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ATI Personal Hygiene

Terms in this set (107)

A nurse is caring for an unconscious patient. Which of the following statements by the nurse indicates an understanding of providing good oral hygiene for the patient
"I'll swab the patient's mouth with diluted hydrogen peroxide."
What is not appropriate for oral hygiene for a patient that removes moisture from the oral cavity and that damages tooth enamel
Lemon-glycerin swabs
When planning morning hygiene care for a postoperative patient, which of the following actions should the nurse include
Ask the patient in what order she typically performs her morning routine
A nurse is caring for an adult patient who is NPO. The patient is refusing oral care. Which of the following is appropriate by the nurse
"Oral care is still important even though you are not eating."
Why is it important to perform oral care
To help reduce oral bacteria and keep the oral cavity moist
A nurse is caring for a patient who is on long-term bed rest and requires frequent linen changes due to excess diaphoresis. Which of the following is the priority rationale for frequent linen changes
Moisture from excessive diaphoresis can cause skin breakdown
A nurse observes an assistive personnel (AP) make a client's bed while the client is out of the room. Which of the following actions by the AP is appropriate for this task
The AP reuses the patient's blanket and spread
Making a clients bed does not require what
Documentation
While performing a complete bed bath for a patient, the nurse should
Raise the room temperature
Why should soap not be added to the water in the basin when giving a bed bath
Irritation to the eyes can occur
What is the nurse going to do when giving a patient a tub bath
First, nurse will gather all necessary supplies. Second, prepare the room by placing a rubber mat on the rub floor to prevent the patient from slipping and falling. Third, nurse will assist patient into the bathroom and give instructions regarding the use of bars to prevent slipping and falling when entering or exiting the bathtub. Lastly, nurse will instruct patient to remain in tub for no longer than 20 min due to possibility of vasodilation from warm water, which can cause light-headedness or dizziness.
A nurse is assisting a patient with personal hygiene care. Which of the following actions by the nurse will reduce the risk of infection
Cleaning the least-soiled areas prior to cleaning the most-soiled areas
How should a bed bath be given
Using long, firm strokes and proceeding from the distal to the proximal areas
activities of daily living (ADLs)
tasks performed routinely during the course of a typical day, such as walking, eating, bathing, brushing the teeth, and grooming
adaptation
adjustment to changes in circumstances such as those resulting from illness or disability
alopecia
hair loss
athlete's foot (tinea pedis)
a chronic superficial fungal infection of the skin of the feet, typically between the toes
buccal
pertaining to or directed toward the bucca (cheek), the fleshy portion of the side of the face that makes up the lateral wall of the oral cavity
callus
a thickening of or a hard thickened area on skin
canthus
the angular junction of the eyelids at either corner of the eye
cheilosis
manifestation of vitamin B complex deficiency characterized by reddened lips with fissures at the angles of the mouth
closed bed
a bed prepared in a hospital room with the top sheet, blanket, and bedspread drawn up to the head of the mattress under the pillows
corn
often painful and inflamed circumscribed lesion of thickened skin, usually on the toes and caused by pressure or friction from ill-fitting shoes
cuticle
the narrow band of epidermis extending from the nail wall onto the nail surface
dental caries
tooth decay
dental plaque
a sticky film accumulating on the teeth that is formed by and harbors bacteria; also called tartar
draw sheet
linen item placed under the patient's torso and used to lift and reposition the patient
excoriation
skin abrasion typically resulting from scratching
expectorate
to expel fluid or secretions from the mouth, throat, or lungs by coughing and/or spitting
fanfolding
applying the proximal half of a piece of linen in successive layers lengthwise for the purpose of tucking it under the patient and rolling the patient over it while stripping or making an occupied bed
fissure
a break, slit, or tear in soft tissue, often at the junction of skin and mucous membrane
foreskin
fold of skin covering the glans penis (head) of an uncircumcised penis; also called prepuce
gingiva
the part of the oral mucosa covering the tooth-bearing border of the jaw; also called gums (plural: gingivae)
gingivitis
inflammation of the gums characterized by redness, swelling, and intermittent bleeding
halitosis
bad breath
hypoallergenic
unlikely to cause an allergic (hypersensitivity) response
incontinence
involuntary release of urine from the bladder or feces via the anus
ingrown nail
painful condition in which the corner or side of a toenail grows into the soft flesh of that toe
labia
folds of skin on either side of the vaginal orifice
lunula
active area of nailbed growth at the base of the fingernails and toenails
neuropathy
any of numerous disturbances or pathologic changes in the peripheral nervous system, most often affecting sensation
NPO
nothing by mouth, derived from the Latin words nil per os
open bed
a bed prepared in a hospital room with the top covers folded back to make it easy for the patient to get into the bed
palate
