6 Hygiene
6 Hygiene
6 Hygiene
HYGIENE
Science of health and its maintenance highly personal matter determined by individual values and practices Involves care of the skin, hair, nails, teeth, oral and nasal cavities, eyes, ears, and perineal-genital areas PERSONAL HYGIENE self-care by which people attend to functions such as bathing, toileting, general body hygiene and grooming
SKIN
Largest
organ of the body Functions: - first line of defense against injury and microorganism - maintains body temperature - secretes sebum - sensory organ - produces and absorbs Vit D
BATHING
Removes
accumulated oil, perspiration, dead skin cells and some bacteria Stimulates circulation Produces sense of well-being Offers an excellent opportunity for nurses to make ASSESSMENTS Categories:
-
Cleaning baths given chiefly for hygiene purposes Therapeutic bath given to produce specific effects
CLEANING BATH
BED BATH the nurse washes the entire body of a dependent client in bed SELF-HELP BED BATH nurse help a client to wash the back and feet PARTIAL/ABBREVIATED BATH only the parts of the clients body that might cause odor or discomfort is washed
COMPLETE
CLEANING BATH
BATH bath that is commercially prepared product that contains a presoaked disposable washcloth that contains a no-rinse cleanser solution TUB BATH SHOWER
BAG
THERAPEUTIC BATH
Given
for physical effects such as to sooth irritated skin or to treat an area Medications may be placed on the water KINDS: Tepid Sponge Bath - done by sponging the body with htin washcloth from cold or tepid water to reduce body temp & refresh patient
Sponge Bath - sponging the body with a washcloth from a mixture of alcohol and tap water (1:3), to reduce temp Hot Sitz Bath - consists of immersion of the pelvic region and the upper thighs in a tub of hot water, to relieve congestion and pain in the pelvic region - to relieve pain and hasten healing after hemorrhoidectomy - to induce urination in some case of urinary retention - to produce muscular relaxation
BED BATHING
Explain
Condition of the skin Physical or emotional factors Presence of pain ROM Need to use gloves
BED BATHING
Assemble
wash basin wash cloth 2 bath towels bath blanket soap & soap dish hygiene supplies (e.g. powders, lotions) warm water bedpan/urinal gloves (optional) laundry hamper
BED BATHING
Identify
yourself and verify clients identity Perform hand hygiene and other appropriate infection control measures Provide for client privacy Prepare the client and the environment
Invite a significant other to participate if desired Close the windows and doors Offer to use the toilet, commode or bedpan/urinal
BED BATHING
Position
the bed at a comfortable working height. Lower the side rail on the side close to you while keeping the other side rail up. Assist the client to a comfortable position and to move near you. Place a bath blanket over the top sheet. Remove the top sheet from under the bath blanket starting at the clients shoulders moving down towards the clients feet
BED BATHING
Remove
the clients gown while keeping the client covered with the bath blanket. Place the gown in the linen hamper Fill the wash basin with warm water. Change water as necessary Make a bath mitt with the wash cloth
BED BATHING
Wash
the face
Place the towel under the clients head Wipe one eye with one side of the wash cloth moistened with clan water from inner to outer canthus. Repeat it to the other eye using the other side of the wash cloth Wash, rinse, and dry the clients face, ears and neck. Ask whether the client prefers to use soap then remove the towel from under the clients head
BED BATHING
Wash the upper extremities Place the towel lengthwise under
away from you. Wash the extremity from the wrist to the shoulder including the axilla using firm strokes by elevating the arm and supporting the clients wrist and elbow Rinse and dry the extremity. Apply powder or deodorant if desired Place a towel on the bed adjacent to the clients hands and place the basin over it. Soak the hand in the basin. Wash, rinse and dry the hands Repeat the procedure to the other extremity
BED BATHING
Wash
Place the bath towel lengthwise over the chest. Fold the bath blanket down to the clients pubic area. Lift the bath towel off the chest and bathe the chest and abdomen with your mitted hand using long, firm strokes. Rinse and dry well then replace the bath blanket when the areas have been dried
BED BATHING
