hygiene and self-care

Question 1

describe the professional appearance of the nurse

Answer 1

-clean and neat hair style
-excellent oral and skin care
-minimal makeup
-minimal jewelry
-short natural nails
-no perfumes
-clean shoes
-clean, wrinkle free uniform

Question 2

what order should you don ppe

Answer 2

bottom up
1. gown
2. mask
3. goggles
4. gloves

Question 3

what order should you doff ppe

Answer 3

alphabetical order
1. gloves
2. goggles
3. gown
4. mask

Question 4

names some different isolation levels

Answer 4

-contact
-droplet
-airborne

Question 5

describe early morning care (before breakfast)

Answer 5

-assist to bathroom, BSC, bedpan or urinal
-provide supplies for hand/face washing, mouth care, comb hair
-assist with glasses, denture, and hearing aide insertion

Question 6

describe AM care (after breakfast)

Answer 6

assist with partial or complete bath or shower

Question 7

what are some things to consider when assisting with partial or complete bath

Answer 7

-provide privacy
-maintain safety
-keep water warm and change it PRN
-wash top to bottom and front to back
-use gentle, firm strokes
-dry thoroughly
-promote independence

Question 8

a nurse is caring for a patient with a skin problem. what question or statement would be most useful in eliciting information about personal care?

A. perhaps you dont recognize you bad body odor
B. you must eat a lot of greasy foods to have this acne
C. tell me about what you do to take care of your skin
D. why do you only take a bath once a week?

Answer 8

C. tell me about what you do to take care of your skin

Question 9

describe leg, foot, and nail care

Answer 9

-wash feet with lukewarm water
-dry thoroughly especially in between toes
-apply lotion to dry areas
-always remove TED hose and SCDs before the bath and replace after completion
-avoid massage of reddened areas
-provide diabetic foot care if indicated. education is imperative. request podiatric consult when indicated. encourage patients to look at their feet

Question 10

describe hair care

Answer 10

-identify patient’s usual hair and scalp care practices and styling preferences (note history of scalp problems such as dandruff, hair loss, or baldness)
-comb or brush hair
-wash as appropriate (shampoo and water/waterless shampoo/shampoo caps)
-shaving (groom beard and mustache, shave in direction of hair growth, note if pt is on blood thinners)
-treat any infestations such as pediculosis and ticks

Question 11

which gum disease manifests as a marked inflammation of the gums that also involves a degeneration of the dental tissues and bone?

A. dental caries
B. gingivitis
C. periodontitis
D. plaque

Answer 11

C. periodontitis

Question 12

describe regular mouth and oral care

Answer 12

assist with brushing and flossing

Question 13

what should you use for oral care if a patient is on blood thinners?

Answer 13

soft brush

Question 14

what should you use to shave with if patient is on blood thinners?

Answer 14

electric razor

Question 15

what should you use for oral care if a patient has stomatitis (inflammation of oral mucosa)

Answer 15

swabs

Question 16

describe mouth and oral care on patients that are on oxygen?

Answer 16

mucous membranes dry out so it is important to keep moist and provide good mouth care

Question 17

describe mouth and oral care for patients who have dentures

Answer 17

-clean mouth
-clean dentures
-line sink with wash cloth or towel as protection in case you drop the dentures
-use sponge or cloth to remove dentures and get a denture cup to keep them in

Question 18

what is the biggest risk with oral care for an unconscious patient

Answer 18

aspiration

Question 19

describe aspiration

Answer 19

when fluids from the mouth or digestive system pass into the respiratory system

Question 20

describe mouth and oral care for an unconscious patient

Answer 20

-lower head of bed
-place patient in the sims position (head well towards the side)
-use kidney basin and suction to prevent aspiration

Question 21

describe eye care

Answer 21

-clean from inner to outer canthus with wet warm cloth, cotton ball, or compress
-use new area of wash cloth on each eye
-assist removal/insertion of contacts/artificial eye
-clean glasses and assist with placement

Question 22

describe ear care

Answer 22

-wash behind ears. wash external ear with washcloth covered finger, do not use cotton swabs
-perform hearing aid teaching and care if indicated
-clean hearing aides with soft cloth
-assist with placement of hearing aides

