Oral HygieneOral Hygiene

Benefits of Oral HygieneBenefits of Oral Hygiene

Benefits of Oral HygieneBenefits of Oral Hygiene Provides comfortProvides comfort Stimulates the appetiteStimulates the appetite Prevents disease and Prevents disease and

dental cariesdental caries Helps to prevent bad Helps to prevent bad

breath (halitosis)breath (halitosis) Stimulates saliva Stimulates saliva

production which production which contains digestive contains digestive enzymes and promotes enzymes and promotes digestiondigestion

Routine Oral HygieneRoutine Oral Hygiene Involves tooth brushing Involves tooth brushing

and flossing.and flossing. Should be done at least Should be done at least

3 times a day.3 times a day. Provide necessary Provide necessary

equipment such as equipment such as toothbrush, toothpaste, toothbrush, toothpaste, dental floss, dental floss, mouthwash, emesis, mouthwash, emesis, basin, cup and water.basin, cup and water.

Assist the patient as Assist the patient as needed.needed.

Denture CareDenture Care Provide privacy for the Provide privacy for the

patient.patient. Have patient remove Have patient remove

dentures if able.dentures if able. Place dentures in a Place dentures in a

denture cup to carry to denture cup to carry to sink.sink.

Use warm water to Use warm water to clean dentures.clean dentures.

Hold dentures securely. Hold dentures securely. Let patient rinse mouth Let patient rinse mouth and brush gums.and brush gums.

Store dentures in a Store dentures in a denture cup labeled denture cup labeled with the patient's with the patient's name.name.

Special Oral HygieneSpecial Oral Hygiene Usually given to unconscious or Usually given to unconscious or

semiconscious patients.semiconscious patients. Tell the patient what you are doing.Tell the patient what you are doing. Turn the patient's head toward youTurn the patient's head toward you Use a very small amount of liquidUse a very small amount of liquid Clean all areas of the mouth: Clean all areas of the mouth:

TeethTeethGumGumTongueTongueRoof of mouthRoof of mouth

Apply lubricant to tongue and lips.Apply lubricant to tongue and lips.

BathingBathing

Types of bathsTypes of baths Complete Bed bath Complete Bed bath

(CBB)(CBB) Patient is usually Patient is usually

confined to bed confined to bed and the health care and the health care worker must bathe worker must bathe all parts of the all parts of the patient’s body.patient’s body.

Complete Bed BathsComplete Bed Baths Use standard Use standard

precautionsprecautions Provide privacy Provide privacy

comfort, and safety.comfort, and safety. Fill basin 2/3 full with Fill basin 2/3 full with

warm water at a warm water at a temperature of 105temperature of 10500 – – 1101100 F 0 F

Form a mitten around Form a mitten around your hand with the your hand with the clothcloth

Wash body parts in this Wash body parts in this order: order:

Face, ears, and neck → Face, ears, and neck → axilla, arms, and hands axilla, arms, and hands (apply deodorant)(apply deodorant)

→→chest, breast, and chest, breast, and abdomen → thighs, abdomen → thighs, legs, and feet (change legs, and feet (change water) → back, buttock, water) → back, buttock, and back of perineum and back of perineum (give back rub) → (give back rub) → perineal area.perineal area.

Change water when it Change water when it becomes too cool, dirty becomes too cool, dirty or soapy.or soapy.

BathingBathing

Partial Bed BathPartial Bed Bath Patient washes some of Patient washes some of

the parts of their body the parts of their body and the health care and the health care worker washes the worker washes the parts of the body the parts of the body the patient cannot reach.patient cannot reach.

Tub bath or showerTub bath or shower Health care worker Health care worker

prepares the tub or prepares the tub or shower area and assists shower area and assists patient as needed.patient as needed.

Tub Baths and ShowersTub Baths and Showers Usually require a physician’s order.Usually require a physician’s order. Make sure tub or shower is clean.Make sure tub or shower is clean. Put a rubber mat in tub or showerPut a rubber mat in tub or shower Fill tubs half full with water at 105Fill tubs half full with water at 1050 0 FF Help the patient into the tub or shower Help the patient into the tub or shower

(use the shower chair for patient who (use the shower chair for patient who cannot stand)cannot stand)

Assist patient as neededAssist patient as needed Stay with patient or make sure patient can Stay with patient or make sure patient can

use the emergency call systemuse the emergency call system After bath or shower cover patient with a After bath or shower cover patient with a

towel or bath blankettowel or bath blanket Clean the tub or shower with a disinfectant Clean the tub or shower with a disinfectant

after each use.after each use.

