Hygiene

Hygiene Overview

  • Hygiene is an essential aspect of nursing care that involves cleansing.

  • It is not exclusively the responsibility of nursing assistants.

  • Nurses must assess and address hygiene needs directly.

  • There are various therapeutic and psychological benefits to maintaining hygiene.

  • Healthcare providers have a responsibility to meet patients' hygiene needs, especially when patients cannot do so themselves.

Factors Affecting Personal Hygiene

  • Culture: Influence of cultural beliefs and practices on hygiene.

  • Socioeconomic Class: Access to resources for maintaining personal hygiene.

  • Spiritual Practices: Impact of religious or spiritual customs surrounding hygiene.

  • Developmental Level: Consideration of age and developmental stage in hygiene practices.

  • Health State: Medical conditions that may affect a patient's ability to maintain hygiene.

  • Personal Preferences: Individual choices and comfort levels regarding hygiene practices.

Nursing History of Skin Assessment

  • Assess the duration of skin problems (e.g., "How long have you had this problem?").

  • Determine the level of discomfort caused by skin issues (e.g., "Does it bother you? How does it bother you?").

  • Inquire about specific symptoms such as itching and previous methods used to alleviate symptoms (e.g., "Have you found anything helpful in relieving these symptoms?").

Nursing History of Mouth, Eyes, Ears, Nose Assessment

  • Identify the patient's normal oral hygiene practices.

  • Assess risk factors such as:

    • Illness

    • Comatose state

    • Dehydration

    • Confusion

    • Depression

    • Paralysis

    • Mental health issues

    • Mouth breathing habits

    • Malnutrition

  • Identify any visual or hearing prosthetics.

  • Obtain a history of problems related to the eyes, ears, and nose.

Nursing History of Hair, Nails, Feet, and Perineal/Vaginal Areas

  • Assess usual practices for hair and scalp care.

  • Note changes in hair distribution, texture, or quantity.

  • Evaluate normal nail and foot care practices, including footwear worn.

  • Gather history regarding nail or foot problems.

  • Investigate any perineal or vaginal problems such as urinary or fecal incontinence, rectal/genital surgery, urinary tract infections, diabetes, or STIs.

Assessing the Skin

  • Skin assessment should be integrated during the review of other body systems.

  • Utilize good lighting, preferably daylight, for a thorough assessment.

  • Compare bilateral body parts for symmetry.

  • Use standardized terminology for accurately reporting and recording findings.

  • Nursing history findings should guide skin assessments.

  • Identify variables known to cause skin problems, such as moisture, pressure, and heat.

Assessment of the Oral Cavity

  • Assess key areas:

    • Lips

    • Buccal mucosa

    • Color and surface of gums

    • Teeth

    • Tongue

    • Hard and soft palates

    • Oropharynx

Potential Oral Problems

  • Common concerns include:

    • Dental caries

    • Plaque accumulation

    • Periodontal disease

    • Gingivitis

    • Periodontitis

    • Tartar buildup

    • Halitosis (bad breath)

    • Stomatitis (inflammation of the mouth)

    • Glossitis (inflammation of the tongue)

    • Cheilosis (cracked lips)

    • Dry oral mucosa

Additional Hygiene Assessments

  • Inspect the eyes, ears, and nose:

    • Look for symmetry, alignment, and presence of cerumen (earwax).

    • Assess for tenderness, patency (openness), dryness, edema (swelling), bleeding, or discharge.

  • Evaluate hair condition:

    • Check texture, cleanliness, oiliness, scaling, lesions, or signs of inflammation.

    • Look for dandruff and hair loss, as well as conditions like pediculosis (lice).

Additional Hygiene Assessment Part 2

  • Examine nails and feet for:

    • Cleanliness and intactness.

    • Capillary refill and nail bed contour.

    • Swelling, inflammation, or lesions on the feet.

  • Assess perineal and vaginal areas for:

    • Color of lesions, swelling, inflammation, tenderness, or discharge.

    • Analyze anal areas for cracks, nodules, distended veins, masses, or polyps.

    • Odor assessment is also important.

Various Forms of Hygiene Care

  • Early Morning Care:

    • Assist the patient with toileting.

    • Provide means to refresh the patient (wash face and hands; mouth care).

  • Morning (AM) Care:

    • Toileting after breakfast.

    • Oral care, bathing, and back massage.

    • Special skin measures, hair care, and cosmetics.

    • Dressing, repositioning for comfort, refreshing bed linens, and tidying up the bedside.

  • Afternoon (PM) Care:

    • Focus on patient comfort after lunch, assist with toileting, handwashing, oral care, and adjusting bed linens.

    • Help with patient mobility as needed.

  • HS (Hours of Sleep) Care:

    • Assist with toileting, washing, and oral care before bed.

    • Offer a back massage, change soiled linens or clothing, and ensure the patient is comfortably positioned.

    • Ensure patient call light and necessities are within reach.

  • PRN Care:

    • Provide hygiene measures based on the individual patient's needs.

    • Change clothing and linens if the patient is diaphoretic.

    • Offer oral care every 2 hours if indicated.

