Facilitating Hygiene Chapter 22

Question 1

What are the benefits of personal hygiene?

Answer 1

Answer:

Personal hygiene has the following benefits:

● Contributes to physical and psychological well-being

● Fosters activity and movement

● Provides comfort

● Improves self-esteem

Question 2

Why should you respect and accommodate your patients’ hygiene preferences?

Answer 2

Answer:

Respecting the patient’s hygiene preferences promotes maximum participation and independence with ADLs and reflects caring.

Question 3

Identify two economic or living environment factors that may influence how frequently a person bathes.

Answer 3

Answer:

The following factors may influence a person’s bathing frequency:

● Inadequate bathing facilities

● Lack of water

● Lack of money to buy supplies

● Lack of energy after focusing on meeting the basic needs for food and shelter

Question 4

Identify one example of a cognitive impairment that may make independent initiation of grooming impossible.

Answer 4

Answer:

Dementia, delirium, psychoses, stroke, Alzheimer’s disease, or traumatic brain injury may make initiation of grooming impossible.

Question 5

Why may people experiencing depression neglect their grooming and hygiene?

Answer 5

Answer:

Patients suffering from depression often report a profound lack of energy or motivation and may neglect their grooming and hygiene practices because of this.

Question 6

What are five functions of the skin?

Answer 6

Answer:

The skin serves five functions: protection, sensation, temperature regulation, secretion/excretion, and formation of vitamin D.

Question 7

How does the skin help regulate body temperature?

Answer 7

Answer:

The skin contains sensory organs or receptors for heat and cold. The skin regulates temperature through the process of dilating and constricting blood vessels and activating or inactivating sweat glands. The sweat glands found in the axillae and external genitalia secrete fatty acids and proteins and excrete perspiration, which produces a cooling effect as the moisture evaporates from the skin.

Question 8

What changes take place in the skin as a person ages?

Answer 8

Answer:

With age, both layers of the skin become thinner and more fragile. As collagen and elastin fibers in the dermis deteriorate, the skin becomes wrinkled. Sebaceous and sweat gland activity decreases, causing the skin to become dry, scaly, and itchy, and temperature regulation in hot weather becomes more difficult. As the number and activity of hair follicles and pigment cells (melanocytes) diminishes, hair becomes thin, turns gray or white, and grows more slowly. Nails thicken and growth decreases. These changes increase the risk for skin problems.

Question 9

True or false: The professional nurse is responsible for making assessments.

Answer 9

Answer:

True

Question 10

True or false: Assisting with the bath is an excellent time to assess the patient.

Answer 10

Answer:

True

Question 11

To inspect for pallor in a dark-skinned person, which areas would you assess for an ashen gray or yellow color?

Answer 11

Answer:

For dark-skinned persons, the conjunctivae, buccal mucosa, tongue, lips, nail beds, palms, and soles should be assessed for pallor.

Question 12

What is the term that means “a bluish color of the skin”?

Answer 12

Answer:

Cyanosis means a bluish discoloration of the skin.

Question 13

Name two causes of erythema.

Answer 13

Answer:

Vasodilation and inflammation are causes of erythema.

Question 14

Where can you best see jaundice?

Answer 14

Answer:

The sclera of the eyes is the best place to see jaundice.

Question 15

What causes body odor?

Answer 15

Answer:

Body odor is caused by the action of bacteria as they mix with fatty acids, proteins, and nitrogenous waste on the skin.

Question 16

What is the best intervention to rid the skin of body odor?

Answer 16

Answer:

Bathing is the best way to remove body odor.

Question 17

What is the rationale for providing perineal care?

Answer 17

Answer:

Perineal care is provided to remove secretions, to promote comfort, and to prevent excoriation, odor, and infection.

Question 18

How can you protect patient privacy during perineal care?

Answer 18

Answer:

During perineal care, the following practices protect patient privacy:

● Drape the patient with bath blanket, exposing only the area needed.

● Pull privacy curtains around the bed.

● Close the door.

● Hang a sign on the door signaling visitors to avoid entering the room (e.g., Do Not Disturb)

Question 19

A nurse has given a bath in which he washed a bedridden patient’s entire body without assistance from the patient. What is the term for this bath?

Answer 19

Answer:

Complete bed bath

Question 20

What are the advantages of a towel or bag bath?

