Ch 31: Hygiene

Question 1

When assessing hygiene what do you want to do first what do you want to do second

Define personal hygiene

What is the link between good hygiene

Answer 1

When assessing hygiene:
#1 assess 
#2 hygiene practice


 personal hygiene: is ensuring to keeping a minimal level of personal cleanliness

There is a link between good hygiene and patient health

Question 2

What do hygiene practices include

When we assess the skin what are two other structures we are assessing “ accessory structures of skin” 

What health does a client general health influence

What kind of deficiency can lead to cavities

Answer 2

Hygiene practices include caring for:

• Skin
• hair
• nails
• eyes ears nose mouth
• feet
• perineal area

When assessing skin also assess hair and nails as accessory structures to skin

A patient’s general health influences the health of the mouth and teeth

Deficiencies in calcium, phosphorus, vitamin D can lead to cavities

Question 3

What is the perineal area that provides a condition that favors bacterial growth and what may happen

Answer 3

The perineal areas characteristics of being dark, warm, moist provide conditions of favor bacterial growth that may cause skin breakdown and odors

Question 4

What endocrine abnormalities can affect skin integrity and hair

Answer 4

• DM (dry, fungal skin, high risk of wound)
• higher temperature
• poor nutrition
• anxiety

are endocrine abnormalities that may affect skin integrity and hair

Question 5

What are factors affect personal hygiene

Answer 5

Culture 
-beating habits and behavior + use of hygiene products

socioeconomic class 
-May lack access to a bath, milk funds to purchase toiletries and clean clothing

spiritual practices 
- beliefs dictate ceremonial washing

developmental level

• Family practices may dictate habits of hygiene (when do you shower)
• elders may not bathe every day due to dry skin

health state
-please, surgery, injury can reduce ability to perform hygiene and motivation to follow habits

personal preference

• shower> Bath
• some people shower to promote self image

Question 6

When you’re doing your nursing history how do you assess hygiene practices what do you want to ask the patient

Answer 6

When doing nursing history use all senses to assess hygiene practices

Ask the patient different thing interferes with them not being able to clean like they would like to

Question 7

When doing a focused assessment for hygiene practices what are you assessing

• habits
• factors
• exposure
• problems
• history / changes

Answer 7

-daily/weekly bathing habits
-factors that affect practices
-pain/sun exposure
-history of skin or mucus mean problems
-any changes or history of problems


Question 8

During the focus assessment for hygiene what are question they want to ask

Answer 8

1. How long have you had this problem
2. Does it bother you (painful/ADL)
3. Have you found anything helpful in relieving symptoms 

Question 9

What are a few factors to consider when assessing the skin

Answer 9

Cleanliness 
color 
temperature 
turgor
 moisture 
sensation 
vascularity (ecchymosis and Petichiea) 
 evidence of lesions

Question 10

When do you want to incorporate the assessment of the skin and what is the best time (activity/time of day) and why

How do you compare for symmetry

What terminology is used to report and record findings 

What direct your skin assessment

what is vital to identify

Answer 10

You want to incorporate the assessment of the skin during the other assessment of the body systems

The best time is doing bathtime in the daylight to avoid assessment mistakes

Compare for symmetry using bilac comparison

Use standard terminology to report and record findings

Allow data Obtained in nursing history to direct skin assessment (guide focus)

Identify any variable known to cause skin problems



Question 11

If you do not have the opportunity to be patient how do you want to assess the skin

Answer 11

If you do not have the opportunity to bathe the patient thouroughly assess the skin especially for pressure ulcers

Question 12

What do you want to look for in the assessment of the oral cavity

What is vital to remember if the patient has prosthetic teeth

Answer 12

Lips 
buccal mucosa
 color and surface if the gums 
 teeth
 tongue 
hard/ soft palate 
oropharynx

If the patient has proceed teeth remove and assist the gums for fungi

Question 13

What are you looking for when you are assessing the eyes ears nose

Answer 13

Eyes : position, alignment, discharge
ears
nose: Patency, discharge

Question 14

What do you want to look for when assessing the hair

Answer 14

Texture cleanliness oiliness
-consider ethnicity in hair (Products and characteristics)

