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Fundamentals of Nursing - Ch. 40 Hygiene - RN Nclex
Adult Health II (NUR 2211)
Hillsborough Community College
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Hygiene
OBJECTIVES
- Describe factors that influence personal hygiene practices.
- Discuss how a nurse applies critical thinking when providing hygiene.
- Conduct a comprehensive assessment of a patient’s total hygiene needs.
- Discuss conditions that place patients at risk for impaired skin integrity.
- Discuss factors that influence the condition of the nails and feet.
- Explain the importance of foot care for the patient with diabetes.
- Discuss conditions that place patients at risk for impaired oral mucous membranes.
- List common hair and scalp problems and their related interventions.
- Describe how hygiene care for the older adult differs from that for the younger patient.
- Discuss different approaches used in maintaining a patient’s comfort and safety during hygiene care.
- Successfully perform hygiene procedures for the care of the skin, perineum, feet and nails, mouth, eyes, ears, and nose.
- Discuss how to adapt hygiene care for a patient who is cognitively impaired.
KEY TERMS
Alopecia, p. 866 Cerumen, p. 866 Cheilitis, p. 866 Complete bed bath, p. 873
Dental caries, p. 860
Edentulous, p. 866
Effleurage, p. 875
Gingivitis, p. 860
Glossitis, p. 866
Halitosis, p. 866
Maceration, p. 875
Mucositis, p. 869
Partial bed bath, p. 874
Pediculosis capitis, p. 866
Perineal care, p. 875
Stomatitis, p. 876
Xerostomia, p. 860 Personal hygiene influences patients’ comfort, safety, and well-being. Hygiene includes cleaning and grooming activities that maintain personal body cleanliness and appearance. A variety of personal, social, financial, and cultural factors influence hygiene practices. Because hygiene care requires close contact with your patients, use communication skills (e., listening, reflecting, focusing) to promote caring therapeutic relationships (see Chapter 24). When providing hygiene, integrate other nursing activities, including patient assessment and interventions such as range-of- motion (ROM) exercises, application of dressings, or inspection and care of intravenous (IV) sites. Healthy people are usually able to meet their own hygiene needs. However, physical or cognitive impairments and emotional challenges often cause individuals to need some degree of assistance with hygiene care. In agency and home care seings, assess each patient’s ability to perform self–hygiene care according to individual needs and preferences. When making adaptations for hygiene techniques and approaches, always ensure privacy, convey respect, and foster a patient’s independence, safety, and comfort.
TABLE 40.
Function of the Skin and Implications for Care
The epidermis (outer layer) shields underlying tissues against water loss and injury, prevents entry of disease-producing microorganisms, and generates new cells to replace the dead cells that are continuously shed from the outer surface of the skin. Bacteria (normal flora) commonly reside on the outer epidermis. The resident normal flora do not cause disease but instead inhibit the multiplication of disease-causing microorganisms (see Chapter 28). Bundles of collagen and elastic fibers form the thicker dermis that underlies and supports the epidermis. Nerve fibers, blood vessels, sweat glands, sebaceous glands, and hair follicles run through the dermal layers. Sebaceous glands secrete sebum, an oily, odorous fluid, into the hair follicles. Sebum softens and lubricates the skin and slows water loss from the skin when the humidity is low. More important, sebum has bactericidal action.
The subcutaneous tissue functions as a heat insulator, supports upper skin layers in withstanding stresses and pressure, and anchors the skin loosely to underlying structures such as muscle. The subcutaneous tissue layer contains blood vessels, nerves, lymph tissue, and loose connective tissue filled with fat cells. Very lile subcutaneous tissue underlies the oral mucosa. The skin often reflects a change in physical condition by alterations in color, thickness, texture, turgor, temperature, and hydration (see Chapter 30 ). As long as the skin remains intact and healthy, its physiological function remains optimal. Hygiene practices frequently influence skin status and can have beneficial and negative effects on the skin. For example, too-frequent bathing and use of hot water frequently lead to dry, flaky skin and loss of protective oils.
The Feet, Hands, and Nails
The feet, hands, and nails often require special aention to prevent infection, odor, and injury. The condition of a patient’s hands and feet influences the ability to perform hygiene care. Without the ability to bear weight, ambulate, or manipulate the hands, a patient is at risk for losing self-care ability. A wide range of dexterity exists in the hand because of the movement between the thumb and fingers. Any condition (e., arthritis, multiple sclerosis, traumatic hand injury) that interferes with hand movement (e., superficial or deep pain or joint inflammation) impairs a patient’s self-care abilities. Foot pain often changes a patient’s gait, causing strain on different joints and muscle groups. Discomfort while standing or walking limits self-care abilities. The nails are epithelial tissues that grow from the root of the nail bed, located in the skin at the nail groove hidden by a fold of skin called the cuticle. A normal healthy nail appears transparent, smooth, and convex, with a pink nail bed and translucent white tip. Inadequate nutrition and disease cause changes in the shape, thickness, and curvature of the nail (see Chapter 30).
