ch 4o hand hygiene

list of diagnosis for patients in need of supportive hygiene care

Activity Intolerance • Bathing Self-Care Deficit • Dressing Self-Care Deficit • Impaired Physical Mobility • Impaired Oral Mucous Membrane • Ineffective Health Maintenance • Risk for Infection • Risk for Impaired Skin Integrity

Routine morning care "complete AM care "

After breakfast help by offering a bedpan or urinal to patients confined to bed; provide a full or partial bath or a shower, including perineal care and oral, foot, nail, and hair care; give a back rub; change a patient's gown or pajamas; change the bed linens; and straighten a patient's bedside unit and room.

alopecia

Alopecia occurs in all races. Balding patches are in periphery of hair line. Hair becomes brittle and broken.Patches of uneven hair growth and loss alter patient's appearance.Stop hair care practices that damage hair. Use of hair curlers, hair picks, tight braiding, and hot comb contributes to hair-loss condition.

vascular insufficiency

Arterial blood supply to tissues is inadequate, or venous return is impaired, causing decreased circulation to extremities. Tissue ischemia and breakdown often occur. Risk for infection is high

athletes foot tinea pedis

Athlete's foot is fungal infection of foot; scaling and cracking of skin occurs between toes and on soles of feet. Small blisters containing fluid appear.Athlete's foot spreads to other body parts, especially hands. It is contagious and frequently recurs.Make sure that feet are well ventilated. Drying feet well after bathing and applying powder help prevent infection. Wearing clean socks or stockings reduces incidence. Health care provider orders application of griseofulvin, miconazole, or tolnaftate

Dehydration, inability to take fluids or food by mouth (NPO)

Dehydration causes excess drying and fragility of mucosa; increases accumulation of secretions on tongue and gums.

Chemotherapeutic drugs

Drugs kill rapidly multiplying cells, including normal cells lining oral cavity. Ulcers and inflammation develop.

dry skin implications and interventions

Flaky, rough texture on exposed areas; skin can become infected if epidermal layer cracks, Bathe less frequently. Rinse body of all soap because residue left on skin can cause irritation and breakdown. Add moisture to air with use of humidifier. Increase fluid intake when skin is dry. Use moisturizing cream to aid healing. (Cream forms protective barrier and helps maintain fluid within skin.) Use creams to clean skin that is dry or allergic to soaps and detergents.

foot odors

Foot odors are result of excess perspiration, promoting microorganism growth.Condition causes discomfort because of excess perspiration.Frequent washing, use of foot deodorants and powders, and wearing clean footwear prevent or reduce problem.

corns

Friction and pressure from ill-fitting or loose shoes cause keratosis. It is seen mainly on or between toes, over bony prominence. Corn is usually cone shaped, round, and raised. Soft corns are macerated.Compresses the underlying dermis, making it thin and tender. Pain is aggravated when wearing tight shoes. Tissue becomes attached to bone if allowed to grow. Resultant pain causes an alteration in gait.Surgical removal is necessary, depending on severity of pain and size of corn. Avoid use of oval corn pads, which increase pressure on toes and reduce circulation. Warm water soaks soften corns before gentle rubbing with a callus file or pumice stone. (Consult with health care provider. Not allowed with patients with diabetes.) Wider and softer shoes, with wider toe box, are helpful.

plantar warts

Fungating lesion appears on sole of foot and is caused by papilloma virus.Some warts are contagious. They are painful and make walking difficult.Treatment ordered by health care provider often includes applications of salicylic acid, electrodessication (burning with electrical spark), or freezing with solid carbon dioxide.

what can affect hair characteristics

Hormonal changes, nutrition, emotional and physical stress, aging, infection, and some illnesses

contact dermatitis implications and interventions

Inflammation of skin characterized by abrupt onset with erythema; pruritus; pain; and appearance of scaly, oozing lesions Dermatitis is often difficult to eliminate because person is usually in continual contact with substance causing skin reaction. Substance is often hard to identify. avoid causative agents

thickened horny nails that seperate from the nail bed

Inflammatory lesions and fungus

acne implications and interventions

Inflammatory, papulopustular skin eruption, usually involving bacterial breakdown of sebum; appears on face, neck, shoulders, and back Infected material within pustule spreads if area is squeezed or picked. Permanent scarring can result. Wash hair and skin thoroughly each day with warm water and soap to remove oil. Use cosmetics sparingly. Oily cosmetics or creams accumulate in pores and make condition worse. Implement dietary restrictions if necessary. (Eliminate foods that aggravate condition from diet.) Use prescribed topical antibiotics for severe forms of acne.

Lozenges, cough drops, antacids, and chewable over-the-counter vitamins

Medications contain large amounts of sugar. Repeated use increases sugar or acid content in mouth, causing dental caries.

sensation implications for care

Minimize friction to avoid loss of stratum corneum, which results in development of pressure ulcers. • Smooth linen out to remove sources of mechanical irritation. • Remove rings from fingers to prevent accidentally injuring patient's skin. • Make sure that bath water is not excessively hot or cold.

