ORAL, GENITAL HYGIENE AND SKIN CARE

• The skin is the body’s first line of defense against disease.

– Intact skin prevents microbes from entering the body and causing an infection.
• Good hygiene:
– Cleanses the skin and mucous membranes
– Prevents body and breath odors
– Is relaxing and increases circulation
• Culture and personal choice affect hygiene.
DAILY CARE
• Most people have hygiene routines and habits.
• You assist with hygiene whenever it is needed.
– Protect the right to privacy and to personal choice.
• Routine care is given during the day and evening.
– Routine care given before breakfast is called early morning care or AM care.
– Morning care is given after breakfast.
– Afternoon care is given after lunch and before the evening meal.
– Care given in the evening at bedtime is called evening care or PM care.
ORAL HYGIENE
• Oral hygiene (mouth care) does the following:
– Keeps the mouth and teeth clean
– Prevents mouth odors and infections
– Increases comfort
– Makes food taste better
– Reduces the risk for cavities (dental caries) and periodontal disease (gum disease,
pyorrhea)
 Flossing does the following:
– Removes food from between the teeth
– Removes plaque and tartar
 Plaque and tartar cause periodontal disease.
 You may have to perform oral hygiene for persons who:
– Are very weak
– Cannot move or use their arms
– Are too confused to brush their teeth
 Mouth care for the unconscious person
– Unconscious persons may have mouth dryness and crusting on the tongue and
mucous membranes.
– The care plan tells you what cleaning agent to use.
 Use sponge swabs to apply the cleaning agent.
– To prevent cracking of the lips, apply a lubricant to the lips after cleaning.
 Check the care plan.
 – Protect unconscious persons from choking and aspiration.
 Aspiration is breathing fluid, food, vomitus, or an object into the lungs.

– To prevent aspiration:
 Position the person on one side with the head turned well to the side.
 Use only a small amount of fluid to clean the mouth.
 Do not insert dentures.
– Keep the person’s mouth open with a padded tongue blade.
– Unconscious persons cannot speak or respond to you.
 Always assume that unconscious persons can hear.
 Explain what you are doing step by step.
– Mouth care is given at least every 2 hours.
 Follow the nurse’s directions and the care plan.
 Denture care
– A denture is an artificial tooth or a set of artificial teeth.
– Mouth care is given and dentures cleaned as often as natural teeth.
– Dentures are slippery when wet. Hold them firmly.
– To use a cleaning agent, follow the manufacturer’s instructions.
– Hot water causes dentures to lose their shape (warp).
– Remind patients and residents not to wrap dentures in tissues or napkins.
BATHING
• Bathing has the following benefits:
– It cleans the skin.
– It cleans the mucous membranes of the genital and anal areas.
• Microbes, dead skin, perspiration, and excess oils are removed.
– A bath is refreshing and relaxing.
– Circulation is stimulated and body parts exercised.
– Observations are made.
– You have time to talk to the person.
• Complete or partial baths, tub baths, or showers are given.
– The method depends on:
• The person’s condition
• Self-care abilities
• Personal choice
• Personal choice, weather, activity, and illness affect bathing frequency.
– The care plan tells you when to bathe the person.
 The complete bed bath involves washing the person’s entire body in bed.
– Bed baths are usually needed by persons who are:
 Unconscious
 Paralyzed
  In casts or traction
 Weak from illness or surgery
 The partial bath involves bathing the face, hands, axillae (underarms), back, buttocks, and
perineal area.
– Some persons bathe themselves in bed or at the sink.
– You assist or give partial baths as needed.
 Tub baths and showers
– Falls, burns, and chilling from water are risks.
– Tub baths are relaxing.
 A tub bath lasts no longer than 20 minutes.
– Showers
 If persons can stand, they use the grab bars for support during the shower.
 Showers have non-skid surfaces or a bath mat is used.
 Never let weak or unsteady persons stand in the shower.
 Some shower rooms have two or more stations.
 Protect the person’s privacy.
THE BACK MASSAGE
• The back massage (back rub):
– Relaxes muscles and stimulates circulation
– Is given after the bath and with evening care
– Can be given after repositioning or helping the person to relax
– Lasts 3 to 5 minutes
 Before giving the massage, observe the skin for:
– Breaks in the skin
– Bruises
– Reddened areas
– Other signs of skin breakdown
 Lotion reduces friction during the massage.
 During the massage:
 Use firm strokes
 Keep your hands in contact with the person’s skin
PERINEAL CARE
• Perineal care (peri-care) involves cleaning the genital and anal areas.
– Cleaning prevents infection and odors, and it promotes comfort.
• Perineal care is done:
– Daily during the bath
– Whenever the area is soiled with urine or feces
 Perineal care is very important for persons who:
– Have urinary catheters
– Have had rectal or genital surgery
 – Have given birth
– Are menstruating
– Are incontinent of urine or feces
– Are uncircumcised
 The person does perineal care if able.
 When giving perineal care, Standard Precautions, medical asepsis, and the Bloodborne
Pathogen Standard are followed.
– Work from the cleanest area to the dirtiest.
 When giving perineal care:
– Use warm water, not hot.
– Use washcloths, towelettes, cotton balls, or swabs according to agency policy.
– Rinse thoroughly.
– Pat dry after rinsing.
ASSESSMENT OF VITAL SIGNS
CONTENTS
• Consciousness
• Body temperature
• Respiration
• Blood pressure
• Pulse
1. CONSCIOUSNESS
Human ability to be aware of own thoughts,
emotions, surroundings → adequate responses
GLASGOW COMA SCALE (GCS)
Patient’s response to:
- verbal stimulation
- painful stimulation
- movement
Scale 3 – 15
Changes in consciousness

