Hygiene

Providing a shaving

- Fill bath basin with comfortably warm (100°F to <120° to 125°F) water. - Press a warm washcloth on the patient's skin to soften the hair. - Dispense shaving cream into palm of hand. Rub hands together, then apply to area to be shaved in a layer approximately 0.5 in thick. -pull the skin taut at the area to be shaved. Using a smooth stroke, begin shaving. If shaving the face, shave with the direction of hair growth in downward, short strokes -If shaving a leg, shave against the hair in upward, short strokes - Remove residual shaving cream with a wet washcloth. - If patient requests, apply aftershave or lotion to area shaved.

PROVIDING FOOT CARE

- Bathe the feet thoroughly in a mild soap and tepid water solution. Avoid soaking the feet. - Rinse the feet to remove soap residue that can dry and irritate the skin. - Dry feet thoroughly, including the area between the toes. - Apply a moisturizer to feet if they are dry.

Considerations for foot care on Patients with diabetes andperipheral artery disease

- Encourage patients with these diseases to see a podiatrist for treatment related to bunions, corns, or calluses - apply moisturizer on the tops andbottoms of the feet to keep the skin soft. These patients should sprinkle talcum powder or cornstarch between the toes to keep the skin dry

Pt educucation foot care

- Teach patients to avoid wearing knee-high stockings, and to not sit with the knees crossed -Advise patients to wear cotton socks - Prop the feet up above the level of the hips a few minutes several times a day if the feet swell.

Nursing Process: Assessment

- Use interview and assessment skills to collect date on pt abilities - determine whether the patient has the knowledge, attitude, skills, and resources to care for the skin and mucous membranes.

Who needs to be take extra precautions and wear sunscreen?

- people who need to be especially careful in the sun are those who have pale skin; blond, red, or light brown hair; those who have been treated for skin cancer; or those who have a family member who's had skin cancer -patients who are prescribed certain medications that increase sun sensitivity, such as furosemide, glyburide, and quinolone antibiotics (e.g., ciprofloxacin).-

Providing Care for Body Piercing

-Clean the jewelry and the piercing site of all crust and debris. Rinse the site with warm water and use a cotton swab to gently remove any crusting. Rinse well. Remove gloves. Perform hand hygiene. -Advise patients to avoid the use of alcohol, peroxide, and ointments at the site. -Oral piercing aftercare includes rinsing with an antibacterial, alcoholfree mouthwash for 30 to 60 seconds after meals and at bedtime. The patient should brush the teeth with a new, soft-bristled toothbrush. - Advise patients to avoid oral tobacco use. -Most piercings take 6 to 8 weeks to heal, but some may take several months or a year to heal

Skill: Brushing Teeth

1- Moisten Toothbrush and apply toothpaste 2- place toothbrush 45 degree angle to gum line and brush from gumline to crown of each tooth brushouter and inner surface 3- brush tongue 4- have pt rinse mouth 5- assist with flossing 6- 18 inches of floss and wrap around middle finger keeping 1-1.5 inches 7- insert between teeth moving up and down 8- Rinse mouth 9- offer mouth wash 10- offer lip balm or petroleum jelly

shower chair

A chair with safety features used for clients who need to sit down in the shower or bath.

Providing Ear Care

After the ears are washed, dry them carefully with a soft towel so that water and cerumen (wax) are removed by capillary action. -

HOUR OF SLEEP CARE (HS 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.

What factors affect hygiene?

Culture Socioeconomic Class Spiritual Practices Developmental Level Health State Personal Preference

DEODORANTS AND ANTIPERSPIRANTS

Deodorants mask odor, and antiperspirants are intended to reduce the amount of perspiration. Advise patients to use antiperspirants and deodorants with care and according to directions to prevent skin irritation.

