2/22/14

Morning, Afternoon, and Evening Care Procedure

• Morning, afternoon, and evening care are used to describe the type of hygienic care given at different times of the day

Early Morning Care
• Is provided to clients as they awaken in the morning
• In a hospital it is provided by nurses on the night shift
• Helps clients ready themselves for breakfast or for early  diagnostic tests Consists of:
• Providing a urinal or bed pan if client is confined to bed
• Washing the face and hands and
• Giving oral care

Late Morning Care
• Is provided after clients have breakfast

Includes:
• The provision of a urinal or bed pan
• A bath or shower
• Perineal care
• Back massage and
• Oral, nail and hair care
• Making clients bed

Afternoon Care
• When clients return from physiotherapy or diagnostic tests
• Includes:
- Providing bed pan or urinal
- Washing the hands and face
- Assisting with oral care refresh clients

Evening Care
• Is provided to clients before they retire for the night
• Involves:
- Providing for elimination needs
- Washing hands
- Giving oral care
- Back massage care as required

Study questions:
1. Explain the purpose of bed bath, mouth care, and perineal care.
2. Describe therapeutic bath.
3. State the three types of massage strokes used in back care.
4. Which position is appropriate to give perineal care in both sexes?
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Procedure of Feeding a Helpless Patient

During illness, trauma or wound healing, the body needs more nutrients than usual. However, many peoples, because of weakness, immobility and/or one or both upper extremities are unable to feed themselves all or parts of the meal. Therefore, the nurse must be knowledgeable, sensitive and skillful in carrying out feeding procedures.

Purpose
• To be sure the pt receives adequate nutrition
• To promote the pt well-beings

Procedure
1. Prepare pt units
• Remove all unsightly equipments; remove solid linens and arranging bedside tables.
• Control unpleasant odors in the room by refreshing the room. Odor free environment makes eating more pleasant and aids digestion.

2. Prepare the patients
• Offers bedpan and urinals. To comfort pt and avoid interruption by elimination needs.
• Assist pt to wash hands, face and oral care
• Position patient comfortably
  - Mid or high Fowler's position
• Protect the bed using suitable protective cover

3. Prepare the food tray
• Identify the types of diet ordered.
• Assess any special conditions in which the pt delayed or omitted (e.g. Lab, radiologic examination or surgery)
• Assess any cultural or religious limitations, specific likes or dislikes.
• Obtain any special utensils that you planned to use

4. Feed the patient
• Place the food tray in such a way that the patient can see the food.
• Position yourself at pt's eye level, if at all possible
- Digestion is better when pt is not emotionally upset.
• Never hurry a pt's eating. This can make pt uncomfortable and fearful of taking up your time.
• Allow pt to determine when enough has been eaten, as way of providing choices.

5. Comfort patient
• Assist hand washing and oral care
• Offer bedpan and commodes, of indicated
• Comfort patient, provide quite environment so that the pt may relax after meal, which also promote good digestion.

6. Care of equipment

7. Document feeding and any assessment
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Pediculosis Treatment Procedure

Pediculosis Capitus
1. DDT (Dichloro Diphenyl Trichloro Ethane) one part to nine parts of talcum powder
• Can destroy the lice in about 2 hrs
• The effect lasts for 6 days if not washed
• Does not destroy nit or eggs
• Also available in liquid forms

2. Kerosene Oil mixed with equal parts of sweet oil
• Destroys both adult lice and eggs of nits
• From aesthetic point of view, kerosene causes foul smell and create discomfort to patient and the attendant

Guidelines for Applying Pediculicides Hair:
• Apply pediculicide shampoo to dry hair until hair is thoroughly saturated and work shampoo in to a lather
• Allow product to remain on hair for stated period (varies with products)
• Pin hair and allow to dry
• Use a fine toothed comb to remove death lice and nits (comb should not be shared by other family members)
• Repeat it in 8-10 days to remove any hatched nits
• Apply pediculious lotion (or cream) to affected areas
• Bath after 12 hrs and put on clean clothes

7. Oil of Sassafras
• Is a kind of scented bark oil
• Only destroy lice not nits
• For complete elimination, the oil should be massaged again after 10 days when the nits hatch
• Is used daily for a week with equal parts of Luke warm H2O then it should be repeated after a week

