hygiene and self-care craven ch. 23 2/5/2016nrs 320 collings1

HYGIENEHYGIENEand Self-Careand Self-Care

Craven Ch. 23 Craven Ch. 23

05/03/23 NRS 320 Collings 1

ImportanceImportance Self – CareSelf – Care: ability to independently perform : ability to independently perform

functions of:functions of: BathingBathing DressingDressing FeedingFeeding ToiletingToileting

Independence in these basic areas enhances Independence in these basic areas enhances health and emotional well-being, dignityhealth and emotional well-being, dignity


Bathing & HygieneBathing & Hygiene How did it feel to be the ‘patient’?How did it feel to be the ‘patient’? To be the provider?To be the provider?

It is difficult for most people to adjust to the It is difficult for most people to adjust to the level of dependence to have another person level of dependence to have another person perform routine hygiene careperform routine hygiene care

It is also difficult to forgo basic hygiene!It is also difficult to forgo basic hygiene!


BathingBathing

Intact skin is first line of defense against Intact skin is first line of defense against infectioninfection

Regular bathing removes perspiration, Regular bathing removes perspiration, bacteria, oil from the skinbacteria, oil from the skin Increases circulationIncreases circulation Maintains muscle & joint mobilityMaintains muscle & joint mobility Promotes relaxationPromotes relaxation Provides a sense of well-being & comfortProvides a sense of well-being & comfort Time for assessment & interactionTime for assessment & interaction

05/03/2305/03/23 NRS 320 CollingsNRS 320 Collings 44

Basic PrinciplesBasic Principles Wash from Wash from clean to dirtyclean to dirty Maintain Maintain privacyprivacy, dignity, dignity Incorporate Incorporate patientpatient preferencespreferences & values & values Distal to proximal Distal to proximal motion increases venous motion increases venous

returnreturn EBPEBP: :

Basin bath Basin bath is associated with increase in infection is associated with increase in infection ratesrates

Peri-carePeri-care is often omitted; associated with UTI is often omitted; associated with UTI Turn Turn unconsciousunconscious pt to side for oral care pt to side for oral care


Oral CareOral Care

Helps maintain strong healthy teeth & Helps maintain strong healthy teeth & gumsgums

Prevent tooth lossPrevent tooth loss Increase saliva, taste, comfortIncrease saliva, taste, comfort Prevent Prevent pneumoniapneumonia


Types of bathsTypes of baths

Tub, shower, sit-down showerTub, shower, sit-down shower Bed bath [partial/complete]Bed bath [partial/complete] Bag bath or towel bathBag bath or towel bath Partial bath [sink bath]Partial bath [sink bath]

Consider energy, ability of ptConsider energy, ability of pt Choose bath type that enhances Choose bath type that enhances

independence while providing benefitsindependence while providing benefits Provide supplies, assist as neededProvide supplies, assist as needed


Foot CareFoot Care Disease state, ROM, perfusion affect needs Disease state, ROM, perfusion affect needs

and abilities R/T foot careand abilities R/T foot care Good foot care and education essentialGood foot care and education essential Diabetes, PVDDiabetes, PVD Do not soak feet [dryness - cracking – skin Do not soak feet [dryness - cracking – skin

breakdown and infection riskbreakdown and infection risk AssessAssess for temperature, circulation, sensation, for temperature, circulation, sensation,

woundswounds EducationEducation – daily VSE, good shoes, report – daily VSE, good shoes, report

changeschanges


Other hygiene needsOther hygiene needs

ShavingShaving in direction of hair growthin direction of hair growth Electric shaver if on anticoagulant TXElectric shaver if on anticoagulant TX

Glasses & contactsGlasses & contacts Clean dailyClean daily

Hearing AidsHearing Aids Check battery, clean per policy, replaceCheck battery, clean per policy, replace


FeedingFeeding

DysphagiaDysphagia: difficulty swallowing: difficulty swallowing Assess patients for dysphagia before feedingAssess patients for dysphagia before feeding SupervisionSupervision Assistive devicesAssistive devices ConsistencyConsistency

• Thickened liquids easier to swallowThickened liquids easier to swallow Separate flavors, do not mixSeparate flavors, do not mix


ToiletingToileting

AssessAssess level & type of assistance needed level & type of assistance needed Assist to BRAssist to BR Raised seat/grab bars/commode chairRaised seat/grab bars/commode chair BSCBSC Urinal/bedpanUrinal/bedpan

Provide Provide privacyprivacy while maintaining safety while maintaining safety Provide Provide hand hygiene hand hygiene for patientfor patient AssessAssess need for assistance with peri-care need for assistance with peri-care


