Class 3-Hygiene

Question 1

Personal Hygiene

Answer 1

-cleanliness and grooming that promotes physical and psychological well being and enhances the healing process
-the nurse is responsible for the patient’s hygiene

Question 2

4 principles of skin function

Answer 2

• intact skin is the body’s first line of defense; resistance to skin injury varies among people
• adequate nutrition and hydration (2-3 L) of cells helps to prevent skin injury
• adequate circulation is needed to maintain skin cell life
  1. intact skin
  2. nutrition
  3. hydration
  4. circulation

**3 things that decrease patient outcome: failure to recognize, rescue, plan

Question 3

What is the Braden scale used for?

Answer 3

-risk assessment for pressure injury
-lower the score the higher the risk for injury

Question 4

Skin in the elderly (gerontology)

Answer 4

-thinning of subcutaneous and dermal layer (more injury prone)
-decrease activity of glands (dryer skin; sebaceous glands)
-longer time window for cell renewal (if breaks down longer to heal)
-nail changes (nails grow up & thicker)
-decrease in collagen fiber (need collagen to heal)

Question 5

Morning care (a.m. care)

Answer 5

-after breakfast, nurse completes morning care
-toileting (normal 1st thing)
-oral care
-bathing & ROM
-back massage
-hair care
-denture care
-anti embolism stockings (come off when washing)
-shaving (face: down; legs: up)
-nail and foot care
-eye, ear, & nose
-perineal care (genital care)
-linens
-position for comfort
-organize & clean up bedside

Question 6

Oral care

Answer 6

Assessment:
-lips
-color and surface of gums
-teeth
-tongue
-hard & soft palates
-dentures

Care:
-the gold standard is brushing the patient’s teeth (oral care with mouth breathing/O2 breathing is drying)
-poor oral care can lead to cardiac, renal, dementia? problems

Question 7

Cleaning dentures

Answer 7

-wear gloves
-use toothbrush
-use washcloth in bottom of sink

Question 8

Tooth brushing

Answer 8

-brush teeth, gums, tongue

Question 9

Swabbing

Answer 9

-use with no teeth or in-between tooth brushes

Question 10

Do we brush an unconscious patient’s teeth?

Answer 10

yes! tilt face to side

Question 11

Medical treatments and/or diseases that create a dry oral cavity

Answer 11

-oxygen therapy
-nasogastric tubes
-side effects of medications
-mouth breathing that occurs with infection
-mechanical ventilation

Question 12

Observing oral care in the mechanically ventilated patient

Answer 12

-oral hygiene is standard nursing care; often neglected in critically ill patients on ventilators or performed by swabbing patients’ mouths

-lack of oral care leads to VAP

Question 13

oral care on mechanically ventilated patients

Answer 13

-observed during random 4 hour time blocks over 2 months at 5 hospitals in chicago
-conclusion:
-effective oral care is lacking for majority of mechanically ventilated patients
-gap exists between evidence-based research and actual nursing practice
-despite importance of brushing teeth to remove dental plaque, swabbing remains primary oral cleansing tool

Question 14

Poor oral hygiene in long term care

Answer 14

-evidence links poor oral care to serious disease processes
-typically assigned to CNA’s
-only 16% of ECF residents received oral care
-average tooth brushing time for ECF residents was 16.2 seconds..DO LONGER!

Question 15

Purposes of bathing

Answer 15

-cleansing and conditioning of skin
-relaxation
-promotes circulation (movement on skin)
-improvement of self-image and emotional well being
-movement and exercise
-assessment opportunities
-strengthens nurse/patient relationship

Question 16

Types of baths

Answer 16

-showers
-bathing:
-complete
-partial assist
-CHG baths (vascular catheter, central line, surgery, have AV fistulas, things that invasively break skin)
-bag baths (no rinse; good for elderly)

Question 17

The bath

Answer 17

-gather all equipment
-wash using no rinse cleansers
-dry
-lotion
-privacy & warmth (close door; close curtain)

**soap is drying & needs to be rinsed; don’t use powders

Question 18

Why CHG baths

Answer 18

-studies show daily baths with CHG cloths reduce the risk of MDRO (multi drug resistant organisms) and HAI’s

