Transcript Chapter 17 Hygiene

CHAPTER 17
HYGIENE
OBJECTIVES
1. Define hygiene.
2. Name five hygiene practices that most people perform regularly.
3. Give two reasons why a partial bath is more appropriate than a daily bath for older
adults.
4. List at least three advantages of towel or bag baths.
5. Name two situations in which shaving with a safety razor is contraindicated.
6. Name three items recommended for oral hygiene.
7.
Identify two methods to prevent the chief hazard when providing oral hygiene to an
unconscious client.
8. Describe two techniques for preventing damage to dentures during cleaning.
9. Describe two methods for removing hair tangles.
10. Name two types of clients for whom nail care is provided with extreme caution.
11. Name four visual and hearing devices.
12. List two alternatives for clients who cannot insert or care for their own contact lenses.
13. Discuss four reasons for sound disturbances experienced by people who wear hearing
aids.
14. Describe an infrared-listening device.
HYGIENE
Hygiene: practices that promote health through
personal cleanliness
Activities that foster hygiene
Bathing; cleaning and maintaining fingernails and
toenails
Performing oral care
Shampooing and grooming hair
Maintaining hearing aids and eyeglasses
INTEGUMENTARY SYSTEM COMPONENTS
Skin
Mucous membrane
Hair
Fingernails, toenails
Teeth
SKIN
Epidermis: Outermost layer, contains dead skin cells
forming a tough protein called keratin. Cells shed
continuously & are replaced by the dermis.
Dermis: True skin, contain most of the secretory glands
SKIN
Subcutaneous layer: Separate the skin from skeletal
muscles, contains fat cells, blood vessels, nerves and
roots of the hair follicles and glands
CROSS-SECTION OF THE SKIN
SKIN
Skin carries out the following functions:
Protect inner body structures from injury & infection
Regulate body temperature
Maintain fluid and chemical balance
Provide sensory information such as pain, temperature,
touch and pressure
Assist in converting precursors to Vitamin D when
exposed to sunlight
SKIN
Common Benign Skin Lesions in Older Adults
Seborrheic keratoses: tan to black raised areas on the
trunk
Senile lentigines: brown, flat patches on the face,
hands, and forearms
SKIN
GLAND
LOCATION
SECRETION
PURPOSE
Sudoriferous
Throughout dermis and
subcutaneous layers,
especially in axilla and
groin
Sweat
Regulate body
temperature.
Excrete body waste
Ceruminous
Ear canals
Cerumen
Protective functions;
has antimicrobial
properties
Sebaceous
Throughout the dermis
Sebum
Lubricate skin and
hair
Ciliary
Eyelids
Sweat and
sebum
Protect lid margin
and lubricate eyelash
follicles
MUCOUS MEMBRANE
Line body passages such as the:
digestive, respiratory, urinary, and reproductive
systems
Mucous membrane also lines the conjunctiva of the eye
Goblet cells in the mucous membranes secrete mucus,
a slimy substance that keeps the membranes soft
and moist
HAIR
Each hair is a thread of keratin
Forms from cells at the base of a single follicle
Helps to prevent heat loss by trapping heat in the air
between the hairs
Basic genetically inherited structure can be altered by
chemicals used to curl, relax or lubricate the hair
NAILS
Fingernails and toenails are made of keratin, which in
concentrated amounts gives them their tough texture
Normal nails are thin, pink, and smooth
Fingernails and toenails provide some protection to the
digits
TEETH
Present beneath the gums at birth
Contain the outer covering, enamel, a keratin structure
Exposed portion of each tooth: crown
Portion within the gum: root
Adults: 28 to 32 permanent teeth
Saliva: keeps the teeth clean and inhibits bacterial
growth
TEETH
Discoloration occurs from chronic consumption
of coffee or tea, tobacco use, certain drugs
such as tetracycline antibiotics taken during
childhood.
Integrity of teeth largely depend on the person’s
oral hygiene practices, diet and general
health.
COMMON DENTAL PROBLEMS
Sugar, plaque, and bacteria may eventually erode the
tooth enamel, causing caries
Tartar leads to gingivitis, while gum inflammation may
cause periodontal disease
Tooth loss is common in older adults as a result of
periodontal disease
HYGIENE
Integument contains many secretory glands that
produce odors and attract debris
Hygiene measures are beneficial for maintaining
personal cleanliness and healthy integumentary
structures
Hygiene practices vary widely, most Americans routinely
perform bathing, shaving, brushing teeth, hair care
and nail care
BATHING
Uses a cleansing agent such as soap and water to
remove sweat, oil, dirt, and microorganisms from
the skin
Advantages of bathing
Eliminates body odor; reduces the potential for
infection
Stimulates circulation; provides a refreshed and
relaxed feeling; improves self-image
TYPES OF BATHING
Most bathing is done in a tub or shower, at a sink or at
the bedside
Partial bathing: washing only those body areas that are
subject to greatest or sources of body odor: generally,
the face, hands, axillae and perineal area. This is
done at a sink or with a basin at the bedside.
