hygiene and self-care Flashcards
describe the professional appearance of the nurse
-clean and neat hair style
-excellent oral and skin care
-minimal makeup
-minimal jewelry
-short natural nails
-no perfumes
-clean shoes
-clean, wrinkle free uniform
what order should you don ppe
bottom up
1. gown
2. mask
3. goggles
4. gloves
what order should you doff ppe
alphabetical order
1. gloves
2. goggles
3. gown
4. mask
names some different isolation levels
-contact
-droplet
-airborne
describe early morning care (before breakfast)
-assist to bathroom, BSC, bedpan or urinal
-provide supplies for hand/face washing, mouth care, comb hair
-assist with glasses, denture, and hearing aide insertion
describe AM care (after breakfast)
assist with partial or complete bath or shower
what are some things to consider when assisting with partial or complete bath
-provide privacy
-maintain safety
-keep water warm and change it PRN
-wash top to bottom and front to back
-use gentle, firm strokes
-dry thoroughly
-promote independence
a nurse is caring for a patient with a skin problem. what question or statement would be most useful in eliciting information about personal care?
A. perhaps you dont recognize you bad body odor
B. you must eat a lot of greasy foods to have this acne
C. tell me about what you do to take care of your skin
D. why do you only take a bath once a week?
C. tell me about what you do to take care of your skin
describe leg, foot, and nail care
-wash feet with lukewarm water
-dry thoroughly especially in between toes
-apply lotion to dry areas
-always remove TED hose and SCDs before the bath and replace after completion
-avoid massage of reddened areas
-provide diabetic foot care if indicated. education is imperative. request podiatric consult when indicated. encourage patients to look at their feet
describe hair care
-identify patient’s usual hair and scalp care practices and styling preferences (note history of scalp problems such as dandruff, hair loss, or baldness)
-comb or brush hair
-wash as appropriate (shampoo and water/waterless shampoo/shampoo caps)
-shaving (groom beard and mustache, shave in direction of hair growth, note if pt is on blood thinners)
-treat any infestations such as pediculosis and ticks
which gum disease manifests as a marked inflammation of the gums that also involves a degeneration of the dental tissues and bone?
A. dental caries
B. gingivitis
C. periodontitis
D. plaque
C. periodontitis
describe regular mouth and oral care
assist with brushing and flossing
what should you use for oral care if a patient is on blood thinners?
soft brush
what should you use to shave with if patient is on blood thinners?
electric razor
what should you use for oral care if a patient has stomatitis (inflammation of oral mucosa)
swabs
describe mouth and oral care on patients that are on oxygen?
mucous membranes dry out so it is important to keep moist and provide good mouth care
describe mouth and oral care for patients who have dentures
-clean mouth
-clean dentures
-line sink with wash cloth or towel as protection in case you drop the dentures
-use sponge or cloth to remove dentures and get a denture cup to keep them in
what is the biggest risk with oral care for an unconscious patient
aspiration
describe aspiration
when fluids from the mouth or digestive system pass into the respiratory system
describe mouth and oral care for an unconscious patient
-lower head of bed
-place patient in the sims position (head well towards the side)
-use kidney basin and suction to prevent aspiration
describe eye care
-clean from inner to outer canthus with wet warm cloth, cotton ball, or compress
-use new area of wash cloth on each eye
-assist removal/insertion of contacts/artificial eye
-clean glasses and assist with placement
describe ear care
-wash behind ears. wash external ear with washcloth covered finger, do not use cotton swabs
-perform hearing aid teaching and care if indicated
-clean hearing aides with soft cloth
-assist with placement of hearing aides
describe nose care
-particular attention is required when a patient has a nasogastric tube or endotracheal tube inserted through the nose
-clean accumulated secretions from around the tube
-replace tape once a day to prevent nasal mucosal irritation
describe the process of feeding
-assess the patients ability to feed themselves
-desire to make food choices/eat
-energy and muscular movement to eat
-ability to safely chew and swallow
describe the process of toileting
-use of toilet, BSC, bedpan, or urinal
-toileting is frequently associated with falls
-assess patient’s ability to assist
-check ambulation orders
-be proactive -> ask while youre in the room to prevent patient from having to call for help
describe urinal use
-keep off over bed table
-if urinal is full, assess amount of urine, color and clarity, empty and record output on I&O sheet
describe dressing and grooming
-discuss personal preferences with pt
-clothing if any (may prefer hospital gown)
-hair-wash and comb
-shaving- use electric razor for patient taking anticoagulants
describe bed time care
-assist with elimination
-assist patient with washing hands and face
-oral care
-skin care
-straighten or change bed linens PRN
describe back massage
-used as a relaxant after the bath or at bedtime
-use warm lotion and side lying position
-use long, slow, gliding strokes (effleurage)
describe some positive effects of back massage
improves:
-mood
-pain
-muscle tension
-blood pressure
-depth of respirations
describe some lifespan considerations with hygiene and self care
-younger people may be independent with self care
-older adults have less elastic skin (more susceptible to injury), thinner hair, dentures, and may be hard of hearing
what are some environmental factors affecting self care
-lack of access to facilities
-poverty may limit resources (water)
-patients in wheelchairs - wheelchair access
ask yourself - what resources does the patient have access to?
describe some motivation factors affecting self care
-belief that self care is important
-patient to be as independent as possible
describe some cognitive ability factors that can affect self care
-may not recognize the need for care
-may not be able to safely perform care
describe some energy factors affecting self care
-acute/chronic illness can decrease energy levels
-acute illness/surgery
-may need assistance
-weakness
describe some pain factors that may affect self care
patient may be unwilling to move or care for themselves
describe some neuromuscular functions that may affect self care
you must assess level of impairment
describe some sensory deficits that may affect self care
-visually impaired
-hearing impaired
-neuropathy
what are some examples of nursing diagnoses regarding hygiene and self care
-self care deficit
-impaired skin integrity
-risk for injury
-impaired mobility
-ineffective health maintenance
what are some rationales for bathing
-provides opportunity for thorough skin assessment
-eliminate perspiration, skin oils, dead skin cells, and bacteria (prevent body odor)
-enhances circulation and conditions the skin
-stimulates respiratory rate and depth
-provides sensory input
-allows for patients teaching, therapeutic conversation and touch
what patients are most in need of perineal care
-indwelling urinary catheters
-rectal/genital/perineal surgery
-vaginal delivery/recent childbirth
describe perineal care
-clean all patients from areas of least contamination to areas most contaminated
-peri care is performed daily with a bath and after every episode of incontinence
-use appropriate terminology
describe male perineal care
-clean from the urinary meatus downward
-retract and replace foreskin
-clean crevices
describe female perineal care
clean from front to back (pubic bone to sacrum)
describe bed making
-wear clean gloves
-encourage pt to get out of bed
-place soiled linens in linen bag avoiding contact with uniform
-avoid shaking sheets, fold out on to the surface of the bed
-do not place pillow under your chin
to ensure bed safety, be sure the bed is..
-in its lowest position
-position is safe for the patient
-controls are functioning and bed is electrically safe
-side rails are raised if indicated
-the wheel or casters are locked
describe room clean up and safety
-functioning call light within reach at all times
-bed in low position
-wheels locked
-uncluttered walkspace
-note temp, ventilation, noise, and lighting in relation to patient’s preference