Title: REIMBURSEMENT ISSUES
1 CHAPTER 18Hygiene and Care of the Patients
Environment
2Hygiene and Care of the Patients Environment
- Personal Hygiene
- The self-care measures persons use to maintain
their health - Hygiene
- The science of health
- Includes care of the skin, hair, hands, feet,
eyes, ears, nose, mouth, back, and perineum - Conscientious personal hygienic practices are
essential for the nurse nurses are role models.
3Hygiene and Care of the Patients Environment
- Factors Influencing Personal Hygiene
- Social practices
- Body image
- Socioeconomic status
- Knowledge
- Personal preference
- Physical condition
- Cultural variables
4Patients Room Environment
- Maintaining Comfort
- Room temperature 68 to 74 F
- Good ventilation
- Bedpans and urinals that are emptied and rinsed
promptly - Monitored noise level
- Proper lighting
5Figure 18-1
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
A typical hospital room.
6Patients Room Environment
- Room Equipment
- Bedside stand
- Used to store the patients personal articles and
hygienic equipment - Overbed table
- On wheels is adjustable to various heights over
the bed or a chair - Chairs
- Straight chairs and lounge chairs
7Patients Room Environment
- Room Equipment (continued)
- Lights
- Lights provide comfort, safety, and ease.
- Call light signal indicates that a patient needs
assistance. - Bed
- Bed is designed for comfort, safety, and
adaptability to position changes. - It has a number of safety features.
8Bathing
- Sitz Bath
- Cleanses and aids in reducing inflammation of the
perineal and anal areas of the patient who has
undergone rectal or vaginal surgery or childbirth - Water temperature 98 to 102 F
- Cool Water Tub Bath
- May be given to relieve tension or lower body
temperature - Water temperature tepid, not cold98.6 F
9Figure 18-2
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
The sitz bath.
10Bathing
- Warm Water Tub Bath
- Given to reduce muscle tension
- Water temperature 109.4 F
- Hot Water Tub Bath
- Given to assist in relieving muscle soreness and
muscle spasms - Water temperature 113 to 115 F
11Bathing
- Other Baths
- Complete Bed Bath
- For patients who are totally dependent and
require total assistance - Tepid Sponge Bath
- Administered to reduce an elevated temperature
- Medicated Bath
- May include agents such as oatmeal, cornstarch,
Burows solution, and soda bicarbonate - To reduce tension and relax the patient and to
relieve pruritus caused by certain skin disorders
12Skill 18-1 Steps 8e(1) 8e(2)
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Bed bath.
13Skill 18-1 Steps 8e(3) 8e(4)
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Bed bath.
14Skill 18-1 Steps 8h 8i
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Bed bath.
15Skill 18-1 Steps 8r 8u
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Bed bath.
16Skill 18-1 Steps 10d(1) 10d(2)
Towel bath.
17Skill 18-1 Step 10e
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Towel bath.
18Bathing
- Back Care/Backrub
- Usually administered after the patients bath
- Promotes relaxation, relieves muscular tension,
and stimulates circulation - Nurse massages for 3 to 5 minutes
- Contraindicated if the patient has such
conditions as fractures of the ribs or vertebral
column, burns, pulmonary embolism, or open wounds
19Skill 18-1 Steps 14e 14f
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Back rub.
20Components of the Patients Hygiene
- Care of the Skin
- When a persons physical condition changes, the
skin often reflects this through alterations in
color, thickness, texture, turgor, temperature,
and hydration. - As long as the skin remains intact and healthy,
its physiological function remains optimal.
21Components of the Patients Hygiene
- Care of the Skin (continued)
- Collection of Data
- Normal skin has the following characteristics
- Intact without abrasions
- Warm and moist
- Localized changes in texture across surface
- Good turgor generally smooth and soft
- Skin color variations from body part to body part
22Components of the Patients Hygiene
- Care of the Skin (continued)
- Impaired Skin Integrity
- A patient who stays in one position without
relief of pressure can develop a pressure sore. - Patients especially at risk are the chronically
ill, debilitated, older, disabled, or incontinent
patient and the patient with spinal cord
injuries, limited mobility, or poor overall
nutrition.
23Figure 18-5
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Thirty-degree lateral position to avoid pressure
points.
24Figure 18-6
Using a rolled bath blanket as a
pressure-reducing device.
