| Unit 7 Hygiene of Patient Chapter 1 Mouth Care Assessment of the Mouth Physical examination The physical examination of the mouth includes inspection and palpation techniques. The status of the lips, mucous membranes, tongue, teeth, and gingiva (gums) is assessed. Lips Lips are inspected for the color, texture, contour, and ability to move. Lip’s color varies with race and heredity. Mucous membranes Mucous membranes in the light-skinned patients are normally pink, moist, and smooth. Any ulcerations, discoloration, white patches, nodules, excessive redness, and irritations are noted. Tongue The tongue normally is moist, slightly coated, and a reddish color. The nurse notes diseases, excessive roughness or smoothness, fissures, ulcerations, and white or red patches. Teeth Healthy teeth appear aligned, smooth, and white. The nurse notes missing teeth, dental caries, discolo- rations, the presence of partial or complete artificial dentures and how they fit, and the state of fillings. Gums The gums are normally pink in color. Black-people may have a bluish pigmentation to their gums, either evenly distributed or in patches. The nurse notes excessive redness, swelling, bleeding, tenderness, or receding gum lines. Personal preferences Great variation exists in the types of toothpaste, mouthwashes, denture cleaners, and types of dental floss available and selected. Sociocultural factors Early practices learned from parents often become well-established habits. For example, children who are encouraged to clean and/or rinse their teeth after every meal and at bedtime will often retain this practice as adults. Peers in work or social settings may also be a substantial influence, as evidenced by the numerous television commercials asserting the social benefits of cleaner, whiter teeth and fresh breath. Knowledge level A person’s knowledge about the most effective ways to brush and floss teeth, the use of fluoride to prevent dental caries, the implications of infrequent oral hygiene, and the need for regular dental examinations often needs updating or reinforcement. Developmental status Children can start to brush their teeth by 2 years of age, when all deciduous teeth have appeared. They require much supervision and assistance, however, a few patients can give them Health state Impaired health may alter a person’s ability to manage oral hygiene self-care. The degree of assistance required needs to be determined by the nurse or doctor.
Oral Hygiene Instructing patient’s oral hygiene The nurse is often in the position to help people, young or old, ill or well, to maintain oral hygiene by helping or teaching them to carry out oral practices, by inspecting whether hygiene has been carried out, particularly with children, or by actually providing hygienic measures for patients who are ill or incapacitated. ● Brush the teeth thoroughly after meals and at bedtime. Assist children or inspect their mouths to be sure the teeth are clean. ● Floss the teeth daily. ● Ensure an adequate intake of nutrients, particularly calcium, phosphorus, vitamins A, C, D and fluoride. ● Avoid sweet foods and drinks between meals. Take them in moderation after meals. ● Have a checkup by a dentist every 6 months. Brushing teeth The technique most recently recommended for brushing teeth is called the sulcular technique. It removes plaque and cleans under the gingival margins. Use of a soft-bristled, small toothbrush is required. The brush is held against the teeth so that the bristles are at a 45 degree angle. The tips of the outer bristles should rest against and penetrate under the gingival sulcus of the gums.
Special Oral Care Special oral care hygiene is needed for the following helpless patients: ● The patient can not take fluids by mouth or has fluids restricted. ● The patient breathes through the mouth. ● Brownish material (sordes) has collected on the tongue and teeth. ● The patient is unconscious, a high temperature, and self-care deficit. ● The patient needs to be encouraged to take food. This procedure should be performed at least three times a day. Mouth care can maintain the clean of the mouth and prevent the mouth and lips from becoming dry and infectious .it helps preventing sordes, odors and stimulating the appetite of the patient. Chapter 2 Skin Care Assessment of the Skin Normal skin should be smooth, soft, warm, flexible and has good tissue turgor and a variety of pigme- nted spots. Color Skin color varies from person to person and from one area of the body to another. Normal skin tones can range from ivory to deep brown (sometimes called black). Some people have hues of pink, yellow, or orange. A description of skin color needs to include deviations from the normal, including increased pigmentation. The skin may reflect pallor, flushing, jaundice, or cyanosis. Temperature Palpation of the skin reveals to the nurse whether it is a normal warm temperature or unusually hot or cold. Skin temperature may be similar throughout the body or particular to one area, such as a foot that feels cold due to decreased blood flow. Lesions Many types of lesions occur on the skin. The nurse’s main responsibility is