HYGIENE.pptx

This is for Both B.sc & GNM nursing students

1. HYGIENE Mr. Subhadip Mondal Asst. Lecturer Ebenezer School & College of Nursing

2. INTRODUCTION The word Hygiene has evolved from Greek term “ Hygia ” which means “ goodness of health ”. Hygiene is the science of health factors & includes all factors , which contribute to healthful living. Hygiene is the science of health & its preservation; it also refers to practices that are conductive to good health. Good Personal Hygiene is important to a person’s general health. Hygiene is a practice related to lifestyle cleanliness, health & medicine. In general, hygiene refers to practices that prevent spread of disease-causing organisms.

3. Cont.…. Personal hygiene is necessarily maintained for a person’s comfort and well-being. A variety of personal & sociocultural factors influences the client's hygiene practices. The nurse determines a clients ability to perform self-care & provides hygienic care according to clients needs and preferences. While providing hygiene, the nurse must preserve as much client’s independence as possible, ensure privacy, convey respect & foster the client’s physical comfort .

4. DEFINITIONS OF HYGIENE According to WHO, “ Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases. ” Hygiene defined as “ the science and art ”, which is associated with the preservation and promotion of health. Hygiene defined as that “ science of health ” which includes all the factors contributing to the healthful living.

5. TYPES OF HYGIENE Good personal hygiene is one of the most effective ways to protect ourselves & others from illness. Washing hands regularly, especially before preparing or eating food and after going to the toilet. PERSONAL HYGIENE: P ersonal hygiene which involves the cleanliness of one’s body & clothing, proper living habits, healthy diet, rest & exercise, basically means cleanliness of body. G ood personal hygiene means keeping all parts of physical body clean & healthy. It is essential part of maintaining both physical & mental health. In people who practice poor personal hygiene, the body offers a perfect environment for growth of germs, hence leaving it vulnerable to infection. Personal hygiene is not limited to taking care of the body & keeping it clean, rather the mental & spiritual aspects are an integral part of it.

6. ENVIRONMENTAL HYGIENE: That involves disinfection activities ( to control the harmful organisms and bacteria that threaten health), rodent control, disinfection, and fumigation activities. Environmental hygiene takes care of the health of both current and future generations. The aim if environmental hygiene is to create safe spaces so a s to prevent diseases. SOCIAL HYGIENE : Social medicine has replaced the word social hygiene, its objective to study man as a social animal in its total environment. The scope of social medicine includes the scope of social structure & functions, social pathology & social treatment etc.

7. INDUSTRIAL HYGIENE: Occupational Health is an area of work in public health to promote and maintain highest degree of physical, mental & social well-being of workers in all occupation. Its scope is extended up to health of labor working in all types of occupation & different aspects of health. FOOD HYGIENE: Food hygiene is the preservation and preparation of foods in a manner that ensures the food is safe for human consumption. Food hygiene is the conditions & practices that preserve the quality of food to prevent contamination & food borne illnesses. Food hygiene is the process of properly cooking, cleaning food & avoiding cross-contamination to prevent the spread of bacteria in food. It is useful for preventing food poisoning.

8. FACTORS INFLUENCING HYGIENE PRACTICES 1.Personal Preferences : Each Individual has its own desires & preferences about when to bath, shave and perform hair care. Same way each individual selects different products according to their personal preferences, needs & financial resources. The nurse assists the client in delivering individualized care to the client. 2.Social Practices: Social Groups influence hygiene practices and preferences. During childhood, hygiene practices and influenced by family customs and as children enter their adolescent years, hygiene practice may be influenced by the peer group behavior. During the adult years, work groups & friends shape the expectations of people & in the older adults hygiene practices may be change because of living conditions & available resources.

9. Cont …. 3.SOCIOECONOMIC STATUS: The type & extent of hygiene practices are influenced by a person’s economic resources. The nurse determinates which products/ supplies, the clients can afford. 4.HEALTH BELIEF & MOTIVATION: Knowledge regarding the importance of hygiene for well-being influences hygiene practices. Only knowledge is not enough. The client must be motivated to maintain self-care. 5.CULTURAL BELIEFS: A clients cultural beliefs & personal values influences hygienic care. 6.PHYSICAL CONDITION: Certain type of physical limitations or disabilities often lacks the physical energy to perform hygienic care, e.g., a client with traction or who has an intravenous line, will need assistance for hygiene maintenance.

10. PERSONAL HYGIENE DEFINITION Personal Hygiene defined as that “the healthy practices and lifestyle helps in the maintenance & promotion of individual health physically, emotionally, socially & spirituality”

11. PURPOSES OF PERSONAL HYGIENE To prevent illness To promote good health To improve the standard of health To maintain quality of life of an individual To promote mental well-being To promote socially & spiritually health To improve the self esteem in the society To maintain resistance & prevent from infection

12. PRINCIPLES OF PERSONAL HYGIENE Hygiene practices are learnt Changes Occur throughout the life span, it also affects the healthcare practices. Individual differences exit from one individual to other Health practices of people vary with cultural values & personal values Health practices directly influences the physical, mental ,social and spiritual health of an individual Good health practices prevent entry of microorganism into the body Nature acts as a first line of defense on human health natural light & ventilation.

13. INDICATIONS OF PERSONAL HYGIENE Personal hygiene refers to maintaining cleanliness of one’s body & clothing to preserve overall health & well-being. Personal hygiene gives us freedom from diseases & infections. When we keep ourselves clean there is no chance of bacteria, germs or virus multiplying in our bodies. Body odor from not showering regularly. Unwashed or disheveled hair. Bed bath, food between teeth, or signs of tooth decay and gingivitis. Wearing soiled clothing. Dirty & untrimmed fingernails & toenails.

