HYGIENE HYGIENE

Six Functions of the SkinSix Functions of the Skin

Protection of other organs from injuryProtection of other organs from injury Body temperature regulationBody temperature regulation Sensation transmission through preceptorsSensation transmission through preceptors Excretion Excretion Maintenance of water and electrolyte Maintenance of water and electrolyte

balancebalance Vitamin D production and absorptionVitamin D production and absorption

Factors affecting the SkinFactors affecting the Skin

Unbroken and healthy skin and mucous Unbroken and healthy skin and mucous membranes defend against harmful agents.membranes defend against harmful agents.

Resistance to injury is affected by age, Resistance to injury is affected by age, amount of underlying tissues, and illness.amount of underlying tissues, and illness.

Adequately nourished and hydrated body Adequately nourished and hydrated body cells are resistant to injury.cells are resistant to injury.

Adequate circulation is necessary to Adequate circulation is necessary to maintain cell life.maintain cell life.

Developmental ConsiderationsDevelopmental Considerations Infant’s skin and mucous membranes are Infant’s skin and mucous membranes are

easily injured and subject to infection.easily injured and subject to infection. Child’s skin becomes increasingly resistant Child’s skin becomes increasingly resistant

to injury and infection.to injury and infection.– Requires special care because of toilet and play Requires special care because of toilet and play

habitshabits

Adolescent has enlarged sebaceous glands Adolescent has enlarged sebaceous glands and increased secretions.and increased secretions.

Adult’s tissue becomes thinner and wrinkles Adult’s tissue becomes thinner and wrinkles appear; liver spots occur.appear; liver spots occur.

Causes of Skin AlterationsCauses of Skin Alterations Very thin and very obese people are more Very thin and very obese people are more

susceptible to skin injury.susceptible to skin injury.– Fluid loss during illness causes dehydration.Fluid loss during illness causes dehydration.– Skin appears loose and flabby.Skin appears loose and flabby.

Excessive perspiration during illness Excessive perspiration during illness predisposes skin to breakdown.predisposes skin to breakdown.

Jaundice causes yellowish, itchy skin.Jaundice causes yellowish, itchy skin. Diseases of the skin cause lesions that Diseases of the skin cause lesions that

require care.require care.

Factors Influencing Personal Factors Influencing Personal HygieneHygiene

CultureCulture Socioeconomic classSocioeconomic class Spiritual practices (religion)Spiritual practices (religion) Developmental and knowledge levelDevelopmental and knowledge level Health status & energy levelHealth status & energy level Personal preferencesPersonal preferences

Interview Questions/Skin AlterationsInterview Questions/Skin Alterations

How long have you had this problem?How long have you had this problem? Does it bother you?Does it bother you? How does it bother you (itching)?How does it bother you (itching)? Have you found anything helpful in relieving Have you found anything helpful in relieving

these symptoms?these symptoms?

Copyright 2008 by Copyright 2008 by Pearson Education, Inc.Pearson Education, Inc.

Nursing Process: AssessmentNursing Process: Assessment

Nursing history to determine:Nursing history to determine:– Self care practicesSelf care practices– Self-care abilitiesSelf-care abilities– Past or current problemsPast or current problems– Identification of clients at risk for developing Identification of clients at risk for developing

impairment impairment

Physical assessmentPhysical assessment

Factors to Consider When Factors to Consider When Examining SkinExamining Skin

CleanlinessCleanliness ColorColor TemperatureTemperature TurgorTurgor MoistureMoisture SensationSensation Evidence of lesionsEvidence of lesions

Patient’s At Risk for Skin Patient’s At Risk for Skin AlterationAlteration

Lifestyle variablesLifestyle variables Changes in health stateChanges in health state IllnessIllness Diagnostic measuresDiagnostic measures Therapeutic measuresTherapeutic measures

Copyright 2008 by Copyright 2008 by Pearson Education, Inc.Pearson Education, Inc.

Abnormal Findings of the Skin Abnormal Findings of the Skin

AbrasionAbrasion Excessive drynessExcessive dryness Ammonia dermatitis (diaper rash)Ammonia dermatitis (diaper rash) AcneAcne ErythemaErythema HirsutismHirsutism

Focus of Self-Care Deficit DiagnosesFocus of Self-Care Deficit Diagnoses

Self-Care DeficitSelf-Care Deficit : Bathing/Hygiene : Bathing/Hygiene Self-Care DeficitSelf-Care Deficit : Dressing/Grooming : Dressing/Grooming Self-Care DeficitSelf-Care Deficit : Toileting : Toileting Self-Care DeficitSelf-Care Deficit : Feeding : Feeding

Types of Hygienic careTypes of Hygienic care

Early Morning CareEarly Morning Care Morning Care (AM Care)Morning Care (AM Care) Afternoon Care (PM Care)Afternoon Care (PM Care) Hours of Sleep Care (HS Care)Hours of Sleep Care (HS Care) As needed (p.r.n Care)As needed (p.r.n Care)

Early Morning CareEarly Morning Care Assist patient with toileting.Assist patient with toileting. Provide comfort measure to refresh patient Provide comfort measure to refresh patient

to prepare for day.to prepare for day. Wash face and hands.Wash face and hands. Provide mouth care.Provide mouth care.

