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  • Figure 33-1 Tub/shower seat in the home. Figure 33-2 Hand bars on the sides of the bathtub. Figure 33–3 A shower chair.
  • Remove top sheet from under the bath blanket.
  • Draping the client for perineal-genital care. Female genitals. Male genitals.
  • The sulcular technique: Place the bristles at a 45-degree angle with the tips of the outer bristles under the gingival margins. Brushing from the sulcus to the crown of the teeth. Brushing the biting surfaces.
  • Stretching the floss between the third finger of each hand. Flossing the lower teeth by using the index fingers to stretch the floss.
  • Removing the top dentures by first breaking the suction. Inserting the dentures at a slight angle.
  • Position of client and placement of curved basin when providing special mouth care to an unconscious patient.
  • Shampooing the hair of a client confined to bed. Note the shampoo basin and the receptacle below.
  • Figure 33-11 Removing hard contact lenses.
    Figure 33-12 Storing lenses. Place the first lens in its designated cup in the storage case before removing the second lens. This avoids mixing up two potentially different lenses.
    Figure 33-13 Removing a soft lens by pinching it between the pads of the thumb and index finger.
  • Figure 33-14 Removing an artificial eye by retracting the lower eyelid and exerting slight pressure below the eyelid.
    Figure 33-15 Holding an artificial eye between the thumb and index finger for insertion.
  • Figure 33-16 A, A behind-the-ear hearing aid. B, A behind-the-ear hearing aid attached to glasses.
  • Figure 33-17 A, An in-the-ear hearing aid. B, Small hearing aid in ear canal. C, Large hearing aid in ear canal.
  • Transcript

    • 1. Kozier & Erb's Fundamentals of Nursing, 8e Berman, Snyder, Kozier, Erb Copyright 2008 by Pearson Education, Inc. Chapter 33 Hygiene
    • 2. Copyright 2008 by Pearson Education, Inc. Learning Outcomes 1. Describe hygienic care that nurses provide to clients. 2. Identify factors influencing personal hygiene. 3. Identify normal and abnormal assessment findings while providing hygiene care. 4. Apply the nursing process to common problems related to hygienic care of the skin, feet, nails, mouth, hair, eyes, ears, and nose. 5. Identify the purposes of bathing. 6. Describe various types of baths.
    • 3. Copyright 2008 by Pearson Education, Inc. Learning Outcomes 7. Explain specific ways in which nurses help hospitalized clients with hygiene. 8. Describe steps for identified hygienic-care procedures. 9. Identify steps in removing contact lenses and inserting and removing artificial eyes. 10. Describe steps for removing, cleaning, and inserting hearing aids. 11. Identify safety and comfort measures underlying bed- making procedures.
    • 4. Copyright 2008 by Pearson Education, Inc. Pretest • Use your clickers to complete the following pretest.
    • 5. Copyright 2008 by Pearson Education, Inc. Question 1 The client is unresponsive and requires total care. Prior to providing oral care, the nurse should assess for which of the following? 1. Presence of pain 2. Condition of the skin 3. Gag reflex 4. Range of motion
    • 6. Copyright 2008 by Pearson Education, Inc. Rationales 1 1. More appropriate prior to bathing the client. 2. More appropriate prior to bathing the client. 3. Correct. The client will be positioned in a sidelying position with the head of the bed lowered because the client is at risk for aspiration. The absence of gag reflex lets the nurse know that the client has no natural defense (cough) and is at a higher risk for aspiration. 4. More appropriate prior to bathing the client.
    • 7. Copyright 2008 by Pearson Education, Inc. Question 2 The client is in surgery and will be returning to his bed via a stretcher. The nurse plans ahead by making which type of bed and placing the bed in which position? 1. An open bed in low position 2. An occupied bed in low position 3. A closed bed in high position 4. A surgical bed in high position
    • 8. Copyright 2008 by Pearson Education, Inc. Rationales 2 1. Incorrect. 2. Incorrect. 3. Incorrect. 4. Correct. Both the placement of the linens for a surgical bed and placing the bed in a high position facilitate the client’s transfer from a stretcher into the bed.