14. COMPONENTS OF PERSONAL HYGIENE Body Hygiene ( skin care) Oral Hygiene (oral care) Hand washing (hand care) Face Hygiene Fingernails & Toenails Hygiene ( nail care) Ear Hygiene Hair Hygiene ( hair care) Foot Hygiene ( foot care) Clothes Hygiene Menstrual Hygiene ( Personal Hygiene for women)

15. IMPORTANCE OF PERSONAL HYGIENE Maintenance of physical hygiene in a state of health is a personal value & individual personality. It helps to maintenance of physical & psychological homeostasis. It helps to promote individuals safety, comfort & well being. A clean mouth & teeth aids to the patients a feeling of self-approval. Healthy hygienic practices & technique which provides economy of time , material & energy. Stimulation of Circulation by message & brushing is essential to maintain the hair healthy.

16. Cont.… Keeping the scalp clean by brushing by brushing & shampooing will help to relieve from dandruff . Good personal hygiene is essential during sickness as well as health.

17. NURSES ROLE IN PERSONAL HYGIENE Direct provision of hygiene care provides the nurse with an ideal opportunity for daily assessment of the patient’s physical & emotional state. The process of daily bathing , oral hygiene , care of hair , nails & massage forms a vital part of nurse patient interaction. The nurse should assess the needs of the patient and identifying related nursing problems. The nurses needs to collect further information about patient’s identified problems. The nurse needs to develop an appropriate nursing care in terms of the data collected and relevant nursing principles.

18. Cont.… The nurse has to implement the nursing care plan to provide optimum quality of nursing care for individual patients. The nurse has to evaluate the success of the nursing care plan & adjusting it to meet the patient’s changing needs. The nurse has to motivate the patient to resume independence & responsibility for care as the condition permits. The Nurse must apply knowledge of pathophysiology to provide good preventive hygienic care. The nurse has to integrate knowledge of anatomy, physiology & pathology during hygienic care.

19. ORAL HYGIENE

20. ORAL HYGIENE Oral Hygiene means maintaining the cleanliness of the mouth. Oral hygiene includes measures to prevent the spread of disease from the mouth & increase the comfort. Certain patients  are prone to oral problems because of lack of knowledge. Good oral hygiene includes daily stimulation of the gums and brushing of the teeth.

21. DEFINITION “Oral hygiene cleaning  the teeth and the oral cavity of the patient. It includes the measures to prevent the spread of disease from mouth and increase the comfort of the patient.”

22. PURPOSES To maintain the  healthy state of mouth, gums, teeth and lips. To remove food particles from and between the teeth. To stimulate appetite. To provide a sense of well-being. To remove dental plaque. To prevent sores and infection of the oral tissues To relieve discomfort resulting from halitosis and taste. To prevent gum inflammation and infection.

23. Cont.… To prevent the mucous membrane from becoming dry. To prevent sores, which results in ulceration. To maintain the intactness and health of the lips and oral cavity. To prevent oral infections. To clean and moisten the membranes of the mouth and lips

24. INDICATIONS Seriously ill patient. Patients with fever. Postoperative patients. Unconscious patients. Patients breathing through mouth. Paralyzed patients. Patients with infections and disease of mouth. Patients under anesthesia. Patients who are not taking oral feeds.

25. ARTICLES Articles needed for conscious patients- A tray containing the following articles- Face towel. Mackintosh with draw sheet or towel. Disposable gloves(clean). Toothbrush . Toothpaste . Log of tepid water. Emollients (liquid paraffin's, coconut oil, borax glycerine, Vaseline). Cotton applicator

26. ARTICLES Articles needed for unconscious patients- A tray containing the following articles- Mackintosh & towel Small jug with warm water Feeding cup Small cup-2 Artery forceps-1 Dissecting Forceps-1

27. Cont.… A Small c ontainer containing of- Paper Bag Kidney tray Choose one of the solution of mouth wash Potassium Permanganate (KMnO4) -1: 5000 (I crystal to a glass of water) Sodium Chloride ( NaCl ) -1 teaspoon to a pint of water Potassium Chloride ( KCl ) -4 to 6% Hydrogen Peroxide ( H2O2)- 1:8 solution Choose one of the emollients (liquid paraffin's, coconut oil, borax glycerine, Vaseline). Gauze piece Face towel-1

28. PROCEDURE Bring patient to edge of the bed Position pillow according to comfort of patient Place small mackintosh with face towel on patient’s chest Place K basin close chin of patient Raise head End Of the bed to 45 ° Pour antiseptic solution into cup Soak gauze place in solution and squeeze out excess solution by using artery clamp Use same clamp to clean patients mouth Clean using up & down movements from gums to crown , clean oral cavity from proximal to distal, outer to inner aspect.

29. Cont.… Clean tongue from inner to outer aspect. Provide water to rinse mouth & dry face with towel Lubricate lips using swab stick Rinse the used articles and replace equipment Document time, solution used, condition of oral cavity, abnormality noticed and patients response.

