Chapter 9

[Audio] Hello, in this presentation, we'll be discussing hygiene and care of the patient's environment. Let's get started!.

[Audio] Today we'll be discussing some important aspects of nursing care, specifically regarding personal hygiene, environmental design, and therapeutic interventions that can promote the physical and psychological well-being of patients...

[Audio] Temperature greatly influences a patient's comfort and overall well-being. If a room is too hot or cold, it can lead to discomfort, sleep disruption, and a potential negative impact on the recovery process. Maintaining a consistent, comfortable temperature tailored to the patient's needs is crucial, as it enables the body to focus on healing. Proper ventilation is essential for a fresh, clean atmosphere. Stale air and lingering odors can adversely affect a patient's mood, comfort, and overall healthcare experience. Ensuring fresh air circulation prevents odor buildup and fosters a pleasant environment for both patients and staff. Reducing noise and odors is vital for a patient's healing process. Excessive noise can cause stress, sleep disruption, and hinder relaxation, while unpleasant odors may lead to nausea, headaches, and discomfort. Creating an environment with minimal noise and odors promotes relaxation and a positive patient experience. Lighting significantly impacts a patient's comfort and well-being. Appropriate lighting helps maintain the sleep-wake cycle, improves mood, and prevents falls or accidents. On the other hand, insufficient or harsh lighting can result in eye strain, headaches, and sleep disruption. Offering adjustable and suitable lighting options ensures a healing and restorative room environment..

[Audio] In healthcare settings, it is crucial to consider the unique needs of patients across their lifespan. Factors such as age, overall health, and mobility can impact how we approach patient care, including bathing and maintaining hygiene. Younger patients, for example, may become chilled more easily, requiring close monitoring of water temperature and room conditions during bathing. Elderly patients or those with limited mobility might struggle with circulation, making it essential to pay attention to pressure points and use appropriate support surfaces during baths. The effects of soap and detergents on the skin should also be considered, as some individuals may have sensitive skin or develop allergies or irritation. In such cases, using mild, fragrance-free soaps or cleansers can minimize potential skin issues. By taking into account these lifespan considerations and tailoring our approach to each patient's unique needs, healthcare providers can ensure effective and compassionate care. This personalized approach contributes to better patient outcomes, improved comfort, and overall well-being..

[Audio] Each piece of room equipment serves a specific purpose and plays a role in providing hygiene to the patient. The bedside stand is used to store personal care items, such as hygiene products and grooming tools, within easy reach for both the patient and healthcare provider. This allows for efficient and organized hygiene care. The bed provides a comfortable and supportive surface for the patient to receive hygiene care. It can be adjusted to different positions to accommodate the patient's needs and ensure their comfort during the hygiene process. The overbed table offers a convenient, adjustable surface for placing hygiene products, washcloths, and towels. This enables easy access to supplies and a stable workspace for the healthcare provider. A chair can be utilized by the healthcare provider during the hygiene process to maintain proper ergonomics and positioning, or by the patient during self-care activities, such as brushing their teeth or combing their hair. Lastly, appropriate lighting is essential for ensuring visibility and safety during the hygiene process. Adjustable lights can cater to the patient's comfort and the healthcare provider's needs, enhancing the overall experience..

[Audio] Nurses, as hygiene role models, must uphold high standards of personal hygiene in their daily practice. This includes regular handwashing, especially before and after patient contact, to minimize the spread of infections. They should also wear clean, professional attire and maintain well-groomed hair and nails to present a tidy and competent appearance. Furthermore, nurses must adhere to any facility-specific guidelines for infection control and hygiene practices, ensuring they consistently set a positive example for patients, colleagues, and visitors in the healthcare setting..