TYPES OF BATHING
Bed bath: washing with basin of water at the bedside.
Towel bath: single large towel to cover and wash a client
Bag bath: commercially packaged kit (p.349)
Any one of these three types of baths would be suitable
for the client who is unable to take a tub bath or shower
independently
THERAPEUTIC BATHS
TYPE
DESCRIPTION
PURPOSE
Sitz bath
Immersion of the buttocks &
perineum in a small basin of
continuously circulating water
Removes blood, serum,
stool or urine.
Reduces local swelling.
Relieves discomfort.
Sponge bath
Applications of tepid water to the
skin
Reduces a fever
Medicated bath
Soaking/immersing in a mixture of
Relieves itching or a rash
water & other substance, such as
baking soda, oatmeal, or cornstarch
Whirlpool bath
Warm water that is continuously
agitated within a tub or tank
Improves circulation
Increases joint mobility
Relieves discomfort
Removes dead tissue
QUESTION
Is the following statement true or false?
Partial bathing is most common in young adults.
ANSWER
False.
Partial bathing is most common in older clients.
ADVANTAGES OF BED BATH
PARTIAL BATHING
Partial bathing is more appropriate for older
adults than a tub bath or shower because they
do not perspire as much as young adults and
soap tends to dry their skin.
GIVING A TOWEL BATH
QUESTION
Is the following statement true or false?
Towel bath is very expensive.
ANSWER
False.
Towel bath saves expense.
(CS: 88yr)
SHAVING
Removes unwanted body hair
Accomplished with an electric or a safety razor
The use of safety razor may not be possible in the
following situations:
 If the client has a face injury
 If the client cannot shave
SHAVING A CLIENT’S FACE
CONTRAINDICATIONS TO USING A SAFETY RAZOR
Receiving anticoagulants (drugs that interfere with
clotting) Ex. Coumadin, Heparin
Treatment of DVT (Deep-Vein Thrombosis), PE
(Pulmonary Embolism), Prosthetic Heart Valves
Receiving thrombolytic agents (drugs that dissolve
blood clots) Ex. Alteplase, Streptokinase
Treatment of PE, MI, stroke
CONTRAINDICATIONS TO USING A SAFETY
RAZOR
Taking high doses of aspirin
Blood disorder such as hemophilia
Liver disease who have impaired clotting
Rashes or elevated or inflamed skin lesions on or near
the face
Those who are suicidal
ORAL HYGIENE
Practices used to clean the mouth, especially brushing
and flossing the teeth
Most dentists recommend twice daily brushing
Dentures and bridges require special cleaning and care
To prevent damage during cleaning, hold
dentures over a plastic or towel-lined
container and uses cold or tepid water.
ORAL CARE FOR UNCONSCIOUS CLIENTS
Because unconscious clients are not salivating
in response to seeing, smelling, and eating food,
they need oral care even more frequently than
conscious clients.
Sordes (dried crusts containing mucus,
microorganisms, and epithelial cells shed from
the mucous membranes) are common on the
lips and teeth of unconscious clients.
ORAL CARE FOR UNCONSCIOUS CLIENTS
The chief hazard in providing oral hygiene for
unconscious clients is aspiration (inhaling) of liquid into
the lungs.
To prevent aspiration, nurses position
unconscious clients on the side with the head
lower than the body.
They use oral suction equipment to remove liquid
from the mouth.
ORAL CARE FOR UNCONSCIOUS CLIENTS
Aspirated liquids predispose clients to pneumonia.
Tooth brushing is the preferred technique for providing
oral hygiene
Oral swabs are also used to moisten and refresh the
mouth
ADVANTAGES OF ELECTRIC TOOTHBRUSHES
QUESTION
Is the following statement true or false?
Dentures are best washed with hot water.
ANSWER
False.
Dentures are best washed with cold or tepid water.
HAIR CARE
Apply a conditioner to loosen tangles
Use oil on the hair if it is dry
Braid the hair to help prevent tangles
Brush the hair slowly to increase circulation of sebum
Use a wide-toothed comb, combing from end to crown
Use shampoo to clean hair
NAIL CARE
Keeping the fingernails and toenails clean and
trimmed
Nail care should be provided with extreme caution for
the following clients:
 Clients with diabetes
 Clients with impaired circulation
 Client with thick nails
NAIL CARE
Clients with diabetes, impaired circulation or thick nails
are at risk for vascular complications secondary to
trauma.