Wash the legs and feet Expose the leg farther from
you by folding the bath blanket towards the other leg. (Keep the perineum covered) Lift the leg and place the bath blanket lengthwise under it. Wash, rinse, and dry the leg using long, firm strokes from the ankle to the knee to the thigh. Reverse the coverings and repeat for the other leg. Wash the feet by placing them in the basin of water then dry each foot. Obtain fresh, warm water now or when necessary
BED BATHING
Wash
Assist the client into a prone or side-lying position facing away from you and place the bath towel lengthwise alongside the buttocks. (Keep the client covered with the bath blanket as much as possible) Wash and dry the clients back, moving from the shoulders t the buttocks and upper thighs, paying attention to the gluteal folds. (Back massage may be performed at this time or after the completion of the bath)
TYPES OF MASSAGE
Back
Rub - massage of the back with 2 chief objectives: (1) relax and relieve muscle tension (2) stimulate blood circulation to the tissues and muscles - effleurage - tapotement - petrissage
TYPES OF MASSAGE
smooth, long stoke, moving the hands up and down the back Tapotement the little finger side of the hand is used in a sharp, hacking movement on the back (tapping) Petrissage a large pinch on the skin, subcutaneous tissue and muscle is quickly done (kneading)
Effleurage
BED BATHING
Assist
the client to supine position and determine if the client can wash the perineal area independently. If the client cannot do so, drape the client and wash the area
BED BATHING
Assist
the client to wear a clean hospital gown and attend to the personal grooming aids such as powder, lotion or deodorant Assist the client to a comfortable position. Lower the bed and raise the side rails Clean and store bath equipments Document all relevant information
PERINEAL-GENITAL CARE
PERINEAL
Female: from front to back Male: cleanse the urinary meatus by moving in circular motion from center of urethral opening around the glans
Purpose: - remove normal perineal secretions and odor - prevent infection - promote comfort
Irritation, excoriation, inflammation, swelling Excessive discharge Odor; pain or discomfort Urinary or fecal incontinence Perineal-genital hygiene practices Self-care abilities
wash basin wash cloth bath towels bath blanket cotton balls/gauze warm water bedpan/urinal gloves (optional)
yourself and verify clients identity Perform hand hygiene and other appropriate infection control measures Provide for client privacy Prepare the client. Fold the top bed linen to the foot of the bed and fold the gown up to expose the genital area. Place the bath towel under the clients hips
(dorsal recumbent position) and drape the client by tucking the bottom corners of the bath blanket under the insides of the legs and bring the middle portion of the base of the blanket up over the pubic area Put on gloves and wash and dry the upper inner thighs Inspect the perineal area. Note for inflammation, excoriation, or swelling
the labia majora then spread the labia to wash the folds between the labia majora and the labia minora. Use separate quarter of the wash cloth for each stroke and wipe from pubis to rectum
For menstruating women and clients with indwelling catheter, use clean wipes, cotton balls or gauze and take a clean wipe for each stroke
the area well and dry the perineum thoroughly Inspect perineal orifices for intactness Assist the client to turn unto side facing away from you. Pay particular area to the anal area. Clean the anus with toilet tissue before washing it if necessary Dry the area well and apply a perineal pad as needed from front to back Clean/dispose equipments/supplies appropriately
the client in a supine position with his knees slightly flexed. Provide appropriate drapes Put on gloves and wash and dry the upper inner thighs Inspect the perineal area. Note for inflammation, excoriation, or swelling
and dry the penis using firm strokes. For uncircumcised, retract the prepuce to expose the glans penis for cleaning. Replace the prepuce after cleaning the glans penis. Wash and dry the scrotum Inspect the perineal orifice for intactness
the client to turn unto side facing away from you. Pay particular attention to the anal area and posterior folds of the scrotum. Clean the anus with toilet tissue before washing it if necessary. Dry the area well Clean/dispose equipments/supplies appropriately