    • 9. Copyright 2008 by Pearson Education, Inc. Question 3 The nurse is observed the UAP perform perineal care for a client. Which of the following actions indicates that further teaching is required? 1. Uses a clean portion of the washcloth for each stroke. 2. Wipes from the pubis to the rectum. 3. Uses clean gloves. 4. Does not retract the foreskin.
    • 10. Copyright 2008 by Pearson Education, Inc. Rationales 3 1. This is appropriate. 2. This is appropriate. 3. This is appropriate. 4. Correct. It is important to retract the foreskin to remove the smegma that collects under the foreskin and can cause bacterial growth.
    • 11. Copyright 2008 by Pearson Education, Inc. Question 4 The nurse is discussing foot care with a client who was recently diagnosed with diabetes. Which of the following statements indicates a need for further teaching? 1. “I am going to use a mirror to check my feet.” 2. “I enjoy walking barefoot around the house.” 3. “I will file my nails.” 4. “I will increase the time that I wear new shoes each day.”
    • 12. Copyright 2008 by Pearson Education, Inc. Rationales 4 1. This is appropriate. 2. Correct. The client needs to avoid walking barefoot as that could cause injury which may result in an infection. Also, neurological impairment is likely which may result in decreased sensation. The client would be unaware of an injury. 3. This is appropriate. 4. This is appropriate.
    • 13. Copyright 2008 by Pearson Education, Inc. Question 5 The client experiencing labored, shortness of breath has a respiratory rate of 28. The bed is currently in the flat position. The best nursing intervention includes putting the bed in which of the following positions? 1. Fowler’s 2. Semi-Fowler’s 3. Trendelenburg 4. Reverse Trendelenburg
    • 14. Copyright 2008 by Pearson Education, Inc. Rationales 5 1. Correct. Fowler’s is a semi-sitting position which should ease the client’s breathing. 2. The HOB in semi-Fowler’s is lower. 3. The HOB is lowered in the Trendelenburg position. 4. The HOB is raised in the reverse Trendelenburg position, it is a straight tilt and may not be as comfortable as Fowler’s.
    • 15. Copyright 2008 by Pearson Education, Inc. Hygienic Care • Involves care of: – Skin – Hair – Nails – Teeth – Oral and nasal cavities – Eyes – Ears – Perineal-genital area
    • 16. Copyright 2008 by Pearson Education, Inc. Types of Hygienic Care • Early morning-offer urinal/bedpan, wash face & hands, & give oral care. • Morning – after breakfast, bedpan/urinal, bath/shw, perineal care, back massage & oral, nail & hair care. • Hours of sleep (HS) or PM- bedpan/urinal, washing hands & face, oral care, & backrub. • As needed (prn)- care as needed
    • 17. Copyright 2008 by Pearson Education, Inc. Factors Influencing Personal Hygiene • Culture-some bath daily, some weekly. Body odor accepted in some cultures, privacy vs communal • Religion-ceremonial washings • Environment-financial limitations
    • 18. Copyright 2008 by Pearson Education, Inc. Factors Influencing Personal Hygiene • Developmental level-children learn at their ability • Health and energy-illness, motivation • Personal preference- shower vs bath, AM vs PM
    • 19. Copyright 2008 by Pearson Education, Inc. Figure 33-9 An African American’s hair styled with braids.
    • 20. Copyright 2008 by Pearson Education, Inc. Figure 33-10 Shaving in the direction of hair growth.