Answer 20

Answer:

A towel or bag bath has the following advantages:

● Rinsing and drying are unnecessary, so it is quick, making efficient use of the nurse’s time.

● It is a preferred method for patients who have mild to moderate Impaired Skin Integrity or Activity Intolerance and for persons who have dementia.

● Cleanliness is satisfactorily achieved with this technique.

● A bag bath with no-rinse cleanser may be less drying to the skin than a traditional bath with soap and water.

Question 21

For which type of bath will you most likely have a medical prescription?

Answer 21

Answer:

Therapeutic bath

Question 22

What are some causes of ingrown toenails?

Answer 22

Answer:

Ingrown toenails are caused by not trimming toenails straight across and by wearing improperly fitted shoes.

Question 23

What is the cause of foot odor?

Answer 23

Answer:

Odor is caused by the action of microorganisms on perspiration. Wearing shoes creates a warm environment where bacteria can grow and also keeps perspiration from evaporating, providing a medium for bacteria.

Question 24

Why should you not apply lotion between the toes?

Answer 24

Answer:

Moisture from perspiration and bathing tends to remain between the toes. Lotion makes these areas even more moist, increasing the tendency for maceration and cracking.

Question 25

True or false: Healthy nails are usually clean, smooth, and convexly curved.

Answer 25

Answer:

True

Question 26

List at least three nail changes that occur with aging.

Answer 26

Answer:

As a person ages, the nails thicken, become ridged, and may yellow or become concave in shape.

Question 27

List at least four things you should teach clients about self-care of their nails.

Answer 27

Answer:

Clients should be taught the following self-care of their nails:

● Inspect the nails daily.

● Trim nails with a nail clipper (people with diabetes or circulatory problems should file only, as cutting poses a risk for injury to the tissues).

● File the nails straight across, rounding the corners slightly to prevent scratching; do not cut deeply into the lateral corners, as this may cause ingrown nails.

● Remove hangnails by carefully cutting them off.

● Clean under the nails with an orangewood stick or other blunt instrument.

● Push back the cuticles gently.

● Use a moisturizing lotion to soften cuticles.

● Avoid biting nails.

● Consult a podiatrist for any ingrown toenails or other nail problems.

● Recommend to patients with diabetes, circulatory insufficiency, or nail problems that they seek nail care from a podiatrist.

Question 28

How do the teeth aid in digesting food?

Answer 28

Answer:

The tongue and teeth begin digestion by breaking up food and mixing it with saliva.

Question 29

How many deciduous teeth does a child usually have?

Answer 29

Children usually have 20 deciduous teeth.

Question 30

List at least three factors that cause dry mouth.

Answer 30

Answer:

The following factors can cause dry mouth:

● Heavy cigarette smoking

● Excessive alcohol use

● Inadequate fluid intake or dehydration (e.g., being NPO)

● Mouth breathing

● Nasogastric tubes

● Oral airways

● Certain medication

● Radiation therapy

● Oxygen therapy

Question 31

List at least two medications or medical treatments that can cause oral problems.

Answer 31

Answer:

Oral problems may be caused by the following medications and medical treatments:

(Note that some of these overlap with the preceding question about dry mouth.)

Medications

● Anticonvulsants, such as phenytoin (Dilantin), cause gingival hyperplasia (excessive growth of cells).

● Other medications cause dryness of the mouth: diuretics, laxatives (used excessively), medications used to treat cancer, and tranquilizers such as chlorpromazine (Thorazine) and diazepam (Valium).

Medical treatments

● Jaw surgery that requires scrupulous oral hygiene to prevent infection

● Radiation treatments of the head and neck; these can permanently damage the salivary glands, resulting in dryness of the mouth; radiation can also damage teeth and jaw structure

● Oxygen therapy that dries the oral mucosa, especially if the client must breathe through the mouth

● Presence of nasogastric tubes, especially if the person breathes through his mouth

Question 32

Name four situations that can compromise self-care ability for oral hygiene.

Answer 32

Answer:

The following situations can compromise oral self-care:

● Decreased level of consciousness (e.g., a person who is comatose or heavily sedated); such patients are, in addition, likely to breathe through the mouth, causing dry mucous membranes

● Serious illness or injury, weakness, activity intolerance, or paralysis

● Cognitive impairment, such as occurs with developmental delay, dementia, and certain mental illnesses

● Depression

● Lack or knowledge or motivation to perform self-care (e.g., lack of daily brushing and flossing)

Question 33

Define and identify several causes of halitosis.