8. Gammaxine (Gamma Bengenhexa Chloride)
• Emphasize the need for treatment of sexual partner
• After complete bathing wash linen available as a cream, lotion, and a shampoo
• 1.5% solution of Gammaxine effective to kill the adult lice in one application
• Does not kill nits
• Should be repeated to kill the newly hatched nits, for complete elimination
• The lotion is applied over scalp after a clean soapy wash of hair
• After 12-24 hrs the scalp is washed with soap to remove the lotion
• Avoid contact with lice
• Can also be used for pubic and body lice
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Pediculosis Treatment

Definition
Pediculosis: infestation with lice

Purpose
• To prevent transmission of some arthropod born diseases
• To make patient comfortable

Equipment
Lindane
1% permethrine cream rinse
Clean linen
Fine-tooth “nit” comb
Disinfectant for comb
Clean gloves
Towel

Lice:
• Are small, grayish white, parasitic insects that infest mammals
• Are of three common kinds:

○ Pediculose capitis: is found on the scalp and tends to stay hidden in the hairs
○ Pediculose pubis: stay in pubic hair
○ Pediculose corporis: tends to cling to clothing, suck blood from the person and lay their eggs the clothing suspect their presence in the cloth and the body:

a. The person habitually scratches
b. There are scratches on the skin, and
c. There are hemorrhagic spots in the skin where the lice have sucked blood Head and body lice lay their eggs on the hairs then eggs look like oval particles, similar to dandruff, clinging to the hair.
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Combing and Brushing of Hair procedure

A patient hair should be combed and brushed daily most patients do this themselves if the required materials provided and others may need nurse's help (assistance)

Purpose
• Stimulates the blood circulation to the scalp
• Distribute hair oils evenly and provide a healthy sheem
• Increase the patient's sense of well-being.

Equipments
• Comb (which is large with open and long toothed)
• Hand mirror
• Towel
• Lubricant/oils (if required)

Procedure
1. Prepare the patient
• Position the patient in either sitting or semi-fowler's or flat, if the pt is weak to seat or unconscious.
• Place the towel over the patient's shoulder, if in sitting position or over the pillow if pt is in semi-fowler or lying position.
• Remove any pins and ribbons

2. Comb the hair by dividing the hair
• Hold a section of hair 2-3 inches from the end and comb the end until it is free from tangles. Move towards the scalp by combing in the same manner to remove tangles.
• Continue fluffing the hair outward and upward until all the hairs combed.
• Arrange the hair as neatly and simply as possible according to the patient's preference of style.

3. Recomfort the pt
• Remove the towel
• Put patient in comfortable position

4. Care of equipment

5. Documentation
E. Shampooing/Washing the Hair of Patient Confined to Bed

Purpose
• Stimulate blood circulation to the scalp through massaging
• Clean the patients hair so it increase a sense of well-being to the pt
• To treat hair disorders like dandruft

Equipments
• Comb and brush
• Shampoo/soap in a dish
• Shampoo basin
• Plastic sheet
• Two wash towels
• Cotton balls
• Water in basin and pitcher
• Receptacle (bucket) to receive the used water
• Lubricants/oil as required

Procedure
1. Prepare the patient
• Assist patient to move to the working side of the bed
• Remove any hair accessories (e.g. pins, ribbons etc)
• Brush and comb the hair to remove tangles

2. Arrange the equipments
• Place the plastic sheet under patient's head and shoulder
• Remove the pillows from under the pt's head and place it under pt's shoulder (to hyper extend the neck)
• Tuck the towel under the pt's shoulder and neck
• Place (arrange) the shampoo basin under the pt's head with one end extending to the receptacle for used water.
• If there is no shampoo basin, use the plastic sheet, which is under pt's shoulder and head, make a funnel type fold and extend it to the receptacle.
• Place the receptacle on chair/table on the working side of the bed.

3. Protect the patient's eyes and ears
• Place damp washcloths over the pt's eyes to protect from soapy water.
• Place cotton balls in the patient's ears to prevent water collecting in the ear canals.