to describe them accurately. Excoriations and abrasions An excoriation is the loss of superficial layers of the skin. Developmental changes Factors Influencing Skin Care Body image Body image is the continually changing concept that an individual has of his or her own body. Sociocultural factors Many sociocultural factors affect hygienic practices. The individual’s economic resources affect such practices as the use of cosmetics. Knowledge level The information an individual possesses about hygiene affects his or her practices. Developmental status Hygiene practices vary with an individual’s stage of development. Health state People who are very ill often are unable or lack the energy to bathe or brush their teeth, for example. They require assistance to carry out many hygienic activities. Chapter 3 Prevention and Care of Pressure Sores Pressure Sores (also called bed sores or decubiti) are ulceration of the skin, which are chiefly due to deprivation of oxygen and essential nutrients to an area because of prolonged pressure that occludes the blood supply to the tissues. Classification of Pressure Sores Unless the institution specifies a different classification system, diagnose the pressure ulcer according to the four-stage classification system commonly used by rehabilitation specialists. StageⅠ The primary sign is redness. The skin does not return to a normal color when the pressure is relieved, but there is no induration (area of hardened tissue); the skin and underlying tissues remain soft. StageⅡ Redness persists, usually accompanied with edema and induration. The epidermis may blister or erode. StageⅢ There is an open lesion and a crat医学全在线er, exposing subcutaneous tissue. You may be able to see fascia at the base of the ulcer. StageⅣ Necrosis extends through the fascia and may even involve the bone. Eschar (crusty, black nonviable tissue) is a common finding. Bone destruction can lead to periostitis, osteitis, and osteomyelitis. Interventions Preventing pressure sores ● Avoid prolonged pressure on the areas of the body. Change the client’s position frequently to relieve pressure, which if unrelieved, is the most important cause of a pressure ulcer. This should be done at least every 2 hours. or on an individualized schedule based on the client’s meals and activities. ● Avoid using waterproof material on the client’s bed. It tends to cause the client to perspire and prevents evaporation of moisture. ● Protect areas, especially prone, from pressure, such as the coccyx, heels, and elbows. ● Avoid using air-inflated rings, or use them only with the greatest care. ● Avoid friction and shearing forces on the skin. Prevent friction on the skin when moving the client. Avoid sliding the client on bed linens or on a chair. ● Protect the patient’s skin. Protect areas of the skin especially susceptible to pressure sores. ● Provide good nutrition for the patient. Treatment and care of pressure sores Pressure sores are a challenge for nurse to cure because of the number of variables involved and because numerous treatment measure are advocated, however, two points in treatment are most important: protect the broken area with sterile dressings and relieve pressure on the area as much as possible. StageⅠ: The primary sign is redness, the measures of the treatment and care mainly include to relieve the cause of pressure sores: ● Change the patient’s position at every 2~3 hours. ● Keep the patient’s skin dry. ● If the patient is incontinent, remove wastes promptly. ● Keep the bottom sheets firm, smooth and no wrinkles. ● Rub the skin to stimulate the circulation of the skin. ● Provide good nutrition for the patient. StageⅡ: Redness persists, usually accompanied by edema and indurations. The epidermis may blister or erode. The measure of the treatment and care mainly include: ● Continue to take the prevention of pressure sores as for stageⅠ. ● Apply sterile dressings to cover the ulcerated area. ● Apply a commercially prewww.lindalemus.com/zhicheng/pared, transparent, self-adhesive firm to superficial ulcers. Stage Ⅲ: There is an open lesion and a crater, exposing subcutaneous tissue. The measures of the treatment and care mainly include: ● Continue to take the prevention of pressure sores. ● The ulcerated area must be kept clean and dry. ● Use a control gel formula dressing, which provides a moist healing environment. These dressings aid in healing, while providing a seal around the wound. Stage Ⅳ: Necrosis extends through the fasia and may even involve the bone. This stage what should be done are: ● Take a wound culture as soon as the ulcer is noticed, to ascertain the specific invading organisms, and then weekly or whenever increase in drainage appear or healing is delayed. Use local or systemic antibiotic according to the results of the wound culture. ● Debride deep ulcers to remove necrotic tissue by chemical or surgical means. ● Irrigate the ulcer with 3% hydrogen peroxide solution, and then rinse the wound with saline. ● Promote healing by keeping the ulcer moist and preventing infection. ● Use the gel foam dressing to cover the ulcerated area and change it daily or every 3~7 days. | 
