Hygiene and Nursing Skills Study Guide

Chapter 40: Hygiene and Nursing Skills

• Hygiene refers to the practice of maintaining cleanliness and health, which is a fundamental aspect of patient care.

• Key Skills associated with Hygiene include:     - Performing a Complete or Partial Bed Bath.     - Performing a Disposable Bed Bath.     - Assisting with a Tub Bath or Shower.     - Performing Perineal Care for a Female Patient.     - Performing Perineal Care for a Male Patient.     - Assisting with a Gown Change.     - Cleaning Dentures.     - Performing Oral Hygiene for an Unconscious Patient.     - Performing Nail and Foot Care.     - Shaving a Male Patient.     - Performing Hair Care and Shampooing in Bed.     - Making an Occupied Bed.     - Making an Unoccupied Bed.

Chapter Key Terms and Verbatim Definitions

• Alopecia: Loss of hair resulting from chemotherapy, hormonal changes, or improper hair care practices.

• Cerumen: Earwax.

• Cheilitis: Cracked lips often identified during oral cavity assessment.

• Complete bed bath: Bath where nurse washes patient's entire body in bed.

• Dental caries: Tooth decay; a common oral problem identified during mouth assessment.

• Edentulous: Without teeth; requires assessment of underlying gums and palate.

• Effleurage: Gentle stroking massage technique; often associated with long, slow, gliding strokes.

• Gingivitis: Inflammation of the gums, an oral problem resulting from inadequate oral care.

• Glossitis: Inflammation of the tongue, identified during oral cavity assessment.

• Halitosis: Foul-smelling breath commonly associated with oral hygiene problems.

• Maceration: Softening and breakdown of skin from prolonged moisture exposure.

• Mucositis: Inflammation of oral mucosa.

• Partial bed bath: Bath where patient bathes only body parts that cause discomfort if left unbathed (e.g., hands, face, axilla, and perineal area).

• Pediculosis capitis: Infestation of head lice requiring inspection with gloves or tongue blades.

• Perineal care: Thorough cleaning of external genitalia and surrounding skin, performed during complete bed bath.

• Stomatitis: General inflammation of the mouth.

• Xerostomia: Dry mouth.

Functions of the Skin and Clinical Implications

• Protection:     - Description: The epidermis is a relatively impermeable layer preventing microorganism entrance. Dryness of the skin surface inhibits bacterial growth. Sebum removes bacteria from follicles, and the acidic pH retards growth.     - Clinical Implications:         - Scrapping or stripping (e.g., dry razors, tape removal, improper positioning) weakens the epidermis.         - Excessive dryness causes cracks/breaks allowing bacterial entry. Emollients and hydration prevent moisture loss.         - Constant moisture causes moisture-associated skin damage (MASD).         - Misuse of soaps/detergents/cosmetics causes chemical irritation; alkaline soaps neutralize the skin's acidic protection.         - Friction increases risk for pressure injuries; avoid loss of the stratum corneum.

• Sensation:     - Description: Contains sensory organs for touch, pain, heat, cold, and pressure.     - Clinical Implications:         - Smooth linen prevents mechanical irritation.         - Bath water must not be excessively hot or cold.         - Patients with dementia or cognitive disorders may not perceive temperature, pressure, or pain.         - Patients with paralysis do not perceive these sensations.

• Temperature Regulation:     - Description: Controlled via radiation, evaporation, conduction, and convection.     - Clinical Implications:         - Wet linen/gowns increase heat loss.         - Excess blankets conserve heat and interfere with loss through radiation/conduction.

• Excretion and Secretion:     - Description: Sweat promotes evaporation/heat loss. Sebum lubricates skin and hair.     - Clinical Implications:         - Perspiration/oil can harbor microorganisms.         - Bathing removes secretions; however, excessive bathing results in dry skin.

Scientific Knowledge Base: Anatomy and Physiology

• Skin Layers:     - Epidermis (Outer Layer): Prevents water loss, injury, and entry of microorganisms. Responsible for tissue regeneration.     - Normal Flora: Reside on the outer epidermis; they inhibit the multiplication of disease-causing microorganisms.     - Sebaceous Glands: Secrete sebum (oily, odorless fluid) into hair follicles to soften, lubricate, and slow water loss. Sebum is bactericidal.     - Subcutaneous Tissue: Contains blood vessels, nerves, lymph tissue, and loose tissue with fat cells. It functions as a heat insulator and support structure.

• Physiological Changes: Reflected in color, thickness, turgor, temperature, and hydration levels.