    • 21. Copyright 2008 by Pearson Education, Inc. Bed-Making • Provide smooth, wrinkle-free bed foundation • Place the bedside table/overbed table within reach • Leave the bed in the high position if returning by stretcher • Leave in the low position if returning to bed after being up
    • 22. Copyright 2008 by Pearson Education, Inc. Bed-Making • When turning the client to the side while making an occupied bed, raise the side rail nearest the client • To ensure continued safety of the client after making an occupied bed: – Raise the side rails – Place the bed in the low position – Put items used by the client within easy reach – Attach the signal cord
    • 23. Copyright 2008 by Pearson Education, Inc. Figure 33-18 Mitering the corner of a bed. A
    • 24. Copyright 2008 by Pearson Education, Inc. Figure 33-18 (continued) Mitering the corner of a bed. B
    • 25. Copyright 2008 by Pearson Education, Inc. Figure 33-18 (continued) Mitering the corner of a bed. C
    • 26. Copyright 2008 by Pearson Education, Inc. Figure 33-18 (continued) Mitering the corner of a bed. D
    • 27. Copyright 2008 by Pearson Education, Inc. Figure 33-18 (continued) Mitering the corner of a bed. E
    • 28. Copyright 2008 by Pearson Education, Inc. Abnormal Findings of the Skin K744 • Abrasion- • Excessive dryness - • Ammonia dermatitis - • Acne - • Erythema • Hirsutism
    • 29. Copyright 2008 by Pearson Education, Inc. Abnormal Findings of the Feet • Excessive dryness • Areas of inflammation or swelling • Fissures • Scaling and cracking of skin • Plantar warts • Swelling and pitting edema • Weak or absent pulses • Cool skin temperature in one or both feet
    • 30. Copyright 2008 by Pearson Education, Inc. Abnormal Findings of the Nails • Spoon nails • Excessive thickness or clubbing • Grooves or furrows • Beau’s lines • Discolored or detached • Bluish or purplish tint or pallor • Hangnails or paronychia • Delayed capillary refilling time
    • 31. Copyright 2008 by Pearson Education, Inc. Figure 33-4 Fingernails are trimmed straight across.
    • 32. Copyright 2008 by Pearson Education, Inc. Abnormal Findings of the Mouth K765 • Halitosis • Glossitis • Gingivitis • Periodontal disease • Reddened or excoriated mucosa • Excessive dryness of the buccal mucosa • Cheilosis (cracked lips) • Dental caries • Sordes (accumulation of foul matter on teeth & lips) • Stomatitis • Parotitis
    • 33. Copyright 2008 by Pearson Education, Inc. Abnormal Findings of the Hair • Dandruff • Hair loss • Ticks • Pediculosis • Scabies • Hirsutism
    • 34. Copyright 2008 by Pearson Education, Inc. Abnormal Findings of Eyes • Loss of hair, scaling, flaky eyebrows • Redness, swelling, flaking, crusting, discharge, asymmetrical closing, ptosis of eyelids • Jaundiced sclera • Unequal pupils • Pupils fail to dilate or constrict • Inability to see
    • 35. Copyright 2008 by Pearson Education, Inc. Abnormal Findings of Ears • Asymmetrical, excessively red or tender auricles • Lesions, flaky, scaly skin over auricles • Normal voice tones not heard
    • 36. Copyright 2008 by Pearson Education, Inc. Abnormal Findings of the Nose • Asymmetrical • Discharge • Localized redness, tenderness or lesions
    • 37. Copyright 2008 by Pearson Education, Inc. Nursing Process: Assessment • Nursing history to determine: – Self care practices – Self-care abilities – Past or current problems – Identification of clients at risk for developing impairment • Physical assessment
    • 38. Copyright 2008 by Pearson Education, Inc. Nursing Process: Nursing Diagnoses • Deficient knowledge • Situational low self-esteem • Risk for impaired skin integrity • Impaired skin integrity • Self-care deficit • Risk for infection • Impaired oral mucous membrane • Disturbed body image • Risk for injury
    • 39. Copyright 2008 by Pearson Education, Inc. Nursing Process: Planning • Nurse and, if appropriate, the client and/or family set goals/desired outcomes • Nurse identifies interventions to assist the client to achieve the designated outcomes
    • 40. Copyright 2008 by Pearson Education, Inc. Nursing Process: Interventions • Assisting dependent clients with hygiene activities • Educating clients and/or family about appropriate hygienic practices • Demonstrating use of assistive equipment and adaptive activities • Assessing and monitoring physical and psychological responses