[Audio] When it comes to bathing patients in healthcare settings, this task is often delegated to unlicensed assistive personnel, such as nursing assistants or patient care technicians. These dedicated individuals perform various types of baths, like complete bed baths, partial baths, or sitz baths, depending on the patient's needs and health requirements. They also ensure the appropriate water temperature is used for each bath to avoid complications or discomfort. By delegating bathing tasks to unlicensed assistive personnel, healthcare professionals can focus on other critical aspects of patient care, while ensuring patients' hygiene and comfort needs are met. Cool water baths reduce body temperature in fever or hyperthermia cases, providing quick relief and easing muscle inflammation. Warm water baths offer relaxation, hygiene, and soothe muscles while promoting circulation and easing joint pain or stiffness. Hot water baths are generally discouraged due to risks like burns, dizziness, and dehydration, especially in patients with certain health conditions. Maintaining a safe water temperature between 98.6°F and 104°F is crucial. Sitz baths, designed for targeted perineal and anal area relief, aid in managing hemorrhoids, postpartum healing, or perineal surgery discomfort. Portable or built-in, sitz baths promote healing by increasing blood flow, reducing inflammation, and providing comfort..

[Audio] First , we have complete bed baths. These are for patients who can't perform their own personal hygiene due to illness, injury, or disability. We wash their entire body while they stay in bed, helping them feel clean, comfortable, and cared for, especially if they are bedridden or have limited mobility. Next, we have partial baths. These focus on specific areas like the face, hands, underarms, and perineal area. Partial baths come in handy when a complete bed bath isn't necessary or when patients can participate in their own hygiene but need assistance with certain areas. Now, let's talk about tepid baths. These use lukewarm water to gently cool down patients with fever or heat exhaustion. The goal is to provide a soothing, relaxing experience without causing shivering, which could raise body temperature. Lastly, we have medicated baths. These involve adding therapeutic agents, like oatmeal, Epsom salts, or prescribed medications, to the bathwater. They're perfect for patients with skin conditions or symptoms like itching, inflammation, or pain, providing relief and promoting healing. By understanding when to provide these different baths, we, as healthcare providers, can effectively address each patient's unique needs, ensuring their comfort and well-being..

[Audio] Healthy skin has several normal characteristics, including consistent color without sudden changes or discoloration, smooth and even texture, warm temperature indicating proper circulation, balanced moisture level, good elasticity demonstrated by quick return to its original position when pinched, and intact sensation without abnormalities. Maintaining intact skin is crucial as it acts as a natural barrier against infection and injury. Proper care includes regular cleansing with mild soap and water, moisturizing, and protection from excessive sun exposure. However, nonintact skin is more vulnerable to infection and requires special care. This includes gentle cleansing with a saline solution or wound cleanser, applying appropriate dressings or topical treatments, and monitoring for signs of infection. Nonintact skin care depends on the severity, type of wound, and underlying cause. By following proper skin care protocols, healthcare providers can help maintain skin health and prevent complications. Pressure injuries often show up around bony areas because of pressure, friction, and shear forces. You see, shearing happens when two surfaces move in opposite directions, stressing and deforming tissue layers, which messes with blood flow and makes the skin more likely to get injured. People who are more at risk, like those with limited mobility, poor circulation, sensory issues, malnutrition, incontinence, or who are elderly, need to be checked regularly and get the right help to prevent pressure ulcers. Preventing pressure injuries is crucial in healthcare. We can achieve this by frequently repositioning patients, utilizing specialized support surfaces like mattresses and cushions, maintaining proper hygiene, and managing moisture. It's also essential to address underlying issues such as malnutrition, poor circulation, and sensory impairments while promoting regular movement and good nutrition. By implementing these strategies, we can ensure healthier skin, reduce pressure injuries, and ultimately improve patient outcomes..