Podiatrist (person with special training in caring for feet)
services are often indicated
It is best to check with the client’s MD before cutting
fingernails or toenails
QUESTION
Is the following statement true or false?
Applying alcohol to tangled hair helps remove
the tangles.
ANSWER
True.
Applying alcohol to tangled hair helps remove the
tangles.
VISUAL AND HEARING DEVICES
Eyeglasses and hearing aids improve
communication and socialization
 Eyeglasses
 Contact lenses
 Artificial eyes
 Hearing aids
 Infrared listening devices
TYPES OF CONTACT LENSES
EYEGLASS CARE
The nurse cleans glass and plastic lenses as follows:
Hold eyeglasses by the nose or ear braces
Run tepid water over both sides of the lenses (hot water
damages plastic lenses)
Wash lenses with soap or detergent
Rinse with running tap water
Dry with a clean, soft cloth. Do not use paper tissues
because can scratch lenses.
CONTACT LENS CARE
Never assume that someone who wears
eyeglasses does not use a contact lens, and
vice versa.
For conscious clients, the nurse asks them to
remove and insert the lenses.
Care for the contact lenses is according to the
client’s established routines.
CONTACT LENS CARE
For clients who cannot remove contact lenses,
the nurse may assist with their removal or
should consult the client’s ophthalmologist
(medical MD who treats eye disorders) or
optometrist (person who prescribes corrective
lenses) about alternatives to promote
adequate vision and safety.
CONTACT LENS CARE
For the unconscious client:
Obtain an appropriate storage container, label it Left &
Right
Elevate client’s head and place towel over the chest to
prevent loss or damage to contact lenses
Soft Lenses p. 356, also see Figure 17-9
Hard Lenses p. 256, also see Figure 17-11
EXAMPLES OF HEARING AIDS
In the ear
Behind the ear
Remote controlled
Refer to Figure 17-10 in the textbook.
Refer to Client and Family Teaching Maintaining a
Hearing Aid 17-2 p. 358
HEARING AIDS
Four types of hearing aids:
1. In-the-ear devices: small self-contained aids
that fit in the outer ear
2. Canal aids: fit deep within the ear canal and
are largely concealed. Because of their size,
may be difficult to remove and adjust
HEARING AIDS
Behind-the-ear devices: microphone and an amplifier
worn behind the ear that delivers sound to an internal
receiver.
Body-aid devices: use electrical components enclosed
in a case carried somewhere on the body to deliver
sound through a wire connected to an ear mold
receiver.
Most clients insert and remove their own hearing aids,
but the nurse may need to assess and troubleshoot
problems that develop.
INFRARED LISTENING DEVICES
Infrared Listening Devices (IRLDs) resemble
earphones attached to a handheld receiver.
They are an alternative to conventional hearing
aids. Converts sound into infrared light & sends
it through a wall- or ceiling mounted receiver to
the person wearing the device. The light is
converted into an auditory stimulus.
INFRARED HEARING DEVICES
Advantage:
IRLD reduces background noise
Disadvantage:
Cannot be used outdoors, in rooms that
contain many windows, brightly lit rooms
because infrared light jams the signal
which causes audio interference
INFRARED HEARING DEVICE
Some geriatric centers are installing IRLDs in
rooms used for social and recreational activities.
People who need help hearing lectures, TV, live
performance may use an IRLD.
QUESTION
Is the following statement true or false?
Infrared listening devices (IRLDs) are used by
clients with hearing impairment to hear sounds
outdoors.
ANSWER
False.
IRLDs cannot be used outdoors or in rooms that
contain many windows or in well-lit rooms.
GENERAL GERONTOLOGIC CONSIDERATIONS
Poor hygiene and grooming in older adults: signs of
visual impairments, functional changes, dementia,
depression, abuse, or neglect
Older adults do not need to bathe as frequently as
younger adults
Use mild, superfatted, nonperfumed soap
Oils are not used in showers or bathtubs due to
increased risk for falls
GENERAL GERONTOLOGIC CONSIDERATIONS
(CONT’D)
For older adults with limited range of motion or mobility,
provide:
Long-handled bath sponges or hand-held shower
attachments
Nonskid strips on the floor of bathtubs
Showers with strategically placed handles and grab
bars; a tub/shower seat
GENERAL GERONTOLOGIC CONSIDERATIONS
(CONT’D)
Due to increased susceptibility to dry skin, tears and
scratches:
 Avoid skin care products containing alcohol,
perfumes that aggravate dry skin
 Nails: keep trimmed and smooth
 Feet: regularly inspect condition
Modify clothing to promote independence
Tooth loss: periodontal disease
QUESTION
Is the following statement true or false?
Older adults need to bathe frequently because
they perspire a lot.
ANSWER
False.
Older adults do not need to bathe frequently because
they have diminished perspiration and sebum
production.