Question

Please provide a detailed response for each of the following:

1. A 14-year-old is admitted with pneumonia and refuses to initiate or participate in any hygiene activities. Discuss what type of hygiene interventions that should be taken with this patient.

2. Discuss the techniques and precautionary measures in administering oral care to the unconscious patient.

3. For the same patient in question 2, what measures should be taken to avoid aspiration?

4. Identify the hygiene needs of an 88-year-old patient who is recovering from a stroke and undergoing rehab at an extended care facility.

5. How can you identify a patient’s ability to use a tub or shower? When should the nurse supervise bathing and when can the patient self-bathe?

6. Summarize the proper technique for female perineal care.

7. Summarize the proper technique for male perineal care.

8. List at least 5 risk factors for impaired skin integrity.

Answer 1

1. Hand hygiene and body hygiene should be followed. Enhance frequent hand washing or use of sanitizers after touching on body surfaces. Use tissues while sneezing or coughing. Body hygiene by taking bath or wipe body surface helps remove microorganisms and to keep body temerature within normal limits. Also it helps to keep the child hydrated.

2.1 Oral care techniques for unconscious patient:-

1. Arrange all equipment on the bedside cabinet or on an over bed table.
2. Set the patient bed in a comfortable position and lower one side rail.
3. Place a bulb syringe or suction machine with suction machine nearby.
4. Place client in side-lying position and raise the level of the bed on one side so that the patient is in partial sitting position.
5. Rinse your hands properly with antiseptic soap and lukewarm water.
6. Wear gloves after drying hands.
7. Place towel or waterproof pad under client’s chin and Wrap the patient’s chest
8. Keep kidney tray under patient’s cheek or remove secretions from mouth by suction catheter.
9. Use padded tongue blade to open teeth gently. Never put your fingers in an unconscious patient’s mouth.
10. Turn the head of the patient towards you in a very gentle manner.
11. Clean mouth, gums, teeth and tongue with toothbrush and toothpaste.
12. Use an Asepto syringe or irrigating bulb without needle to rinse oral cavity. Swab or use oral suction to remove pooled secretions
13. Clean immediately after brushing and Suction the saliva and toothpaste from the mouth of the patient.
14. Wipe out the extra water on the mouth with a clean small towel.
15. Removes basin, dries face and mouth and applies water-soluble lip moisturizer.
16. Bring the patient back to the comfortable position.
17. Raise side rail and lower bed position.
18. Dispose of gloves in paper bag and wash hands properly.
19. Report & documents oral findings and procedure

2.2 Precautionary measures in administering oral care in unconscious patient:-

1. Sit the patient fully upright to prevent aspiration during mouth cleaning.
2. Choose the appropriate devices and cleaning products for the oral cavities.
3. Use Yankauer suction to remove excessive secretions and loose debris.
4. Avoid oral care with Hydrogen Peroxide if oral thrush or oral lesions present.
5. Use toothpaste to brush the teeth and use an electric suction toothbrush to reduce risk for aspiration of contaminated water.

3. Sit the patient in fully upright position, Suction the oral cavity to remove all secretions, Check for dentures or loose teeth.

4. Self care, Bowel and bladder care, Oral hygiene

5. A patient who is not confined to bed and is not helpless will, in some cases, be recommended to have a tub bath.

6. 1 Wash hands
       Reason: To prevent cross infection.
2. Pour water over perineum.
       Reason: To wash off the discharge from the perineal area.
3. Clean the perineum using the wet swabs.
       Reason: To prevent the entrance of bacteria from the colon into urinary tract.
4. Hold the swabs with forceps and clean from above.
5. Use one swab for one swabbing.
6. Clean perineum from the midline outward in following order
a.  The vulva
b. The labia c. Inside of labia on both sides.
d. Outside of labia on both sides.
7. Clean the perineal region and anal area thoroughly.
8. Remove the bed pan by supporting the hip as before. Turn the patient to one side and dry the buttocks with dry rag piece.

8. 1. If not circumcised, hold shaft of male private part and gently retract foreskin. 2. Using circular motion, wash tip of male private part (if using soap, avoid getting it into meatus.) 3. Repeat cleaning from meatus outward until clean; if needed, return foreskin to natural position. 4. Wash shaft and testicles. Pay attention to folds and groin area. 5. Rinse ( if soap used) and pat thoroughly dry (Note: premoistened wipes preferable.) 6. Using separate cloth, wash lower abdomen or any other areas that may have been exposed to urine or feces. 7. Reposition resident to side-lying position, cleanse anal and buttocks area with toilet tissue if excess fecal matter. 8. Rinse (if soap used) and pat dry. 9. Apply barrier cream in thin layer to all skin-fold areas if recommended by facility protocol. 10. Make client comfortable.

9. Pressure, shear, moisture, trauma, friction, poor nutrition, incontinence, medications, hydration, impaired mental status, and loss of sensation.