25Components of the Patients Hygiene
- Care of the Skin (continued)
- Impaired Skin Integrity
- Pressure ulcers occur when there is sufficient
pressure on the skin to cause the blood vessels
in an area to collapse. - The flow of blood and fluid to the cells is
impaired, resulting in ischemia to the cells. - When the external pressure against the skin is
greater than the pressure in the capillary bed,
blood flow decreases to the adjacent tissue. - If the pressure continues for longer than 2
hours, cell necrosis may occur.
26Components of the Patients Hygiene
- Care of the Skin (continued)
- Impaired Skin Integrity
- Shearing force
- The tissue layers of skin slide onto each other,
resulting in kinking or stretching of
subcutaneous blood vessels this results in an
interruption of blood flow to the skin. - Friction
- Rubbing of skin over a surface produces friction,
which may remove layers of tissue.
27Figure 18-3
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Diagram of shearing force exerted against sacral
area.
28Components of the Patients Hygiene
- Care of the Skin (continued)
- Stages of Pressure Ulcers
- Stage I nonblanchable erythema of the skin
- Stage II partial-thickness skin loss epidermis
- Stage III full-thickness skin loss, damage or
necrosis of subcutaneous
tissue - Stage IV full-thickness skin loss with
- extensive destruction, tissue
necrosis, - or damage to muscle, bone, or
- supporting structures
29Figure 18-4, A
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
A, Stage I pressure ulcer.
30Figure 18-4, B
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
B, Stage II pressure ulcer.
31Figure 18-4, C
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
C, Stage III pressure ulcer .
32Figure 18-4, D
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
D, Stage IV pressure ulcer .
33Components of the Patients Hygiene
- Care of the Skin (continued)
- Nursing Interventions
- Assess improvement.
- Assess size and depth of the ulcer, the amount
and color of any exudate, the presence of pain or
odor, and the color of the exposed tissue. - Specific interventions are determined by the
stage of the ulcer.
34Components of the Patients Hygiene
- Oral Hygiene
- Care of the oral cavity
- Helps maintain a healthy state of the mouth,
teeth, gums, and lips - Brushing the teeth removes food particles,
plaque, and bacteria massages the gums and
relieves discomfort resulting from unpleasant
odors and tastes.
35Skill 18-2 Steps 9a 9c
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Administering oral hygiene.
36Components of the Patients Hygiene
- Oral Hygiene (continued)
- Dentures
- A set of artificial teeth not permanently fixed.
- Should be stored in an enclosed, labeled cup for
soaking or when they are not worn - Should be cleaned as often as for natural teeth
to prevent infection and irritation - Oral care provided on a regular basis
37Skill 18-2 Step 10c
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Administering oral hygiene.
38Components of the Patients Hygiene
- Hair Care
- Combing, brushing, and shampooing are basic
hygiene measures for all patients. - Patient may shampoo in the shower or tub, use a
portable chair in front of a sink, or in bed. - Shaving the Patient
- Patient may prefer to shave at the time of
bathing. - Patients who have a bleeding disorder or are
taking anticoagulants should use electric razors. - Do not allow a disoriented or depressed patient
to use a razor with a blade.
39Skill 18-3 Steps 9a 10e
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Care of the hair, nails, and feet.
40Components of the Patients Hygiene
- Hand, Foot, and Nail Care
- Hands and feet often require special attention to
prevent infection, odors, and injury. - Assessment
- Examine all skin surfaces.
- Carefully assess between the toes.
- Observe for adequate circulation.
41Components of the Patients Hygiene
- Perineal Care
- Care of the genitalia
- Part of the complete bed bath
- Assess for signs of vaginal or urethral exudate,
skin impairment, unpleasant odors, complaints of
burning during urination, or localized tenderness
or pain of the perineum - Catheter care is to be performed twice daily on
all patients with indwelling catheters. - Includes cleansing of the meatal-catheter
junction with a mild soap and water and sometimes
application of a water-soluble microbial ointment
42Skill 18-4 Step 9b
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Female perineal care.
43Skill 18-4 Steps 9e 9g
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Female perineal care.
44Skill 18-4 Step 10c/10d
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Male perineal care.
45Components of the Patients Hygiene
- Eye, Ear, and Nose Care (continued)
- Care of the eyes
- Cleansing of the circumorbital area of the eyes
is usually performed during the bath. - Case involves washing with a clean washcloth
moistened with clear water. - The use of soap is omitted because it may cause
burning and irritation. - The eye is cleansed from the inner to the outer
canthus. - Patient may need assistance with care of
eyeglasses or contact lenses.