Morning Care (AM Care)Morning Care (AM Care)

After breakfast, nurse completes morning After breakfast, nurse completes morning care:care:

ToiletingToileting Oral careOral care BathingBathing Back massageBack massage Special skin measuresSpecial skin measures Hair care, cosmeticsHair care, cosmetics

Morning Care (AM Care) (continued)Morning Care (AM Care) (continued)

DressingDressing Positioning for comfortPositioning for comfort Refreshing or changing bed linensRefreshing or changing bed linens Tidying up bedsideTidying up bedside

Afternoon Care (PM Care)Afternoon Care (PM Care)

Ensure patient’s comfort after lunch:Ensure patient’s comfort after lunch: Offer assistance with toileting, handwashing, Offer assistance with toileting, handwashing,

oral careoral care Straighten bed linens Straighten bed linens Help patients with mobility to reposition Help patients with mobility to reposition

themselvesthemselves

Hours of Sleep Care (hs Care)Hours of Sleep Care (hs Care)

Before patient retires:Before patient retires: Offer assistance with toileting, washing, and Offer assistance with toileting, washing, and

oral careoral care Offer a back massageOffer a back massage Change any soiled bed linens or clothingChange any soiled bed linens or clothing Position patient comfortablyPosition patient comfortably Ensure that call light and other objects Ensure that call light and other objects

patient requires are within reachpatient requires are within reach

As Needed Care (prn Care)As Needed Care (prn Care)

Offer individual hygiene measure as neededOffer individual hygiene measure as needed Change clothing and bed linens of Change clothing and bed linens of

diaphoretic patientsdiaphoretic patients Provide oral care every two hours if Provide oral care every two hours if

indicated indicated

Reasons for Providing Back Reasons for Providing Back MassageMassage

Acts as a general body conditionerActs as a general body conditioner Relieves muscle tension and promotes Relieves muscle tension and promotes

relaxationrelaxation Provides opportunity for nurse to assess the Provides opportunity for nurse to assess the

skin for signs of breakdownsskin for signs of breakdowns Promotes circulationPromotes circulation May decrease pain, distress, and anxiety May decrease pain, distress, and anxiety May improve sleep qualityMay improve sleep quality

Purposes of BathingPurposes of Bathing

Cleanses the skinCleanses the skin Acts as a skin conditionerActs as a skin conditioner Helps to relax a personHelps to relax a person Promotes circulation Promotes circulation Serves as musculoskeletal exercise Serves as musculoskeletal exercise Stimulates the rate and depth of respirationsStimulates the rate and depth of respirations

Purposes of Bathing (continued)Purposes of Bathing (continued)

Promotes comfort through muscle relaxation Promotes comfort through muscle relaxation and skin stimulationand skin stimulation

Provides person with sensory inputProvides person with sensory input Helps improve self-imageHelps improve self-image Strengthens nurse patient relationshipStrengthens nurse patient relationship

Providing a Bed BathProviding a Bed Bath Provide articles for bathing on over-bed Provide articles for bathing on over-bed

table or bedside stand.table or bedside stand. Provide privacy for patient.Provide privacy for patient. Remove top linens and replace with bath Remove top linens and replace with bath

blanket.blanket. Place cosmetics in convenient place.Place cosmetics in convenient place. Assist patients who cannot bathe Assist patients who cannot bathe

themselves completely.themselves completely.

Physical Assessment of Oral Physical Assessment of Oral CavityCavity

Observe for oral problems.Observe for oral problems.– Dental cariesDental caries– Periodontal diseasePeriodontal disease– Other oral problemsOther oral problems

Identify actual or potential oral problems that Identify actual or potential oral problems that nurses can treat.nurses can treat.

Identify appropriate nursing measures.Identify appropriate nursing measures. Carry out the plan of care.Carry out the plan of care.

Copyright 2008 by Copyright 2008 by Pearson Education, Inc.Pearson Education, Inc.

Abnormal Findings of the Mouth Abnormal Findings of the Mouth

GlossitisGlossitis GingivitisGingivitis Periodontal diseasePeriodontal disease Reddened or Reddened or

excoriated mucosaexcoriated mucosa

Excessive dryness of Excessive dryness of the buccal mucosathe buccal mucosa

CheilosisCheilosis Dental cariesDental caries StomatitisStomatitis Parotitis Parotitis

Administering Oral HygieneAdministering Oral Hygiene

Moistening the mouthMoistening the mouth Cleaning the mouthCleaning the mouth Caring for denturesCaring for dentures Toothbrushing and flossingToothbrushing and flossing Using mouthwashesUsing mouthwashes

Care of EyesCare of Eyes

Clean from inner to outer canthus with wet, Clean from inner to outer canthus with wet, warm cloth, cotton ball or compress.warm cloth, cotton ball or compress.