• Feet, Hands, and Nails:     - Vulnerability in conditions like arthritis, MS, or traumatic injury because inability to ambulate/manipulate hands leads to self-care deficits.     - Nail characteristics (shape, thickness, curvature) change due to inadequate nutrition or disease.

• Oral Cavity:     - Saliva: Functions include cleansing the mouth, dissolving food for taste, moistening food, and providing enzymes. Affected by medications, radiation, dehydration, and mouth breathing.     - Pathologies: Gingivitis (gum inflammation) and Dental Caries (decay).

• Hair: Influenced by hormones, nutrition, emotional state, aging, infection, and physical stress.

• Eyes, Ears, and Nose:     - Eyes: Cornea is easily irritated; secretes tears.     - Ears: Auditory canal secretes cerumen.     - Sensory deficiencies directly impact the patient's ability for self-care.

Nursing Knowledge Base: Factors Influencing Hygiene

• Social Practices: Influenced by social groups, finances, living conditions, and culture.

• Personal Preferences: Patients have individual choices for bathing (shower vs. bath) and grooming products.

• Body Image: This is subjective. It is altered by surgery, illness, or changes in emotional status.

• Socioeconomic Status: Affects the affordability of supplies like deodorant, shampoo, and toothpaste.

• Health Benefits and Motivation: Nurses must teach benefits (e.g., flossing to prevent dental disease).

• Cultural Variables:     - Maintain privacy/modesty (especially for women).     - Provide gender-congruent caregivers.     - Allow family participation in hygiene schedules.     - Align hygiene with religious timings (e.g., prayers and holidays).     - Respect prohibitions on touching and preferences for personal space.     - Do not cut or shave hair without discussion (cultural significance).

• Developmental Stages (Older Adults):     - Skin: Thins and loses resiliency; prone to dryness and flaking; daily bathing can worsen this.     - Feet/Nails: Chronic problems like ill-fitting shoes or systemic disease; Morton’s disease causes burning and numbness.     - Mouth: Gums lose vascularity; dentures may fit poorly; increased risk in DM.     - Hair: Scalp becomes thinner and drier.

• Physical Conditions:     - Paresthesia: Abnormal sensations of tingling, burning, or numbness.     - Sensory/Motor disorders: Risks for pressure or thermal injuries (e.g., Stroke, Arthritis).     - Cardiac/Pulmonary: Fatigue and Shortness of Breath (SOB) limit participation. Administer analgesics $30$ minutes prior to care if needed.     - Cognitive: Strokes, dementia, or psychoses may lead to aggressiveness or agitation.

Nursing Process: Assessment

• Priority History Focus:     - Diabetic patients: Foot ulcers.     - Overweight patients: Skinfolds.     - Immobilized patients: Skin condition.

• Patient-Centered Questions:     - Preferences: "How can I best perform your bath and personal care?" "In what way can I best help with your skin and hair care?"     - Tolerance: "What symptoms do you experience during bathing (SOB, pain, fatigue)?" "Is there a particular time of day that is less fatiguing?"     - Assistance Needs: "Do you use aids like grab bars?" "Which parts can you do for yourself?"     - Oral Care: "Do you have mouth pain or toothaches?" "Do you wear dentures or a partial plate?"     - Foot/Nail Care: "Do you soak your feet?" "Do you file or trim your own nails?"

• Self-Care Ability Assessment: Evaluate muscle strength, flexibility, balance, visual acuity, mental status, and manual dexterity.

• Aspiration Risk: Stroke or dementia patients with poor oral care are at high risk for aspiration.

Common Skin and Foot Problems

• Dry Skin: Flaky, rough texture. Intervention: Use warm (not hot) water, rinse soap thoroughly, pat dry, and use hydrating creams/humidifiers.

• Acne: Inflammatory papulopustular eruption. Intervention: Daily wash with warm water and soap; avoid oily cosmetics.

• Skin Rashes: Resulting from sun, moisture, or allergies. Intervention: Wash thoroughly, apply antiseptic spray/lotion, or cold soaks.

• Contact Dermatitis: Erythema, pruritus, and scaly lesions. Intervention: Identify and avoid causative agents (adhesives, soaps).

• Abrasion: Rubbing away of epidermis. Intervention: Wash with mild soap; dry gently.

• Callus: Flat, thickened epidermis from pressure. Intervention: Refer to podiatrist; use orthotics.