    • 41. Copyright 2008 by Pearson Education, Inc. Purposes of Bathing • Remove transient microorganisms, body secretions and excretions, and dead skin cells • Stimulate circulation • Produce a sense of well-being • Promote relaxation and comfort • Prevent or eliminate unpleasant body odors
    • 42. Copyright 2008 by Pearson Education, Inc. Categories of Baths • Cleansing baths • Therapeutic baths
    • 43. Copyright 2008 by Pearson Education, Inc. Types of Baths • Complete bed • Self-help • Partial • Bag • Tub • Sponge • Shower
    • 44. Copyright 2008 by Pearson Education, Inc. Bath Equipment
    • 45. Copyright 2008 by Pearson Education, Inc. Hospitalized Client • Early morning care – Urinal or bedpan – Washing face and hands – Oral care • Morning care – Usually after breakfast – Elimination – Bath or shower – Perineal care – Back massage – Oral, nail, and hair care
    • 46. Copyright 2008 by Pearson Education, Inc. Hospitalized Client • Hour of sleep (HS) or P.M. – Elimination – Washing face and hands – Oral care – Back massage • As needed (prn) – As required by client need • More frequent bathing • Changes of clothes
    • 47. Copyright 2008 by Pearson Education, Inc. Bathing an Adult or Pediatric Client: Skill 33-1
    • 48. Copyright 2008 by Pearson Education, Inc. Providing Perineal-Genital Care Skill 33-2
    • 49. Copyright 2008 by Pearson Education, Inc. Figure 33-5 The anatomic parts of a tooth.
    • 50. Copyright 2008 by Pearson Education, Inc. Figure 33-8 Example of a foam swab used to clean the mouth of a dependent client.
    • 51. Copyright 2008 by Pearson Education, Inc. Brushing and Flossing Teeth Skill 33-4
    • 52. Copyright 2008 by Pearson Education, Inc. Brushing and Flossing Teeth Skill 33-4
    • 53. Copyright 2008 by Pearson Education, Inc. Artificial Dentures Skill 33-4
    • 54. Copyright 2008 by Pearson Education, Inc. Oral Care for the Unconscious Client: Skill 33-5
    • 55. Copyright 2008 by Pearson Education, Inc. Shampooing Hair of Client Confined to Bed: Skill 33-7
    • 56. Copyright 2008 by Pearson Education, Inc. Removing Contact Lenses
    • 57. Copyright 2008 by Pearson Education, Inc. Inserting and Removing Artificial Eye
    • 58. Copyright 2008 by Pearson Education, Inc.
    • 59. Copyright 2008 by Pearson Education, Inc. Figure 33-17 (continued) A, An in-the-ear hearing aid. B, Small hearing aid in ear canal. C, Large hearing aid in ear canal. (Source: Jane Schemilt; Science Photo Library/Photo Researcher’s, Inc.) B
    • 60. Copyright 2008 by Pearson Education, Inc. Figure 33-17 (continued) A, An in-the-ear hearing aid. B, Small hearing aid in ear canal. C, Large hearing aid in ear canal. (Source: Jane Schemilt; Science Photo Library/Photo Researcher’s, Inc.) C
    • 61. Copyright 2008 by Pearson Education, Inc. Figure 33-16 (continued) A, A behind-the-ear hearing aid. B, A behind-the-ear hearing aid attached to glasses. B
    • 62. Copyright 2008 by Pearson Education, Inc. Figure 33-17 A, An in-the-ear hearing aid. B, Small hearing aid in ear canal. C, Large hearing aid in ear canal. (Source: Jane Schemilt; Science Photo Library/Photo Researcher’s, Inc.) A
    • 63. Copyright 2008 by Pearson Education, Inc. Removing, Cleaning, and Inserting Hearing Aids
    • 64. Copyright 2008 by Pearson Education, Inc. Post Test • Use your clickers to complete the following post test.
    • 65. Copyright 2008 by Pearson Education, Inc. Question 1 The client is unresponsive and requires total care. Prior to providing oral care, the nurse should assess for which of the following? 1. Presence of pain 2. Condition of the skin 3. Gag reflex 4. Range of motion
    • 66. Copyright 2008 by Pearson Education, Inc. Rationales 1 1. More appropriate prior to bathing the client. 2. More appropriate prior to bathing the client. 3. Correct. The client will be positioned in a sidelying position with the head of the bed lowered because the client is at risk for aspiration. The absence of gag reflex lets the nurse know that the client has no natural defense (cough) and is at a higher risk for aspiration. 4. More appropriate prior to bathing the client.
