ADL Hygiene

Performing Activities of Daily Living (ADLs)

• Key Aspects:

  • Hygiene

  • Do's and Don'ts (DOO)

  • Health Implications (H)

The Nursing Process in Hygiene

• Emphasizes the importance of assessing patient needs through a structured nursing process, such as:

  • Assessment - Building knowledge about the patient’s hygiene through observation and inquiry.

  • Diagnosis - Identifying hygiene-related issues.

  • Planning - Determining suitable interventions.

  • Interventions - Implementing plans to assist the patient.

  • Evaluation - Assessing the outcome of interventions.

Factors Influencing Hygiene

1. Social Practices - Norms and customs affecting hygiene.

2. Personal Preferences - Individual likes and dislikes concerning hygiene practices.

3. Body Image - How a person perceives their body can influence their hygiene habits.

4. Socioeconomic Status - Financial ability to maintain hygiene.

5. Health Beliefs - Personal beliefs about health can drive hygiene behaviors.

6. Culture - Significant variations in hygiene practices across different cultures.

7. Developmental Stage - Varies from childhood to elderly care; considerations change with age.

8. Physical Condition - Overall health status and physical ability to perform routines.

Assessing Hygiene Needs

• Key considerations for assessment include:

  • Prior Experiences: Reflect on similar past experiences with patients.

  • Environmental Factors: Identify any environmental issues that might affect hygiene care (e.g., cleanliness of the environment).

  • Medical Records: Review patient records for any updates or information relevant to their hygiene needs.

  • Professional Standards: Adhere to established guidelines and protocols.

  • Risk Assessment: Evaluate the risk for developing hygiene problems.

  • Patient Interaction: Engage with patients to understand their personal needs and limitations better, including inquiring about what help they require.

Planning and Prioritizing Care

• Questions to guide planning for individual patient care:

  • What is the most important thing for this patient?

  • What actions will I take for this patient?

  • What outcomes are most critical for this patient’s well-being?

  • How will teamwork and collaboration play a role in supporting this patient?

  • How can I provide holistic care to meet all needs?

  • What individualized care plan can be developed?

Safety Guidelines for Hygiene Practices

• Essential safety considerations include:

  • Follow infection prevention principles to protect patients.

  • Perform tasks moving from cleanest areas to the dirtiest.

  • Utilize appropriate personal protective equipment (PPE).

  • Check warmth of solutions or water before use.

  • Ensure personal hygiene items are accessible to the patient.

  • Provide clear directions to unlicensed assistive personnel (UAP) when delegating tasks.

  • Review lab results prior to activities that might cause bleeding.

  • Involve the patient or their family in understanding their needs and interests regarding care.

Types of Baths in Patient Hygiene

1. Partial Bed Bath

2. Complete Bed Bath

   • Includes various methods such as:

     • Disposable bed bath.

     • Sponge bath.

     • Shower.

     • Chlorhexidine bath.

     • Tub bath.

Considerations for Hygiene Interventions

• Important Reminders:

  • Safety throughout the process.

  • Ensuring patient privacy.

  • Clean to dirty - maintain hygiene protocols.

  • Providing warmth to patients.

  • Encourage independence where possible.

  • Anticipate patient needs for comfort and care.

  • Conduct skin assessments throughout the process.

  • Include educational moments for the patient's understanding.

  • Make comfort a priority in all interventions.

Complete Bed Bath Procedure

1. Perform hand hygiene and put on gloves.

2. Raise the bed for comfort.

3. Cover the patient with a bath blanket, then lower top sheets.

4. Begin by removing the patient's gown.

   • Wash body sections in the following order:

     • Eyes - different section of the mitt for each eye.

     • Face.

     • Upper body - arms, chest, abdomen.

     • Lower body - legs, feet.

     • Perineal area.

     • Back and buttocks/anus.

5. Use new gloves after each procedure area.

6. Offer the patient a new gown.

7. Reposition the patient and lower the bed when finished.

8. Ensure the call light is within reach and perform hand hygiene again.

Perineal Care

• Specific instructions include:

  • Often necessary for patients with incontinence or those with a Foley catheter.

