeletal systems, documenting any abnormalities in the patient care record.

Review Questions

  • Scenario 1: While giving a patient a tub bath they request hotter water. What to do?

    • a) Turn on the tap and add more hot water

    • b) Immediately remove the patient

    • c) Explain the need to adhere to AHS temperature guidelines

  • Scenario 2: What is crucial to remember for patient care?

    • a) Pat dry areas under skin folds

    • b) Ensure privacy during bathing

    • c) Regularly perform skin assessments on dependent areas

    • d) All of the above

  • Scenario 3: In which area is it inadvisable to use soap?

    • a) Perineum

    • b) Underarm area

    • c) Eye area

    • d) Feet

References

  • Alberta Health Services (2018). Safe bath temperatures policy.

  • Gregory, D., Raymond, C., Patrick, L., & Stephen, T. (Eds.). Fundamentals: Perspectives on the art and science of Canadian nursing. (2nd ed.). Wolters Kluwer.

  • Tellier, C., & Lee, H. (2020). Client hygiene.

  • Hunter, & Thompson (2019). Supporting Elimination.

  • Hannon, R.A., Porth, C.M. (2017). Pathophysiology: Concepts of altered health states. (2nd Canadian ed., p. 1586).

  • Wolf, Z. R., & Czekanski, K. E. (2015). Bathing Disability and Bathing Persons with Dementia. Medsurg Nursing, 24(1), 9-22.