Use artificial tear solution or normal saline Use artificial tear solution or normal saline every 4 hours if blink reflex is absent.every 4 hours if blink reflex is absent.

Care for eyeglasses, contact lens, or Care for eyeglasses, contact lens, or artificial eye if indicated.artificial eye if indicated.

Copyright 2008 by Copyright 2008 by Pearson Education, Inc.Pearson Education, Inc.

Abnormal Findings of EyesAbnormal Findings of Eyes

Loss of hair, scaling, flaky eyebrowsLoss of hair, scaling, flaky eyebrows Redness, swelling, flaking, crusting, Redness, swelling, flaking, crusting,

discharge, asymmetrical closing, ptosis of discharge, asymmetrical closing, ptosis of eyelidseyelids

Jaundiced scleraJaundiced sclera Unequal pupilsUnequal pupils Pupils fail to dilate or constrictPupils fail to dilate or constrict Inability to seeInability to see

Ear and Nose CareEar and Nose Care Wash external ear with washcloth-covered Wash external ear with washcloth-covered

finger; do not use cotton-tipped swabs.finger; do not use cotton-tipped swabs. Perform hearing aid teaching and care if Perform hearing aid teaching and care if

indicated.indicated. Clean nose by having patient blow it if both Clean nose by having patient blow it if both

nares are patent.nares are patent. If indicated, use nasal suctioning with bulb If indicated, use nasal suctioning with bulb

syringe.syringe. Remove crusted secretions around nose Remove crusted secretions around nose

and apply petroleum jelly.and apply petroleum jelly.

Providing Hair CareProviding Hair Care Identify patient’s usual hair and scalp care Identify patient’s usual hair and scalp care

practices and styling preferences.practices and styling preferences. Note any history of hair or scalp problems, Note any history of hair or scalp problems,

such as dandruff, hair loss, or baldness.such as dandruff, hair loss, or baldness. Treat any infestations, such as pediculosis Treat any infestations, such as pediculosis

and ticks.and ticks. Groom and shampoo hair.Groom and shampoo hair. Care for beards and mustaches.Care for beards and mustaches. Assist with unwanted hair removal.Assist with unwanted hair removal.

Copyright 2008 by Copyright 2008 by Pearson Education, Inc.Pearson Education, Inc.

Abnormal Findings of the Hair Abnormal Findings of the Hair

DandruffDandruff Hair lossHair loss TicksTicks Pediculosis (Lice)Pediculosis (Lice)

HirsutismHirsutism

Nail and Foot CareNail and Foot Care

Assess nails for color and shape, intactness Assess nails for color and shape, intactness and cleanness, and tenderness.and cleanness, and tenderness.

Check for history of nail or foot problems.Check for history of nail or foot problems. Soak nails and feet and assist with cleaning Soak nails and feet and assist with cleaning

and trimming nails (if not contraindicated).and trimming nails (if not contraindicated). Massage the feet to promote relaxation and Massage the feet to promote relaxation and

comfort.comfort. Provide diabetic foot care if indicated.Provide diabetic foot care if indicated.

Copyright 2008 by Copyright 2008 by Pearson Education, Inc.Pearson Education, Inc.

Abnormal Findings of the NailsAbnormal Findings of the Nails

Spoon nailsSpoon nails Excessive thickness or clubbingExcessive thickness or clubbing Grooves or furrowsGrooves or furrows Discolored or detachedDiscolored or detached Bluish or purplish tint or pallorBluish or purplish tint or pallor Hangnails or paronychiaHangnails or paronychia Delayed capillary refilling timeDelayed capillary refilling time

Copyright 2008 by Copyright 2008 by Pearson Education, Inc.Pearson Education, Inc.

Abnormal Findings of the Feet Abnormal Findings of the Feet

Excessive drynessExcessive dryness Areas of inflammation or swellingAreas of inflammation or swelling FissuresFissures Scaling and cracking of skinScaling and cracking of skin Swelling and pitting edemaSwelling and pitting edema Weak or absent pulses Weak or absent pulses Cool skin temperature in one or both feet Cool skin temperature in one or both feet

Ensuring Bedside SafetyEnsuring Bedside Safety Patient call light is functioning and within Patient call light is functioning and within

reachreach Bed is positioned properly, at appropriate Bed is positioned properly, at appropriate

height, wheels lockedheight, wheels locked Side rails are safely used when indicatedSide rails are safely used when indicated Principle of medical asepsis are followedPrinciple of medical asepsis are followed Electrical equipment is safely groundedElectrical equipment is safely grounded Walk space is unclutteredWalk space is uncluttered

Patient Outcome AchievementPatient Outcome Achievement Level of patient participation in hygiene Level of patient participation in hygiene

programprogram Elimination of, reduction in, or compensation Elimination of, reduction in, or compensation

for factors interfering with independent for factors interfering with independent execution of hygiene measuresexecution of hygiene measures

Changes related to specific skin problemsChanges related to specific skin problems