the roof of the mouth separating the mouth from the nasal cavity, comprised of the hard palate (in the front of the mouth, separating cavities of the mouth and the nose) and the soft palate (the fleshy portion that separates the mouth from the pharynx)
pediculosis
lice infestation
perineum
area between the anus and the posterior portion of the external genitalia
peridontal
surrounding or near a tooth
plantar wart
a skin lesion on the sole of the foot typically caused by any of the human papillomaviruses
sebaceous gland
oil-secreting organ of the skin
sebum
fatty lubricant secreted by the skin's sebaceous glands
semi-Fowler's position
position with the head of the bed raised approximately 30 degrees
smegma
thick, cheesy secretion that accumulates under the labia minora or the male foreskin
sordes
foul brown crusts or accumulations of food, microorganisms, and epithelial elements on the teeth and lips, usually associated with a febrile or gastrointestinal disorder
stomatitis
any inflammatory disorder of the mouth
tartar
a sticky film accumulating on the teeth that is formed by and harbors bacteria; also called dental plaque
thrush
a fungal infection in the mouth and/or throat caused by Candida albicans and manifesting as white patches and ulcers
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The most common methods are a complete bed bath, partial bed bath, therapeutic bath, shower, and tub bath.
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For patients who must remain in bed and depend on someone else for their care, you'll provide a complete bed bath. Use either a pre-packaged bathing product or a basin of warm water and soap.
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You or the patient can complete a partial bath, bathing only those parts of the body that cause discomfort if not bathed. These include the hands, face, axillae, back, and perineal area. Patients who are dependent and require only a partial bed bath or self-sufficient patients who must remain in bed but cannot reach all body parts often receive a partial bed bath.
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A therapeutic bath is part of the treatment plan for such conditions as skin disorders, burns, elevated body temperature, and muscular injuries. Oatmeal, cornstarch, and commercial bath products are sometimes added to the bath water to relieve skin irritation. For patients who have had rectal or perineal surgery, a sitz bath is often prescribed to reduce pain and inflammation. To add this type of bath to a patient's plan of care, you must obtain an order from the patient's provider.
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For patients who are ambulatory or able to sit in a shower chair, showering is the preferred bathing method. Because this can be tiring, however, it is important to monitor patients closely to make sure they are safe and not at risk for falls or other injuries.
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A tub bath involves immersing the patient in a tub of water to provide more thorough washing and rinsing than a bed bath can provide. This type of bath is appropriate for independent patients and for dependent patients if a lifting device such as a Hoyer lift is available to help with positioning the patient in the tub.
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Even though bathing has many benefits, excessive bathing of older adults can be harmful since some products can cause drying and cracking of the skin. To help prevent this, use a pre-packaged disposable bed bath product. This type of product usually includes disposable cloths that clean, moisturize, and condition the skin all at the same time.
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It is ideal to change the bed linens when the patient is out of the bed. However, if the patient is too weak to get out of bed or restricted to bed rest, you'll have to change the linens while the patient is in bed. Because this can be tiring for the patient, be sure you are organized before beginning the process. If the patient is experiencing any pain, administer a prescribed PRN analgesic about 30 to 60 minutes beforehand to help control the pain and make the patient as comfortable as possible while you change the linens.
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When changing the linens on the patient's bed, you might not have to change all the linens each day. Typically, you'll change the bottom sheet, top sheet, and the pillowcase. However, you can leave the same mattress pad, blanket, and bedspread in place if they are not wet or soiled.
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Follow standard precautions by wearing gloves if the linens are soiled and by keeping the linens away from your scrubs when throwing them in the linen hamper. Also, avoid shaking the linens since this can spread micro-organisms in the air. If at anytime during the linen change the clean linens touch the floor, place them in the linen hamper and use clean ones instead.
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Observing good body mechanics and patient safety is also important when changing the linens on the patient's bed. Be sure the bed is at a comfortable working height so that you don't have to bend or stretch over the mattress to remove the dirty linens or to put clean ones on the bed. Also, make sure the side rails are up when changing an occupied bed to keep the patient from rolling out of bed and to give the patient something to hold onto while moving from side to side.
