Ch. 9: Hygiene and Care of the Patient's Environment

Question 1

Keep patient

Answer 1

comfortable and safe

Question 2

Factors affecting enviornment

Answer 2

temperature, ventilation, noise, odors, lighting

Question 3

Room equipment

Answer 3

clean bed tables and side rails

Question 4

Older adults are more prone to

Answer 4

becoming more easily chilled, limited mobility, impaired circulation, effects of soap and detergent on skin

Question 5

Due to limited ROM

Answer 5

bathing and dressing can be uncomfortable

Question 6

Hygiene

Answer 6

science of health, includes skin, hair, hands, feet, eyes, ears, nose, mouth, back, and perineum

Question 7

Personal hygiene

Answer 7

self-care measures people use to maintain their health and prevent disease

Question 8

Nurses are role models for

Answer 8

hygiene

Question 9

Why are role models good for hygiene?

Answer 9

Promotes medical asepsis and inhibits the spread of pathogens

Question 10

What personal hygiene should nurses practice daily?

Answer 10

Shower, deodorant, clean uniform, hair clean and up off of collar, clean shoes, short clean nails, jewelry to a minimum, nothing dangling, stones in rings harbor bacteria, no perfumes

Question 11

Factors that affect hygiene

Answer 11

touch, beliefs, values, habits, individual performances, culture, physical condition

Question 12

Bathing

Answer 12

often delegated to unlicensed assistive personnel

Question 13

Therapeutic baths

Answer 13

cool water tub bath, warm water tub bath, hot water tub bath, sitz bath

Question 14

Water temp should be

Answer 14

110 degrees

Question 15

What should the nurse do prior to delegating oral care?

Answer 15

Gag reflex

Question 16

Purpose of sitz bath

Answer 16

cleanses and aids in reducing inflammation of perineal and anal areas

Question 17

Other baths

Answer 17

complete bed bath, partial bath, tepid sponge bath, medicated bath

Question 18

Purpose of tepid baths

Answer 18

febrile patients

Question 19

Examples of medicated baths

Answer 19

oatmeal, oils, salts,

Question 20

Complete bed baths and showers only need to be done weekly in the

Answer 20

geriatric unit

Question 21

Pressure ulcers

Answer 21

occur when there is sufficient pressure on the skin to cause blood vessels in the area to collapse

Question 22

Factors that play roles in pressure ulcers

Answer 22

shearing force, friction

Question 23

Shearing

Answer 23

the result of gravity pushing down on the patient’s body and the resistance between the patient and the chair or bed

Question 24

Friction

Answer 24

the force of rubbing two surfaces against on another, sometimes accompanies shear

Question 25

Why do pressure ulcers occur?

Answer 25

Due to lack of nutrients, oxygen, and red blood cells to the area

Question 26

Stages of pressure injuries

Answer 26

Stages I-IV; and unstageable/unclassified, suspected deep tissue injury

Question 27

Stage I pressure ulcer

Answer 27

localized area of skin intact with nonblanchable redness

Question 28

Stage II pressure ulcer

Answer 28

partial-thickness, loss of dermis

Question 29

Stage III pressure ulcer

Answer 29

full-thickness tissue loss in which subcutaneous fat is sometimes visible, but bone, tendon, and muscle are not exposed

Question 30

Stage IV pressure ulcer

Answer 30

involves full-thickness tissue loss with exposed bone, tendon, or muscle

Question 31

Unstageable/unclassified

Answer 31

full thickness tissue loss, a wound base covered by slough and/or eschar in the wound bed that will usually be tan, brown, or black

Question 32

Suspected deep tissue injury

Answer 32

wound appears as a localized purple or maroon area of discolored intact skin or a blood-filled blister

Question 33

Patients with injury may benefit from the application of

Answer 33

heat or cold therapy

Question 34

Purpose of heat applications

Answer 34

provide comfort and speed healing

Question 35

Purpose of cold applications

Answer 35

decrease swelling and reduce pain

Question 36

Components of patient’s hygiene

Answer 36

oral hygiene
hair care
shaving
hand, foot, and nail care
eye, ear, and nose care

Question 37

Back care and back rubs

Answer 37

given after baths

promote relaxation, relieve muscle tension, and stimulate circulation

Question 38

Contraindications for back rubs

Answer 38

anyone that has fractures of the ribs, or vertebrae, burns, pulmonary embolism, or open wounds on the back

Question 39

Perineal care

Answer 39

care of the genitalia, catheter care

Question 40

Catheter care

Answer 40

perform twice daily, cleanse metal catheter with mild soap and water and sometimes apply a water-soluble microbicidal ointment

Question 41

When physical condition changes, what reflects this?

Answer 41

Skin

Question 42

Assisting the patient with elimination

Answer 42

bedpan, urinal, and care of the continent patient

Question 43

Why would coughing, laughing, or lifting cause incontinence in a female patient?

Answer 43

Lack of estrogen causes muscle weakness in the sphincter muscles

Question 44

What type of exercises might help incontinence in the female patient?

Answer 44

Kegel

Question 45

Why should the nurse should offer the bedpan or urinal frequently?

Answer 45

Patients may accidentally soil bedclothes if their elimination needs are not met

Question 46

What can assist in removing the bedpan from the patient?

Answer 46

Trapeze, powder is not used anymore due to respiratory issues

Question 47

Nursing Process-Assessment

Answer 47

can the patient perform ADL’s and how much can they perform, what are their limitations, are there safety concerns, do they complete the process adequately, what are their normal routines at home, observe physical and emotional conditions, cognition, understanding, note cultural preferences