Hygiene and Care of the Patient’s Environment

Chapter 18Chapter 18

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

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Hygiene and Care of the Patient’s EnvironmentHygiene and Care of the Patient’s Environment

• Personal Hygiene The self-care measures persons use to maintain their

health

• Hygiene The science of health Includes care of the skin, hair, hands, feet, eyes, ears,

nose, mouth, back, and perineum

• Conscientious personal hygienic practices are essential for the nurse; nurses are role models.

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• Factors Influencing Personal Hygiene Social practices Body image Socioeconomic status Knowledge Personal preference Physical condition Cultural variables

Hygiene and Care of the Patient’s EnvironmentHygiene and Care of the Patient’s Environment

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Patient’s Room EnvironmentPatient’s Room Environment

• Maintaining Comfort Room temperature: 68° to 74° F Good ventilation Bedpans and urinals that are emptied and rinsed

promptly Monitored noise level Proper lighting

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Figure 18-1Figure 18-1

A typical hospital room.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Patient’s Room EnvironmentPatient’s Room Environment

• Room Equipment Bedside stand

• Used to store the patient’s personal articles and hygienic equipment

Overbed table• On wheels; is adjustable to various heights over the bed

or a chair Chairs

• Straight chairs and lounge chairs

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Patient’s Room EnvironmentPatient’s Room Environment

• Room Equipment (continued) Lights

• Lights provide comfort, safety, and ease.

• Call light signal indicates that a patient needs assistance.

Bed• Bed is designed for comfort, safety, and adaptability to

position changes.

• It has a number of safety features.

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BathingBathing

• Sitz Bath Cleanses and aids in reducing inflammation of the

perineal and anal areas of the patient who has undergone rectal or vaginal surgery or childbirth

Water temperature 98° to 102° F

• Cool Water Tub Bath May be given to relieve tension or lower body

temperature Water temperature tepid, not cold—98.6° F

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Figure 18-2Figure 18-2

The sitz bath.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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BathingBathing

• Warm Water Tub Bath Given to reduce muscle tension Water temperature 109.4° F Observe s/s of dizziness/fainting

• Hot Water Tub Bath Given to assist in relieving muscle soreness and

muscle spasms Water temperature 113° to 115° F

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BathingBathing

• Other Baths Complete bed bath

• For patients who are totally dependent and require total assistance

Tepid sponge bath• Administered to reduce an elevated temperature

Medicated bath• May include agents such as oatmeal, cornstarch,

Burow’s solution, and soda bicarbonate

• To reduce tension and relax the patient and to relieve pruritus caused by certain skin disorders

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Skill 18-1: Steps 8h & 8iSkill 18-1: Steps 8h & 8i

Bed bath.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Skill 18-1: Steps 8r & 8uSkill 18-1: Steps 8r & 8u

Bed bath.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Skill 18-1: Steps 10d(1) & 10d(4)Skill 18-1: Steps 10d(1) & 10d(4)

Towel bath.

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Skill 18-1: Step 10e2Skill 18-1: Step 10e2

Towel bath.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

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BathingBathing

• Back Care/Back Rub Usually administered after the patient’s bath Promotes relaxation, relieves muscular tension, and

stimulates circulation Nurse massages for 3 to 5 minutes Contraindicated if the patient has such conditions as

fractures of the ribs or vertebral column, burns, pulmonary embolism, or open wounds

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Skill 18-1: Steps 14e & 14fSkill 18-1: Steps 14e & 14f

Back rub.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Care of the Skin When a person’s physical condition changes, the skin

often reflects this through alterations in color, thickness, texture, turgor, temperature, and hydration.

As long as the skin remains intact and healthy, its physiological function remains optimal.

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Care of the Skin (continued) Collection of data

• Normal skin has the following characteristics: Intact without abrasions Warm and moist Localized changes in texture across surface Good turgor; generally smooth and soft Skin color variations from body part to body part

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Care of the Skin (continued) Impaired skin integrity

• A patient who stays in one position without relief of pressure can develop a pressure sore.

• Patients especially at risk are the chronically ill, debilitated, older, disabled, or incontinent patient and the patient with spinal cord injuries, limited mobility, or poor overall nutrition.

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Pressure sore stagingPressure sore staging

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Figure 18-5Figure 18-5

Thirty-degree lateral position to avoid pressure points.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Figure 18-6Figure 18-6

Using a rolled bath blanket as a pressure-reducing device.