The Oral Cavity
The oral cavity consists of the lips surrounding the opening of the mouth, the cheeks running along the sidewalls of the cavity, the tongue and its muscles, and the hard and soft palate. The mucous membrane, continuous
hygiene needs. Chapter 30 describes the structure and function of these organs.
Personal Preferences
Patients have individual preferences about how and when to perform hygiene and grooming care. Some patients prefer to shower, whereas others prefer to bathe. Patients select different hygiene and grooming products according to personal preferences. Knowing patients’ personal preferences promotes individualized care. Culture plays a role in sensitivity to personal space and gender (see Box 40. and Chapter 9). Help a patient develop new hygiene practices when indicated by an illness or condition. For example, you may need to teach a patient with diabetes proper foot hygiene or a bariatric patient adaptive bathing methods. Safe and effective patient- centered nursing care improves patient satisfaction and health and reduces costs (Burman et al., 2013).
B ox 4 0 .1 Cultural Aspects of CareHygiene
Practices
Patients deserve a culturally congruent plan for hygiene care. For many patients, culture influences hygiene practices, and hygiene care may become a potential source of conflict and stress in the caregiving environment (Marion et al., 2017). Patient-centered care mandates that care is aligned with patients’ values, needs, practices, and expectations, providing equitable and ethical care, and that care be based on respect for an individual patient’s cultural background (Henderson et al., 2018). A nurse must also consider other aspects of culture, such as a patient’s educational and developmental levels, extent of any physical disabilities, and geographical location of home when delivering hygiene.
Implications for Patient-Centered Care
Maintain privacy, especially for women from cultures that value female modesty, and provide gender-congruent caregivers as requested (Giger, 2017).
Collaborate with community leaders when providing health education for a diverse community (LaFleur et al., 2017).
Allow family members to participate in care if desired by adapting the schedule of hygiene activities.
Recognize that some cultures prohibit or restrict touching. Incorporate awareness that people from different cultural backgrounds have differing preferences regarding personal space. In some cases touch is considered magical and healing; others view it as evil or anxiety producing (Giger, 2017).
Recognize cultural hair practices, and do not cut or shave hair without prior discussion with patient or family (Bowen and O’Brien-Richardson, 2017).
Be aware that toileting practices vary by culture (Giger, 2017).
Recognize that different cultures have preferences about hot and cold water and their effects on healing or diseases (Morgan- Consoli and Unzueta, 2018).
Body Image
Body image is a person’s subjective concept of his or her body, including physical appearance, structure, or function (see Chapter 33 ). Body image affects the way in which individuals maintain personal hygiene. If a patient maintains a neatly groomed appearance, be sure to consider the details of grooming when planning care, and consult with the patient before making decisions about how to provide hygiene. Patients who appear unkempt or uninterested in hygiene sometimes need education about its importance or further assessment regarding their ability to participate with daily hygiene. Surgery, illness, or a change in emotional or functional status often affects a patient’s body image. Discomfort and pain, emotional stress, and fatigue diminish the ability or desire to perform hygiene self-care and require extra effort to promote hygiene and grooming.
Socioeconomic Status
9 ). For example, maintaining cleanliness does not hold the same importance for some ethnic or social groups as it does for others (Giger, 2017). In North America many are fortunate to be able to bathe or shower daily and use deodorant to prevent body odors. However, people from some socioeconomic or cultural groups are not sensitive to body odors, prefer to bathe less frequently, and do not use deodorant. Avoid expressing disapproval or forcing changes in hygienic practices unless the practices affect a patient’s health. In these situations, use tact, provide information, and allow choices.
Developmental Stage
The normal process of aging affects the condition of body tissues and structures. Apply your knowledge of physical and psychosocial developmental changes as you assess your patients and plan, implement, and evaluate hygiene care. A patient’s developmental stage affects the ability of a patient to perform hygiene care and the type of care needed. Use your knowledge of developmental changes when planning hygiene care.
