Learning Objectives
By the end of this section, you will be able to:
- Identify the steps for assisting with patient hygiene
- Analyze differences related to hygiene in the older adult
- Recognize how nurses can use education to promote healthy hygiene habits
The nurse must assess the patient’s preferences, physical limitations, and cognitive status in order to analyze, develop, and promote a hygiene and health plan of care. Patients who are completely independent, require some assistance, or are fully dependent on the nurse or nurse’s assistant to complete hygiene practices are all factors needing consideration. A nurse’s priority when scheduling hygiene is to ensure the patient’s safety. This section will focus on the steps for assisting patients with hygiene, the differences related to hygiene in older adults, and how nurses can promote healthy hygiene habits through education.
Steps for Assisting with Patient Hygiene
When assisting the patient with hygiene, the nurse must integrate the individual’s preferences into the plan of care. Determining the patient’s normal practices through inquiry are variables that influence hygienic practices. Those variables may include the person’s health status, physical limitations, mental health state, cultural beliefs, and personal preferences. The nurse must also assess the appropriateness of these practices to conclude whether the patient has the attitude, skills, resources, and knowledge to carry out the measures independently or if assistance is required for this purpose. The nurse performs a physical assessment to determine the adequacy of the patient’s hygiene practices. For the recognized practices to be deemed inadequate, a distinct health threat must exist. For example, upon examining the oral cavity, if gingivitis or periodontitis is visible, the patient may be at a higher risk for conditions such as heart disease, stroke, arthritis, and diabetes if left untreated.
For patients with intravenous (IV) access, the bag of IV fluids and IV tubing may be threaded through the sleeve of the gown to keep the system intact. There are covers available to keep the site dry during bathing. Dressing changes for the IV must follow facility protocols. Finally, the nurse must try to preserve the patient’s privacy throughout the bathing process. To accomplish such privacy, a nurse should reveal only the areas about to be cleaned and keep the rest of the body covered, ensuring the door and/or curtains remain closed. The nurse needs to encourage the individual to perform all tasks as independently as appropriate. Using the bath or various hygienic procedures is an excellent opportunity for the nurse to assess the person’s skin, cognition, and mobility status. These simple tasks can reveal subtle changes in the patients’ status and allow for early intervention.
In addition, whether the individual is conscious or not, the nurse or UAP must introduce themselves and always inform the patient of what is about to happen and why. This will hopefully prevent any surprises, obtain consent, and complement the nurse’s professional demeanor. Research suggests that unconscious patients may hear what others are saying. Nurses who continue to introduce themselves and explain procedures before proceeding will decrease the stress on the individual through their journey to consciousness in a strange and foreign environment.
Clinical Safety and Procedures (QSEN)
QSEN Competency: Patient-Centered Care
Definition: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
The nurse will:
- Integrate understanding of multiple dimensions of patient-centered care: information, communication, and education; involvement of family and friends; patient/family/community preferences and values; coordination and integration of care; physical comfort and emotional support; and transition and continuity.
- Assess own level of communication skill in encounters with other members of the healthcare team as well as patients and families.
- Communicate patient values, preferences, and expressed needs to other members of the healthcare team.
- Communicate care needed and provided at each transition in care.
- Value continuous improvement of own conflict resolution and communication skills.
- Describe strategies to empower patients or families in all aspects of the healthcare process.
- Respect patient preferences for degree of active engagement in care process.
Delegation Considerations
The execution of hygiene practices may be delegated to a nurse’s assistant, UAP, or a licensed vocational nurse. The term delegation in nursing is shifting the responsibility of tasks to another person while remaining accountable for the outcome. For example, the nurse may delegate a stable patient’s bath to a UAP if and only if the bath is meant for cleanliness and not for assessment of skin or patient condition. Safe and proper delegation allows the registered nurse to attend to more complex patient care needs, such as medication administration or head-to-toe assessments, helps control cost for the organization and advances the skills of nursing assistive personnel. The patient’s needs and health status plus the qualifications of the person the task is being delegated to must all be carefully evaluated. The nurse must have the proper qualifications prior to delegating: skills, experience, competency, and education. The person the nurse is delegating the tasks to must also have adequate education, skills, training, experience, and evidence of competency. Table 7.2 summarizes the National Council of State Boards of Nursing (2016) Five Rights of Delegation.
