SHUROUQ QADOSE29/3/2009**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Personal hygiene

Is the self-care by which people attend to such functions as bathing, toileting, general body hygiene, and grooming.

It involves care of the skin, hair, nails, teeth, oral and nasal cavities, eyes, ears, and perineal genital areas.

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Factors influencing individual hygienic practices:*Mrs. Mahdia Samaha Kony *CultureReligionEnvironmentDevelopmental levelHealth and energyPersonal preference

See table 33-1

Mrs. Mahdia Samaha Kony

Types of hygienic care*Mrs. Mahdia Samaha Kony *Early morning careMorning care Hour of sleep (HS) or PM As needed care (prn)

Mrs. Mahdia Samaha Kony

Anatomy of the skin *Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Functions of the Skin

*Mrs. Mahdia Samaha Kony *The largest organ of the body. Protection: from injury by preventing the passage of MO, considered the first line of defense.Regulation of body temperatureSecretory function: sebum, an oily that softens and lubricates the hair and skin.Sensations: nerve receptors are sensitive to pain, temperature, touch, and pressure.Absorption of vitamin D.

Mrs. Mahdia Samaha Kony

Nursing Management

*Mrs. Mahdia Samaha Kony *Assessment, includes:(a) A nursing history to determine the clients skin care practices, self-care abilities, and past or current skin problems (b) Physical assessment of the skin(c) Identification of clients at risk for developing skin impairments

Mrs. Mahdia Samaha Kony

Nursing History

*Mrs. Mahdia Samaha Kony *Assessment of the clients self-care abilities determines the amount of nursing assistance and the type of bath best suited for the client. Important considerations include:The clients balanceActivity toleranceCoordinationAdequate muscle strengthAppropriate joint range of motionVisionThe clients preferenceCognition and motivation .See Table 33-2

Mrs. Mahdia Samaha Kony

Physical Assessment

*Mrs. Mahdia Samaha Kony *Involves inspectionPalpation.

Mrs. Mahdia Samaha Kony

Diagnosing

*Mrs. Mahdia Samaha Kony *Self- care Deficit diagnoses are used for clients who have problems performing hygiene care.Self- care Deficit: Bathing / HygieneSelf- care Deficit: Dressing/GroomingSelf- care Deficit: Toileting

Mrs. Mahdia Samaha Kony

Etiologies of self-care deficit:

*Mrs. Mahdia Samaha Kony *Decreased or lack of motivationWeakness or tirednessPain or discomfortPerceptual or cognitive impairmentInability to perceive body part Neuromuscular or musculoskeletal impairmentsMedically imposed restrictionTherapeutic procedure restraining mobilitySevere anxietyEnvironmental barriers

Mrs. Mahdia Samaha Kony

Planning

*Mrs. Mahdia Samaha Kony *The nurse and the client and /or family set outcomes for each nursing diagnosis.ImplementationThe nurse applies the general guidelines for skin care while providing one of the various types of baths available to clients.

Mrs. Mahdia Samaha Kony

General guidelines for skin care

*Mrs. Mahdia Samaha Kony *An intact, healthy skin is the body's first line of defense. Ensure that all skin care measures prevent injury and irritation.

The degree of the skin protection depends on the general health of the cells, the amount of subcutaneous tissue, and the dryness of the skin.

Body odors are caused by resident skin bacteria acting on body secretions

Skin sensitivity to irritation and injury varies among individuals.

Agents used for skin care have selective actions and purposes.

Moisture in contact with the skin can result in increased bacterial growth and irritation.

Mrs. Mahdia Samaha Kony

Bathing

*Mrs. Mahdia Samaha Kony *Bathing removes accumulated oil, perspiration, dead skin cells and some bacteria.Two categories of baths are given to clients: Cleaning baths are given for hygiene purposes and include:Complete bed bathSelf-help bed bathPartial bathBag bathTub bathShower

Mrs. Mahdia Samaha Kony

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Therapeutic bath*Mrs. Mahdia Samaha Kony *Baths are given for physical effects: To soothe irritated skinTo treat an area such as perineumMedication may be placed in the water.Perineal-genital care is also referred to as perineal care or pericare.