►Making an Unoccupied Bed

Disconnect all call and tubes fold reusable linens like sheets, blankets, or spread push sheet open to the center of the mattress pulling from the corners

Providing Scheduled Hygiene Care

EARLY MORNING CARE MORNING CARE (AM CARE) AFTERNOON CARE (PM CARE) HOUR OF SLEEP CARE (HS CARE) AS NEEDED CARE (PRN CARE)

Nursing Process: Diagnosis

Each nursing diagnosis statement identifies a patient problem and suggests expected patient outcomes - Each nursing diagnosis statement identifies a patient problem and suggests expected patient outcomes -examples of appropriate nursing diagnoses: Bathing Self-Care Deficit related to postoperative weakness Impaired Oral Mucous Membrane related to dehydration and altered nutrition Impaired Social Interaction related to negative body image: acne

AFTERNOON CARE (PM CARE)

Ensure that the patient is comfortable after lunch and offer assistance with toileting, handwashing, and oral care. Straighten the bed or help someone to reposition for comfort.

complete bed bath

For patients in critical and long-term care settings who are unable to bathe themselves - using either a commercial bag bath or cleansing pack. -

AS NEEDED CARE (PRN CARE)

In addition to the standard care some patients may need prn care such as repositioning, more frequent oral care, or more frequent bed changes for sweating.

Perineal care for uncircumcised male

In an uncircumcised male patient (teenage or older), retract the foreskin (prepuce) while washing the penis. Pull the uncircumcised male patient's foreskin back into place over the glans penis to prevent constriction of the penis, which may result in edema and tissue injury. It is not recommended to retract the foreskin for cleaning during infancy and childhood, as injury and scarring could occur

Nursing Process: Evaluating

Indicators that can be used to determine outcome achievement include the following: - Level of patient's participation in hygiene program - Elimination of, reduction in, or compensation for factors interfering with the patient's independent execution of hygiene measures; for example, weakness, decreased motivation, and lack of knowledge - Changes related to specific skin problems; for example, healing of skin lesions

pediculosis

Infestation with lice

When should a pt not apply deodorants or antiperspirants?

Keep in mind that these products are contraindicated in some situations, such as before mammography and during the postoperative period for a patient who has had a mastectomy

When performing the physical assessment of the oral cavity, examine the following:

Lips: color, moisture, lumps, ulcers, lesions, and edema Buccal mucosa: color, moisture, lesions, nodules, and bleeding Color of the gums and surface of the gums: lesions, bleeding, and edema Teeth: any loose, missing, or carious (decayed) teeth. Note the presence and condition of dentures or other orthodontic devices Tongue: color, symmetry, movement, texture, and lesions Hard and soft palates: intactness, color, patches, lesions, and petechiae (pinpoint round, red, purple, or brown spots that result from bleeding) Oropharynx: movement of the uvula and condition of tonsils, if present

Assisting the Patient With Oral Care

Lower side rail and place pt in sitting position or turn to the side - Moisten toothbursh - place brush 45 degree angle of gum line Brush outer and inner surface back and forth across biting surface brush tongue gently Have pt rinse

Do we cut a pt nails?

No

What pts would be at risk for alterations with oral health

Patients with mental health problems are also at risk for alterations in oral health

When providing a bed bath starting bed position

Raise side rails

When providing a bed bath and having them take off gown...

Rehang container and check drip rate

When done providing a bed bath bed position

Side rails up and bed in lowest position

TEACH PT ABOUT SKIN CARE

Teaching can be taught during assessment, and care procedure. • Ways to prevent or reduce skin problems • Teaching addressing topics: diabetic foot care, acne, rash, dry skin

caries

The decay of teeth with the formation of cavities

therapeutic bath

a bath given for physical effects, such as to soothe irritated skin or to promote healing of an area (e.g., the perineum); two common types are the sitz bath and the medicated bath

A nurse caring for patients in a critical care unit knows that providing good oral hygiene is an essential part of nursing care. What are some of the benefits of providing this care? Select all that apply. a. It promotes the patient's sense of well-being. b. It prevents deterioration of the oral cavity. c. It contributes to decreased incidence of aspiration pneumonia. d. It eliminates the need for flossing. e. It decreases oropharyngeal secretions. f. It helps to compensate for an inadequate diet.

a, b, c. Adequate oral hygiene is essential for promoting the patient's sense of well-being and preventing deterioration of the oral cavity. Diligent oral hygiene care can also improve oral health and limit the growth of pathogens in oropharyngeal secretions, decreasing the incidence of aspiration pneumonia and other systemic diseases. Oral care does not eliminate the need for flossing, decrease oropharyngeal secretions, or compensate for poor nutrition.