| Right | Definition | Example |
|---|---|---|
| Right task | The activity coincides with the person’s job description or is part of the written policies and procedures of the practice setting. | The nurse can ask a UAP to brush a patient’s teeth but not to give medication. |
| Right circumstance | Appropriate patient setting, available resources, and other relevant factors are considered. | The nurse may ask the UAP to provide a bed bath for a stable patient. The nurse should ask for the UAP to not provide a bed bath when the patient is in severe physical distress, as the nurse should perform the patient’s hygiene themselves. |
| Right person | Delegating the right task to the right person to be executed on the right person | The nurse may ask a unit secretary to call for supplies needed for the bath, such as special surgical wipes, but not ask the unit secretary to bathe the patient. |
| Right directions and communication | Clear, concise description of the task, including its objective, limits, and expectations | The nurse asking to be notified if the blood pressure is “abnormal” following the patient’s bath is not appropriate. The nurse should ask the UAP to notify them if patients’ blood pressure is above 130/80 or below 100/60 after the bath, in order to give clear expectations. |
| Right supervision and evaluation | Apt monitoring, evaluation, intervention, when necessary, and feedback | The nurse may ask the UAP to chart a patient’s response to hygiene care if the patient is alert, awake, and oriented because the outcome is expected. The nurse may not ask the UAP to evaluate a patient’s response to hygiene care if the patient is confused and unstable because the outcome is unexpected, and this type of evaluation is out of their scope of practice. |
Unfolding Case Study
Unfolding Case Study #2: Part 2
Refer back to the Unfolding Case Study #2: Part 1 to review the patient data.
| Nursing Notes | 0900: Skin assessment performed. Redness in sacral and perineal areas noted but all skin intact. Patient was soiled at time of assessment so perineal care was performed and new briefs applied. Barrier cream applied on sacrum and buttocks. Patient resting comfortably in bed at this time. Daughter assured that charge nurse will speak to staff regarding importance of maintaining patient’s hygiene care. |
Oral Care
Care of the oral cavity, oral hygiene, helps preserve a healthy state of the lips, gums, teeth, and mouth. Brushing the teeth removes plaque, food particles, and bacteria as well as massages the gums and alleviates any discomfort that may be caused from tastes or unpleasant odors. Patients should be encouraged to brush their own teeth when possible. Independent individuals should be offered supplies to also carry out personal hygiene needs as appropriate. If the patient is unable to do so independently, the nurse or appropriate delegate (i.e., the person who is delegated a responsibility by the nurse) will need to assist with or perform the oral care for this individual. Patients who are unable to perform their own oral care may require care every one to two hours, if and as necessary. Individuals who are either unable to breathe through the nose or are mouth breathers will need more frequent oral care. More frequent care will ensure that the integrity of the oral mucous is maintained. The nurse must ensure that available suction equipment is available to prevent aspiration, raise the head of the bed to 30–45 degrees, use suction to remove excess fluid/secretions, routinely moisten the mouth, and apply lip balm to prevent lips from cracking.
Teeth should be brushed twice a day and the mouth should be rinsed with water after meals. The toothbrush should be soft-bristled and reach all the teeth. Automatic toothbrushes may be adequate substitutes for patients with arthritis or other conditions that impair their ability to brush adequately. Because the toothbrush cannot reach the areas between the teeth, flossing is recommended once a day to remove food particles and plaque. Water picks, pressured water spray units, and cone-shaped brushes may be used when patients are unable to use floss or perform their own oral hygiene. Toothpastes and other powders aid in the brushing process. Mouthwashes may also be used to reduce bacteria, plaque, tartar, and gingivitis. Many mouthwashes also freshen breath and can protect tooth enamel.
Clinical Safety and Procedures (QSEN)
QSEN Competency: Patient-Centered Care
Knowledge: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Skill: The nurse will:
- Assemble supplies (e.g., toothbrush, basin, toothpaste, floss).
- Introduce themselves.
- Identify patient and explain procedure.
- Perform hand hygiene and don clean gloves;
- If the patient is independent, arrange the supplies in the bathroom, if the patient prefers, and ensure privacy.
- If the patient is unconscious, prepare the patient for the procedure by ensuring privacy, raising the bed to a comfortable position, and arranging supplies.
- Position patient’s head to the side (dependent side if possible).
