Fundamentals of Nursing Care: Fundamentals of Nursing Care: Concepts, Connections, & SkillsConcepts, Connections, & Skills
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Chapter 15
Personal Care
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Activities of Daily Living (ADLs) Related to Personal Care
Bathing Washing and styling hair Brushing and flossing teeth Dressing Shaving
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Routine Care Who’s job is it? Delegate? Responsibility
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Scheduled Care A.M. Care
Before or after breakfast ADL’s Linen’s
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Scheduled Care P.M. Care
Address any needs—hourly rounding Straighten sheets Back rub?
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Scheduled Care Bedtime (hs) Care
Prepare for sleep Brush teeth, remove dentures Remove glasses, remove hearing aid Back rub? Extra blanket Dim lights
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Benefits of Bathing Patients Patient
Cleansing the skin Increasing circulation and sensation Providing comfort and relaxation Improving self-esteem
Nurse Opportunity for skin assessment Nurse–patient relationship
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Benefits of Bathing Skin assessment
Look for redness, cracking, and maceration Crevices, under breasts and scrotum, axilla and
groin, between toes, and between buttocks Excoriation or scrapes on skin Temperature Breakdown
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Benefits of Bathing Gain your patient’s trust and respect
Respect Preserve modesty Demonstrate care and compassion More time spent with patient=ability of patient to
confide in you
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Factors to Consider When Planning Patient Care and Bathing
Patient preferences Patient’s culture Timing of the care Patient’s abilities
Understands directions Moves and turns enough to assist Tolerates physical demands of a bath
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Preparing Ability to turn Follow directions Need for assistance Is patient in pain? Experiencing fatigue? SOB? Determine appropriate bath
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Supplies Basin or bag Several towels, washcloths, bath blanket Linens Laundry bag or somewhere to place dirty linen
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Bath Test water temperature Provide privacy Position bed to appropriate height Lower siderail nearest you Place bath blanket Remove gown
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Approach is Important Positive attitude Do not rush patient Do not make their care seem like a chore to
you How would you like to be treated or your
family member
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Three Categories of Personal Care
Self-care: patients who are able to perform ADLs without assistance
Assisted care: patients who need some assistance with ADLs
Total care: patients who are able to do very little or nothing for themselves
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Types of Baths Complete bed bath Assisted or help bath Partial bath Tub bath* Shower* Therapeutic bath Towel or blanket bath* Bag bath*
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Complete Bed Bath View video Skill 15-1 pg. 294
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Assisted Bath Bed or chair Patient participates as much as possible Nurse completes what patient can not reach
or if becomes fatigued
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Special Considerations Older adults
Sebaceous and sweat glands produce less oil and sweat
Optional daily full bath—cleanse areas of necessity
Prevent dryness Keep patient warm
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Partial Bath Only selected areas are washed Patient condition Post-op Dryness Face, hands, axilla, buttocks, and perineal
area, or parts of the patient that would cause odor if not washed
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Tub Bath Sits in tub Whirlpool Disadvantages—difficult to get in and out of
tub, risk of falls
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Shower Shower chair Monitor temperature of water Wash hair
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Key Points Tub baths, showers, or therapeutic baths
Monitor water temperature Warm water dilates blood vessels (vasodilatation) Lowers blood pressure Possible dizziness or fainting Stay with patient or in close proximity Inform patient of emergency call system
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Bag Bath
12-15 washcloths saturated with no-rinse skin cleanser
Heat bag in microwave Each washcloth washed one part of body—
then discard
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Guidelines Use of bath blanket Fold washcloth into a mitt Move cleanest to dirtiest areas—prevent
transferring bacteria Extremities—distal to proximal Start with extremity farthest away from you—
prevent contamination
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Guidelines Change water
Dirty Soapy Cool After bathing buttocks and rectal area
Perform perineal care during bath and anytime patient is incontinent
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Nurse Responsibilities When Bathing Patients
Assess the skin for rashes, bruises, and lesions Complete the bathing process in timely
manner Be alert to signs of patient fatigue Intervene in ways to conserve patient energy
during the bath
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Oral Care Freshens mouth Decrease bacterial count Assess mouth for problems
Teeth—decaying, broken, or missing Reddened or bleeding gums Ulcerations Coating on the tongue
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Examples of Patients Needing Special Mouth Care
Patients who are NPO Patients receiving oxygen by cannula or mask Patients having a nasogastric or feeding tube
in place Patients who are unconscious
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Unconscious Patient Oral care needs to be provided Highest priority—Prevent aspiration of fluids Proper positioning Availability of suction Assess for lesions and sordes (dried mouth
secretions) Skill 15-4, pg. 298
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Conscious Patient Independent—help with necessary supplies Assistance needed—use small amount of
toothpaste, circular motion on inner and outer surface of teeth, and back and forth motion on chewing surfaces
Possible swallowing difficulties*--stay with patient and position patient properly
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Denture Care Be careful! Expensive Interfere with nutrition Pad cleaning surface Use cool rather than hot water Follow policy or patient’s preference
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Dressing Underwear? Intravenous line? Size of patient Don’t forget their HAIR!