A nurse is providing foot care for patients in a long-term care facility. Which actions are recommended guidelines for this procedure? Select all that apply. a. Bathe the feet thoroughly in a mild soap and tepid water solution. b. Soak the feet in warm water and bath oil. c. Dry feet thoroughly, including the area between the toes. d. Use an alcohol rub if the feet are dry. e. Use an antifungal foot powder if necessary to prevent fungal infections. f. Cut the toenails at the lateral corners when trimming the nail

a, c, e. The following are recommended guidelines for foot care: bathe the feet thoroughly in a mild soap and tepid water solution; dry feet thoroughly, including the area between the toes; and use an antifungal foot powder if necessary to prevent fungal infections. The nurse should avoid soaking the feet, use moisturizer if the feet are dry, and avoid digging into or cutting the toenails at the lateral corners when trimming the nails.

Nurses performing skin assessments on patients must pay careful attention to cleanliness, color, texture, temperature, turgor, moisture, sensation, vascularity, and lesions. Which guidelines should nurses follow when performing these assessments? Select all that apply. a. Compare bilateral parts for symmetry. b. Proceed in a toe-to-head systematic manner. c. Use standard terminology to report and record findings. d. Do not allow data from the nursing history to direct the assessment. e. Document only skin abnormalities on the patient record. f. Perform the appropriate skin assessment when risk factors are identified.

a, c, f. When performing a skin assessment, the nurse should compare bilateral parts for symmetry, use standard terminology to report and record findings, and perform the appropriate skin assessment when risk factors are identified. The nurse should proceed in a head-to-toe systematic manner, and allow data from the nursing history to direct the assessment. When documenting a physical assessment of the skin, the nurse should describe exactly what is observed or palpated, including appearance, texture, size, location or distribution, and characteristics of any findings.

A nurse is teaching a student nurse how to cleanse the perineal area of both male and female patients. What are accurate guidelines when performing this procedure? Select all that apply. a. For male and female patients, wash the groin area with a small amount of soap and water and rinse. b. For a female patient, spread the labia and move the washcloth from the anal area toward the pubic area. c. For male and female patients, always proceed from the most contaminated area to the least contaminated area. d. For male and female patients, use a clean portion of the washcloth for each stroke. e. For a male patient, clean the tip of the penis first, moving the washcloth in a circular motion from the meatus outward. f. In an uncircumcised male patient, do not retract the foreskin (prepuce) while washing the penis.

a, d, e. Wash and rinse the groin area (both male and female patients) with a small amount of soap and water, and rinse. For male and female patients, always proceed from the least contaminated area to the most contaminated area and use a clean portion of the washcloth for each stroke. For a male patient, clean the tip of the penis first, moving the washcloth in a circular motion from the meatus outward. For a female patient, spread the labia and move the washcloth from the pubic area toward the anal area. In an uncircumcised male patient (teenage or older), retract the foreskin (prepuce) while washing the penis.

A nurse is caring for an adolescent with severe acne. Which recommendations would be most appropriate to include in the teaching plan for this patient? Select all that apply. a. Wash the skin twice a day with a mild cleanser and warm water. b. Use cosmetics liberally to cover blackheads. c. Use emollients on the area. d. Squeeze blackheads as they appear. e. Keep hair off the face and wash hair daily. f. Avoid sun-tanning booth exposure and use sunscreen

a, e, f. Washing the skin removes oil and debris, hair should be kept off the face and washed daily to keep oil from the hair off the face, and sunbathing should be avoided when using acne treatments. Liberal use of cosmetics and emollients can clog the pores. Squeezing blackheads is always discouraged because it may lead to infection.

A nurse is removing rigid gas-permeable (RGP) contact lenses from the eyes of a patient who is unable to assist with removal. The nurse notices that one of the lenses is not centered over the cornea. What would be the nurse's first action in this procedure? a. Apply gentle pressure on the lower eyelid to center the lens prior to removing it. b. Move the eyelids toward one another to cause the lens to slide out between the eyelids. c. Do not attempt to remove the lens as it should only be removed by an eyecare specialist. d. Have the patient look forward, retract the lower lid, and move the lens down on the sclera.

a. If the lens is not centered over the cornea, the nurse should apply gentle pressure on the lower eyelid to center the lens, gently pull the outer corner of the eye toward the ear, position the hand below the lens to receive it, and ask the patient to blink. Moving the eyelids toward one another to cause the lens to slide out between the eyelids is a later step in the procedure. Having the patient look forward, retracting the lower lid and moving the lens down on the sclera occurs during removal of soft contact lenses. It is not necessary to call in an eyecare specialist unless there is damage to the eye.