- Place a towel under the patient’s face and an emesis basin under the chin.
- Carefully separate the patient’s jaws. Use a tongue depressor to hold the patient’s mouth open with one hand.
- With the other hand, brush teeth, gum, and cheeks gently with soft-bristled brush and toothpaste. Swab the tongue and roof of the mouth. Rinse several times.
- Apply lubricant to lips.
- Clean and store supplies, and dispose of linens and trash appropriately.
- Remove gloves and perform hand hygiene.
- Reposition or assist patient to a comfortable position. Ensure the bed is in the lowest position.
- Document procedure and patient’s response.
Denture Care
Artificial teeth not permanently implanted, called dentures, are the patient’s personal property and must be handled with care. Dentures should soak in a labeled, enclosed cup to be stored when not being worn. Many patients do not wear dentures when sleeping, and dentures must be removed for surgeries or other diagnostic procedures. Many patients also prefer to wear dentures as soon as wakening or coming out of a procedure to avoid embarrassment due to feeling self-conscious without them. If the patient goes long periods of time without wearing the dentures, the gum line may change and affect the fit of the dentures. It is also recommended that dentures not be worn twenty-four hours a day, seven days a week. Patients are usually familiar with the necessary care of dentures to prevent infection and irritation, and prefer to perform denture care according to standard practice at home.
Clinical Safety and Procedures (QSEN)
QSEN Competency: Assisting the Patient with Oral Care
See the competency checklist for Assisting the Patient with Oral Care. You can find the checklists on the Student resources tab of your book page on openstax.org.
Eyes, Ears, and Nose
Special attention is given to care of the eyes, ears, and nose due to the sensitivity or these areas, and taking exceptional care to avoid injury is important. The nurse should ask the patient about any specific care the patient normally performs in relationship to the eyes, ears, and nose. For example, some people prefer using cotton swabs to clean the outer parts of the ears. The nurse should also be aware of any use of hearing or visual aids, such as eyeglasses, hearing aids, or contacts. The nurse should also ask the patient about any history or treatments of eye, ear, or nose problems.
The circular areas around the eyes are usually cleaned during the bath with the use of a clean washcloth, moistened with warm water. Soap may cause burning or irritation, so avoiding soap around the eyes is advisable. The eye should be cleaned from the inner to outer canthus. A separate section of the rag should be used each time to avoid the risk of spreading infection. If the patient has dried exudate (dried or crusty fluid) that is not easily loosened, try placing a damp gauze or cotton ball on the lid margins to loosen secretions. Avoid applying direct pressure over the eyeball as this may cause injury. Remove any exudate from the eyes carefully and as often as needed to keep the eye clean. Unconscious patients may require more frequent eye care due to the buildup of secretions from the absence of the blink reflex.
The ears are also cleansed during a shower or bed bath. The ear canal should be cleaned with a gentle rotation using a moistened washcloth. A cotton swab is useful for cleaning the pinna or outer aspects of the external ear. Educating patients to never use toothpicks, cotton swabs, or any other device to clean the internal auditory canal is important, as the tympanic membrane can easily be damaged through this action.
Care of the nose includes clearing secretions. Most patients are able to gently blow into a disposable paper tissue. The individual should avoid harsh blowing as this can cause pressure capable of injuring the nasal mucosa, sensitive eye structures, and the tympanic membrane. The patient should blow with both nostrils open to avoid forcing debris into the eustachian tubes. If the external nares are crusted, a warm, moist compress may be used to help soften and remove any exudate. A moist washcloth or cotton swab may be used to clean the opening of the nares but should never exceed past the nares to avoid injury.
Contacts and Glasses
Eyeglasses are often expensive and are the patient’s personal property. Therefore, eyeglasses should be stored in a case or bedside drawer when not in use to prevent damage or loss. Eyeglasses may require special cleaning with the use of cloths made of soft microfiber, cleansing solutions, or lens wipes. Washcloths, paper towels, and tissue paper should be avoided because they can scratch the lenses.