30. COMPLICATION OF NEGLECTED MOUTH CARE LOCAL COMPLICATIONS Par-otitis: Inflammation of parotid gland Stomatitis: Inflammation of mucus membrane of mouth Gingivitis: Inflammation of the gums Glossitis : Inflammation of the tongue Dental Carries : forms cavity on the teeth Root abscess : pus formation in the root of the teeth Periodontal disease : pus formation in the socket of the teeth Bleeding Gums

31. NEIGHBORING STRUCTURE COMPLICATION Rhinitis Otitis media Tonsillitis Adenitis SYSTEMIC COMPLICATION Anorexia Bacterial Endocarditis Gastritis Nephritis Rheumatic arthiritis

32. RECORDING & REPORTING Record the procedure with date, time and condition of the mouth, teeth, etc., on nurse's record . Report and record any abnormal condition to the ward sister and physician . Give health education to the patient and relatives on oral hygiene

33. CARE OF EYES , NOSE & EARS

34. CARE OF EYES , NOSE & EARS Hygienic care of eyes, ears and nose prevent infection and helps to maintain their functions. Hygienic care of these organs is always done as part of the general bathing procedure

35. PURPOSE To maintain the cleanliness of eye, ear and nose. To prevent infection To keep the organ normal functioning To prevent obstruction

36. FACTORS AFFECTING Systemic disease condition (diabetes and hypertension). Acute illness (viral or bacterial infection ). Trauma (blow or foreign bodies). Medication ( oto toxic drugs ). Allergic substances . Congenital anomalies

37. COMMON PROBLEMS Eye : Conjunctivitis (burning, itching, red-watery and painful eyes with increased secretions) cataracts, glaucoma etc. Ear : Otitis media, impact cerumen and foreign bodies . Nose : Mechanical irritation and obstruction

38. GENERAL INSTRUCTIONS EYE Unconscious patients are at risk for eye injury. Daily swabbing of eye with wet sterile cotton important . Cleaning is done from the inner canthus of eye to the outer canthus of the eye . Use normal saline to remove the crust . During bath, each eye cleaned with separate portion of the wash cloth . When sterile procedure is required, each eye cleaned with separate swabs, swabbing each once only.

39. EAR Do not use pins or slides to clean ears. Only use clean buds to clean ears . Poor hygiene of ear, debris may accumulate behind the ear and in the anterior aspect of the external ear . NOSE Observation of nose for signs of discharge, lesions, edema and deformity is required . External crusted secretions can be removed with a wet wash cloth or a cotton applicator moistened with oil, normal saline or water . Foreign bodies and small children a wisp of cotton moistened with water or oil, introduced into the anterior flares, and rotated gently cleanses the nostrils.

40. PRELIMINARY ASSESSMENT Check Patients diagnosis . Doctors order for specific instructions. Assess the general condition . Self-care ability . Articles available in the unit . Preparation of the patient and environment Explain the procedure. Arrange the articles at the bedsides . Place the patient in flat if the condition permits. Protect the pillow and the bed with a Mackintosh and towel under the head.

41. PROCEDURE Wash the hand to prevent cross infection. Pour sterile saline into the bowl and wet the cotton balls. Stand in front of the patient . Clean the eyes with the sterile swabs: Squeeze the excessive water from the swab in the saline bowl . No pressure on the eye ball . Gently wipe the lids from the inner to the outer canthus. One swab for one swabbing . Separate swabs for each eye . When the eyes are clean, stop the procedure, wipe the face with the face towel.

42. AFTER CARE Instill any medications that are ordered. Remove the mackintosh and towel from under the patient head. Adjust the position of the patient . Replace the articles to the utility room . Wash hand thoroughly. Record and report the procedure in the nurse's record.

43. CARE OF HANDS , FEET & NAILS

44. CARE OF HANDS , FEET & NAILS Hands are more contaminated area and soaking in water enables the nurse to clean them thoroughly . Feet are considered to be the least clean area, Placing the foot in the water and cleaning facilitates through cleaning . Care nail is done by cut short finger nails and the toe nails. To prevent skin injury and injection.

45. PURPOSE To keep clean. To prevent skin injury (% scratching ). To prevent infection. To promote comfort . To improve grooming . To promote self esteem. To detect or examine the abnormalities. To prevent worm infestations.

46. FACTORS AFFECTING Infection and injury. Vascular insufficiency. Systemic disease condition . Poor health practices. Sociocultural background . Examination of all skin surfaces, areas between fingers and between toes, shape, size and number of fingers and toes. The condition of the nails, such as nail plate, nail color, shape, thickness, texture, angle and then tissues around the nails.

47. COMMON PROBLEMS Calculus : Thickened position of epidermis. It is painless. Corns : Keratosis caused by friction and pressure from shoes . Plantar warts: Fingerling lesions on sole of foot . Ingrown nails: It occurs due to improper nail trimming , Athletics foot: Tinea pedis -fungal infection of foot. Ram's horn nails : Long curved nails. Paronychia : Inflammation of tissues surrounds nails.

48. SPECIAL FOOT CARE Clean the feet daily in lukewarm water using soap. Dry the feet and the part between toes . Do not cut corns or calculus. . Wear shoes with porous uppers . If dryness is noted along the feet, use olive oil or lanolin and rub gently into the skin . Avoid wearing elastic stocking. Inspect the feet the soles, the heels and the area between toes daily . Wear clean socks and stockings daily. Do not walk bare foot . Wear shoes or chapels, especially designed soft ones. Exercise lower extremities to improve circulation . Avoid burns to feet by hot water or hot water bag. Treat minor injuries immediately under strict aseptic techniques . Consult doctor for even minor injuries.

49. ARTICLES Clean basin-2 with warm water. Large tray-1 . Basin to dip foot or hand-1. Sponge cloths. Towel-1. Nail clipper-1. Mackintosh and towel-1 . Over bed table-1 . Bath thermometer-1.