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Depending on whether you are changing the bed linens for the current patient or for a patient who will be admitted, you'll leave the linens either in an open or a closed position. For an open bed, fold back the top covers so that it is easy for the patient to get back into bed. For a closed bed, leave the top sheet and the bedspread at the top of the mattress under the pillow until the patient is admitted.
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In addition to an open or closed bed, you'll prepare unoccupied beds for patients who will be brought to your unit after surgery. With this type of bed, you won't tuck in or mitre the corners. Instead, you'll fold them to the bottom third of the bed to make transferring the patient from the stretcher to the bed easier.
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After you have replaced the bed linens, lower the bed to its original position and make sure the wheels are locked to keep the patient from falling when getting in and out of bed. In addition, place the call light, bed controls, patient-controlled analgesia button, and any other devices the patient needs within the patient's reach.
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Encourage patients who wear dentures to care for them in the same manner as they would care for their natural teeth. Keeping dentures clean can help prevent the gums from becoming irritated and infected. To keep bacteria from building up underneath the dentures and to give the gums a rest, dentures should be removed at night.
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Before removing a patient's dentures, be sure to break the seal on the upper denture by gently moving the denture up and down or by placing your finger on the edge of the denture and pulling down. Because the upper denture is larger than the lower denture, remove the upper one first and later insert it first.
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For patients who are unable to care for their own dentures, it is your responsibility to provide this care for them. Because dentures are the patient's personal property and are costly to replace if broken or damaged, handle them with care when cleaning them. When preparing to clean dentures over a sink, place a towel or a washcloth in the bottom of the sink to avoid breakage if you drop them.
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When rinsing the patient's dentures, be sure to use cool or tepid water. Avoid hot water because heat can soften the material that some dentures are made of, resulting in damage to the dentures.
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If dentures are stained, soak them in a commercial cleaner following the manufacturer's directions. If the dentures have any metal pieces, avoid soaking them overnight as this can cause corrosion. Be sure to rinse them well before putting them back in the patient's mouth.
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When the patient is not wearing the dentures, store them in a small amount of water in a denture cup or in a container with a lid. Label the cup with the patient's name and room number and store it in a safe place to prevent loss. Discourage the patient from placing dentures in a napkin or a facial tissue because they can be easily mistaken as garbage and discarded.
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Because dentures improve the patient's speech, appearance, and self-image, it's important to put back them back in as soon as possible after oral hygiene or after the patient returns from a procedure. If the dentures are dry, moisten them with water before putting them back in the patient's mouth.
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Begin combing the hair by dividing it into three or four sections. Then, brush or comb each section one at a time starting at the scalp and moving to the ends of the hair to minimize pulling. For tangled hair, use a wide-toothed comb and comb the tangles out from the ends of the hair toward the scalp.
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Shampooing cleans the hair and scalp and can also relax the patient. Start shampooing at the hairline and work toward the neck. To wash the hair on the back of the patient's head, gently lift the head with one hand and shampoo with the other. Before rinsing, massage the patient's scalp by applying light pressure with your fingertips.
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Depending on the patient's health status, you can shampoo the hair in any of a variety of ways. If the patient is ambulatory, use the shower. If the patient is able to sit in a chair and lean back, shampoo the hair at the sink. For patients on bed rest, use a plastic shampoo trough. Dry or no-rinse shampoos and shampoo caps are also options for patients on bed rest.
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Place a folded or rolled towel behind the patient's neck to pad the edge of the sink. Before beginning, make sure there are no contraindications to having the patient's head and neck manipulated or extended back over the sink.
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When using a plastic shampoo trough for a patient on bed rest, place a small basin at the side of the bed to catch the water that drains from the trough. To keep the bed linens and the patient's gown dry, place a waterproof pad underneath the trough and a towel around the patient's shoulders. Also, place a washcloth over the patient's eyes to protect them from the water and the shampoo.