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Let them select outfit Any limitations? Style hair Apply makeup if desired
Dressing
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Hair Care Keep patient well groomed Improves self-esteem Comb or brush—eliminate bed head—style age
appropriate Shampoo if needed or desired Shower or no rinse shampoo Shampoo board
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Shaving Shave in direction of hair growth Electric razor—circular motion—clean razor
when finished to prevent clogging Safety: DO NOT USE a razor blade for any
patient on anticoagulation therapy (blood thinning medication) A cut can cause excessive, difficult to control bleeding
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Contraindications Thrombolytic agents High doses of aspirin Blood disorders Liver disease Rashes, lesions, inflamed lesions Suicidal patients
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Nail Care Follow facility policy Do not cut nails on diabetics or patients with
circulatory problems—Podiatrist Clip nails straight then file—stay away from
skin
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Observations Made During Nail Care
Discoloration Ridges Redness Infections Thick yellow toenails (fungal infection)
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Care of Piercings New piercings
Keep clean—soap, water, and alcohol S/S of infection—redness, swelling, pain, or
drainage
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Situations Requiring Removal of Jewelry From Piercings
Surgery Intubation Diagnostic testing Catheterization Table 15-1, pg. 289
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Eye Care Glassess
Clean with warm water and soft cloth Inform patient of placement of glasses Safe but accessible site
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Removing Contact Lenses Wash hands; put on gloves Pull down on lower lid; place finger across
upper lid; apply gentle pressure Ask patient to blink Grasp lens with fingers Hold lens carefully and put in well Fill the well with saline or soaking solution
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Contact Lenses Properly labeled containers (R and L) Place in correctly Saline or special soaking solution
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Procedure for Removing a Prosthetic Eye
Wash your hands and put on gloves Dip the end of the suction cup in saline Lift the upper eyelid Squeeze the suction cup and place it on the iris of
the prosthesis Stop squeezing Use the handle of the suction cup to lift the
prosthesis out of the socket
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Cleansing Prosthesis Cleanse prosthesis with sterile water or saline Irrigate the eye socket with eye irrigating
solution Small amounts of mucus may accumulate Observe for thick yellow or green mucus
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Removing a Hearing Aid
Turn off the hearing aid Turn the earmold slightly toward the nose and
lift out Store the aid in its case or moisture-control
container
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Inserting a Hearing Aid Check the battery by turning the hearing aid
on to full volume and listening for it to whistle, which indicates that it is working
If you do not hear a whistle, check the battery and replace as needed
Turn off the hearing aid and lower the volume Insert the hearing aid into the ear and adjust
the volume as needed
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Types of Unoccupied Beds
Open bed: made with top linens fan folded to foot of bed
Surgical bed: made with top linens fan folded to side of bed
Closed bed: only used when patient is discharged; top linens are spread to the head of the bed
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Nurse Responsibility in Bed Making
Often delegated to a CNA or UAP Must be made tightly without wrinkles Number one concern is patient safety Use side rails appropriately Apply drawsheet according to policy Miter corners
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Common Bed Positions
Flat Fowler’s—45 to 60° Semi-Fowler’s or low-fowler’s—30° High Fowler’s—sitting upright in bed Trendelenburg Reverse Trendelenburg
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Controlling the Patient Environment
Provide for privacy Arrange furniture Keep patient door closed to block noise Control odors by removing bed pans Remove clutter from room Keep pathway to bed clear of equipment
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Orient Patient to Surroundings Use of bed controls Importance of siderails Call light and television controls Over bed table—compartments Importance of cleanliness and order Bedside stand Closet