MORNING CARE (AM CARE)

after breakfast, complete morning care, which includes: bathing, oral care, toileting, mouth care, back massage, special skin care measure (decubitus ulcer or fungal infection), hair care, cosmetics, dressing, and positioning. This is the time to change the bed linens and tidy the bedside area also.

Gingivitis

an inflammation of the gingiva, the tissue that surrounds the teeth.

plaque

an invisible, destructive, bacterial film that builds up on everyone's teeth and eventually leads to the destruction of tooth enamel

A nurse caring for patients in a skilled nursing facility performs risk assessments on the patients for foot and nail problems. Which patients would be at a higher risk? Select all that apply. a. A patient who is taking antibiotics for chronic bronchitis b. A patient diagnosed with type II diabetes c. A patient who is obese d. A patient who has a nervous habit of biting his nails e. A patient diagnosed with prostate cancer f. A patient whose job involves frequent handwashing

b, c, d, f. Variables known to cause nail and foot problems include deficient self-care abilities, vascular disease, arthritis, diabetes mellitus, history of biting nails or trimming them improperly, frequent or prolonged exposure to chemicals or water, trauma, ill-fitting shoes, and obesity.

A nurse assisting with a patient bed bath observes that an older female adult has dry skin. The patient states that her skin is always "itchy." Which nursing action would be the nurse's best response? a. Bathe the patient more frequently. b. Use an emollient on the dry skin. c. Massage the skin with alcohol. d. Discourage fluid intake.

b. An emollient soothes dry skin, whereas frequent bathing increases dryness, as does alcohol. Discouraging fluid intake leads to dehydration and, subsequently, dry skin.

A nurse is scheduling hygiene for patients on the unit. What is the priority consideration when planning a patient's personal hygiene? a. When the patient had his or her most recent bath b. The patient's usual hygiene practices and preferences c. Where the bathing fits in the nurse's schedule d. The time that is convenient for the patient care assistant

b. Bathing practices and cleansing habits and rituals vary widely. The patient's preferences should always be taken into consideration, unless there is a clear threat to health. The patient and nurse should work together to come to a mutually agreeable time and method to accomplish the patient's personal hygiene. The availability of staff to assist may be important, but the patient's preferences are a higher priority.

A nurse is caring for a 25-year-old male patient who is comatose following a head injury. The patient has several piercings in his ears and nose. The piercing in his nose appears to be new and is crusted and slightly inflamed. Which action would be appropriate when caring for this patient's piercings? a. Do not remove or wash the piercings without permission from the patient. b. Rinse the sites with warm water and remove crusts with a cotton swab. c. Wash the sites with alcohol and apply an antibiotic ointment. d. Remove the jewelry and allow the sites to heal over.

b. When providing care for piercings, the nurse should perform hand hygiene and put on gloves, then cleanse the site of all crusts and debris by rinsing the site with warm water, removing the crusts with a cotton swab. The nurse should then apply a dab of liquid-medicated cleanser to the area, turn the jewelry back and forth to work the cleanser around the opening, rinse well, remove gloves, and perform hand hygiene. The nurse should not use alcohol, peroxide, or ointments at the site or remove the piercings unless it is absolutely necessary (e.g., when an MRI is ordered.)

periodontal disease symptoms

bleeding gums; swollen, red, painful gum tissues; receding gum lines with the formation of pockets between the teeth and gums; pus that appears when gums are pressed; and loose teeth

A nurse is assisting an older adult with an unsteady gait with a tub bath. Which action is recommended in this procedure? a. Add bath oil to the water to prevent dry skin. b. Allow the patient to lock the door to guarantee privacy. c. Assist the patient in and out of the tub to prevent falling. d. Keep the water temperature very warm because older adults chill easily

c. Safe nursing practice requires that the nurse assist a patient with an unsteady gait in and out of the tub. Adding Alpha Keri oil to the bath water is dangerous for this patient because it makes the tub slippery. Although privacy is important, if the patient locks the door, the nurse cannot help if there is an emergency. The water should be comfortably warm at 43° to 46°C. Older adults have an increased susceptibility to burns due to diminished sensitivity.