Purpose of Bathing

  • Benefits of bathing include:

    • Cleansing the skin and acting as a skin conditioner.

    • Promoting relaxation and circulation.

    • Serving as a form of musculoskeletal exercise.

    • Stimulating breathing by enhancing the rate and depth of respirations.

    • Contributing to muscle relaxation and comfort, sensory input, improving self-image, and strengthening the nurse-patient relationship.

Providing a Bed Bath

  • Steps for providing a bed bath:

    • Prepare bathing articles on an overbed table or bedside stand.

    • Ensure patient privacy.

    • Change top linens for a bath blanket and lay out essential cosmetics.

    • Assist patients unable to bathe themselves completely.

Preparing for Hygiene Care

  • Assess the patient's needs and preferences.

  • Gather necessary supplies and ensure privacy and respect.

  • Provide warmth using a bath blanket.

  • Confirm that the wheels of the bed are locked before commencing care.

Performing Hygiene Care

  • Recommendations for performing hygiene tasks include:

    • Adjust the bed height to a comfortable position for the caregiver.

    • Cover the patient with a bath blanket, exposing only the areas being cleansed.

    • Work from the face down, cleaning with a clean to dirty approach and patting the skin dry.

    • Work systematically side to side down the body, avoiding soap on the face.

    • Change gloves and water when becoming cold or dirty.

    • Utilize washcloth mitts for efficiency, and follow protocols for IV saline access and patient gowns.

Factors to Consider When Cleansing Skin/Hair/Nails

  • Factors influencing cleansing choices:

    • Types of soaps or cleansers used.

    • Moisturizers and products such as oatmeal or cornstarch for soothing skin.

    • Proper application of deodorants.

    • Avoidance of harmful cosmetics.

    • Techniques such as placing towels under extremities and washing skin folds to ensure thorough cleansing.

    • Important washing techniques should include long strokes toward the heart.

    • Regular turning and repositioning of patients is crucial.

Hair Care and Shaving

  • Guidelines for hair care:

    • Brush or comb hair daily and provide shampooing as appropriate.

    • Consider using a shampoo cap for bedridden patients.

  • Recommendations for shaving:

    • Electric razors are typically safer and are preferred.

    • Shave in the direction of hair growth using short, downward strokes.

    • Apply a warm washcloth to the face prior to shaving for comfort.

Nail and Foot Care

  • Fingernail care:

    • Soak nails briefly and clean under them with sticks.

  • Foot care should involve mild soaking in tepid water for short durations and avoiding prolonged soaks.

    • Moisturizers can be applied to the feet after drying.

Nail and Foot Care for Diabetics

  • Special recommendations for diabetic patients:

    • File nails straight across instead of cutting them to avoid injury.

    • Inspect feet daily for abnormalities.

    • Avoid over-the-counter products containing alcohol and any heating treatments unless prescribed.

    • Advise wearing white cotton socks to reduce irritation and report any foot problems to a physician.

    • Consult a podiatrist for professional treatment of corns and calluses as needed.

Oral Hygiene Maintenance

  • Importance of oral hygiene:

    • Essential for long-term care residents and routine dental care including brushing, flossing, and using mouthwash.

    • Special attention for unconscious patients to ensure lubrication of lips and mouth care.

Denture Care

  • Patients should remove dentures at night.

  • They should be stored in a labeled container with cold water for soaking.

Special Mouth Care Considerations

  • Special considerations are made for:

    • Unconscious patients, mouth breathers, patients on oxygen, and those who are NPO (nothing by mouth).

    • Care for patients with nasogastric tubes also requires extra vigilance.

Eye, Ear, Nose Care

  • Required assessments include:

    • Eye care for unconscious patients, maintaining glasses or contacts, and caring for artificial eyes.

  • Ear care entails checking for cerumen buildup and ensuring hearing aids are functional.

Perineal and Vaginal Care

  • Key considerations include:

    • Assessing for pain, swelling, discharge, or unusual hygiene practices.

    • Assess for legions and abnormal odors.

    • Maintain coverage of these areas to uphold dignity.

    • Special techniques, such as sitz baths, should be employed for comfort.

Linen Change Protocols

  • Determine when to change linens based on whether the bed is occupied or unoccupied.

  • Techniques include replacing draw sheets, fitted sheets, and mitering corners for a tidy appearance.

Environmental Safety in Hygiene Care

  • Ensure patient safety:

    • Return the bed to a low position after care.

    • Ensure side rails are raised where appropriate.

    • Check that bed controls are functional.

    • Maintain a clean and organized room environment.

    • Avoid holding soiled linens close to the body.

    • Keep call bells within reach at all times to minimize risk of falls.

Providing Back Massage

  • Back massages can benefit all immobile patients.

  • It promotes circulation and muscle relaxation, enhancing comfort.

Key Points to Remember in Hygiene Care

  • Organize a comprehensive plan before initiating hygiene care.

  • Thoroughly assess the client's needs.

  • Assemble all necessary equipment in advance.

  • Approach the task from clean to dirty.

  • Remember to uphold principles of comfort, safety, and privacy during care.

Questions

  • Open floor for any questions regarding the material covered.