-Chlorhexidine baths on medical/surgical units
-central IV lines
-PICC lines & mid lines
-hemodialysis catheters
-bath patient first then chlorhexidine wipe all body areas, then use a lotion compatible with CHG

Question 19

CHG wipes

Answer 19

-rinse free; need 3 packs
-don’t bring into room until ready to use
-CHG bath wipes come prepackaged in a single packet that contains 3 individual packets
-each individual packet contains 2 CHG impregnated wipes
-CHG wipes will be warmed using the CHG warming cabinet
-warming helps activate

Question 20

Indicator lights

Answer 20

Yellow light:
-cloth is warming, not ready yet

Solid green light:
-cloth is ready to. use

Blinking green light:
-cloth is aging out, use this one first

Red light:
-cloth is expired, do not use, dispose of it

Question 21

CHG bath instructions

Answer 21

**see slide 29 for picture
-Use one wipe each (6 total)
1. to clean neck, chest, abdomen, & groin
2. to clean back & buttocks
3. to clean left arm
4. to clean right arm
5. to clean left leg
6. to clean right leg

-do not wash face or perineal area with CHG wipes
-do not use CHG on mucous membranes or severely abraded skin (mouth)

Question 22

Remember to chart it

Answer 22

all CHG baths should be documented in EPIC

Question 23

Purewick external female catheter

Answer 23

Criteria:
-strict I&O ordered, incontinent & unable to use a bedpan or commode
-post surgery and requires immobilization
-approved by wound care and/or surgery
-palliative care CMO
-patient is critically ill with life threatening hemodynamic/respiratory instability

Question 24

Purewick external female catheter

Answer 24

Best practice:
-attach to low suction
-replace at least every 8-12 hours
-empty the urine container Q8 hours or more frequently
-do not use barrier cream-cream may impede suction
-change suction tubing at least every 30 days
-not recommended for agitated patient’s or having frequent BM’s

Question 25

Perineal care

Answer 25

-clean from LEAST contaminated to MOST contaminated (front to back)
-clean vaginal area with no rinse cleansers not soap
-peri-bottles for rinsing and cleaning
-apply skin barrier creams/ointments if appropriate
-condom catheter
-retract foreskins to clean then replace

Question 26

Foley care

Answer 26

1. wash peri area
2. clean 6 inches down tubing
3. catheter has to be attached to leg
4. green clamp attached to bed
5. no lose tubing; no kinks
6. bag kept lower than bladder and not touching floor

Question 27

Products to think of using

Answer 27

-mepilex (for pressure injuries?) 18 or less Braden scale: sacral & heels-use in ICU’s
-moisture barrier cream/ointment (for incontinence)

Question 28

Eye, ear, nose care

Answer 28

-only water soluble ointment for nose
-cleaning eyes from inner to outer canthus
-don’t forget those glasses
-assess hearing aid function
-elderly might have breakdown from nasal cannula but vaseline is for lips only
-check to see if O2 tubing is breaking down skin behind ears
-diabetics change socks daily

Question 29

Benefits of back massage

Answer 29

-acts as a general body conditioner
-relieves muscle tension and promotes relaxation
-provides opportunity for nurse to observe skin for signs of breakdowns
-improves circulation
-may decrease pain, distress, and anxiety
-may improve sleep quality

Question 30

Providing hair care

Answer 30

-wash hair
-comb hair
-offer to shave face
-care for beards and mustaches

Question 31

Taking care of your feet in diabetes

Answer 31

1.wash your feet daily with lukewarm (cannot feel) water and soap
2. dry your feet well especially between the toes
3. apply moisturizing lotion, but do not apply between toes
4. check your feet for blisters, cuts, redness, etc. If present, consult your doctor
5. trim nails straight across and file the edge with a nail nile (do not trim/use clippers!)
6. change socks daily; avoid dirty and tight socks (cotton socks)
7. never walk barefoot either indoors or outdoors
8. examine your shoes daily for cracks, stones, nails which may irritate feet

Question 32

Making the bed

Answer 32

-occupied
-unoccupied

**gather linens first thing in the morning

Question 33

Before you leave the room comfort & safety

Answer 33

-position for comfort
-lighting/noise of TV
-call light in reach
-bed in low position
-HOB elevated
-side rails as appropriate

Environmental care:
-label everything
-remove trash
-bedside bag
-curtains open
-room stocked
-check sharps containers