Hygiene and bedding fundimental nursing care

Hygiene care for disabled patients

1. Hygiene And bed making

2. Objectives At the end of this lecture the students will be able to : Define hygiene and hygienic care Identify factors influencing personal hygienic practices agents commonly used on the skin. List Purposes of bathing, oral hygiene, skin, feet, nails, hair, eyes, ears, and nose care. Identify the supporting hygienic environment (Hospital beds, Mattresses, Side rails, Foot board, Bed cradles). List and differentiate types of beds (Occupied, unoccupied, surgical beds)

3. Personal Hygiene Hygiene: Is The science of health and it's maintenance. Personal hygiene: It is the self care by which people attend to such functions: as bathing, toileting, general body hygiene, and grooming. Hygiene is a highly personal matter determined by individual values and practices. It involves care of the skin, feet, nails, oral and nasal cavities, teeth, hair, eyes, ears, and perineal-genital areas.

4. The Types of hygienic care: Early morning care: Provided to clients as they awaken in the morning. This care consists of: Providing a urinal or bedpan, washing the face and hands, and giving oral care. Morning care: Provided after clients have breakfast, although it may be provided before breakfast. It usually includes: the provision of a urinal or bedpan, a bath or shower, perineal care, back massages, and oral, nail, and hair care. In addition, the bed making.

5. The Types of hygienic care: Hour of Sleep care (PM care): Provided to clients before they retire for the night. It usually involves: providing for elimination needs, washing face and hands, giving oral care, and giving back massage. As –needed (PRN) care: Provided as required by the client. For example, a client who is diaphoretic (sweating profusely) may need more frequent bathing and a change of clothes and linen.

6. Factors that influence hygienic practices. Culture Religion Environment (Finances may affect the availability of facilities for bathing. For example, homeless people may not have warm water available; soap, shampoo, shaving lotion, and deodorants may be too expensive for people who have limited resources.) Developmental level ( Children learn hygiene in the home. ) Health and energy ( Ill people may not have the motivation or energy to attend to hygiene. Some clients who have neuromuscular impairments may be unable to perform hygienic care. ) Personal preferences ( Some people prefer a shower to a tub bath. The time of bathing varies (e.g., morning versus evening) )

7. Skin Major functions of the skin. Protects underlying tissue Regulates body temperature Secretes sebum Oily substance that softens and lubricates hair and skin and decrease water loss. Transmits sensation Produces and absorbs vitamin D Sweat glands: are on all body surfaces , present at birth.

8. Assessing Determine : Client's skin care practices Self-care abilities Client's functional, cognitive levels and motivation Presence of past or current skin problems Physical assessment: inception and palpitation.

9. Table 33–3 Common Skin Problems

10. Intact, healthy skin is the body's first line of defense. Protection afforded by skin depends on general health of skin cells, amount of subcutaneous tissue, and dryness of skin. Increased Moisture leads to increased bacterial growth and irritation. Body odors are caused by resident skin bacteria. Skin sensitivity varies among individuals. Skin care agents have selective actions and purposes. General guidelines for skin care

11. Bathing The purposes: To removes accumulated oil, perspiration, dead skin cells, and some bacteria. To prevent or eliminate unpleasant body odor. To simulate circulation to the skin. To produce a sense of well being. It is refreshing and relaxing and frequently improves morale, appearance, and self respect. Bathing offers an excellent opportunity for the nurse to assess clients.

12. Bathing and Skin Care There are two major categories of baths are given to clients: Cleansing Bath Therapeutic Bath

13. Cleansing Bath Include these types: Complete bed bath: The wash of entire body of dependent client in bed. Self help bed bath: The nurse help the client on washing the back and perhaps the feet. Partial bath (abbreviated bath): washes only the parts of the entire client's body that might cause discomfort or odor (face, hands, axillae, perineal area, and back).

