Patient’s EnvironmentComplete bed bath •For patients who are totally dependent and require total assistance Tepid sponge bath •Administered to reduce an elevated temperature

Hygiene and Care of the

Patient’s Environment

Chapter 18

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

Slide 2 Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Hygiene 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.


• Factors Influencing Personal Hygiene

Social practices

Body image

Socioeconomic status

Knowledge

Personal preference

Physical condition

Cultural variables

Hygiene and Care of the Patient’s

Environment


Patient’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


Figure 18-1

A typical hospital room.

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



• 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



• 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.


Bathing

• 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


Figure 18-2

The sitz bath.



Bathing

• 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



Bathing

• 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


Skill 18-1: Steps 8h & 8i

Bed bath.



Skill 18-1: Steps 8r & 8u

Bed bath.



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

Towel bath.


Skill 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.)


Bathing

• 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


Skill 18-1: Steps 14e & 14f

Back rub.



Components 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.




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



Hygiene


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.


Pressure sore staging


Figure 18-5

Thirty-degree lateral position to avoid pressure points.



Figure 18-6

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



Hygiene



• 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.


http://drchetan.com/dentalpics/images/general_diseases/necrosis/necrosis-1.jpg



Hygiene



• 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.


http://www.safetycuff.com/images/skin_tears8.jpg

http://www.safetycuff.com/images/skin_tears8.jpg


Figure 18-3

Diagram of shearing force exerted against sacral area.




Hygiene


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


Figure 18-4, A

A, Stage I pressure ulcer.



Figure 18-4, B

B, Stage II pressure ulcer.



Figure 18-4, C

C, Stage III pressure ulcer .



Figure 18-4, D

D, Stage IV pressure ulcer .



Stable eschar of heelS

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Hygiene


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.



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.


Skill 18-2: Steps 9a & 9c

Administering oral hygiene.



St. Louis: Mosby.)



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


Skill 18-2: Step 10c

Administering oral hygiene.




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.


Skill 18-3: Steps 9a & 10e

Care of the hair, nails, and feet.


St. Louis: Mosby.)




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.



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.


http://www.google.com/imgres?imgurl=http://www.glaucoma-eye-info.com/images/ilustacion10-canthus.jpg&imgrefurl=http://www.glaucoma-eye-info.com/glaucoma-treatment.html&usg=__Va64J1RQVSpFwhzUQQ2jz5FhKCM=&h=230&w=300&sz=68&hl=en&start=35&zoom=1&itbs=1&tbnid=jlG8XMF-h3Z1BM:&tbnh=89&tbnw=116&prev=/images%3Fq%3Dcanthus%2Bof%2Beye%26start%3D18%26hl%3Den%26sa%3DN%26gbv%3D2%26ndsp%3D18%26tbs%3Disch:1



Hygiene


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.



Hygiene


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.


Figure 18-8

Hearing aid.


St. Louis: Mosby.)



Hygiene


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.



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


Skill 18-4: Step 9b

Female perineal care.


St. Louis: Mosby.)


Skill 18-4: Steps 9e & 9g

Female perineal care.



Skill 18-4: Step 10c/10d

Male perineal care.




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.


Skill 18-5: Step 8i

Bed making: occupied bed.


St. Louis: Mosby.)


Skill 18-5: Step 8j


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

Louis: Mosby.)


Skill 18-5: Step 8m



Louis: Mosby.)


Skill 18-5: Step 8o



Louis: Mosby.)


Skill 18-5: Step 8q



Louis: Mosby.)


Skill 18-5: Step 8r



St. Louis: Mosby.)



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.


Figure 18-9

The postoperative bed.


St. Louis: Mosby.)


Figure 18-10

Selected equipment and supplies for elimination.



Figure 18-11

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



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.



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.


Skill 18-6: Steps 11b & 11c

Positioning the bedpan.


St. Louis: Mosby.)



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.



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.


Nursing Process

• Nursing Diagnoses

Oral mucous membranes, impaired

Mobility, impaired physical

Skin integrity, impaired

Self-care deficit—bathing/hygiene, dressing/grooming

Documents

Patient’s EnvironmentComplete bed bath •For patients who are totally dependent and require total assistance Tepid sponge bath •Administered to reduce an elevated temperature