Question 23

describe nose care

Answer 23

-particular attention is required when a patient has a nasogastric tube or endotracheal tube inserted through the nose
-clean accumulated secretions from around the tube
-replace tape once a day to prevent nasal mucosal irritation

Question 24

describe the process of feeding

Answer 24

-assess the patients ability to feed themselves
-desire to make food choices/eat
-energy and muscular movement to eat
-ability to safely chew and swallow

Question 25

describe the process of toileting

Answer 25

-use of toilet, BSC, bedpan, or urinal -toileting is frequently associated with falls -assess patient's ability to assist -check ambulation orders -be proactive -> ask while youre in the room to prevent patient from having to call for help

Question 26

describe urinal use

Answer 26

-keep off over bed table -if urinal is full, assess amount of urine, color and clarity, empty and record output on I&O sheet

Question 27

describe dressing and grooming

Answer 27

-discuss personal preferences with pt -clothing if any (may prefer hospital gown) -hair-wash and comb -shaving- use electric razor for patient taking anticoagulants

Question 28

describe bed time care

Answer 28

-assist with elimination -assist patient with washing hands and face -oral care -skin care -straighten or change bed linens PRN

Question 29

describe back massage

Answer 29

-used as a relaxant after the bath or at bedtime -use warm lotion and side lying position -use long, slow, gliding strokes (effleurage)

Question 30

describe some positive effects of back massage

Answer 30

improves: -mood -pain -muscle tension -blood pressure -depth of respirations

Question 31

describe some lifespan considerations with hygiene and self care

Answer 31

-younger people may be independent with self care -older adults have less elastic skin (more susceptible to injury), thinner hair, dentures, and may be hard of hearing

Question 32

what are some environmental factors affecting self care

Answer 32

-lack of access to facilities -poverty may limit resources (water) -patients in wheelchairs - wheelchair access ask yourself - what resources does the patient have access to?

Question 33

describe some motivation factors affecting self care

Answer 33

-belief that self care is important -patient to be as independent as possible

Question 34

describe some cognitive ability factors that can affect self care

Answer 34

-may not recognize the need for care -may not be able to safely perform care

Question 35

describe some energy factors affecting self care

Answer 35

-acute/chronic illness can decrease energy levels -acute illness/surgery -may need assistance -weakness

Question 36

describe some pain factors that may affect self care

Answer 36

patient may be unwilling to move or care for themselves

Question 37

describe some neuromuscular functions that may affect self care

Answer 37

you must assess level of impairment

Question 38

describe some sensory deficits that may affect self care

Answer 38

-visually impaired -hearing impaired -neuropathy

Question 39

what are some examples of nursing diagnoses regarding hygiene and self care

Answer 39

-self care deficit -impaired skin integrity -risk for injury -impaired mobility -ineffective health maintenance

Question 40

what are some rationales for bathing

Answer 40

-provides opportunity for thorough skin assessment -eliminate perspiration, skin oils, dead skin cells, and bacteria (prevent body odor) -enhances circulation and conditions the skin -stimulates respiratory rate and depth -provides sensory input -allows for patients teaching, therapeutic conversation and touch

Question 41

what patients are most in need of perineal care

Answer 41

-indwelling urinary catheters -rectal/genital/perineal surgery -vaginal delivery/recent childbirth

Question 42

describe perineal care

Answer 42

-clean all patients from areas of least contamination to areas most contaminated -peri care is performed daily with a bath and after every episode of incontinence -use appropriate terminology

Question 43

describe male perineal care

Answer 43

-clean from the urinary meatus downward -retract and replace foreskin -clean crevices

Question 44

describe female perineal care

Answer 44

clean from front to back (pubic bone to sacrum)

Question 45

describe bed making

Answer 45

-wear clean gloves -encourage pt to get out of bed -place soiled linens in linen bag avoiding contact with uniform -avoid shaking sheets, fold out on to the surface of the bed -do not place pillow under your chin

Question 46

to ensure bed safety, be sure the bed is..

Answer 46

-in its lowest position -position is safe for the patient -controls are functioning and bed is electrically safe -side rails are raised if indicated -the wheel or casters are locked

Question 47

describe room clean up and safety

Answer 47

-functioning call light within reach at all times -bed in low position -wheels locked -uncluttered walkspace -note temp, ventilation, noise, and lighting in relation to patient's preference