Skin
The neonate’s skin is relatively immature at birth. The epidermis and dermis are bound together loosely, and the skin is very thin. Friction against the skin layers causes bruising. Handle a neonate carefully during bathing. Any break in the skin easily results in an infection. A toddler’s skin layers become more tightly bound together. Thus, the child has a greater resistance to infection and skin irritation. However, because of his or her more active play and the absence of established hygiene habits, parents and caregivers need to provide thorough hygiene and teach good hygiene habits. During adolescence the growth and maturation of the integument increase. In girls, estrogen secretion causes the skin to become soft, smooth, and thicker with increased vascularity. In boys, male hormones produce an increased thickness of the skin with some darkening in color. Sebaceous glands become more active, predisposing adolescents to acne (i., active inflammation of the sebaceous glands accompanied by pimples). Sweat glands become
fully functional during puberty. Adolescents usually begin to use antiperspirants. More frequent bathing and shampooing also become necessary to reduce body odors and eliminate oily hair. The condition of the adult’s skin depends on bathing practices and exposure to environmental irritants. Normally the skin is elastic, well hydrated, firm, and smooth. When an adult bathes frequently or is exposed to an environment with low humidity, it becomes dry and flaky. With aging the rate of epidermal cell replacement slows, and the skin thins and loses resiliency. Moisture leaves the skin, increasing the risk for bruising and other types of injury. As the production of lubricating substances from skin glands decreases, the skin becomes dry and itchy (Touhy and Je, 2018). These changes warrant caution when bathing, turning, and repositioning older adults. Too-frequent bathing and bathing with hot water or harsh soap cause the skin to become excessively dry (American Academy of Dermatology, 2018).
Feet and Nails
Foot health is a key component to a person’s mobility, health, and overall well-being. With aging and continued exposure to the trauma of walking and weight-bearing, a patient is more likely to develop chronic foot problems compounded as a result of poor foot care, improper fit of footwear, and local abnormalities and systemic disease (Persaud et al., 2018). For example, Morton’s neuroma, a common condition in middle-age women, affects health-related quality of life by causing burning, numbness, and pain of the foot on weight-bearing (Park et al., 2018). Older adults do not always have the strength, flexibility, visual acuity, or manual dexterity to care for their feet and nails. Foot problems may be overlooked and impact a patient’s comfort, mobility, and quality of life (Persaud et al., 2018). Older adults frequently complain of foot pain. They also often have dry feet because of a decrease in sebaceous gland secretion and dehydration of epidermal cells. Common problems of the feet affecting older adults include corns, calluses, bunions, hammertoes, maceration between toes, and fungal infections (Arthritis Foundation, 2017).
Patients with certain types of physical limitations or disabilities associated with disease and injury lack the physical energy and dexterity to perform hygiene self-care safely. A patient whose arm is in a cast or who has an IV line needs help with hygiene care. A weakened grasp resulting from arthritis, stroke, or muscular disorders makes using a toothbrush, washcloth, or hairbrush difficult or ineffective. Sensory deficits not only alter a patient’s ability to perform care but also place the patient at risk for injury. Safety is a priority for a patient with a sensory deficit. For example, a patient with paresthesia who is unable to feel that bath water is too hot can incur a burn injury during bathing. Chronic illnesses such as cardiac, pulmonary, and neurological diseases; cancer; dementia; and some mental health illnesses often exhaust or incapacitate patients. Patients who become tired or short of breath frequently need to have complete hygiene care provided. Include periods of rest during care to allow patients who are tired the opportunity to participate in their care. Pain often accompanies illness and injury, limiting a patient’s ability to tolerate hygiene and grooming activities or perform self-care. Pain frequently limits ROM, resulting in impaired use of the arms or hands or limited ability to move about in the environment, impairing the ability to perform hygiene self-care. Sedation and drowsiness associated with analgesics used for pain management also limit a patient’s ability to safely participate in care. Limited mobility caused by a variety of factors (e., obesity, physical injury, weakness, surgery, pain, prolonged inactivity, medication effect, and presence of medical devices [e., indwelling catheter, feeding tube, or IV line]) decreases a patient’s ability to perform hygiene self-care activities safely. Individualized care considers a patient’s ability to perform care, the amount of assistance needed, and the need for assistive and safety devices to facilitate safe hygiene care. Acute and chronic cognitive impairments resulting from conditions such as stroke, brain injury, psychoses, and dementia often result in the inability to perform self-care independently. Patients with dementia often forget to aend to their basic hygiene needs. When people with cognitive impairments are unaware of
their hygiene and grooming needs, they may become fearful and agitated during hygiene care, resulting in aggressive behavior (Mendes, 2018). Safe, effective patient-centered care takes the effect of cognitive impairment on personal care into consideration and provides appropriate modifications.
Critical Thinking
Successful critical thinking requires a synthesis of knowledge, experience, information gathered from patients, critical thinking aitudes, and intellectual and professional standards. Clinical judgments require you to anticipate the information, analyze the data, and make decisions regarding your patient’s care. During assessment consider all elements that build toward making appropriate nursing diagnoses (Fig. 40).
FIG. 40 Critical thinking model for hygiene assessment. ADA, American Diabetes Association; NPUAP, National Pressure Ulcer Advisory Panel; WOCN, Wound, Ostomy and Continence Nurses Society.
Fundamentals of Nursing - Ch. 40 Hygiene - RN Nclex
Course: Adult Health II (NUR 2211)
University: Hillsborough Community College
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