Mrs. Mahdia Samaha Kony

Nursing Management

*Mrs. Mahdia Samaha Kony *FeetThe feet are essential for ambulation and merit attention even when people are confined to bed.Assessing it includes the followingNursing Health History of:Normal nail and foot practicesType of foot wear wornSelf-care abilitiesPresence of risk factors for foot problemsAny foot discomfortAny perceived problems with foot mobility.

Mrs. Mahdia Samaha Kony

Physical Assessment

*Mrs. Mahdia Samaha Kony *Each foot and toe is inspected for:Shape SizePresence of lesions Palpated to:Assess areas of tendernessEdemaCirculatory status. Normally, the toes are straight and flat.

Mrs. Mahdia Samaha Kony

Common foot problems include:-

*Mrs. Mahdia Samaha Kony *Callus: is a thickened portion of epidermis, a mass of keratotic material. Most calluses are painless and flat and are found on the bottom or side of the foot over a bony prominenceUsually caused by pressure from shoes.

Corn: is a keratosis caused by friction and pressure from a shoe. It commonly occurs on the forth or fifth toe, usually on a bony prominence such as a joint.

Mrs. Mahdia Samaha Kony

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Common foot problems include:-

*Mrs. Mahdia Samaha Kony *Unpleasant odors: occur as a result of perspiration and its interaction of microorganisms.Planter warts: appear on the sole of the foot.Fissures: or deep grooves frequently occur between the toes as a result of dryness and cracking of the skin.

Mrs. Mahdia Samaha Kony

Common foot problems include:-

*Mrs. Mahdia Samaha Kony *Athletes foot or tinea pedis (ringworm of the foot) it is caused by a fungus. The symptoms are scaling and cracking of the skin, particularly between the toes. Sometimes small blisters form, containing a thin fluid.

Mrs. Mahdia Samaha Kony

Common foot problems include:-

*Mrs. Mahdia Samaha Kony *Ingrown toenail: the growing inward of the nail into the soft tissues around it, most often results from improper nail trimming.

Mrs. Mahdia Samaha Kony

Clients at Risk

*Mrs. Mahdia Samaha Kony *Diabetes Peripheral vascular diseaseAre prone to infection if skin breakage occurs because of reduced peripheral circulation to the feet, clients with.

Mrs. Mahdia Samaha Kony

Diagnosing

*Mrs. Mahdia Samaha Kony **Self care deficit: Hygiene (foot care) R/T- Visual impairment- Impaired hand coordination* Risk for impaired skin integrity R/T Poorly fitting shoes* Risk for infection R/T- Impaired skin integrity (trauma, corn)- Deficient nail or foot care* Deficient knowledge (diabetic foot care) R/T- Lack of teaching/learning activities about diabetic foot care- Newly established medical diagnosis (diabetes)

Mrs. Mahdia Samaha Kony

Planning *Mrs. Mahdia Samaha Kony *(a) identifying nursing interventions that will help the client maintain or restore healthy foot care practices

(b) establishing desired outcomes for each client.

Implementation In Skill lab

Mrs. Mahdia Samaha Kony

NailsNursing Management

*Mrs. Mahdia Samaha Kony *AssessingHealth history: the nurse explores:The clients usual nail care practicesSelf care abilitiesAny problems associated with them.

Physical assessment: inspection of the nails (shape and texture, nail bed color, and tissues surrounding the nails).

Mrs. Mahdia Samaha Kony

Diagnosing

*Mrs. Mahdia Samaha Kony **Self care Deficit: Grooming related to impaired vision

*Risk for infection around the nail bed related to- Impaired skin integrity of cuticles- Altered peripheral circulation

Mrs. Mahdia Samaha Kony

Planning

*Mrs. Mahdia Samaha Kony *The nurse identifies measures that will assist the client to develop or maintain healthy nail care practices.

