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Unit five





Mr. Ahmad Ata
RN,CNS,MSN
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Lecture Objectives
1. Know about hygiene, hygiene measure.
2. Know about common problem of the skin.
3. Describe common kind of hygiene.
4. Ability to identify patients with self care deficit
related hygiene.
5. Ability to communicate and interact effectively
with patients
6. Commitment to safety and quality
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Introduction
Personal hygiene practices well vary
widely among persons.
Well people are ordinarily responsible
for their own hygiene.
In some cases the nurse assist well
person through teaching to develop
personal habits the person may lack.
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Definition:
Hygiene: is self care by which people
attended to such function as bathing,
oral care, grooming hair, cleaning
fingernails, genital area, ear and eye
care.
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Hygiene involves cleansing of
the:
Skin
Mouth
Teeth
Hair
Nails

Eyes
Ears
Nose
Perineal Area
Feet

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Hygiene
Cleansing by nurse is part of historical
giving of care
The more ill patient, the more skill
needed in providing the hygiene care.
Cleansing skin is first line of defense
against organisms

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Kinds of hygiene may nurses described:
1. Early morning care:
Assist patient with toileting.
Provide comfort measure to refresh patient to prepare for day.
Wash face and hands.
Provide mouth care.
2. Morning care:
After breakfast, nurse completes morning care:
Toileting
Oral care
Bathing
Back massage
Hair care, cosmetics
Dressing
Positioning for comfort
Refreshing or changing bed linens
Tidying up bedside
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Kinds of hygiene may nurses described:
3. After noon care:
Ensure patients comfort after lunch:
Offer assistance with toileting, hand washing, oral care
Straighten bed linens
Help patients with mobility to reposition themselves

4. Hours of sleep care:
Before patient retires:
Offer assistance with toileting, washing, and oral care
Offer a back massage
Change any soiled bed linens or clothing
Position patient comfortably
Ensure that call light and other objects patient requires are within reach

5. As needed care: is provided required by client.

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Factor influencing individual
hygiene:
culture.
Religion.
Environment.
Development level.
Health status.
Personal preferences
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Etiologies of self care deficit
Visual impairment.
Activity intolerance or weakness.
Pain or discomfort.
Mental impairment.
Therapeutic procedures.
Skeletal impairment.
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Functional level of the patient may
described as following:

Total dependent.
Partial dependent.
Independent.
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PURPOSE OF NURSE PROVIDED
HYGIENE
Remove microorganisms
Do physical assessment
Increase circulation
Improve self image
Provide comfort

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Skin:
Definition: is the largest organ that cover
all surface of the body.

The skin contains:
Epidermis.
Dermis.
Subcutaneous layer.
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1) Epidermis

1. Keratinocyte the most important cell in the
epidermis become filled with a tough fibrous
protien called keratin.
They make up more than 90% of the epidermal
cells
2. Melanocyte contribute color to the skin and
serve to decrease the amount of ultraviolet light
that can penetrate into deeper layers of the skin.

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Cell Types

3. Langerhans cell : it plays limited role in
immunological reaction that effect the
skin and may serve defense mechanism
for the body.
4. Merkel cells - combines with disclike
sensory nerve endings to make Merkels
discs

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2) Dermis
It is some time called true skin , it is
composed of a thin papillary and thicker
reticular layer.
It may exceed 4mm on the soles and
palms .
At various level in the dermis , there are
muscle fibers, sweet gland, hair follicles
and many blood vessels.
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Functions of the skin
1) Protection:
A) from micro organism.
B) from dehydration.
C) from ultraviolet.
D) mechanical trauma.
E) pain
F) heat and cold

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Functions of the skin
2) Sensation: the widespread of the millions
of different somatic sensory receptors that
detect stimuli.
3) Excretion by regulating the volume and
chemical content of sweat.
4) Vitamin D production .
5) Immunity (langerhans cell).
6) Regulation of body temperature.
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Assessment:
Cleanliness.
Color.
Temperature.
Moisture.
Sensation.
Turgor
Texture.
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NURSING ASSESSMENT WHILE
BATHING
History
Relationship
Color and condition of skin
Pain on movement
Level of consciousness
Injuries
Scars
Skin turgor
Nevi
Wt loss or gain
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PATIENTS AT RISK FOR SKIN
PROBLEMS
Altered level of consciousness
Altered nutrition
Immobility
Dehydration
Altered sensation
Secretions on skin
Mechanical devices, casts, restraints
Altered venous circulation

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Practices related skin care:
1) Bathing: practice that use soap and
water to remove sweet, oil, dirt, and
microorganism from skin.
Type of bathing:
1. Tube bath.
2. Partial bath.
3. Bed bath.
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1. Tube Bath:
For all clients who are independent and there no
safly risk.
Nurse should encourage clients to take shower
independent.
Most bath room are equipped with rails and
handle to promote client safety.
2. Partial bath:
Washing only body area that are directly cause
odor ( face, hand, axillae, perineal area).
Partial bathing done at sink or with basin at bed
side.
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Perineum: area around the genital and
rectum, its required special cleaning
technique.