Redness Excoriation Skin breakdown Discharge Any localized areas of tenderness Any unusual findings
Inspect for shape, size, presence of lesions Palpate for tenderness, edema, circulatory status
Common
problems:
feet daily, dry thoroughly esp the interdigital spaces Use warm water for foot soak to soften nails and loosen debris under them Use cream or lotion to moisten skin and soften calluses Use deodorant sprays or foot powder to prevent or control unpleasant odor
toenails straight across, file toenails Change socks or stockings daily Wear comfortable, well-fitted shoes Dont go barefooted Exercise the feet to promote circulation
NAIL CARE
Trim nails straight across, or follow the contour of the fingers File nails to have smooth edges Do not trim at the lateral corners to prevent ingrowns (inguis incarnatu) Diabetic clients: do not cut hangnails or cuticles Onycholysis separation of the nail from the nail bed Paronychia inflammation of the skin folds at the nail margin
Remove food particles from around and between the teeth Remove dental plaque Promote sense of well-being Prevent sores and infection of oral tissues
Assessment:
- lips, gums, oral mucosa, tongue, tooth caries, halitosis, gingivitis, loose or broken teeth, dentures
Towel Disposable gloves Emesis basin Soft bristled toothbrush Water Toothpaste Mouthwash Dental floss
yourself and verify clients identity Perform hand hygiene and other appropriate infection control measures Provide for client privacy Lower the side rail nearest to you and assist client to a sitting or high fowlers position, if health permits; or assist to a side-lying position with head turned Place the towel under the his chin then put on the gloves
the bristle of the toothbrush then apply the toothpaste to the toothbrush. Place and hold the emesis basin under the clients chin Hold the brush against the teeth with the bristles at a 45 angle then move the bristles up and down using a vibrating or juggling motion. Repeat until all outer and inner surfaces of the teeth and sulci of the gums are cleaned. Clean the biting surfaces by moving the brush back and forth in short stokes. Brush the tongue gently
the client the glass of water to rinse mouth vigorously. Remove emesis basin after then assist client in wiping his mouth. Assist client to floss independently or floss his teeth by holding the dental floss in both hand and floss between all teeth. Assist the client in rinsing and wiping is mouth Clean and return the equipment to the appropriate location Document all relevant information
dentures:
Wear cloves when handling and cleansing dentures - Place a washcloth in a basin or bowl of the sink when brushing dentures to prevent damage if the dentures are dropped
-
client:
Place in side lying position to prevent aspiration Have suction apparatus readily available Use padded tongue blade to open mouth Brush teeth and gums, using toothbrush or soft sponge ended swab Apply thin layer of petroleum jelly to lips to prevent drying or cracking
(HAIR)
scalp HAIR LOSS permanent thinning of the hair usually because of aging TICKS small gray-brown parasites that bite into tissue and suck blood SCABIES contagious skin infestation by the itch mite
Burrow lesion
growth of excessive
body hair PEDICULOSIS parasitic insects that infest mammals (lice); infestation of lice
PEDICULOSIS CAPITIS (head louse) PEDICULOSIS CORPORIS (body louse) PEDICULOSIS PUBIS (crab louse)
HAIR SHAMPOO
Purpose:
Stimulate circulation of the blood in the scalp - Clean the hair and improve the clients well being
-
Assessment:
- Hair care practices, condition of the hair and scalp, self-care abilities, evenness of hair growth
HAIR SHAMPOO
EQUIPMENTS:
water pitcher waterproof pad 3 bath towels wash cloths shampoo drain/Kelly pad shampoo comb basin warm water
HAIR SHAMPOO
Identify yourself and verify clients identity Perform hand hygiene and other appropriate infection control measures Provide for client privacy Assist the client to the side of the bed from which you will work. Remove pins and ribbons from the hair and comb it to remove any tangles
HAIR SHAMPOO
Remove
the pillow from under the clients head and place it under the shoulders (unless contraindicated). Tuck a bath towel around the clients shoulders. Place the shampoo drain under the head, putting a folded washcloth or pad where the clients neck rests Fanfold the top sheet down to the waist and cover the upper part of the body with a bath blanket.
