The _______ and __________ exchange oxygen, nutrients, and fluids with underlying blood vessels.

Skin; Mucosal Cells

Good hygiene technique promote normal structure and functional of __________.

Tissues

The _________ require adequate nutrition, hydration, and circulation to resist injury and disease.

Cells

Apply knowledge of ___________ to provide preventive hygiene care. Recognize disease states that create changes in the integument, oral cavity, and sensory organs. For example, diabetes mellitus often results in chronic vascular changes that impair healing of the skin and mucosa.

Pathophysiology

The skin serves several functions, including protection, secretion, excretion, body temperature regulation, and cutaneous sensation (Table 39-1).

TABLE 39-1
Page 769

Skin consists of two primary layers: the _______ and the ________. Just beneath the skin lies the ___________ tissue (also known as the hypodermis), which shares some of the protective functions of the skin.

Epidermis; Dermis; Subcutaneous

Several thin layers of epithelial cells comprise the outer layer, or _________; these cells shield underlying tissue against water loss and injury and prevent entry of disease-producing microorganisms.

Epidermis

Bundles of collagen and elastic fibers form the thicker _______ that underlies and supports the epidermis. Nerve fibers, blood vessels, sweat glands, sebaceous glands, and hair follicles run through the _______ layers. Sebaceous glands secrete sebum, an oily, odorous fluid, into the hair follicles.

Dermis; Dermal

The subcutaneous tissue layer contains blood vessels, nerves, lymph, and loose connective tissue filled with fat cells. The fatty tissue functions as a heat insulator for the body. This tissue also supports upper skin layers to withstand stresses and pressure without injury and anchors the skin loosely to underlying structures such as muscle.

Subcutaneous Tissue

The _______, _______, and _______ often require special attention to prevent infection, odor, and injury.

Feet; Hands; Nails

The hand in contrast to the foot is used for manipulation rather than for ___________.

Support

The condition of a patient’s hands and feet influences his or her ability to perform ____________.

Hygiene Care

What grows from root of nail bed, hidden by fold of skin?

Cuticle

Nail

A normal healthy ________ appears transparent, smooth, and convex, with a pink bed and translucent white tip. Disease causes changes in the shape, thickness, and curvature.

Nail

The ________ consists of the lips surrounding the opening of the mouth, the cheeks running along the sidewalls of the cavity, the tongue and its muscles, and the hard and soft palate.

Oral Cavity

Normal or abnormal(?) oral mucosa glistens and is pink, soft, moist, smooth, and without lesions.

Normal

_________ cleanses the mouth, dissolves food chemicals to promote taste, moistens food to facilitate bolus formation, and contains enzymes that start breakdown of starchy foods.

Saliva

The effects of medications, exposure to radiation, dehydration, and mouth breathing impair salivary secretion in the __________.

Mouth

What is Xerostomia?

Dry Mouth

What is Gingivitis?

Inflammation of the gums

What is Dental Caries?

Tooth Decay

Growth, distribution, and pattern indicate general health status. Hormonal changes, nutrition, emotional stress, physical stress, aging, infection, and other illnesses can affect the ________.

Hair

Note:
When hygiene care is provided, the eyes, ears, and nose require careful attention. Clean the sensitive sensory tissues in a way that prevents injury and discomfort for a patient, such as by taking care to not get soap in his or her eyes. The sense of smell is an important aid to appetite.
(True or False) A number of factors influence personal preferences for hygiene and the ability to maintain hygiene practices.

Eyes, Ears, and Nose

(True or False) A number of factors influence personal preferences for hygiene and the ability to maintain hygiene practices.

True

Individualized hygiene care requires use of ____________ communication skills to promote the therapeutic relationship. In addition, use the opportunity provided during hygiene care to assess a patient's health promotion practices, emotional status, and health care education needs.