Various types of contact lenses are available, ranging from daily, weekly, or even monthly use. Some patients may sleep in contact lenses, while others cannot or prefer not to leave these lenses in the eyes overnight. The nurse must assess the type of contacts the person wears and any preferred special care measures. Several products are available for lens care, such as saline solutions and hydrogen peroxide solutions. Most patients will prefer to care for their own lenses but should not wear these contacts if unable to independently insert and remove the lenses. Contacts should remain clean and sterile. Reusable lenses should soak in a solution of the owner’s choosing when not in use to keep the lens from drying out. Hand hygiene when inserting or removing contacts is essential to prevent infection. A towel may be placed in the sink to prevent a dropped contact from accidentally falling into the drain.
Hearing Aids
Hearing loss is a common health problem. The ability to hear impacts a person’s ability to communicate and react appropriately to things in their environment, and many patients have hearing aids (Figure 7.2). The care of hearing aids includes battery care, proper insertion, and routine cleanings. The nurse should determine the patient’s normal method of cleaning the hearing aids. In addition, the nurse should assess the quality of the patient’s hearing with the use of the devices to ensure effectiveness and functionality. The hearing aids should not be used when water exposure is a risk to avoid damage to the devices. When hearing aids are not in use, the devices should be labeled and stored in a case or a safe place to avoid damage or loss. The battery should also be removed or turned off when not in use to preserve the battery life. The hearing aids may be cleaned with a dry, soft cloth.
Hair
Hair care will depend greatly on the patient’s preferences, culture, and physical and cognitive limitations. Hair should be shampooed as often as necessary or per individual preference. The brush and comb should be washed each time the hair is washed, or as appropriate. Prior to shampooing the hair, brush or comb the hair to stimulate the scalp and untangle hair. Whenever possible, encourage the patient to brush and wash their own hair. In the event regular shampooing is contraindicated for various conditions, bedside products such as foams, dry powders, or concentrates that do not require rinsing may be used. Shampoo caps are also available and should be warmed in the microwave if they are not stored in a warmer. Once the cap is on the patient’s head, massage the hair and scalp to lather the shampoo per manufacturer’s directions, and discard after use. Towel dry the hair after each type of cleansing, followed by combing and styling to the patient’s preference. If the person requests, an electric razor can be provided. If a hair dryer is not appropriate or available, the hair should be covered with a towel until dry to minimize the individual becoming chilled. Some healthcare facilities, such as a skilled nursing facility, may have beauticians or barbers to assist with hair care but this does not dismiss the nurse of obligation.
Hair type should also be considered with hair care. For tightly curled hair, a wide-toothed comb is best to untangle the hair, working from the neckline to the forehead. This hair type may also prefer small braids that do not need to be undone for shampooing. Application of a lubricant oil should be applied to the braids to prevent hair breakage. Those individuals with alopecia and/or baldness should still cleanse and moisturize the scalp to prevent dryness. Dandruff may also be present and is not considered contagious or infectious. Dandruff and hair loss may be embarrassing for a patient, so the nurse must remain professional and preserve the person’s dignity.
Nails
Nails may harbor bacteria, so maintaining nail care to prevent the risk of infection or injury from scratching is crucial. Nurses must follow the agency's policy related to nail care, as some facilities do not allow nail trimming by clippers. If allowed, nails should be trimmed straight across then rounded at the tips in a gentle curve. The nails should not be trimmed too short as the skin and cuticles may become injured. Hangnails, which are broken pieces of cuticle, should be cut off with cuticle scissors and not torn or ripped off. Cuticles should be gently pushed back, after softening by washing with warm water, using a terry cloth or blunt instrument. A moisturizer or emollient may be applied to the nails and cuticle to prevent hangnails. The underside of the nails should be cleaned with a blunt instrument or nail brush. Damaging the area where the underlying tissue and nail are attached by being forceful is discouraged. Once the care is completed, a massage to the hands using lotion may increase blood flow and provide comfort.
Feet
Feet also require special attention to prevent odors, injury, and infection. Poor care of the feet may result in conditions such as calluses, neuropathy, pain, ingrown toenails, or deformities (such as hammertoe). Feet may be cleaned in the shower or using a basin with tepid water and mild soap for bedside baths. The feet should not be soaked. Feet should be dried immediately after being washed. Lotion may be applied and massaged on the feet to promote circulation and provide comfort. In the presence of athlete’s foot, an antifungal foot powder should be ordered and used for treatment. Toenails should also be kept short to minimize bacteria underneath the nail. Care of the toenails is very similar to the care of fingernails. In some facilities, only the registered nurse may be allowed to trim the toenails of patients with diabetes, using a nail file to reduce the risk of trauma or injury. The patient with diabetes may have reduced sensation in their feet and must be taught how to examine and care for the feet daily. Some patients may need to see a podiatrist for treatment of corns, calluses, or bunions. The nurse should also educate the individual or ensure the use of cotton socks for warmth and perspiration absorption, as well as the importance of properly fitting footwear to avoid complications.