A nurse is assisting a patient with dementia with bathing. Which guideline is recommended in this procedure? a. Shift the focus of the interaction to the "process of bathing." b. Wash the face and hair at the beginning of the bath. c. Consider using music to soothe anxiety and agitation. d. Do not perform towel baths or alternate forms of bathing with which the patient is unfamiliar.

c. The nurse should consider the use of music to soothe anxiety and agitation. The nurse should also shift the focus of the interaction from the "task of bathing" to the needs and abilities of the patient, and focus on comfort, safety, autonomy, and self-esteem, in addition to cleanliness. The nurse should wash the face and hair at the end of the bath or at a separate time. Water dripping in the face and having a wet head are often the most upsetting parts of the bathing process for people with dementia. The nurse should also consider other methods for bathing. Showers and tub baths are not the only options in bathing. Towel baths, washing under clothes, and bathing "body sections" one day at a time are other possible options.

A nurse is about to bathe a female patient who has an intravenous access in place in her forearm. The patient's gown, which does not have snaps on the sleeves, needs to be removed prior to bathing. What is the appropriate nursing action? a. Temporarily disconnect the IV tubing at a point close to the patient and thread it through the gown sleeve. b. Cut the gown with scissors to allow arm movement. c. Thread the bag and tubing through the gown sleeve, keeping the line intact. d. Temporarily disconnect the tubing from the IV container, threading it through the gown.

c. Threading the bag and tubing through the gown sleeve keep the system intact. Opening an IV line, even temporarily, causes a break in a sterile system and introduces the potential for infection. Cutting a gown is not an alternative except in an emergency.

patient uses a hearing aid...

check the batteries routinely and clean the earpieces or ear mold daily with mild soap and water.

PROVIDING PERINEAL CARE male

clean the tip of the penis first, moving the washcloth in a circular motion from the meatus outward Wash the shaft of the penis using downward strokes toward the pubic area

What thing to check when assessing a pt skin

cleanliness - color, - texture - temperature - turgor - moisture - sensation - vascularity - any lesions

A nurse is performing oral care on a patient who is in traction. The nurse notes that the mouth is extremely dry with crusts remaining after the oral care. What should be the nurse's next action? a. Make a recommendation for the patient to see an oral surgeon. b. Report the condition to the primary care provider. c. Gently scrape the oral cavity with a tongue depressor. d. Increase the frequency of the oral hygiene and apply mouth moisturizer to oral mucosa.

d. If the mouth is extremely dry with crusts that remain after oral care provided, the nurse should increase frequency of oral hygiene, apply mouth moisturizer to oral mucosa, and monitor fluid intake and output to ensure adequate intake of fluid. It is not necessary to report this condition prior to providing the interventions mentioned above. The crusts should not be scraped with a tongue depressor.

A patient has an eye infection with a moderate amount of discharge. Which action is an appropriate step for the nurse to perform when cleaning this patient's eyes? a. Use hydrogen peroxide on a clean washcloth to wipe the eyes. b. Wipe the eye from the outer canthus to the inner canthus. c. Position the patient on the opposite side of the eye to be cleansed. d. Cleanse the eye using a different section of the cleaning cloth for each stroke until clean.

d. When cleaning the eyes, the nurse should wear gloves during the cleaning procedure, use water or normal saline, and a clean washcloth or compress to clean the eyes. The nurse should dampen a cleaning cloth with the solution of choice and wipe once while moving from the inner canthus to the outer canthus of the eye. This technique minimizes the risk for forcing debris into the area drained by the nasolacrimal duct. The nurse should turn the cleaning cloth and use a different section for each stroke until the eye is clean.

variables known to cause skin problems

deficient self-care abilities, immobility, malnutrition, decreased hydration, decreased sensation, sun exposure, vascular problems (altered tissue perfusion or venous return), or the presence of irritants (body secretions or excretions on the skin, other chemicals, mechanical devices

variables known to cause nail and foot problems

deficient self-care abilities, vascular disease, arthritis, diabetes mellitus, history of biting nails or trimming them improperly, frequent or prolonged exposure to chemicals or water, trauma, ill-fitting shoes, or obesity