Therapeutic

During hygiene, assess:

Emotional status, Health promotion practices, and Health care education needs

Factors Influencing Hygiene:

Social Practices, Personal Preferences, Body Image, Socioeconomic status, Health beliefs and motivation, Cultural variables, Developmental stage and Physical condition

Ethnic, social, and family influences on hygiene patterns

Social Practices

Dictate hygiene practices

Personal Preferences

A person’s subjective concept of his or her body appearance

Body Image

Influences the type and extent of hygiene practices used

Socioeconomic Status

Motivation is the key factor in hygiene

Health Beliefs and Motivation

People from diverse cultures practice different hygiene rituals

Cultural Variables

Affects the patient’s ability to perform hygiene care

Developmental Stage

May lack physical energy and dexterity to perform self-care

Physical Condition

The normal process of aging influences the condition of body tissues and structures. A patient's ______________ affects the ability of the patient to perform hygiene care and the type of care needed.

Developmental Stage

The ___________ is relatively immature at birth. The epidermis and dermis are loosely bound together, and the skin is very thin. Friction against the skin layers causes bruising.

Neonate’s Skin

A __________layers become more tightly bound together has a greater resistance to infection and skin irritation.

Toddler’s Skin

During ___________ the growth and maturation of the integument increases. In girls estrogen secretion causes the skin to become soft, smooth, and thicker with increased vascularity. In boys male hormones produce an increased thickness of the skin with some darkening in color.

Adolescence

The condition of the ___________ depends on hygiene practices and exposure to environmental irritants. Normally the skin is elastic, well hydrated, firm, and smooth.

Adult’s Skin

As the production of lubricating substances from skin glands decreases, the skin becomes dry and itchy. These changes warrant caution when turning and repositioning _______ adults and when bathing. Too-frequent bathing and bathing with hot water or harsh soap cause the skin to become excessively dry.

Older

With aging and continued exposure the patient is more likely to develop chronic foot problems as a result of __________, __________, and ____________.

Poor foot care; Improper fit of footwear; systemic disease

At approximately ________ months of age, infants begin teething. The first permanent (secondary) teeth erupt at about _________ of age. From _________, when all of the permanent teeth are in place, through middle _____________, the teeth and gums remain healthy if a person follows healthy eating patterns and dental care.

6 to 8; 6 years; Adolescence; Adulthood

In addition, regular brushing and flossing help to prevent ________ and periodontal disease.

Caries (tooth decay)

If the older adult becomes __________ (i.e., without teeth) and wears complete or partial dentures, include assessment of underlying gums and palate.

Edentulous

Throughout life changes in the growth, distribution, and condition of the hair influence ___________. As males reach adolescence, shaving becomes a part of routine grooming. Young girls who reach puberty often begin to shave their legs and axillae.

Hair Hygiene

____________ in sensory function often require modifications in hygiene care. Use your knowledge of developmental changes when planning hygienic care.

Alterations

Critical Thinking for Hygiene:

Integrate nursing knowledge, consider developmental and cultural influences, think creatively, be nonjudgmental and confident, draw on your own experiences, and rely on professional standards

Although many possible nursing diagnoses apply to patients in need of supportive hygiene care, list the following that represents examples of diagnoses commonly associated with hygiene problems:

• Activity intolerance
• Bathing self-care deficit
• Dressing self-care deficit
• Impaired physical mobility
• Impaired oral mucous membrane
• Ineffective health maintenance
• Risk for infection

List nursing process: planning for goals and outcomes:

1) Partner with the patient and family to identify goals and expected outcomes
2) develop an individualized plan of care based on the patient's nursing diagnoses
3) Make outcomes measurable and achievable within patient limitations.
4) Work with the patient to select individualized hygiene measures.

Set __________ based on the necessary assistance required by the patient, the extent of the hygiene-related problems, and the nature of the patient's nursing diagnoses. For example, a seriously ill patient usually needs a daily bath because body secretions accumulate and the patient is unable to independently maintain cleanliness.

Priorities

Collaborate with other health team members as indicated (e.g., work with physical therapy and occupational therapy to enhance the patient's independence with self-care activities). The family often becomes a valuable resource to the nurse and helps with hygiene measures. Collaborate with community agencies as needed.

