Hygiene and Care of The Patient's Envirnment

Hygiene and Care of the Patient’s
Environment
Slide 1
Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
Environment
• Personal Hygiene
 The self-care measures persons use to maintain their
health
• Hygiene
 The science of health
 Includes care of the skin, hair, hands, feet, eyes, ears,
nose, mouth, back, and perineum
• Conscientious personal hygienic practices are
essential for the nurse; nurses are role models.
Slide 2
Environment
• Factors Influencing Personal Hygiene
 Social practices
 Body image
 Socioeconomic status
 Knowledge
 Personal preference
 Physical condition
 Cultural variables
Slide 3
Patient’s Room Environment
• Maintaining Comfort
 Room temperature: 68° to 74° F
 Good ventilation
 Bedpans and urinals that are emptied and rinsed
promptly
 Monitored noise level
 Proper lighting
Slide 4
Figure 18-1
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
A typical hospital room.

Slide 5
• Room Equipment
 Bedside stand
• Used to store the patient’s personal articles and
hygienic equipment
 Overbed table
• On wheels; is adjustable to various heights over the bed
or a chair
 Chairs
• Straight chairs and lounge chairs
Slide 6
• Room Equipment (continued)

 Lights
• Lights provide comfort, safety, and ease.
• Call light signal indicates that a patient needs
assistance.
 Bed
• Bed is designed for comfort, safety, and adaptability to
position changes.
• It has a number of safety features.
Slide 7
Bathing
• Sitz Bath
 Cleanses and aids in reducing inflammation of the
perineal and anal areas of the patient who has
undergone rectal or vaginal surgery or childbirth
 Water temperature 98° to 102° F
• Cool Water Tub Bath
 May be given to relieve tension or lower body
temperature
 Water temperature tepid, not cold—98.6° F
Slide 8
Figure 18-2
The sitz bath.

Slide 9
Bathing
• Warm Water Tub Bath

 Given to reduce muscle tension
 Water temperature 109.4° F
• Hot Water Tub Bath
 Given to assist in relieving muscle soreness and
muscle spasms
 Water temperature 113° to 115° F
Slide 10
Bathing
• Other Baths
 Complete Bed Bath
• For patients who are totally dependent and require total
assistance
 Tepid Sponge Bath
• Administered to reduce an elevated temperature
 Medicated Bath
• May include agents such as oatmeal, cornstarch,
Burow’s solution, and soda bicarbonate
• To reduce tension and relax the patient and to relieve
pruritus caused by certain skin disorders
Slide 11
Skill 18-1: Steps 8e(1) & 8e(2)
Bed bath.
Slide 12
Skill 18-1: Steps 8e(3) & 8e(4)
Bed bath.
Slide 13
Skill 18-1: Steps 8h & 8i
Bed bath.
Slide 14
Skill 18-1: Steps 8r & 8u
Bed bath.
Slide 15
Skill 18-1: Steps 10d(1) & 10d(2)
Towel bath.
Slide 16
Skill 18-1: Step 10e
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St.
Louis: Mosby.)
Towel bath.
Slide 17
Bathing
• Back Care/Backrub
 Usually administered after the patient’s bath
 Promotes relaxation, relieves muscular tension, and
stimulates circulation
 Nurse massages for 3 to 5 minutes
 Contraindicated if the patient has such conditions as
fractures of the ribs or vertebral column, burns,
pulmonary embolism, or open wounds
Slide 18
Skill 18-1: Steps 14e & 14f
Back rub.
Slide 19
Components of the Patient’s Hygiene
• Care of the Skin

 When a person’s physical condition changes, the skin
often reflects this through alterations in color,
thickness, texture, turgor, temperature, and hydration.
 As long as the skin remains intact and healthy, its
physiological function remains optimal.
Slide 20
• Care of the Skin (continued)

 Collection of Data
• Normal skin has the following characteristics:
 Intact without abrasions
 Warm and moist
 Localized changes in texture across surface
 Good turgor; generally smooth and soft
 Skin color variations from body part to body part
Slide 21

 Impaired Skin Integrity
• A patient who stays in one position without relief of
pressure can develop a pressure sore.
• Patients especially at risk are the chronically ill,
debilitated, older, disabled, or incontinent patient and
the patient with spinal cord injuries, limited mobility, or
poor overall nutrition.
Slide 22
Figure 18-5
Thirty-degree lateral position to avoid pressure points.

Slide 23
Figure 18-6
Using a rolled bath blanket as a pressure-reducing device.

Slide 24

• Pressure ulcers occur when there is sufficient pressure
on the skin to cause the blood vessels in an area to
collapse.
• The flow of blood and fluid to the cells is impaired,
resulting in ischemia to the cells.
• When the external pressure against the skin is greater
than the pressure in the capillary bed, blood flow
decreases to the adjacent tissue.
• If the pressure continues for longer than 2 hours, cell
necrosis may occur.
Slide 25

• Shearing force
 The tissue layers of skin slide onto each other, resulting
in kinking or stretching of subcutaneous blood vessels;
this results in an interruption of blood flow to the skin.
• Friction
 Rubbing of skin over a surface produces friction, which
may remove layers of tissue.
Slide 26
Figure 18-3
Diagram of shearing force exerted against sacral area.