• Corns: Cone-shaped keratosis on toes. Tissue can attach to bone if untreated. Intervention: Podiatrist referral; use wider shoes; avoid oval pads.

• Plantar Warts: Fungating lesions caused by papillomavirus. They are contagious.

• Athlete’s Foot (Tinea Pedis): Fungal infection; scaliness and blisters. Intervention: Ventilate feet, dry well, apply powder. Medications include griseofulvin, miconazole nitrate, or tolnaftate.

• Ingrown Nails: Nail grows into soft tissue. Intervention: Warm soaks (except DM patients), proper trimming.

• Paronychia: Inflammation of the nail fold. Intervention: Warm compresses (except DM) and antibiotic ointment.

Specialized Hygiene Interventions

• Types of Baths:     - Complete Bed Bath: For totally dependent bedridden patients.     - Partial Bed Bath: Focuses on body parts causing discomfort (hands, face, axilla, perineum) and includes a back rub.     - Sponge Bath at Sink: Patient sits in a chair; nurse helps with hard-to-reach areas.     - Tub Bath: Immersion; allows thorough rinsing; may use lifting devices.     - Shower: Continuous stream; sits or stands.     - Disposable Bed Bath (Travel Bath): Handled via bag bath; contains nonwoven cloths premoistened with no-rinse surfactant and emollient.     - Chlorhexidine Gluconate (CHG) Bath: Antimicrobial agent used to reduce Hospital-Acquired Infections (HAIs), MRSA, and VRE. Note: CHG can leave skin feeling sticky.

• Back Rub (Effleurage):     - Promotes relaxation and decreases pain perception.     - Studies show $3$-minute back massages and $10$-minute hand massages improve relaxation in older adults.     - Contraindications: Fractured ribs, burns, heart surgery. Never massage reddened areas or bony prominences to avoid capillary damage.

• Head Lice Procedure (Pediculosis Capitis):     - Use gown and gloves.     - Do not use shampoo/conditioner before lice medicine.     - Medicine takes $8$ to $12$ hours; if no dead lice are found after this period, consult a provider.     - Use a nit comb; dip in water or use paper towel between passes.     - Soak combs in hot water ($\ge 130^\circ\text{F}$) for $5$ to $10$ minutes.     - Wash linens/towels in $\ge 130^\circ\text{F}$ water and dry on hot cycle.

• Oral Hygiene for Unconscious Patients:     - High risk for aspiration; provide care every $1$ to $2$ hours.     - Use High Fowler’s position if permitted.     - Use suction-aided swabs and a padded tongue blade (never fingers).

• Shaving:     - Use long firm strokes in the direction of hair growth.     - For Pseudofolliculitis barbe (razor bumps), use clippers or a single blade razor; do not pull skin taught.     - Use electric razors for patients at risk for bleeding (anticoagulants, low platelets).

Patient Positioning Definitions

• Supine (Dorsal Recumbent): Flat on back; head/shoulders slightly elevated.

• Fowler’s: Semi-sitting, head at $45-60$ degrees.

• Semi-Fowler’s: Head at $30-45$ degrees.

• High Fowler’s: Head nearly vertical.

• Low Fowler’s: Head at $15-30$ degrees.

• Trendelenburg’s: Head of bed lowered, foot raised.

• Reverse Trendelenburg’s: Head of bed elevated, foot lowered.

• Orthopneic (Tripod): Sitting or on side of bed leaning on overbed table with pillows.

• Sim’s (Semiprone): Posture halfway between lateral and prone; upper leg more acutely flexed.

• Lateral (Side-Lying): Side-lying with top hip and knee flexed for stability.

• Lithotomy: On back, hips/knees flexed, thighs apart.

• Prone: On abdomen, head to one side.

Room Environment and Safety

• Temperature: Maintain between $20-30^\circ\text{C}$ ($69-73.4^\circ\text{F}$).

• Noise/Light: Minimize; explain unfamiliar sounds like IV pumps or pulse oximeter alarms.

• Bed Safety:     - Maintain bed in the lowest horizontal position.     - Do not use side rails as restraints without a healthcare provider (HCP) order.

• Bed Making Principles:     - Use medical asepsis.     - Handle linens properly; hold away from uniform to prevent microorganism transfer.     - For unoccupied beds, miter corners and make a horizontal toe pleat ($5-10\,\text{cm}$ or $2-4\,\text{inches}$) to prevent pressure on feet.

• Occupied Bed Considerations: If patient is on aspiration precautions, keep the head of the bed no lower than a $30$-degree angle.