14. Bag bath. This bath is a commercially prepared product that contains 10 to 12 presoaked disposable washcloths that contain no-rinse cleanser solution. Each area of the body is cleaned with a different cloth and then air dried. the emollient in the solution remains on the skin.

15. Towel bath. This bath is similar to a bag bath but uses regular towels. It is useful for clients who are bedridden and clients with dementia. The nurse gradually replaces the bath blanket with a large towel that has been soaked with warm water and no-rinse soap. The client is then gently massaged with the warm, wet, soapy towel. The wet towel is replaced with a large dry towel for drying the client’s skin.

16. Cleansing Bath Tub Bath using of tube to bath the client which reduce the work of the nurse in lifting client. The amount of assistance the nurse offers depends on the abilities of the client. There are specially designed tubs for dependent clients. Shower. People vary in their sensitivity to heat; generally, the temperature should be 43°C to 46°C

17. It usually ordered by a physician and given for physical effects, such as to sooth irritated skin or to treat an area. The medication may be placed in the water, also, the client remains in the bath for a designated time, often 20-30 minutes. The bath temperature is generally included in the order; 37.7°C to 46°C may be ordered for adults and 40.5°C is usually ordered for infants. Therapeutic Bath

18. Evaluating (after bathing) Functional ability for self-care Efficacy of instructions and assistive devices Client status Need for analgesics Tissue integrity Nutrition adequate to support skin integrity

19. Feet Developmental variations. Essential for ambulation. Feet develop, are affected by restrictive or supportive shoes. Feet fully grown by about 20 years. Changes with aging; aging may affect self-care.

20. Assessing Determine : Normal nail and foot care practices Type of footwear worn Self-care abilities Presence of risk factors for foot problems Any foot discomfort Any perceived foot problems with foot mobility

21. Assessing Physical assessment Calluses, Corns مسمار اللحم) ), Unpleasant odors, Plantar warts (ثالول) , Fissures, Athlete's foot (tinea pedis), Ingrown toe nails Identifying clients at risk Diabetes Peripheral vascular disease Long-term steroid therapy

22. Nails Normally present at birth Continue to grow throughout life Nails tend to be tougher, more brittle, and in some cases, thicker with age. Older person's nails may grow more slowly and be ridged.

23. Assessing Determine: Normal nail care practices Self-care abilities Any problems associated with them Physical assessment Inspection of the nails

24. Mouth Each tooth has three parts: Crown Root Pulp cavity

25. Mouth Developmental variations Appear 5–8 months after birth 32 adult teeth Gingiva (gum) Periodontal (gum) disease Main cause of loss of teeth Dental caries (cavities)

26. Assessing Determine: Oral hygiene practices Dental visits Self-care abilities Past or current mouth problems Physical assessment Plaque, Tartar, Gingivitis Identifying clients at risk Serious illness, Confusion, Coma, Depression, Dehydration

27. Oral hygiene It’s one of the most overlooked aspects of basic nursing care Low priority Dislike of work Insufficient time Daily stimulation of gums Mechanical brushing and flossing Flushing of the mouth

28. Promoting oral health throughout the life span Infants and toddlers After tooth eruption, start dental hygiene Dental visit starting 2 or 3 years Preschoolers and school-age children Care essential in deciduous-to-permanent tooth transition Brush teeth after eating Regular checkups Maintenance Older adults Number of edentulous adults declining, so cavities a factor

29. Brushing and flossing the teeth Removes food particles Stimulates circulation in gums Sulcular technique Removes plaque Cleans under gingival margins Fluoride toothpaste recommended

30. Caring for artificial dentures Lower, upper plate or both need to be cleaned regularly, at least once a day Ill-fitting prostheses can cause discomfort, chewing difficulties

31. Clients with special oral hygiene needs Xerostomia (dry mouth) Can be caused by medications, being unconscious Irritated, dry soft tissues Water-soluble moisturizer Saliva substitute

