ORAL HYGIENE AND SHAVING

By: Jay Vincent B. Medrano, RN

Mechanism of Tooth decay• Bacteria in the presence of sugary substance • produce acid that causes demineralization of

teeth.

Enamel is affected first, as decay continues it reaches to dentin and then to pulp. Saved by filling. Needs RCT

GINGIVITIS• Inflammation of the

gingival tissue.• Bleeding gums.• Factors may also be

hormonal, drug induced.

PERIODONTITISInfected gum recedes.Plaque continue to increase.Pockets become infected.Bone loss starts.Periodontal disease causes 70% of tooth loss.It affects 3 out of 4 people .

ORAL CARE (CONSCIOUS PATIENT)Definition:

A procedure of promoting oral health for patient who is incapable of performing it independently.

Purposes:1. Maintains intactness and health of the lips,

tongue and mucous membranes of the mouth.

2. Prevents oral infection.3. Enhances the patient’s feelings of well-

being.

ASSESSMENT1. The extent of the patient’s self- care abilities2. The patient’s usual mouth care practices3. Inspect lips, gums, oral, mucosa, tongue for deviations

from normal and for bridgework or dentures

Prepare materials/ supplies:1. Small towel2. A pair of clean gloves3. Kidney basin4. Toothbrush5. Cup of tepid water6. Toothpaste7. Mouthwash

IMPLEMENTATION:1. Introduce self.2. Verify patient’s identity (discreetly look into the arm of

patient checking his ID band).3. Explain the procedure to the patient and significant

others.4. Invite a family member or significant other to

participate, if desired.5. Perform hand hygiene.

6. Provide for patient’s privacy, close the curtain 7. Lower side rail near you, leaving the other side raised.8. Assist the patient to a sitting position in bed, if health

permits. If not, assist the patient to a side- lying position with head turned.

9. Put on clean gloves.10.Moisten the bristle of the toothbrush with tepid

water, and apply the toothpaste to the toothbrush.11.Use a soft toothbrush and the patient’s choice of

toothpaste.12.For the patient who must remain in bed, place or hold

the kidney basin under the chin, fitting the small curve around the chin or neck.

13.Hand the toothbrush to the patient. If the patient can’t brush his own teeth, hold the brush against the teeth with the bristle at 45 degree angle. The tips of the outer bristles should rest against and penetrate under the gingival sulcus.

14.Move the bristles up and down, using a vibrating or jiggling motion from the sulcus to the crowns of the teeth.

15.Repeat until all outer and inner surfaces of the teeth and sulci of the gums are cleaned.

16.Clean the biting surfaces by moving the brush back and forth over them in short strokes.

17.Brush the tongue gently with the toothbrush.

18.Hand the patient the water cup or mouthwash to rinse mouth vigorously. Then ask the patient to spit the water and excess toothpaste into the basin.

19.Repeat the preceding steps until the mouth is free of toothpaste and food particles.

20.Remove the kidney basin, and help the patient wipe his mouth.

Cleaning artificial dentures1. A pair of clean gloves2. Tissue or piece of gauze3. Denture container4. Toothbrush5. Denture cleaner or toothpaste6. Tepid water7. Mouthwash/ Cleaning agent8. Kidney basin9. Small towel

ARTIFICIAL DENTURES1. Put on gloves. If the patient can’t remove the

dentures, take a tissue or gauze, grasp the upper plate at the front teeth with your thumb and index finger, and move the denture up and down slightly.a) Lower the upper plate, move it out of the mouth,

and place it in the denture containerb) Lift the lower plate, turning it so that the left side,

for example, is slightly lower than the right. Place the lower plate in the denture container

c) Remove a partial denture by exerting equal pressure on the border of each side of the denture, not on the clasps

2. Clean the denture:a) Take the denture container to a sink then place it in

a washclothb) Using a toothbrush or special stiff- bristled brush,

scrub the dentures with cleaning agent and tepid water

c) Rinse the dentures with tepid running water

3. Inspect the dentures and the mouth:a) Observe the dentures for any rough, sharp, or worn

areas. Inspect the mouth for any redness, irritated areas, or indications of infection

4. Return the dentures to the mouth. Offer some mouthwash and a kidney basin to rinse the mouth. If the patient can’t insert the dentures independently, insert the plates one at a time.

5. Hold each plate at a slight angle while inserting it.6. Wipe the patient’s hands and mouth with a towel.7. If the patient does not want or can’t wear the

dentures, store them in a denture container with water. Label the cup with the patient’s name and bed number.

8. Remove clean gloves9. Reposition the patient; raise the side rails near you

and place call button within reach10.Discard oral secretions in the kidney basin to the sink

then flush it with water then discard gloves to yellow trash bin

11.Perform hand hygiene

QUESTIONS???

SHAVING A MALE PATIENT’S MOUSTACHE/BEARD Definition:

It is a process of removing the moustache or beard of the male patient.

Purpose:1. Promotes patient comfort by removing

moustache or beard that can irritate the skin and produce an unkempt appearance.

2. Promotes the patient’s well-being and dignity.

•ASSESSMENT1.Skin integrity and hair growth2.Patient’s self-care ability

Prepare the materials/supplies:1. Pair of clean gloves2. Electric shaver or safety razor3. Shaving cream4. Basin of warm water5. Face towel6. Mirror7. Aftershave lotion

IMPLEMENTATION:1. Introduce yourself.2. Verify identity of the patient by discreetly looking into

the arm of the patient checking the ID band.3. Explain the procedure to the patient and significant

others. Make sure that the patient agrees to the procedure.