Excessive secretions or excretions on skin from perspiration, urine, watery fecal material, and wound drainage

Moisture is medium for bacterial growth and causes local skin irritation, softening of epidermal cells, and skin maceration.

what is in dermal layers

Nerve fibers, blood vessels, sweat glands, sebaceous glands, and hair follicles

bathing self care deficit box 40-3 assessment activities

Observe patient attempt to bathe self (Patient is unable to wash lower body, back, or perineal area). Assess patient's upper-extremity strength and range of motion.(Patient has restricted upper-extremity range of motion and weakness. Patient has difficulty turning in bed by self or reaching items needed. Patient is unable to turn water faucets on and off) Observe patient's ability to move from bed to bathroom and maneuver in bathroom (Patient cannot transfer from bed to chair without assistance, cannot ambulate, relies on wheelchair to move around, is unable to maneuver wheelchair in bathroom without help or transfer to shower seat unassisted. Patient may need lift equipment for transfers.)

assessment feet and nails

Palpate the dorsalis pedis and posterior tibial pulses and assess for intact sensation to light touch, pinprick, and temperature observe gait

pediculosis capitis

Parasite resides on scalp attached to hair strands. Eggs look like oval particles, similar to dandruff. Bites or pustules may be observed behind ears and at hairline.Head lice are difficult to remove and spread to furniture and other people if not treated. They do not carry disease, cannot fly or jump, and are carried by animals.Wearing gloves, check entire scalp by using tongue depressor or special lice comb. Use medicated shampoo for eliminating lice. Caution against use of products containing lindane because the ingredient is toxic and known to cause adverse reactions (CDC, 2015). Manual removal is best option when treatment has failed. Vacuum infested areas of home.

pediculosis pubis

Parasites are in pubic hair. Crab lice are gray-white with red legs.Lice spread through bed linen, clothing, or furniture or between people via sexual contact.Shave hair off affected area. Clean as for body lice. If lice were sexually transmitted, notify partner.

pediculosis corporis

Parasites tend to cling to clothing; thus they are not always easy to see. Body lice suck blood and lay eggs on clothing and furniture.Patient itches constantly. Scratches seen on skin become infected. Hemorrhagic spots appear on skin where lice are sucking blood.Bathe or shower thoroughly. After skin is dried, apply recommended pediculicide lotion. After 12 to 24 hours take another bath or shower. Bag infested clothing or linen until laundered in hot water. Vacuum rooms thoroughly and throw away bag after completion.

bariatric problems

Patient cannot visualize skin properly and keep it clean and dry. Excessive adipose tissue creates pressure from weight, lack of air circulation, and an increase in moisture with poor tissue perfusion

Inability to use upper extremities because of paralysis, weakness, or restriction (e.g., cast, dressing)

Patient lacks upper-extremity strength or dexterity needed to brush teeth

Reduced dexterity and hand coordination

Physical limitations create inability to safely insert or remove contact lenses.

Endotracheal intubation with mechanical ventilation

Potential for ventilator-associated pneumonia (VAP) exists. Use of chlorhexidine gluconate (CHG) reduces risk of VAP.

Limited protein or caloric intake and reduced hydration (e.g., fever, burns, gastrointestinal alterations, poorly fitting dentures)

Predispose to impaired tissue synthesis. Skin becomes thinner, less elastic, and smoother with loss of subcutaneous tissue. Poor wound healing results. Reduced hydration impairs skin turgor.

drandruff

Scaling of scalp is accompanied by itching. In severe cases dandruff is on eyebrows.Dandruff causes embarrassment. If it enters eyes, conjunctivitis often develops.Shampoo regularly with medicated shampoo. In severe cases obtain health care provider's advice.

abrasions implications and interventions

Scraping or rubbing away of epidermis that results in localized bleeding and later weeping of serous fluid Infection occurs easily because of loss of protective skin layer. Be careful not to scratch patient with jewelry or fingernails. Wash abrasions with mild soap and water; dry thoroughly and gently. Observe dressing or bandage for retained moisture because it increases risk of infection.

adolescent and skin

Sebaceous glands more active on face & back & genitals, increased sebum leads to acne & oily hair, apocrine glands in armpits & genitals & anal area produce sweat in response to hair follicles

skin rashes implications and interventions

Skin eruptions that result from overexposure to sun or moisture or from allergic reaction (flat or raised, localized or systemic, pruritic or nonpruritic) If skin is scratched continually, inflammation and infection may occur. Rashes also cause discomfort. Wash area thoroughly and apply antiseptic spray or lotion to prevent further itching and aid in healing process. Apply warm or cold soaks to relieve inflammation if indicated.

ticks

Small, gray-brown parasites burrow into skin and suck blood.Ticks transmit several diseases to people. Most common are Rocky Mountain spotted fever, tularemia, and Lyme disease.Using blunt tweezers, grasp tick as close to the head as possible and pull upward with even, steady pressure. Hold until tick pulls out, usually for about 3-4 minutes. Save tick in plastic bag and put in freezer if it is necessary to identify type of tick.