Implementation In Skill lab

Mrs. Mahdia Samaha Kony

Evaluation*Mrs. Mahdia Samaha Kony *Examples of desired outcomes:The client being able to:Demonstrate healthy nail care practices as shown by:Clean, short nails with smooth edgesIntact cuticles and hydrated surrounding skinDescribe factors contributing to the nail problemsDescribe preventive interventions for the specific nail problemDemonstrate nail care as instructed

Mrs. Mahdia Samaha Kony

Mouth

*Mrs. Mahdia Samaha Kony *Each tooth has three parts: the crown, the root, and the pulp cavity.Nursing ManagementAssessingAssessment of the clients mouth and hygiene practices includes:-Nursing historyThe nurse obtains data about the clients oral hygiene practices, including dental visits, self care abilities, and past or current mouth problems.

Mrs. Mahdia Samaha Kony

Physical assessment

Most common problems affect the teeth.Tarter is a visible, hard deposit of plaque and dead bacteria that forms at the gum lines.Gingivitis "red, swollen gingival", bleeding, receding gum lines, and the formation of pockets between the teeth and gums. Pyorrhea; the teeth are loose and pus is evident when the gums are pressed.

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Plaque is an invisible soft film that adheres to the enamel surface of teeth , it consist of bacteria, molecules of saliva.**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Identifying Clients at risk

Clients who lack of knowledge Clients who has inability to maintain oral hygiene: Seriously ill clients.Confused clients.Comatose clients.Depressed clients.Dehydrated clients. Clients with nasogastric tubes Clients receiving oxygen Clients who have had oral or jaw surgery must have meticulous oral hygiene care to prevent the development of infections.

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

Identifying Clients at risk

Clients in long-term care settings.A dry mouth can be aggravated by:Poor fluid intakeHeavy smokingAlcohol useHigh salt intakeAnxietyMedications.Clients who are receiving or having radiation treatments to the head and neck may have permanent damage to salivary glands

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

Diagnosing

*Self care deficit: oral hygiene will be used for clients unable to perform oral care independently.*Impaired oral mucous membrane related to- Ineffective oral hygiene- Physical injury or drying effect (mouth breathing, oxygen therapy)

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

Planning

Specific detailed nursing activities taken by the nurse may include the following:Monitor every shift to dryness of the oral mucosaMonitor for signs and symptoms of glossitis" inflammation of the tongue" and stomatitis" inflammation of the mouth.Assist dependent clients with oral care.Provide special oral hygiene for clients who are debilitated, unconscious, or have lesions of the mucous membrane or other oral tissues.

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

Teach clients about good oral hygiene practices and other measures to prevent tooth decay.

Reinforce oral hygiene regimen as part of discharge teaching.

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Implementation

Good oral hygiene includes daily stimulation of the gums, brushing, flushing of the mouth.Promoting Oral Health through the Life SpanInfant and ToddlerThe nurse should give parents the following instructions to promote and maintain dental health:Beginning at about 18 months of age, brush the child's teeth with a soft toothbrush

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

Infant and Toddler

Give a fluoride supplement daily or as recommendedSchedule an initial dental visit for the child at about 2-3 years of age.Some dentists recommend an inspection type of visit when the child is about 18 months old to provide an early pleasant introduction to the dental examination.Seek professional dental attention for any problem such as discoloring of the teeth.

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Preschools and School-Age ChildrenAdolescents and AdultsAssisting clients with oral careClients with special oral hygiene needs

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Caring for artificial dentures

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Brushing and flossing the teeth

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

A foam Swab**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Hair

Developmental VariationsNewborn may have lanugo" fine hair on the body of the fetus.