4. Shampooing/washing the hair
• Wet the hair thoroughly with water
• Apply shampoo (soap) to the scalp.
• Massage all over the scalp symmetrically using your fingertips
• Rinse the hair with plane water to remove the shampoo/soap
• Remove damp washcloth from pt eyes and cotton balls from ears.

5. Dry the patient's hair
• Squeeze the hair with your hands to remove as much water as possible
• Rub pt's hair with towel
• Use hair drier (if available)

6. Ensure pt's comfort
• Remove plastic sheet shampoo basin
• Assist pt for comfortable position
• Assist pt in grooming

7. Care of equipment

8. Documentation and reporting
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Male Perineum

• The penis contains pathways for urination and ejaculation through the urethral orifice (meatus)

• At the end of the penis is the glans covered by a skin flap (fore skin or prepuce)

• The urethral orifice is located in the center of the penis and opens at the tip

• The shaft of the penis consists of erectile tissue bound by the foreskin’s dense fibrous tissue

Care
• Hold the shaft of the penis firmly with one hand and the wash cloth with the other – to prevent erection – embarrassment
• Use a circular motion, cleaning from the center to the periphery
• Use a separate section of the wash cloth

Position
• Lying in bed with knee flexed to clean the perineal part and side lying cleaning the perineal area

N.B The urethral orifice is the cleanest area and the anal orifice is the dirtiest area – always stroke from front to back to wash from ‘clean’ to ‘dirty’ parts

Note: Entry of organisms into the urethral orifice can cause UTI Hair Care
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Female Perineum

• Is made up of the vulva (external genitalia), including the mons pubis, prepuce, clitoris, urethral and vaginal orifices, and labia majora and minora
• The skin of the vaginal orifice is normally moist
• The secretion has a slight odor due to the cells and normal vaginal florae
• The clitoris consists of erectile tissues and many nerves fibers. It is very sensitive to touch.

Care
• Convenient for a woman to be on a bed pan to clean and rinse the vulva and perineum
• Secretion collects on the inner surface of the labia
• Use on hand to gently retract the labia
• Use a separate section of wash cloth for each wipe in a downward motion (from urethra to back perineum)
• Then clean the rectal area

Note
• Following genital or rectal surgery, sterile supplies may be required for cleaning the operative site, E.g. Sterile cotton balls
• The operative site and perineal area may be washed with an antiseptic solution – apply by squirting them on the perineum from a squeeze bottle
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Perineal Genital Care

Perineal Area:
• Is located between the thighs and extends from the symphysis pubis of the pelvic bone (anterior) to the anus (posterior).
• Contains sensitive anatomic structures related to sexuality, elimination and reproduction

Perineal Care (Hygiene)
• Is cleaning of the external genitalia and surrounding area
• Always done in conjunction with general bathing

Patients in special needs of perineal care
• Post partum and surgical patients (surgery of the perineal area)
• Non surgical patients who unable to care for themselves
• Patients with catheter (particularly indwelling catheter)

Other indications for perineal care are:
1. Genito- urinary inflammation
2. Incontinence of urine and feces
3. Excessive secretions or concentrated urine, causing skin irritation or excoriation

Purpose
• To remove normal perineal secretions and odors
• To prevent infection (e.g. when an indwelling catheter is in place)
• To promote the patient's comfort
• To facilitate wound healing process

Equipments
• Bath towel
• Cotton balls and gauze squares
• Pitcher with worm water or/and prescribed solution in container
• Gloves
• Bed pan
• Bed protecting materials
• Perineal pad or dressing (if needed)

Procedure
1. Patient preparation
• Give adequate explanation
• Provide privacy
• Fold the top bedding and pajamas (given to expose perineal area and drape using the top linen.)
• Position pt lying on back with knees flexed and spread apart.
• Place bed protecting materials under the pt's hip
• Place the bedpan under pt's buttock.