Scalp for lesions inflammation infection (pediculosis)

Dandruff alopecia infestations

Question 15

What are you looking for when you are assessing the nails, feet and perineal vaginal area’s

What do you want to look for in a patient’s feet and what do you suspect if there’s a history of falls

Regarding the vaginal and perineal area -what do you want to Pay special attention to

• how often do you assess and clean clean
• what do you want to avoid andvwhy

Answer 15

Nails
feet
perineal vaginal areas
-CLEANLINESS IN ALL 4!

• Look at the footwear worn
• There may be a history of falls if foot issues

Vaginal and perineal area:

• Pay special attention if urinary or fecal incontinence as well as indwelling catheters
• assess and clean every 12 hours
• do not over clean as you may cause irritation And dryness

Question 16

What are risk factors for skin alterations (cuts or issues)

Answer 16

-nutrition
- sunbathing
-fillers/ Botox
-smokers
being diabetic

Question 17

When creating a nursing diagnosis would do you carefully want to assess that may lead to the development of one or more diagnosis related to hygiene

Give three nursing diagnosis is related to hygiene

Answer 17

When creating a nursing diagnosis carefully assess patient’s hygiene practice and skin, mucous membranes, other areas I may lead to the development of one or more nursing diagnosis related to hygiene

1. Self-care deficit
   - BOT WANTING TO DO feeding bathing dressing toileting
2. Impaired oral mucous membranes
   - impaired hygiene
   - malnutrition
   - dehydration
3. Impaired social interaction
   - negative body image

Question 18

Good hygiene care or practices are provided early morning

Answer 18

Early morning:
-after waking: 
    •wash hands, face ,mouth 
     •toilet
-after breakfast: 
      •bathe 
      •back massage 
      •special care (patient getting ready for date) 
      •dress 
- change bed linens

Question 19

When bathing the patient how do you introduce the topic and what do you say

 what do you never want to do regarding bathing

Answer 19

When bathing:
-clearly state SHOWER TIME give the patient the equipment and say you’ll be back in 10 to 15 minutes

🚫Never ask “IF” The patient wants to shower 

Question 20

What is provided in afternoon care



Answer 20

Afternoon care:

• Toilet
• wash hands
• oral care

Straighten bed linens
- help client preposition

Question 21

What is provided during hour of sleep care

Answer 21

Hour of sleep care:

• toilet, washing (bath?), oral care
• back massage
• change soiled linens and clothing
• Position patient comfortably

Question 22

What is considered as needed care

Answer 22

• hygiene measures as needed
• frequency of clothing and bed line changing as well as oral and bathing
• Oral care every two hours if indicated

Question 23

What is the reason for providing back massages

Who do you specially want to provide that massages for

Answer 23

***Promote opportunity to observe skin for breakdown
-General body conditioner
- relieves tension, relaxation
-Improve circulation
-decrease pain anxiety
-improve sleep
-means to Communicate through touch
• shows caring

Provide back massages especially if your patient is non-ambulatory

Question 24

What are a few purposes of bathing

Answer 24

• Cleaning conditioning skin
• Relaxing patient
• promote circulation
• serves as musculoskeletal exercise -stimulates rate and depth of respirations
• helps improve self image
• strengthens nurse patient relationship

Question 25

When providing a bed bath - how do you want to avoid Disruptions - when is the best time for bed bath - what do you want to replace linens with - what do you want to place within reach - Who do you want to assist And you’re older population what do you want to be cautious with when beating

Answer 25

-avoid disruptions  by ensuring all items are in close proximity -Best time: non-visiting hours for privacy -replace linens with bath blankets • decrease splash -please cosmetics inconvenient within reach places -assist those who cannot self bath  an older because she of generational differences regarding being exposed (expose what you need drip as you go)