46Components of the Patients Hygiene
- Eye, Ear, and Nose Care (continued)
- Care of the ears
- The ears are cleansed by the nurse during the bed
bath. - A clean corner of a moistened washcloth rotated
gently into the ear canal works best for
cleaning. - A cotton-tipped applicator is useful for
cleansing the pinna. - The nurse should teach patients never to use
bobby pins, toothpicks, or cotton-tipped
applicators to clean the internal auditory canal.
47Components of the Patients Hygiene
- Eye, Ear, and Nose Care (continued)
- Care of the ears (continued)
- Hearing aids
- This involves routine cleaning, battery care, and
proper insertion technique. - When not in use, the hearing aid should be stored
where it will not become damaged.
48Figure 18-8
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Hearing aid.
49Components of the Patients Hygiene
- Eye, Ear, and Nose Care (continued)
- Care of the nose
- The patient can usually remove secretions from
the nose by gently blowing into a soft tissue. - Teach the patient that harsh blowing causes
pressure capable of injuring the tympanic
membrane, nasal mucosa, and even sensitive eye
structures. - If the patient is not able to clean the nose, the
nurse will assist, using a saline-moistened
washcloth or cotton-tipped applicator for
excessive secretions, suctioning may be required.
50Components of the Patients Hygiene
- Bedmaking
- The patients bed is usually made in the morning
after the bath. - When possible, the bed is made while it is not
occupied when the patient is unable to be out of
bed, the nurse will make an occupied bed. - The patients safety is always foremost in the
nurses mind comfort and privacy are also
important. - Use side rails, keep the call light within easy
reach, and maintain the bed in the proper
position.
51Skill 18-5 Step 8i
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Bedmaking occupied bed.
52Skill 18-5 Step 8j
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Bedmaking occupied bed.
53Skill 18-5 Step 8m
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Bedmaking occupied bed.
54Skill 18-5 Step 8o
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Bedmaking occupied bed.
55Skill 18-5 Step 8q
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Bedmaking occupied bed.
56Skill 18-5 Step 8r
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Bedmaking occupied bed.
57Components of the Patients Hygiene
- Bedmaking (continued)
- It is the nurses responsibility to keep the bed
as clean and comfortable as possible. - This may require frequent inspections to make
sure the bedding is clean, dry, and wrinkle free. - Check the linens for food particles after meals
and for urine incontinence or involuntary stool. - Use proper body mechanics raise bed to a working
level.
58Figure 18-9
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
The postoperative bed.
59Figure 18-10
(From Potter, P.A., Perry, A.G. 2005.
Fundamentals of nursing. 6th ed.. St. Louis
Mosby.)
Selected equipment and supplies for elimination.
60Figure 18-11
The bedside commode has a toilet seat with a
container underneath.
61Components of the Patients Hygiene
- Assisting the Patient with Elimination
- Bedpan
- A device for receiving feces or urine from either
male or female patients confined to the bed - Urinal
- A device for collecting urine from male patients
urinals for females also available - Bedpans or urinals are used when a patient is
unable to get up to go to the bathroom for the
purpose of urination or defecation.
62Components of the Patients Hygiene
- Assisting the Patient with Elimination
(continued) - The nurse should offer the bedpan or urinal
frequently, because patients may accidentally
soil bedclothes if their elimination needs are
not met. - Report any abnormalities and record in the
nurses notes. - Flow sheets are usually provided for
documentation of normal voidings and stools.
63Skill 18-6 Steps 11(2) 11(3)
(From Elkin, M.K., Perry, A.G., Potter, P.A.
2004. Nursing interventions and clinical
skills. 3rd ed.. St. Louis Mosby.)
Positioning the bedpan.
64Components of the Patients Hygiene
- Care of the Incontinent Patient
- Incontinence is a very common problem, especially
among older adults. - Incontinence occurs because pressure in the
bladder is too great, sphincters are weak, or the
innervation has been compromised due to illness
or injury. - Incontinence may involve a small leakage of urine
when the person laughs, coughs, or lifts
something heavy.
65Components of the Patients Hygiene
- Care of the Incontinent Patient (continued)
- Care requires the use of disposable adult
undergarments or underpads. - Cleansing the skin thoroughly after each episode
of incontinence with warm soapy water and drying
it thoroughly help to prevent skin impairment. - When urinary incontinence results from decreased
perception of bladder fullness or impaired
voluntary motor control, bladder training can be
helpful.
66Nursing Process
- Nursing Diagnoses
- Oral mucous membranes, impaired
- Mobility, impaired physical
- Skin integrity, impaired
- Self-care deficitbathing/hygiene,
dressing/grooming