50. PROCEDURE Collect all articles and place near the bed side to save time and energy . Explain the procedure to allay fear and anxiety. Wash hand to prevent cross-infection . Provide privacy by screening . Take the warm water 100-110" F in a basin. Wash the hands first and then feet with soap and water and dry it with clean towel . Soak the nails in the warm water and apply soap. Brush the nails and place between fingers and toes and clean it with water . Remove the water basin and dry the areas with towel . Cut short the nails and collect it in the K-basin or paper bag. Use wet cotton balls or gauze pieces to clean the tips of the nails.

51. AFTER CARE Place the patients hand, feet comfortably. Replace the articles and equipment . Discard the dirty water in sluice room . Wash the articles used and keep ready for the next use . Wash hands . Record and report the date, time, procedure and abnormalities noted in the nurse's record.

52. BACK CARE/ BACK MASSAGE/ BACK RUB Back care means cleaning and massaging back, paying special attention to pressure points. Back massage provides comfort pleases and relaxes the patient; thereby it facilitates the physical stimulation to the skin and the emotional relaxation. Back rub means attending the back and pressure points of body with special care it is often called as back care or back massage

53. PURPOSE To give comfort to the patient . To stimulate blood circulation . To promote rest and sleep. To prevent pressure sores . To assess the skin condition . To relax and relieve tension in tissues and muscles. To refresh patient and relieve fatigue.

54. GENERAL INSTRUCTIONS Back care given as a part of morning care and evening care.• Pressure points are attended more frequently and the position is changed. . When the skin is greasy, moist, thin about to break or patient is in continent or edematous used spirit or powder to reduce friction. . When the skin is dry, use oil for back rub. Spirit toughens the skin and powder reduces friction oil lubricates the skin and , hence, reduces friction. . When giving back rub, use more pressure on upward strokes towards the head and less pressure on the down- ward strokes. Back rub may be contraindicated in patients susceptible.to clotting disorders.

55. ARTICLES A tray containing of A basin of warm water . Sponge cloths-2 Soap and towel . Surgical spirit or back-rub lotion and powder. Mackintosh and towel . Kidney tray and paper bag

56. PROCEDURE Wash hands and explain the procedure . Screen the patient and explain the procedure, Turn the patient on his side . Turn back top bedding and expose only required part . Spread towel close to the patients back to protect bed liner Wash back thoroughly from cervical spine to the coccyx. Apply soap in the same manner. Run hands firmly an slowly up the back on either side of the vertebral column up the neck and down across the shoulders . Pour some spirit into hand applies firmly in a circular motion repeat until back is thoroughly rubbed with it. . Wash off soap and dry thoroughly with towel . The back must be rubbed three to five minutes especially over pressure points . Apply back powder after through drying of the spirit. Remove the towel . Cover the patient with top bedding.

57. AFTER CARE Make the patient comfortable . Remove the screen and equipment. Clean the articles with soap and water and keep ready for next use. Wash hands. Record the date, time treatment and observation made on nurse's record

58. CARE OF BED SORE

59. ASSESSMENT OF PRESSURE ULCERS Pressure ulcer (decubitus, bedsore) is defined as localized injury to the skin or underlying tissue over a bony prominence as a result of pressure with friction and shear. Clinical presentation can vary from simple reactive hyperemia to severe osteomyelitis. It is very common in the elderly bed- bound patients, and the most commonly affected body portions are sacrum and heel. Prevention of pressure ulcers should be started by primary care givers through education of the patient and the family, and every measure should be undertaken to prevent its development. There are two well-known scaling systems in prediction of pressure ulcers: Norton & Braden .

60. STAGES OF PRESSURE/BED SORES

61. SCALES FOR ASSESSMENT FOR BED SORES NORTON SCALE BRADEN SCALE

62. CARE OF PRESSURE POINTS/BED SORE A bed sore or pressure sore decubitus ulcer is an ulcer occurring on the skin of any bedridden patient, particularly over bony prominences or where two skin surfaces press against each other . Bed sore is the term applied to the local gangrene or ulcer caused by certain conditions associated with the confinement of bed. Due to constant pressure circulation becomes slow and finally death of tissues occurs.

63. PURPOSE To improve circulation . To facilitate healing . To prevent infection. To prevent further damage. To treat bedsores.

64. CAUSE OF PRESSURE SORES Direct or immediate cause : The pressure is caused by the weight of the body continuously remaining in one position, splints, casts and bandages . Friction : Friction of the skin with rough bedding causes injury to the skin. The friction is caused by wrinkles in the bed cloths, cramps of food in the bed, chipped or rough bed pans and hard surfaces of plaster casts and splints . Moisture : The skin contact with moisture for a prolong period can lead maceration of the skin . Pressure of pathogenic organisms due to unhygienic condition pathogenic organic multiplies and infection settles on the skin.

65. PREDISPOSING FACTORS Patient with long-term illness, fracture patients. Patients with spinal injury . Paralysis and limited movements. Emaciated and malnourished patients . Elderly with circulatory problems. Obese patients. Oedematous patients. Patients with incontinence. Diabetic patients with ulcers (diabetic foot).