When perineal care:
After vaginal delivery.
Gynecological or rectal surgery.
Urine, stool.
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3. Bed bath:
Washing with a basin of water at the bed
side.
For client who cannot take shower
independently.
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3. Bed bath
Wash head to toe, front to back, distal to
proximal
Physical assessment as you are washing;
must also loosen and secure lines as moving
and turning patient
Change wash clothes for different areas
Change water if cold or soiled or very soapy
Some put oil in bath water of elderly
Use powder in your hand, very sparingly
not with respiratory patients or those with
allergies

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Change linen as needed
Do range of motion as needed
Do oral care, hair care, and give back
rub
Leave bed in low position, rails up, and
call light in place. Straighten room.
Report and chart findings


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ASSESSING TUBES AND LINES
Oxygen stays on during bath, check
connections, liters per minute, cleanliness of
prongs or mask, water if used, plugged in if
concentrator
IV lines use special gown, dont open lines
to change gown, look at IV site, rate and
solution
Urinary catheter draining, unkinked, bag
below bladder
Enteral tubes in place, running or draining
properly, or clamped properly
Dressings Clean and dry, drains properly
working
Does anything need to be emptied, changed
or cleaned?

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Purposes of bathing:

Provides Cleanse of skin.
Acts as skin conditioner.
Helping in relaxation patient.
Promote circulation.
Serve as musculoskeletal exercise.
Promote comfort.
Improve body image.

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2) Shaving:
To remove unwanted body hair.
3) Oral hygiene:
Practice used to clean the mouth includes:
Tooth brushes and flossing.
Denture care.
4) Hair care: hair grooming, shampooing and
identify patient usual hair practice and styling
preferences
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5) Bed making: Make bed for patient
comfort
If incontinent, wash, rinse, dry, change
linen
Use aids to relieve pressure points
heel, elbow protectors
bed frame with trapeze
frame to keep covers off feet
special beds and mattresses
Position as ordered


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Diagnosis:

Self care deficit (bathing, grooming, and
dressing) R/T pain.
Knowledge deficit R/T lack of experience.
Self esteem disturbance R/T body odor.
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Implementation:

Avoid long shape finger nails, jewelry may
be irritant skin.
Maintain nutrition to prevent skin dryness.
Reduce moisturing in the irritant area such
as axilla and between toes by apply corn
starch.
Maintain level of cleanliness.
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Causes of skin alteration:

Thin and obese people.
Fluid loss.
Excessive perspiration
jaundice.
Age.
Poor circulation.

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Hair:

Hair is composed of column of dead keratinized.
Its consists of shaft and root.

Hair covers the whole body part but its distribution,
color, texture, differ according to:
1. Location.
2. Age .
3. Gender.
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Hair
Hair color is determined by the amount
and type of melanin present.
Melanocytes become less active with age.
Gray hair is a mixture of pigmented and
non-pigmented hairs.
Red hair results from a a modified type of
melanin that contains iron.

Alopecia is the term for hair loss.

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Culture may influence HAIR care:

Hmong do not touch without permission
Muslim May keep covered, wear wig
Sikh Does not cut


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Importance of hair:

Appearance.
Prevent heat loss.
Protection.
Assessment:

Alopecia, dandruff, lice, scabies, hirsutism.
Diagnosis:

Self care deficit grooming R/T activity intolerance.
Risk for infection R/T scalp laceration.

Implementation:

Brushing, shampooing that stimulate circulation and
distribute the oil.
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Nail :
Nails made of keratin.

Parts of nail:
Nail root.
Nail body.
Nail bed.
Clupping fingers:
is condition in which the angle between the nail
and nail bed is 180 degree may cause by long
term lack of oxygen.
Koilonychias:
is condition of nails which is like spoon shape
may be caused by iron deficiency anemia.
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Parts of Nail
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Assessment :
Observe circulation; color, capillary refill
time
Observe color, sensation, and movement
(CSM)
Polish removed to observe color and use
pulse oximeter
Assess for clubbing sign of long term lack of
oxygen
Cut nails straight across and file smooth; Do
not go down into corners
Assess for rings too tight or too loose

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Teeth
Each tooth has three parts:
1. Crown: is exposed parts of the tooth which is
out side of gum.
2. Root: is embedded in the jaw and covered by
bony tissue called cementum.
3. Pulp: is the center of the tooth contains the
blood vessels and nerves.
Teeth begin to erupt at six month to two year.
Deciduous teeth (temporary teeth).
Permanent teeth.
Adults have 28 32 permanent teeth
depending on wisdom teeth.
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Assessment
1. Caries: erode tooth enamel because of
accumulation of sugur, bacteria.
2. Tartar: is avisible, hard deposite of
plague and dead bactria.
3. Pyorrhea: the teeth are loose and pus is
evident when the gums are pressed.
4. Periodontal disease: gums appear
spongy and bleeding.
5. Halitosis: bad breathing.
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Diagnosis:
Self care deficit.
Altered oral mucosa.
Implementation:
Good oral hygiene.
Brushing and flossing the teeth.
Caring of artificial denture.
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Mouth care
Examine with gloves and light, especially
smokers
Use only water soluble lubricants
If feeding tubes present, assess for parotitis
Unconscious patient has no gag reflex,
position on side for care
May have gum hyperplasia from meds
May have teeth staining from meds
May have accumulated debris in mouth
called sordes
Teach about brushing and flossing

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Care of eyes:
Clean from inner to outer conthus with
wet, warm cotton ball or compress.
Use artificial tear solution or normal saline
every four hour, if blink reflex is absent.
Care for eye glass, contact lens.
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Eye care
Contact lenses usually removed
Stored in saline liquid; case labeled
Also label and safeguard glasses in drawer
Clean inner to outer canthus
Patient must be able to blink to protect
cornea
Never use cotton near eyes
Treat each eye separately
Eyes considered sterile
Care of artificial eye similar to dentures

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Ear and nose:
Wash external ear with wash cloth -
covered finger .
Clean nose by having patient blow.
If indicated use nasal suction with bulb
syringe.
Remove crusted secretion around nose
and apply moisturing gill.
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