Personal Hygiene (Nursing)

00:01 Hi! My name is Diana Shenefield, and we’re going to talk during this lecture about personal hygiene. Now, you may think, “Really? That’s the topic for NCLEX?” But there’s a lot more about personal hygiene than just taking a shower or taking a bath. We’re going to talk a little about how important it is, not only for our patient’s wellbeing but for their skin and for disease prevention. So we’re going to look at what kind of problems people can get into, by not taking care of their skin, not taking care of their body, not being able to go about their activities of daily living. One of the things we look at, as nurses, is we want to encourage our patients for self-care. And so if they can’t take care of themselves, what kind of complications can happen? And what can we do to get them to the point where they can’t care for themselves. We’re going to look out at assessing and intervening when patients can’t go about their activities of daily living.

01:00 We’re going to look at performing post-mortem care. Now, you may think, why is that on this topic? And honestly, I think NCLEX just needed a place to kind of stick that so when you’re doing your review, you can talk about it. But again, post-mortem care does have a lot to do with hygiene, cleansing the body. So we’re going to talk a little bit about that as well.

01:22 So, our practice question for this topic is a nurse is bathing a febrile patient.

01:28 So think about your patients that have had fevers, whether you’re actually sticking them in a bathtub or whether you’re just sponge bathing them. Why should the nurse use tepid water? So, what is tepid water? It’s water that’s not hot or cold.

01:42 So, be thinking about the purpose that you would be sponging or bathing a patient with tepid water that has a fever. Is it A, to increase heat loss; B, to remove surface debris, C, reduce surface tension of the skin; or D, stimulate peripheral circulation? Now, lot of those things would go along with giving somebody a bath. But we’re talking about your patient that has a fever. What is the purpose of a tepid bath? And hopefully, you said A, to increase heat loss. Just remember that you don’t want your patient to shiver.

02:19 So there’s a difference between just sponging somebody and lowering their temperature too fast. So, watch that on NCLEX as well. So what are we going to review here? There's a lot of reasons why people are unable to take care of themselves. Some things are easily fixed, and some things are going to require a change in the way somebody lives, a change in the way that they’re mobile, maybe the change in the place that they live. And one of the things that can interfere with our activities of daily living is somebody with the vision impairment. Do you have an older person maybe that’s suffering from cataracts or glaucoma, or there has been an injury, a form body to where they’ve lost vision of an eye for maybe temporarily or permanently? Vision can affect the way we take care of ourselves, the way we see ourselves. So we’re going to want to look at that. How about activity intolerance? If you have a patient with CHF or COPD that gets dyspnea when they’re up and around, they’re going to get up and around less. They may be not going to get up and prepare their meals, or maybe not get up to brush their teeth and those kinds of things if they are exhausted after movement. So, what can we do to help them with that? Mental impairment, if your patient does not understand about getting up and around, whether it’s a head injury or whether they were born with a defect, do they know how important it is to take care of themselves, to bath, to brush their teeth, and all of those kinds of things? Is it somebody that needs help to remind them or to show them daily how to do those things? Is it a neuromuscular problem? Again, your patient that has had a stroke, they want maybe to take care of themselves, but maybe because of paralysis, they can’t. Maybe they can’t get to the bathroom. Maybe they can’t get to the kitchen. Again, looking at, is it a change? Is it a progression? Is it something that happened because of a accident, that one minute, they were able to do things, and the next minute, that they weren’t? Don’t get so focused on just their care but think about how are they going to be able to take care of themselves. And if they can’t take of themselves, what kind of complications are we going to see? And then skeletal impairments. Again, whether a broken leg or a broken arm, obviously, that’s going to be a detriment to how I can move around my house, how I can take care of myself. So again, is it something that just happened? And maybe it’s only short-term.

04:44 Or is it something that your patients going to have to learn to live with and readapt how they take care of themselves? So, things that you need to review. What is an activity restriction? Sometimes our patients are on activity restrictions because it would cause harm to them. So, if they are, what is that restriction? And then, what do we need to do to make sure that they can still have theirselves taken care of? It doesn’t mean that I have to bring maybe the bedside table to them and put it base in the water.

05:16 Doesn’t mean that they now maybe can’t get into their tub at home, they’re not able to lift their legs up. So again, be thinking about not only what’s happening in the hospital, but be thinking about at home or at the nursing home. Are they going to be able to take care of themselves because of that physician has told them that they can’t do something? What about therapeutic procedures that limit? In the hospital, maybe they’ve had a catheterization and they are left and they have to lie flat, and they have to go to the bathroom. So, what do you do to help with activities of daily living when it’s something that we have done to them, short-term, but it can affect their skin and it can affect their wellbeing? Environmental barriers. Maybe the person just doesn’t have access to water. Maybe they’re homeless. Don’t forget about your homeless patients, that it’s easy to say, “You need to do good oral care. You need to do good skin care.” And you’re sending them out and they don’t have running water. They don’t have soap. They don’t have a place to stay to keep any soaps or toothpastes that you’ve given them.