Link to Learning
The ADA provides a reference for daily foot care tips as diabetes can alter a person’s ability to feel pain, heat, or cold in their feet. This leaves an individual susceptible to injury or infection. Therefore, it is essential that the nurse educates the patient on proper foot care.
Perineal and Vaginal Care
Care of the genitalia, called perineal care, is part of a complete shower or bath. Patients who are able to perform hygiene independently may prefer to cleanse on their own. Those persons not able to perform this practice independently may request someone of the same gender to assist with perineal care or a bath in general. This request must be communicated and followed as best as possible. Patients who require help may include those who have physical or cognitive limitations. Individuals who are postpartum, recovering from rectal or genital surgery, or have an indwelling catheter require meticulous care to avoid infection. Other instances that may also cause vaginal or perineal problems include douching, some sexually transmitted infections, diabetes mellitus, and urinary or fecal incontinence. Maintaining a professional attitude, preserving the patient’s dignity, ensuring privacy, and gaining permission to touch the patient is important when aiding in perineal care regardless of consciousness. The nurse needs to remember to always clean from the least contaminated areas to the most contaminated areas to prevent infection.
Sitz baths may also be used after childbirth, rectal surgery, or vaginal surgery. This treatment may also be used to relieve discomfort from a fissure or hemorrhoids. A sitz bath is most often performed on the toilet with a tub lining the bowl. The tub is filled with three to four inches of warm, not hot, water. The patient will submerge the pelvic area for twenty to thirty minutes to aid in reducing inflammation. Other options for cleansing the perineal and vaginal areas of a patient who is postpartum include either a shower or sitting on a stool using a perineal irrigation bottle.
Clinical Safety and Procedures (QSEN)
QSEN Competency: Performing Perineal Care
See the competency checklist for Performing Perineal Care. You can find the checklists on the Student resources tab of your book page on openstax.org.
Catheter Care
Catheters come in many forms, such as internal (indwelling and Foley catheters) and external (wick and condom catheters). For patients with an indwelling catheter, powders and lotions should be avoided after cleaning. Betadine, antibiotic, or other microbial cleaners should be avoided at the urethral meatus. Catheter care is usually performed after perineal care and is usually ordered twice daily. Nurses should pay close attention to how long the catheter has been inserted and request confirmation from the provider to remove the catheter as soon as possible if it needs removal. Prompt removal and precise cleaning can help to avoid an associated infection. According to the CDC, catheter-associated urinary tract infections (CAUTIs) have been cited as the number one healthcare-associated infection (HAIs) (Werneburg, 2022). Patients with fecal incontinence may require more frequent cleanings. Nurses wear clean gloves and perform hand hygiene before and after caring for the patient. The catheter should always be cleansed gently from the meatus outward using mild soap and running water. Each stroke should use a clean portion of the washcloth or disposable wipe.
Clinical Safety and Procedures (QSEN)
QSEN Competency: Performing Catheter Care
See the competency checklist for Performing Catheter Care. You can find the checklists on the Student resources tab of your book page on openstax.org.
Life-Stage Context
Menstrual Hygiene
Patients who experience menstrual cycles will need proper menstrual hygiene. There are various products available such as pads, tampons, cups, sponges, and padded underwear or briefs. Some cultures practice free bleeding. Assessing the patient’s preferences for the type of products normally used for these purposes is important. Sanitary pads and briefs should be changed every few hours or more frequently depending on the menstrual flow. Tampons should be changed every four to eight hours or more frequently with heavier flows. Menstrual cups should be cleaned daily after use and can be sanitized by rinsing thoroughly and boiling in water for one to two minutes or per manufacturer guidelines. Period underwear should be washed per manufacturer instructions. The risks associated with improper menstrual hygiene can lead to yeast infection, toxic shock syndrome, rash, irritation, and impaired skin integrity. The nurse must assess the patient’s knowledge and preferences, as well as provide education about menstrual hygiene.
