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.
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.
So, our practice question for this topic is a
nurse is bathing a febrile patient.
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
So enclosing, hygiene, yes, it’s more than
just taking a shower and washing your hair.
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.
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.