06:21 So again, looking at their environment, what is available, and how can you help them to get the supplies that they need. And then again, psychological barriers. Does the patient understand why this is important? Do they understand how to do the activities of daily living? Or is it somebody that’s going to rely on help for the rest of their lives? So one of the things that we’re going to look at is care of the skin, and we’ve talked about that in a lot of the lectures. But don’t ever forget care of the skin. And it can be the care of the skin of a COPD patient, a diabetic, somebody that’s in a trauma, a burn. The skin is very important. It’s our first line of defence. And so, maintaining healthy skin is just as important as helping it to heal. So, make sure your patients know and make sure you’re watching to watch for dryness. Can they use lotions? How am I going to keep the skin as healthy as I can? And how am I going to relate to the patient how important that is? What about ears, eyes, nose, and mouth? Keeping ears clean and not sticking Q-tips in. Mouth care, so many people don’t understand the importance of mouth care. But as nurses, we know that the mouth is full of bacteria.

07:34 And if your mouth isn’t taken care of, any kind of infection that gets under the teeth leads right to the bloodstream and it can cause all kinds of problems in the heart. It can cause sepsis. And so, watching teeth and having regular dental exams, and understanding how important it is to brush your teeth every day, and watching for inflammation in those kinds of things. Care of the feet. Whenever we think of care of the feet, we always think of our diabetic patient, and it’s so important that they have somebody checking their feet, especially if they had diabetic neuropathy. Do they know when they have sores? Who’s trimming their toe nails? We know as nurses that we can’t, but we don’t just let it go. Does your patient understand how important it is to do good foot care? And your elderly patient, maybe that can’t see their feet. Are we watching those and making sure that they don’t have calluses or open sores? Again, looking and teaching people or helping them, whatever that they need to make sure that we’re keeping that skin clean and dry. And then again, preventing pressure points.

08:36 Know your pressure points. Know where your bony prominences are. And then look over, again, the four stages or pressure ulcers. Do you know how to recognize a pressure ulcer? Do you know how to measure a pressure ulcer? Again, looking at all of that and preventing.

08:53 But if I don’t know where to look, I’m going to miss it. And making sure you’re looking at your patient’s backside. Again, many patients spend the time in the chair or the bed, and we don’t look at the skin on their back. So make sure you’re doing that as well. And then, do they need adaptation devices? Does your patient need a shower chair? Maybe they haven’t been going into the shower to bath because they can’t stand up that long. Find out, do they need a shower chair? Do they need a way to get into the bathtub? Do they need handrails? That will involve talking to the patient, maybe talking to family members. There is resources out there to get those for patients. So again, we’re looking at safety, but we’re also encouraging as much self-care as the patient can do. So now, to post-mortem care, lot of things to consider. As nurses, as people, we don’t like to think about post-mortem care, but it is a fact of life. So one of the things we need to think about, first and foremost, is culture and religion. Death is a very spiritual time for a lot of people. There's a lot of emotions. So we need to make sure that we’re sensitive to that. We need to make sure that we’ve talked to the families, what do they want. Do they want to spend time with the deceased? What kind of rituals? Do they need a priest? Again, all of that need to be discussed with the family.

10:12 We need to know exactly so that we don’t offend them, but also so that they feel that they have a chance to say goodbye. Lot of times, families in some cultures want to prepare the body, which is perfectly fine. Again, making sure that they understand how to do it, supplying the things that they need, giving them guidance, but also then allowing them to do as much as possible.

10:36 Watching out for infection precautions, again, as nurses and as family. Being able to prevent those, maybe garbing up or knowing our patients and knowing who’s infectious and who’s not.

10:45 And then again, following our policies and procedures. We know that sometimes, autopsies are mandatory. Sometimes they’re elective. Again, when the corner gets involved in wherever you are, you have to know your rules. But we need to make sure we’re following our policies and procedures for our institutions to make sure that we are being respectful to the family, but also respectful for the body as well.

11:11 So enclosing, hygiene, yes, it’s more than just taking a shower and washing your hair.

11:16 We need to make sure that our patients have good care, that they’re comfortable, and that we’re sending them out to be able to do as much care for themselves as they can.

11:27 We know that self-care raises self-esteem. It makes patients feel better, the more that they can do for themselves. So as nurses, we need to find ways to help them achieve that goal. Good luck on NCLEX.