Teamwork and Collaborate

_____________ focuses on assisting and preparing patients to be able to perform as much of their hygiene care as they can independently. Teach patients proper hygiene techniques and signs and symptoms of hygiene problems. Inform patients about available resources in the community for dealing with these problems if they arise.

Implementation

Key points when teaching patients about hygiene (health promotion) include the following:

• Make any instruction relevant based on your assessment of the patient's knowledge, motivation, preferences, and health beliefs.
• Adapt instruction to the patient's personal bathing facilities and resources.
• Teach the patient ways to avoid injury.
• Reinforce infection control practices.

Nursing knowledge and skills needed for performing hygiene care are consistent across all health care settings where __________, ____________, and __________ are provided. In addition, some of the skills in this section are applicable in areas of health promotion.

Acute Care; Restorative Care; Continuing Care

(True or False) The variety and timing of hygiene measures vary across health care settings and according to individual patient needs.

True

Consider a patient's normal grooming routines, including type of hygiene products used and the time of day when hygiene is routinely performed. Individualize your care based on the patient's preferences.

Bathing

Consider a patient's normal grooming routines, including type of hygiene products used and the time of day when hygiene is routinely performed. Individualize your care based on the patient's preferences.

Complete

Bath administered to totally dependent patient in bed
FYI

Complete Bed Bath
(Skill 39-1 on pp. 797-805)
In addition to cleansing baths, the health care provider may prescribe therapeutic baths, including sitz baths or medicated baths (e.g., oatmeal, cornstarch, or Aveeno). A sitz bath cleans and reduces pain and inflammation of perineal and anal areas. Medicated baths relieve skin irritation and create an antibacterial and drying effect.

Bed bath that consists of bathing only body parts that would cause discomfort if left unbathed such as the hands, face, axillae, and perineal area.

Partial Bed Bath
(see Skill 39-1)

Patient sits or stands under a continuous stream of water. The shower provides more thorough cleaning than a bed bath but can cause fatigue.

Shower

Contains several soft, nonwoven cotton cloths that are premoistened in a solution of no-rinse surfactant cleanser and emollient.

Bag Bath

Cleansing patients’ genital and anal areas is called?

Perineal Care

A __________ or back massage usually follows the patient's bath. It promotes relaxation, relieves muscular tension, and decreases perception of pain.

Back Rub

Incorporate ____________ care into a person's regular hygiene routine. Routine care involves soaking to soften cuticles and layers of horny cells, thorough cleaning, drying, and proper nail trimming.

Foot and Nail

What are the bath guidelines?

1) Provide Safety
2) Maintain Safety
3) Maintain Warmth
4) Promote Independence
5) Anticipate Needs

Regular ___________, including brushing, flossing, and rinsing, prevents and controls plaque-associated oral diseases.

Oral Hygiene

____________ cleans the teeth of food particles, plaque, and bacteria. It also massages the gums and relieves discomfort resulting from unpleasant odors and tastes.

Brushing

___________ removes tartar that collects at the gum line.

Flossing

___________ removes dislodged food particles and excess toothpaste.

Rinsing

Diabetes, artificial airways, unconscious, chemotherapy, are all considered?

Patients with special needs

Encourage patients to clean their dentures on a regular basis to avoid gingival infection and irritation. When patients become disabled, someone else assumes responsibility for denture care (Box 39-10).

Denture Care

A person's appearance and feeling of well-being often depend on the way the hair looks and feels. Illness or disability often prevents a patient from maintaining daily __________.

Hair Care

Frequent brushing helps keep hair clean and distributes oil evenly along hair shafts. Combing prevents hair from tangling. Encourage patients to maintain routine hair care and provide help for patients with limited mobility or weakness and those who are confused or weakened by illness.

Brushing and Combing

Braiding helps to avoid repeated tangles; however, patients need to unbraid hair periodically and comb it to ensure good hygiene. Braids that are too tight lead to bald patches. Should you obtain permission from the patient before braiding the hair?