2. Cleaning the genital area
• Put on gloves

For Female
• Remove dressing or pad used
• Inspect the perineal area for inflammation excoriation, swelling or any discharge.

a. In case of post partum or surgical patient
• Clean by cotton swabs, first the labia majora then the skin folds between the majora and minora by retracting the majora using gauze squares, clean from anterior to posterior direction using separate swab for each stroke. (This directions lessens the possibility of urinary tract contamination)

b. In case of non-surgical patients
• Wash or clean the genital area with soapy water using the different quarters of the washcloth in the same manner.
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Offering and Removing Bed Pan

• If the individual is weak or helpless, two peoples are needed to place and remove bed pans

• If a person needs the bed pan for a longer time periodically remove and replace the pan to ease pressure and prevent tissue damage

• Metal bed pans should be warmed before use by:
o Running warm water inside the rim of the pan or over the pan
o Covering with cloth

• Semi-Fowler’s position relieves strain on the client’s back and permits a more normal position for elimination Improper placement of the bedpan can cause skin abrasion to the sacral area and spillage

o Place a regular bed pan under the buttocks with the narrow end towards the foot of the bed and the buttocks resting on the smooth, rounded rim
o Place a slipper (fracture) pan with the flat, low end under the client’s buttocks
o Covering the bed pan after use reduces offensive odors and the clients embarrassment

If the client is unable to achieve regular defecation help by attending to:
1. The provision of privacy
2. Timing – do not ignore the urge to defecate
• A patient should be encouraged to defecate when the urge to defecate is recognized
• The patient and the nurse can discuss when mass peristalsis normally occurs and provide time for defecation (the same time each day)

If the client is unable to achieve regular defecation help by attending to:
1. The provision of privacy

2. Timing – do not ignore the urge to defecate
• A patient should be encouraged to defecate when the urge to defecate is recognized
• The patient and the nurse can discuss when mass peristalsis normally occurs and provide time for defecation (the same time each day)

3. Nutrition and fluids
For a constipated client: increase daily fluid intake, drink hot liquids and fruit juices etc

For the client with diarrhea – encourage oral intake of foods and fluids

For the client who has flatulence: limit carbonated beverages; avoid gas-forming foods

4. Exercise
• Regular exercise helps clients develop a regular defecation pattern and normal feces

5. Positioning
• Sitting position is preferred

Measures to assist the person to void include:
• Running water in the sink so that the client can hear it
• Warming the bed pan before use
• Pouring warm water over the perineum slowly
• Having the person assume a comfortable position by raising the head of the bed (men often prefer to stand)
• Providing sufficient analgesia for pain
• Having the person blow through a straw into a glass of water
– relaxes the urinary sphincter
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Three Types of Massage Strokes

1. Effleurage: stroking the body
2. Light, circular friction and straight, dup, firm, strokes
3. Petrissape: kneading and making large quick pinches of the skin, tissue, and muscle

• Clean the back first
• Warm the massage lotion or oil before use by pouring over your hands: cold lotion may startle the client and increase discomfort

1. Effleurage the entire back: has a relaxing sedative effect if slow movement and light pressure are used

2. Petrissape first up the vertebral column and them over the entire back: is stimulating if done quickly with firm p

• Assess: signs of relaxation and /or decreased pain (relaxed breathing, decreased muscles tension, drowsiness, and peaceful affect)
○ Verbalizations of freedom from pain and tension
○ Areas or redness, broken skin, bruises, or other sings of skin breakdown

Note
• The duration of a massage ranges from 5-20 minutes
• Remember the location of bony prominence to avoid direct pressure over this areas
• Frequent positioning is preferable to back massage as massaging the back could possibly lead to subcutaneous tissue degeneration.

NB. Backrub requires special skills as it might cause subcutaneous tissue degeneration; mainly in elderly.
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Back Care massage

Includes the area from the back and shoulder to the lower buttocks

Purpose
• To relieve muscle tension
• To promote physical and mental relaxation
• To improve muscle and skin functioning
• To relieve insomnia
• To relax patient
• To provide a relieve from pain
• To prevent pressure sores (decubitus)
• To enhance circulation

Equipment
Basin of warm water
Washcloth
Towel
Soap
Skin care lotion

Procedure
1. Prepare the pt and pt's unit • Provide privacy by using screen or closing windows and doors.
• Assist pt to move close to your working side
• Position patient prone (lie on abdomen) if possible. If not because of the pt's condition, use side lying position with the pt facing away from you.
• Expose the back of the pt.
• Spread towel close to pt's back to protect foundation of the bed.
• Wash the back with warm water and soap using wash towel, rinse and dry it (if it is not given with bath)