66. CLINICAL MANIFESTATION Redness, heat, tenderness, and discomfort in the area. The area becomes cold to touch and insensitive. Local edema.. Later, the area becomes blue, purple of mottled. Due to continued pressure that circulation is cut off, the gangrene develops and affected area is sloughed

67. PREVENTIVE MEASURES Confirm the high-risk patients and daily examination for the signs and symptoms. Relieve pressure by using special mattress, beds and comfort devices. Change position and giving back care four times a day for all bedridden patients. Loosening tight bandages and restraints. Avoid friction by providing smooth, firm and wrinkle free bed, keep the bottom clothes free from crumbs and foreign bodies. Prevent moisture by changing linen when, it is wet or soiled. Giving back care to patients immediately. Avoid mechanical or physical injury to the skin from improper fitting of prosthesis or from burns caused by excessively hot or cold applications. Use a bed cradle to lift the weight of bed linen off the patient to enable him/her to move in bed freely. Supply well-balanced diet and adequate fluids to maintain general health of the patient

68. STAGES/DEGREE OF PRESSURE SORE BASED ON CLINICAL MANIFESTATIONS First degree : The skin is red, tender, inflamed and painful. Second degree : The skin is blue or mottled insensitive, circulation cut off, gangrene develops and epidermis breaks. Third degree : Suppuration and sloughing occurs which may burrow right down to the bones.

69. CURATIVE MEASURES BASED ON DEGREES OF PRESSURE SORE FIRST DEGREE Detect the early signs and symptoms of bedsore and report them to the sister in charge and the doctor. Carry out all the preventive measure with special care to prevent extension of bedsore and further occurrence of pressure sores. While giving back care/massage, do not over the reddened or inflamed area itself but start just outside the affected area and move outwards in a circle using circular motion . SECOND DEGREE If the pressure sore is blue or mottled insensitive, circulation cut, off gangrene develops or epidermis breaks . The treatment included Inform and report to the ward sister and physician Prevent the ulcerated area from infection

70. Cont.… Use normal saline for cleaning the area . Sloughing is more; use hydrogen peroxide solution also for cleaning, cut off the slough, Apply heat for healing of the wound. Use 100 watt electric bulb for 10 minutes, Apply zinc oxide ointment on the surface of the wound THIRD DEGREE If the bed sore is suppuration and sloughing occurs which may burrow right down to the bones.

71. Cont.… Inform and report to the ward sister and physician, To treat infection, apply soframycin ointment locally and give systematic antibiotics after culture and sensitivity. Provide nutritious diet (high in protein and vitamins)sunlight and fresh air. If slough is present, clean the wound with hydrogen peroxide twice daily if the slough is loose, it may be cut off. If there is delay in wound healing, skin grafting can be done.

72. AFTER CARE Place the patient in comfortable position. Use proper and adequate comfort devices . Change the patient's position at frequent intervals. Remove the articles from the bedside and replace it in a proper place . Hand Washing. Recording & reporting- date time, type of pressure sore & treatment in the nurses record.

73. CARE OF HAIR & MAINTAINING HAIR CARE

74. CARE OF HAIR & MAINTAINING HAIR CARE Care of hair means maintaining cleanliness of hair, i.e., free from dandruff, dirt, nits, lice, flakes, dryness and irritation SCIENTIFIC PRINCIPLES Well-combed and attend hair provide comfort to the patient and make appearance more attractive . Neglected hair and scalp contain dirt and microorganism and also produce infection of the scalp Unbroken skin acts as a barrier to infection

75. PURPOSE To keep hair clean and healthy. To promote growth of hair. To have a neat and tidy appearance. To prevent itching, infection, dandruff, lice, flakes, dryness and irritation. To prevent loss of hair. To prevent accumulation of dirt. To stimulate circulation. To prevent tangles. To promote comfort. To have a sense of well-being.

76. TYPES OF HAIR CARE Daily care: The hair should be thoroughly combed and brushed daily. A woman usually needs more attention to the hair due to its length. Hair shampoo : Shampooing the hair in order to maintain its cleanliness. Treatment of hair : Pediculosis treatment-it is the treatment given with DDT 5% of carbolic lotion 1:40 applied thoroughly on the scalp and it is left for overnight, and the next day a thorough bath is given and the linen is change ASPECTS Daily care by brushing and combing. Head bath in order to maintain to cleanliness. Treatment of hair for lice infestation..

77. FACTORS INFLUENCE ON HAIR General health of a person. A well-balanced diet. Light and fresh air . Daily practices (hair wash and combing ). Hair brushing and massage. Endocrine disorder.

78. FACTORS AFFECTING HAIR Altered level of consciousness. Physical weakness or disease condition. Immobility and aging. Insect bite and infestations. Accumulated secretions. Hormonal changes . Physical and emotional stress . Poor health practices. Effects on drug.

79. COMMON HAIR SCALP PROBLEMS Dandruff-sealing of scalp accompanied by itching Pediculosis-lice infestation. Alopecia-hair loss. Tangled and matted hair. Dryness. Flakes. Irritation .

80. HAIR COMBING

81. HAIR COMBING The hair can be combed & washed in the morning so that the patient can feel refreshed & appeared well-groomed before starting daily activities. General Instructions Hair needs to be brushed daily in order to be healthy. Long air should be combed at least once a day to prevent it from matting . Teeth of the comb should be dull to prevent scratching ofthe scalp Hair must be kept free from snarls, combed and brushed without hurting the patient

82. PRELIMINARY ASSESSMENT Check Doctors order for specific precautions. General condition and self-care ability . Condition of the scalp and hair . Mental status to follow directions . Articles available in the unit . Preparation of the Patient & Environment Explain the procedure . Arrange the article at the bedside,

83. Cont.… Provide privacy and adequate light. Make the patient to sit on a bedside chair or stool. Protect the bottom sheet and pillow case with a towel. Protect the nurse's uniform by wearing aprons . Equipment Clean comb. Mackintosh and towel. Coconut oil in a container , Kidney tray and paper bag . Kidney tray with carbolic lotion 1:20 to destroy the lice an to disinfect the comb.