Special Focus on the Older Adult
Life span considerations for the older adult include age-related changes that require special focus and nursing strategies. Age-related changes include impaired physical mobility, impaired oral mucous membranes, and an increased risk for impaired skin integrity. Older adults are also more likely to become chilled when left uncovered during bathing. The room should be maintained at a warmer temperature, and drapes should be used during care to provide modesty and avert chilling. Older adults also may experience neurologic changes or impaired circulation that impede the ability to sense temperature changes in water. Using caution to prevent burns or injury to the skin is also important to remember. In addition, frequent bathing and use of soaps may have harmful effects on the skin.
Age-Related Changes
Impaired physical mobility related to aging includes decreased dexterity and muscle strength, chronic conditions that compromise functional mobility, and decreased range of motion. Some examples of chronic conditions that compromise functional ability include heart disease, diabetes mellitus, rheumatoid arthritis (RA), coronary heart disease, chronic obstructive pulmonary disease (COPD), and osteoarthritis. Patients with deficits after a stroke, Parkinson disease, or other neurologic disorders may also experience physical limitations.
Part of the aging process also includes a loss of elasticity, reduced blood supply to connective tissue, and degeneration of epithelial cells that lead to impaired mucous membranes. Older patients are also likely to have impaired oral mucous membrane due to the decreased production of saliva and medications that cause dry mouth. For example, decongestants, antidepressants, antihistamines, blood pressure medications, Alzheimer disease medications, analgesics, and diuretics may cause dry mouth.
Older adults are also at risk for impaired skin integrity due to the loss of elasticity, thinning of the epidermis and subcutaneous fat, and dryness caused by decreased activity of oil and sweat glands. The older adult’s nails may become opaque, brittle, scaly, tough, or hypertrophied. These skin-related changes may also be visible in the feet. Older adults are at an increased risk of friction shear and pressure ulcers due to age-related skin changes and impaired mobility.
Nursing Strategies
Nursing strategies for patients with impaired physical mobility include ensuring patient safety. For example, grab bars, adequate lighting, and nonslip mats in the bathrooms should be available to reduce the chances of falling or injury. Providing frequent rest periods, and scheduling hygiene sessions after periods of rest can ensure the patient does not become overly exhausted. Older adults may benefit from adaptive hygiene devices such as a long-handled body sponge, shower chair, large or extended handled toothbrushes, and grab bars (Figure 7.3). Physical therapy, or exercise, and occupational therapy may also be needed to aid in activities of daily living and help patients retain their independence by improving their mobility and functionality.
Good oral hygiene measures may aid in the preservation of the older person’s ability to eat and can also reduce the alteration in taste common with aging. Patients should be encouraged to have dental exams every six months and should avoid spicy, acidic, coarse, and sugary foods that may cause dental caries. Mouthwashes that contain alcohol should also be avoided. Nurses should also encourage or aid with brushing teeth with fluoride toothpaste twice a day. Dentures should be brushed twice daily and rinsed with cool water. Other strategies include rinsing the mouth after meals, examining the mouth daily to check for inflammation and lesions, and applying lubricant to lips. Patients may have sugar-free gum or candies and salivary substitutes, such as mouth sprays, gel, swabs, dissolving tablets, or an oral rinse.
Maintaining skin integrity is essential to ensure the integumentary system is able to properly perform its functions of protection, sensation, heat regulation, excretion, secretion, and absorption. For example, the nurse can incorporate strategies for how hygiene can be tailored to keep the patient warm, such as keeping a blanket over the patient while exposing one body part at a time for personal care. The nurse can also perform bathing as quickly as possible and place a warm blanket on the exposed individual immediately after the bath. Because older adults are more susceptible to friction shear and other injuries, the bedding should be wrinkle free, clean, and dry. Draw sheets should be used when repositioning or moving patients to avoid skin injury as well. Water temperature for bathing should be monitored to ensure the temperature is tepid and not hot. Older patients who are able should use showers and avoid bathtubs as this method can dry out the skin. The skin should be rehydrated with lotions or emollients daily while avoiding excessive amounts. Any excessive amounts of lotions of emollients should be wiped off to avoid skin breakdown. Older adults should also be encouraged to drink hydrating fluids to aid in hydrating the skin. Because frequent bathing and the use of detergent soaps can be harmful to the skin, bathing should be regular but not every day and pH-balanced skin cleansers should be used.
