Hygiene

1. Hygiene Chapter 38

2. Objectives • Define key terms • Describe factors that influence hygiene • Explain importance of foot care in the diabetic client • Successfully perform hygiene procedures

3. Assessments • Skin/Hair • Feet and nails • Oral cavity • Eye, Ear and Nose

4. Risk Factors for Skin Impairment • Immobilization • Reduced Sensation • Secretions & excretions • Vascular insufficiency • External devices

5. Developmental Changes • Skin • Feet & Nails • The mouth • Eye, ear, & nose • Self-care Ability

6. Assessment of Hygienic Practices • Preferred routine • Preferred products • Preferred method • Dental care

7. CULTURAL FACTORS • Chinese Americans • Vietnamese Americans • “What would make them feel most comfortable during a bath?”

8. At Risk for Hygiene Problems • Oral Problems • Skin Problems • Foot Problems • Eye Care Problems

9. Special Considerations • Footwear • Eating Patterns • Sensory Aids

10. Nursing Diagnosis • Self-care deficit, bathing/hygiene • Dentition, altered • Fatigue

11. Planning • Individual for each client & each nursing diagnosis • Client’s condition influences care plan • Plan around client’s schedule, needs • Include family • Community resources

12. Interventions/Implementation • Pre-medicate if needed • Health promotion • Acute & restorative care, e.g.: • Bathing & skin care • Perineal Care • Foot & nail care • Oral hygiene

13. Bathing Times • Am Care – before breakfast • Complete AM Care – after breakfast • Afternoon Care - afternoon • PM Care – at bedtime, backrub

14. Bathing • Complete Bed Bath • Partial Bed Bath • Bag Baths • Perineal Care • Back Rub • Infant

15. Foot & Nail Care • Soaking feet • Teach proper technique, inspection • High risk clients • Diabetes • PVD • Peripheral neuropathy • Vascular insufficiency

16. Peripheral neuropathy • Muscle wasting • Absent DTR’s • Foot deformities • Abnormal gait • Decreased sensation

17. Vascular insufficiency • Decreased hair growth • Absent or decreased pulses • Infection • Shiny skin • Blanching on elevation • Thickened nails

18. ADA Guidelines for Foot & Nail care • Inspect & wash daily (check temp) • Do not soak • Podiatrist to TX corns/calluses • Unscented powder • File toenails straight across, do not cut • Annual foot exam • Do not walk barefoot • Proper fitting shoes • Break in new shoes • Exercise regularly • Avid hot water bottles • TX minor cuts

19. Oral Hygiene • Brushing 4 x a day • Fluoride paste • Soft brush • Electrical • Replace q 3 months • Replace after a cold • Soft rubber ball on handle • Foam rubber brush • (Lemon-glycerin swabs not recommended) • Rinsing • Mouthwash • Don’t share brush • Don’t drink from bottle • Disclosure tabs/drops • Flossing 1 x a day

20. Oral Care for Unconscious Clients • Mouth care at least q 2 h • Assess for aspiration • Suction secretions • Do not use fingers to hold mouth open

21. Clients with Cancer, NGT, Infection & Diabetes • Stomatitis (chemo,radiation,NGT, infection) • gentle brushing & flossing • avoid alcohol, mouthwash, stop smoking • NS rinses 4x a day - q 2h • Oral analgesic • Diabetes- frequent periodontal disease • Dentist q 3-4 months • good oral hygiene

22. Denture Care • Remove at night • Keep covered in water when not worn • Enclosed labeled cup in bedside stand • Don’t place in napkin or tissue

23. Hair & Scalp Care • Brushing & combing • preferred hair practices • braiding • brush in sections • Lice

24. Shampooing • Shower/bath • Shower or tub chair • Sink/washbasin • Stretcher to shower or sink • In bed • Dry shampoo

25. Grooming • Shaving • warm washcloth, shaving cream • pull skin taught • use short, firm strokes in direction of hair growth • electric razors if risk for bleeding • Mustache & beard

26. Care of Eyes • Clean wet washcloth - no soap • Eyeglasses - cool water, soft cloth • Contact lenses • rigid (hard) • soft • rigid gas permeable (RGP) • daily wear, extended wear, disposable • At risk for infection, corneal ulceration

27. Artificial Eye/prosthesis • Enucleation • Permanent implant or temporary • To remove prosthesis: • retract lower lip & put pressure below eye • or use small bulb syringe or medicine dropper • clean with NS, assess socket for infection • Replace - retract upper & lower lids

28. Care of Ear • End of wet washcloth • Gentle downward retraction at entrance to ear canal to remove visible cerumen • No sharp objects • No cotton tipped applicators

29. Hearing Aids • Three types: • in the canal (ITC) • in the ear (ITE) • behind the ear (BTE)

30. Irrigation of Ear • To remove impacted cerumen • Glycerin ( 3 gtts) at bedtime • H2O2 BID • 250ml. Of warm water into ear canal • Client sit or lies on side • Water pik or bulb syringe • Do not occlude canal

31. Care of Nose • Teach client to blow nose gently • Gentle suctioning • Wet washcloth or cotton tipped applicator • Only insert cotton tip of applicator • NGT or endotracheal tubes through nose • change tape QD • hold tube & clean & dry nasal surface

32. Maintaining Comfort • Temperature • Good ventilation • Noise level • Proper lighting • Room equipment • Beds/bed making/linens

33. Evaluation • Reassess condition of client’s skin • Determine if comfort improves • Ask client to demonstrate self-care skills • Ask client if expectations are being met