Question 26

``` When observing for oral problems: Define: -Peridontitis -gingivitis -carries -plaque -Cheilosis -Stomatitis -Glossitis ```

Answer 26

***Peridontitis: information of gum + Degen of dental tissue and bone  -gingivitis: information of gums  -carries : decay of teeth to cavities  -plaque: invisible destructive bacterial film destroying enamel ***Cheilosis: ulceration of the lips at the mouth angle  ***Stomatitis: Inflammation of oral mucosa  ***Glossitis: inflammation of tongue

Question 27

What are risks for oral problems and what do you do a patient cannot do self oral care

Answer 27

Risk for oral problems: - coma - Confused - depressed - chemo If oatient cannot do oral care do it for the patient

Question 28

What is the angle placing of the brush to the gums in what direction do you brush in What is the technique for oral hygiene

Answer 28

Please brush at 45° angle to gumline brush from gumline to crown of EACH tooth ``` Moisten mouth clean mouth care for dentures brush and floss use mouthwash ```

Question 29

What direction do you clean the eye + why, what is the temperature of the water What do you want to use if your patience blink reflex is gone What do you want to assess for if you note an abnormal Eye

Answer 29

Clean the eye from inner to outer direction with warm cloth to prevent introduction of infection Patient does not have blink reflex use artificial tears or normal sailing every four hours Assess for prosthetic eye

Question 30

What should you wash when caring for ear What do you AVOID USING How do you have the patient clean their nose How do you remove crusted secretions around nose

Answer 30

When caring for ear wash external ear NEVER USE COTTON SWABS Have the patient clean nose by blowing Remove Kirsten secretions by applying warm moist compress

Question 31

When providing hair care what do you want to give preference to What do you want to treat and how does it spread In males what is important to care for

Answer 31

One providing care give preference to patients preferences Treat any infestations by Películosis -Spreads direct (contact) indirect (close linens brushes) In males: care for beards and mustaches

Question 32

Give the technique for shampoo and hair using protective pad or plastic tray

Answer 32

1. Prepare several pictures with warm water (100 -125°) + towels 2. Please protect a pad or plastic tree underhead 3. Play patient overpad so water drains into receptacle 4. With hair, apply shampoo, massage scalp 5. Rinse hair thouroghly and reapply shampoo if needed 6. Apply conditioner if requested or dry scalp 7. Dry hair as quickly as possible to prevent chills 8. Do hair to patient preference

Question 33

What action may assist with cleaning and trimming of nails

Answer 33

-Soak nails and feet to assist with -cleaning and trimming massage feet -provide diabetic foot care

Question 34

What do you do before caring for the peroneal or vaginal area How do you want to perform perineal care -What do you do if patient requires an erection during care How do you want to cleanse vaginal area + Perineal area (men) What do you want to AVOID 

Answer 34

PhysicallyAssess Peroneal or vaginal area FIRST  perform perineal care in a matter of fact and dignified manner -if erection: excuse yourself give patient time and come back Cleanse vaginal area + perineal area (men) with plain soap and water AVOID LAUGHING!  

Question 35

How do you clean a woman’s vagina -Direction and towel How do you clean a mans penis

Answer 35

Woman:  - use front to back direction - change folding of the towel each pass Men: - Circular motion from the meatus out - go from shaft head to base

Question 36

What do you do to ensure bedside safety

Answer 36

Ensure bed is in lowest position The position is safe for patient and controls are functioning  call light within reach 

Question 37

What side rail do you always want to have up when turning the patient

Answer 37

Always have upper side rails up to prevent falls when turning patient

Question 38

What are patient outcomes for the hygiene assessment

Answer 38

Ensure participation of patient in hygiene program Eliminate, reduce, compensate for factors interfering with independent execution of hygiene measures Changes related to specific skin problems and independent patient management of prescribed treatment program -ensure patient can self-care skin conditions

Question 39

What is number one regarding patient care When bathing what do you bathe last

Answer 39

#1 Is patient preference Face face and hair last

Question 40

Who is at risk for nail in foot problems

Answer 40

Diabetics obese nailbiter‘s frequent washers