Measuring and Recording Measuring and Recording Intake and OutputIntake and Output

Amount of fluid taken Amount of fluid taken into the body should into the body should equal the amount of equal the amount of fluid lost from the fluid lost from the body.body.

Excessive fluid Excessive fluid retained by body= retained by body= edema (swelling)edema (swelling)

Excessive fluid lost by Excessive fluid lost by body=dehydrationbody=dehydration

What do you measure?What do you measure? Intake Intake – Oral (P.O.)– Oral (P.O.)

----Intravenous Intravenous

(IV)(IV)

--Irrigation--Irrigation OutputOutput --Bowel --Bowel

Movement Movement (BM)(BM)

--Emesis--Emesis

--Urine--Urine

--Irrigation--Irrigation

INTAKEINTAKE

OralOral Includes liquids taken by mouthIncludes liquids taken by mouth Also includes foods that are liquid at Also includes foods that are liquid at

room temperature such as soup, Jell-room temperature such as soup, Jell-O, ice cream, pudding, and Popsicles.O, ice cream, pudding, and Popsicles.

Fluids are measured in metric unitsFluids are measured in metric units 1 Cubic Centimeter (cc) = 1 milliliter 1 Cubic Centimeter (cc) = 1 milliliter

(ml)(ml)

INTAKEINTAKE

1 ml or cc1 ml or cc == 15 gtt (drops)15 gtt (drops) 5 ml or cc5 ml or cc == 1 tsp (teaspoon)1 tsp (teaspoon) 15 ml or cc15 ml or cc == 1 tbsp (tablespoon)1 tbsp (tablespoon) 30 ml or cc30 ml or cc == 1 (oz) ounce1 (oz) ounce 240 ml or cc240 ml or cc == 1 cup (8 oz)1 cup (8 oz) 500 ml or cc500 ml or cc == 1 pint (16 oz)1 pint (16 oz) 1000 ml or cc1000 ml or cc == 1 quart (32 oz)1 quart (32 oz)

MEASURING INTAKEMEASURING INTAKEPRACTICEPRACTICE

Fred is on intake and output. When you go into his room after lunch, you examine his lunch tray and find he consumed the following:

1 hamburger½ bowl of chicken broth (1

soup bowl = 200 cc)4 soda crackers1 cup of tea¾ carton of milk ( 1 carton = 8

oz)½ bowl of Jell-O ( 1 small bowl

= 120 cc)What was Fred’s fluid intake?

MEASURING OUTPUTMEASURING OUTPUT

Output = all fluids eliminated by the Output = all fluids eliminated by the patientpatient

Bowel movements (BM) Bowel movements (BM) Liquid BMs are measured and recordedLiquid BMs are measured and recorded

Solid or formed BM is usually noted Solid or formed BM is usually noted under feces on the remarks columnunder feces on the remarks column

EMESISEMESIS Measure anything that is vomited.Measure anything that is vomited. Also note color, type, and other facts in the remarks Also note color, type, and other facts in the remarks

columncolumnUrineUrine

Measure all urine voided or drained via a catheterMeasure all urine voided or drained via a catheter Men can collect their urine in a urinal and women Men can collect their urine in a urinal and women

can collect their urine in a bedpan or a special urine can collect their urine in a bedpan or a special urine collector that can be placed under the seat of the collector that can be placed under the seat of the toilet.toilet.

IrrigationIrrigation Measure any drainage from nasogastric tubes, hemo-Measure any drainage from nasogastric tubes, hemo-

vacs, chest tubes or other drainage tubesvacs, chest tubes or other drainage tubes These measurements are usually done by the nurse.These measurements are usually done by the nurse.

MEASURING OUTPUTMEASURING OUTPUT

PRACTICEPRACTICEJennifer is on intake and output. At the end of

an 8 hour shift, you note the following:0800 (8:00 am) she voided 400 cc of urine1000 (10:00 am) she vomited 200 cc of thick

yellow emesis with food particles in it1130 (11:30 am) she had one formed green

BM1315 (1:15 PM) she voided 350 cc of urineWhat was Jennifer’s output for the 7-3 shift?

Feeding the PatientFeeding the Patient

Prior to the mealPrior to the mealProvide privacyHelp patient use the bedpan or urinal if neededProvide oral hygiene if desiredRemove emesis basins or bedpans from sightPosition patient in a sitting position if allowedWash patient’s hands and facePut overbed table in positionCheck to make sure the patient is not NPOMake sure the diet is correct for the patientPlace a towel or napkin under patient’s chinOpen packages and cartons, season and cut foods if

necessary.