2. Massaging the back
• Pour small amount of lotion (oil) on your palm and rub your palms together to warm the lotion (oil) before massaging.
• Massage the back using appropriate technique

Technique for Backbub (massage)
• Rub towards the neck line using long, firm, smooth strokes
• Pause at the neckline, using your fingers to massage the side of the neck.
• With a kneading motion, rub out along the shoulders continue the kneading motion and move down on each side of the trunk with both hands until you are again at the sacral area.
• Then, placing your hands side by side with the palms down, rub in figure of 8 patterns over the buttock and sacral area.
• Massaging back using appropriate techniques (Light pressure to smooth, heavy pressure to stumulate).
• Next, again using the kneading motion, move up the sides (about the vertebra) through the intrascapular space towards the shoulder.
• Ask the pt if there is any area that he/she would especially like to be rubbed.
• Complete the back rub using long, firm strokes up and sown the back. (shoulder to sacrum and back to shoulder).

Recomfort the pt.
• Mop extra oil/lotion from the pt's back using towel.
• Apply powder / alcohol to dry further moisture from the back, if the skin is moist in its nature
• Dress up the pt's pajama and replace the top cover.
• Reposition the pt.
• Leave the pt comfortably

4. Give proper care of equipments

5. Document the procedure, your observations and pt's reactions
• Report any abnormal observations on the skin of the back (such as signs of pressure sore) to the nurse and physician in charge of the pt.
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Tub Bath Procedure

Typically, bathtubs are low in height to ease the process of getting in and out of the tub. Guide rails are essential. Be sure to assist the client as necessary.

Equipment
• Bath blanket
• Bath mat
• Bath towel
• Soap
• Clean gown or pajama
• Clean bed linen
• Bath thermometer if available
• Disinfectant for cleansing the tub

Procedure
◘ Check the bath room temperature, which should be warmer than the normal room temperature.

◘ Make sure that the tub is clean. Scour it carefully with disinfectant. Unless using long handled swab, wear the glove when cleansing the tub.

◘ Rinse the tub well

◘ Place a chair near the tub, with a bath blanket opened over it.

◘ Place towel, wash cloth, and soap where the client reach them easily

◘ Fill the tub about halfway (less for children)

◘ Check the water with bath thermometer, if available or with the sensitive part of the skin. Water temperature should be warm to very warm, but never over 40.6 oC.

◘ Place a bath mat in the front of the tub

◘ Bring the client to the bathroom. Help the person to remove closing and, if necessary, to get in to tub. Show the client how to use the handrails.

◘ Explain to the client how to use the bath room call signals

◘ Check frequently, if the client need assistance

◘ Don’t leave a child or a client who is unsure, unsteady, self injurious alone.

◘ When the client has finished bathing, help the client out of tub and to dry. After dressing assist the client back to the room

◘ Inform the cleaner to carefully clean the tub after the bath

◘ Dispose of the glove and wash your hands

◘ Document the procedure, describing any unusual client reactions
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Therapeutic Baths procedure

• Are usually ordered by a physician/ nurse in charge.
• Are given for physical effects, such as sooth irritated skin or to treat an area (perineum)
• Medications may be placed in the water
• Is generally taken in a tub 1/3 or ½ full, about 114 liters (930’gal)
• The client remains in the bath for a desired time, often 20-30 min
• If the clients back, chest and arms are to be treated, immerse in the solution
• The bath temperature is generally included in the order, 37.7- 46oc (100-115 oF) for adults and 40-50 oc (105 oF) for infants

Bath Solutions
1. Saline: 4 ml (1Tsp) NaCl to 500 ml (1 pt) water
• Has a cooling effect
• Cleans

• Decrease skin irritation
2. Sodium: 4 ml (1Tsp) NCHCO3 to 500 ml (1 pt) water, bicarbonate or 120-360 ml 120 liters
• Has a cooling effect
• Relieves skin irritation

3. Potassium permanganate (Kmno4): available in tablets, which are crushed, dissolved in a little water, and added to the bath
• Cleans and disinfects
• Treats infected skin areas

4. Oatmeal (Aveeino) and cornstarch can also be used
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Bed bath procedure

Equipment
• Trolley
• Bed protecting materials such as rubber sheet and towels
• Bath blanket (or use top linen)
• Two bath towels
• Wash cloth
• Clean pajamas or gown
• Additional bed linens
• Hamper for soiled cloths
• Basin with warm water (43-460c for adult and 38-400c for children)
• Soap on a soap dish
• Hygienic supplies, such as, lotion, powder or deodorants (if required)
• Screen
• Disposable gloves
• Lotion thermometer (if available)

Procedures
1. Prepare the patient unit
• Close windows and doors, use screen to provide privacy.