[Audio] Pressure ulcers, also known as bedsores or pressure sores, are classified into different stages based on the extent of tissue damage: Stage I: In this stage, there is a localized area of intact skin with nonblanchable redness. The skin may feel warm to the touch, and the patient might experience discomfort or pain. Stage I pressure ulcers indicate that the skin is under pressure and at risk for further damage if not addressed promptly. Stage II: This stage involves partial-thickness loss of the dermis, presenting as a shallow, open ulcer or a ruptured blister. The wound bed is typically red or pink, and there may be some surrounding edema or inflammation. Stage II pressure ulcers are still relatively superficial but warrant attention to prevent further tissue damage. Stage III: In this stage, there is full-thickness tissue loss extending through the dermis and into the subcutaneous fat layer. The wound may have a crater-like appearance, but bone, tendon, and muscle are not exposed. Stage III pressure ulcers indicate more severe damage and necessitate comprehensive wound care and pressure-relief measures. Stage IV: Stage IV pressure ulcers involve full-thickness tissue loss with exposed bone, tendon, or muscle. These ulcers are deep and can extend beyond the primary wound, potentially causing damage to surrounding structures. Stage IV pressure ulcers are considered severe and require aggressive treatment to prevent complications such as infection or sepsis. Unstageable/unclassified: In this category, the pressure ulcer exhibits full-thickness tissue loss, but the wound base is covered by slough and/or eschar, making it difficult to determine the true depth of the wound. The slough and eschar can be tan, brown, or black. Before proper staging and treatment can be initiated, debridement may be necessary to remove the non-viable tissue. Suspected deep tissue injury: This type of pressure ulcer appears as a localized purple or maroon area of discolored intact skin or a blood-filled blister. The discolored area may be painful, firm, or boggy, and the damage may be concealed beneath the intact skin. Suspected deep tissue injuries can rapidly progress to more severe stages if left untreated..

[Audio] Heat and cold therapy are commonly used to manage pain and promote healing in patients with injuries. Both types of therapy can be either dry or moist. Heat therapy is typically used to provide comfort and accelerate the healing process. Heat can help to increase circulation to the affected area, bringing oxygen and nutrients to the site of injury. It can also help to relax muscles and relieve stiffness. On the other hand, cold therapy is used to reduce swelling and alleviate pain. Cold can help to numb the affected area and reduce inflammation by constricting blood vessels. Both heat and cold therapy can be effective in managing pain and promoting healing, depending on the nature of the injury and the patient's individual needs. It is important to consult with a healthcare provider to determine the appropriate type and duration of therapy for a specific injury..

[Audio] Maintaining a healthy mouth is essential for overall well-being, as it helps prevent gum disease, tooth decay, and bad breath, and contributes to proper nutrition and clear speech. Hair care should be performed as needed, depending on factors such as individual preferences, hair type, and hygiene requirements. For disoriented or depressed patients, a nurse's assistance in shaving can help maintain personal hygiene, dignity, and self-esteem, which can contribute to their overall mental health and recovery. Patients with diabetes or peripheral vascular disease should be closely monitored for foot conditions because they are more prone to poor circulation, nerve damage, and delayed wound healing, increasing the risk of infection and other complications. When cleansing the eye, it is important to move from the inner to outer canthus to prevent the introduction of bacteria or debris from the outer area into the tear ducts, reducing the risk of infection or irritation..

[Audio] During a back rub, the nurse should observe the patient's skin for any abnormalities, such as redness, swelling, bruising, rashes, dryness, or open wounds. This is an opportunity to assess skin integrity and detect early signs of pressure injuries, infections, or other skin conditions that may require intervention. Back rubs are a common technique used to provide comfort and relaxation to patients. However, there are certain contraindications to consider before performing a back rub. These include open wounds or skin lesions in the area where the massage would be performed, acute inflammation or infection, deep vein thrombosis, unstable fractures or spinal injuries, severe osteoporosis, fever, or systemic illness. Massaging in the presence of any of these conditions could potentially worsen the issue or cause further damage. For example, massaging an area with an open wound or skin lesion could exacerbate the problem or introduce infection, and massaging an area with deep vein thrombosis could potentially dislodge a clot and cause a life-threatening embolism. In summary, it is important to carefully consider the patient's medical history and current condition before performing a back rub to ensure the safety and well-being of the patient In any case, it is essential to consider the patient's overall health status, medical history, and comfort level before proceeding with a back rub.

Lesson 9.2: Further Hygiene and Care of the Patient’s Environment.