Slide 27

 Stages of Pressure Ulcers
• Stage I: nonblanchable erythema of the skin
• Stage II: partial-thickness skin loss; epidermis
• Stage III: full-thickness skin loss, damage or
necrosis of subcutaneous tissue
• Stage IV: full-thickness skin loss with
extensive destruction, tissue necrosis,
or damage to muscle, bone, or
supporting structures
Slide 28
Figure 18-4, A
A, Stage I pressure ulcer.

Slide 29
Figure 18-4, B
B, Stage II pressure ulcer.

Slide 30
Figure 18-4, C
C, Stage III pressure ulcer .

Slide 31
Figure 18-4, D
D, Stage IV pressure ulcer .

Slide 32

 Nursing Interventions
• Assess improvement.
• Assess size and depth of the ulcer, the amount and
color of any exudate, the presence of pain or odor, and
the color of the exposed tissue.
• Specific interventions are determined by the stage of
the ulcer.
Slide 33
• Oral Hygiene
 Care of the oral cavity
 Helps maintain a healthy state of the mouth, teeth,
gums, and lips
 Brushing the teeth removes food particles, plaque,
and bacteria; massages the gums; and relieves
discomfort resulting from unpleasant odors and tastes.
Slide 34
Skill 18-2: Steps 9a & 9c
Louis: Mosby.)
Administering oral hygiene.

Slide 35
• Oral Hygiene (continued)

 Dentures
• A set of artificial teeth not permanently fixed.
• Should be stored in an enclosed, labeled cup for
soaking or when they are not worn
• Should be cleaned as often as for natural teeth to
prevent infection and irritation
• Oral care provided on a regular basis
Slide 36
Skill 18-2: Step 10c
Administering oral hygiene.

Slide 37
• Hair Care
 Combing, brushing, and shampooing are basic
hygiene measures for all patients.
 Patient may shampoo in the shower or tub, use a
portable chair in front of a sink, or in bed.
• Shaving the Patient
 Patient may prefer to shave at the time of bathing.
 Patients who have a bleeding disorder or are taking
anticoagulants should use electric razors.
 Do not allow a disoriented or depressed patient to use
a razor with a blade.
Slide 38
Skill 18-3: Steps 9a & 10e
Louis: Mosby.)
Care of the hair, nails, and feet.

Slide 39
• Hand, Foot, and Nail Care

 Hands and feet often require special attention to
prevent infection, odors, and injury.
 Assessment
• Examine all skin surfaces.
• Carefully assess between the toes.
• Observe for adequate circulation.
Slide 40
• Perineal Care
 Care of the genitalia
 Part of the complete bed bath
 Assess for signs of vaginal or urethral exudate, skin
impairment, unpleasant odors, complaints of burning
during urination, or localized tenderness or pain of the
perineum
 Catheter care is to be performed twice daily on all
patients with indwelling catheters.
• Includes cleansing of the meatal-catheter junction with
a mild soap and water and sometimes application of a
water-soluble microbial ointment
Slide 41
Skill 18-4: Step 9b
Louis: Mosby.)
Female perineal care.

Slide 42
Skill 18-4: Steps 9e & 9g
Female perineal care.

Slide 43
Skill 18-4: Step 10c/10d
Male perineal care.

Slide 44
• Eye, Ear, and Nose Care (continued)

 Care of the eyes
• Cleansing of the circumorbital area of the eyes is
usually performed during the bath.
• Case involves washing with a clean washcloth
moistened with clear water.
• The use of soap is omitted because it may cause
burning and irritation.
• The eye is cleansed from the inner to the outer canthus.
• Patient may need assistance with care of eyeglasses or
contact lenses.
Slide 45

 Care of the ears
• The ears are cleansed by the nurse during the bed
bath.
• A clean corner of a moistened washcloth rotated gently
into the ear canal works best for cleaning.
• A cotton-tipped applicator is useful for cleansing the
pinna.
• The nurse should teach patients never to use bobby
pins, toothpicks, or cotton-tipped applicators to clean
the internal auditory canal.
Slide 46

 Care of the ears (continued)
• Hearing aids
 This involves routine cleaning, battery care, and proper
insertion technique.
 When not in use, the hearing aid should be stored where
it will not become damaged.
Slide 47
Figure 18-8
Louis: Mosby.)
Hearing aid.
Slide 48

 Care of the nose
• The patient can usually remove secretions from the
nose by gently blowing into a soft tissue.
• Teach the patient that harsh blowing causes pressure
capable of injuring the tympanic membrane, nasal
mucosa, and even sensitive eye structures.
• If the patient is not able to clean the nose, the nurse will
assist, using a saline-moistened washcloth or cotton-
tipped applicator; for excessive secretions, suctioning
may be required.
Slide 49
• Bedmaking
 The patient’s bed is usually made in the morning after
the bath.
 When possible, the bed is made while it is not
occupied; when the patient is unable to be out of bed,
the nurse will make an occupied bed.
 The patient’s safety is always foremost in the nurse’s
mind; comfort and privacy are also important.
• Use side rails, keep the call light within easy reach, and
maintain the bed in the proper position.
Slide 50
Skill 18-5: Step 8i
Louis: Mosby.)
Bedmaking: occupied bed.