2. Prepare the patient and the bed
• Place the bed in high position to reduce undue strain on the nurse's back
• Remove pt's gown and pajamas
• Assist pt to move toward you so it facilitates access to reach pt without undue straining. Position the pt in supine, semi -Fowler’s or Fowler’s depending on the pt's condition.

Check the temperature of the water using lotion thermometer /back of the hand.

3. Make a bath with the washcloth, so it retains water and heat than a cloth loosely held

4. Washing body parts
• Expose only the parts of the patient's body being washed avoid unnecessary exposing.
• Wash, rinse and dry each body parts thoroughly using washing towels and paying particular attention to skin folds.
• Suggested order for washing body parts; Face, ear, neck

♦ Arms and hands further away from the nurse
♦ Chest
♦ Arms and hands nearest to the nurse
♦ Buttocks and genital area
♦ Change the water after it gets dirty
♦ If possible assist patient to wash own face, hands, feet and genital area by placing the basin on bed.

Assist the patient with grooming
• Apply powder lotion or deodorants (of pt uses)
• Help patient to care for hair, mouth and nails.

5. Recomfort the patient
• Change linen if soiled
• Arrange the bed
• Put pt in comfortable position
• Remove the screen

Give proper care of materials used for bathing
• Document and report pertinent data
• Observation of the skin condition
• General appearance or reaction of the pt
• Type of bath give
Report any abnormal findings to the nurse in charge
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Bath (Bathing and Skin Care)

It is a bath or wash given to a patient in the bed who is unable to care for himself/herself.

1. Cleansing bath: Is given chiefly for cleansing or hygiene purposes and includes:
• Complete bed bath: the nurse washes the entire body of a dependent patient in bed
• Self-help bed bath: clients confined to bed are able to bath themselves with help from the nurse for washing the back and perhaps the face
• Partial bath (abbreviated bath): only the parts of the client’s body that might cause discomfort or odor, if neglected are washed the face, hands, axilla, perineum
and back (the nurse can assist by washing the back) omitted are the arms, chest, and abdomen.
• Tub bath: preferred to bed baths because it is easier to wash and rinse in a tub. Also used for therapeutic baths
• Shower: many ambulatory clients are able to use shower
• The water should feel comfortably warm for the client
• People vary in their sensitivity to heat generally it should be 43-46 oc (110-115of)
• The water for a bed bath should be changed at least once

Before bathing a patient, determine
a. The type of bath the client needs
b. What assistance the client needs
c. Other care the client is receiving – to prevent undue fatigue
d. The bed linen required

Note: when bathing a client with infection, the caregiver should wear gloves in the presence of body fluids or open lesion.

Principles
• Close doors and windows: air current increases loss of heat from the body by convection
• Provide privacy – hygiene is a personal matter & the patient will be more comfortable
• The client will be more comfortable after voiding and voiding before cleansing the perineum is advisable
• Place the bed in the high position: avoids undue strain on the nurses back
• Assist the client to move near you – facilitates access which avoids undue reaching and straining
• Make a bath mitt with the washcloth. It retains water and heat better than a cloth loosely held
• Clean the eye from the inner canthus to the outer using separate corners of the wash cloth – prevents transmitting micro organisms, prevents secretions from entering the nasolacrmal duct
• Firm strokes from distal to proximal parts of the extremities increases venous blood return

Purpose:
◘ To remove transient moist, body secretions and excretions, and dead skin cell
◘ To stimulate circulation
◘ To produce a sense of well being
◘ To promote relaxation, comfort and cleanliness
◘ To prevent or eliminate unpleasant body odors
◘ To give an opportunity for the nurse to assess ill clients
◘ To prevent pressure sores Two categories of baths given to clients
◘ Cleansing
◘ Therapeutic
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Types of Bedpan