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Care of the Skin (continued) Impaired skin integrity

• Pressure ulcers occur when there is sufficient pressure on the skin to cause the blood vessels in an area to collapse.

• The flow of blood and fluid to the cells is impaired, resulting in ischemia to the cells.

• When the external pressure against the skin is greater than the pressure in the capillary bed, blood flow decreases to the adjacent tissue.

• If the pressure continues for longer than 2 hours, cell necrosis may occur.

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Care of the Skin (continued) Impaired skin integrity

• Shearing force The tissue layers of skin slide onto each other, resulting

in kinking or stretching of subcutaneous blood vessels; this results in an interruption of blood flow to the skin.

• Friction Rubbing of skin over a surface produces friction, which

may remove layers of tissue.

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Figure 18-3Figure 18-3

Diagram of shearing force exerted against sacral area.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Care of the Skin (continued) Stages of pressure ulcers

• Stage I: nonblanchable erythema of the skin

• Stage II: partial-thickness skin loss; epidermis

• Stage III: full-thickness skin loss, damage or necrosis of subcutaneous tissue

• Stage IV: full-thickness skin loss with

extensive destruction, tissue necrosis,

or damage to muscle, bone, or

supporting structures

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Figure 18-4, AFigure 18-4, A

A, Stage I pressure ulcer.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Figure 18-4, BFigure 18-4, B

B, Stage II pressure ulcer.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Figure 18-4, CFigure 18-4, C

C, Stage III pressure ulcer .

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Figure 18-4, DFigure 18-4, D

D, Stage IV pressure ulcer .

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Stable eschar of heelSStable eschar of heelS

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Care of the Skin (continued) Nursing interventions

• Assess improvement.

• Assess size and depth of the ulcer, the amount and color of any exudate, the presence of pain or odor, and the color of the exposed tissue.

• Specific interventions are determined by the stage of the ulcer.

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Oral Hygiene Care of the oral cavity Helps maintain a healthy state of the mouth, teeth,

gums, and lips Brushing the teeth removes food particles, plaque,

and bacteria; massages the gums; and relieves discomfort resulting from unpleasant odors and tastes.

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Skill 18-2: Steps 9a & 9cSkill 18-2: Steps 9a & 9c

Administering oral hygiene.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Oral Hygiene (continued) Dentures

• A set of artificial teeth not permanently fixed.

• Should be stored in an enclosed, labeled cup for soaking or when they are not worn

• Should be cleaned as often as for natural teeth to prevent infection and irritation

• Oral care provided on a regular basis

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Skill 18-2: Step 10cSkill 18-2: Step 10c

Administering oral hygiene.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Hair Care Combing, brushing, and shampooing are basic

hygiene measures for all patients. Patient may shampoo in the shower or tub, use a

portable chair in front of a sink, or in bed.

• Shaving the Patient Patient may prefer to shave at the time of bathing. Patients who have a bleeding disorder or are taking

anticoagulants should use electric razors. Do not allow a disoriented or depressed patient to use

a razor with a blade.

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Skill 18-3: Steps 9a & 10eSkill 18-3: Steps 9a & 10e

Care of the hair, nails, and feet.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Hand, Foot, and Nail Care Hands and feet often require special attention to

prevent infection, odors, and injury. Assessment

• Examine all skin surfaces.

• Carefully assess between the toes.

• Observe for adequate circulation.

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Eye, Ear, and Nose Care (continued) Care of the eyes

• Cleansing of the circumorbital area of the eyes is usually performed during the bath.

• Case involves washing with a clean washcloth moistened with clear water.

• The use of soap is omitted because it may cause burning and irritation.

• The eye is cleansed from the inner to the outer canthus.

• Patient may need assistance with care of eyeglasses or contact lenses.

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Eye, Ear, and Nose Care (continued) Care of the ears

• The ears are cleansed by the nurse during the bed bath.

• A clean corner of a moistened washcloth rotated gently into the ear canal works best for cleaning.

• A cotton-tipped applicator is useful for cleansing the pinna.

• The nurse should teach patients never to use bobby pins, toothpicks, or cotton-tipped applicators to clean the internal auditory canal.

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Eye, Ear, and Nose Care (continued) Care of the ears (continued)

• Hearing aids This involves routine cleaning, battery care, and proper

insertion technique. When not in use, the hearing aid should be stored where

it will not become damaged.