DressingDressing AssessAssess needs, abilities, energy level needs, abilities, energy level AnalgesiaAnalgesia if indicated if indicated Allow Allow timetime Provide Provide choiceschoices when possible when possible RoutineRoutine for cognitive deficits for cognitive deficits AidsAids [shoehorn, zipper pull, Velcro] help [shoehorn, zipper pull, Velcro] help

maintain independencemaintain independence PrivacyPrivacy


Other considerationsOther considerations

Personal itemsPersonal items:: Overbed table s/b clean, neatOverbed table s/b clean, neat Personal items, call light within easy reachPersonal items, call light within easy reach Trash nearby and/or bag taped to bedrailTrash nearby and/or bag taped to bedrail

BedBed placed in position of comfort, placed in position of comfort, appropriate for activity & pt needsappropriate for activity & pt needs

LinensLinens s/b changed in conjunction with s/b changed in conjunction with bathingbathing Medical asepsisMedical asepsis


CRITICAL EVALUATIONCRITICAL EVALUATION WHAT IS THE ABILITY OF THIS WHAT IS THE ABILITY OF THIS

PERSON TO CARE FOR THEMSELVES?PERSON TO CARE FOR THEMSELVES? PHYSICAL DisabilityPHYSICAL Disability MENTAL DisabilityMENTAL Disability Lack of KnowledgeLack of Knowledge Lack of resourcesLack of resources → → Self-care deficitsSelf-care deficits

05/03/23 NRS 320 Collings 14

CRITICAL EVALUATIONCRITICAL EVALUATION ARE THERE ANY ARE THERE ANY CULTURALCULTURAL ISSUES ISSUES

THAT NEED TO BE ADDRESSED PRIOR THAT NEED TO BE ADDRESSED PRIOR TO BATHING? TO BATHING? Privacy, Gender, OtherPrivacy, Gender, Other

WHAT DO YOU DO WITH THIS WHAT DO YOU DO WITH THIS INFORMATION ABOUT THE PATIENT?INFORMATION ABOUT THE PATIENT? CARE PLANCARE PLAN

05/03/23 NRS 320 Collings 15

NURSING NURSING DIAGNOSISDIAGNOSIS SELF-CARE DEFICIT: (BATHING) R/T SELF-CARE DEFICIT: (BATHING) R/T

confusion, fatigue: AEB unwashed hair, confusion, fatigue: AEB unwashed hair, body odor, incontinent episodebody odor, incontinent episode

SELF-CARE DEFICIT: feeding R/T SELF-CARE DEFICIT: feeding R/T unilateral weakness, difficulty (2* to unilateral weakness, difficulty (2* to RECENT CVA) AEB Right sided weakness, RECENT CVA) AEB Right sided weakness, inability to feed self, weight loss of 1 lb. in 5 inability to feed self, weight loss of 1 lb. in 5 daysdays

05/03/23 NRS 320 Collings 16

Self-Care Deficit Self-Care Deficit PlanningPlanning

Goal/Outcome:Goal/Outcome: Overall goals are increased Overall goals are increased independenceindependence

and and safetysafety1.1. Pt will participate in hygiene routine this Pt will participate in hygiene routine this

morningmorning2.2. Pt will demonstrate ability to feed himself Pt will demonstrate ability to feed himself

using assistive devices [large-handled using assistive devices [large-handled utensils] within 24 hoursutensils] within 24 hours


ImplementationImplementation

AssessAssess functional abilities/ areas of deficit functional abilities/ areas of deficit Assess Assess resourcesresources available available

Is patient aware of/using available aids?Is patient aware of/using available aids? EducationEducation, referrals, encouragement, referrals, encouragement

Provide appropriate education, assistive Provide appropriate education, assistive devicesdevices, help, , help, referral referral [OT/PT, home health, Meals on Wheels…][OT/PT, home health, Meals on Wheels…] Provide Provide encouragementencouragement EvaluateEvaluate results of interventions results of interventions


EvaluationEvaluation

Was the goal metWas the goal met??1.1. Was Pt able to assist in a.m. hygiene?Was Pt able to assist in a.m. hygiene?

• If If yesyes, move to higher-level goal [more , move to higher-level goal [more independence]independence]

• If not, reassess patient needs, methods, goal…If not, reassess patient needs, methods, goal… Revise plan; provide shower chair at sink this p.mRevise plan; provide shower chair at sink this p.m..

2.2. Goal met; patient demonstrated ability to feed self Goal met; patient demonstrated ability to feed self >75% of all meals today using assistive utensils. >75% of all meals today using assistive utensils. Continue with plan; OT to assess food preparation Continue with plan; OT to assess food preparation needs/abilities prior to discharge in 48 hoursneeds/abilities prior to discharge in 48 hours


Questions?Questions?

Discussion?Discussion?


hygiene and self-care craven ch. 23 2/5/2016nrs 320 collings1

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