1. The high back, or regular pan (standard pan)
2. A fracture, the slipper or low back pan

Advantage
• Has a thinner rim than as standard bed pan
• Is designed to be easily placed under a person’s buttocks

Disadvantage
• Easier to spill the contents of the fracture pan
• Are useful for people who are

a. Paralyzed or who cannot be turned safely (e.g. Spinal injury)
b. Confined in a body or long leg cost
c. Immobilized by some types of fracture
d. Very thin or emaciated

3. The pediatric bedpan
• Are small sized
• Usually made of a plastic

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Flossing Technique

It removes resides particles between the teeth

Technique
1. Wrap one end of the floss around the 3rd finger of each hand

2. To floss the upper teeth. Use the thumb and index finger to stretch the floss. Move the floss up and down between the teeth from the tops of the crowns to the gum

3. To floss the lower teeth, use your index fingers to stretch the  floss

Note: If the patient has denture, remove them before starting and wash them with brush

Mouth care for unconscious patient
◘ Position
• Side lying with the head of the bed lowered, the saliva automatically runs out by gravity rather than being aspirated by the lungs or if patient's head can not be
lowered, turn it to one side: the fluid will readily run out of the mouth, where it can be suctioned
• Rinse the patient's mouth by drawing about 10 ml of water or mouth wash in to the syringe and injecting it gently in to each side of the mouth
• If injected with force, some of it may flow down the clients throat and be aspirated into the lung
• All the rinse solution should return; if not suction the fluid to prevent aspiration

Giving and Receiving Bedpans and Urinals
• Bedpan is a material used to receive urine and feces in females and feces in male
• Urinal -is used to receive urine
Are of two types male and female
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Brush the teeth procedure

• Moisten the tooth with water and spread small amount of tooth paste on it
• Brush the teeth following the appropriate technique.

Brushing technique
• Hold the brush against the teeth with the bristles at up degree angle.
• Use a small vibrating circular motion with the bristle at the junction of the teeth and gums use the some action on the front and the back of the teeth.
• Use back and forth motion over the biting surface of the teeth.
• Brush the tongue last

1. Give pt water to rinse the mouth and let him/her to spit the water into the basin.
• Assist patient in wiping the mouth

2. Recomfort the pt
• Remove the basin
• Remove the towel
• Assist the patient in wiping the mouth
• Reposition the patient and adjust the bed to leave patient comfortably

3. Give proper care to the equipments

4. Document assessment of teeth, tongue, gums and oral mucosa. Report any abnormal findings.
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Mouth Care Procedure

Purpose
• To remove food particles from around and between the teeth
• To remove dental plaque to prevent dental caries
• To increase appetite
• To enhance the client’s feelings of well-being
• To prevent sores and infections of the oral tissue
• To prevent bad odor or halitosis

Equipments
• Toothbrush (use the person’s private item. If patient has none use of cotton tipped applicator and plain water)
• Tooth paste (use the person’s private item. If patient has none of use cotton tipped applicator and plain water)
• Cup of water
• Emesis basin
• Towel
• Denture bowel (if required)
• Cotton tipped applicator, padded applicator
• Vaseline if necessary

Procedure
1. Prepare the pt:
• Explain the procedure
• Assist the patient to a sitting position in bed (if the health condition permits). If not assist the patient to side lying with the head on pillows.
• Place the towel under the pt's chin.
• If pt confined in bed, place the basin under the pt's chin
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Personal Hygiene and Skin Care

Learning Objectives:

At the end of this chapter the learners will be able to:
• State the purposes of giving mouth care
• Demonstrate the skill of assisting a client with oral care
• Demonstrate for cleansing and caring for dentures
• Demonstrate caring for client’s fingernails, and toes nails, addressing reasons for attention of each other.
• List reasons for routine hair care
• Describe and demonstrate giving a backrub, hand and foot massage, and foot soak
• Demonstrate how to assist a client with cleansing bath.

Key terminology
Halitosis
Nits
Pediculosis
Perineal care

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