32. Hair Reflects person's feeling or self-concept, well-being, state of health Developmental variations Lanugo: Fine hair on body of fetus Puberty Pubic hair Sebaceous glands Thinning hair in older adults

33. Assessing Determine: Usual hair care Self-care abilities History of hair or scalp problems Conditions known to affect the hair Alopecia (hair loss) Physical assessment Dandruff, Hair loss, Ticks, Pediculosis (lice), Scabies, Hirsutism

34. Brushing and combing hair Hair needs to be brushed or combed daily. Long hair may present a problem. Dark-skinned people often have thicker, drier, curlier hair than light-skinned people. Shampooing the hair Shower or sink for clients who are able Frequency of need highly individual

35. Beard and mustache care Most important aspect to keep clean Grooming may be requested. Shaving If client taking anticoagulant, use an electric shaver.

36. Eyes Require no special hygiene Lacrimal fluid washes the eye. Eyelids and eyelashes prevent entrance of foreign particles.

37. Assessing Determine: Client's eyeglasses or contact lenses Recent examinations by ophthalmologist Any history of eye problems and related treatments Physical assessment: External eye structures

38. Eye care Wipe away dried secretions. Prevent drying and irritation of the cornea. Eyeglass care Clean with warm water and dry with soft tissue that will not scratch lens.

39. General eye care Avoid home remedies If dirt or dust gets into eyes, clean them copiously with clean, tepid water Take measures to guard against eyestrain and to protect vision Schedule regular eye examinations to detect problems

40. Ears Cleaning the ears Minimal hygiene Clean auricles and excessive cerumen (earwax) during bed bath Hearing aids may require nursing assistance. Hearing aids are usually removed before surgery.

41. Nose Usually cared for by client blowing into tissue Clean with cotton-tipped applicator (not inserted farther than cotton tip) or saline

42. Supporting a Hygienic Environment Holistic Bed-making as preparation of a healing space Basic furniture Equipment Basic suction outlet Oxygen outlet Sphygmomanometer

43. Environment Room temperature: A room temperature between 20°C and 23°C is comfortable for most clients. Ventilation: Good ventilation is important to remove unpleasant odors and stale air . Noise Staff communication, hallways Device alarms creating "alarm fatigue“ " Quiet times" mostly in the afternoon. Noise can cause for patients: - Sleep disturbance - Increased perception of pain

44. Hospital Beds Frame divided into three sections to allow separate elevation Usually narrower than the usual bed Most have "high" and "low" positions

45. Mattresses Water-repellent material that resists soiling and can be cleaned easily. Special mattresses to relieve pressure on body's bony prominences

46. Side Rails Bed rails used on both h ospital beds and stretchers Two full-length rails or four half- or quarter-length rails Multiple options for positions May be considered restraint

47. Footboard Support immobilized client's foot in Normal right angle to the legs to prevents plantar flexion contractures

48. Making Beds Making Beds

49. Making Beds Nurses need to be able to prepare hospital beds in different ways for specific purposes . Practice guidelines Wash hands thoroughly after handling a client's bed linen Hold soiled linen away from uniform Never place linen for one client on another client's bed (cross-contamination)

50. Making Beds Practice guidelines Place soiled linen directly in a portable hamper. Do not shake soiled linen into air Conserve time and energy Make one side of bed first Gather all linen before starting to strip bed

51. Unoccupied Bed Open Top covers are folded back Makes it easier for the client to enter Closed Top covers are drawn up to the top of bed and under pillows. Open and closed beds are made the same way, except that the top sheet, blanket, and bedspread of a closed bed are drawn up to the top of the bed and under the pillows.

52. Mitering the corner

53. Changing an Occupied Bed Maintain client in good body alignment Move client gently and smoothly Explain what you plan to do before you do it Use bed-making time to assess and meet client's needs

54. Surgical beds surgical bed is used for the client who is having surgery and will return to bed for the postoperative phase.