Podiatrists must be consulted with clients with:

diabetes peripheral vascular disease long term steroid therapy anticoagulant therapy

When making an occupied bed...

disconnect call bell or any tubes from bed linens

When removing soiled linens...

do not place on furniture or floor do not place against clothes

tartar

hard deposit on the teeth near the gum line formed by plaque buildup and dead bacteria

chlorhexidine gluconate

has been shown to reduce colonization of skin with pathogens and is an important measure utilized by institutions in an attempt to decrease health care-associated infections (HAIs)

Periodontitis or periodontal disease

is a marked inflammation of the gums that also involves degeneration of the dental periosteum (tissues) and bone.

plaque-fighting program includes

limiting sweet snacks such as soft drinks, candy, gum, jams, and jellies between meals; thorough cleansing of the teeth; and regular dental checkups. The use of antiplaque fluoride toothpastes, mouth rinses, and flossing also help prevent dental caries.

Nursing Process: Planning

measures to assist the patient to develop or maintain hygiene practices that contribute to a sense of well being. - examples of appropriate outcome: verbalize importance of good teeth-brushing habits, fluoride use, and regular dental examinations. demonstrate proper use and care of visual or auditory aids.

PROVIDING PERINEAL CARE female

move the washcloth from the pubic area toward the anal area to prevent carrying organisms from the anal area back over the genital area

Impairment of the musculoskeletal system that can interfere with hygiene

muscle weakness, decreased range of motion, impaired balance, fatigue, and/or lack of coordination

partial bath

only those parts of the body that cause discomfort if not bathed. These include the hands, face, axillae, back, and perineal area. -

tub bath

patient is submerged, more thorough wash, can require some assistance from the RN - type of bath is appropriate for independent patients and for dependent patients if a lifting device such as a Hoyer lift is available to help with positioning the patient in the tub

variables known to cause oral problems

poor nutrition or excessive intake of refined sugars, family history of periodontal disease, or ingestion of chemotherapeutic agents that produce oral lesions

Providing Oral Care for the Dependent Patient reminder

position pt head to allow for return of water. if using regular toothbrush then use suction catheter to remove water and cleanser

When performing general hygiene measures...

respect the patient's personal preferences and encourage as much self-care as the patient can perform.

Nursing Process: Implementation

respect the patient's personal preferences and encourage as much self-care as the patient can perform. Nurses should implement interventions to meet the patient's need for privacy, and promote physiologic and psychological wellness. Examples: Providing Scheduled Hygiene Care Assisting With Bathing and Skin Care

Patients at increased risk for oral problems

seriously ill, comatose, dehydrated, confused, depressed, or paralyzed. Patients with mental health problems are also at risk for alterations in oral health - Patients who are mouth breathers, those who can have no oral intake of nutrition or fluids, those with nasogastric tubes or oral airways in place, and those who have had oral surgery are also at increased risk

EARLY MORNING CARE

shortly after the patient wakes up, assisting them with toileting and then providing comfort measures to refresh the patient and prepare them for breakfast, including washing the face and hands and providing mouth care.

7 Agents commonly used on the skin:

soapchlorhexidine gluconate (CHG) Bath oil Skin cream/lotion powder deodorant antiperspirant

3 functions of hair brushing:

stimulates the circulation of blood in the scalp distributes oil along the hair shaft helps arrange the hair

variables known to cause perineal or vaginal problems

urinary or fecal incontinence, an indwelling Foley catheter, childbirth, douching, rectal or genital surgery, and diseases such as urinary tract infection, diabetes mellitus, and certain sexually transmitted infections (STIs; e.g., herpes).