[Audio] Perineal care for male and female patients involves maintaining hygiene in the genital and anal areas. For both, gather supplies, provide privacy, and wear gloves. For males, clean the penis tip, shaft, scrotum, and inner thighs, moving front to back, and clean the anal area last. For females, clean the perineal area, starting from the front, moving towards the back, and clean the labia and anal area using a front-to-back motion. Catheter care is a crucial aspect of patient care, particularly for those with indwelling catheters. Daily cleaning of the tubing and insertion site with warm, soapy water is necessary to reduce the risk of infection and ensure patient comfort. To clean, start at the insertion site and clean downwards, away from the body. Rinse thoroughly and pat dry. Patients with catheters are at risk of infection since the catheter can introduce bacteria into the urinary tract, circumventing the body's natural defenses. Infections may cause a range of symptoms such as fever, pain, and foul-smelling urine. Signs of infection in the perineum, vagina, or urethra may include pain, discharge, redness, itching, swelling, and an unpleasant odor. It is crucial to perform catheter care twice daily to maintain cleanliness and prevent bacteria buildup around the insertion site and along the catheter tubing. Proper care can help prevent infections and ensure patient comfort..

[Audio] Skin care is a crucial component of patient care, and it involves various procedures that promote skin health, prevent infection, and aid in healing. To clean the skin, it is essential to use mild soap and warm water while avoiding scrubbing and hot water. Moisturizing lotions or creams should be used to prevent dryness, and fragrance-free options are ideal. Barrier creams or ointments are crucial for patients who are incontinent or bedridden as they protect against friction, moisture, and irritation. Patients who are immobile or bedridden should be repositioned frequently, and pressure injuries prevented using pillows, cushions, or specialty beds. Regular skin inspections for signs of redness, swelling, blisters, or sores should be performed, and healthcare providers should be promptly informed of any changes. Wound care should be carried out following healthcare providers' instructions, such as cleaning the wound, applying dressings, or using topical treatments. Proper skin care is essential for patients of all ages and medical conditions, ensuring healthy skin and preventing complications..

[Audio] When making an unoccupied bed, it's crucial to remove used linens while keeping them away from your body. If necessary, clean and sanitize the mattress before placing a fitted sheet and tucking it under the mattress. Add a flat sheet, tuck it under the mattress at the foot and sides, and fold the top over the blanket. Position the pillow with the open end facing away from the door. For an occupied bed, begin by explaining the procedure to the patient and providing privacy. Raise the bed to a comfortable working height and help the patient roll onto their side, facing away from you. Loosen and fold the used linens toward the patient, then place clean fitted and flat sheets on the exposed side, tucking them under the mattress. Help the patient roll onto the clean linens, remove the used linens without contacting your body, and pull the clean linens taut before tucking them under the mattress. Lastly, position the pillow with the open end facing away from the door. During both procedures, ensure the patient's comfort, safety, and privacy are maintained..

[Audio] Placing a patient on a bedpan requires a careful and considerate approach. First and foremost, it's important to explain the process to the patient and provide them with privacy. Once the patient is ready, place the bedpan on the bed or chair and assist them to roll onto their back, if possible. Lift their hips slightly and slide the bedpan underneath them, making sure it's positioned correctly and secure. Encourage the patient to relax and remain comfortable while they use the bedpan. When they're finished, remove the bedpan carefully to avoid any spillage. This may involve loosening the bed linens, elevating the patient's hips slightly, and sliding the bedpan out from underneath them. Disposable bedpan liners or a bedpan washer can be helpful for a more hygienic and efficient process. Overall, placing a patient on a bedpan requires patience, care, and attention to detail to ensure the patient's comfort and well-being. Managing an incontinent patient requires a multifaceted approach to prevent skin breakdown and infection. To achieve this, healthcare providers should use incontinence pads or briefs to absorb urine or fecal matter and ensure regular cleaning of the patient with mild soap and water. Applying barrier creams or ointments is essential to protect the skin, as is repositioning the patient frequently to avoid pressure injuries. Nurses should encourage patients to maintain adequate fluid intake to prevent dehydration while also assessing and addressing any underlying medical conditions contributing to incontinence, such as urinary tract infections or medication side effects. Moreover, open communication with the patient and their family members is vital to guarantee the patient's needs are met, and they remain comfortable and safe throughout their care..