Oral surgery, trauma to mouth, placement of oral airway

These cause trauma to oral cavity with swelling, ulcerations, inflammation, and bleeding

callus

Thickened part of epidermis consists of mass of horny, keratotic cells. Callus is usually flat, painless, and found on undersurface of foot or palm of hand.Local friction or pressure causes callus formation, which causes discomfort when wearing tight shoes. Recommend soft-sole shoes with insoles. Advise patient to wear gloves when using tools or objects that create friction on palmar surfaces. Advise patients, especially with callus formation, not to self-treat but seek interventions from a podiatrist.

ingrown nails

Toenail or fingernail grows inward into soft tissue around nail. Ingrown nail often results from improper nail trimming.Ingrown nails cause localized pain when pressure is applied.Treatment is frequent warm soaks in antiseptic solution and removal of part of nail that has grown into skin. Instruct patient in proper nail-trimming techniques and refer to podiatrist.

Presence of nasogastric or oxygen tubes; mouth breathers

Tubes cause pressure, friction, and drying of mucosa and/or lips.

skin care assessment Qs

Which type of bath do you prefer? • How often and when do you usually bathe? • What kind of soap and lotion do you use? • Have you noticed any skin changes or irritation? • Do you have any known allergies or reactions to soaps, cosmetics, or skin care products?

eye redness

allergies or conjunctivits

what conditions interfere with hand movement?

arthritis, multiple sclerosis, traumatic hand injury

halitosis

bad breath

hair as aging adult

becomes thinner and drier, shampooing is usually performed less frequently.

subcuntaneous layer

blood vessels, nerves, lymph, and loose connective tissue filled with fat cells

morton's neuroma

burning, numbness, and pain of the foot on weight bearing

Presence of external medical devices (e.g., cast, restraint, bandage, dressing)

casts, cloth restraints, bandages, tubing, and orthopedic devices exert pressure or friction against surface of skin

problems with women and nail polish for nail care

chemicals in these products cause excessive nail drynes

causes of alopecia

chemotherapy medications, hormonal changes, or improper hair care practices

importance of saliva

cleanses the mouth, dissolves food chemicals to promote taste, moistens food to facilitate bolus formation, and contains enzymes that start breakdown of starchy foods.

allergies and nasal mucosa

clear watery discharge

assessment oral cavity

color, hydration, texture, and lesions

assessment of skin

color, texture, thickness, turgor, temperature, and hydration.

assessment

conduct a brief history to determine priority areas (e.g., an obese patient's skinfolds, a trauma patient's skin condition) and help you plan individualized hygiene care.

common foot problems older adults

corns, calluses, 825bunions, hammertoes, maceration between toes, and fungal infections

cheilitis

cracked lips

cultural/religious assessment

do you have preferences for how you bathe or clean your teeth? • How comfortable are you with someone helping you, with how we care for you? • In what way can I best help you with your bath, hair care. ...?

xerostoma

dry mouth

If patients have any form of tubing exiting the nose (e.g., nasogastric), observe for:

edema, skin ulceration, localized tenderness, inflammation, drainage, and bleeding

what can cause dry mouth

effects of medications, exposure to radiation, dehydration, and mouth breathing strong sympathetic NS stimulaiton

normal appearance of adult skin

elastic, well hydrated, firm, and smooth.

neonate's skin

epidermis and dermis are bound together loosely, and the skin is very thin. Friction against the skin layers causes bruising.

contact lenses

evaluate to see if patient has these esp in unresponsive or confused state; can cause corneal injury if left on too long

how to care for nails when pt has loss of sensation

file instead of clipping

what is the most common precursor to LL amputations in diabetics

foot ulceration

appearance normal oral mucosa

glistens and is pink, soft, moist, smooth, and without lesions.

dialysis

halitosis, xerostomia (dry mouth), gingivitis, stomatitis, tooth decay, tooth loss, and jaw problems. Causes may include elevated blood sugar, weight control, and smoking

purpose of fatty tissue

heat insulator

epidermis

impermeable layer that prevents entrance of microorganisms. Although microorganisms reside on skin surface and in hair follicles, relative dryness of surface of skin inhibits bacterial growth. Sebum removes bacteria from hair follicles. Acidic pH of skin further retards bacterial growth.

skin male adolescence

increased thickness of the skin with some darkening in color.