BACK RUBS

• After bath/ general conditioner to relive muscle tension and promote relaxation • Observe the skin of breakdown improves circulation • Decreases anxiety, pain and distress, • Improve sleep quality/ means of communication via touch • 4-6 mins w. warm lotion

PERINEAL GUIDELINES FEMALE

• Assemble supplies provide privacy • Explain procedure, hand hygiene, don gloves • Wash and rinse groin area, small amount mid unscented soap • Female: spread labia, move wash cloth from pubic down to anal to prevent transferring organism Least contaminated to most. Use clean portion of wash cloth for each stroke] • Change wash cloth with each stroke

PERINEAL CARE GENERAL

• Assemble supplies provide privacy • Explain procedure, hand hygiene, don gloves • Wash and rinse growing area, small amount mid unscented soap • Dry clean areas apply emollient as indicated (AVOID powder) • Turn pt on side continue cleansing anal area least contaminated to most female vagina to anal

EARLY MORNING CARE AFTER PT AWAKES

• Assist with toileting • Refresh pt prepare for brkfst • Prepare for diagnostic test • Wash face handws and provide mouth care

Who should not use Sun protectant

• Avoid sunscreen on infants 6month younger • 6 month younger keep in shade

BED SAFETY/ COMFORT BEFORE LEAVING BEDSIDE

• Bed in lowest position • Bed position safe for pt • Bed controls are functioning/ electrically safe • Call light functioning and within reach • Side rails raised if indicated • Wheels or casters are locked

PERINEAL GUIDELINES MALE

• Clean tip of penis first, moving wash cloth in circular motion from meatus outward. • Wash shaft of penis using downward strokes toward pubic area • Rinse well • If uncircumcised foreskin back into place over glans to prevent constriction of penis which may result in edema or tissue injury. • Wash rinse scrotum handle with care because it is sensitive • Do not move back in children • Change wash cloth with each stroke

PROVIDING FINGERNAIL CARE

• File nail straight across then round tips in gentle curve. DN trim far down the sides • Remove hangnails, cut them off avoid injuring tissue with scissors • Push back cuticle off nail when pliable and soft after washing with warm water • Push back cuticle with blunt instrument or terry cloth • Apply emollient to cuticle to prevent hangnail • Clean under nails with blunt instrument be careful

PROMOTE BED COMFORT

• Linens are always clean free of crumbs and wrinkles • Pt comfy and warm • Pressure areas protected from rough sheets , hem edges water repellent material

PRN CARE

• Offer individual hygiene care • Some pt require oral care if diabetic • Diaphoretic pt sweat a lot need lining change clothing change

HR OF SLP CARE (HS CARE)

• Toileting • wash face/hands./.oral care • Back massage • Soiled lining / clothing • positioning

MORNING AM CARE

• Toileting, oral care • Bathing • Back massage • Skin care (pressure ulcer) • Hair care (shaving) • Cosmetics, • Positioning for comfort • Change bed linens

SUN PROTECTION MEASURES

• Use broad spectrum sunscreen sun protection factor15 or higher regularly • Reaply every 2 hours, more often if sweating or swimming • Limit time in sun between 10-2 • Where clothing to cover skin • Avoid sunscreen on infants 6month younger • 6 month younger keep in shade

SITZ BATHS

• Used to clean and soother perineal and anal areas. • Apply tepid or warm water to pelvic, perineal, or rectal by sitting in a tub, chair,or basin w. enough water to reach umbilicus. • Special basin fit on toilet/ design so pt butt can fit into deep seat filled with water. • 93-99F . The purpose of the bath is to apply heat for 15 mins • Use to produce relaxation and or promote healing to a wound by cleansing it • Monitor for signs of weakness, fatigue, discontinue if faint, pallor, rapid pulse or nausea.

AFTERNOON CARE PM

• Visiting • Testing • Therapies • Resting • Lunch • Toileting • Wash hands • oral

LICE CARE/ TEACHING

• Whos at risk? ages 3-11 • How do you become infected? • Signs symp/ tickling, scalp itching sores, irritability, difficulty sleeping • Treatment pendiculicide, machine wash everything worn 2 days prior to treatment w hot water 5 min grater than 128 degrees F. • Soak combs and brushes 5-10 min 130 degree F

GUIDELINES TO SHAVING

• With one hand pull skin taut at the area to be shaved using smooth stroke, begin shaving • If shaving face stroke in the direction the hair grow downward short strokes • If shaving leg shave against the grain going up. • Nvr trim or shave a mustache without consent • Blade razors give closer shave • Electrical razor recommended when pt receiving anticoagulant therapy/ has bleeding disorder/ • Shaving after warm bath makes it easier