4. Provide privacy by closing the curtains.5. Perform hand hygiene.

6. Raise the head of the bed. Place the materials/supplies on the over bed table.

7. Lower side rail near you while leaving the opposite side raised.

8. Wear gloves.9. Using a small towel, wet the patient’s entire beard

with warm water. Let the warm cloth soak the beard for at least a minute.

10.Apply shaving cream to the beard. If you’re using soap, rub to form lather.

11.Gently stretch the patient’s skin taut with one hand and shave with the other, holding the razor firmly.

12.Ask the patient to puff his cheeks or turn his head, as necessary.

13.Begin at the sideburns and work toward the chin using short, firm, downward strokes in the direction of hair growth.

14.Rinse the razor often. 15.Apply more warm water or shaving cream to the face,

as needed16.Shave across the chin and down to the neck and

throat. Use short, gentle strokes for the neck and the area around the nose and mouth

17.Change the water, and rinse any remaining lather from the patient’s face.

18.Dry his face with a small towel and, if the patient desires, apply after-shave lotion or talcum powder.

19.Remove gloves20.Raise side rails near you.21.Provide after care of the materials and discard used

supplies.22.Perform hand hygiene.

 SKIN PREPARATIONDefinition

Skin preparation is the removal of as many bacteria as possible from the patient’s skin through shaving, mechanical washing and chemical disinfection

Purpose or advantages:

1. Reduce the number of microorganisms in the field of operation.

2. Prevent infection.3. Makes suturing

easier

Disadvantages:1. Cuts2. Razor bumps3. Discomfort during

hair re-growth4. embarrassment

Special Considerations:1. To determine the area to be shaved, know

the operation to be done, the organ involved and its location and the proposed incision.

2. Practice modesty and provide privacy.3. Ask the patient’s permission in cutting the

eyelashes and hair.

4. Examine the area to be shaved for any signs of irritation or any abnormal conditions. Report this to your head nurse.

5. Do not cut the patient’s skin.6. In abdominal operations, pay particular

attention to the umbilicus

7. Shave the operative site the day or the night before operation.

8. In shaving, follow the direction of the growth of hair while the free hand exerts an opposite force by pulling the skin to the opposite direction. This is done:a) to make the shaving less painfulb) to shave off the hair thoroughly from the

skin

Equipment:1. Shaving tray with the following:2. Razor with blade3. Container with dry cherries or sponges4. Container with cherries in liquid soap or

Cotton balls soaked in Povidone5. Pick-up forceps6. (2) Kidney basins

Procedure:1. Introduce yourself2. Verify patient’s identity(discreetly look

into the arm of the patient checking his ID band)

3. Explain the procedure to the patient4. Observe proper hygiene.5. Provide privacy

6. Place a rubber protector under the patient7. Wear a pair of clean gloves8. Expose the area to be shaved 6-

8inches from the probable line of incision9. Using the pick-up forceps, get sponges

saturated with liquid soap and make a thick lather on the skin staring from the probable line of incision going to the periphery

10.Shave the area.

11.Clean the area with wet sponges12.Saturate again the skin with liquid soap

and continue on shaving until the area is completely devoid of hair

13.Dry with sponges14.Discard all used supplies in the kidney

basin then remove gloves.

14. Return the patient to a comfortable position and fix the linen

15. Raise side rail near you.16.Discard waste from the kidney basin to the

yellow trash bin 17. Perform Hand hygiene.

Areas to be Prepared:

1.Eye Operation– cut the eyelashes of the affected eye.

This is done in operating room. Uses mall straight eye scissors (Steven’s). Clean with alcohol and apply Vaseline.

2.Nasal and Sinus Operation–no shaving is done unless the patient

has moustache, with hairy face or hairy nose

3.Ear Operation– shave 2 ½ inches around the ear

4. Neck Operation– anteriorly shave from the chin down to

the nipple line. Laterally shave from the patient’s hairline to the sides of the neck including the shoulders and axilla. Posteriorly, shave the hairline down to the level of the clavicle.

5.Chest Operation– shave from the base of the neck to the

waistline including the axilla an dinner aspect of the arm.

6. Abdominal and Pelvic Operations– shave from the nipple line down to

the symphysis pubis, perineum and the thighs 2 inches from the groin.

7. Kidney Operation–anteriorly shave from the nipple line

down to the perineum from side to side posteriorly on the affected side, shave from the subscapular area down to the buttocks and 2 inches beyond the spinal column.

8.Vaginal, Scrotal, and Rectal Operations– shave the waistline to the perineum.

Include the anterior and inner aspects of the thighs 6 inches from the groin. Posteriorly, shave the entirebuttocks. Pay particular attention to the hair between the folds of the buttocks and anus.

9.Lower Extremity – if the operation is in the distal portion,

clean from the 2 inches above the knee, all around the extremity to the toes. If the operation is at the knee or little bit above or below it, clean the entire extremity from the groin to the toes. Pay attention to digital spaces.

10.Upper Extremity – if operation is at the distal portion,

clean from 2 inches above the elbow to the fingers all around. If the operation is at the elbow or a little above or below it, shave from the axilla to the fingers and all around the extremity.

THANK YOU!