Answer 33

Answer:

Halitosis is bad breath. It results from poor oral hygiene, eating certain foods (e.g., garlic, onions), tobacco use, dental caries, infections, or even a systemic disease, such as uncontrolled diabetes or liver disease.

Question 34

What are the two most common problems affecting the teeth?

Answer 34

Answer:

Dental caries and periodontal disease are the two most common problems affecting teeth.

Question 35

What is the end result of severe periodontal disease?

Answer 35

Answer:

Severe periodontal disease causes severe inflammation and destruction of the surrounding bone structure. As a result, teeth loosen from a lack of structural support and may fall out or need to be removed. Without the necessary teeth to chew food, the patient may be at risk for impaired nutrition.

Question 36

List at least four assessments you should make of a patient’s hair.

Answer 36

Answer:

The following assessments should be made on a patient’s hair:

● Use of special products or medicated shampoos

● History of hair problems or current conditions necessitating treatment (e.g., pediculosis [head lice])

● History or presence of disease or therapy that affect the hair (e.g., chemotherapy)

● Factors influencing the patient’s ability to manage hair and scalp care (e.g., Impaired Mobility)

● Personal or cultural preferences for styling of the hair

● Condition, cleanliness, texture, and oiliness of the hair

● Inspection of the scalp for dandruff, pediculosis, alopecia (hair loss), secretions or lesions

Question 37

What is pediculosis?

Answer 37

Answer:

Pediculosis is an infestation of head lice.

Question 38

What is alopecia?

Answer 38

Answer:

Alopecia is hair loss.

Question 39

True or false: Eyes should be cleansed from the outer to the inner canthus.

Answer 39

Answer:

False

Rationale:

Eyes should be cleansed from the inner to outer canthus to avoid dragging debris into the nasolacrimal duct.

Question 40

How can a contact lens wearer help prevent eye infections?

Answer 40

Answer:

To prevent eye infections, contact lens wearers should follow these practices:

● Wash hands thoroughly with soap and water before handling the lenses.

● Clean and store lens according to manufacturer’s instructions.

● Do not wear lenses longer than time recommended by the manufacturer.

Question 41

After you have cleansed a prosthetic eye, should you dry it before reinserting it or leave it wet?

Answer 41

Answer:

After cleaning the prosthetic eye, leave it wet so it will slide in more easily.

Question 42

When selecting the method of bathing for a patient, the nurse should consider which of the following?

A. The patient’s mobility limitations

B. Any dressings, drains, or IV lines

C. The patient’s self-care needs

D. All of the above

Answer 42

Answer:

D. All of the above

Question 43

What should be the temperature of the water used to bathe the client in bed? Approximately

A. 120°F (48.9°C)

B. 115°F (46.1°C)

C. 105°F (40.6°C)

D. 100°F (37.8°C)

Answer 43

Answer:

B. Approximately 105°F (40.6°C)

Question 44

When providing oral care for the unconscious patient, the nurse should do which of the following?

A. Place the patient on his side with the head of the bed in a lowered position

B. Not attempt to brush the patient’s teeth because the patient could aspirate

C. Swab the patient’s lips and oral cavity with lemon glycerin swabs at least hourly

D. Place the patient in an upright position, and brush his teeth with a sponge brush

Answer 44

Answer:

A. Place the client on his side with the head of the bed in a lowered position

Rationale:

To facilitate oral hygiene and protect the patient’s airway, the nurse should keep the patient on his side with his head lower than his stomach.

Question 45

Why does the nurse use a different portion of the washcloth to cleanse the patient’s eyes?

A. Avoid irritating the eyes if the patient wears contacts

B. Minimize the spread of infection

C. Use the warmest portion of the cloth

D. Minimize stretching the skin around the eyes

Answer 45

Answer:

B. Minimize the spread of infection

Question 46

What is the preferred position of the patient when giving a back rub?

A. Side lying

B. Supine

C. Prone

D. Fowler’s

Answer 46

C. Prone

Rationale:

A prone position allows the nurse to rub the largest portion of the patient’s back in a position to smooth and relax the muscles.

Question 47

List the sequence of body areas that the nurse follows when giving a bed bath.