HAIR SHAMPOO
Place
the receiving receptacle on the bedside and put the spout of the shampoo drain over the receptacle Place a damp washcloth over the clients eyes Wet the hair thoroughly with water using the water pitcher. Apply shampoo to scalp and make a good lather while massaging the scalp Rinse the hair thoroughly to remove all the shampoo. Squeeze as much water as possible out of the hair with your hands
HAIR SHAMPOO
Remove
the shampoo drain and dry the hair thoroughly with the towel placed under the head or another towel Comb the clients hair Assist the client to a comfortable position Clean/dispose equipments/supplies Perform hand hygiene Document all relevant information
EYE CARE
Cleanse
the eyes from inner to outer canthus, use a new cotton balls for each wipe Avoid rubbing eyes Maintain adequate lighting when reading Avoid regular use of eye drops If dirt/FB gets into the eyes, clean them with copious, clean, tepid water as emergency treatment
EAR CARE
Cleanse
the pinna with moist wash cloth Do not use bobby pins, toothpicks or cotton-tipped applicators to remove cerumen
NOSE CARE
Clean
nasal secretions by blowing the nose gently into a soft tissue Both nares should be open when blowing the nose to prevent forcing debris into the middle ear May use cotton-tipped applicator moistened with saline or water to remove encrusted, dried secretions
MAKING BEDS
ENVIRONMENT
ROOM
TEMPERATURE VENTILATION important to remove unpleasant odors and stale air NOISE
HOSPITAL BEDS
usually covered with a waterrepellent material that resist soiling and can be cleaned easily SIDE RAILS safety sides; prevents client from falling out of bed FOOTBOARD/FOOTBOOT used to support the immobilized clients foot in normal right angle to the legs BED CRADLES device designed to keep the top bedcloths off the feet, legs and abdomen INTRAVENOUS RODS poles, stands, standards; supports IV infusion containers while IVF is administered
MATTRESSES
MAKING BEDS
UNOCCUPIED
BED
OCCUPIED
UNOCCUPIED BED
Perform
2 flat sheets or 1 fitted sheet & 1 flat sheet bottom sheet pillowcase waterproof draw sheet cotton draw sheet blanket linen hamper gloves (optional)
UNOCCUPIED BED
Identify
yourself and verify clients identity Perform hand hygiene and other appropriate infection control measures Assist client out of bed to a comfortable chair Adjust the bed to a comfortable height and lower both side rails Remove pillowcase and set pillows aside in a clean area
UNOCCUPIED BED
Strip the bed Check the bed
the client. Loosen all beddings starting on the head of the bed on the far side moving around the bed up to the head of the bed to the near side. Remove reusable linens and fold it. Remove the waterproof pad and discard it if soiled. Roll all soiled linens inside the bottom sheet. Hold it away from your uniform and place it directly in the linen hamper Move the mattress securely up to the head of the bed
UNOCCUPIED BED
Apply the bottom sheet and draw sheet Place the bottom sheet with its centerfold on
the center of the bed. Position the sheet high enough to tuck under the head of the mattress and along the edge of the mattress at the foot of the bed. Spread the sheet out over the mattress. Tuck the top of the sheet under the mattress and miter the corner nearest you. Tuck the remaining sheet under the mattress from head to the foot of the bed If waterproof drawsheet is used, place the centerfold over the center line of the bottom sheet and position it from the clients back to the knee area. Fanfold the upper most half and spread over the lower half. Place the cotton drawsheet in the same manner over the waterproof drawsheet. Tuck the drawsheets securely over the side of the mattress
UNOCCUPIED BED
Move
Pull the bottom sheet firmly, tuck in the bottom sheet and miter the corner of the sheet. Ensure that there should be no wrinkles Complete this same process for the drawsheets
Apply
Place the top sheet on the bed with its centerfold at the center of the bed and the top edge is even with the top edge of the mattress. Spread the sheet over the bed. Make a horizontal or vertical toe pleat