Unfolding Case Study
Unfolding Case Study #2: Part 3
Refer back to Unfolding Case Study #2: Part 1 to review the patient data.
| Nursing Notes | 1030: After speaking with the charge nurse about concerns, patient’s daughter is visibly upset. She is crying and states, “I just feel so helpless. I want to be here to be the one to help him to the bathroom and keep him clean, but I can’t. I work fifty hours a week and barely see my own kids. I just don’t know what to do.” 1400: Patient educated on how to call nursing staff when he needs to use the bathroom. Patient expresses understanding and agrees to call. |
| Flow Chart | 1030: Assessment Blood pressure: 128/81 mmHg Heart rate: 93 beats/minute Respiratory rate: 20 breaths/minute Temperature: 99.1°F Oxygen saturation: 98% on room air |
Promoting Health through Education
One of the most essential roles nurses have in disease prevention and health promotion is through education. The nurse should assess a patient’s knowledge about hygiene as well as individual cultural and personal preferences. The nurse should educate people on the importance of good hygiene practices. For example, promoting medical asepsis prohibits the growth of pathogenic microorganisms, which leads to decreased chances of infections. In addition, good hygiene can aid in preventing the spread of diseases to others, promote self-esteem, and boost mood. Once the nurse assesses the patient’s knowledge and ensures understanding, the nurse should educate the person on the steps needed to perform hygiene to avoid infection or injury. The nurse should also assess a patient’s ability to perform care independently via performing a head-to-toe assessment. The nurse should reinforce proper steps as needed while educating and giving instructions on the importance of diet and nutrition to promote healthy skin and mobility.
Patient Conversations
What If Your Patient Does Not Have Adequate Knowledge about Oral Hygiene?
Scenario: Nurse walks into the newly admitted patient’s room to determine hygiene needs. The patient is a college student that has not seen a dentist in a few years and has red, inflamed gums.
Nurse: Hi, my name is Marie, and I am going to be your nurse today. Do you mind verifying your name and date of birth?
Patient: My name is Sarah Milton, date of birth December 4, 2003.
Nurse: Thank you. I am going to ask you a few questions about your personal hygiene. Is that okay?
Patient: What is personal hygiene? Like how I do my private care? I’m confused.
Nurse: Personal hygiene is the self-care measures you would perform such as bathing, brushing and flossing your teeth, hair care, and nail care.
Patient: Well, I let my roommate do my nails, since she is in cosmetology school. I shower almost daily and wash my hair every other day. I brush my teeth a few times a week and never floss.
Nurse: Okay, when was the last time you saw a dentist?
Patient: I don’t know, maybe two or three years ago. I was still in high school, and my mom made me go.
Nurse: Have you ever had cavities, gingivitis, or any other dental issues?
Patient: I do not know what gingivitis is. My gums bleed when I brush them, which is why I do not brush as much. I remember the dentist made me use a special mouthwash once. I had several cavities as a kid. I think I had to get fillings at almost every visit.
Nurse: Gingivitis is inflammation of the gums. If left untreated, it can lead to periodontal disease that can ultimately lead to loss of teeth due to infection and deterioration of the gums. If infection entered the bloodstream, it could also increase the chances of stroke, heart attack, or other serious events. Signs of gingivitis include swollen gums, reddened gums, gums that bleed easily with brushing or flossing, bad breath, and tender gums. I know you said your gums bleed easily. Do you experience any of the other symptoms?
Patient: Yeah, my gums are pretty tender. I have never looked for the other things though.
Nurse: Okay, do you mind if I examine your mouth?
Patient: Sure.
Scenario follow-up: Upon examination, the nurse noted a foul odor, visible food particles in the patient’s mouth, and reddened, swollen gums.
Nurse: You do have reddened, swollen gums with food particles present. Food left in between teeth can cause irritation and inflammation. Flossing will aid in the removal of food particles, plaque, and tartar. Seeing a dentist for examination and professional cleaning to remove plaque, tartar, and bacteria regularly will aid in the prevention of dental issues as well. I will go over oral care with you and demonstrate the steps to perform twice a day as well as rinsing your mouth after meals. I will also provide you with a mouthwash to use while you are here.
Patient: Okay, great. Thank you. My parents did not tell me any of this. I do not want my teeth to fall out.