glossitis

inflamed tongue

assessment ear

inspection of the auricle and external ear canal (see Chapter 31). Observe for the presence of accumulated cerumen (earwax) or drainage in the ear canal and local inflammation. Question patients about tenderness on palpation or the presence of pain and ask how they usually clean their ears.

what to note in the skin

lesions, dryness indicated by flaking, redness, scaling, and cracking, skin around medical device at least daily (look for edema under these sites)

assessment of self care ability

muscle strength, flexibility, balance, visual acuity, and ability to detect thermal and tactile stimuli; mental status (orientation and cognitive function); respiratory rate and effort, skin color, and pulse rate, dizziness, weakness, or fatigue; note the presence of medical devices such as feeding tubes, IV lines, or urinary catheters. These devices require special hygiene measures; how family can help with care; and how to improve hygiene practice at home

limited mobility that can affect self care

obesity, physical injury, weakness, surgery, pain, prolonged inactivity, medication effect, and presence of medical devices [e.g., indwelling catheter, feeding tube, or IV line

evening (HS) care

offer personal hygiene care that helps patients relax and promotes sleep. "PM care" often includes changing soiled bed linens, gowns, or pajamas; helping patients wash the face and hands; providing oral hygiene; giving a back massage; and offering the bedpan or urinal to nonambulatory patients.

AM care

offering a bedpan or urinal if the patient is not ambulatory, washing the patient's hands and face, and helping with oral care.

importance of sebum

oftens and lubricates the skin and slows water loss from the skin when the humidity is low. bacteriocidal action

Immunosuppression; altered blood clotting

predispose to inflammation and bleeding gums.

importance regular oral hygiene

prevent gingivitis and tooth carries

DM

prone to dryness of mouth, gingivitis, periodontal disease, and loss of teeth.

functions of skin

protection, secretion, excretion, body temperature regulation, and cutaneous sensation

Radiation therapy to head and neck

reduces salivary flow and lowers pH of saliva; leads to stomatitis and tooth decay

immobilization

risk for pressure ulcers.

what is a priority for a patient with sensory deficit

safety

inspect nares for __

signs of inflammation, discharge, lesions, edema, and deformity

skin female adolescence

soft, smooth, and thicker with increased vascularity.

acute and chronic cognitive impairments

stroke, brain injury, psychoses, and dementia

appearance of normal healthy nail bed

transparent, smooth, and convex, with a 823pink nail bed and translucent white tip

Patient unable to bend over or has reduced visual acuity

unable to fully visualize entire surface of each foot, impairing ability to adequately assess condition of skin and nails.

Reduced sensation caused by stroke, spinal cord injury, diabetes, local nerve damage

unable to sense skin injury. Does not receive normal transmission of nerve impulses when applying excessive heat or cold, pressure, friction, or chemical irritants to skin.

altered cognition

unable to verbalize skin care needs. Does not realize effect of pressure or prolonged contact with excretions or secretions, requiring more vigilant assessment.

afternoon care

washing the hands and face, helping with oral care, offering a bedpan or urinal, and straightening bed linen.

appearance healthy teeth

white, smooth, shiny, and properly aligned.

Edentulous

without teech

mouth care assessment questions

• Do you have any mouth pain or toothaches, have you noticed any sores in your mouth, do your gums bleed during brushing or flossing? • Do you wear dentures or a partial plate?

assistance with hygiene

• Do you use any aids to help you with your bath such as grab bars in your tub or shower? • Do you prefer someone of the same gender to help in your hygiene care? • Which parts of the bath, toothbrushing, and foot care can you do for yourself? With which parts of hygiene care do you need help?

tolerance of hygiene assesment Qs

• Does bathing cause any symptoms such as shortness of breath, pain, or fatigue? • What can I do to minimize these symptoms? • Which aspects of bathing or toothbrushing cause discomfort or fatigue?

hair and scalp care assessment Qs

• Have you recently experienced itching of the scalp or noticed flaking or dandruff? • Have you noticed any changes in the texture or thickness of your hair?

foot and nail care assessment Qs

• How do you usually care for your feet and nails? Do you soak your feet? • Do you file or trim your own fingernails and toenails?

implications for patient centered care

• Maintain privacy, especially for women from cultures that value female modesty (e.g., Asian, Muslim, Hispanic, Nigerian) (Giger, 2013). • Avoid uncovering the lower torso and exposing the arms of Middle Eastern and East Asian women. • Allow family members to participate in care if desired by adapting the schedule of hygiene activities. • Provide gender-congruent caregivers as needed or requested. • 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, 2013). • Do not cut or shave hair without prior discussion with patient or family because of cultural or religious beliefs (e.g., Muslims) (Giger, 2013). • Be aware that toileting practices vary by culture (Giger, 2013). • Recognize that different cultures (e.g., Hindu, Asians, Hispanics) have preferences about hot and cold water and their effects on healing or diseases