UNOCCUPIED BED
VERTICAL
TOE PLEAT: make a fold in the sheet 2-4 inches perpendicular to the foot of the bed HORIZONTAL TOE PLEAT: make a fold in the sheet 2-4 inches across the bed near the foot
Tuck in the sheet and miter the corner. Leave the sides of the sheet hanging freely unless toe pleats were provided. Move to other side of the bed and secure the top bedding in the same manner then fold the top of the top sheet down over the spread, providing a cuff
UNOCCUPIED BED
Put
Grasp the closed end of the pillowcase then gather up the sides of the pillowcase and place them over the hand grasping the case and with the free hand, pull the pillowcase over the pillow. Adjust the pillowcase so that it fits snugly. Place the pillows appropriately at the head of the bed with the open ends facing away from the door. Place the pillows appropriately at the head of the bed with the open ends facing away from the door
UNOCCUPIED BED
Clean
and return the equipment to the appropriate location Document all relevant information
OCCUPIED BED
Perform
OCCUPIED BED
Identify
yourself and verify clients identity. Explain the procedure Perform hand hygiene and other appropriate infection control measures Provide for client privacy Adjust the bed to a comfortable working height and lower the side rails nearest you leaving the opposite side rail up
OCCUPIED BED
Remove
Remove any equipment attached to the bed linen Remove any equipment attached to the bed linen Spread the bath blanket over the patient and pull gently the top linens by grasping the top edge of the sheet drawing it down to the foot of the bed, leaving the blanket in place. Put the soiled linen in the hamper
OCCUPIED BED
Change
sheet
Assist the client in a side lying position facing away from you. Keep the side rail on the far side up or have another nurse support the client on the other side. Loosen the bottom linens from the head, side to the foot of the bed. Roll/fanfold soiled linens as close as possible to the client. Keep the client covered throughout the procedure
OCCUPIED BED
Place the clean bottom sheet with its centerfold in the middle of the bed and the edge of the sheet even with the foot of the mattress. Vertically fanfold the half to be used on the far side of the bed as close to the client as possible. Spread the bottom sheet, tuck and miter the sheet at the head of the bed. Tuck the remaining sheet from head to foot of the bedPlace the clean bottom sheet with its centerfold in the middle of the bed and the edge of the sheet even with the foot of the mattress. Vertically fanfold the half to be used on the far side of the bed as close to the client as possible. Spread the bottom sheet, tuck and miter the sheet at the head of the bed. Tuck the remaining sheet from head to foot of the bed
OCCUPIED BED
Place
the waterproof and cotton drawsheet in the same manner as the bottom sheet. Position the drawsheet at the middle from the clients back to the knee area. Unfold and tuck the drawsheet at the side of the bed. Assist the client to roll over toward you onto the clean side of the bed. Move the pillows to the clean side of the bed. Raise the side rail near you
OCCUPIED BED
Move
to the other side f the bed. Lower the side rail and remove the soiled linen and pace it in the hamper Pull the bottom sheet firmly, tuck and miter the corner at the head of the bed. Tuck the remaining side of the sheet from the head to the foot of the bed. Repeat this with the drawsheet
OCCUPIED BED
Reposition
the client to the center of the bed, reposition the pillow on the center of the bed and assist him/her to a comfortable position Apply or complete the top bedding
Spread the top sheet over the client and pull the soiled top sheet or bath blanket. Tuck the top linen at the bottom of the bed and miter the corners leaving the sides hanging freely
OCCUPIED BED
Change
the pillowcase and replace it under the clients head with the open ends facing away from the door Ensure patient safety and comfort Dispose/clean equipments/supplies Document all relevant information
THE END