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Another option for shampooing the hair of patients on bed rest is to use a dry shampoo, a no-rinse shampoo, or a shampoo cap. These shampoos are activated by heat and must be warmed in a microwave oven before you massage them into the patient's hair and scalp. Although these shampoos are convenient and require minimal movement of the patient, they can make the hair and scalp dry.
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Nail, hand, and foot care is performed on a regular basis to assess for lesions, dryness, and signs of infection. This is especially essential for patients who have peripheral vascular disease or diabetes mellitus and for patients with immunosuppression or who are otherwise at higher risk for developing foot and nail problems.
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You'll perform nail, hand, and foot care during bathing. Soak the patient's hands and feet in a basin of water for a short period of time while performing other hygiene procedures and then wash the hands and feet with soap and water. When drying the hands and feet, be sure to dry between each finger and each toe.
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If you trim the patient's fingernails or toenails, cut them straight across to prevent injury or trauma to the surrounding tissue. Before cutting any patient's nails, check your facility's policy; some require an order from the patient's provider while others allow only a podiatrist to cut some or all patients' nails.
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Be sure to clean underneath the patient's nails using an orange stick or the end of a plastic applicator stick to remove debris that can harbor micro-organisms. Shape the nails and smooth rough edges using a nail file. Apply lotion to the patient's hands and feet, focusing on dry or callused areas. If the patient's hands or feet are extremely dry and the skin is cracked, use a deep-penetrating moisturizer.
Your foot and nail care will vary from the standard when you care for a patient who has diabetes mellitus. Do not soak the feet due to the risk of infection and do not cut the nails. Instead, file them using a nail file. Do not apply lotion between the fingers or toes since the moisture can cause skin irritation and breakdown.
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For patients who are receiving oxygen therapy, have a nasogastric tube in place, or are NPO (receiving nothing by mouth), oral hygiene is particularly important. Because these patients often have dryer mouths, the risk of sordes (a collection of bacteria, mucus, and other mouth secretions on the tongue, teeth, and lips) increases. As a result, the risks of inflammation, infection, and a general state of poor oral health increase.
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Oral hygiene includes different components depending on the patient, the patient's health status, and whether the patient has dentures or his natural teeth or both. Most often, though, oral hygiene includes brushing the teeth several times a day, flossing at least once a day, and rinsing with an antiseptic mouthwash once or twice a day.
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When oral hygiene is performed correctly and often enough, the patient's mucous membranes and gums should be pink, moist, and intact, teeth should appear clean and shiny, and no mouth odor should be noticeable. A patient whose mouth has any signs of inflammation, infection, or sordes may need oral hygiene more frequently as well as education about the proper techniques for brushing and flossing.
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When oral hygiene is not performed correctly or often enough, oral health problems can develop. The most common of these are plaque and tartar build-up, tooth decay,gingivitis, and periodontitis.
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Plaque is a soft, sticky, colorless substance that forms on the hard, rough surfaces of the teeth. If plaque is not removed and accumulates on the teeth, the gums can become irritated, the outer enamel of the teeth can be destroyed, and halitosis can develop.
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When plaque remains on the teeth for long periods of time, it usually hardens into a yellowish brown mineral substance called tartar, which allows for more plaque to accumulate on the rough surfaces of the teeth. If tartar accumulates below the gum line, periodontal disease is likely to develop.
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Another common dental problem resulting from the accumulation of plaque on the patient's teeth is tooth decay, also known as dental caries or cavities. It is caused by the acid in the plaque's bacteria destroying the outer surfaces of the tooth. Cavities are usually treated by removing the area of decay and replacing it with a filling to repair the tooth and protect it from further damage. Left untreated, decay can destroy the entire tooth.
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Gingivitis is the early stage of periodontal disease. It involves inflammation of the gums and often times bleeding when the patient brushes and flosses the teeth. With proper oral hygiene, which includes both brushing and flossing, gingivitis can usually be reversed.
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Patients who are able to sit in a Fowler's or semi-Fowler's position can usually perform their own oral hygiene as long as the necessary supplies are within easy reach. For independent patients, sitting on the edge of the bed or standing at the sink is also an option when performing oral hygiene.