QUALITATIVE QUANTITATIVE
anxiety somnolent
depression sopor
delirium coma (shallow/deep)
 2. Human Body Temperature
Balance between heat produced and heat lost by the body
Heat regulating centre – hypothalamus
Heat production caused by increasing cell metabolism
Heat losses (cool off process):
- perspiration
- respiration
- radiation
Types of thermometers:
- mercury-in-glass
- electronic
- chemical
BODY TEMPERATURE SYMPTOMS

Hypothermia Skin paleness

↓ 36 °C Tiredness

Normal Lowest 5 – 6am

36 – 36,9 °C Highest 4 – 6pm

Pyrexia / slight fever Perspiration

37,0 – 37,9 °C Skin redness
Headache

Fever General weakness

38 °C Tachycardia /
Presence of infection → body hyperpnea
defence Skin paleness/redness
Shivers
Perspiration

ROUTES FOR MEASURING THE BODY TEMPERATURE

- ORAL
best site for measuring in the clinical settings
triangle shaped thermometer
 axillo – oral difference 0,3 °C
- AXILLARY
more likely to be affected by the environmental temperature,
used in children/adults
- RECTAL
fast thermometer, used in infants/confused patients/receiving O2 th.
axillo – rectal difference 0,5 °C
- VAGINAL
used in gynecology
3. Respiration
NORMAL RESPIRATIONS
• Effortless
• Regular
• Smooth
AVERAGE RESPIRATIONS
• Infant to 2 years 24–34/min
• To puberty 20-26/min
• Adults 12-18/min
RESPIRATORY RATE
• Normal 12 – 20 / min
• Bradypnea ↓ 10 / min
• Tachypnea 25 / min
• Apnea
RESPIRATORY RHYTHM
• Normal
• Dyspnea (exertion/rest)
• Cheynes-Stokes respiration (irregular deep/slow/shallow )
• Kussmaul’s breathing (deep)
4. Blood Pressure (BP)
The pressure of blood in the arterial wall

Factors affecting BP:

- blood volume
- strength of contraction
- elasticity of artery wall
Assessment:
- Normal 120-140/60-80 mmHg
- Hypertension 150/90 mmHg
- Hypotension ↓100 mmHg
Measurements stated in terms of millimetres of mercury (mmHg)
BP reading:
- systolic pressure (ventricle contraction)
- diastolic pressure (ventricle at rest)
BP readings record: BP 120/80
Equipment:
- sphygmomanometer
- stethoscope
Places for measuring:
- upper arm (brachial artery)
- calf / thigh (popliteal artery)
Measuring techniques:
- auscultation
(sphygmomanometer+stethoscope) - palpation
(sphygmomanometer)
- invasive methods (CVP)
5. Pulse
Expansion of an artery with each hart beat
Measuring techniques / places of assessing:
- PALPATION
a. carotis
a. brachialis, radialis
a. femoralis, poplitea etc.
- AUSCULTATION
stethoscope
PULSE RATE
• Normal 60 – 90 / min
• Bradycardia ↓ 50 / min
• Tachycardia 100 / min
• Asystolia
PULSE RHYTHM
• Regular
• Irregular – arrythmia
PULSE QUALITY
• Strong (fever)
• Weak (shock/heart failure)