Answer 47

Answer:

When giving a bed bath, body areas are washed in the following order:

1. Face
2. Arms
3. Chest
4. Legs
5. Back
6. Buttocks

Question 48

1.Which change in hygiene practices may be necessary as the patient ages?

1) Brushing teeth twice a day
2) Bathing every other day
3) Decreasing moisturizer use
4) Increasing soap use

Answer 48

Answer:

2) Bathing every other day

Rationale:

As a person ages, sebaceous glands become less active, causing skin to dry. Older people may find it necessary to bathe every 2 days, increase the use of moisturizers, and decrease soap use to prevent further drying of skin. Older adults should brush their teeth after every meal and at bedtime to prevent tooth decay. It is recommended that people of all ages brush their teeth at least twice a day, so that option does not represent a change in an older adult’s hygiene practices.

Question 49

2.A woman of Orthodox Jewish faith who underwent a hysterectomy for cancer is being cared for on the surgical floor. Which healthcare team member(s) could be assigned to bathe this patient? Choose all correct answers.

1) Male nursing assistant
2) Male licensed practical nurse
3) Female graduate nurse
4) Female registered nurse

Answer 49

Answer:

3) Female graduate nurse
4) Female registered nurse

Rationale:

Orthodox Judaism prohibits personal care being provided by a member of the opposite sex. The patient who underwent a hysterectomy is female; therefore, out of respect for her religious beliefs, she should not be bathed by the male licensed practical nurse or nursing assistant.

Question 50

3.A 75-year-old patient who is 5 feet 7 inches tall and weighs 170 pounds is admitted with dehydration. A nursing diagnosis of Risk for Impaired Skin Integrity is identified for this patient. Which factor places the client at Risk for Impaired Skin Integrity?
______________

Answer 50

Answer:

Dehydration

Rationale:

Dehydration places the patient at risk for impaired skin integrity. Dehydration, caused by fluid volume deficit, causes the skin to become dry and crack easily, impairing skin integrity. People who are very thin or very obese are more likely to experience impaired skin integrity. This patient is of normal height and weight; therefore, his body stature does not place him at risk. There is nothing to suggest that this patient has an impaired nutritional status.

Question 51

4.The nurse notes a lesion that appears to be caused by tissue compression on the right hip of a patient who suffered a stroke 5 days ago. How should the nurse document this finding?

1) Maceration
2) Abrasion
3) Excoriation
4) Pressure ulcer

Answer 51

Answer:

4) Pressure ulcer

Rationale:

The nurse should document a lesion caused by tissue compression and inadequate perfusion as a pressure ulcer. Abrasion, a rubbing away of the epidermal layer of skin, is commonly caused by shearing forces that occur when a patient moves or is moved in bed. Maceration is a softening of skin from prolonged moisture. Excoriation is a loss of the superficial layers of the skin caused by the digestive enzymes in feces.

Question 52

5.The charge nurse asks the nursing assistive personnel (NAP) to give a bag bath to a patient with end-stage chronic obstructive pulmonary disease. How should the NAP proceed?

1) Bathe the patient’s entire body using 8 to 10 washcloths.
2) Assist the patient to a chair and provide bathing supplies.
3) Saturate a towel and blanket in a plastic bag, and then bathe the patient.
4) Assist the patient to the bathtub and provide a bath chair.

Answer 52

Answer:

1) Bathe the patient’s entire body using 8 to 10 washcloths.

Rationale:

A towel bath is a modification of the bed bath in which the NAP places a large towel and a bath blanket into a plastic bag, saturates them with a commercially prepared mixture of moisturizer, nonrinse cleaning agent, and water; warms in them in a microwave, and then uses them to bathe the patient. A bag bath is a modification of the towel bath, in which the NAP uses 8 to 10 washcloths instead of a towel or blanket. Each part of the patient’s body is bathed with a fresh cloth. A bag bath is not given in a chair or in the tub.

Question 53

6.For a morbidly obese patient, which intervention should the nurse choose to counteract the pressure created by the skin folds?

1) Cover the mattress with a sheepskin.
2) Keep the linens wrinkle free.
3) Separate the skin folds with towels.
4) Apply petrolatum barrier creams.

Answer 53

Answer:

2) Keep the linens wrinkle free.

Rationale:

Separating the skin folds with towels relieves the pressure of skin rubbing on skin. Sheepskins are not recommended for use at all. Petrolatum barrier creams are used to minimize moisture caused by incontinence.