Slide 51
Skill 18-5: Step 8j
Louis: Mosby.)

Slide 52
Skill 18-5: Step 8m
Louis: Mosby.)

Slide 53
Skill 18-5: Step 8o
Louis: Mosby.)

Slide 54
Skill 18-5: Step 8q
Louis: Mosby.)

Slide 55
Skill 18-5: Step 8r
Louis: Mosby.)

Slide 56
• Bedmaking (continued)
 It is the nurse’s responsibility to keep the bed as clean
and comfortable as possible.
 This may require frequent inspections to make sure
the bedding is clean, dry, and wrinkle free.
 Check the linens for food particles after meals and for
urine incontinence or involuntary stool.
 Use proper body mechanics; raise bed to a working
level.
Slide 57
Figure 18-9
Louis: Mosby.)
The postoperative bed.

Slide 58
Figure 18-10
Selected equipment and supplies for elimination.

Slide 59
Figure 18-11
The bedside commode has a toilet seat with a container underneath.

Slide 60
• Assisting the Patient with Elimination

 Bedpan
• A device for receiving feces or urine from either male or
female patients confined to the bed
 Urinal
• A device for collecting urine from male patients; urinals
for females also available
 Bedpans or urinals are used when a patient is unable
to get up to go to the bathroom for the purpose of
urination or defecation.
Slide 61
• Assisting the Patient with Elimination (continued)

 The nurse should offer the bedpan or urinal frequently,
because patients may accidentally soil bedclothes if
their elimination needs are not met.
 Report any abnormalities and record in the nurse’s
notes.
 Flow sheets are usually provided for documentation of
normal voidings and stools.
Slide 62
Skill 18-6: Steps 11(2) & 11(3)
Louis: Mosby.)
Positioning the bedpan.

Slide 63
• Care of the Incontinent Patient

 Incontinence is a very common problem, especially
among older adults.
 Incontinence occurs because pressure in the bladder
is too great, sphincters are weak, or the innervation
has been compromised due to illness or injury.
 Incontinence may involve a small leakage of urine
when the person laughs, coughs, or lifts something
heavy.
Slide 64
• Care of the Incontinent Patient (continued)

 Care requires the use of disposable adult
undergarments or underpads.
 Cleansing the skin thoroughly after each episode of
incontinence with warm soapy water and drying it
thoroughly help to prevent skin impairment.
 When urinary incontinence results from decreased
perception of bladder fullness or impaired voluntary
motor control, bladder training can be helpful.
Slide 65
Nursing Process
• Nursing Diagnoses
 Oral mucous membranes, impaired
 Mobility, impaired physical
 Skin integrity, impaired
 Self-care deficit—bathing/hygiene, dressing/grooming
Slide 66

Hygiene and Care of The Patient's Envirnment

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Hygiene and Care of The Patient's Envirnment

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Hygiene and Care of the Patient’s

A typical hospital room.

• Room Equipment (continued)

The sitz bath.

• Warm Water Tub Bath

• Care of the Skin

• Care of the Skin (continued)

• Care of the Skin (continued)

Thirty-degree lateral position to avoid pressure points.

Using a rolled bath blanket as a pressure-reducing device.

• Care of the Skin (continued)

• Care of the Skin (continued)

Diagram of shearing force exerted against sacral area.

• Care of the Skin (continued)

A, Stage I pressure ulcer.

B, Stage II pressure ulcer.

C, Stage III pressure ulcer .

D, Stage IV pressure ulcer .

• Care of the Skin (continued)

Administering oral hygiene.

• Oral Hygiene (continued)

Administering oral hygiene.

Care of the hair, nails, and feet.

• Hand, Foot, and Nail Care

Female perineal care.

Female perineal care.

Male perineal care.

• Eye, Ear, and Nose Care (continued)

• Eye, Ear, and Nose Care (continued)

• Eye, Ear, and Nose Care (continued)

• Eye, Ear, and Nose Care (continued)

Bedmaking: occupied bed.

Bedmaking: occupied bed.

Bedmaking: occupied bed.

Bedmaking: occupied bed.

Bedmaking: occupied bed.

Bedmaking: occupied bed.

The postoperative bed.

Selected equipment and supplies for elimination.

The bedside commode has a toilet seat with a container underneath.

• Assisting the Patient with Elimination

• Assisting the Patient with Elimination (continued)

Positioning the bedpan.

• Care of the Incontinent Patient

• Care of the Incontinent Patient (continued)

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