While a patient is performing oral hygiene, it is important for you to observe the process and provide any necessary teaching about brushing and flossing. This is also a good time to discuss the importance of oral hygiene and good oral health with the patient.

When patients become ill, have surgery, or have a medical condition that inhibits the use of their hands, you must perform oral hygiene for them. Before assuming dependent patients are incapable of performing any of their oral hygiene, be sure to assess their level of dependence and invite them to participate in any way they can.

Be sure to add the level of assistance that is required to the patient's plan of care. The healthcare team can then be aware of how and to what extent they have to assist the patient with oral care.
Dependent patients

When patients become ill, have surgery, or have a medical condition that inhibits the use of their hands, you must perform oral hygiene for them. Before assuming dependent patients are incapable of performing any of their oral hygiene, be sure to assess their level of dependence and invite them to participate in any way they can.

Be sure to add the level of assistance that is required to the patient's plan of care. The healthcare team can then be aware of how and to what extent they have to assist the patient with oral care.
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Unconscious patients

An unconscious patient requires frequent and meticulous oral hygiene to prevent oral health problems from developing. Because these patients usually breathe through their mouth and are unable to take in anything by mouth, sordes can easily accumulate on the lips, teeth, and tongue causing additional health concerns.
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Before beginning perineal care, position the bed at a comfortable working height. Position the patient with knees bent and legs slightly apart, unless contraindicated. This position exposes the areas you will clean and allows for more thorough bathing.
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If the patient is taking anticoagulants or has a bleeding disorder, use an electric razor. Before using it, though, make sure it is in good working condition and will not harm the patient. Check your facility's policy about using the patient's electric razor or a hospital-issued electric razor.
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When using a disposable razor, be sure the patient's skin is soft before beginning to shave it. To accomplish this, place a warm washcloth over the patient's face for a few seconds before applying shaving cream. Softening the skin first helps prevent pulling, scraping, or cutting the skin during shaving.
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To avoid causing discomfort and to reduce the risk of cutting the patient's skin during shaving, pull the skin taut and use long, firm strokes to shave the larger areas of the face and short downward strokes to shave around the chin and lips. Shaving in the direction of hair growth is also helpful.
female perineal care
For a female patient, place a bath blanket over her abdomen so that one corner is pointing in the direction of her head and the other corner is covering the perineal area. Secure the lateral corner of the blanket loosely around the patient's legs. When you are ready to begin, fold the corner covering the perineal area back onto the patient's abdomen to expose the area you will bathe.
Clean the perineal area from front to back to prevent contamination from the rectal area to the urethra. It is also important to use a separate area of the washcloth for each area or a new washcloth if the one you are using becomes soiled. After you wash and thoroughly rinse each area, pat them dry to prevent skin irritation and breakdown.
Male perineal cleaning
Wash the patient's upper thighs and inguinal area.

Draping a male patient for perineal care involves placing a bath blanket over his abdomen and covering his legs with a sheet or towel. Once you have organized all supplies and you are ready to begin providing care, fold the blanket or towel back to expose the perineal area.
incontinence care
If you are caring for a patient who is incontinent, provide perineal care frequently to help prevent skin breakdown and infection. The procedure is the same as it is for routine perineal care with one difference: After you have washed, rinsed, and dried the perineal area, apply a cream or ointment on the perineum and surrounding skin as prescribed to act as a barrier that will help protect the patient's skin.
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Because unconscious patients are at risk for aspirating during oral hygiene, you must always have suction set up at the bedside and ready to be used before you begin providing oral hygiene.
Proper positioning can help reduce the risk of aspiration. For an unconscious patient, the best position is side-lying with the patient's head turned toward you in either a semi-Fowler's position or with the head of the bed flat. Placing the patient in one of these positions allows fluid and any oral secretions to collect in the dependent side of the mouth and drain out.
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Use a soft-bristled toothbrush and toothpaste to brush your patient's teeth gently to remove any debris, then brush the patient's tongue. Use a syringe and water to rinse the teeth and tongue. Then use foam swabs moistened with diluted hydrogen peroxide or other facility-approved solution to remove crusts and secretions from the mucous membranes of the mouth. Be sure to suction any oral secretions that pool in the patient's mouth during the procedure.
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Since an unconscious patient cannot report any mouth pain or discomfort, perform a thorough assessment of the oral cavity each time you provide oral hygiene. If you note any inflammation, infection, sores, or bleeding, initiate treatment immediately since oral health can affect the patient's overall health status.
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