84. PROCEDURE Wash hands and take required articles at bed If possible as patient to sit on a stool otherwise side lying or Fowler's position. Place the Mackintosh under the head of the patient . Each half of the hair is treated separately without causing strain on the patient . Separate the hair in small strands. To prevent pulling hold strands above the part being combed, so that there will be no pain to the patient. Comb the tangle out from the ends first and then go up gradually. Use oil to remove tangles . After combing the hair thoroughly, use ribbon to tie the hair. Discard loose hair into the paper bag

85. AFTER CARE Place the patient comfortable and tidy. Replace the articles to the utility room . Wash hands thoroughly. Record and report the procedure in nurse's record sheet.

86. HAIR WASH/ BED SHAMPOOING

87. HAIR WASH/ BED SHAMPOOING Hair was is a special care of the hair may be required for patients who are in bed for prolonged period of time. Shampooing in hair should be performed whenever the hair and scalp are dirty. PURPOSE To keep hair & scalp clean & healthy To promotes sense of comfort & self esteem To complete the treatment of pediculi .

88. GENERAL PRINCIPLES OF HAIR WASHING Keep the patient warm at all times Position a linen skip near the patient and ensure you dispose of used linen immediately to minimize the dispersal of microorganisms and dead skin cells into the environment . Check the scalp and surrounding skin for pressure damage and underlying skin conditions Avoid contaminating dressings and drains with water Gently pat the hair and surrounding skin dry to reduce the risk of friction damage and discomfort for the patient Use the correct manual handling procedures and equipment to avoid injury to yourself and the patient If the patient is unconscious remember to talk them through what you are doing-and avoid talking to colleagues over the patient.

89. GENERAL INSTRUCTIONS The patients are given hair wash at least once a week for bedridden patients. Avoid hair wash for patients who have just taken meals at least for an hour. Avoid exposure and chilling by keeping the patient covered with top clothes. If the patients are very sick, note pulse before and after the hair wash. Do not let the patient exert and try to avoid exertion to the patient as far as possible.

90. PRELIMINARY ASSESSMENT Check Doctors order for specific precautions . General condition for the patient. Self-care ability . Patients preference for soap, shampoo, oil, etc . Patients mental state to follow instructions . Availabilities of ward article.

91. Preparation of the Patient and Environment Explain the procedure. Arrange the articles at the bedside. Provide privacy. Position the patient (flat) comfortably to the edge of the bed (if condition permits ). Remove the extra pillows and back rest . Make an improvised through (Kelley's pad) and place it under the hand to facilitate the drainage of water into receptacle. Place the bucket on the low stool close to the side of the bed.The distal end of the Mackintosh (trough) is received into it. Plug the ear with cotton balls.

92. ARTICLES The following equipment will be required: Apron Towels Laundry skip Disposable wash cloths Plastic sheet Preferred shampoo and conditioner Comb or brush Clean clothes and bed linen Shampoo tray Disposable jug and basin.

93. PROCEDURE Review the patient's care plan for hygiene needs and check there are no contraindications to positioning the p patient flat in bed. Ensure someone will be available to help position the patient during the procedure if required. Discuss the procedure with the patient, ask about their usual hair routine and gain their informed consent for the procedure. Check whether the patient has any pain. Administer analgesia if necessary and ensure it has taken effect before starting the procedure, to help relieve any pain associated with moving the patient Ensure the patient's privacy and check that the environment is warm and free of draughts . Check whether the patient needs to empty their bowel/bladder before the procedure. Assemble your equipment and ensure everything is to hand to minimize the amount of time the patient is lying flat . Ensure the bed is at the correct working height.

94. Decontaminate your hands and put on an apron to reduce the risk of infection. Remove the patient's clothes from their upper body and cover them with a sheet to maintain dignity Remove the pillows from behind the patient's head so they are lying flat. This allows water to drain away from the eyes and ears during the procedure. Ask the patient to let you know if they feel uncomfortable in this position at any time. Remove the head of the bed so you can access the patient's hair easily Place a plastic sheet under the patient's head and shoulders, and wrap a towel around their shoulders . Position the patient's head on the shampoo tray, ensuring you follow manufacturer's instructions carefully. A towel can be placed under the neck for support. Following manufacturer's instructions, ensure the receptacle that will collect the water from the shampoo tray is positioned under the drainage spout.

95. Fill a disposable wash bowl with warm water and allow the patient to check the temperature. If required, cover the patient's eyes with a disposable washcloth to protect them from water and shampoo. Using a disposable jug, take water from the disposable bowl and wet the patient's hair. Start at the front hairline and allow the water to drain down and away from the face, avoiding the eyes and ears. Apply the shampoo and massage it into the hair. Using the jug, rinse the patient's hair with water. Figure2.33 shows the Shampooing technique . Apply conditioner, if required by the patient, and rinse the hair again. Check , regularly, the patient is comfortable and can maintain their position. Pat the hair with a towel to remove the excess water-avoid pulling on the hair as this can be uncomfortable.

96. Remove the shampoo tray and wrap a towel around the patient's head to dry the hair and ensure they do not feel cold. Dry the surrounding skin, paying particular attention to skin folds in the neck. Change any wet bed linen. Dispose of soiled bed linendirectly into the linen skip. Replace the bed head and reposition the patient so they are comfortable Help the patient get dressed. Style the patient's hair according to their preferences. If possible, try to make this a social situation-offer them a drink and a mirror so they can advise you about the style and participate in their care. Finish making the bed and ensure the patient is warm and comfortable with a call bell, a drink (if allowed) and their belongings within reach . Dispose of equipment according to local policy. Decontaminate the shampoo tray and drainage receptacle according to local policy . Remove and dispose of your apron and decontaminate your hands. Record care that has been given, record and report any abnormal findings and update the patient's care plan if required.