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Figure 18-8Figure 18-8

Hearing aid.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Eye, Ear, and Nose Care (continued) Care of the nose

• The patient can usually remove secretions from the nose by gently blowing into a soft tissue.

• Teach the patient that harsh blowing causes pressure capable of injuring the tympanic membrane, nasal mucosa, and even sensitive eye structures.

• If the patient is not able to clean the nose, the nurse will assist, using a saline-moistened washcloth or cotton-tipped applicator; for excessive secretions, suctioning may be required.

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Perineal Care Care of the genitalia Part of the complete bed bath Assess for signs of vaginal or urethral exudate, skin

impairment, unpleasant odors, complaints of burning during urination, or localized tenderness or pain of the perineum.

Catheter care is to be performed twice daily on all patients with indwelling catheters.

• Includes cleansing of the meatal-catheter junction with a mild soap and water and sometimes application of a water-soluble microbial ointment

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Skill 18-4: Step 9bSkill 18-4: Step 9b

Female perineal care.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

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Skill 18-4: Steps 9e & 9gSkill 18-4: Steps 9e & 9g

Female perineal care.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Skill 18-4: Step 10c/10dSkill 18-4: Step 10c/10d

Male perineal care.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Bed Making The patient’s bed is usually made in the morning after

the bath. When possible, the bed is made while it is not

occupied; when the patient is unable to be out of bed, the nurse will make an occupied bed.

The patient’s safety is always foremost in the nurse’s mind; comfort and privacy are also important.

• Use side rails, keep the call light within easy reach, and maintain the bed in the proper position.

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Skill 18-5: Step 8iSkill 18-5: Step 8i

Bed making: occupied bed.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

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Skill 18-5: Step 8jSkill 18-5: Step 8j

Bed making: occupied bed.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

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Skill 18-5: Step 8mSkill 18-5: Step 8m

Bed making: occupied bed.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

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Skill 18-5: Step 8oSkill 18-5: Step 8o

Bed making: occupied bed.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

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Skill 18-5: Step 8qSkill 18-5: Step 8q

Bed making: occupied bed.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

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Skill 18-5: Step 8rSkill 18-5: Step 8r

Bed making: occupied bed.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Bed Making (continued) It is the nurse’s responsibility to keep the bed as clean

and comfortable as possible. This may require frequent inspections to make sure

the bedding is clean, dry, and wrinkle free. Check the linens for food particles after meals and for

urine incontinence or involuntary stool. Use proper body mechanics; raise bed to a working

level.

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Figure 18-9Figure 18-9

The postoperative bed.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

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Figure 18-10Figure 18-10

Selected equipment and supplies for elimination.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

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Figure 18-11Figure 18-11

The bedside commode has a toilet seat with a container underneath.

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Assisting the Patient with Elimination Bedpan

• A device for receiving feces or urine from either male or female patients confined to the bed

Urinal• A device for collecting urine from male patients; urinals

for females also available Bedpans or urinals are used when a patient is unable

to get up to go to the bathroom for the purpose of urination or defecation.

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Assisting the Patient with Elimination (continued) The nurse should offer the bedpan or urinal

frequently, because patients may accidentally soil bedclothes if their elimination needs are not met.

Report any abnormalities and record in the nurse’s notes.

Flow sheets are usually provided for documentation of normal voidings and stools.

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Skill 18-6: Steps 11b & 11cSkill 18-6: Steps 11b & 11c

Positioning the bedpan.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Care of the Incontinent Patient Incontinence is a very common problem, especially

among older adults. Incontinence occurs because pressure in the bladder

is too great, sphincters are weak, or the innervation has been compromised due to illness or injury.

Incontinence may involve a small leakage of urine when the person laughs, coughs, or lifts something heavy.

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Components of the Patient’s HygieneComponents of the Patient’s Hygiene

• Care of the Incontinent Patient (continued) Care requires the use of disposable adult

undergarments or underpads. Cleansing the skin thoroughly after each episode of

incontinence with warm soapy water and drying it thoroughly help to prevent skin impairment.

When urinary incontinence results from decreased perception of bladder fullness or impaired voluntary motor control, bladder training can be helpful.

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Nursing ProcessNursing Process

• Nursing Diagnoses Oral mucous membranes, impaired Mobility, impaired physical Skin integrity, impaired Self-care deficit—bathing/hygiene, dressing/grooming