In older adults the hair is generally thinner, grows more slowly and loses its color as a result of aging.

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

Nursing ManagementAssessingNursing historyThe nurse collect data about usual hair care, self care abilities, history of hair or scalp problems.

Physical assessmentProblems include*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

Hair problems Scabies;Is a contagious skin infestation by the itch mite.

Treatment involves through cleansing of the body with soap and water to remove scales and debris from crusts, and then an application of the scabicide lotion.

All bed linens and clothing should be washed in very hot or boiling water.

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

Hair problems Hirsutism; the growth of excessive body hair. The cause is not always known.

Dandruff; Often accompanied by itching.

Pediculosis (Lice)

Hair loss

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Nursing diagnosing related to hair hygiene and hair and scalp problems include:* Self care deficit: Grooming related to- Activity intolerance- Immobility- Pain in upper extremities- Altered level of consciousness- Lack of motivation associated with depression*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

Nursing diagnosing related to hair hygiene and hair and scalp problems include:

Self care deficit: Grooming related to- Activity intolerance- Immobility- Pain in upper extremities- Altered level of consciousness- Lack of motivation associated with depression

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Nursing diagnosing related to hair hygiene and hair and scalp problems include:

Impaired skin integrity related to:- Scalp lacerationInsect bite

Risk for infection related to - Scalp laceration- Insect bite

Disturbed body image related to alopecia

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

Implementing

Brushing and Combing HairShampooing the hair.Beard and mustache care

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Nursing Management of the eyes

AssessingAssessment of the clients eyes includes:- - Nursing health historyThe nurse obtains data about the clients eyeglasses or contact lenses, recent examination by an ophthalmologist, and any history of eye problems.

- Physical assessmentInspection of the external eye structures

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

Nursing diagnosing related to eye problems may include:Self care deficit (insertion and removal contact lens, cleaning) related to:

- Deficient Knowledge

- Impaired vision associated with cataracts

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

Nursing diagnosing related to eye problems may include:Risk for infection related to - Improper contact lens hygiene- Accumulation of secretions on eyelidsRisk for injury related to- Prolonged wearing of contact lenses- Absence of blink reflex associated with unconsciousness

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

Implementing

Nursing activities may include:-Eye Care; dried secretions that have accumulated on the lashes need to be softened and wiped away. Eyeglass CareRemoving Contact LensesInserting Contact Lenses

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

General Eye CareAvoid home remedies for eye problems.

If dirt or dust gets into the eyes, clean them copiously with clean, tepid water as an emergency treatment.

Take measures to guard against eyestrain and to protect exertion.

Schedule regular eye examinations, particularly after age 40 to detect problems such as cataracts.

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

Evaluation

Conjunctiva and sclera free of inflammationEyelids free of secretionsNo tearingNo eye discomfort Demonstrate appropriate methods of caring for contact lensesDescribe interventions to prevent eye injury and infection

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

EARS

Normal ears require minimal hygiene. Clients who have excessive earwax and dependent clients who have hearing aids may require assistance from the nurse.Cleaning the EarsCare of Hearing Aids

*Mrs. Mahdia Samaha Kony *

Mrs. Mahdia Samaha Kony

NOSENurses usually need not provide special care for the nose, because clients can ordinarily clear nasal secretions by blowing gently into a soft tissue.Supporting A Hygienic Environment When providing a comfortable environment it is important to consider the clients age, severity of illness, and level of activityRoom TemperatureVentilation.Noise

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

Hospital BedsCommonly used bed positions- Flat - Fowlers position (semisitting position in which head of bed is raised to angle of at least 45.)- Semi- Fowlers position (head of bed is raised only to 30 angle.)- Trendelenburgs position (head of bed is lowered and the foot raised in a straight)- Reverse Trendelenburgs position (head of bed raised and the foot lowered).

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

**Mrs. Mahdia Samaha Kony

Mrs. Mahdia Samaha Kony

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