Professional Documents
Culture Documents
Care of Eyes
➲Clean from inner to outer canthus with wet, warm
cloth, cotton ball, or compress
➲Use artificial tear solution or normal saline every 4
hours if blink reflex is absent
➲Care for contact lenses
Ear and Nose Care
➲Wash external ear with washcloth-covered finger; do not
use cotton-tipped swabs
➲Perform hearing aid teaching and care if indicated
➲Clean nose by having patient blow it if both nares are
patent
➲If indicated, use nasal suctioning with bulb syringe
➲Remove crusted secretions around nose and apply
petroleum jelly
The Oral Cavity
➲Observe for oral problems
–Dental caries-decay of teeth, cavities (diet)
–Periodontal disease-inflammation of gums
–Other oral problems-stomatitis, glossitis, cheilosis
➲Identify actual or potential oral problems that
nurses can treat
➲Identify appropriate nursing measures
➲Carry out the plan of care
Hearing Aids
➲Batteries must be checked routinely.
➲Ear pieces or molds must be cleaned daily with mild
soap and water.
Shaving
➲Follow agency policy
➲Safety razors can cause nicks or cuts
Be careful when shaving a confused patient
Diagnosing
➲Careful assessment
➲Each diagnosis statement identifies a patient
problem and suggests expected patient outcomes.
➲The etiology of the problem directs nursing
interventions
➲P.1135
Nursing Diagnosis for Hygiene Problems
➲Self care deficit diagnoses address four specific
activities necessary to meet daily needs:
➲Feeding
➲Bathing
➲Dressing
➲Grooming
➲Toileting
Outcome Identification and Planning
➲Nursing measures to assist the patient to develop or
maintain hygiene practices .
Implementing
➲Providing schedule hygiene care
Early morning care
Morning Care (a.m. care)
Afternoon Care (p.m.)
Hour of Sleep Care (h.s. care)
As Needed Care (p.r.n. care)
Early Morning Care
➲Assist patient with toileting
➲Provide comfort measure to refresh patient to
prepare for day
➲Wash face and hands
➲Provide mouth care
Morning Care (AM Care)
After breakfast, nurse completes morning care:
➲Toileting
➲Oral care
➲Bathing
➲Back massage
➲Special skin measures
➲Hair care, cosmetics
Purposes of Bathing
➲Cleanses the skin
➲Acts as a skin conditioner
➲Helps to relax a person
➲Promotes circulation
➲Serves as musculoskeletal exercise
➲Stimulates the rate and depth of respirations
Bathing
➲Bathing
➲Types of bathes
–Tub or shower
–Partial bath
–Perineum- the area around the genitals and rectum
–Perineal care (peri-care) techniques used to cleanse the
perineum
–Bed bath
Bathing
➲Cleans the skin, mucous membranes of the genitals
and anal areas
➲Refreshing and relaxing
➲Observations are made, talk to client
➲Method of bathing depends on the patients
conditions, self-care abilities and personal choice
➲Ask choice of bath time if possible
Bedmaking
Bedmaking
➲Straighten linens when loose or wrinkled
➲Check linens for dentures, eyeglasses, hearing aids,
sharp objects and other items
➲Clear food and crumbs
➲Change when wet, soiled or damp
Types of Bedmaking
Linens
➲Practice medical asepsis when handling linens
➲Your uniform is considered dirty
➲Never shake linens in the air
➲Clean linens on clean surfaces
–Never place dirty linen on floor
➲Only bring linen needed to room
➲Collect in order you will use
Drawsheets
➲Itis a small sheet placed over the middle of the
bottom sheet
–Helps keep the mattress and bottom linens clean and dry
–Lifting or turning sheets
➲Some are precut (ideally) but if not fold in half
Needed items
➲Bottom sheet
➲Drawsheet
➲Pad
➲Top sheet
➲Blanket
➲Bedspread
➲Two pillowcases
➲Bath towels
➲Hand towels
➲Washcloths
➲Hospital gown
➲Bath blanket
➲Gloves
➲Use one arm to hold linen away from body and the
other to pick linen up
–Item you will use first will be on bottom of stack until
complete then turn over
➲Place on clean surface in room
Linens
➲Practice medical asepsis when handling linens
➲Your uniform is considered dirty
➲Never shake linens in the air
➲Clean linens on clean surfaces
–Never place dirty linen on floor
➲Only bring linen needed to room
➲Collect in order you will use
Evaluating
➲Patient participation in hygiene
➲Changes related to specific skin problems, for
example healing of skin lesions, elimination or
reduction in causative factors, and independent
patient management of the prescribed treatment
➲Did you see improvement, if not revise your
interventions----increase frequency of oral care
Compare and contrast oral hygiene for clients with natural teeth and
dentures.
Demonstrate safety awareness when providing oral care for
unconscious clients.
Discuss the rationale for cutting the nails straight across.
Describe the steps in providing perineal care for male and female
clients.
Describe the necessary actions to care for clients with prosthetic eye
or contact lens.
Describe how to perform care to hearing aids, and ways to facilitate
communication with clients that have difficulty hearing.
State at least two nursing diagnosis pertinent to clients requiring
assistance with personal hygiene.