FEEDING A PATIENTFEEDING A PATIENT Steps for feeding a patientSteps for feeding a patient

Test the temperature of hot foods by placing small amount on wrist

Feed patient slowly and give them time to chew Use separate straw for each liquid Hold utensil at a 900 to the patients mouth Give small bites Alternate foods and liquids Allow patient to help as much as they are able Offer choices to the patient Wipe patient’s mouth as needed Encourage patient to eat as much as possible.

AFTER THE MEAL AFTER THE MEAL Allow patient to wash Allow patient to wash

their face and handstheir face and hands Provide oral hygieneProvide oral hygiene Position patient in Position patient in

correct body correct body alignmentalignment

Clean areaClean area Note how much food Note how much food

was eatenwas eaten Calculated I&O if this Calculated I&O if this

is ordered for patient.is ordered for patient.

BEDPANS AND URINALSBEDPANS AND URINALS Urinate, micturate, or Urinate, micturate, or

void – terms for void – terms for emptying of the emptying of the bladder, which stores bladder, which stores urine.urine.

Urinals are used by Urinals are used by male patient when male patient when they need to micturatethey need to micturate

A bedpan is used by A bedpan is used by females when they females when they need to micturateneed to micturate

DefecateDefecate Having a bowel movement Having a bowel movement

(BM)(BM) Both men and women must Both men and women must

use a bedpan when they need use a bedpan when they need to defecate.to defecate.

Two main types of bedpansTwo main types of bedpans 1. Fracture or orthopedic 1. Fracture or orthopedic

bedpanbedpan 2. Standard bedpan2. Standard bedpan Many patients are sensitive Many patients are sensitive

about using the bedpan. about using the bedpan. Always provide privacy and Always provide privacy and make them as comfortable as make them as comfortable as possible.possible.

Assisting with a BedpanAssisting with a Bedpan Use standard precautions and wear glovesUse standard precautions and wear gloves Provide privacy for the patientProvide privacy for the patient Warm bedpan by running warm water over Warm bedpan by running warm water over

itit There are two positions to place the pan There are two positions to place the pan

under the patientsunder the patients1.1. Patient flexes knees and puts weight Patient flexes knees and puts weight on heels. They then lift their hips up.on heels. They then lift their hips up.2. 2. Patient is turned to one side and the Patient is turned to one side and the pan is placed against the buttock and then pan is placed against the buttock and then the patient is rolled back in the pan.the patient is rolled back in the pan.

Bedpan Cont.Bedpan Cont. The patient's buttock should rest on the rounded The patient's buttock should rest on the rounded

portion of the panportion of the pan Place call bell and tissue within patient’s reachPlace call bell and tissue within patient’s reach Raise siderail before leaving the patientRaise siderail before leaving the patient All done…………All done………… Answer call bell immediatelyAnswer call bell immediately Use the same positions to get the patient off the Use the same positions to get the patient off the

pan, but hold onto the pan firmlypan, but hold onto the pan firmly Cover the bedpan and place on nearby chair or Cover the bedpan and place on nearby chair or

tabletable Make sure perineum is clean and dryMake sure perineum is clean and dry Assist patient in washing handsAssist patient in washing hands Clean bedpan and note any abnormalities of urine Clean bedpan and note any abnormalities of urine

or BMor BM

ASSISTING WITH A ASSISTING WITH A URINALURINALUse standard precautions and wear glovesUse standard precautions and wear gloves

Provide privacy for the patientProvide privacy for the patientAssist patient with placement of the urinal if Assist patient with placement of the urinal if

neededneededLeave the call bell and toilet tissue near the Leave the call bell and toilet tissue near the

patientpatientAnswer patient’s call bell immediatelyAnswer patient’s call bell immediatelyAll finished…………..All finished…………..Avoid exposing the patientAvoid exposing the patientHave patient hand you the urinal if they are Have patient hand you the urinal if they are

ableableClose the lid or cover the top of the urinalClose the lid or cover the top of the urinalAssist patient with washing perineal area if Assist patient with washing perineal area if

neededneededAssist patient with washing his handsAssist patient with washing his handsMeasure contents if patient is on I&OMeasure contents if patient is on I&OEmpty urinal and clean with warm soapy waterEmpty urinal and clean with warm soapy waterReport any abnormalities to the urineReport any abnormalities to the urine

Never empty a bedpan or an urinal until you check to see if a specimen is needed!!