    • 67. Copyright 2008 by Pearson Education, Inc. Question 2 The client is in surgery and will be returning to his bed via a stretcher. The nurse plans ahead by making which type of bed and placing the bed in which position? 1. An open bed in low position 2. An occupied bed in low position 3. A closed bed in high position 4. A surgical bed in high position
    • 68. Copyright 2008 by Pearson Education, Inc. Rationales 2 1. Incorrect. 2. Incorrect. 3. Incorrect. 4. Correct. Both the placement of the linens for a surgical bed and placing the bed in a high position facilitate the client’s transfer from a stretcher into the bed.
    • 69. Copyright 2008 by Pearson Education, Inc. Question 3 The nurse is observed the UAP perform perineal care for a client. Which of the following actions indicates that further teaching is required? 1. Uses a clean portion of the washcloth for each stroke. 2. Wipes from the pubis to the rectum. 3. Uses clean gloves. 4. Does not retract the foreskin.
    • 70. Copyright 2008 by Pearson Education, Inc. Rationales 3 1. This is appropriate. 2. This is appropriate. 3. This is appropriate. 4. Correct. It is important to retract the foreskin to remove the smegma that collects under the foreskin and can cause bacterial growth.
    • 71. Copyright 2008 by Pearson Education, Inc. Question 4 The nurse is discussing foot care with a client who was recently diagnosed with diabetes. Which of the following statements indicates a need for further teaching? 1. “I am going to use a mirror to check my feet.” 2. “I enjoy walking barefoot around the house.” 3. “I will file my nails.” 4. “I will increase the time that I wear new shoes each day.”
    • 72. Copyright 2008 by Pearson Education, Inc. Rationales 4 1. This is appropriate. 2. Correct. The client needs to avoid walking barefoot as that could cause injury which may result in an infection. Also, neurological impairment is likely which may result in decreased sensation. The client would be unaware of an injury. 3. This is appropriate. 4. This is appropriate.
    • 73. Copyright 2008 by Pearson Education, Inc. Question 5 The client experiencing labored, shortness of breath has a respiratory rate of 28. The bed is currently in the flat position. The best nursing intervention includes putting the bed in which of the following positions? 1. Fowler’s 2. Semi-Fowler’s 3. Trendelenburg 4. Reverse Trendelenburg
    • 74. Copyright 2008 by Pearson Education, Inc. Rationales 5 1. Correct. Fowler’s is a semi-sitting position which should ease the client’s breathing. 2. The HOB in semi-Fowler’s is lower. 3. The HOB is lowered in the Trendelenburg position. 4. The HOB is raised in the reverse Trendelenburg position, it is a straight tilt and may not be as comfortable as Fowler’s.
    • 75. Copyright 2008 by Pearson Education, Inc. Resources • Audio Glossary • American Dental Hygienists' Association A source for information on oral health, potential problems, and oral hygiene instructions for consumers, reporters, and professionals • American Dental Association--Oral Health Topics Covers a variety of oral health topics from A-Z • CDC's Oral Health Resources Provides information, resources, guidelines, and recommendations for oral health
    • 76. Copyright 2008 by Pearson Education, Inc. Resources • Prosthetic Eye Institute Describes how to care for an artificial eye • American Academy of Dermatology Provides information for consumers and health care professionals about skin conditions • MEDLINEplus--Skin Diseases Provides a wealth of information for skin diseases in the following areas: latest news, general overviews, anatomy/physiology, clinical trials, diagnosis/symptoms, pictures/diagrams, prevention/screening, specific conditions, treatments, and statistics. Talks about seniors', teenagers', and children's skin conditions. • National Institute of Arthritis and Musculoskeletal and Skin Diseases Their health topic page covers a multitude of skin diseases from A-Z. • Canadian Dermatology Association Canada's association for the distribution of information concerning the skin. Has sun awareness, public education, professional and archive links.
    • 77. Copyright 2008 by Pearson Education, Inc. Removing, Cleaning, and Inserting Hearing Aids