YES

What are the steps for treating head lice?
Question 1

Answer 1
• Apply disposable gown and gloves.
• Use a grooming comb or hairbrush to remove tangles.
• Divide the patient's hair in sections and fasten off hair that is not being combed.
• Comb out from the scalp to the end of the hair (special combs are available in drug stores).
• Dip the comb in a cup of water or use a paper towel to remove lice between each passing.
• After combing look through the hair carefully for attached lice.
• You can catch live lice with a tweezers or comb.
• After combing thoroughly, move to next section.

What are the steps for treating head lice?
(cont’d)
Question 2

Answer 2
• After combing thoroughly, move to next section.
• Instruct family to clean the comb with an old toothbrush and dental floss and boil the comb. The ideal is to discard the comb after each use, but some patient's financial situations prevent the purchase of multiple combs.
• Instruct family to comb and screen for lice daily.
• Instruct family to contain patient's clothes and wash them in hot water.
• Instruct family to vacuum the home and patient's room and immediately empty vacuum bag or bagless collection device.
• Instruct caregivers in how to prevent transmission of lice:
• Do not share bed linens or hair care products.
• Avoid placing bare hand on patient's head.
• Immediately wash hands after providing hair care.

Remind patients in hospitals or extended care facilities that staying in bed, excess perspiration, or treatments that leave blood or solutions in the hair require more frequent ____________.

Shampooing

Shave facial hair after the bath or shampoo. Some women prefer to shave their legs or axillae while bathing. When assisting a patient, take care to avoid _________ him or her with the razor blade.

Cutting

Mustaches or beards require _______ grooming. Grooming keeps food particles and mucus from collecting in the hair.

Daily

Give special attention to cleaning the eyes, ________, and ________ during a routine bath and when drainage or discharge accumulates. This aspect of hygiene not only makes a patient more comfortable but also improves sensory reception.

Ears; Nose

Cleaning the eyes involves simply washing with a clean washcloth moistened in water (see Skill 39-1). Soap causes burning and irritation. Never apply direct pressure over the ________ because it causes serious injury.

Eyeball

Glasses are made of hardened glass or plastic that is impact resistant to prevent shattering. Nevertheless, because of the cost, be careful when ____________ glasses and protect them from breakage or other damage when they are not worn.

Cleaning

A ___________ is a thin, transparent, circular disk that fits directly over the cornea of the eye. Contact lenses correct refractive errors of the eye or abnormalities in the shape of the cornea.

Contact Lens

Patients with artificial eyes have had an ___________ (i.e., removal) of an entire eyeball as a result of tumor growth, severe infection, or eye trauma. Some are permanently implanted, whereas others must be removed for cleaning.

Enucleation

Routine ear care involves cleaning the ear with the end of a moistened washcloth, rotated gently into the ear ________. Gentle, downward retraction at the entrance of the ear canal usually causes visible ________ to loosen and slip out. Instruct patients never to use objects such as bobby pins, toothpicks, paper clips, or cotton-tipped applicators to remove earwax.

Canal; Cerumen (Wax)

A ___________ amplifies sounds in a controlled manner; the aid receives normal low-intensity sound inputs and delivers them to the patient's ear as louder output.

Hearing Aid

The patient usually removes secretions from the nose by gently blowing into a soft tissue. Caution the patient against harsh blowing that creates pressure capable of injuring the ________, _________, and even _________ structures. Bleeding from the nares is a sign of harsh blowing.

Eardrum; Nasal Mucosa; Sensitive Eye

What can make patient’s room environment comfortable?

1) Maintain comfort: temperature, noise, lighting, ventilation, odors
2) Beds: Raising, adjusting, side rails, clean, comfortable, and safe
3) Bed making: occupied and unoccupied (box 39-14)

Keep a patient's bed clean and comfortable. This requires frequent inspection to be sure that linen is ______, ______, and _______of wrinkles.

Clean; Dry; Free of Wrinkles

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