  • Encourage patients to perform this when possible, though embarrassment may occur.

  • Assess the area for skin breakdown or any issues.

  • Important technique:

    • Always clean from front to back for female patients.

    • Retract the foreskin back for uncircumcised males.

Nail and Foot Care

• General Guidelines:

  • Soaking hands and feet can help soften skin but is an exception for patients with Chronic conditions, such as Diabetes Mellitus (DM) or Peripheral Vascular Disease (PVD).

  • After cleaning, ensure thorough drying, especially between toes.

• Education for Diabetic Patients includes:

  • Daily inspection of feet.

  • Daily washing in lukewarm water.

  • Wearing well-fitting shoes and keeping feet dry with clean socks.

  • Avoid putting lotion between toes to prevent moisture buildup.

  • Advising trimming toenails straight across to avoid ingrown nails.

  • Protecting feet from extreme temperatures.

Oral Hygiene Considerations

• Importance of oral care includes:

  • Regular cleaning of the mouth and teeth.

  • Methods like CHG rinses may be effective, particularly in unconscious patients.

  • Encourage good hygiene practices amongst patients.

Denture Care

• Routine practices include:

  • Regular cleaning and careful handling of dentures.

  • Remove dentures nightly and place them in a labeled cup filled with water.

  • Assess the gums for any signs of irritation or infection.

Hair Care in Patient Hygiene

• Specific aspects include:

  • Brushing and combing according to patient preferences.

  • Alternatives like shampoo caps, dry shampoo, or using a hair basin where appropriate.

Shaving in Patient Care

• Techniques include:

  • Perform shaving after a bath using warm water and shaving cream.

  • Caution with electric razors if the patient is on anticoagulants.

  • For hand-held razors:

    • Pull the skin taut.

    • Shave in long, firm strokes in the direction of hair growth; use short downward strokes for sensitive areas like the upper lip and chin.

Cleanliness of the Eyes, Ears, and Nose

• Guidelines for care include:

  • Cleaning from the inner to outer region,

  • Using a wet washcloth or a moistened cotton swab (no soap).

  • For outer ear cleaning, use warm water but avoid inserting items into the ear canal.

  • Use caution with medical devices when performing hygiene routines.

Making an Occupied Bed

• Steps to follow:

  • Position the patient lying flat if tolerated, and raise the bed to a comfortable working height.

  • Lower the side rail on the side where standing and remove the top blanket, leaving the patient covered.

  • Cover them with a bath blanket and remove the top sheet from beneath.

  • Turn the patient onto the side away from you, remove and replace the sheet and other linens on the exposed half of the bed.

  • Roll all soiled linens under the patient and ensure a clean environment.

  • Finish by ensuring safety measures such as lower bed, bed rails, and call light availability post-completion.

Tips for Safety and Best Practices

• Key reminders for healthcare providers include:

  • Importance of teamwork in patient hygiene.

  • Maintain proper room temperature for patient comfort.

  • Avoid shaking or throwing dirty linen, maintaining protocol while handling.

  • Collect all necessary supplies prior to entering the patient's room.

  • Always wear gloves while handling linens or performing care tasks.

Delegation to Unlicensed Assistive Personnel (UAP)

• Tasks that may be delegated include:

  • Bathing.

  • Oral care.

  • Making the bed.

  • Gown changes.

Documentation of Hygiene Practices

• Essential components include:

  • Type of bath provided.

  • Documentation reflecting the patient's assistance required.

  • Education or teaching that was conducted.

  • Assessment findings regarding the patient's condition.

  • Safety and functional status indicators (e.g., range of motion (ROM)).

Evaluating Hygiene Practices

• Key questions to guide evaluation include:

  • Are hygiene practices effective in keeping the patient's skin healthy and free from infection?

  • How is the patient's skin condition evolving, including wound healing and infection status?

  • Reflection on necessary modifications to the hygiene plan to better suit the patient's needs and preferences.