97. PEDICULOSIS TREATMENT Pediculosis is defined as the state of being infected with lice. Pediculi or lice is a small blood sucking parasite . It is associated with poor personal hygiene. It can be acquired in overcrowded, unsanitary conditions and exposure to infected persons . Purpose To destroy pediculi and nits. To prevent its transmission to other. To promote comfort. To promote sense of well-being.

98. DANGERS OF PEDICULOSIS Severe itching . Scratching and as a result, abscess formation. Presence of dandruff. Restlessness and insomnia due to discomfort. Anemia. Presence of nodules at the back of head due to infected glands.

99. PREVENTION OF PEDICULOSIS Proper personal hygiene should be maintained by every person. Daily hair combing and frequently washing it. If the patient complains of itching or scratches the head, examine hair and scalp thoroughly . Medications Used for Pediculosis Treatment DDT powder one part to nine part of talcum powder. Kerosene mixed with equal parts of sweet oil destroys both lice and nits . Carbolic lotion 1:40 . Readily available Lysol. Preparations containing Gamma Benzene Hexachloride available in the market and can be used according to the instruction on the label.

100. GENERAL INSTRUCTIONS The parasiticides are applied thoroughly on the scalp (to the body if necessary) and is left for overnight. On the next day, a thorough bath is given and the linen is changed. The linen should be thoroughly disinfected to remove the lice from the clothes. Since the parasiticides are not effective against the nits lice from the cloths. (eggs) the procedure is repeated after a week.

101. PRELIMINARY ASSESSMENT Check Doctors order for specific precautions. General condition of the patient . Condition of the scalp and the hair. Assess mental stale to follow instructions. Articles available in the patients unit.

102. EQUIPMENT A tray containing: Mackintosh-1. Bath towels-2. Wash cloth-1. A cap, a triangular bandage or a towel folded diagonally. Safety pins . Kidney tray with disinfectant, e.g., carbolic acid 1:40. Paper bag. Hair comb. Cotton swabs or gauze piece in a container . Vaseline. Gown mask and cap. Bucket with antiseptic solution, e.g., carbolic acid 5%

103. PREPARATION OF THE PATIENT & THE UNIT Explain the sequence of procedure . Provide privacy by means of screens . Arrange the articles conveniently on the bedside . Place the patient flat if the condition permits . Bring the patients head and shoulder to the edge of the bed . Protect the pillow and bed with a mackintosh and a towel . Protect the patient's eyes with a clean damp wash cloth .. Put off the fan to prevent the parasiticide spilling over the face during its application. Loosen the hair and comb out the tangles.

104. PROCEDURE Wash hands thoroughly. Put on gown, mask and cap. Part the hair into small sections and apply the parasiticide on the hair and scalp, rubbing gently. In long hairs, the medicine is to be applied along the whole length of the hair. Roll up the long hair to the top of the head and cover the head with cap or triangular bandage or by a towel folded diagonally secure it with pins . Note: The treatment is done in the evening and left over night.

105. AFTER CARE Remove the Mackintosh and towels from under the patients head . Tidy up the bed; place the patient in a a comfortable position. Remove the gown, mask and cap and put them into the antiseptic lotion. Replace the articles in their proper place after clean and disinfect. Record and report the procedure in the nurses record sheet . The hair is washed in the following morning Comb the hair with a fine toothed comb. Repeat the procedure after one week because the units are not affected by the parasiticides . Disinfect all the articles that have come in contact with the hair by immersing them in carbolic acid 1:20 for one hour before washing

106. CARE OF PERINIUM

107. CARE OF PERINIUM The perineum is the anatomic area between the urethra, the tube that carries urine from the bladder, and the anus. In women, the perineum includes the vaginal opening. This area undergoes a lot of stress and change during pregnancy and delivery, and it needs special care afterward. It is also defined as perineal -genital care. The perineal area is condusive to the growth of pathogenic organisms because it is warm, moist and it is not well-ventilated. Since there are many orifices example, urinary meatus, vaginal orifice and the anus situated in this area, the pathogenic organisms can enter into the body. Thoroughly cleanliness is essential to prevent bad odor to promote comfort.

108. DEFINITION Perineal care defined as clean the perineum from the cleanest to the less clean area, the urethral orifice to the anal orifice. Perineal care includes the external genitalia and surrounding area. During perineal care, clean the area around the urinary meatus before cleaning the area around the anus . Perineal care involves washing the external genitalia and surrounding with soap and water/with water alone or in combination with any commercially prepared peri -wash.

109. PURPOSE To prevent sepsis. To remove discharges and prevent bad odor. To relieve itching. To promote healing of stitches. To promote comfort.

110. PERINUM CARE FOR SPECIAL GROUP OF PATIENTS Unable to do self-care or bedridden patients. After surgery on the genitourinary system. Patients with indwelling catheters. Patients with excessive vaginal discharges . Postpartum patients . Incontinence of urine and stool. Genitourinary tract infections.

111. PRELIMINARY ASSESSMENT Check Doctors order for any specific instruction. Assess the condition of the perineal skin-itching, irritation , ulcers , edema, drainage, etc. Assess the need and frequency of care . Assess the self-care ability of the patient. Mental state to follow instructions . Articles available in the patients unit.

112. Cont.… Preparation of the Patient and the Environment Explain the sequence of the procedure . Provide privacy . Arranged the needed articles at the bed side. . Place the Mackintosh under the buttocks, over the draw sheet. . Place a clean bedpan on the bed on your working side . Unite the pads-if any, and observe the discharges its color odor , amount, etc.

113. Cont.… Principle Clean the perineum from the cleanest to less clean area. Patient who require special attention to perineal area . Patient who are unable to do self-care . Patient with genitourinary tract infection . Patient with incontinence of urine and stool. Patient with indwelling catheters.Postpartum patients . Patients after surgery on the genitourinary system. Patients with injury, ulcer or surgery on perineal area

114. Washing a Woman’s Perineum Fill the basin with clean warm water. Fold the towel in hair. Ask or help the woman to lift her buttocks. Put the towel under the buttocks. Ask the woman to bend her knees and spread her legs. With a soapy washcloth in one hand, separate the labia ("lips" of the vagina) with the other hand. Wash the labia from front to back. Do not touch the anus with the washcloth. Germs from the anus could get into the vagina and cause an infection . Rinse the washcloth and remove the soap from the perineum. It is important to remove all the soap because it can irritate the skin . Dry the area with a dry towel. Do not put powder on the perineum because the powder may harden. Wash the anus next. Ask the woman to turn onto her side so that she is facing away from you. Ask her to rise up her top leg. This will let you see and clean the skin around the anus . Slide the towel under the woman's buttocks . Use toilet paper or a paper towel to remove BM that may be on the skin. You need to wet the toilet paper or paper towel if the BM has dried . Throw the toilet paper or paper towel away in a trash bag. Wash , rinse & dry the anal area.

115. Washing a M an’s Perineum Empty the dirty water into the sink. Fill the basin with clean warm water. Ask or help the man to lie on his back . Fold the towel in half and put in under the man's buttocks. Ask the man to bend his knees slightly and spread his legs. Hold the penis with one hand. With the other hand, wash the tip of the penis with a soapy washcloth . Rinse the washcloth and remove the soap from the penis If the man has a foreskin, gently push it back. The foreskin is the skin that covers the rounded end of the penis . Wash the end of the penis. Rinse the washcloth and remove the soap from the end of the penis

116. Cont.… Using a soapy washcloth, wash the rest of the penis and the scrotum. The scrotum is the bag of skin that hangs under the penis. Rinse and dry well The anus should be washed next. Ask the man to turn onto his side with the top leg raised. This will let you see & clean the anal area easier. Fold the towel in half & out it under the man’s buttocks . Use toilet paper or a paper towel to remove BM that may be on the skin. You may need to wet the toilet paper or paper towel if the BM has dried . Throw the toilet paper or paper towel away in a trash bag. Wash, rinse and dry the anal area.

117. PRELIMINARY ASSESSMENT ( F or Female) Assess the condition of perineal skin - any itching , irritation , ulcers, edema, drainage, etc. Assess the need and frequency of perineal care. Assess whether perineal care should be done under an aseptic technique or a clean technique. Check the physician's order for any specific instructions. Assess the patient ability for self care. Assess the patient mental state to follow instructions . Check the articles available in patients unit.

118. EQUIPMENTS A tray containing Mackintosh. A jug with warm water or antiseptic solution. Wet cotton balls or rag pieces in a bowl . Gauze or rag pieces in a container . Long artery forceps in the kidney tray. Paper bag . Clean (personal and bed linen) dressing pads, etc., as needed . Soap , soap dish, towel and wash cloth of the patient is able to do himself.

119. PREPARATION OF ARTICLES A tray containing Mackintosh : Purpose-to protect the bed. Wet cotton ball or rag pieces in a bowl: Purpose-to clean perineum. A jug with warm water or antiseptic solution : Purpose-gauze or rag pieces in a container . Long artery forceps in kidney tray: Purpose-to holdswabs for cleaning Paper bag : Purpose-to receive wastes. Clean linen, pads, dressing etc as needed: Purpose-toke ep patient clean . Bed pan: Purpose-if the patient is in need to passing urine or stool.

120. PREPARATION OF PATIENT Explain procedure to the patient. Provide privacy by screens and drapes. Drape the patient as for vaginal examinations. Remove all articles that may interfere with the procedure,e.g ., air cushion . Give extra pillows to raise the head . Roll the draw sheet to opposite side to prevent soiling when bedpan is placed under buttocks, over draw sheet . Offer bed pan. Keep the clean bed-pan on the bed on your working side . Untie the pads, if any and observe the discharges its color, odor, amount, etc . Leave the patient for sometime so that she may pass urine or stool if necessary. Get the toilet tray and arrange the articles conveniently on bed side table.

121. PROCEDURE Steps Wash hands. Reason-to prevent cross infection. Pour water over perineum. Reason-to wash off the discharge from the perineal area. Clean the perineum using the wet swabs. Reason-to prevent the entrance of bacteria from the colon into urinary tract. from above. Hold the swabs with forceps and clean. Use one swab for one swabbing. Clean perineum from the midline outward in following : The vulva The labia. Inside of labia on both sides. Outside of labia on both sides. Clean the perineal region and anus thoroughly. Remove the bed pan by supporting the hip as before. Turn the patient to one side and dry the buttocks with dry rag piece.

122. AFTER CARE Apply the medicine and pad if necessary. Remove the mackintosh if extra one is used. Change linen if necessary straighten the bed clothes . Arrange the bed linen. Make patient comfortable. Take the bed pan to sanitary annex. Remove cotton swabs and empty the contents into toilet. Clean all articles. Boil forceps. Replace articles. Remove screen and tidy up the unit.

123. THANK YOU